%0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e59688 %T Understanding Patient and Physiotherapist Requirements for a Personalized Automated Smartphone Telemonitored App for Posttotal Knee Arthroplasty Rehabilitation: Qualitative Study %A Chew,Eleanor Shuxian %A Scully,Aileen Eugenia %A Koh,Samanth Shi-Man %A Woon,Ee-Lin %A Low,Juanita Krysten Miao-Shi %A Kwan,Yu-Heng %A Tan,John Wei-Ming %A Pua,Yong-Hao %A Tan,Celia Ia-Choo %A Haseler,Luke Jonathan %K knee replacement %K knee arthroplasty %K mobile %K application %K interview %K telemonitored %K smartphone rehabilitation %K mobile phone %D 2025 %7 14.4.2025 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Total knee arthroplasty (TKA) is a cost-effective surgical intervention for painful knee osteoarthritis in older adults, but postsurgery rehabilitation access is limited. Telerehabilitation offers a solution, but existing models require significant therapist involvement and a costly setup. A personalized smartphone-based automated program could be a cost-effective alternative. Objective: This study aimed to understand the requirements of both patients and physiotherapists in developing an automated telemonitored rehabilitation smartphone app for individuals undergoing TKA. To ensure uptake and long-term sustainability, this study adopted a person-based approach. Methods: A multistakeholder qualitative study of user needs was conducted. Physiotherapists and patients who underwent TKA were recruited via purposive sampling. Individual in-depth, hour-long interviews were conducted via Zoom by an experienced, trained female interviewer with a Master of Arts in Sociology. Data were audio-recorded and transcribed by the same interviewer. Two reviewers (ESC and SSK) independently analyzed the data using thematic analysis, with data triangulation achieved through cross-checking of data sources by 3 reviewers (ESC, SSK, and AES). Interviews were conducted to data saturation. Results: Six patients and 4 physiotherapists participated. For the patient interface, patients emphasized ease of use and specified features like a search function and multilingual options. For the physiotherapist interface, physiotherapists stated ease of accessing patient data and outcome measures for effective monitoring as important. Both patients and physiotherapists highlighted the need for timely, condition-specific information, supplemented by visual aids to support exercises, pain management, and recovery goals. They also stressed the significance of progress tracking, feedback, and the ability to access health care professionals for reassurance. Motivational features, including reminders, prompts, and exercise logs, were recommended to improve adherence. Both groups similarly identified the need for initial training to ensure confident use of the app. Conclusion: This study provided insights into the requirements of potential end users of a smartphone app for automated telemonitored rehabilitation following TKA. This is useful for steering the development of a user-centric smartphone app. %R 10.2196/59688 %U https://rehab.jmir.org/2025/1/e59688 %U https://doi.org/10.2196/59688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65188 %T Development of an eHealth Mindfulness-Based Music Therapy Intervention for Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: Qualitative Study %A Fleszar-Pavlovic,Sara E %A Noriega Esquives,Blanca %A Lovan,Padideh %A Brito,Arianna E %A Sia,Ann Marie %A Kauffman,Mary Adelyn %A Lopes,Maria %A Moreno,Patricia I %A Koru-Sengul,Tulay %A Gong,Rui %A Wang,Trent %A Wieder,Eric D %A Rueda-Lara,Maria %A Antoni,Michael %A Komanduri,Krishna %A Lesiuk,Teresa %A Penedo,Frank J %K allogeneic stem cell transplantation %K hematologic malignancy %K bone marrow transplant %K mindfulness-based music therapy %K mindfulness %K music therapy %K eHealth %K music therapy intervention %K adult %K adolescence %K allogeneic %K stem cell transplantation %K stem cell %K transplantation %K qualitative study %K treatment %K hematologic cancers %K psychological distress %K side effects %K mindfulness-based stress reduction %K stress reduction %K anxiety %K depression %K diagnosis %K blood sample collection %K eHealth tool %K quality of life %K cancer survivors %D 2025 %7 11.4.2025 %9 %J JMIR Form Res %G English %X Background: Allogeneic hematopoietic stem cell transplantation (allo-SCT) is an effective treatment for various hematologic cancers, though it often results in severe side effects and psychological distress, which can negatively impact health outcomes. Integrative therapies like mindfulness-based stress reduction (MBSR), mindfulness meditation (MM), and music therapy (MT) yield promising results in enhancing both psychosocial outcomes (eg, reducing anxiety and depression) and physiological adaptation (eg, decreasing inflammation) in cancer patients. Objective: We developed and refined, using focus groups and environmental and field testing, an eHealth-delivered mindfulness-based music therapy (eMBMT) intervention aimed at improving health-related quality of life, symptom burden (ie, pain, fatigue, and sleep), disease activity (ie, chronic graft-versus-host disease, cytomegalovirus activation, and infections) and psychosocial (ie, depression, anxiety, and cancer-specific distress) and physiological adaptation (ie, inflammation and immune reconstitution) tailored to adults receiving allo-SCT. Methods: eMBMT intervention content is grounded in MT, MM, and MBSR, developed by a multidisciplinary team, and adapted for adults undergoing allo-SCT. eMBMT content was refined through focus groups and usability and field testing. Focus groups used a semistructured interview guide, while field testing used the “think aloud” method. Usability was evaluated using the 30-item Usefulness, Satisfaction, and Ease of Use (USE) questionnaire. Descriptive statistics analyzed the USE questionnaire and participant characteristics, while rapid qualitative analysis was applied to focus groups and field-testing sessions. Survivors eligible to participate in the focus groups and usability and field testing were adults (>18 years old) who received an allo-SCT (<36 months) for myelodysplastic syndrome, acute myeloid leukemia, or chronic myeloid leukemia, and were in remission for greater than 3 months. Results: During the focus groups, participants (n=11; mean age 43.6, SD 17.8 years) provided qualitative feedback highlighting the shock of diagnosis, challenges during hospitalization, and coping strategies posttreatment. The eMBMT platform received positive evaluations for usefulness (mean 6.47, SD 0.29), ease of use (mean 6.92, SD 0.60), and satisfaction (mean 6.16, SD 0.82). Key themes from field testing highlighted the significance of social support, hope, and maintaining an active lifestyle. Suggestions for improvement included incorporating more representative content, reducing text, enhancing guidance, offering diverse music options, and streamlining blood sample collection. Conclusions: The eMBMT intervention is a comprehensive, user-friendly eHealth tool tailored to the unique needs of allo-SCT patients. The positive feedback and identified areas for improvement underscore its potential to enhance well-being, symptom management, and overall quality of life for cancer survivors. A future pilot randomized controlled trial will further evaluate the feasibility, acceptability, and preliminary efficacy of the eMBMT intervention in improving health-related quality of life, symptom burden, disease activity, and psychosocial and physiological adaptation. Trial Registration: ClinicalTrials.gov NCT05968963; https://clinicaltrials.gov/study/NCT05968963 %R 10.2196/65188 %U https://formative.jmir.org/2025/1/e65188 %U https://doi.org/10.2196/65188 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67275 %T Evaluating User Experience and Satisfaction in a Concussion Rehabilitation App: Usability Study %A Hutchison,Michael G %A Di Battista,Alex P %A Pyndiura,Kyla L %K mild traumatic brain injury %K recovery %K mHealth %K app %K digital health %K smartphone %K eHealth %K digital %K technology %K usability %K concussion rehabilitation %K brain injury %K rehabilitation protocols %K evidence-based exercise %K single-arm pilot study %K home-based rehabilitation %K user-friendly %K questionnaire %K telehealth %K telemedicine %D 2025 %7 11.4.2025 %9 %J JMIR Form Res %G English %X Background: Evidence-based guidelines support the use of structured exercise to facilitate concussion recovery. Despite the growing number of mobile health (mHealth) apps aimed at managing concussions, few focus on delivering exercise rehabilitation protocols. Therefore, a mobile app was developed to provide personalized rehabilitation programs based on evidence-based exercise principles designed to cater to individuals recovering from concussions. Objective: This study aimed to evaluate the usability and user experience of a mobile app designed to deliver an evidence-based rehabilitation program to individuals recovering from concussions. Methods: A two-week prospective single-arm pilot study was conducted among adults with a physician-diagnosed concussion. Participants engaged in home-based rehabilitation exercises through a mobile app. Usability was assessed using a combination of the mHealth App Usability Questionnaire (MAUQ) and five custom questions evaluating confidence in recommendations, exercise flow, clarity of voice commands, and usability of the exercise report feature. Following the two-week period, participants rated each question on a 7-point Likert scale ranging from “strongly agree” to “strongly disagree”. Results: Twenty-six participants consented and were enrolled in the study, with 23 participants (82%) completing all study components at the end of two weeks. The majority of participants were women, aged 26-38 years, and on average, approximately at three months postconcussion. Responses to both the MAUQ and custom questions were overwhelmingly positive. Overall, seven MAUQ questions received 100% positive responses, with no single question scoring below 83% positive responses. In the “ease of use and satisfaction” category, 100% of users responded positively to questions on ease of learning, usability, interface likeness, and comfort in social settings, while 83%-96% (19-22) of users responded positively to the remaining four questions. In the “system information arrangement” category, 100% (N=23) of users rated screen navigation, function usability, and health care service acceptability positively, with 87%-96% of users approving action acknowledgment, error recovery, and expected functions. Under the “usefulness” category, 96% (n=22) of users found the app beneficial for health and well-being, and 91% (n=21) users felt it effectively managed their health. For the five custom questions, 100% (N=23) users responded positively to voice command clarity, exercise awareness, ease of following exercises, and report understandability, with a single unfavorable response noted for confidence in app recommendations. Conclusions: The findings of this study indicate that the mobile app is a user-friendly platform for delivering evidence-based exercise rehabilitation to individuals recovering from concussions. Positive user feedback, particularly in the areas of recommendation confidence, ease of exercise flow, and clarity of voice commands, highlights the app’s potential to support concussion recovery. Future iterations of the app will aim to improve time efficiency and streamline error recovery processes to further enhance the user experience. %R 10.2196/67275 %U https://formative.jmir.org/2025/1/e67275 %U https://doi.org/10.2196/67275 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66298 %T Mobile App–Delivered Motivational Interviewing for Women on Eating Disorder Treatment Waitlists (MI-Coach: ED): Protocol for an App Development and Pilot Evaluation %A Halicki-Asakawa,Amané %A Mocci,Julia %A Libben,Maya %+ Department of Psychology, University of British Columbia, Irving K. Barber Faculty of Arts and Social Sciences, 3187 University Way, Kelowna, BC, V1V1V7, Canada, 1 2508079026, maya.libben@ubc.ca %K eating disorders %K motivational interviewing %K treatment barriers %K digital interventions %K pilot test %K protocol %K eating disorder %K eating %K woman %K women %K female %K Canada %K Canadian %K mobile apps %K mobile health %K mHealth %K app development %K app-based %K mental health %K pilot evaluation %K waitlists %K mixed methods %K feasibility %K acceptability %K service delivery %D 2025 %7 10.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: A significant increase in eating disorder (ED) service waitlists has been observed in the past several years, exacerbating existing barriers to care (eg, long waitlists, scarcity of treatment centers, and positive beliefs surrounding pathology). Given that treatment delays have important clinical correlates (eg, entrenchment of ED pathology), exploring new methods of mental health service delivery for this population is of critical concern. App-based motivational interviewing (MI) delivered prior to the start of treatment has the potential to improve accessibility by simultaneously addressing structural (eg, travel costs) and individual (eg, low motivation) barriers to care. Despite the potential benefits, there remains a lack of empirically validated, ED-specific MI-based mobile apps. Evaluating the feasibility and acceptability of such interventions is a crucial first step before progressing to full-scale efficacy trials. Objective: This multiphasic mixed methods study aims to develop and assess the feasibility and acceptability of MI-Coach: ED, a novel app designed to increase motivation among women waitlisted for ED treatment. Specifically, this study seeks to determine participant engagement levels, user satisfaction, and perceived usability of the app, as well as to explore preliminary trends in motivation and ED-related symptoms following app use. Methods: Phase I adapted the content and interface of an existing app based on evidence-based principles (MI-Coach) for an ED population. Phase II pilot tested the app through a pre-post evaluation. Participants (n=30) aged 18 years and older were recruited from ED treatment waitlists in British Columbia, Canada. After completing baseline assessments evaluating demographic and clinical variables (eg, motivation, eating pathology, depression, and anxiety symptoms), participants were provided access to MI-Coach: ED for 1 month. Participants completed postintervention assessments and provided both quantitative and qualitative feedback on the app. Feasibility will be evaluated through the total number of participants recruited, study dropout rates, and engagement indicators (eg, modules completed) within the app. Acceptability will be assessed through self-report measures and semistructured exit interviews, which will explore user experiences, perceived benefits, and barriers to app engagement. Additionally, exploratory analyses will examine changes in motivation and ED symptoms before and after the intervention. Results: The MI-Coach: ED app has been developed, and recruitment was initiated in November 2022 and terminated in May 2024. Results are being analyzed and will be submitted for publication in May 2025. Conclusions: This study has the potential to transform ED service delivery and mitigate the impacts of existing treatment barriers for this population. By leveraging a digital MI-based intervention, MI-Coach: ED could serve as a scalable and accessible pretreatment tool, helping to bridge the gap between initial help-seeking and formal ED treatment. Findings from this study will inform the refinement of the intervention and recruitment strategies for future large-scale efficacy trials. International Registered Report Identifier (IRRID): DERR1-10.2196/66298 %M 40209224 %R 10.2196/66298 %U https://www.researchprotocols.org/2025/1/e66298 %U https://doi.org/10.2196/66298 %U http://www.ncbi.nlm.nih.gov/pubmed/40209224 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e53133 %T Development of a Mobile Intervention for Procrastination Augmented With a Semigenerative Chatbot for University Students: Pilot Randomized Controlled Trial %A Lee,Seonmi %A Jeong,Jaehyun %A Kim,Myungsung %A Lee,Sangil %A Kim,Sung-Phil %A Jung,Dooyoung %+ Graduate School of Health Science and Technology, Ulsan National Institute of Science and Technology, UNIST-gil 50, Ulsan, 44919, Republic of Korea, 82 522174010, dooyoung@unist.ac.kr %K procrastination %K chatbot %K generative model %K semigenerative model %K time management %K cognitive behavioral therapy %K psychological assessment %K intervention engagement %K emotional support %K user experience %K mobile intervention %K artificial intelligence %K AI %D 2025 %7 10.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Procrastination negatively affects university students’ academics and mental health. Traditional time management apps lack therapeutic strategies like cognitive behavioral therapy to address procrastination’s psychological aspects. Therefore, we developed and integrated a semigenerative chatbot named Moa into a to-do app. Objective: We intended to determine the benefits of the Moa-integrated to-do app over the app without Moa by verifying behavioral and cognitive changes, analyzing the influence of engagement patterns on the changes, and exploring the user experience. Methods: The developed chatbot Moa guided users over 30 days in terms of self-observation, strategy establishment, and reflection. The architecture comprised response-generating and procrastination factor–detection algorithms. A pilot randomized controlled trial was conducted with 85 participants (n=37, 44% female; n=48, 56% male) from a university in South Korea. The control group used a to-do app without Moa, whereas the treatment group used a fully automated Moa-integrated app. The Irrational Procrastination Scale, Pure Procrastination Scale, Time Management Behavior Scale, and the Perceived Stress Scale were examined using linear mixed models with repeated measurements obtained before (T0) and after (T1) 1-month use and after 2-month use (T2) to assess the changes in irrational procrastination, pure procrastination, time management and behavior, academic self-regulation, and stress. Intervention engagement, divided into “high,” “middle” and “low” clusters, was quantified using app access and use of the to-do list and grouped using k-means clustering. In addition, changes in the psychological scale scores between the control and treatment groups were analyzed within each cluster. User experience was quantified based on the usability, feasibility, and acceptability of and satisfaction with the app, whereas thematic analysis explored the users’ subjective responses to app use. Results: In total, 75 participants completed the study. The interaction of time × procrastination was significant during the required use period (P=.01). The post hoc test indicated a significant improvement from T0 to T1 in the Time Management Behavior Scale and Perceived Stress Scale scores only in the treatment group (P<.001 and P=.009). The changes in Pure Procrastination Scale score after the required use period were significant in all clusters except for the low cluster of the control group. The high cluster in the treatment group exhibited a significant change in the Irrational Procrastination Scale after Bonferroni correction (P=.046). Usability was determined to be good in the treatment group (mean score 72.8, SD 16.0), and acceptability was higher than in the control group (P=.03). Evaluation of user experience indicated that only the participants in the treatment group achieved self-reflection and experienced an alliance with the app. Conclusions: The chatbot-integrated app demonstrated greater efficacy in influencing user behavior providing psychological support. It will serve as a valuable tool for managing procrastination and stress together. Trial Registration: Clinical Research Information Service (CRIS) KCT0009056; https://tinyurl.com/yc84tedk %M 40208664 %R 10.2196/53133 %U https://mhealth.jmir.org/2025/1/e53133 %U https://doi.org/10.2196/53133 %U http://www.ncbi.nlm.nih.gov/pubmed/40208664 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65889 %T Co-Designing a Web-Based and Tablet App to Evaluate Clinical Outcomes of Early Psychosis Service Users in a Learning Health Care Network: User-Centered Design Workshop and Pilot Study %A Burch,Kathleen E %A Tryon,Valerie L %A Pierce,Katherine M %A Tully,Laura M %A Ereshefsky,Sabrina %A Savill,Mark %A Smith,Leigh %A Wilcox,Adam B %A Hakusui,Christopher Komei %A Padilla,Viviana E %A McNamara,Amanda P %A Kado-Walton,Merissa %A Padovani,Andrew J %A Miller,Chelyah %A Miles,Madison J %A Sharma,Nitasha %A Nguyen,Khanh Linh H %A Zhang,Yi %A Niendam,Tara A %+ Department of Psychiatry & Behavioral Sciences, University of California-Davis, 4701 X St, Sacramento, CA, 95817, United States, 1 916 699 5193, knye@ucdavis.edu %K eHealth %K user-centered design %K learning health system %K psychosis %K early psychosis %K user-driven development %K web-based %K data visualization %K surveys and questionnaires %K measurement-based care %D 2025 %7 9.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Early Psychosis Intervention Network of California project, a learning health care network of California early psychosis intervention (EPI) programs, prioritized incorporation of community partner feedback while designing its eHealth app, Beehive. Though eHealth apps can support learning health care network data collection aims, low user acceptance or adoption can pose barriers to successful implementation. Adopting user-centered design (UCD) approaches, such as incorporation of user feedback, prototyping, iterative design, and continuous evaluation, can mitigate these potential barriers. Objective: We aimed to use UCD during development of a data collection and data visualization web-based and tablet app, Beehive, to promote engagement with Beehive as part of standard EPI care across a diverse user-base. Methods: Our UCD approach included incorporation of user feedback, prototyping, iterative design, and continuous evaluation. This started with user journey mapping to create storyboards, which were then presented in UCD workshops with service users, their support persons, and EPI providers. We incorporated feedback from these workshops into the alpha version of Beehive, which was also presented in a UCD workshop. Feedback was again incorporated into the beta version of Beehive. We provided Beehive training to 4 EPI programs who then piloted Beehive’s beta version. During piloting, service users, their support persons, and EPI program providers completed Beehive surveys at enrollment and every 6 months after treatment initiation. To examine preliminary user acceptance and adoption during the piloting phase, we assessed rates of participant enrollment and survey completion, with a particular focus on completion of a prioritized survey: the Modified Colorado Symptom Index. Results: UCD workshop feedback resulted in the creation of new workflows and interface changes in Beehive to improve the user experience. During piloting, 48 service users, 42 support persons, and 72 EPI program providers enrolled in Beehive. Data were available for 88% (n=42) of service users, including self-reported data for 79% (n=38), collateral-reported data for 42% (n=20), and clinician-entered data for 17% (n=8). The Modified Colorado Symptom Index was completed by 54% (n=26) of service users (total score: mean 24.16, SD 16.81). In addition, 35 service users had a support person who could complete the Modified Colorado Symptom Index, and 56% (n=19) of support persons completed it (mean 26.71, SD 14.43). Conclusions: Implementing UCD principles while developing the Beehive app resulted in early workflow changes and produced an app that was acceptable and feasible for collection of self-reported clinical outcomes data from service users. Additional support is needed to increase collateral-reported and clinician-entered data. %M 40203298 %R 10.2196/65889 %U https://humanfactors.jmir.org/2025/1/e65889 %U https://doi.org/10.2196/65889 %U http://www.ncbi.nlm.nih.gov/pubmed/40203298 %0 Journal Article %I %V %N %P %T %D %7 .. %9 %J %G English %X %U %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57789 %T A Trauma Support App for Young People: Co-design and Usability Study %A Thell,Maria %A Edvardsson,Kerstin %A Aljeshy,Reem %A Ibrahim,Kalid %A Warner,Georgina %+ Child Health and Parenting, Department of Public Health and Caring Science, Uppsala University, BMC, Husargatan 3, Uppsala, 751 23, Sweden, 46 18 471 6632, georgina.warner@uu.se %K co-design %K young people %K trauma %K app development %K usability testing %D 2025 %7 18.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: One of the most common reasons young people with mental health issues, such as posttraumatic stress disorder, do not seek help is stigma, which digital support tools could help address. However, there is a lack of trauma support apps specifically designed for young people. Involving the target group in such projects has been shown to produce more engaging and effective results. Objective: This study aimed to apply a child rights–based participatory approach to develop a trauma support app with young people. Methods: Seven young people (aged 14-19 years; 3 males and 4 females) with experiences of trauma were recruited as coresearchers. A child rights–based framework guided the working process. The app was developed through a series of Design Studio workshops and home assignments, using the manualized intervention Teaching Recovery Techniques as the foundation for its content. The coresearchers were trained in research methodology and conducted usability testing with other young people (n=11) using the think-aloud method, the System Usability Scale (SUS), and qualitative follow-up questions. Results: A functional app prototype was developed using a no-code platform, incorporating various trauma symptom management techniques. These techniques covered psychoeducation, normalization, relaxation, and cognitive shifting, presented in multiple formats, including text, audio, and video. The contributions of the coresearchers to the design can be categorized into 3 areas: mechanics (rules and interactions shaping the app’s structure), dynamics (user-visible elements, such as the outcome when pressing a button), and aesthetics (the emotional responses the app aimed to evoke in users during interaction). Beyond influencing basic aesthetics, the coresearchers placed significant emphasis on user experience and the emotional responses the app could evoke. SUS scores ranged from 67.5 to 97.5, with the vast majority exceeding 77.5, indicating good usability. However, usability testing revealed several issues, generally of lower severity. For instance, video content required improvements, such as reducing light flickering in some recordings and adding rewind and subtitle selection options. Notably, the feature for listening to others’ stories was removed to minimize emotional burden, shifting the focus to text formats with more context. Conclusions: Young people who have experienced trauma can actively participate in the cocreation of a mental health intervention, offering valuable insights into the needs and preferences of their peers. Applying a child rights–based framework to their involvement in a research project supported the fulfillment of the Convention on the Rights of the Child Article 12. %M 40100259 %R 10.2196/57789 %U https://formative.jmir.org/2025/1/e57789 %U https://doi.org/10.2196/57789 %U http://www.ncbi.nlm.nih.gov/pubmed/40100259 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e63260 %T Development of an eHealth Intervention in Pediatric Home Infusion Therapy: Interview Study of Needs and Preferences of Parents and Health Care Professionals %A Hansson,Helena %A Castor,Charlotte %A Larsen,Hanne Bækgaard %A Topperzer,Martha Krogh %A Olesen,Mette Linnet %K pediatrics %K digital %K interventions %K eHealth %K home care %K intravenous infusion %K qualitative research %D 2025 %7 13.3.2025 %9 %J JMIR Pediatr Parent %G English %X Background: With the provision of home infusion therapy in children with acute or long-term illness on the rise, eHealth technologies have the potential to bridge the transition between hospital and home. However, eHealth interventions intended to support parents in managing home infusion therapy are sparse. Gaining insight into the needs and experiences of parents and health care professionals is crucial to developing feasible and sustainable eHealth interventions that target their needs. This study describes the first phase of a research study designed to develop and evaluate an eHealth intervention to support home infusion therapy. Objective: This study aimed to identify the experiences and needs of parents and health care professionals during home infusion therapy and their preferences for digital features in a future eHealth intervention. Methods: A qualitative study was conducted at 3 pediatric departments at a university hospital in Denmark. We individually interviewed 17 parents of 14 children who had received home infusion therapy with a portable pump. In addition, 5 focus groups were conducted with 15 health care professionals. We conducted a qualitative content analysis of the data, which we collected from February to July 2020. Results: We identified 6 subthemes that we merged into 3 main themes: increasing safe self-management at home; adapting information and responsibility to individual changing needs; and requesting digital features to ensure skill level, safety, and quality of care. The analysis showed that parents and health care professionals had corresponding needs and preferences, for example, a need for a high sense of safety and easier ways to communicate during home infusion therapy. Both groups emphasized the need for digital features to improve problem-solving and communication as a supplement to existing care to promote a safe environment, self-management, and quality of care. A vital issue was that an eHealth intervention should be aligned with the workflow of health care professionals and comply with regulations regarding confidentiality in communication and data sharing. Conclusions: Our study highlights the needs that parents and health care professionals have for increased safety and easier access to communication when receiving and providing home infusion therapy. The findings will be used to help develop an eHealth intervention supporting home infusion therapy tailored to individual needs. %R 10.2196/63260 %U https://pediatrics.jmir.org/2025/1/e63260 %U https://doi.org/10.2196/63260 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e59485 %T Building a Decentralized Biobanking App for Research Transparency and Patient Engagement: Participatory Design Study %A Dewan,Ananya %A Eifler,M %A Hood,Amelia %A Sanchez,William %A Gross,Marielle %+ Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD, 21205, United States, 1 8135416103, mariellesophiagross@gmail.com %K mobile health %K mHealth %K application %K smartphone %K digital health %K digital intervention %K participatory design %K biobanking %K research transparency %K donation %K patient-derived biospecimens %K plain language communications %K patient education %D 2025 %7 5.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patient-derived biospecimens are invaluable tools in biomedical research. Currently, there are no mechanisms for patients to follow along and learn about the uses of their donated samples. Incorporating patients as stakeholders and meaningfully engaging them in biomedical research first requires transparency of research activities. Objective: In this paper, we describe the use of participatory design methods to build a decentralized biobanking “de-bi” mobile app where patients could learn about biobanking, track their specimens, and engage with ongoing research via patient-friendly interfaces overlaying institutional biobank databases, initially developed for a breast cancer use case. Methods: This research occurred in 2 phases. In phase 1, we designed app screens from which patients could learn about ongoing research involving their samples. We embedded these screens in a survey (n=94) to gauge patients’ interests regarding types of feedback and engagement opportunities; survey responses were probed during 6 comprehensive follow-up interviews. We then held an immersive participatory design workshop where participants (approximately 50) provided general feedback about our approach, with an embedded codesign workshop where a subset (n=15) provided targeted feedback on screen designs. For phase 2, we refined user interfaces and developed a functional app prototype in consultation with institutional stakeholders to ensure regulatory compliance, workflow compatibility, and composability with local data architectures. We presented the app at a second workshop, where participants (n=25, across 9 groups) shared thoughts on the app’s usability and design. In this phase, we conducted cognitive walkthroughs (n=13) to gain in-depth feedback on in-app task navigation. Results: Most of the survey participants (61/81, 75%) were interested in learning the outcomes of research on their specimens, and 49% (41/83) were interested in connecting with others with the same diagnosis. Participants (47/60, 78%) expressed strong interest in receiving patient-friendly summaries of scientific information from scientists using their biospecimens. The first design workshop identified confusion in terminology and data presentation (eg, 9/15, 60% of co-designers were unclear on the biospecimens “in use”), though many appreciated the ability to view their personal biospecimens (7/15, 47%), and most were excited about connecting with others (12/15, 80%). In the second workshop, all groups found the app’s information valuable. Moreover, 44% (5/9) noted they did not like the onboarding process, which was echoed in cognitive walkthroughs. Walkthroughs further confirmed interest in biospecimen tracking, and 23% (3/13) had confusion about not finding any of their biospecimens in the app. These findings guided refinements in onboarding, design, and user experience. Conclusions: Designing a patient-facing app that displays information about biobanked specimens can facilitate greater transparency and engagement in biomedical research. Co-designing the app with patient stakeholders confirmed interest in learning about biospecimens and related research, improved presentation of data, and ensured usability of the app in preparation for a pilot study. %M 40053747 %R 10.2196/59485 %U https://humanfactors.jmir.org/2025/1/e59485 %U https://doi.org/10.2196/59485 %U http://www.ncbi.nlm.nih.gov/pubmed/40053747 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64661 %T Identifying Food Preferences and Malnutrition in Older Adults in Care Homes: Co-Design Study of a Digital Nutrition Assessment Tool %A Connelly,Jenni %A Swingler,Kevin %A Rodriguez-Sanchez,Nidia %A Whittaker,Anna C %+ Faculty of Health Sciences and Sport, University of Stirling, 3a74a Cottrell Building, Stirling, FK9 4LA, United Kingdom, 44 1786 466399, jenni.connelly1@stir.ac.uk %K ageing %K digital technology %K dietary measurement %K care homes %K co-design %K dietary intake %K food diary %D 2025 %7 3.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Malnutrition is a challenge among older adults and can result in serious health consequences. However, the dietary intake monitoring needed to identify malnutrition for early intervention is affected by issues such as difficulty remembering or needing a dietitian to interpret the results. Objective: This study aims to co-design a tool using automated food classification to monitor dietary intake and food preferences, as well as food-related symptoms and mood and hunger ratings, for use in care homes. Methods: Participants were 2 separate advisory groups and 2 separate sets of prototype testers. The testers for the first prototype were 10 community-dwelling older adults based in the Stirlingshire area in Scotland who noted their feedback on the tool over 2 weeks in a food diary. The second set of testers consisted of 14 individuals (staff: n=8, 57%; and residents: n=6, 43%) based in 4 care homes in Scotland who provided feedback via interview after testing the tool for a minimum of 3 days. In addition, 130 care home staff across the United Kingdom completed the web-based survey on the tool’s needs and potential routes to pay for it; 2 care home managers took part in follow-up interviews. Data were collected through food diaries, a web-based survey, audio recordings and transcriptions of focus groups and interviews, and research notes. Systematic text condensation was used to describe themes across the different types of data. Results: Key features identified included ratings of hunger, mood, and gastrointestinal symptoms that could be associated with eating specific foods, as well as a traffic light system to indicate risk. Issues included staff time, Wi-Fi connectivity, and the accurate recognition of pureed food and fortified meals. Different models for potential use and commercialization were identified, including peer support among residents to assist those considered less able, staff-only use of the tool, care home–personalized database menus for easy meal photo selection, and targeted monitoring of residents considered to be at the highest risk using the traffic light system. Conclusions: The tool was deemed useful for monitoring dietary habits and associated symptoms, but necessary design improvements were identified. These should be incorporated before formal evaluation of the tool as an intervention in this setting. Co-design was vital to help make the tool fit for the intended setting and users. %M 40053797 %R 10.2196/64661 %U https://aging.jmir.org/2025/1/e64661 %U https://doi.org/10.2196/64661 %U http://www.ncbi.nlm.nih.gov/pubmed/40053797 %0 Journal Article %I %V %N %P %T %D %7 .. %9 %J %G English %X %U %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57826 %T Exploring the Effect of an 8-Week AI-Composed Exercise Program on Pain Intensity and Well-Being in Patients With Spinal Pain: Retrospective Cohort Analysis %A Griefahn,Annika %A Avermann,Florian %A Zalpour,Christoff %A Marshall,Robert Percy %A Cordon Morillas,Inés %A Luedtke,Kerstin %K exercise %K mHealth %K app engagement %K spinal pain %K artificial intelligence %K AI %K intensity %K well-being %K mobile health %K apps %K applications %K retrospective analysis %K physical activity %K adults %K questionnaire %D 2025 %7 18.2.2025 %9 %J JMIR Form Res %G English %X Background: Spinal pain, one of the most common musculoskeletal disorders (MSDs), significantly impacts the quality of life due to chronic pain and disability. Physical activity has shown promise in managing spinal pain, although optimizing adherence to exercise remains a challenge. The digital development of artificial intelligence (AI)-driven applications offers a possibility for guiding and supporting patients with MSDs in their daily lives. Objective: The trial aimed to investigate the effect of an 8-week AI-composed exercise program on pain intensity and well-being in patients with spinal pain. It also examined the relationship between exercise frequency, pain intensity, and well-being. In addition, app usage frequency was examined as a proxy for app engagement. Methods: Data from users who met the inclusion criteria were collected retrospectively from the medicalmotion app between January 1, 2020, and June 30, 2023. The intervention involved the use of the medicalmotion app, which provides 3‐5 personalized exercises for each session based on individual user data. The primary outcomes assessed pain intensity and well-being using the numeric rating scale (NRS) and the Likert scale. Data were collected at baseline (t0), 4 weeks (t1), and 8 weeks (t2). The correlation between exercise frequency, pain intensity, and well-being was analyzed as a secondary outcome. In addition, average session length and frequency were measured to determine app engagement. Statistical analysis included ANOVA and Spearman correlation analysis. Results: The study included 379 participants with a mean age of 50.96 (SD 12.22) years. At t2, there was a significant reduction of 1.78 points on the NRS (P<.001). The score on the Likert scale for well-being improved by 3.11 points after 8 weeks. Pain intensity showed a negative correlation with the number of daily exercises performed at t1 and t2. Well-being had a small negative correlation with the average number of exercises performed per day. The average number of exercises performed per day was 3.58. The average session length was approximately 10 minutes, and the average interaction with the app was 49.2% (n=27.6 days) of the 56 available days. Conclusions: Overall, the study demonstrates that an app-based intervention program can substantially reduce pain intensity and increase well-being in patients with spinal pain. This retrospective study showed that an app that digitizes multidisciplinary rehabilitation for the self-management of spinal pain significantly reduced user-reported pain intensity in a preselected population of app users. Trial Registration: OSF Registries osf.io/kjhef; https://osf.io/kjhef %R 10.2196/57826 %U https://formative.jmir.org/2025/1/e57826 %U https://doi.org/10.2196/57826 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e56533 %T Assessment of Environmental, Sociocultural, and Physiological Influences on Women’s Toileting Decisions and Behaviors Using “Where I Go”: Pilot Study of a Mobile App %A Smith,Abigail R %A Mueller,Elizabeth R %A Lewis,Cora E %A Markland,Alayne %A Smerdon,Caroline %A Smith,Ariana L %A Sutcliffe,Siobhan %A Wyman,Jean F %A Low,Lisa Kane %A Miller,Janis M %A , %K ecological momentary assessment %K time location factors %K voiding diary %K voiding behaviors %K population studies %K mobile application %K app %K bladder health %K data collection tool %K decision support %D 2025 %7 12.2.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Little is known about women’s decisions around toileting for urination and how those decisions influence moment-to-moment behaviors to manage bladder needs. The new smartphone app “Where I Go” captures such nuanced and granular data in real-world environments. Objective: This study aims to describe participant engagement with “Where I Go”, variation in novel parameters collected, and readiness for the data collection tool’s use in population-based studies. Methods: “Where I Go” has three components: (1) real-time data, (2) short look-back periods (3‐4 h), and (3) event location (GPS recorded at each interaction). The sample size was 44 women. Recording of real-time toileting events and responding to look-back questions was measured over 2 days of data collection. The participant’s self-entered location descriptions and the automatic GPS recordings were compared. Results: A total of 44 women with an average age of 44 (range 21-85) years interacted with the app. Real-time reporting of at least 1 toileting event per day was high (38/44, 86%, on day 1 and 40/44, 91%, on day 2) with a median of 5 (IQR 3-7 on day 1 and IQR 3-8 on day 2) toileting events recorded each day. Toileting most commonly occurred at home (85/140, 61%, on day 1 and 129/171, 75%, on day 2) due to a need to go (114/140, 66%, on day 1 and 153/171, 74%, on day 2). The most common reasons for delaying toileting were “work duties” (33/140, 21%, on day 1 and 21/171, 11%, on day 2) and “errands or traveling” (19/140, 12%, on day 1 and 19/171, 10%, on day 2). Response to at least 1 look-back notification was similarly high (41/44, 93%, on day 1 and 42/44, 95%, on day 2), with number of responses higher on average on day 2 compared with day 1 (mean on day 1=3.2, 95% CI 3.0-3.5; mean on day 2=4.3, 95% CI 3.9-4.7; P<.001). Median additional toileting events reported on the look-back survey were 1 (IQR 1-2) and 2 (IQR 1-2) on days 1 and 2, respectively. Overall concordance between self-reported location recording and GPS was 76% (188/247). Participants reported lower urge ratings when at home versus away when reporting real-time toileting (median rating 61, IQR 41-84 vs 72, IQR 56-98), and daily fluid intake showed a small to medium positive correlation with toileting frequency (day 1 r=0.3, day 2 r=0.24). Toileting frequency reported in “Where I Go” showed a small positive correlation with the frequency item from the International Consultation on Incontinence Questionnaire (r=0.31 with day 1 toileting frequency and r=0.21 with day 2 toileting frequency). Conclusions: “Where I Go” has potential to increase the understanding of factors that affect women’s toileting decisions and long-term bladder health. We anticipate its use as a data collection tool in population-based studies. International Registered Report Identifier (IRRID): RR2-10.2196/54046 %R 10.2196/56533 %U https://mhealth.jmir.org/2025/1/e56533 %U https://doi.org/10.2196/56533 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e67043 %T Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study %A Jacob,Christine %A Müller,Roman %A Schüler,Sonja %A Rey,Alix %A Rey,Guillaume %A Armenian,Berj %A Vonlaufen,Alain %A Drepper,Michael %A Zimmerli,Marius %K eHealth %K mobile health %K mHealth %K digital health %K technology assessment %K technology adoption %K technology implementation %K usability study %K colonoscopy %K app %K application %K examinations %K smartphone %K usability %D 2025 %7 12.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures. Objective: This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app’s usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users. Methods: From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants’ task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles. Results: In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app’s usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids. Conclusions: The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial. %R 10.2196/67043 %U https://humanfactors.jmir.org/2025/1/e67043 %U https://doi.org/10.2196/67043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e51271 %T An Explanation Interface for Healthy Food Recommendations in a Real-Life Workplace Deployment: User-Centered Design Study %A De Croon,Robin %A Segovia-Lizano,Daniela %A Finglas,Paul %A Vanden Abeele,Vero %A Verbert,Katrien %K food recommender systems %K personalized nutrition %K healthy eating %K human-computer interaction %K real-life deployment %K food catering %K meal recommendations %K nutritional profile %K transparency %D 2025 %7 11.2.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Despite widespread awareness of healthy eating principles, many individuals struggle to translate this knowledge into consistent, sustainable dietary change. Food recommender systems, increasingly used in various settings, offer the potential for personalized guidance and behavior change support. However, traditional approaches may prioritize user preferences or popularity metrics without sufficiently considering long-term nutritional goals. This can inadvertently reinforce unhealthy eating patterns. Emerging research suggests that incorporating explanations into recommender systems can increase transparency, promote informed decision-making, and potentially influence food choices. Yet, the effectiveness of explanations in promoting healthy choices within complex, real-world food environments remain largely unexplored. Objective: This study aims to investigate the design, implementation, and preliminary evaluation of a food recommender system that integrates explanations in a real-world food catering application. We seek to understand how such a system can promote healthy choices while addressing the inherent tensions between user control, meal variety, and the need for nutritionally sound recommendations. Specifically, our objectives are to (1) identify and prioritize key design considerations for food recommenders that balance personalization, nutritional guidance, and user experience; and (2) conduct a proof-of-principle study in a real-life setting to assess the system’s effect on user understanding, trust, and potentially on dietary choices. Methods: An iterative, user-centered design process guided the development and refinement of the system across 4 phases: (Phase 0) an exploratory qualitative study (N=26) to understand stakeholder needs and initial system impressions, (Phases 1 and 2) rapid prototyping in real-life deployments (N=45 and N=16, respectively) to iteratively improve usability and features, and (Phase 3) a proof-of-principle study with employees (N=136) to evaluate a set of design goals. We collected a mix of data, including usage logs, pre- and post-study questionnaires, in-app feedback, and a pre- and post–Food Frequency Questionnaire to establish nutritional profiles. Results: Although we experienced a high drop-out (77% after 7 weeks), motivated and remaining participants valued personalization features, particularly the ability to configure allergies and lifestyle preferences. Explanations increased understanding of recommendations and created a sense of control, even when preferences and healthy options did not fully align. However, a mismatch persisted between individual preferences and nutritionally optimal recommendations. This highlights the design challenge of balancing user control, meal variety, and the promotion of healthy eating. Conclusions: Integrating explanations into personalized food recommender systems might be promising for supporting healthier food choices and creating a more informed understanding of dietary patterns. Our findings could highlight the importance of balancing user control with both the practical limitations of food service settings and the need for nutritionally sound recommendations. While fully resolving the tension between immediate preferences and long-term health goals is an ongoing challenge, explanations can play a crucial role in promoting more conscious decision-making. %R 10.2196/51271 %U https://mhealth.jmir.org/2025/1/e51271 %U https://doi.org/10.2196/51271 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59386 %T Involving End Users in the Development and Usability Testing of a Smartphone App Designed for Individuals With Prediabetes: Mixed-Methods Focus Group Study %A Grieve,Natalie %A Braaten,Kyra %A MacPherson,Megan %A Liu,Sam %A Jung,Mary E %K usability evaluation %K mHealth %K usability testing %K app %K end-user %K focus group %K participant %K survey %K diabetes %K user-centered %K cognitive walkthrough %K cognitive walkthroughs %K questionnaire %K mobile phone %K digital health %K prediabetes %D 2025 %7 11.2.2025 %9 %J JMIR Form Res %G English %X Background: Technology is more likely to be used when it is designed to meet the needs of end users. To supplement the Small Steps for Big Changes diabetes prevention program, a smartphone app was developed in partnership with past Small Steps for Big Changes clientele. Usability testing is critical for the ongoing use and adoption of mobile health apps by providing insight on where appropriate adjustments and improvements need to be made to ensure user satisfaction. Objective: A focus group with 7 participants was conducted to examine the app’s usability and collect feedback for future iterations. Methods: Past Small Steps for Big Changes clientele participated in a cognitive walkthrough of 8 novel tasks and completed the System Usability Scale survey. Participants were then given the option to use the app for 3 weeks before completing the User-Mobile Application Rating Scale. Results: Analysis of the cognitive walkthrough identified 26 usability problems; each was coded using a heuristic evaluation to describe usability errors. The most frequently coded errors included inappropriate progress feedback, information appearing in an illogical order, counterintuitive design, and issues with app aesthetics. A mean summary score of 66.8% (SD 18.91) was reported for the System Usability Scale, representing a marginal acceptability score and indicating that design issues needed to be resolved. A User-Mobile Application Rating Scale mean score of 3.59 (SD 0.33) was reported, implying an average acceptability rating. Conclusions: These findings identified necessary improvements in the app, ranging from minor aesthetic problems to major functionality problems. Involving end users allows the app to be tailored to the client’s preferences and increases the likelihood of usage. This app aligns with Small Steps for Big Changes’ program components and behavior change techniques that can improve health outcomes for future clients and allow them to self-monitor their exercise, diet, and goals. %R 10.2196/59386 %U https://formative.jmir.org/2025/1/e59386 %U https://doi.org/10.2196/59386 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e60333 %T Efficacy, Feasibility, and Acceptability of an Emotional Competence Tele-Intervention for Mandarin-Speaking Children Aged 5 to 7 Years With Developmental Language Disorder: Pilot Study With an Interrupted Time-Series Design %A Lu,Hsin-Hui %A Liang,Shih-Yuan %A Huang,Yi-Chia %+ Division of Clinical Psychology, Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 33302 No 259, Wenhua 1st Rd, Guishan Dist, Taoyuan City, 33302, Taiwan, 886 03 2118800, hsinhuilupsy@gmail.com %K language disorder %K pediatrics %K evidence-based intervention %K telemedicine %K tele-practice %K visual support %K mobile phone %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Children with developmental language disorder (DLD) often experience language difficulties that hinder their ability to acquire emotional competence. Poor emotional competence is associated with emotional and behavioral problems in young children. Objective: This research involved two studies focusing on (1) the emotional competence of Mandarin-speaking children aged 5 to 7 years with DLD and (2) the efficacy, feasibility, and acceptability of a tele-intervention designed to enhance their emotional competence in Taiwan. Methods: Five children with DLD from study 1 declined to participate in study 2, the emotional competence tele-intervention, and were excluded from the analysis. We compared the emotional competence of 20 Mandarin-speaking children with DLD to that of 24 children with typical language development (TLD). The children with DLD were, on average, aged 5.79 (SD 0.47) years, whereas the children with TLD were, on average, aged 5.93 (SD 0.31) years. We assessed the children’s emotional competence, nonverbal ability, verbal comprehension, vocabulary acquisition, and expressive language skills. In study 2, all children with DLD included in study 1 engaged in an emotional competence tele-intervention. An interrupted time-series design was used to examine their emotional competence. In total, 20 children with DLD provided data on emotional competence evaluated using the Emotional Lexicon Test. These data were individually collected at 3 time points after study 1 (time 1). These phases included baseline (time 1 to time 2), during the tele-intervention (time 2 to time 3), and follow-up (time 3 to time 4), spanning approximately 18 to 20 weeks from time 1 to time 4. Recruitment, retention, and attendance rates were calculated to evaluate the intervention’s feasibility, and participant mood was evaluated after each session to calculate the intervention’s acceptability. Results: No significant changes in the children’s ability to understand basic or complex emotional terms were observed during the baseline period. However, changes were observed during the tele-intervention period, and these changes remained throughout the follow-up period. With a recruitment rate of 80% (20/25), all participants completed 4 intervention sessions, with retention and attendance rates exceeding 95% (19/20). A total of 90% (18/20) of the participants deemed each session to be acceptable. Conclusions: Mandarin-speaking children aged 5 to 7 years with DLD exhibited lower emotional competence compared with their counterparts with TLD. Tele-interventions are effective in enhancing the emotional competence of children with DLD, demonstrating feasibility and acceptability for these children and their parents in Taiwan. %M 39933173 %R 10.2196/60333 %U https://pediatrics.jmir.org/2025/1/e60333 %U https://doi.org/10.2196/60333 %U http://www.ncbi.nlm.nih.gov/pubmed/39933173 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62738 %T Development of Chatbot-Based Oral Health Care for Young Children and Evaluation of its Effectiveness, Usability, and Acceptability: Mixed Methods Study %A Pupong,Kittiwara %A Hunsrisakhun,Jaranya %A Pithpornchaiyakul,Samerchit %A Naorungroj,Supawadee %K chatbot %K conversational agents %K tele-dentistry %K oral health behavior %K in-person toothbrushing %K hands-on %K children %K covid-19 %K oral health education %K development. %D 2025 %7 3.2.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Chatbots are increasingly accepted in public health for their ability to replicate human-like communication and provide scalable, 24/7 services. The high prevalence of dental caries in children underscores the need for early and effective intervention. Objective: This study aimed to develop the 30-Day FunDee chatbot and evaluate its effectiveness, usability, and acceptability in delivering oral health education to caregivers of children aged 6 to 36 months. Methods: The chatbot was created using the artificial intelligence (AI) chatbot behavior change model, integrating behavioral change theories into content designed for 3‐5 minutes of daily use over 30 days. A pre-post experimental study was conducted from December 2021 to February 2022 in Hat Yai District, Songkhla Province, and Maelan District, Pattani Province, Thailand. Fifty-eight caregivers completed a web-based structured questionnaire at baseline and 2 months post baseline to evaluate knowledge, protection motivation theory-based perceptions, and tooth-brushing practices. Usability was assessed via chatbot logfiles and a web-based questionnaire at 2 months post baseline. Acceptability was evaluated through three methods: (1) open-ended chatbot interactions on day 30, (2) a web-based structured questionnaire at 2 months post baseline, and (3) semistructured telephone interviews with 15 participants 2 weeks post intervention. Participants for interviews were stratified by adherence levels and randomly selected from Hatyai and Maelan districts. All self-reported variables were measured on a 5-point Likert scale (1=lowest, 5=highest). Results: The chatbot was successfully developed based on the 4 components of the AI chatbot behavior change model. Participants had a mean age of 34.5 (SD 8.6) years. The frequency of tooth brushing among caregivers significantly improved, increasing from 72.4% at baseline to 93.1% two months post baseline (P=.006). Protection motivation theory-based perceptions also showed significant improvement, with mean scores rising from 4.0 (SD 0.6) at baseline to 4.5 (SD 0.6) two months post baseline (P<.001). The chatbot received high ratings for satisfaction (4.7/5, SD 0.6) and usability (4.7/5, SD 0.5). Participants engaged with the chatbot for an average of 24.7 (SD 7.2) days out of 30. Caregivers praised the chatbot’s content quality, empathetic communication, and multimedia design, but noted the intervention’s lengthy duration and messaging system as limitations. Conclusions: The 30-Day FunDee chatbot effectively enhanced caregivers’ perceptions of oral health care and improved tooth-brushing practices for children aged 6‐36 months. High user satisfaction and engagement demonstrate its potential as an innovative tool for oral health education. These findings warrant further validation through large-scale, randomized controlled trials. Trial Registration: Thai Clinical Trials Registry Tctr20210927004; https://www.thaiclinicaltrials.org/show/Tctr20210927004 %R 10.2196/62738 %U https://pediatrics.jmir.org/2025/1/e62738 %U https://doi.org/10.2196/62738 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54216 %T Self-Guided Smartphone App (Vimbo) for the Reduction of Symptoms of Depression and Anxiety in South African Adults: Pilot Quantitative Single-Arm Study %A Steyn,Sherrie %A Slabbert,Meggan %+ Vimbo Health SA (Pty) Ltd, 20 Riverclub Mews, 7 Sycamore Avenue, Riverclub, Sandton, 2191, South Africa, 27 63 861 6780, sherrie@vimbohealth.com %K treatment gap %K mental health %K health %K depression %K anxiety %K South Africa %K CBT %K cognitive behavioral therapy %K app-based intervention %K mobile health %K mental health app %K smartphone %K mobile phone %D 2025 %7 30.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Barriers to mental health assessment and intervention have been well documented within South Africa, in both urban and rural settings. Internationally, evidence has emerged for the effectiveness of technology and, specifically, app-based mental health tools and interventions to help overcome some of these barriers. However, research on digital interventions specific to the South African context and mental health is limited. Objective: This pilot study investigated the feasibility of using an app (Vimbo) to treat symptoms of anxiety and depression in South African adults recruited from a community sample. The Vimbo app is a self-guided, cognitive behavioral therapy–based digital intervention for common mental health difficulties developed for the South African context. Methods: This pilot study used a naturalistic, single-arm design testing the Vimbo app over 12 weeks, from October 2020 to February 2021. Participants were recruited through the South African Depression and Anxiety Group and social media advertisements online. A 2-week retention period was used to allow for a minimum of 2 datasets. App usage and engagement metrics were extracted directly from the back end of the app. Based on the model, researchers expected many users to discontinue usage when their symptom levels entered a healthy range. Pre-post review of symptom levels was used to reflect on clinical recovery status at discontinuation after the retention period. Results: A total of 218 applicants met study eligibility criteria and were invited to download the Vimbo app. Of these, 52% (114/218) of the participants registered with the app, who indicated multiple variances of depression and anxiety symptoms ranging in severity from mild to severe. Two participants users withdrew from the study. Moreover, 69% (77/112) of users were retained, including 8 who had technical issues with their treatment. When comparing broad uptake across all interested participants, chi-square analysis indicated significantly reduced uptake in participants identifying as “unemployed but seeking employment” (χ24=10.47; N=251; P=.03). When considering app usage for the entire cohort (n=69, excluding participants with technical issues), there was a mean of 72.87 (SD 71.425) total module pages read, a mean of 30% (SD 29.473%) of prescribed content completed, and a mean of 19.93 (SD 27.517) times engaging with tools and skills. Conclusions: Our findings support the case for continued exploration of app-based interventions for treating depression and anxiety in South Africa. Developing strategies to increase access and improve intervention uptake may prove essential to helping mobile health interventions make as significant an impact as possible. Future research should include a randomized controlled trial with a larger sample to further assess the efficacy of app-based interventions in treating mental health difficulties in South Africa. %M 39883938 %R 10.2196/54216 %U https://formative.jmir.org/2025/1/e54216 %U https://doi.org/10.2196/54216 %U http://www.ncbi.nlm.nih.gov/pubmed/39883938 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63564 %T LoVE4MUM Mobile App to Prevent Postpartum Depression: Protocol for a Pilot Randomized Controlled Trial %A Kamarudin,Siti Sabrina %A Idris,Idayu Badilla %A Sharip,Shalisah %A Ahmad,Norfazilah %+ Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia, 60 91455887 ext 5888, idayubadilla.idris@ukm.edu.my %K postpartum depression %K mHealth intervention %K mobile phone %K prevention %K self-guided %K virtual engagement %K engagement %K maternal %K protocol %K randomized controlled trial %K postpartum %K depression %K maternal %K well-being %K mobile health %K preventive care %K mobile app %K mental health literacy %K postpartum care %D 2025 %7 27.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression remains a significant concern, posing substantial challenges to maternal well-being, infant health, and the mother-infant bond, particularly in the face of barriers to traditional support and interventions. Previous studies have shown that mobile health (mHealth) interventions offer an accessible means to facilitate early detection and management of mental health issues while at the same time promoting preventive care. Objective: This study aims to evaluate the effectiveness of the Leveraging on Virtual Engagement for Maternal Understanding & Mood-enhancement (LoVE4MUM) mobile app, which was developed based on the principles of cognitive behavioral therapy and psychoeducation and serves as an intervention to prevent postpartum depression. Methods: This single-blinded, pilot randomized controlled trial includes 64 mothers recruited from the postnatal ward and randomized using a 1:1 ratio to receive either postpartum care (treatment as usual) or postpartum care (treatment as usual) plus the self-guided LoVE4MUM mobile app. The primary outcome is the effectiveness of the mobile app at improving postpartum depression. Secondary outcomes are changes in the mental health literacy score and negative automatic thoughts, which are collected using a self-reported questionnaire. Results: Patient recruitment began on September 1, 2024. As of January 1, 2025, recruitment was successfully completed, with a total of 72 participants enrolled: 36 in the intervention group and 36 in the control group . The final results are anticipated to be available by March 2025, and publication is expected by the end of 2025. Conclusions: By examining the LoVE4MUM app alongside standard postpartum care, this pilot randomized controlled trial seeks to offer preliminary evidence on the potential of mHealth tools to improve maternal mental health as well as to reduce postpartum depression symptoms. The findings are expected to contribute to the future development of effective, accessible, and scalable interventions for mothers. Trial Registration: ClinicalTrials.gov NCT06366035; https://clinicaltrials.gov/study/NCT06366035 International Registered Report Identifier (IRRID): PRR1-10.2196/63564 %M 39869891 %R 10.2196/63564 %U https://www.researchprotocols.org/2025/1/e63564 %U https://doi.org/10.2196/63564 %U http://www.ncbi.nlm.nih.gov/pubmed/39869891 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65022 %T A User-Centered Design Approach for a Screening App for People With Cognitive Impairment (digiDEM-SCREEN): Development and Usability Study %A Zeiler,Michael %A Dietzel,Nikolas %A Haug,Fabian %A Haug,Julian %A Kammerer,Klaus %A Pryss,Rüdiger %A Heuschmann,Peter %A Graessel,Elmar %A Kolominsky-Rabas,Peter L %A Prokosch,Hans-Ulrich %K dementia %K usability %K development %K digiDEM %K cognitive impairment %K older adults %K aging %K mobile health %K mHealth %K design %K feedback %K screening %K user centred %K cognitive disorder %K user-centered %K mobile app %D 2025 %7 22.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Dementia is a widespread syndrome that currently affects more than 55 million people worldwide. Digital screening instruments are one way to increase diagnosis rates. Developing an app for older adults presents several challenges, both technical and social. In order to make the app user-friendly, feedback from potential future end users is crucial during this development process. Objective: This study aimed to establish a user-centered design process for the development of digiDEM-SCREEN, a user-friendly app to support early identification of persons with slight symptoms of dementia. Methods: This research used qualitative and quantitative methods and involved 3 key stakeholder groups: the digiDEM research team, the software development team, and the target user group (older adults ≥65 years with and without cognitive impairments). The development of the screening app was based on an already existing and scientifically analyzed screening test (Self-Administered Tasks Uncovering Risk of Neurodegeneration; SATURN). An initial prototype was developed based on the recommendations for mobile health apps and the teams’ experiences. The prototype was tested in several iterations by various end users and continuously improved. The app’s usability was evaluated using the System Usability Scale (SUS), and verbal feedback by the end users was obtained using the think-aloud method. Results: The translation process during test development took linguistic and cultural aspects into account. The texts were also adapted to the German-speaking context. Additional instructions were developed and supplemented. The test was administered using different randomization options to minimize learning effects. digiDEM-SCREEN was developed as a tablet and smartphone app. In the first focus group discussion, the developers identified and corrected the most significant criticism in the next version. Based on the iterative improvement process, only minor issues needed to be addressed after the final focus group discussion. The SUS score increased with each version (score of 72.5 for V1 vs 82.4 for V2), while the verbal feedback from end users also improved. Conclusions: The development of digiDEM-SCREEN serves as an excellent example of the importance of involving experts and potential end users in the design and development process of health apps. Close collaboration with end users leads to products that not only meet current standards but also address the actual needs and expectations of users. This is also a crucial step toward promoting broader adoption of such digital tools. This research highlights the significance of a user-centered design approach, allowing content, text, and design to be optimally tailored to the needs of the target audience. From these findings, it can be concluded that future projects in the field of health apps would also benefit from a similar approach. %R 10.2196/65022 %U https://humanfactors.jmir.org/2025/1/e65022 %U https://doi.org/10.2196/65022 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65142 %T Evaluating the Safety and Usability of an Over-the-Counter Medical Device for Adults With Mild to Moderate Hearing Loss: Formative and Summative Usability Testing %A Salwei,Megan Elizabeth %A Anders,Shilo %A Reale,Carrie %A Slagle,Jason M %A Ricketts,Todd %A Weinger,Matthew B %K usability %K human factors %K patient safety %K over-the-counter hearing aids %K direct-to-consumer hearing aids %K medical device %K hearing loss %K adult %K hearing impairment %K hearing aid use %K hearing care %K formative usability test %K safety %K mobile phone %D 2025 %7 20.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Only 15% of the nearly 30 million Americans with hearing loss use hearing aids, partly due to high cost, stigma, and limited access to professional hearing care. Hearing impairment in adults can lead to social isolation and depression and is associated with an increased risk of falls. Given the persistent barriers to hearing aid use, the Food and Drug Administration issued a final rule to allow over-the-counter hearing aids to be sold directly to adult consumers with perceived mild to moderate hearing loss at pharmacies, stores, and online retailers without seeing a physician or licensed hearing health care professional. Objective: We evaluated the safety and usability of an over-the-counter hearing aid prior to Food and Drug Administration approval and market release. Methods: We first conducted a formative usability test of the device and associated app with 5 intended users to identify outstanding safety and usability issues (testing round 1). Following design modifications, we performed a summative usability test with 15 intended users of the device (testing round 2). We concurrently conducted a test with 21 nonintended users (ie, users with contraindications to use) to ascertain if consumers could determine when they should not use the device, based on the packaging, instructions, and labeling (testing round 3). Participants were asked to complete 2‐5 tasks, as if they were using the hearing aid in real life. After each task, participants rated the task difficulty. At the end of each session, participants completed a 10-question knowledge assessment and the System Usability Scale and then participated in debriefing interviews to gather qualitative feedback. All sessions were video recorded and analyzed to identify use errors and design improvement opportunities. Results: Usability issues were identified in all 3 usability testing rounds. There were minimal safety-related issues with the device. Round 1 testing led to several design modifications which then increased task success in round 2 testing. Participants had the most difficulty with the task of pairing the hearing aids to the cell phone. Participants also had difficulty distinguishing the right and left earbuds. Nonintended users did not always understand device contraindications (eg, tinnitus and severe hearing loss). Overall, test findings informed 9 actionable design modifications (eg, clarifying pairing steps and increasing font size) that improved device usability and safety. Conclusions: This study evaluated the usability and safety of an over-the-counter hearing aid for adults with mild to moderate hearing loss. Human factors engineering methods identified opportunities to improve the safety and usability of this direct-to-consumer medical device for individuals with perceived mild-moderate hearing loss. %R 10.2196/65142 %U https://humanfactors.jmir.org/2025/1/e65142 %U https://doi.org/10.2196/65142 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57614 %T A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability %A Romm,Kristin Lie %A Skoge,Mari %A Barrett,Elizabeth Ann %A Berentzen,Lars-Christian %A Bergsager,Dagfinn %A Fugelli,Pål %A Bjella,Thomas %A Gardsjord,Erlend Strand %A Kling,Kristine %A Kruse,Sindre Hembre %A Kværner,Kari Jorunn %A Melle,Ingrid %A Mork,Erlend %A Ihler,Henrik Myhre %A Rognli,Eline Borger %A Simonsen,Carmen %A Værnes,Tor Gunnar %A Aminoff,Sofie Ragnhild %+ Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Sognsvannsveien 21, Oslo, 0372, Norway, 47 91 50 27 70, k.l.romm@medisin.uio.no %K eHealth %K shared decision-making %K user involvement %K user-centered design %K mental disorder %K mobile technology %K illness course %K recovery %K mobile apps %K mHealth %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians. Objective: This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services. Methods: We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed. Results: To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial. Conclusions: iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings—from development to implementation—and to conduct further research on early health technology assessments to guide these processes. %M 39823632 %R 10.2196/57614 %U https://formative.jmir.org/2025/1/e57614 %U https://doi.org/10.2196/57614 %U http://www.ncbi.nlm.nih.gov/pubmed/39823632 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60447 %T Healthy Kai (Food) Checker Web-Based Tool to Support Healthy Food Policy Implementation: Development and Usability Study %A Rosin,Magda %A Ni Mhurchu,Cliona %A Umali,Elaine %A Mackay,Sally %+ Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Building 507, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand, 64 093737599 ext 88733, m.rosin@auckland.ac.nz %K healthy food policy %K policy implementation %K nutrition %K food environment %K hospital %K workplace %K web-based tool %K digital tool %K database %K user testing %K food %K drink %K nutrition professionals %K acceptability %K usability %D 2025 %7 13.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Public health programs and policies can positively influence food environments. In 2016, a voluntary National Healthy Food and Drink Policy was released in New Zealand to improve the healthiness of food and drinks for hospital staff and visitors. However, no resources were developed to support policy implementation. Objective: This study aimed to design, develop, and test a new web-based tool to support food providers implementing the National Healthy Food and Drink Policy in New Zealand. Methods: The Double Diamond model, a structured framework with 4 design phases, was used to design and develop a web-based tool. Findings from our previous research, such as (1) systematic review of barriers and facilitators to workplace healthy food policy implementation; (2) scoping review of current tools and resources available in New Zealand, Australia, and Canada; (3) interviews with food providers and public health nutrition professionals; and (4) food and drink availability audit results in New Zealand hospitals were used in the “Discover” (understanding of current gaps) and “Define” (prioritizing functions and features) phases. Subsequent phases focused on generating ideas, creating prototypes, and testing a new web-based tool using Figma, a prototyping tool. During the “Develop” phase, project stakeholders (11 public health nutrition professionals) provided feedback on the basic content outline of the initial low-fidelity prototype. In the final “Deliver” phase, a high-fidelity prototype resembling the appearance and functionality of the final tool was tested with 3 end users (public health nutrition professionals) through interactive interviews, and user suggestions were incorporated to improve the tool. Results: A new digital tool, Healthy Kai (Food) Checker—a searchable database of packaged food and drink products that classifies items according to the Policy’s nutritional criteria—was identified as a key tool to support Policy implementation. Of 18 potential functions and features, 11 were prioritized by the study team, including basic and advanced searches for products, sorting list options, the ability to compile a list of selected products, a means to report products missing from the database, and ability to use on different devices. Feedback from interview participants was that the tool was easy to use, was logical to navigate, and had an appealing color scheme. Suggested visual and usability improvements included ensuring that images represented the diverse New Zealand population, reducing unnecessary clickable elements, adding information about the free registration option, and including more frequently asked questions. Conclusions: Comprehensive research informed the development of a new digital tool to support implementation of the National Healthy Food and Drink Policy. Testing with end users identified features that would further enhance the tool’s acceptability and usability. Incorporation of more functions and extending the database to include products classified according to the healthy school lunches program policy in the same database would increase the tool’s utility. %M 39805585 %R 10.2196/60447 %U https://formative.jmir.org/2025/1/e60447 %U https://doi.org/10.2196/60447 %U http://www.ncbi.nlm.nih.gov/pubmed/39805585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64191 %T A Mobile App for Promoting Breastfeeding-Friendly Communities in Hong Kong: Design and Development Study %A Fan,Heidi Sze Lok %A Leung,Emily Tsz Yan %A Lau,Ka Wing %A Wong,Janet Yuen Ha %A Choi,Edmond Pui Hang %A Lam,Christine %A Tarrant,Marie %A Ngan,Hextan Yuen Sheung %A Ip,Patrick %A Lin,Chia Chin %A Lok,Kris Yuet Wan %K Baby-Friendly Community Initiative %K Baby-Friendly Hospital Initiative %K breastfeeding %K community %K stakeholders %K mobile app %K friendly communities %K baby-friendly %K well-being %K mother %K infant %K application %K mHealth %K qualitative %K user-friendly %K self-management %D 2025 %7 10.1.2025 %9 %J JMIR Form Res %G English %X Background: Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices. Objective: The objective of this paper was to describe the development of a breastfeeding-friendly app called “bfGPS” (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community. Methods: The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data. Results: bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged—bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant’s growth, and provides suggestions for further development. Conclusions: The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app’s potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies. %R 10.2196/64191 %U https://formative.jmir.org/2025/1/e64191 %U https://doi.org/10.2196/64191 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59937 %T Unified Mobile App for Streamlining Verbal Autopsy and Cause of Death Assignment in India: Design and Development Study %A Kaur,Harleen %A Tripathi,Stuti %A Chalga,Manjeet Singh %A Benara,Sudhir K %A Dhiman,Amit %A Gupta,Shefali %A Nair,Saritha %A Menon,Geetha %A Gulati,B K %A Sharma,Sandeep %A Sharma,Saurabh %K verbal autopsy %K cause of death %K mortality %K mHealth %K public health %K India %K mobile health %D 2025 %7 10.1.2025 %9 %J JMIR Form Res %G English %X Background: Verbal autopsy (VA) has been a crucial tool in ascertaining population-level cause of death (COD) estimates, specifically in countries where medical certification of COD is relatively limited. The World Health Organization has released an updated instrument (Verbal Autopsy Instrument 2022) that supports electronic data collection methods along with analytical software for assigning COD. This questionnaire encompasses the primary signs and symptoms associated with prevalent diseases across all age groups. Traditional methods have primarily involved paper-based questionnaires and physician-coded approaches for COD assignment, which is time-consuming and resource-intensive. Although computer-coded algorithms have advanced the COD assignment process, data collection in densely populated countries like India remains a logistical challenge. Objective: This study aimed to develop an Android-based mobile app specifically tailored for streamlining VA data collection by leveraging the existing Indian public health workforce. The app has been designed to integrate real-time data collection by frontline health workers and seamless data transmission and digital reporting of COD by physicians. This process aimed to enhance the efficiency and accuracy of COD assignment through VA. Methods: The app was developed using Android Studio, the primary integrated development environment for developing Android apps using Java. The front-end interface was developed using XML, while SQLite and MySQL were employed to streamline complete data storage on the local and server databases, respectively. The communication between the app and the server was facilitated through a PHP application programming interface to synchronize data from the local to the server database. The complete prototype was specifically built to reduce manual intervention and automate VA data collection. Results: The app was developed to align with the current Indian public health system for district-level COD estimation. By leveraging this mobile app, the average duration required for VA data collection to ascertainment of COD, which typically ranges from 6 to 8 months, is expected to decrease by approximately 80%, reducing it to about 1‐2 months. Based on annual caseload projections, the smallest administrative public health unit, health and wellness centers, is anticipated to handle 35‐40 VA cases annually, while medical officers at primary health centers are projected to manage 150‐200 physician-certified VAs each year. The app’s data collection and transmission efficiency were further improved based on feedback from user and subject area experts. Conclusions: The development of a unified mobile app could streamline the VA process, enabling the generation of accurate national and subnational COD estimates. This mobile app can be further piloted and scaled to different regions to integrate the automated VA model into the existing public health system for generating comprehensive mortality statistics in India. %R 10.2196/59937 %U https://formative.jmir.org/2025/1/e59937 %U https://doi.org/10.2196/59937 %0 Journal Article %I %V %N %P %T %D %7 .. %9 %J %G English %X %U %0 Journal Article %I %V %N %P %T %D %7 .. %9 %J %G English %X %U %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55032 %T Collecting Feedback From Neurologists and Patients to Guide Development of a Parkinson Disease App (DigiPark): Qualitative, Noninterventional Study %A Duracinsky,Martin %A Brown Hajdukova,Eva %A Péretz,Fabienne %A Sauzin,Julie %A Gouider-Khouja,Neziha %A Atlani,Caroline %A Dalili,Djamchid %K DigiPark %K Parkinson disease %K patient-centered app %K smartphones %K usability testing %K mHealth %K mobile health %D 2024 %7 31.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Parkinson disease (PD) is a worldwide, fast-growing, progressive neurodegenerative condition. Its multifaceted clinical presentation includes a wide range of motor and nonmotor symptoms. Smartphones present a potential solution to better monitor and subsequently alleviate PD symptoms. Objective: The aim of this study is to explore neurologists’ and patients’ needs and preferences regarding the design and functionality of a new smartphone app for PD, DigiPark. Methods: This qualitative, noninterventional study gathered data through two primary methods: (1) by conducting interviews with 9 neurologists and (2) through a usability test including 5 patients with PD. Results: The neurologists affirmed the necessity for a patient-centered app, highlighting the complexities of PD management. They advocated for personalized app functionalities to improve patients’ quality of life and emphasized the need for enhanced patient-provider communication. Feedback from the usability test indicated a preference for a clear, simple user interface, as well as elucidation of the app’s benefits. Concerns about the app’s time demands and the complexity of certain features like medication management were expressed. Furthermore, patients with PD consistently showed interest in features that could track and monitor their progress over time. This highlights the need to include clear benefits within the app to maintain user engagement and commitment. Conclusions: Neurologists’ and patients’ feedback on the design and functionality of the app complement each other. Collaborative efforts in shaping the app should better address genuine PD management needs. Future clinical trial inclusion can further validate the efficacy of DigiPark. %R 10.2196/55032 %U https://humanfactors.jmir.org/2024/1/e55032 %U https://doi.org/10.2196/55032 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53613 %T Using Active and Passive Smartphone Data to Enhance Adolescents’ Emotional Awareness in Forensic Outpatient Setting: A Qualitative Feasibility and Usability Study %A Leijse,Merel M L %A van Dam,Levi %A Jambroes,Tijs %A Timmerman,Amber %A Popma,Arne %+ Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC location Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 020 8901000, m.m.l.leijse@amsterdamumc.nl %K emotion regulation %K emotion awareness %K smartphone data %K forensic outpatient youth care %K treatment motivation %K treatment alliance %K emotion %K behavioral %K interview %K mHealth %K app %K forensic %K usability %K feasibility %K delinquent %K pediatrics %K youth %K adolescent %K teenager %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %K emoji %K behavioral data %K mobile phone %D 2024 %7 30.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delinquent behavior in adolescence is a prevalent issue, often associated with difficulties across multiple life domains, which in turn perpetuates negative life outcomes. While current treatment programs show partial success in improving behavioral changes and reducing recidivism, comprehensive conclusions regarding the overall efficacy of these interventions have yet to be established. In forensic outpatient settings, the discrepancy between adolescents’ limited emotional awareness and the predominant emphasis on cognitive reflection, combined with low treatment adherence, may be factors that undermine treatment efficacy. New technologies, such as smartphone apps, may offer a solution by integrating real-life data into treatment to improve emotional and behavioral patterns. The low-threshold use of smartphone data can be useful in addressing these treatment challenges. Objective: This study aimed to explore the feasibility and usability of Feelee (Garage2020), a smartphone app that integrates active emoji and passive behavioral data, as a potential addition to treatment for adolescents in a forensic outpatient setting. Methods: We conducted a prepilot study with adolescents (n=4) who used the Feelee app over a 2-week period. App usage included completing a brief emoji survey 3 times a day (active data) and allowing Feelee to track the call logs, Bluetooth devices in proximity, cell tower IDs, app usage, and phone status (passive data). During treatment sessions, both adolescents and clinicians reviewed and discussed the active and passive data. Semistructured interviews were conducted with adolescents and clinicians (n=7) to gather experiences and feedback on the feasibility and usability of incorporating smartphone data into treatment. Results: The study showed that adolescents (n=3) succeeded in using Feelee for the full 2 weeks, and data were available for discussion in at least 1 session per participant. Both adolescents and clinicians (n=7) stated that Feelee was valuable for viewing, discussing, and gaining insight into their emotions, which facilitated targeted actions based on the Feelee data. However, neither adolescents nor clinicians reported increased engagement in treatment as a result of using Feelee. Despite technical issues, overall feedback on the Feelee app, in addition to treatment, was positive (n=7). However, further improvements are needed to address the high battery consumption and the inaccuracies in the accelerometer. Conclusions: This qualitative study provides an in-depth understanding of the potential benefits of integrating active and passive smartphone data for adolescents in a forensic outpatient setting. Feelee appears to contribute to a better understanding of emotions and behaviors, suggesting its potential value in enhancing emotional awareness in treatment. Further research is needed to assess Feelee’s clinical effectiveness and explore how it enhances emotional awareness. Recommendations from adolescents and clinicians emphasize the need for prepilot studies to address user issues, guiding technical improvements and future research in forensic outpatient settings. %M 39753211 %R 10.2196/53613 %U https://formative.jmir.org/2024/1/e53613 %U https://doi.org/10.2196/53613 %U http://www.ncbi.nlm.nih.gov/pubmed/39753211 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59333 %T Developing a Mood and Menstrual Tracking App for People With Premenstrual Dysphoric Disorder: User-Centered Design Study %A Apsey,Chloe %A Di Florio,Arianna %A Stawarz,Katarzyna %K premenstrual dysphoric disorder %K menstrual tracking %K mood tracking %K mobile health %K mHealth %K user-centered design %K menstrual %K tracking app %K hormonal fluctuations %K mood monitoring %K menstruation %D 2024 %7 24.12.2024 %9 %J JMIR Form Res %G English %X Background: People with premenstrual dysphoric disorder (PMDD) experience a range of symptoms that increase and decline as a result of the natural hormonal fluctuations of the menstrual cycle. For the diagnosis of PMDD, symptom severity needs to be recorded daily for at least two symptomatic cycles. In recent years, the rise in interest in Femtech (tools and technology developed to address women’s health issues) has resulted in a large quantity of “period-tracking apps” being developed and downloaded. However, there is not currently a menstrual and mood tracking app that has the full capabilities to accurately capture the symptoms of PMDD to aid with diagnosis. Objective: This study aimed to collect feedback and insights from potential users (ie, people with lived experience of PMDD or severe premenstrual syndrome) to inform the development of a prototype app that could support prospective mood monitoring of PMDD symptoms for research, and to support diagnosis. Methods: We conducted two user-centered design studies. Study 1 consisted of 4 interviews with individual participants who had taken part in our previous web-based mood tracking study for PMDD. During the interviews, participants were encouraged to identify the strengths and weaknesses of the existing web-based mood tracking system. Study 2 consisted of 2 workshops with a total of 8 participants, in which participants were asked to discuss the needs and desirable features they would like in a PMDD-specific tracking app. Interviews and workshops were recorded, and the transcripts were analyzed inductively following a thematic approach. Results: A total of four themes were identified from the interviews and workshops with potential users: (1) ease of use as a key consideration for users with PMDD; (2) avoiding a reductionist approach for a broad range of symptoms; (3) recognizing the importance of correct language; and (4) integrating features for the users’ benefits. These suggestions align with the current understanding of the implications of PMDD symptoms on daily activities and with findings from previous research on encouraging long-term engagement with apps. Conclusions: To meet the needs of potential users with PMDD or suspected PMDD, there needs to be a special consideration to how their symptoms impact the way they might interact with the app. In order for users to want to interact with the app daily, particularly during the days where they may not have symptoms to track, the app needs to be simple yet engaging. In addition, if the app provides insights and feedback that can benefit the well-being of the users, it is suggested that this could ensure prolonged use. %R 10.2196/59333 %U https://formative.jmir.org/2024/1/e59333 %U https://doi.org/10.2196/59333 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e47730 %T Targeting Key Risk Factors for Cardiovascular Disease in At-Risk Individuals: Developing a Digital, Personalized, and Real-Time Intervention to Facilitate Smoking Cessation and Physical Activity %A Versluis,Anke %A Penfornis,Kristell M %A van der Burg,Sven A %A Scheltinga,Bouke L %A van Vliet,Milon H M %A Albers,Nele %A Meijer,Eline %+ Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 712568433, E.Meijer@lumc.nl %K smoking %K physical activity %K virtual coach %K eHealth %K development %K collaboration %K conversational agent %K risk factor %K cardiovascular disease %K CVD %K digital %K smoking cessation %K intervention %D 2024 %7 20.12.2024 %9 Viewpoint %J JMIR Cardio %G English %X Health care is under pressure due to an aging population with an increasing prevalence of chronic diseases, including cardiovascular disease. Smoking and physical inactivity are 2 key preventable risk factors for cardiovascular disease. Yet, as with most health behaviors, they are difficult to change. In the interdisciplinary Perfect Fit project, scientists from different fields join forces to develop an evidence-based virtual coach (VC) that supports smokers in quitting smoking and increasing their physical activity. In this Viewpoint paper, intervention content, design, and implementation, as well as lessons learned, are presented to support other research groups working on similar projects. A total of 6 different approaches were used and combined to support the development of the Perfect Fit VC. The approaches used are (1) literature reviews, (2) empirical studies, (3) collaboration with end users, (4) content and technical development sprints, (5) interdisciplinary collaboration, and (6) iterative proof-of-concept implementation. The Perfect Fit intervention integrates evidence-based behavior change techniques with new techniques focused on identity change, big data science, sensor technology, and personalized real-time coaching. Intervention content of the virtual coaching matches the individual needs of the end users. Lessons learned include ways to optimally implement and tailor interactions with the VC (eg, clearly explain why the user is asked for input and tailor the timing and frequency of the intervention components). Concerning the development process, lessons learned include strategies for effective interdisciplinary collaboration and technical development (eg, finding a good balance between end users’ wishes and legal possibilities). The Perfect Fit development process was collaborative, iterative, and challenging at times. Our experiences and lessons learned can inspire and benefit others. Advanced, evidence-based digital interventions, such as Perfect Fit, can contribute to a healthy society while alleviating health care burden. %M 39705698 %R 10.2196/47730 %U https://cardio.jmir.org/2024/1/e47730 %U https://doi.org/10.2196/47730 %U http://www.ncbi.nlm.nih.gov/pubmed/39705698 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59865 %T Development of a Tablet-Based Outpatient Care Application for People With Dementia: Interview and Workshop Study %A Supplieth,Juliana %A Lech,Sonia %A O’Sullivan,Julie Lorraine %A Spang,Robert %A Voigt-Antons,Jan‐Niklas %A Schuster,Johanna %K dementia %K tablet application development %K multidisciplinary health care %K feasibility study %K general practitioners %K digital health care %D 2024 %7 19.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Dementia management presents a significant challenge for individuals affected by dementia, as well as their families, caregivers, and health care providers. Digital applications may support those living with dementia; however only a few dementia-friendly applications exist. Objective: This paper emphasizes the necessity of considering multiple perspectives to ensure the high-quality development of supportive health care applications. The findings underscore the importance of incorporating input from stakeholders and the needs of affected families into application development. Method: A qualitative approach was chosen, consisting of three interviews and an expert workshop. The interviews and the workshop were recorded and transcribed, and qualitative content analysis was carried out according to the methodology described by Kuckartz with the support of MAXQDA. Results: During the development phases of the application, team meetings and discussions took place. We found that general practitioners and family caregivers play pivotal roles in the treatment and care of people with dementia, often expressing specific preferences and suggestions regarding supportive and assistive technologies. Moreover, the successful development of a useful tablet application requires robust scientific and multidisciplinary discussions and teamwork within the health care community. Conclusion: This paper underscores the necessity of including multiple scientific, clinical, and technical perspectives to ensure the high-quality development of supportive health care applications. Furthermore, adopting a spiral development approach inclusive of feedback loops is imperative for iterative refinement and enhancement of the application. International Registered Report Identifier (IRRID): RR2-10.1024/1662-9647/a000210 %R 10.2196/59865 %U https://humanfactors.jmir.org/2024/1/e59865 %U https://doi.org/10.2196/59865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57403 %T Assessing the Feasibility and Acceptability of the Daybreak Drink Tracker: Prospective Observational Study %A Fletcher,Kathryn %A Robert-Hendren,Dominique %K app %K alcohol use %K self-monitoring %K tracker %K digital health %D 2024 %7 18.12.2024 %9 %J JMIR Form Res %G English %X Background: Excessive alcohol use is associated with significant harms, with wide-ranging social and economic impacts. Efforts to prevent and reduce the harmful use of alcohol are a public health priority. Smartphone apps have the potential to provide accessible and cost-effective support to those seeking to reduce alcohol consumption; however, the evidence base regarding which components are effective is lacking. Self-monitoring is considered as one of the most effective components for behavior change across multiple health domains, yet there is mixed evidence for its role in the alcohol use space. An improved understanding of the use, acceptability, and outcomes of smartphone apps and their inherent components is required to determine their potential role in alcohol behavior change. Objective: We investigated the feasibility and acceptability of the Drink Tracker, a novel feature of the commercially available Daybreak (Hello Sunday Morning) app. Methods: The Daybreak app is accessible worldwide via major app stores and is offered free of charge to Australian residents. Individuals (aged over 18 years) registering for Daybreak were invited to access the Drink Tracker to monitor their alcohol consumption as part of an uncontrolled observational prospective study. Feasibility was assessed via uptake and frequency of use of the Drink Tracker. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the Drink Tracker to others. Self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) and psychological distress (Kessler Psychological Distress Scale score) at 3-month follow-up were also measured. Preliminary data collected for the first 4 months (October 2023 to February 2024) of the study were reported, including 3-month follow-up outcomes. Results: Feasibility was demonstrated, with almost 70% (2847/4119) of those registering for Daybreak going on to access the Drink Tracker. Of those accessing the Drink Tracker, 71.1% (n=2024) consented to research, comprising the final participant sample. Frequency of use was high, with over half of participants (1112/2024, 54.9%) using the Drink Tracker more than once, and more than one-third (757/2024, 37.4%) using the Drink Tracker more than 5 times. Of the 30 participants completing a 3-month follow-up, acceptability was high, with 73% (n=22) reporting high satisfaction levels with the Drink Tracker overall, 87% (n=26) indicating it was easy to use and rating a mean score of 7.7 (SD 2.8) out of 10 in terms of likelihood of recommending to others. Significant reductions in alcohol consumption (P<.001) and psychological distress scores (P<.001) were observed at the 3-month follow-up. Conclusions: Our results suggest that the Daybreak Drink Tracker is highly feasible and acceptable in supporting individuals accessing commercially available smartphone apps to change their relationship with alcohol. While positive clinical outcomes were observed, the absence of a control group disallows any conclusions with regard to the efficacy of the Drink Tracker. Further testing via a randomized controlled trial is required. %R 10.2196/57403 %U https://formative.jmir.org/2024/1/e57403 %U https://doi.org/10.2196/57403 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e63316 %T Efficacy of the mHealth App Intellect in Improving Subclinical Obsessive-Compulsive Disorder in University Students: Randomized Controlled Trial With a 4-Week Follow-Up %A Lee Yoon Li,Madeline %A Lee Si Min,Stephanie %A Sündermann,Oliver %+ National University of Singapore, 9 Arts Link, #13-02, Singapore, 117570, Singapore, 65 80435120 ext 5120, psymos@nus.edu.sg %K mobile health app %K self-guided interventions %K obsessive-compulsive disorder %K cognitive behavioral therapy %K maladaptive perfectionism %K randomized controlled trial %K behavioral %K efficacy %K mHealth app %K university students %K Singapore %K symptoms %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obsessive-compulsive disorder (OCD) is the third most prevalent mental health disorder in Singapore, with a high degree of burden and large treatment gaps. Self-guided programs on mobile apps are accessible and affordable interventions, with the potential to address subclinical OCD before symptoms escalate. Objective: This randomized controlled trial aimed to examine the efficacy of a self-guided OCD program on the mobile health (mHealth) app Intellect in improving subclinical OCD and maladaptive perfectionism (MP) as a potential moderator of this predicted relationship. Methods: University students (N=225) were randomly assigned to an 8-day, self-guided app program on OCD (intervention group) or cooperation (active control). Self-reported measures were obtained at baseline, after the program, and at a 4-week follow-up. The primary outcome measure was OCD symptom severity (Obsessive Compulsive Inventory–Revised [OCI-R]). Baseline MP was assessed as a potential moderator. Depression, anxiety, and stress (Depression Anxiety and Stress Scales-21) were controlled for during statistical analyses. Results: The final sample included 192 participants. The intervention group reported significantly lower OCI-R scores compared with the active control group after the intervention (partial eta-squared [ηp2]=0.031; P=.02) and at 4-week follow-up (ηp2=0.021; P=.044). A significant, weak positive correlation was found between MP and OCI-R levels at baseline (r=0.28; P<.001). MP was not found to moderate the relationship between condition and OCI-R scores at postintervention (P=.70) and at 4-week follow-up (P=.88). Conclusions: This study provides evidence that the self-guided OCD program on the Intellect app is effective in reducing subclinical OCD among university students in Singapore. Future studies should include longer follow-up durations and study MP as a moderator in a broader spectrum of OCD symptom severity. Trial Registration: ClinicalTrials.gov NCT06202677; https://clinicaltrials.gov/study/NCT06202677 %M 39680884 %R 10.2196/63316 %U https://mhealth.jmir.org/2024/1/e63316 %U https://doi.org/10.2196/63316 %U http://www.ncbi.nlm.nih.gov/pubmed/39680884 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e63416 %T Web-Based Parent Training With Telephone Coaching Aimed at Treating Child Disruptive Behaviors in a Clinical Setting During the COVID-19 Pandemic: Single-Group Study With 2-Year Follow-Up %A Sourander,Saana %A Westerlund,Minja %A Baumel,Amit %A Hinkka-Yli-Salomäki,Susanna %A Ristkari,Terja %A Kurki,Marjo %A Sourander,Andre %K parent training %K disruptive behavior %K child psychopathology %K child functioning %K behaviors %K behavioral %K coaching %K web-based %K family counseling %K child %K disruptive %K counseling %K training %K parents %K parenting %K telephone %K telehealth %K telemedicine %K pediatrics %K COVID-19 %D 2024 %7 16.12.2024 %9 %J JMIR Pediatr Parent %G English %X Background: There is a lack of studies examining the long-term outcomes of web-based parent training programs implemented in clinical settings during the COVID-19 pandemic. Objective: The aim is to study 2-year outcomes of families with 3‐ to 8-year-old children referred from family counseling centers to the Finnish Strongest Families Smart Website (SFSW), which provides digital parent training with telephone coaching aimed at treating child disruptive behaviors. Methods: Counseling centers in Helsinki identified fifty 3‐ to 8-year-old children with high levels of disruptive behavioral problems. Child psychopathology and functioning as well as parenting styles and parental mental health were collected from parents at baseline; posttreatment; and at 6-, 12-, and 24-month follow-ups. Results: The SFSW program had positive long-term changes in child psychopathology and parenting skills. Improvements in child psychopathology, including Strengths and Difficulties Questionnaire total score (Cohen d=0.47; P<.001), Strengths and Difficulties Questionnaire conduct scores (Cohen d=0.65; P<.001), and Affective Reactivity Index irritability scores (Cohen d=0.52; P<.001), were maintained until the 24-month follow-up. Similarly, changes in parenting skills measured with the Parenting Scale, including overreactivity (Cohen d=0.41; P=.001) and laxness (Cohen d=0.26; P=.02), were maintained until the 24-month follow-up. However, parental hostility changes were not maintained at long-term follow-up (Cohen d=−0.04; P=.70). Conclusions: The study shows that the SFSW parent training program can yield significant long-term benefits. Findings indicate that the benefits of the treatment may vary between different parenting styles, which is important to consider when developing more personalized parenting interventions. %R 10.2196/63416 %U https://pediatrics.jmir.org/2024/1/e63416 %U https://doi.org/10.2196/63416 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e66052 %T Evaluating the Effectiveness and Scalability of the World Health Organization MyopiaEd Digital Intervention: Mixed Methods Study %A Lee,Yeonsu %A Keel,Stuart %A Yoon,Sangchul %+ Department of Medical Humanities and Social Sciences, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2467, littleluke@yuhs.ac %K World Health Organization %K digital intervention %K MyopiaEd %K behavior change %K risk factor %K myopia %K refractive error %K mobile phone %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The rapid rise of myopia worldwide, particularly in East and Southeast Asia, has implied environmental influences beyond genetics. To address this growing public health concern, the World Health Organization and International Telecommunication Union launched the MyopiaEd program. South Korea, with its high rates of myopia and smartphone use, presented a suitable context for implementing and evaluating the MyopiaEd program. Objective: This is the first study to date to evaluate the effectiveness and scalability of the MyopiaEd program in promoting eye health behavior change among parents of children in South Korea. Methods: Parents of children aged 7 and 8 years were recruited through an open-access website with a recruitment notice distributed to public elementary schools in Gwangju Metropolitan City. Beginning in September 2022, parents received 42 SMS text messages from the MyopiaEd program over 6 months. This digital trial used a mixed methods approach combining both quantitative and qualitative data collection. Pre- and postintervention surveys were used to assess changes in parental knowledge and behavior regarding myopia prevention. Additionally, semistructured interviews were conducted to explore participants’ experiences in depth and receive feedback on program design. Prior to the intervention, the MyopiaEd program design and message libraries were adapted for the Korean context following World Health Organization and International Telecommunication Union guidelines. Results: A total of 133 parents participated in this study, including 60 parents whose children had myopia and 73 parents whose children did not. Both groups reported high engagement and satisfaction with the program. Significant increases in knowledge about myopia were observed in both groups (P<.001). While time spent on near-work activities did not change significantly, parents of children with myopia reported increased outdoor time for their children (P=.048). A substantial increase in eye checkups was observed, with 52 (86.7%) out of 60 children with myopia and 50 (68.5%) out of 73 children without myopia receiving eye examinations following the intervention. Qualitative analysis indicated a shift in parents’ attitudes toward outdoor activities, as increased recognition of their benefits prompted positive changes in behavior. However, reducing near-work activities posed challenges due to children’s preference for smartphone use during leisure periods and the demands of after-school academies. The credibility of the institution delivering the program enhanced parental engagement and children’s adoption of healthy behaviors. Messages that corrected common misconceptions about eye health and provided specific behavioral guidance were regarded as impactful elements of the program. Conclusions: This study demonstrates the MyopiaEd program’s potential as a scalable and innovative digital intervention to reduce myopia risk in children. The program’s effectiveness provides support for broader adoption and offers valuable insights to inform future myopia prevention policies. %M 39680893 %R 10.2196/66052 %U https://publichealth.jmir.org/2024/1/e66052 %U https://doi.org/10.2196/66052 %U http://www.ncbi.nlm.nih.gov/pubmed/39680893 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e52340 %T Evaluation of a New Mobile Virtual Reality Setup to Alter Pain Perception: Pilot Development and Usability Study in Healthy Participants %A Knobel,Samuel E J %A Oberson,Raphael %A Räber,Jonas %A Schütz,Narayan %A Egloff,Niklaus %A Botros,Angela %A Gerber,Stephan M %A Nef,Tobias %A Heydrich,Lukas %K immersive virtual reality %K embodiment %K pain management %K chronic pain %K full-body illusion %K cardiovisual illusion %K pain %K virtual reality %K pilot study %K development %K mobile virtual reality %K mobile %K virtual environment %K usability %K heart rate %K mobile phone %D 2024 %7 11.12.2024 %9 %J JMIR Serious Games %G English %X Background: Chronic pain presents a significant treatment challenge, often leading to frustration for both patients and therapists due to the limitations of traditional methods. Research has shown that synchronous visuo-tactile stimulation, as used in the rubber hand experiment, can induce a sense of ownership over a fake body part and reduces pain perception when ownership of the fake body part is reported. The effect of the rubber hand experiment can be extended to the full body, for example, during the full-body illusion, using both visuo-tactile and cardiovisual signals. Objective: This study first aimed to evaluate the usability and accuracy of a novel, mobile virtual reality (VR) setup that displays participants’ heartbeats as a flashing silhouette on a virtual avatar, a technique known as the cardiovisual full-body illusion. The second part of the study investigated the effects of synchronous cardiovisual stimulation on pain perception and ownership in 20 healthy participants as compared with asynchronous stimulation (control condition). Methods: The setup comprised a head-mounted display (HMD) and a heart rate measurement device. A smartphone-based HMD (Samsung Galaxy S8+) was selected for its mobility, and heart rates were measured using smartwatches with photoplethysmography (PPG). The accuracy of 2 smartwatch positions was compared with a 5-point electrocardiogram (ECG) standard in terms of their accuracy (number and percent of missed beats). Each participant underwent two 5-minute sessions of synchronous cardiovisual stimulation and two 5-minute sessions of asynchronous cardiovisual stimulation (total of 4 sessions), followed by pain assessments. Usability, symptoms of cybersickness, and ownership of the virtual body were measured using established questionnaires (System Usability Scale, Simulator Sickness Questionnaire, Ownership Questionnaire). Pain perception was assessed using advanced algometric methods (Algopeg and Somedic algometer). Results: Results demonstrated high usability scores (mean 4.42, SD 0.56; out of 5), indicating ease of use and acceptance, with minimal side effects (mean 1.18, SD 0.46; out of a possible 4 points on the Simulator Sickness Questionnaire). The PPG device showed high heart rate measurement precision, which improved with optimized filtering and peak detection algorithms. However, compared with previous work, no significant effects on body ownership and pain perception were observed between the synchronous and asynchronous conditions. These findings are discussed in the context of existing literature on VR interventions for chronic pain. Conclusions: In conclusion, while the new VR setup showed high usability and minimal side effects, it did not significantly affect ownership or pain perception. This highlights the need for further research to refine VR-based interventions for chronic pain management, considering factors like visual realism and perspective. %R 10.2196/52340 %U https://games.jmir.org/2024/1/e52340 %U https://doi.org/10.2196/52340 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60079 %T Mental Health Care Navigation Tools in Australia: Infoveillance Study %A Woods,Cindy E %A Furst,Mary-Anne %A Dissanayake,Manoj %A Koerner,Jane %A de Miquel,Carlota %A Lukersmith,Sue %A Rosenberg,Sebastian %A Salvador-Carulla,Luis %K digital health %K infoveillance %K mental health %K mental health care %K navigation tools %K Australia %K fragmentation %K digital mental healthcare %K web-based digital resources %K diagnostic screening %K accessibility %K user friendly %D 2024 %7 22.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In response to the well-documented fragmentation within its mental health system, Australia has witnessed recently rapid expansion in the availability of digital mental health care navigation tools. These tools focus on assisting consumers to identify and access appropriate mental health care services, the proliferation of such varied web-based resources risks perpetuating further fragmentation and confusion for consumers. There is a pressing need to systematically assess the characteristics, comprehensiveness, and validity of these navigation tools, especially as demand for digital resources continues to escalate. Objective: This study aims to identify and describe the current landscape of Australian digital mental health care navigation tools, with a focus on assessing their comprehensiveness, identifying potential gaps, and the extent to which they meet the needs of various stakeholders. Methods: A comprehensive infoveillance approach was used to identify Australian digital mental health care navigation tools. This process involved a systematic web-based search complemented by consultations with subject matter experts. Identified navigation tools were independently screened by 2 authors, while data extraction was conducted by 3 authors. Extracted data were mapped to key domains and subdomains relevant to navigation tools. Results: From just a handful in 2020, by February 2024 this study identified 102 mental health care navigation tools across Australia. Primary Health Networks (n=37) and state or territory governments (n=21) were the predominant developers of these tools. While the majority of navigation tools were primarily designed for consumer use, many also included resources for health professionals and caregivers. Notably, no navigation tools were specifically designed for mental health care planners. Nearly all tools (except one) featured directories of mental health care services, although their functionalities varied: 27% (n=27) provided referral information, 20% (n=21) offered geolocated service maps, 12% (n=12) included diagnostic screening capabilities, and 7% (n=7) delineated care pathways. Conclusions: The variability of navigation tools designed to facilitate consumer access to mental health services could paradoxically contribute to further confusion. Despite the significant expansion of digital navigation tools in recent years, substantial gaps and challenges remain. These include inconsistencies in tool formats, resulting in variable information quality and validity; a lack of regularly updated service information, including wait times and availability for new clients; insufficient details on program exclusion criteria; and limited accessibility and user-friendliness. Moreover, the inclusion of self-assessment screening tools is infrequent, further limiting the utility of these resources. To address these limitations, we propose the development of a national directory of mental health navigation tools as a centralized resource, alongside a system to guide users toward the most appropriate tool for their individual needs. Addressing these issues will enhance consumer confidence and contribute to the overall accessibility, reliability, and utility of digital navigation tools in Australia’s mental health system. %R 10.2196/60079 %U https://publichealth.jmir.org/2024/1/e60079 %U https://doi.org/10.2196/60079 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55639 %T Embedding Technology-Assisted Parenting Interventions in Real-World Settings to Empower Parents of Children With Adverse Childhood Experiences: Co-Design Study %A Aldridge,Grace %A Wu,Ling %A Seguin,Joshua Paolo %A Robinson,Jennifer %A Battaglia,Elizabeth %A Olivier,Patrick %A Yap,Marie B H %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, 3800, Australia, 61 3 9905 0723, marie.yap@monash.edu %K co-design %K service design %K intervention %K digital technology %K parenting %K children %K technology %K parenting program %K health care services %K adverse childhood experience %K ACE %K mental disorder %K innovate %K social services %K community health %K evidence-based %K parenting intervention %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adverse childhood experiences are strongly associated with mental disorders in young people. Parenting interventions are available through community health settings and can intervene with adverse childhood experiences that are within a parent’s capacity to modify. Technology can minimize common barriers associated with engaging in face-to-face parenting interventions. However, families experiencing adversity face unique barriers to engaging with technology-assisted parenting interventions. Formative research using co-design methodology to provide a deep contextual understanding of these barriers can help overcome unique barriers and ensure these families can capitalize on the benefits of technology-assisted parenting interventions. Objective: This study aims to innovate the parenting support delivered by a community health and social service with technology by adapting an existing, evidence-based, technology-assisted parenting intervention. Methods: Staff (n=3) participated in dialogues (n=2) and co-design workshops (n=8) exploring needs and preferences for a technology-assisted parenting intervention and iteratively developing a prototype intervention (Parenting Resilient Kids [PaRK]-Lite). Parents (n=3) received PaRK-Lite and participated in qualitative interviews to provide feedback on their experience and PaRK-Lite’s design. Results: PaRK-Lite’s hybrid design leverages simple and familiar modes of technology (podcasts) to deliver intervention content and embeds reflective practice into service provision (microcoaching) to enhance parents’ empowerment and reduce service dependency. A training session, manuals, session plans, and templates were also developed to support the delivery of microcoaching. Feedback data from parents overall indicated that PaRK-Lite met their needs, suggesting that service providers can play a key role in the early phases of service innovation for parents. Conclusions: The co-designed technology-assisted parenting intervention aims to offer both parents and clinicians a novel and engaging resource for intervening with maladaptive parenting, contributing to efforts to respond to childhood adversity and improve child mental health. Future research in the field of human-computer interaction and health service design can consider our findings in creating engaging interventions that have a positive impact on the well-being of children and families. %M 39576676 %R 10.2196/55639 %U https://formative.jmir.org/2024/1/e55639 %U https://doi.org/10.2196/55639 %U http://www.ncbi.nlm.nih.gov/pubmed/39576676 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56553 %T An Educational Digital Tool to Improve the Implementation of Switching to a Biosimilar (Rapid Switch Trainer): Tool Development and Validation Study %A Marras,Carlos %A Labarga,María %A Ginard,Daniel %A Carrascosa,Jose Manuel %A Escudero-Contreras,Alejandro %A Collantes-Estevez,Eduardo %A de Mora,Fernando %A Robles,Tamara %A Romero,Elisa %A Martínez,Rafael %K consumer health information %K treatment switching %K biosimilar pharmaceuticals %K immune-mediated diseases %K education %K qualitative research %K training %K nocebo %K digital tool %K implementation %D 2024 %7 21.11.2024 %9 %J JMIR Form Res %G English %X Background: Switching to biosimilars is an effective and safe practice in treating inflammatory diseases; however, a nocebo effect may arise as a result of the way in which the switch is communicated to a given patient. Objective: We aimed to design a gaming-based digital educational tool (including a discussion algorithm) to support the training of health care professionals in efficiently communicating the switch to biosimilars, minimizing the generation of a nocebo effect and thus serving as an implementation strategy for the recommended switch. Methods: The tool was developed based on interviews and focus group discussions with key stakeholders, both patients and health care professionals. Messages likely to either generate trust or to trigger a nocebo effect were generated on the basis of the interviews and focus group discussions. Results: A total 7 clinicians and 4 nurses specializing in rheumatology, gastroenterology, and dermatology, with balanced levels of responsibility and experience, as well as balance between geographic regions, participated in the structured direct interviews and provided a list of arguments they commonly used, or saw used, to justify the switching, and objections given by the patients they attended. Patients with immune-mediated inflammatory diseases who were taking biologic drugs with (n=4) and without (n=5) experience in switching attended the focus groups and interviews. Major topics of discussion were the reason for the change, the nature of biosimilars, and their quality, safety, efficacy, and cost. Based on these discussions, a list of objections and of potential arguments was produced. Patients and health care professionals rated the arguments for their potential to evoke trust or a nocebo effect. Two sets of arguments, related to savings and sustainability, showed discrepant ratings between patients and health care professionals. Objections and arguments were organized by categories and incorporated into the tool as algorithms. The educators then developed additional arguments (with inadequate answers) to complement the valid ones worked on in the focus groups. The tool was then developed as a collection of clinical situations or vignettes that appear randomly to the user, who then has to choose an argument to counteract the given objections. After each interaction, the tool provides feedback. The tool was further supported by accredited medical training on biosimilars and switching. Conclusions: We have developed a digital training tool to improve communication on switching to biosimilars in the clinic and prevent a nocebo effect based on broad and in-depth experiences of patients and health care professionals. The validation of this implementation strategy is ongoing. %R 10.2196/56553 %U https://formative.jmir.org/2024/1/e56553 %U https://doi.org/10.2196/56553 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e64681 %T Mobile App for Improving the Mental Health of Youth in Out-of-Home Care: Development Study Using an Intervention Mapping Approach %A Park,Jinyoung %A Lee,Jungeun %A Noh,Dabok %+ College of Nursing, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do, 13135, Republic of Korea, 82 31 740 7415, daboknoh@eulji.ac.kr %K out-of-home youth %K mental health intervention %K mobile app %K intervention mapping %K youth %K mental health %K mHealth %K mobile health %K app %K interview %K need %K focus group %K emotion %K emotional %K young adult %K independent living %K emotional support %K tool %K emotion regulation %K user %K app usage %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Youth in out-of-home care encounter substantial mental health challenges because of the absence of stable family and social support systems. Their vulnerability is heightened by trauma, neglect, and abuse. They struggle, especially when transitioning to independent living, coping with loneliness, anxiety, and pressure. Objective: This study aimed to develop a mobile app with high accessibility and long-term continuous effects to support independent living and improve mental health among youth in out-of-home care. The approach used was the systematic and step-by-step intervention mapping (IM) framework. Methods: The program was created using the IM framework and had 6 steps. Drawing from data from individual and focus group interviews and literature reviews, we developed a logical model of the problem. We established program outcomes and objectives, defining performance objectives and variable determinants. We identified theoretical and evidence-based methods that influence determinants. The app design integrated these methods into practical applications, allowing for the creation of self-management and emotional support tools. The development process included ongoing discussions between app designers and the research team to ensure that user needs and preferences were addressed. Results: Individual interviews and focus group discussions revealed challenges in managing daily routines and regulating emotions. The program design was based on the transtheoretical model, social cognitive theory, and elaboration likelihood model. Key features included goal setting, structured routines, emotion recognition flashcards, character models demonstrating emotion regulation strategies, verbal persuasion, and self-monitoring tools to support habit formation and emotion regulation. An implementation plan was developed to facilitate the app’s adoption, execution, and maintenance, while an evaluation plan was established, including app usage analytics, user logs, and feedback surveys. A randomized controlled trial will be conducted to assess the app’s impact on mental health outcomes, focusing on reducing anxiety and depressive symptoms, improving emotion regulation, and enhancing daily living skills. Conclusions: The IM framework was beneficial in developing a mobile app to enhance the mental health of youth in out-of-home care. The study produced a program grounded in theory and evidence that caters to the needs of these individuals. Further research should aim to verify the app’s effectiveness in real-world settings and refine it continuously based on user input. %M 39571152 %R 10.2196/64681 %U https://humanfactors.jmir.org/2024/1/e64681 %U https://doi.org/10.2196/64681 %U http://www.ncbi.nlm.nih.gov/pubmed/39571152 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54679 %T Development and Implementation of an Online Patient Education Program for Children and Adolescents With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Their Parents, Siblings, and School Personnel: Protocol for the Prospective BAYNET FOR ME/CFS Study %A Keicher,Franca %A Thomann,Julia %A Erlenwein,Jana %A Schottdorf,Mara %A Reiter,Nils Lennart %A Scholz-Schwärzler,Nadine Patricia %A Vogel,Barbara %A Warlitz,Cordula %A Stojanov,Silvia %A Augustin,Silvia %A Goldbrunner,Lola %A Schanz,Linda %A Dodel,Veronika %A Zipper,Charlotte %A Schiweck,Nicole %A Jaeschke,Robert %A Saramandic,Milica %A Wiejaczka,Karolina %A Eberhartinger,Maria %A Dettmer,Kristina %A Hattesohl,Daniel Bruno Ricardo %A Englbrecht,Stephanie %A Behrends,Uta %A Spiegler,Juliane %+ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Margarete-Höppel-Platz 1, Würzburg, 97080, Germany, 49 93120127769, Keicher_F1@ukw.de %K patient education %K ME/CFS %K children %K adolescents %K ModuS %K parents %K teachers %K siblings %K training %D 2024 %7 21.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) presents significant challenges for affected children and adolescents, their social environment, and treating physicians, due to its profound impact on quality of life and the lack of causal therapeutic approaches. One crucial aspect of care that has been missing for these patients is comprehensive education for both them and their social circles. Objective: This study protocol aims to outline the goals, study design, execution, and evaluation of the subproject within the BAYNET FOR ME/CFS project. The focus is on developing online education programs for children and adolescents with ME/CFS, as well as for their parents, siblings, and school staff. These programs are designed to improve independent disease management, increase knowledge, and promote interaction with other affected individuals. Methods: In phase I, the group-based online education programs were developed by a multidisciplinary team based on the ModuS concept created by the Competence Network for Patient Education (KomPaS). These programs were then piloted and finalized. Phase II involved recruiting participants and implementing the finalized programs. Given the restricted physical and cognitive capacities of the affected individuals, the patient education programs were exclusively designed in a digital format to facilitate participation. In phase III, the programs will be evaluated for acceptance, completeness, and participant satisfaction. The qualitative assessment will focus on individual expectations and benefits derived from the training. Phase IV will further assess the programs in terms of improvements in disease knowledge, health-related quality of life, life satisfaction, and family burden. Results: The programs were developed, piloted, and finalized during phase I, which ran from December 2022 to May 2023. The pilot phase, from March to May 2023, led to adaptations in the program concept. In total, 8 patients and their parents, 5 siblings, and 59 school staff participated in the piloting. Adjustments were made to the format, content, duration, and schedule to better meet the needs of the affected individuals and their social circles. In phase II, participant recruitment for the patient education program took place from January to July 2023. The study successfully recruited 24 young patients with ME/CFS and their parents, along with 8 siblings and 51 school staff. Two program blocks for patients and parents and 2-3 blocks for siblings and school staff commenced in May 2023 and were completed within the same year. Phase III began after phase II and involves the evaluation of the programs, with the process expected to conclude by the end of 2024. Phase IV, planned for 2025-2026, will involve the rollout of the program to 150 children and their caretakers. This phase will focus on evaluating disease knowledge, health-related quality of life, life satisfaction, and family burden, as well as include longitudinal assessments. Conclusions: The data aim to support the development of a comprehensive, interprofessional care model for children and adolescents with ME/CFS. International Registered Report Identifier (IRRID): DERR1-10.2196/54679 %M 39570662 %R 10.2196/54679 %U https://www.researchprotocols.org/2024/1/e54679 %U https://doi.org/10.2196/54679 %U http://www.ncbi.nlm.nih.gov/pubmed/39570662 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56400 %T Mental Health Monitoring for Young People Through Mood Apps: Protocol for a Scoping Review and Systematic Search in App Stores %A Boege,Selina %A Milne-Ives,Madison %A Ananthakrishnan,Ananya %A Cong,Cen %A Sharma,Aditya %A Anderson,David %A Meinert,Edward %+ Translational and Clinical Research Institute, Newcastle University, Edwardson Building, Newcastle upon Tyne, NE4 5PL, United Kingdom, 44 191 20 83811, edward.meinert@newcastle.ac.uk %K digital health %K mental health %K mood apps %K mobile apps %K mobile phone %D 2024 %7 19.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The researchers have used mobile phones to assist in monitoring, analyzing, and managing moods to acquire insight into mood patterns. There is a lack of evidence in their use as clinical tools and interventions, which necessitates a comprehensive review and quality assessment to understand barriers and facilitators for app implementation as an impactful clinical intervention. Objective: This review aims to (1) provide an overview of the recent evidence on mobile mood-monitoring apps that are intended for facilitating self-management and support of mental health in children, adolescents, and young people; and (2) investigate the quality of publicly available apps. Methods: The study will first involve a scoping review of the literature on mood-monitoring apps for children, adolescents, and young people followed by an evaluation of features of the apps available in the marketplace. The scoping review will follow the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and search 6 databases— Embase, CINAHL, PubMed, ACM Digital Library, Scopus, and Springer LNCS—for relevant studies and reviews published in the last 3 years. The author will then screen the references, extract data from the included studies, and analyze them to synthesize the evidence on mood apps. Next, the Apple App Store and Google Play Store will be searched for mood apps. A total of 2 independent reviewers will screen the apps based on eligibility criteria, and disagreements will be resolved through consensus. The features of the selected apps will then be evaluated using the Mobile Health Index and Navigation framework, and descriptive analysis will be used to synthesize the findings. Results: Literature search and screening began soon after submission of the protocol and is expected to be completed by September 2024. The app evaluation will be completed by October 2024. Conclusions: Combined, the scoping literature review and app evaluation will provide an in-depth overview of the most recent scientific evidence related to mood apps and the quality of apps actually available for use. International Registered Report Identifier (IRRID): PRR1-10.2196/56400 %M 39561357 %R 10.2196/56400 %U https://www.researchprotocols.org/2024/1/e56400 %U https://doi.org/10.2196/56400 %U http://www.ncbi.nlm.nih.gov/pubmed/39561357 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55694 %T Design Guidelines for Improving Mobile Sensing Data Collection: Prospective Mixed Methods Study %A Slade,Christopher %A Benzo,Roberto M %A Washington,Peter %+ Computer Science Department, Brigham Young University—Hawaii, 55-220 Kulanui Street #1919, Laie, HI, 96762, United States, 1 8086753471, christopher.slade@byuh.edu %K mobile health sensing %K mHealth %K active data collection %K passive data collection %K ecological momentary assessment %K mobile data %K mobile phone %K machine learning %K real-world setting %K mixed method %K college %K student %K user data %K data consistency %D 2024 %7 18.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Machine learning models often use passively recorded sensor data streams as inputs to train machine learning models that predict outcomes captured through ecological momentary assessments (EMA). Despite the growth of mobile data collection, challenges in obtaining proper authorization to send notifications, receive background events, and perform background tasks persist. Objective: We investigated challenges faced by mobile sensing apps in real-world settings in order to develop design guidelines. For active data, we compared 2 prompting strategies: setup prompting, where the app requests authorization during its initial run, and contextual prompting, where authorization is requested when an event or notification occurs. Additionally, we evaluated 2 passive data collection paradigms: collection during scheduled background tasks and persistent reminders that trigger passive data collection. We investigated the following research questions (RQs): (RQ1) how do setup prompting and contextual prompting affect scheduled notification delivery and the response rate of notification-initiated EMA? (RQ2) Which authorization paradigm, setup or contextual prompting, is more successful in leading users to grant authorization to receive background events? and (RQ3) Which polling-based method, persistent reminders or scheduled background tasks, completes more background sessions? Methods: We developed mobile sensing apps for iOS and Android devices and tested them through a 30-day user study asking college students (n=145) about their stress levels. Participants responded to a daily EMA question to test active data collection. The sensing apps collected background location events, polled for passive data with persistent reminders, and scheduled background tasks to test passive data collection. Results: For RQ1, setup and contextual prompting yielded no significant difference (ANOVA F1,144=0.0227; P=.88) in EMA compliance, with an average of 23.4 (SD 7.36) out of 30 assessments completed. However, qualitative analysis revealed that contextual prompting on iOS devices resulted in inconsistent notification deliveries. For RQ2, contextual prompting for background events was 55.5% (χ21=4.4; P=.04) more effective in gaining authorization. For RQ3, users demonstrated resistance to installing the persistent reminder, but when installed, the persistent reminder performed 226.5% more background sessions than traditional background tasks. Conclusions: We developed design guidelines for improving mobile sensing on consumer mobile devices based on our qualitative and quantitative results. Our qualitative results demonstrated that contextual prompts on iOS devices resulted in inconsistent notification deliveries, unlike setup prompting on Android devices. We therefore recommend using setup prompting for EMA when possible. We found that contextual prompting is more efficient for authorizing background events. We therefore recommend using contextual prompting for passive sensing. Finally, we conclude that developing a persistent reminder and requiring participants to install it provides an additional way to poll for sensor and user data and could improve data collection to support adaptive interventions powered by machine learning. %R 10.2196/55694 %U https://www.jmir.org/2024/1/e55694 %U https://doi.org/10.2196/55694 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e60049 %T Mobile App for Patients With Chronic Obstructive Pulmonary Diseases During Home-Based Exercise Care: Usability Study %A Chien,Shih-Ying %+ Department of Industrial Design, Chang Gung University, No.259, Wen-Hwa 1st Rd, Kweishan, Taoyuan, Taiwan, R.O.C., Taoyuan, 333, Taiwan, 886 3 2118800 ext 5669, shihying@mail.cgu.edu.tw %K digital health %K chronic obstructive pulmonary disease %K COPD %K usability %K telerehabilitation %K mobile health app %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital health tools have demonstrated promise in the treatment and self-management of chronic diseases while also serving as an important means for reducing the workload of health care professionals (HCPs) and enhancing the quality of care. However, these tools often merely undergo large-scale testing or enter the market without undergoing rigorous user experience analysis in the early stages of their development, leading to frequent instances of low use or failure. Objective: This study aims to assess the usability of and satisfaction with a mobile app designed for the clinical monitoring of patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation at home. Methods: This study used a mixed methods approach involving two key stakeholders—patients with chronic obstructive pulmonary disease and HCPs—across three phases: (1) mobile app mock-up design, (2) usability testing, and (3) satisfaction evaluation. Using convenience sampling, participants were grouped as HCPs (n=12) and patients (n=18). Each received a tablet with mock-ups for usability testing through interviews, with audio recordings transcribed and analyzed anonymously in NVivo12.0, focusing on mock-up features and usability insights. Task difficulty was rated from 1 (very easy) to 5 (very difficult), with noncompletion deemed a critical error. Usability satisfaction was measured on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Results: The research indicated a notable difference in app usability perceptions: 66% (8/12) of HCPs found tasks “very easy,” compared to only 22% (4/18) of patients. Despite this, no participant made critical errors or withdrew, and satisfaction was high. HCPs completed tasks in about 20 minutes, while patients took 30. Older adults faced challenges with touch screens and scroll menus, suggesting the need for intuitive design aids like auditory support and visual health progress indicators, such as graphs. HCPs noted potential data delays affecting service, while non–native-speaking caregivers faced interpretation challenges. A secure pairing system for privacy in teleconsultations proved difficult for older users; a simpler icon-based system is recommended. This study highlights the need to consider stakeholder abilities in medical app design to enhance function implementation. Conclusions: Most HCPs (11/12, 91%) found the app intuitive, though they recommended adding icons to show patient progress to support clinical decisions. In contrast, 62% (11/18) of patients struggled with tablet navigation, especially with connectivity features. To ensure equitable access, the design should accommodate older users with diverse abilities. Despite challenges, both groups reported high satisfaction, with patients expressing a willingness to learn and recommending the app. These positive usability evaluations suggest that, with design improvements, such apps could see increased use in home-based care. %M 39546767 %R 10.2196/60049 %U https://humanfactors.jmir.org/2024/1/e60049 %U https://doi.org/10.2196/60049 %U http://www.ncbi.nlm.nih.gov/pubmed/39546767 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59831 %T Patient and Health Care Professional Perspectives About Referral, Self-Reported Use, and Perceived Importance of Digital Mental Health App Attributes in a Diverse Integrated Health System: Cross-Sectional Survey Study %A Miller,Michael J %A Eberhart,Lindsay G %A Heliste,Jennifer L %A Tripuraneni,Bhaskara R %+ Mid-Atlantic Permanente Research Institute (MAPRI), 700 2nd St NE, 5th Floor, Washington, DC, 20002, United States, 1 202 317 0618, Michael.J1.Miller@kp.org %K digital mental health applications %K DMHA %K mobile health %K mHealth %K mobile phone %K smartphone %K user experience %K engagement %K implementation %K Kaiser Permanente %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health applications (DMHAs) are emerging, novel solutions to address gaps in behavioral health care. Accordingly, Kaiser Permanente Mid-Atlantic States (KPMAS) integrated referrals for 6 unique DMHAs into clinical care in 2019. Objective: This study investigated patient and health care professional (HCP) experiences with DMHA referral; DMHA use; and perceived importance of engagement, functionality, design, and information attributes in real-world practice. Methods: Separate cross-sectional surveys were developed and tested for patients and HCPs. Surveys were administered to KPMAS participants through REDCap (Research Electronic Data Capture), and completed between March 2022 and June 2022. Samples included randomly selected patients who were previously referred to at least 1 DMHA between April 2021 and December 2021 and behavioral health and primary care providers who referred DMHAs between December 2019 and December 2021. Results: Of the 119 patients e-mailed a survey link, 58 (48.7%) completed the survey and 44 (37%) confirmed receiving a DMHA referral. The mean age of the sample was 42.21 (SD 14.08) years (29/44, 66%); 73% (32/44) of the respondents were female, 73% (32/44) of the respondents had at least a 4-year college degree, 41% (18/44) of the respondents were Black or African American, and 39% (17/44) of the respondents were White. Moreover, 27% (12/44) of the respondents screened positive for anxiety symptoms, and 23% (10/44) of the respondents screened positive for depression. Overall, 61% (27/44) of the respondents reported DMHA use for ≤6 months since referral, 36% (16/44) reported use within the past 30 days, and 43% (19/44) of the respondents reported that DMHAs were very or extremely helpful for improving mental and emotional health. The most important patient-reported DMHA attributes by domain were being fun and interesting to use (engagement); ease in learning how to use (functionality); visual appeal (design); and having well-written, goal- and topic-relevant content (information). Of the 60 sampled HCPs, 12 (20%) completed the survey. Mean HCP respondent age was 46 (SD 7.75) years, and 92% (11/12) of the respondents were female. Mean number of years since completing training was 14.3 (SD 9.94) years (10/12, 83%). Of the 12 HCPs, 7 (58%) were physicians and 5 (42%) were nonphysicians. The most important HCP-reported DMHA attributes by domain were personalized settings and content (engagement); ease in learning how to use (functionality); arrangement and size of screen content (design); and having well-written, goal- and topic-relevant content (information). HCPs described “typical patients” referred to DMHAs based on perceived need, technical capability, and common medical conditions, and they provided guidance for successful use. Conclusions: Individual patient needs and preferences should match the most appropriate DMHA. With many DMHA choices, decision support systems are essential to assist patients and HCPs with selecting appropriate DMHAs to optimize uptake and sustained use. %M 39546791 %R 10.2196/59831 %U https://formative.jmir.org/2024/1/e59831 %U https://doi.org/10.2196/59831 %U http://www.ncbi.nlm.nih.gov/pubmed/39546791 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53340 %T Survey of Citizens’ Preferences for Combined Contact Tracing App Features During a Pandemic: Conjoint Analysis %A Bito,Seiji %A Hayashi,Yachie %A Fujita,Takanori %A Takahashi,Ikuo %A Arai,Hiromi %A Yonemura,Shigeto %+ National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 1528602, Japan, 81 334113130, bitoseiji@gmail.com %K digital contact tracing apps %K infectious disease %K conjoint analysis %K user attitudes %K public preferences %K citizen values %K attitude to health %K COVID-19 %K contact tracing %K privacy %K questionnaires %D 2024 %7 14.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, an increased need for novel solutions such as digital contact tracing apps to mitigate virus spread became apparent. These apps have the potential to enhance public health initiatives through timely contact tracing and infection rate reduction. However, public and academic scrutiny has emerged around the adoption and use of these apps due to privacy concerns. Objective: This study aims to investigate public attitudes and preferences for contact tracing apps, specifically in Japan, using conjoint analysis to examine what specifications the public values most in such apps. By offering a nuanced understanding of the values that citizens prioritize, this study can help balance public health benefits and data privacy standards when designing contact tracing apps and serve as reference data for discussions on legal development and social consensus formation in the future. Methods: A cross-sectional, web-based questionnaire survey was conducted to determine how various factors related to the development and integration of infectious disease apps affect the public’s intention to use such apps. Individuals were recruited anonymously by a survey company. All respondents were asked to indicate their preferences for a combination of basic attributes and infectious disease app features for conjoint analysis. The respondents were randomly divided into 2 groups: one responded to a scenario where the government was assumed to be the entity dealing with infectious disease apps (ie, the government cluster), and the other responded to a scenario where a commercial company was assumed to be this entity (ie, the business cluster). Samples of 500 respondents from each randomly selected group were used as target data. Results: For the government cluster, the most important attribute in scenario A was distributor rights (42.557), followed by public benefits (29.458), personal health benefits (22.725), and profit sharing (5.260). For the business cluster, the most important attribute was distributor rights (45.870), followed by public benefits (32.896), personal health benefits (13.994), and profit sharing (7.240). Hence, personal health benefits tend to be more important in encouraging active app use than personal financial benefits. However, the factor that increased motivation for app use the most was the public health benefits of cutting infections by half. Further, concern about the use of personal data collected by the app for any secondary purpose was a negative incentive, which was more significant toward app use compared to the other 3 factors. Conclusions: The findings suggest that potential app users are positively motivated not only by personal health benefits but also by contributing to public health. Thus, a combined approach can be taken to increase app use. %M 39541579 %R 10.2196/53340 %U https://publichealth.jmir.org/2024/1/e53340 %U https://doi.org/10.2196/53340 %U http://www.ncbi.nlm.nih.gov/pubmed/39541579 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55874 %T Development of a Mobile App for Occupational Stress Screening Among Female Workers: Protocol for an Exploratory Sequential Design Study %A Widianti,Dini %A Mahardhika,Zwasta Pribadi %A Modjo,Robiana %+ Faculty of Medicine, YARSI University, Jln Letjend Soeprapto Cempaka Putih, Jakarta Pusat, 10510, Indonesia, 62 21 4246674, dini.widianti@yarsi.ac.id %K mobile app %K study protocol %K occupational stress %K female workers %K stress %K screening %K worker %K app %K safety hazards %K technological innovation %K ergonomic %K psychological hazards %K mobile health %K digital platform %K algorithm %D 2024 %7 14.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Occupational safety hazards include physical, chemical, ergonomic, biological, and psychological hazards. Technological innovation in screening for occupational stress, especially among female workers, is needed to improve their health and productivity. Objective: This research is being conducted to obtain a prediction model of work stress through a questionnaire instrument that includes stressors and symptoms based on the transactional model, as well as measurement of work stress through a mobile app that can be used anywhere. Methods: The research is conducted in 3 stages: qualitative research, quantitative research (cross-sectional), and mobile app development. Data were collected from companies located in Jakarta, Indonesia. The sample was chosen based on purposive sampling. For the quantitative research (n=430), logistic regression analysis was used. Results: We are developing a work stress screening instrument for female workers, which includes stressors and symptoms based on the transactional model, in the form of a digital platform so that female workers can undertake the examination anywhere without interfering with working hours or home duties. This research was funded in January 2024 and qualitative data collection began in February 2024. Quantitative data were obtained in March 2024; the number of respondents in the qualitative stage was 6, and in the quantitative stage it was 430. The work stress screening app is in the development stage and will be launched at the same time as the data collection is performed so we can examine the respondents’ perspectives on the use of the app. Conclusions: This study analyzes the prediction of work stress to help female workers screen for work stress. Workers who are detected as experiencing work stress will be educated using an algorithm programmed in the app. International Registered Report Identifier (IRRID): PRR1-10.2196/55874 %M 39541152 %R 10.2196/55874 %U https://www.researchprotocols.org/2024/1/e55874 %U https://doi.org/10.2196/55874 %U http://www.ncbi.nlm.nih.gov/pubmed/39541152 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59155 %T Collecting Real-Time Patient-Reported Outcome Data During Latent Labor: Feasibility Study of the MyCap Mobile App in Prospective Person-Centered Research %A Kissler,Katherine %A Phillippi,Julia C %A Erickson,Elise %A Holmes,Leah %A Tilden,Ellen %+ College of Nursing, Anschutz Medical Campus, University of Colorado, 13120 E 19th Ave., Mailstop C288, Aurora, CO, 80045, United States, 1 3037244769, katherine.kissler@cuanschutz.edu %K patient-reported outcomes %K survey methods %K smartphone %K labor onset %K prodromal symptoms %K prospective studies %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The growing emphasis on patient experience in medical research has increased the focus on patient-reported outcomes and symptom measures. However, patient-reported outcomes data are subject to recall bias, limiting reliability. Patient-reported data are most valid when reported by patients in real time; however, this type of data is difficult to collect from patients experiencing acute health events such as labor. Mobile technologies such as the MyCap app, integrated with the REDCap (Research Electronic Data Capture) platform, have emerged as tools for collecting patient-generated health data in real time offering potential improvements in data quality and relevance. Objective: This study aimed to evaluate the feasibility of using MyCap for real-time, patient-reported data collection during latent labor. The objective was to assess the usability of MyCap in characterizing patient experiences during this acute health event and to identify any challenges in data collection that could inform future research. Methods: In this descriptive cohort study, we quantified and characterized data collected prospectively through MyCap and the extent to which participants engaged with the app as a research tool for collecting patient-reported data in real time. Longitudinal quantitative and qualitative surveys were sent to (N=18) enrolled patients with term pregnancies planning vaginal birth at Oregon Health Sciences University. Participants were trained in app use prenatally. Then participants were invited to initiate the research survey on their personal smartphone via MyCap when they experienced labor symptoms and were asked to return to MyCap every 3 hours to provide additional longitudinal symptom data. Results: Out of 18 enrolled participants, 17 completed the study. During latent labor, 13 (76.5%) participants (all those who labored at home and two-thirds of those who were induced) recorded at least 1 symptom report during latent labor. A total of 191 quantitative symptom reports (mean of 10 per participant) were recorded. The most commonly reported symptoms were fatigue, contractions, and pain, with nausea and diarrhea being less frequent but more intense. Four participants recorded qualitative data during labor and 14 responded to qualitative prompts in the postpartum period. The study demonstrated that MyCap could effectively capture real-time patient-reported data during latent labor, although qualitative data collection during active symptoms was less robust. Conclusions: MyCap is a feasible tool for collecting prospective data on patient-reported symptoms during latent labor. Participants engaged actively with quantitative symptom reporting, though qualitative data collection was more challenging. The use of MyCap appears to reduce recall bias and facilitate more accurate data collection for patient-reported symptoms during acute health events outside of health care settings. Future research should explore strategies to enhance qualitative data collection and assess the tool’s usability across more diverse populations and disease states. %M 39515816 %R 10.2196/59155 %U https://formative.jmir.org/2024/1/e59155 %U https://doi.org/10.2196/59155 %U http://www.ncbi.nlm.nih.gov/pubmed/39515816 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53299 %T Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study %A Perme,Natalie %A Reid,Endia %A Eluagu,Macdonald Chinwenwa %A Thompson,John %A Hebert,Courtney %A Gabbe,Steven %A Swoboda,Christine Marie %+ The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Suite 4101, 700 Ackerman Rd., Columbus, OH, 43210, United States, 1 13157612701, swoboda.2@osu.edu %K health resources %K pregnancy %K patient engagement %K mHealth %K maternal %K mobile health %K app %K focus group %K landscape analysis %K birth %K preterm %K premature %K mortality %K death %K pediatric %K infant %K neonatal %K design %K development %K obstetric %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app’s intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. %M 39514852 %R 10.2196/53299 %U https://formative.jmir.org/2024/1/e53299 %U https://doi.org/10.2196/53299 %U http://www.ncbi.nlm.nih.gov/pubmed/39514852 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60787 %T Exploration of Features of Mobile Applications for Medication Adherence in Asia: Narrative Review %A Wang,Tzu %A Huang,Yen-Ming %A Chan,Hsun-Yu %+ Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S Rd, Zhongzheng Dist, Taipei City, 100025, Taiwan, 886 33668784, yenming927@ntu.edu.tw %K Asia %K adherence %K application %K feature %K medication %K mobile %D 2024 %7 8.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Medication is crucial for managing chronic diseases, yet adherence rates are often suboptimal. With advanced integration of IT and mobile internet into health care, mobile apps present a substantial opportunity for improving adherence by incorporating personalized educational, behavioral, and organizational strategies. However, determining the most effective features and functionalities for these apps within the specific health care context in Asia remains a challenge. Objective: We aimed to review the existing literature, focusing on Asian countries, to identify the optimal features of mobile apps that can effectively enhance medication adherence within the unique context of Asian societies. Methods: We conducted a narrative review with the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. We identified studies on mobile apps for medication adherence from January 2019 to August 2024 on PubMed and Scopus. Key search terms included “Asia,” “chronic disease,” “app,” “application,” “survey,” “experiment,” “questionnaire,” “group,” “medical adherence,” “medication adherence,” “case-control,” “cohort study,” “randomized controlled trial,” “clinical trial,” “observational study,” “qualitative research,” “mixed methods,” and “analysis,” combined using logical operators “OR” and “AND.” The features of mobile apps identified in the studies were evaluated, compared, and summarized based on their disease focuses, developers, target users, features, usability, and use. Results: The study identified 14 mobile apps designed to enhance medication adherence. Of these, 11 were developed by research teams, while 3 were created by commercial companies or hospitals. All the apps incorporated multiple features to support adherence, with reminders being the most common, present in 11 apps. Patient community forums were the least common, appearing in only 1 app. In total, 6 apps provided lifestyle modification functions, offering dietary and exercise recommendations, generating individualized plans, and monitoring progress. In addition, 6 apps featured health data recording and monitoring functions, with 4 allowing users to export and share records with researchers or health care professionals. Many apps included communication features, with 10 enabling feedback from researchers or health care professionals and 7 offering web-based consultation services. Educational content was available in 8 apps, and 7 used motivation strategies to encourage adherence. Six studies showed that mobile apps improved clinical outcomes, such as blood glucose, lipid, and pressure, while reducing adverse events and boosting physical activities. Twelve studies noted positive humanistic effects, including better medication adherence, quality of life, and user satisfaction. Conclusions: This review has identified key components integrated into mobile apps to support medication adherence. However, the lack of government and corporate involvement in their development limits the generalizability of any individual app. Beyond basic reminder functions, features such as multiuser support, feedback mechanisms, web-based consultations, motivational tools, and socialization features hold significant promise for improving medication adherence. Further pragmatic research is necessary to validate the effectiveness of these selected apps in enhancing adherence. %M 39514859 %R 10.2196/60787 %U https://www.jmir.org/2024/1/e60787 %U https://doi.org/10.2196/60787 %U http://www.ncbi.nlm.nih.gov/pubmed/39514859 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59158 %T A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study %A Straand,Ingjerd J %A Følstad,Asbjørn %A Wünsche,Burkhard C %+ Department of Social Work, University of Stavanger, Kjell Arholms hus, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 93222289, ingjerd.j.straand@uis.no %K web-based intervention %K positive psychology %K mental health %K user experience %K persuasive design %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. Objective: This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Methods: Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. Results: The result of this study is a modular intervention web application named RØST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users’ motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. Conclusions: This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design. %M 39514255 %R 10.2196/59158 %U https://formative.jmir.org/2024/1/e59158 %U https://doi.org/10.2196/59158 %U http://www.ncbi.nlm.nih.gov/pubmed/39514255 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51865 %T Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders %A Lange-Drenth,Lukas %A Schulz,Holger %A Suck,Isabell %A Bleich,Christiane %+ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 07410 56811, l.lange-drenth@uke.de %K telerehabilitation %K rehabilitation %K eHealth development %K value specification %K stakeholder participation %K occupational injuries %K vocational rehabilitation %K aftercare %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. Objective: This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods: We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results: The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients’ lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions: Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries. %M 39514260 %R 10.2196/51865 %U https://formative.jmir.org/2024/1/e51865 %U https://doi.org/10.2196/51865 %U http://www.ncbi.nlm.nih.gov/pubmed/39514260 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59897 %T Exploring the Needs of People With Chronic Low Back Pain and Health Care Professionals for mHealth Devices to Support Self-Managed Physical Activity and Pain: User-Centered Design Approach %A Berger,Mathilde %A Deblock-Bellamy,Anne %A Chèze,Laurence %A Robert,Thomas %A Desrosiers,Julie J %A Christe,Guillaume %A Bertrand,Anne Martine %+ Department of Occupational Therapy, University of Applied Sciences and Arts Western Switzerland (HETSL | HES-SO), Chemin des Abeilles 14, Lausanne, 1010, Switzerland, 41 (0)216510330, mathilde.berger@hetsl.ch %K chronic low back pain %K needs %K self-management %K physical activity %K mobile health %K mHealth %K user-centered design %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Chronic low back pain (CLBP) is a major economic and social problem worldwide. Despite the variety of recommended treatments, long-term self-management of this condition is complex and requires the development of innovative interventions. Mobile health (mHealth) technologies hold great promise for the management of chronic pain, particularly to support physical activity. However, their implementation is challenged by a lack of user compliance and limited engagement, which may be due to insufficient consideration of the needs of potential users during development. Objective: This study aims to explore the needs of people with CLBP and health care professionals regarding mHealth technologies to support self-managed physical activity, and to delineate design recommendations based on identified needs. Methods: A participatory study was conducted using a 3-phase, user-centered design approach: needs investigation with a group of experts in a workshop (phase 1), needs exploration with end users in focus groups (phase 2), and validation of needs using Delphi questionnaires followed by the development of a set of recommendations (phase 3). Results: A total of 121 people with CLBP, expert patients, health care professionals, rehabilitation researchers, and biomechanical engineers participated in this study. The results indicated how technology could help people with CLBP overcome their difficulties with managing physical activity. Specific needs were formulated concerning device objectives, expected strategies, functionalities, technical features, conditions of use, and potential facilitators and barriers to use. These needs were validated by consensus from the potential end users and translated into design recommendations. Conclusions: This study provides design recommendations for the development of an mHealth device specifically adapted for people with CLBP. %M 39509701 %R 10.2196/59897 %U https://humanfactors.jmir.org/2024/1/e59897 %U https://doi.org/10.2196/59897 %U http://www.ncbi.nlm.nih.gov/pubmed/39509701 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55239 %T Initial Evaluation of Acceptability, Engagement, and Effectiveness of the MO App to Provide Tailored and Comprehensive Support for Smoking Cessation: Development and Usability Study %A Zhou,Shuo %A Brunetta,Paul %A Silvasstar,Joshva %A Feldman,Greg %A Oromi,Nicolas %A Bull,Sheana %+ Department of Communication Studies, School of Communication and System Health Lab, Hong Kong Baptist University, 913, No. 5 Hereford Rd, KL, Hong Kong, China (Hong Kong), 852 34118230, shuozhou@hkbu.edu.hk %K smoking cessation %K tobacco %K mobile phone app %K mHealth %K mobile health %K iterative design %K feasibility %K acceptability %K engagement %K efficacy %K mobile phone %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the growing availability of smoking cessation apps, low engagement and cessation rates have remained a significant challenge. To address this issue, we used a user-centered design to iteratively develop a mobile app (MO) to provide comprehensive, tailored, and evidence-based content to support smokers in their quitting journey. Objective: This study examined the acceptability, use, and preliminary efficacy of the MO app for smoking cessation. Specifically, we sought to understand smokers’ preferred features, engagement, and satisfaction with MO; identify concerns in using the app and ways to improve the app; and evaluate its smoking cessation outcomes. Methods: Through 3 cohorts, we recruited 10, 12, and 85 adult smokers who attempted to quit smoking to pilot-test the MO app between December 2019 and July 2022. Participants were instructed to complete a baseline survey, interact with the app for 6 weeks, and fill in a postsurvey at week 6. Participants in cohort 3 completed an additional postsurvey at week 12. Participants’ app use was tracked and analyzed. The primary outcome measures were participants’ 7-day point prevalence abstinence at 6 and 12 weeks. Results: Participants reported high levels of satisfaction with the MO app across all 3 cohorts, rating it between 4.40 and 4.76 on a scale of 5 for acceptability. Users engaged with app activities for an average of 89 to 159 times over 35 days. The most liked features of the app included “quit plan,” “tracking,” “reminders and notifications,” “MOtalks,” and “motivational quotes.” The 7-day point prevalence abstinence rate of the modified intention to treat population in cohort 3 was 58% at 6 weeks and 52% at 12 weeks. Those who interacted more frequently with app features and engaged with more diverse activities were more likely to maintain abstinence at weeks 6 and 12. For each additional time logged into the app, the odds of staying abstinent at week 12 increased by 5% (odds ratio [OR] 1.05, 95% CI 1.01-1.08). Participants who earned >5000 points during app use also had higher odds of quitting at both 6 weeks (OR 3.12, 95% CI 1.25-7.75) and 12 weeks (OR 4.65, 95% CI 1.83-11.76), compared with those who earned <5000 points. Conclusions: Our study demonstrated that MO is a feasible mobile phone app with high acceptability and usability and can effectively deliver smoking cessation support to individuals who want to quit. Implications for developing and evaluating mobile phone apps for smoking cessation are discussed. %M 39471372 %R 10.2196/55239 %U https://mhealth.jmir.org/2024/1/e55239 %U https://doi.org/10.2196/55239 %U http://www.ncbi.nlm.nih.gov/pubmed/39471372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57376 %T Outcomes of a Comprehensive Mobile Vaping Cessation Program in Adults Who Vape Daily: Cohort Study %A Marler,Jennifer D %A Fujii,Craig A %A Utley,MacKenzie T %A Balbierz,Daniel J %A Galanko,Joseph A %A Utley,David S %+ Pivot Health Technologies, Inc, 1010 Commercial St, Suite C, San Carlos, CA, 94070, United States, 1 4082145545, marler@pivot.co %K app %K digital health %K mobile health %K mHealth %K mobile apps %K smartphone %K vaping %K vaping cessation %K mobile phone %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, e-cigarettes, or vapes, are the second most commonly used tobacco product. Despite abundant smartphone app–based cigarette cessation programs, there are few such programs for vaping and even fewer supporting data. Objective: This exploratory, prospective, single-arm, remote cohort study of the Pivot vaping cessation program assessed enrollment and questionnaire completion rates, participant engagement and retention, changes in attitudes toward quitting vaping, changes in vaping behavior, and participant feedback. We aimed to establish early data to inform program improvements and future study design. Methods: American adults aged ≥21 years who vaped daily, reported ≥5 vape sessions per day, and planned to quit vaping within 6 months were recruited on the web. Data were self-reported via app- and web-based questionnaires. Outcomes included engagement and retention (ie, weeks in the program, number of Pivot app openings, and number of messages sent to the coach), vaping attitudes (ie, success in quitting and difficulty staying quit), vaping behavior (ie, quit attempts, Penn State Electronic Cigarette Dependence Index, 7- and 30-day point-prevalence abstinence [PPA], and continuous abstinence [defined as ≥7-day PPA at 12 weeks+30-day PPA at 26 weeks+0 vaping sessions since 12 weeks]), and participant feedback. Results: In total, 73 participants onboarded (intention-to-treat sample); 68 (93%) completed the 12- and 26-week questionnaires (completer samples). On average, participants were active in Pivot for 13.8 (SD 7.3) weeks, had 87.3 (SD 99.9) app sessions, and sent 37.6 (SD 42.3) messages to their coach over 26 weeks. Mean success in quitting and difficulty staying quit (scale of 1-10) improved from baseline to 12 weeks—4.9 (SD 2.9) to 7.0 (SD 3.0) and 4.0 (SD 2.8) to 6.2 (SD 3.1), respectively (P<.001 in both cases). Most participants (64/73, 88%) made ≥1 quit attempt. At 26 weeks, intention-to-treat 7-day PPA, 30-day PPA, and continuous abstinence rates were 48% (35/73), 45% (33/73), and 30% (22/73), respectively. In total, 45% (33/73) of the participants did not achieve 7-day PPA at 26 weeks; their mean Penn State Electronic Cigarette Dependence Index score decreased from baseline (13.9, SD 3.1) to 26 weeks (10.8, SD 4.5; mean change –3.2, SD 3.9; P<.001); 48% (16/33) of these participants improved in the e-cigarette dependence category. At 2 weeks, 72% (51/71) of respondents reported that using Pivot increased their motivation to quit vaping; at 4 weeks, 79% (55/70) reported using Pivot decreased the amount they vaped per day. Conclusions: In this first evaluation of Pivot in adult daily vapers, questionnaire completion rates were >90%, average program engagement duration was approximately 14 weeks, and most participants reported increased motivation to quit vaping. These and early cessation outcomes herein suggest a role for Pivot in vaping cessation and will inform associated future study and program improvements. %M 39331522 %R 10.2196/57376 %U https://formative.jmir.org/2024/1/e57376 %U https://doi.org/10.2196/57376 %U http://www.ncbi.nlm.nih.gov/pubmed/39331522 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53394 %T Co-Designing a Digital App to Support Young People’s Patient and Public Involvement and Engagement (VoiceIn): Development and Usability Study %A Branitsky,Alison %A Bee,Penny %A Bucci,Sandra %A Lovell,Karina %A Foster,Simon %A Whelan,Pauline %K patient and public involvement and engagement %K PPIE %K digital mental health %K young people %K co-design %K mental health %D 2024 %7 24.10.2024 %9 %J JMIR Hum Factors %G English %X Background: While patient and public involvement and engagement (PPIE) is now seen as a cornerstone of mental health research, young people’s involvement in PPIE faces limitations. Work and school demands and more limited independence can make it challenging for young people to engage with PPIE. Lack of ability or desire to attend face-to-face meetings or group discussions can further compound this difficulty. The VoiceIn app and digital platform were codeveloped by a multidisciplinary team of young people, mental health researchers, and software designers, and enables young people to engage directly with PPIE opportunities via a mobile app. Objective: This paper aims to describe how VoiceIn was developed through a series of co-design workshops with relevant stakeholders, specifically (1) how the initial design of VoiceIn was informed and driven by focus groups with young people, mental health professionals, and PPIE leads; (2) how VoiceIn was refined through collaboration with the aforementioned stakeholders; (3) the priorities for an app to support PPIE; (4) the key features necessary in the PPIE app; and (5) the recommended next steps in testing and deploying the digital platform. Methods: Initial co-design workshops took place with young people, mental health professionals, and PPIE leads to identify key features of an app to support PPIE. A series of VoiceIn design prototypes were developed and iterated based on the priorities and preferences of the stakeholders. The MoSCoW (must have, should have, could have, won’t have) prioritization method was used throughout the process to identify priorities across the different stakeholder groups. Results: Co-design with young people, mental health professionals, and PPIE leads supported the successful development and improvement of the VoiceIn app. As a result of this process, key features were identified, including allowing for various modes of providing feedback (eg, polls and comments), reviewing project updates, and expressing interest in categories of research. The researcher platform was developed to support multimedia uploads for project descriptions; a jargon detector; a dedicated section for providing project updates; and a visually appealing, user-friendly design. While all stakeholder groups emphasized the importance of allowing app users to engage with the app in various ways and for there to be ongoing progress updates, group differences were also noticed. Young people expressed a desire for incentives and rewards for engaging with the app (eg, to post on their public social media profiles), and mental health professionals and PPIE leads prioritized flexibility in describing the project and its PPIE needs. Conclusions: A co-design approach was pivotal to the development of the VoiceIn app. This collaborative approach enabled the app to meet the divergent needs of young people, mental health professionals, and PPIE leads. This process mirrored the aspirations of PPIE initiatives by cocreating a digital health research tool with key stakeholders. %R 10.2196/53394 %U https://humanfactors.jmir.org/2024/1/e53394 %U https://doi.org/10.2196/53394 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e63393 %T A Culturally Sensitive Mobile App (DiaFriend) to Improve Self-Care in Patients With Type 2 Diabetes: Development Study %A LeSeure,Peeranuch %A Chin,Elizabeth %A Zhang,Shelley %+ College of Nursing and Health Sciences, University of Massachusetts, 285 Old Westport Road, North Dartmouth, MA, 02747, United States, 1 508 910 6511, pleseure@umassd.edu %K cultural sensitivity %K design thinking %K mobile app %K self-care %K type 2 diabetes %K mobile phone %K app %K design %K diabetes %K development %K prototype %K effectiveness %K user engagement %K blood glucose %K glucose %K weight %K carbohydrate %K exercise %K Portuguese Americans %K ethnic group %D 2024 %7 21.10.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Mobile apps designed with cultural sensitivity have demonstrated higher user acceptability and greater effectiveness in enhancing self-care skills. However, a significant gap exists in developing such apps for specific populations, such as Portuguese Americans living in southern Massachusetts, home to the second-largest Portuguese community in the United States. This group possesses unique cultural traditions, particularly in dietary practices, including a tendency toward high carbohydrate intake. Tailoring diabetes self-care apps to address these specific cultural requirements could substantially improve diabetes management within this population. Objective: The aim of this app development project was to develop a prototype diabetes management app for Portuguese Americans with type 2 diabetes mellitus using the design thinking methodology, incorporating user-centered design principles and cultural sensitivity. This paper describes the phase-2 results, focusing on app design and development. Methods: Phase 2 of this app development project adhered to the design thinking methodology delineated by the Hasso Plattner Institute of Design at Stanford University, focusing on 2 critical steps: ideation and prototyping. This phase started in March 2022 and continued until April 2024. The project was driven by a multidisciplinary team consisting of 2 nurse educators; an app development specialist; and 2 graduate research assistants from the university’s Computer and Information Sciences Department, both well-versed in mobile app development. Data collected during phase 1, which will be published separately, informed the app design and development process. Results: The prototype of the DiaFriend app (version 1) was designed and developed. The app comprises five features: (1) blood glucose monitoring, (2) weight tracking, (3) carbohydrate tracking, (4) exercise log, and (5) medication reminder. The carbohydrate tracking feature was explicitly tailored to correspond to Portuguese food culture. This paper presents the front-end interface flowchart, demonstrating how the user navigates through each screen. It also discusses the challenges faced during the backend development, such as data not being able to be stored and retrieved. Conclusions: The DiaFriend app (version 1) distinguishes itself from conventional diabetes self-care apps through its emphasis on cultural sensitivity. The development of this app underscores the importance of cultural considerations in health informatics. It establishes a foundation for future research in developing and evaluating culturally sensitive mobile health apps. The adaptation of such technologies has the potential to enhance self-care practices among Portuguese Americans with type 2 diabetes mellitus, with improved glycated hemoglobin levels as a potential outcome. The last step of the design thinking methodology, testing the app, will be conducted in phase 3 and the results will be published elsewhere. %M 39432893 %R 10.2196/63393 %U https://diabetes.jmir.org/2024/1/e63393 %U https://doi.org/10.2196/63393 %U http://www.ncbi.nlm.nih.gov/pubmed/39432893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50028 %T Increasing Colorectal Cancer Screening Among Black Men in Virginia: Development of an mHealth Intervention %A Thomson,Maria D %A Shahab,Guleer H %A Cooper-McGill,Chelsey A %A Sheppard,Vanessa B %A Hill,Sherrick S %A Preston,Michael %A Keen II,Larry %+ Department of Social and Behavioral Sciences, Virginia Commonwealth University, 830 E Main Street, Richmond, VA, 23219, United States, 1 8044844910, mthomson2@vcu.edu %K colorectal cancer %K cancer screening %K mHealth %K screening %K Black men %K early detection %K health disparities %K design thinking %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, colorectal cancer (CRC) is the third leading cause of cancer death among Black men. Compared to men of all other races or ethnicities, Black men have the lowest rates of CRC screening participation, which contributes to later-stage diagnoses and greater mortality. Despite CRC screening being a critical component of early detection and increased survival, few interventions have been tailored for Black men. Objective: This study aims to report on the multistep process used to translate formative research including prior experiences implementing a national CRC education program, community advisory, and preliminary survey results into a culturally tailored mobile health (mHealth) intervention. Methods: A theoretically and empirically informed translational science public health intervention was developed using the Behavioral Design Thinking approach. Data to inform how content should be tailored were collected from the empirical literature and a community advisory board of Black men (n=7) and reinforced by the preliminary results of 98 survey respondents. Results: A community advisory board identified changes for delivery that were private, self-paced, and easily accessible and content that addressed medical mistrust, access delays for referrals and appointments, lack of local information, misinformation, and the role of families. Empirical literature and survey results identified the need for local health clinic involvement as critical to screening uptake, leading to a partnership with local Federally Qualified Health Centers to connect participants directly to clinical care. Men surveyed (n=98) who live or work in the study area were an average of 59 (SD 7.9) years old and held high levels of mistrust of health care institutions. In the last 12 months, 25% (24/98) of them did not see a doctor and 16.3% (16/98) of them did not have a regular doctor. Regarding CRC, 27% (26/98) and 38% (37/98) of them had never had a colonoscopy or blood stool test, respectively. Conclusions: Working with a third-party developer, a prototype mHealth app that is downloadable, optimized for iPhone and Android users, and uses familiar sharing, video, and text messaging modalities was created. Guided by our results, we created 4 short videos (1:30-2 min) including a survivor vignette, animated videos about CRC and the type of screening tests, and a message from a community clinic partner. Men also receive tailored feedback and direct navigation to local Federally Qualified Health Center partners including via school-based family clinics. These content and delivery elements of the mHealth intervention were the direct result of the multipronged, theoretically informed approach to translate an existing but generalized CRC knowledge–based intervention into a digital, self-paced, tailored intervention with links to local community clinics. Trial Registration: ClinicalTrials.gov NCT05980182; https://clinicaltrials.gov/study/NCT05980182 %M 39388688 %R 10.2196/50028 %U https://formative.jmir.org/2024/1/e50028 %U https://doi.org/10.2196/50028 %U http://www.ncbi.nlm.nih.gov/pubmed/39388688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57185 %T Complementary App-Based Yoga Home Exercise Therapy for Patients With Axial Spondyloarthritis: Usability Study %A Grube,Lara %A Petit,Pascal %A Vuillerme,Nicolas %A Nitschke,Marlies %A Nwosu,Obioma Bertrand %A Knitza,Johannes %A Krusche,Martin %A Seifer,Ann-Kristin %A Eskofier,Bjoern M %A Schett,Georg %A Morf,Harriet %+ Department of Internal Medicine 3- Rheumatology & Immunology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 091318543023, harriet.morf@uk-erlangen.de %K DTx %K DHA %K usability %K Yoga %K YogiTherapy %K ankylosing spondylitis %K axial spondylarthritis %K digital health application %K eHealth %K self-assessment %K physical exercise %K patient acceptance %K therapy %K home exercise %K exercise %K patients %K patient %K spondyloarthritis %K usability study %K app %K apps %K rheumatic disease %K chronic %K spine %K adjacent joints %K joints %K joint %K correlation analysis %K digital therapeutics %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease characterized by potentially disabling inflammation of the spine and adjacent joints. Regular exercise is a cornerstone of treatment. However, patients with AS currently have little support. YogiTherapy (MaD Lab) is an app developed to support patients with AS by providing instructions for yoga-based home exercise therapy. Objective: This study aimed to evaluate the usability and acceptance of the newly designed YogiTherapy app for patients with AS. Methods: Patients completed the User Version of the Mobile Application Rating Scale (uMARS) and net promoter score (NPS) questionnaires after the app introduction. Wilcoxon Mann-Whitney rank sum test, chi-square test for count data, and correlation analysis were conducted to examine the usability of the app, acceptance, and patient characteristics. Results: A total of 65 patients with AS (33, 51% female; age: mean 43.3, SD 13.6 years) were included in the study from May 2022 to June 2023. Subsequently, the data were analyzed. Usability was rated moderate, with a mean uMARS of 3.35 (SD 0.47) points on a scale from 0 to 5. The highest-rated uMARS dimension was information (mean 3.88, SD 0.63), followed by functionality (mean 3.84, SD 0.87). Females reported a significantly higher uMARS total score than males (mean 3.47, SD 0.48 vs mean 3.23, SD 0.45; P=.03, Vargha and Delaney A [VDA] 0.66, 95% CI 0.53-0.77). The mean average of the NPS was 6.23 (SD 2.64) points (on a scale from 0 to 10), based on 43% (26/65 nonpromoters, 42% (25/65) indifferent, and 15% (9/65) promoters. A total of 7% (5/65) of those surveyed did not answer the question. When applying the NPS formula, the result is –26%. The NPS showed a positive correlation with the usage of mobile apps (r=0.39; P=.02). uMARS functionality was significantly higher rated by patients younger than 41 years (mean 4.17, SD 0.55 vs mean 3.54, SD 1; P<.001; VDA 0.69, 95% CI 0.56-0.80). Patients considering mobile apps as useful reported higher uMARS (r=0.38, P=.02). The uMARS app quality mean score was correlated with the frequency of using apps (r=–0.21, P<.001). Conclusions: The results revealed moderate acceptance and usability ratings, prompting further app improvement. Significant differences were observed between age and gender. Our results emphasize the need for further improvements in YogiTherapy. %M 39298754 %R 10.2196/57185 %U https://formative.jmir.org/2024/1/e57185 %U https://doi.org/10.2196/57185 %U http://www.ncbi.nlm.nih.gov/pubmed/39298754 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56486 %T Nutrition Management Miniprograms in WeChat: Evaluation of Functionality and Quality %A Sun,Hui %A Wu,Yanping %A Sun,Jia %A Zhou,Wu %A Xu,Qian %A Hu,Dandan %K nutrition management %K WeChat mini-program %K User Version of the Mobile Application Rating Scale %K uMARS %K function and quality evaluation %D 2024 %7 12.9.2024 %9 %J JMIR Hum Factors %G English %X Background: With the rise in people’s living standards and aging populations, a heightened emphasis has been placed in the field of medical and health care. In recent years, there has been a drastic increase in nutrition management in domestic research circles. The mobile nutritional health management platform based on WeChat miniprograms has been widely used to promote health and self-management and to monitor individual nutritional health status in China. Nevertheless, there has been a lack of comprehensive scientific evaluation regarding the functionality and quality of the diverse range of nutritional miniprograms that have surfaced in the market. Objective: This study aimed to evaluate the functionality and quality of China’s WeChat nutrition management miniprogram by using the User Version of the Mobile Application Rating Scale (uMARS). Methods: This observational study involves quantitative methods. A keyword search for “nutrition,” “diet,” “food,” and “meal” in Chinese or English was conducted on WeChat, and all miniprograms pertaining to these keywords were thoroughly analyzed. Then, basic information including name, registration date, update date, service type, user scores, and functional scores was extracted from January 2017 to November 2023. Rating scores were provided by users based on their experience and satisfaction with the use of the WeChat miniprogram, and functional scores were integrated and summarized for the primary functions of each miniprogram. Moreover, the quality of nutrition management applets was evaluated by 3 researchers independently using the uMARS. Results: Initially, 27 of 891 miniprograms identified were relevant to nutrition management. Among them, 85.2% (23/27) of them offered features for diet management, facilitating recording of daily dietary intake to evaluate nutritional status; 70.4% (19/27) provided resources for nutrition education and classroom instruction; 59.3% (16/27) included functionalities for exercise management, allowing users to record daily physical activity; and only 44.4% (12/27) featured components for weight management. The total quality score on the uMARS ranged 2.85-3.88 (median 3.38, IQR 3.14-3.57). Engagement scores on the uMARS varied from 2.00 to 4.33 (median 3.00, IQR 2.67-3.67). Functional dimension scores ranged from 3.00 to 4.00 (median 3.33, IQR 3.33-3.67), with a lower score of 2.67 and a higher score of 4.33 outside the reference range. Aesthetic dimension scores ranged from 2.33 to 4.67 (median 3.67, IQR 3.33-4.00). Informational dimension scores ranged from 2.33 to 4.67 (median 3.33, IQR 2.67-3.67). Conclusions: Our findings from the uMARS highlight a predominant emphasis on health aspects over nutritional specifications in the app supporting WeChat miniprograms related to nutrition management. The quality of these miniprograms is currently at an average level, with considerable room for functional improvements in the future. %R 10.2196/56486 %U https://humanfactors.jmir.org/2024/1/e56486 %U https://doi.org/10.2196/56486 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e57406 %T How Patient-Generated Data Enhance Patient-Provider Communication in Chronic Care: Field Study in Design Science Research %A Staehelin,Dario %A Dolata,Mateusz %A Stöckli,Livia %A Schwabe,Gerhard %+ Department of Informatics, University of Zurich, Binzmühlestrasse 14, Zurich, 8050, Switzerland, 41 763103137, dario.staehelin@ost.ch %K patient-provider communication %K patient-generated data %K field study %K chronic care %K design science research %K patient-centered care %K integrated care %K patient-provider collaboration %K mobile phone %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: Modern approaches such as patient-centered care ask health care providers (eg, nurses, physicians, and dietitians) to activate and include patients to participate in their health care. Mobile health (mHealth) is integral in this endeavor to be more patient centric. However, structural and regulatory barriers have hindered its adoption. Existing mHealth apps often fail to activate and engage patients sufficiently. Moreover, such systems seldom integrate well with health care providers’ workflow. Objective: This study investigated how patient-provider communication behaviors change when introducing patient-generated data into patient-provider communication. Methods: We adopted the design science approach to design PatientHub, an integrated digital health system that engages patients and providers in patient-centered care for weight management. PatientHub was developed in 4 iterations and was evaluated in a 3-week field study with 27 patients and 6 physicians. We analyzed 54 video recordings of PatientHub-supported consultations and interviews with patients and physicians. Results: PatientHub introduces patient-generated data into patient-provider communication. We observed 3 emerging behaviors when introducing patient-generated data into consultations. We named these behaviors emotion labeling, expectation decelerating, and decision ping-pong. Our findings show how these behaviors enhance patient-provider communication and facilitate patient-centered care. Introducing patient-generated data leads to behaviors that make consultations more personal, actionable, trustworthy, and equal. Conclusions: The results of this study indicate that patient-generated data facilitate patient-centered care by activating and engaging patients and providers. We propose 3 design principles for patient-centered communication. Patient-centered communication informs the design of future mHealth systems and offers insights into the inner workings of mHealth-supported patient-provider communication in chronic care. %M 39255481 %R 10.2196/57406 %U https://medinform.jmir.org/2024/1/e57406 %U https://doi.org/10.2196/57406 %U http://www.ncbi.nlm.nih.gov/pubmed/39255481 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55790 %T Evaluating the Usability and Quality of a Clinical Mobile App for Assisting Physicians in Head Computed Tomography Scan Ordering: Mixed Methods Study %A Meidani,Zahra %A Omidvar,Aydine %A Akbari,Hossein %A Asghari,Fatemeh %A Khajouei,Reza %A Nazemi,Zahra %A Nabovati,Ehsan %A Holl,Felix %+ Health Information Management Research Center, Kashan University of Medical Sciences, Qotbe Ravandi, Pezeshk Blvd, Kashan, 8715973449, Iran, 98 55589343, nabovati@kaums.ac.ir %K mobile apps %K user-centered design %K user-computer interface %K physicians %K tomography %K x-ray computed %K mobile phone %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Among the numerous factors contributing to health care providers’ engagement with mobile apps, including user characteristics (eg, dexterity, anatomy, and attitude) and mobile features (eg, screen and button size), usability and quality of apps have been introduced as the most influential factors. Objective: This study aims to investigate the usability and quality of the Head Computed Tomography Scan Appropriateness Criteria (HAC) mobile app for physicians’ computed tomography scan ordering. Methods: Our study design was primarily based on methodological triangulation by using mixed methods research involving quantitative and qualitative think-aloud usability testing, quantitative analysis of the Mobile Apps Rating Scale (MARS) for quality assessment, and debriefing across 3 phases. In total, 16 medical interns participated in quality assessment and testing usability characteristics, including efficiency, effectiveness, learnability, errors, and satisfaction with the HAC app. Results: The efficiency and effectiveness of the HAC app were deemed satisfactory, with ratings of 97.8% and 96.9%, respectively. MARS assessment scale indicated the overall favorable quality score of the HAC app (82 out of 100). Scoring 4 MARS subscales, Information (73.37 out of 100) and Engagement (73.48 out of 100) had the lowest scores, while Aesthetics had the highest score (87.86 out of 100). Analysis of the items in each MARS subscale revealed that in the Engagement subscale, the lowest score of the HAC app was “customization” (63.6 out of 100). In the Functionality subscale, the HAC app’s lowest value was “performance” (67.4 out of 100). Qualitative think-aloud usability testing of the HAC app found notable usability issues grouped into 8 main categories: lack of finger-friendly touch targets, poor search capabilities, input problems, inefficient data presentation and information control, unclear control and confirmation, lack of predictive capabilities, poor assistance and support, and unclear navigation logic. Conclusions: Evaluating the quality and usability of mobile apps using a mixed methods approach provides valuable information about their functionality and disadvantages. It is highly recommended to embrace a more holistic and mixed methods strategy when evaluating mobile apps, because results from a single method imperfectly reflect trustworthy and reliable information regarding the usability and quality of apps. %M 39250788 %R 10.2196/55790 %U https://humanfactors.jmir.org/2024/1/e55790 %U https://doi.org/10.2196/55790 %U http://www.ncbi.nlm.nih.gov/pubmed/39250788 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54356 %T Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial %A Dieter,Valerie %A Janssen,Pia %A Krauss,Inga %+ Department of Sports Medicine, Medical Clinic, University Hospital Tübingen, Hoppe-Seyler-Str. 6, Tübingen, 72076, Germany, 49 7071 2986477, valerie.dieter@med.uni-tuebingen.de %K digital app %K mobile health %K mHealth %K knee osteoarthritis %K exercise %K knee brace %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply. Objective: This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis. Methods: This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately. Results: A total of 61 participants were included (IG: n=30, 49%; CG: n=31, 51%; male: n=31, 51%; female: n=30, 49%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m2). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5% (899/972) of all scheduled exercise sessions. Conclusions: Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-based exercise intervention with or without an additional knee brace experienced clinically meaningful treatment effects regarding pain relief and improvements in physical function as well as other osteoarthritis-specific concerns compared to controls. Trial Registration: German Clinical Trials Register (DRKS) DRKS00023269; https://drks.de/search/de/trial/DRKS00023269 %M 39250181 %R 10.2196/54356 %U https://mhealth.jmir.org/2024/1/e54356 %U https://doi.org/10.2196/54356 %U http://www.ncbi.nlm.nih.gov/pubmed/39250181 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59963 %T Development of an mHealth App by Experts for Queer Individuals’ Sexual-Reproductive Health Care Services and Needs: Nominal Group Technique Study %A Seretlo,Raikane James %A Smuts,Hanlie %A Mokgatle,Mathildah Mpata %+ Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa, Tshwane, 0208, South Africa, 27 012 521 4111, Raikane.seretlo@smu.ac.za %K experts %K mobile health app %K mHealth app %K digital health care %K telemedicine %K digital innovation %K sexual-reproductive health care services and needs %K lesbian, gay, bisexual, transgender, queer, intersex, asexual individuals, and related identities %K LBQTQIA+ %K queer individuals %K nominal group technique %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Queer individuals continue to be marginalized in South Africa; they experience various health care challenges (eg, stigma, discrimination, prejudice, harassment, and humiliation), mental health issues (eg, suicide and depression), and an increased spread of HIV or AIDS and sexually transmitted illnesses (STIs; chlamydia, gonorrhea, and syphilis). Mobile health (mHealth) apps have the potential to resolve the health care deficits experienced by health care providers when managing queer individuals and by queer individuals when accessing sexual-reproductive health care services and needs, thus ensuring inclusivity and the promotion of health and well-being. Studies have proven that the nominal group technique (NGT) could be used to solve different social and health problems and develop innovative solutions. This technique ensures that different voices are represented during decision-making processes and leads to robust results. Objective: This study aims to identify important contents to include in the development of an mHealth app for addressing the sexual-reproductive health care services and needs of queer individuals. Methods: We invited a group of 13 experts from different fields, such as researchers, queer activists, sexual and reproductive health experts, private practicing health care providers, innovators, and private health care stakeholders, to take part in a face-to-face NGT. The NGT was conducted in the form of a workshop with 1 moderator, 2 research assistants, and 1 principal investigator. The workshop lasted approximately 2 hours 46 minutes and 55 seconds. We followed and applied 5 NGT steps in the workshop for experts to reach consensus. The main question that experts were expected to answer was as follows: Which content should be included in the mHealth app for addressing sexual-reproductive health care services and needs for queer individuals? This question was guided by user demographics and background, health education and information, privacy and security, accessibility and inclusivity, functionality and menu options, personalization and user engagement, service integration and partnerships, feedback and improvement, cultural sensitivity and ethical considerations, legal and regulatory compliance, and connectivity and data use. Results: Overall, experts voted and ranked the following main icons: menu options (66 points), privacy and security (39 points), user engagement (27 points), information hub (26 points), user demographics (20 points), connectivity (16 points), service integration and partnerships (10 points), functionalities (10 points), and accessibility and inclusivity (7 points). Conclusions: Conducting an NGT with experts from different fields, possessing vast skill sets, knowledge, and expertise, enabled us to obtain targeted data on the development of an mHealth app to address sexual-reproductive health care services and needs for queer individuals. This approach emphasized the usefulness of a multidisciplinary perspective to inform the development of our mHealth app and demonstrated the future need for continuity in using this approach for other digital health care innovations and interventions. %M 39167434 %R 10.2196/59963 %U https://formative.jmir.org/2024/1/e59963 %U https://doi.org/10.2196/59963 %U http://www.ncbi.nlm.nih.gov/pubmed/39167434 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56921 %T Examining the Light Heart Mobile Device App for Assessing Human Pulse Interval and Heart Rate Variability: Validation Study %A Klassen,Stephen A %A Jabbar,Jesica %A Osborne,Jenna %A Iannarelli,Nathaniel J %A Kirby,Emerson S %A O'Leary,Deborah D %A Locke,Sean %+ Faculty of Applied Health Sciences, Brock University, 1812 Sir Issac Brock Way, St. Catharines, ON, L2S 3A1, Canada, 1 9056885550, slocke@brocku.ca %K pulse interval %K mobile app %K validation %K mHealth %K mHealth app %K app mobile device %K mobile device app %K pulse %K heart %K heart rate %K validation study %K biomarker %K psychological %K physiological %K pulse rate %K young adults %K youth %K linear correlation %K heart rate variability %K examining %K examine %K validity %K psychological health %K physiological health %K interval data %K mobile phone %D 2024 %7 20.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Pulse interval is a biomarker of psychological and physiological health. Pulse interval can now be assessed using mobile phone apps, which expands researchers’ ability to assess pulse interval in the real world. Prior to implementation, measurement accuracy should be established. Objective: This investigation evaluated the validity of the Light Heart mobile app to measure pulse interval and pulse rate variability in healthy young adults. Methods: Validity was assessed by comparing the pulse interval and SD of normal pulse intervals obtained by Light Heart to the gold standard, electrocardiogram (ECG), in 14 young healthy individuals (mean age 24, SD 5 years; n=9, 64% female) in a seated posture. Results: Mean pulse interval (Light Heart: 859, SD 113 ms; ECG: 857, SD 112 ms) demonstrated a strong positive linear correlation (r=0.99; P<.001) and strong agreement (intraclass correlation coefficient=1.00, 95% CI 0.99-1.00) between techniques. The Bland-Altman plot demonstrated good agreement for the mean pulse interval measured with Light Heart and ECG with evidence of fixed bias (–1.56, SD 1.86; 95% CI –5.2 to 2.1 ms), suggesting that Light Heart overestimates pulse interval by a small margin. When Bland-Altman plots were constructed for each participant’s beat-by-beat pulse interval data, all participants demonstrated strong agreement between Light Heart and ECG with no evidence of fixed bias between measures. Heart rate variability, assessed by SD of normal pulse intervals, demonstrated strong agreement between techniques (Light Heart: mean 73, SD 23 ms; ECG: mean 73, SD 22 ms; r=0.99; P<.001; intraclass correlation coefficient=0.99, 95% CI 0.97-1.00). Conclusions: This study provides evidence to suggest that the Light Heart mobile app provides valid measures of pulse interval and heart rate variability in healthy young adults. %M 39163099 %R 10.2196/56921 %U https://formative.jmir.org/2024/1/e56921 %U https://doi.org/10.2196/56921 %U http://www.ncbi.nlm.nih.gov/pubmed/39163099 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57600 %T Assessment of Sexual Violence Risk Perception in Men Who Have Sex With Men: Proposal for the Development and Validation of “G-Date” %A Angelone,D J %A Mitchell,Damon %A Wells,Brooke %A Korovich,Megan %A Nicoletti,Alexandra %A Fife,Dustin %+ Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 856 256 4500 ext 53780, angeloned@rowan.edu %K sexual violence %K risk perception %K laboratory analog %K dating and sexual networking apps %K men who have sex with men %D 2024 %7 19.8.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Sexual violence (SV) is a significant problem for sexual minorities, including men who have sex with men (MSM). The limited research suggests SV is associated with a host of syndemic conditions. These factors tend to cluster and interact to worsen one another. Unfortunately, while much work has been conducted to examine these factors in heterosexual women, there is a lack of research examining MSM, especially their SV risk perception. Further, MSM are active users of dating and sexual networking (DSN) mobile apps, and this technology has demonstrated usefulness for creating safe spaces for MSM to meet and engage partners. However, mounting data demonstrate that DSN app use is associated with an increased risk for SV, especially given the higher likelihood of using alcohol and other drugs before sex. By contrast, some researchers have demonstrated that DSN technology can be harnessed as a prevention tool for HIV; unfortunately, no such work has progressed regarding SV. Objective: This study aims to (1) use qualitative and quantitative methods to tailor an existing laboratory paradigm of SV risk perception in women for MSM using a DSN mobile app framework and (2) subject this novel paradigm to a rigorous validation study to confirm its usefulness in predicting SV, with the potential for use in future prevention endeavors. Methods: To tailor the paradigm for MSM, a team of computer scientists created an initial DSN app (G-Date) and incorporated ongoing feedback about the usability, feasibility, and realism of this tool from a representative sample of MSM. We used focus groups and interviews to assist in the development of G-Date, including by identifying relevant stimuli, developing the cover story, and establishing the appropriate study language. To confirm the paradigm’s usefulness, we are conducting an experimental study with web-based and face-to-face participants to determine the content, concurrent, and predictive validities of G-Date. We will evaluate whether certain correlates of SV informed by syndemics and minority stress theories (eg, history of SV and alcohol and drug use) affect the ability of MSM to detect SV risk within G-Date and how paradigm engagement influences behavior in actual DSN app use contexts. Results: This study received funding from the National Institute on Alcohol Abuse and Alcoholism on September 10, 2020, and ethics approval on October 19, 2020, and we began app development for aim 1 immediately thereafter. We began data collection for the aim 2 validation study in December 2022. Initial results from the validation study are expected to be available after December 2025. Conclusions: We hope that G-Date will enhance our understanding of factors associated with SV risk and serve as a useful step in creating prevention programs for this susceptible population. %M 39159453 %R 10.2196/57600 %U https://www.researchprotocols.org/2024/1/e57600 %U https://doi.org/10.2196/57600 %U http://www.ncbi.nlm.nih.gov/pubmed/39159453 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56505 %T Co-Designing a Smoking Cessation Chatbot: Focus Group Study of End Users and Smoking Cessation Professionals %A Bendotti,Hollie %A Lawler,Sheleigh %A Ireland,David %A Gartner,Coral %A Marshall,Henry M %+ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, L5 Clinical Sciences Building, The Prince Charles Hospital, 627 Rode Road, Brisbane, 4032, Australia, 61 7 3139 4110, h.bendotti@uq.edu.au %K artificial intelligence %K chatbot %K smoking cessation %K behavior change %K smoking %K mobile health %K apps %K digital interventions %K smartphone %K mobile phone %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Our prototype smoking cessation chatbot, Quin, provides evidence-based, personalized support delivered via a smartphone app to help people quit smoking. We developed Quin using a multiphase program of co-design research, part of which included focus group evaluation of Quin among stakeholders prior to clinical testing. Objective: This study aimed to gather and compare feedback on the user experience of the Quin prototype from end users and smoking cessation professionals (SCPs) via a beta testing process to inform ongoing chatbot iterations and refinements. Methods: Following active and passive recruitment, we conducted web-based focus groups with SCPs and end users from Queensland, Australia. Participants tested the app for 1-2 weeks prior to focus group discussion and could also log conversation feedback within the app. Focus groups of SCPs were completed first to review the breadth and accuracy of information, and feedback was prioritized and implemented as major updates using Agile processes prior to end user focus groups. We categorized logged in-app feedback using content analysis and thematically analyzed focus group transcripts. Results: In total, 6 focus groups were completed between August 2022 and June 2023; 3 for SCPs (n=9 participants) and 3 for end users (n=7 participants). Four SCPs had previously smoked, and most end users currently smoked cigarettes (n=5), and 2 had quit smoking. The mean duration of focus groups was 58 (SD 10.9; range 46-74) minutes. We identified four major themes from focus group feedback: (1) conversation design, (2) functionality, (3) relationality and anthropomorphism, and (4) role as a smoking cessation support tool. In response to SCPs’ feedback, we made two major updates to Quin between cohorts: (1) improvements to conversation flow and (2) addition of the “Moments of Crisis” conversation tree. Participant feedback also informed 17 recommendations for future smoking cessation chatbot developments. Conclusions: Feedback from end users and SCPs highlighted the importance of chatbot functionality, as this underpinned Quin’s conversation design and relationality. The ready accessibility of accurate cessation information and impartial support that Quin provided was recognized as a key benefit for end users, the latter of which contributed to a feeling of accountability to the chatbot. Findings will inform the ongoing development of a mature prototype for clinical testing. %M 39159451 %R 10.2196/56505 %U https://humanfactors.jmir.org/2024/1/e56505 %U https://doi.org/10.2196/56505 %U http://www.ncbi.nlm.nih.gov/pubmed/39159451 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e52166 %T A Novel Approach for Improving Gait Speed Estimation Using a Single Inertial Measurement Unit Embedded in a Smartphone: Validity and Reliability Study %A Lee,Pei-An %A Yu,Wanting %A Zhou,Junhong %A Tsai,Timothy %A Manor,Brad %A Lo,On-Yee %K smartphone app %K gait speed %K dual-task walking %K validity %K reliability %K mobile phone %D 2024 %7 13.8.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Gait speed is a valuable biomarker for mobility and overall health assessment. Existing methods to measure gait speed require expensive equipment or personnel assistance, limiting their use in unsupervised, daily-life conditions. The availability of smartphones equipped with a single inertial measurement unit (IMU) presents a viable and convenient method for measuring gait speed outside of laboratory and clinical settings. Previous works have used the inverted pendulum model to estimate gait speed using a non–smartphone-based IMU attached to the trunk. However, it is unclear whether and how this approach can estimate gait speed using the IMU embedded in a smartphone while being carried in a pants pocket during walking, especially under various walking conditions. Objective: This study aimed to validate and test the reliability of a smartphone IMU–based gait speed measurement placed in the user’s front pants pocket in both healthy young and older adults while walking quietly (ie, normal walking) and walking while conducting a cognitive task (ie, dual-task walking). Methods: A custom-developed smartphone application (app) was used to record gait data from 12 young adults and 12 older adults during normal and dual-task walking. The validity and reliability of gait speed and step length estimations from the smartphone were compared with the gold standard GAITRite mat. A coefficient-based adjustment based upon a coefficient relative to the original estimation of step length was applied to improve the accuracy of gait speed estimation. The magnitude of error (ie, bias and limits of agreement) between the gait data from the smartphone and the GAITRite mat was calculated for each stride. The Passing-Bablok orthogonal regression model was used to provide agreement (ie, slopes and intercepts) between the smartphone and the GAITRite mat. Results: The gait speed measured by the smartphone was valid when compared to the GAITRite mat. The original limits of agreement were 0.50 m/s (an ideal value of 0 m/s), and the orthogonal regression analysis indicated a slope of 1.68 (an ideal value of 1) and an intercept of −0.70 (an ideal value of 0). After adjustment, the accuracy of the smartphone-derived gait speed estimation improved, with limits of agreement reduced to 0.34 m/s. The adjusted slope improved to 1.00, with an intercept of 0.03. The test-retest reliability of smartphone-derived gait speed was good to excellent within supervised laboratory settings and unsupervised home conditions. The adjustment coefficients were applicable to a wide range of step lengths and gait speeds. Conclusions: The inverted pendulum approach is a valid and reliable method for estimating gait speed from a smartphone IMU placed in the pockets of younger and older adults. Adjusting step length by a coefficient derived from the original estimation of step length successfully removed bias and improved the accuracy of gait speed estimation. This novel method has potential applications in various settings and populations, though fine-tuning may be necessary for specific data sets. %R 10.2196/52166 %U https://mhealth.jmir.org/2024/1/e52166 %U https://doi.org/10.2196/52166 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56250 %T Adaptation of a Theory-Based Mobile App to Improve Access to HIV Prevention Services for Transgender Women in Malaysia: Focus Group Study %A Gautam,Kamal %A Shrestha,Roman %A Dlamini,Sihlelelwe %A Razali,Belle %A Paudel,Kiran %A Azwa,Iskandar %A Saifi,Rumana %A Toh,YuHang %A Justin Lim,Hazriq %A Sutherland,Ryan %A Restar,Arjee %A Phanuphak,Nittaya %A Wickersham,Jeffrey A %+ Department of Internal Medicine, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06511, United States, 1 2037374158, jeffrey.wickersham@yale.edu %K HIV %K AIDS %K pre-exposure prophylaxis %K PrEP %K mobile health %K mHealth %K transgender women %K Malaysia %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Globally, transgender women have been disproportionately affected by the HIV epidemic, including in Malaysia, where an estimated 11% of transgender women are living with HIV. Available interventions designed specifically to meet transgender women’s needs for HIV prevention are limited. Mobile health, particularly smartphone mobile apps, is an innovative and cost-effective strategy for reaching transgender women and delivering interventions to reduce HIV vulnerability. Objective: This study aims to adapt a theory-based mobile health HIV prevention smartphone app, HealthMindr, to meet the unique needs of transgender women in Malaysia. We conducted theater testing of the HealthMindr app with transgender women and key stakeholders and explored barriers to transgender women’s uptake of HIV pre-exposure prophylaxis (PrEP). Methods: From February to April 2022, a total of 6 focus group (FG) sessions were conducted with 29 participants: 4 FG sessions with transgender women (n=18, 62%) and 2 FG sessions with stakeholders (n=11, 38%) providing HIV prevention services to transgender women in Malaysia. Barriers to PrEP uptake and gender-affirming care services among transgender women in Malaysia were explored. Participants were then introduced to the HealthMindr app and provided a comprehensive tour of the app’s features and functions. Participants provided feedback on the app and on how existing features should be adapted to meet the needs of transgender women, as well as any features that should be removed or added. Each FG was digitally recorded and transcribed. Transcripts were coded inductively using Dedoose software (version 9.0.54; SocioCultural Research Consultants, LLC) and analyzed to identify and interpret emerging themes. Results: Six subthemes related to PrEP barriers were found: stigma and discrimination, limited PrEP knowledge, high PrEP cost, accessibility concerns, alternative prevention methods, and perceived adverse effects. Participants suggested several recommendations regarding the attributes and app features that would be the most useful for transgender women in Malaysia. Adaptation and refinement of the app were related to the attributes of the app (user interface, security, customizable colors, themes, and avatars), feedback, and requests for additional mobile app functional (appointment booking, e-consultation, e-pharmacy, medicine tracker, mood tracker, resources, and service site locator) and communication (peer support group, live chat, and discussion forum) features. Conclusions: The results reveal that multifaceted barriers hinder PrEP uptake and use among transgender women in Malaysia. The findings also provide detailed recommendations for successfully adapting the HealthMindr app to the context of Malaysian transgender women, with a potential solution for delivering tailored HIV prevention, including PrEP, and increasing accessibility to gender-affirming care services. %M 39137407 %R 10.2196/56250 %U https://formative.jmir.org/2024/1/e56250 %U https://doi.org/10.2196/56250 %U http://www.ncbi.nlm.nih.gov/pubmed/39137407 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 5 %N %P e48213 %T Development of a Digital Platform to Promote Mother and Child Health in Underserved Areas of a Lower-Middle-Income Country: Mixed Methods Formative Study %A Haq,Zaeem Ul %A Naeem,Ayesha %A Zaeem,Durayya %A Sohail,Mohina %A Pervaiz,Noor ul Ain %K primary health care %K mother and child health %K community health worker %K slums %K digital applications %K health communication. %D 2024 %7 31.7.2024 %9 %J JMIRx Med %G English %X Background: Primary health care (PHC) is the backbone of universal health coverage, with community health workers (CHWs) being one of its critical pillars in lower-middle-income countries. Most CHW functions require them to be an efficient communicator, but their program development has been deficient in this area. Can IT provide some solutions? Moreover, can some IT-based CHW-delivered innovations help mothers and children in areas not covered by PHC services? We explored these questions during the development and feasibility testing of a digital application designed to improve the communication capacity of CHWs in two underserved areas of Islamabad. Objective: This study aims to explore the perceptions, practices, and related gaps about mother and child health, and child development in an underserved area; develop and deploy a behavior change communication program to address the gaps; and assess the feasibility of the program. Methods: We carried out a mixed methods study with three steps. First, we conducted 13 in-depth interviews and two focus group discussions with stakeholders to explore the issues faced by mothers living in these underserved areas. To address these barriers, we developed Sehat Ghar, a video-based health education application to demonstrate practices mothers and families needed to adopt. Second, we trained 10 volunteer CHWs from the same community to deliver health education using the application and assessed their pre-post knowledge and skills. Third, these CHWs visited pregnant and lactating mothers in the community with random observation of their work by a supporting supervisor. Results: Initial exploration revealed a need for health-related knowledge among mothers and suboptimal utilization of public health care. Sehat Ghar used behavior change techniques, including knowledge transfer, enhancing mothers’ self-efficacy, and improving family involvement in mother and child care. Volunteer CHWs were identified from the community, who after the training, showed a significant improvement in mean knowledge score (before: mean 8.00, SD 1.49; after: mean 11.40, SD 1.43; P<.001) about health. During supportive supervision, these CHWs were rated as excellent in their interaction with mothers and excellent or very good in using the application. The CHW and her community reported their satisfaction with the application and wanted its delivery regularly. Conclusions: Sehat Ghar is a simple, easy-to-use digital application for CHWs and is acceptable to the community. Mothers appreciate the content and presentation and are ready to incorporate its messages into their daily practices. The real-world effectiveness of the innovation tested on 250 mother-infant pairs will be important for its proof of effectiveness. With its usefulness and adaptability, and the rapidly spreading use of mobile phones and internet technology, this cost-effective innovation can help in delivering health communications at a large scale in a minimum amount of time. %R 10.2196/48213 %U https://xmed.jmir.org/2024/1/e48213 %U https://doi.org/10.2196/48213 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e51491 %T Development of a Novel Mobile Health App to Empower Young People With Type 1 Diabetes to Exercise Safely: Co-Design Approach %A Shetty,Vinutha B %A Fried,Leanne %A Roby,Heather C %A Soon,Wayne H K %A Nguyen,Rebecca %A Ong,Arthur %A Jaimangal,Mohinder %A Francis,Jacinta %A Paramalingam,Nirubasini %A Cross,Donna %A Davis,Elizabeth %+ Department of Endocrinology and Diabetes, Perth Children's Hospital, Telethon Kids Institute, University of Western Australia, Division of Paediatrics, Medical School, 15 Hospital Avenue, Nedlands, Perth City, 6009, Australia, 61 428325867, vinutha.shetty@health.wa.gov.au %K Mobile health application %K Exercise %K fitness %K physical activity %K design %K co-design %K focus group %K focus groups %K acT1ve %K Type 1 diabetes %K Young people %K Blood glucose level %K diabetic %K diabetes %K young %K youth %K type 1 %K prototype %K develop %K development %K mHealth %K mobile health %K app %K apps %K applications %K applications %K user-centered design %K mobile phone %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Blood glucose management around exercise is challenging for youth with type 1 diabetes (T1D). Previous research has indicated interventions including decision-support aids to better support youth to effectively contextualize blood glucose results and take appropriate action to optimize glucose levels during and after exercise. Mobile health (mHealth) apps help deliver health behavior interventions to youth with T1D, given the use of technology for glucose monitoring, insulin dosing, and carbohydrate counting. Objective: We aimed to develop a novel prototype mHealth app to support exercise management among youth with T1D, detail the application of a co-design process and design thinking principles to inform app design and development, and identify app content and functionality that youth with T1D need to meet their physical activity goals. Methods: A co-design approach with a user-centered design thinking framework was used to develop a prototype mHealth app “acT1ve” during the 18-month design process (March 2018 to September 2019). To better understand and respond to the challenges among youth with diabetes when physically active, 10 focus groups were conducted with youth aged 13-25 years with T1D and parents of youth with T1D. Thereafter, we conducted participatory design workshops with youth to identify key app features that would support individual needs when physically active. These features were incorporated into a wireframe, which was critically reviewed by participants. A beta version of “acT1ve” was built in iOS and android operating systems, which underwent critical review by end users, clinicians, researchers, experts in exercise and T1D, and app designers. Results: Sixty youth with T1D, 14 parents, 6 researchers, and 10 clinicians were engaged in the development of “acT1ve.” acT1ve included key features identified by youth, which would support their individual needs when physically active. It provided advice on carbohydrates and insulin during exercise, information on hypoglycemia treatment, pre- and postexercise advice, and an educational food guide regarding exercise management. “acT1ve” contained an exercise advisor algorithm comprising 240 pathways developed by experts in diabetes and exercise research. Based on participant input during exercise, acT1ve provided personalized insulin and carbohydrate advice for exercise lasting up to 60 minutes. It also contains other features including an activity log, which displays a complete record of the end users’ activities and associated exercise advice provided by the app’s algorithm for later reference, and regular reminder notifications for end users to check or monitor their glucose levels. Conclusions: The co-design approach and the practical application of the user-centered design thinking framework were successfully applied in developing “acT1ve.” The design thinking processes allowed youth with T1D to identify app features that would support them to be physically active, and particularly enabled the delivery of individualized advice. Furthermore, app development has been described in detail to help guide others embarking on a similar project. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001414101; https://tinyurl.com/mu9jvn2d %M 39078700 %R 10.2196/51491 %U https://diabetes.jmir.org/2024/1/e51491 %U https://doi.org/10.2196/51491 %U http://www.ncbi.nlm.nih.gov/pubmed/39078700 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e57318 %T Conversational Chatbot for Cigarette Smoking Cessation: Results From the 11-Step User-Centered Design Development Process and Randomized Controlled Trial %A Bricker,Jonathan B %A Sullivan,Brianna %A Mull,Kristin %A Santiago-Torres,Margarita %A Lavista Ferres,Juan M %+ Division of Public Health Sciences, Fred Hutch Cancer Center, 1100 Fairview Avenue N, Seattle, WA, 98109, United States, 1 206 667 5074, jbricker@fredhutch.org %K chatbot %K conversational agent %K conversational agents %K digital therapeutics %K smoking cessation %K development %K develop %K design %K smoking %K smoke %K smokers %K quit %K quitting %K cessation %K chatbots %K large language model %K LLM %K LLMs %K large language models %K addict %K addiction %K addictions %K mobile phone %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Conversational chatbots are an emerging digital intervention for smoking cessation. No studies have reported on the entire development process of a cessation chatbot. Objective: We aim to report results of the user-centered design development process and randomized controlled trial for a novel and comprehensive quit smoking conversational chatbot called QuitBot. Methods: The 4 years of formative research for developing QuitBot followed an 11-step process: (1) specifying a conceptual model; (2) conducting content analysis of existing interventions (63 hours of intervention transcripts); (3) assessing user needs; (4) developing the chat’s persona (“personality”); (5) prototyping content and persona; (6) developing full functionality; (7) programming the QuitBot; (8) conducting a diary study; (9) conducting a pilot randomized controlled trial (RCT); (10) reviewing results of the RCT; and (11) adding a free-form question and answer (QnA) function, based on user feedback from pilot RCT results. The process of adding a QnA function itself involved a three-step process: (1) generating QnA pairs, (2) fine-tuning large language models (LLMs) on QnA pairs, and (3) evaluating the LLM outputs. Results: We developed a quit smoking program spanning 42 days of 2- to 3-minute conversations covering topics ranging from motivations to quit, setting a quit date, choosing Food and Drug Administration–approved cessation medications, coping with triggers, and recovering from lapses and relapses. In a pilot RCT with 96% three-month outcome data retention, QuitBot demonstrated high user engagement and promising cessation rates compared to the National Cancer Institute’s SmokefreeTXT text messaging program, particularly among those who viewed all 42 days of program content: 30-day, complete-case, point prevalence abstinence rates at 3-month follow-up were 63% (39/62) for QuitBot versus 38.5% (45/117) for SmokefreeTXT (odds ratio 2.58, 95% CI 1.34-4.99; P=.005). However, Facebook Messenger intermittently blocked participants’ access to QuitBot, so we transitioned from Facebook Messenger to a stand-alone smartphone app as the communication channel. Participants’ frustration with QuitBot’s inability to answer their open-ended questions led to us develop a core conversational feature, enabling users to ask open-ended questions about quitting cigarette smoking and for the QuitBot to respond with accurate and professional answers. To support this functionality, we developed a library of 11,000 QnA pairs on topics associated with quitting cigarette smoking. Model testing results showed that Microsoft’s Azure-based QnA maker effectively handled questions that matched our library of 11,000 QnA pairs. A fine-tuned, contextualized GPT-3.5 (OpenAI) responds to questions that are not within our library of QnA pairs. Conclusions: The development process yielded the first LLM-based quit smoking program delivered as a conversational chatbot. Iterative testing led to significant enhancements, including improvements to the delivery channel. A pivotal addition was the inclusion of a core LLM–supported conversational feature allowing users to ask open-ended questions. Trial Registration: ClinicalTrials.gov NCT03585231; https://clinicaltrials.gov/study/NCT03585231 %M 38913882 %R 10.2196/57318 %U https://mhealth.jmir.org/2024/1/e57318 %U https://doi.org/10.2196/57318 %U http://www.ncbi.nlm.nih.gov/pubmed/38913882 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47578 %T Consumer Perspectives for a Future Mobile App to Document Real-World Listening Difficulties: Qualitative Study %A Galvin,Karyn %A Tomlin,Dani %A Timmer,Barbra H B %A McNeice,Zoe %A Mount,Nicole %A Gray,Kathleen %A Short,Camille E %+ Department of Audiology and Speech Pathology, University of Melbourne, 550 Swanston St, Carlton, 3053, Australia, 61 61390355323, kgalvin@unimelb.edu.au %K adults %K hearing loss %K listening difficulties %K digital health %K app %K self-management %K mobile health %K smartphone %K mobile phone %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: By enabling individuals with hearing loss to collect their own hearing data in their personal real-world settings, there is scope to improve clinical care, empower consumers, and support shared clinical decision-making and problem-solving. Clinician support for this approach has been established in a separate study. Objective: This study aims to explore, for consumers with hearing loss, their (1) experiences of listening difficulties, to identify the data an app could usefully collect; (2) preferences regarding the features of mobile apps in general; and (3) opinions on the potential value and desirable features of a yet-to-be designed app for documenting listening difficulties in real-world settings. Methods: A total of 3 focus groups involved 27 adults who self-reported hearing loss. Most were fitted with hearing devices. A facilitator used a topic guide to generate discussion, which was video- and audio-recorded. Verbatim transcriptions were analyzed using inductive content analysis. Results: Consumers supported the concept of a mobile app that would facilitate the documenting of listening difficulties in real-world settings important to the individual. Consumers shared valuable insights about their listening difficulties, which will help determine the data that should be collected through an app designed to document these challenges. This information included early indicators of hearing loss (eg, mishearing, difficulty communicating in groups and on the phone, and speaking overly loudly) and prompts to seek hearing devices (eg, spousal pressure and the advice or example provided by others, and needing to rely on lipreading or to constantly request others to repeat themselves). It also included the well-known factors that influence listening difficulties (eg, reverberation, background noise, group conversations) and the impacts and consequences of their difficulties (eg, negative impacts on relationships and employment, social isolation and withdrawal, and negative emotions). Consumers desired a visual-based app that provided options for how data could be collected and how the user could enter data into an app, and which enabled data sharing with a clinician. Conclusions: These findings provide directions for the future co-design and piloting of a prototype mobile app to provide data that are useful for increasing self-awareness of listening difficulties and can be shared with a clinician. %M 39042452 %R 10.2196/47578 %U https://formative.jmir.org/2024/1/e47578 %U https://doi.org/10.2196/47578 %U http://www.ncbi.nlm.nih.gov/pubmed/39042452 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e49393 %T The Impact of User Engagement With Exposure Components on Posttraumatic Stress Symptoms in an mHealth Mobile App: Secondary Analysis of a Randomized Controlled Trial %A Davis,C Adrian %A Miller,Madeleine %A McLean,Carmen P %K posttraumatic stress disorder %K PTSD %K mHealth apps %K user engagement %K mHealth interventions %K digital interventions %K veterans %D 2024 %7 18.7.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Mobile mental health apps are a cost-effective option for managing mental health problems, such as posttraumatic stress disorder (PTSD). The efficacy of mobile health (mHealth) apps depends on engagement with the app, but few studies have examined how users engage with different features of mHealth apps for PTSD. Objective: This study aims to examine the relationship between app engagement indices and PTSD symptom reduction using data from an unblinded pilot randomized controlled trial of “Renew” (Vertical Design), an exposure-based app for PTSD with and without coaching support. Because exposure is an effective approach for treating PTSD, we expected that engagement with exposure activities would be positively related to symptom reduction, over and above overall app usage. Methods: Participants were veterans (N=69) with clinically significant PTSD symptoms who were recruited online using Facebook advertisements and invited to use the Renew app as often as they wanted over a 6-week period. Participants completed screening and assessments online but provided informed consent, toured the app, and completed feedback interviews via telephone. We assessed users’ self-reported PTSD symptoms before and after a 6-week intervention period and collected app usage data using a research-instrumented dashboard. To examine overall app engagement, we used data on the total time spent in the app, the number of log-in days, and the number of points that the user gained in the app. To examine engagement with exposure components, we used data on total time spent completing exposure activities (both in vivo and imaginal), the number of in vivo exposure activities completed, and the number of characters written in response to imaginal exposure prompts. We used hierarchical regression analyses to test the effect of engagement indices on change in PTSD symptoms. Results: Usage varied widely. Participants spent an average of 166.09 (SD 156.52) minutes using Renew, over an average of 14.7 (SD 10.71) mean log-in days. Engagement with the exposure components of the app was positively associated with PTSD symptom reduction (F6,62=2.31; P=.04). Moreover, this relationship remained significant when controlling for overall engagement with the app (ΔF3,62=4.42; P=.007). The number of characters written during imaginal exposure (β=.37; P=.009) and the amount of time spent completing exposure activities (β=.36; P=.03) were significant contributors to the model. Conclusions: To our knowledge, this is the first study to show a relationship between symptom improvement and engagement with the active therapeutic components of an mHealth app (ie, exposure) for PTSD. This relationship held when controlling for overall app use, which suggests that it was engagement with exposure, specifically, that was associated with symptom change. Future work to identify ways of promoting greater engagement with self-guided exposure may help improve the effectiveness of mHealth apps for PTSD. Trial Registration: ClinicalTrials.gov NCT04155736; https://clinicaltrials.gov/ct2/show/NCT04155736 %R 10.2196/49393 %U https://mhealth.jmir.org/2024/1/e49393 %U https://doi.org/10.2196/49393 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54945 %T A Chatbot-Delivered Stress Management Coaching for Students (MISHA App): Pilot Randomized Controlled Trial %A Ulrich,Sandra %A Lienhard,Natascha %A Künzli,Hansjörg %A Kowatsch,Tobias %+ School of Applied Psychology, Zurich University of Applied Sciences, Pfingstweidstrasse 96, Zurich, 8005, Switzerland, 41 58 934 ext 8451, sandra.ulrich@zhaw.ch %K conversational agent %K mobile health %K mHealth %K smartphone %K stress management %K lifestyle %K behavior change %K coaching %K mobile phone %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Globally, students face increasing mental health challenges, including elevated stress levels and declining well-being, leading to academic performance issues and mental health disorders. However, due to stigma and symptom underestimation, students rarely seek effective stress management solutions. Conversational agents in the health sector have shown promise in reducing stress, depression, and anxiety. Nevertheless, research on their effectiveness for students with stress remains limited. Objective: This study aims to develop a conversational agent–delivered stress management coaching intervention for students called MISHA and to evaluate its effectiveness, engagement, and acceptance. Methods: In an unblinded randomized controlled trial, Swiss students experiencing stress were recruited on the web. Using a 1:1 randomization ratio, participants (N=140) were allocated to either the intervention or waitlist control group. Treatment effectiveness on changes in the primary outcome, that is, perceived stress, and secondary outcomes, including depression, anxiety, psychosomatic symptoms, and active coping, were self-assessed and evaluated using ANOVA for repeated measure and general estimating equations. Results: The per-protocol analysis revealed evidence for improvement of stress, depression, and somatic symptoms with medium effect sizes (Cohen d=−0.36 to Cohen d=−0.60), while anxiety and active coping did not change (Cohen d=−0.29 and Cohen d=0.13). In the intention-to-treat analysis, similar results were found, indicating reduced stress (β estimate=−0.13, 95% CI −0.20 to −0.05; P<.001), depressive symptoms (β estimate=−0.23, 95% CI −0.38 to −0.08; P=.003), and psychosomatic symptoms (β estimate=−0.16, 95% CI −0.27 to −0.06; P=.003), while anxiety and active coping did not change. Overall, 60% (42/70) of the participants in the intervention group completed the coaching by completing the postintervention survey. They particularly appreciated the quality, quantity, credibility, and visual representation of information. While individual customization was rated the lowest, the target group fitting was perceived as high. Conclusions: Findings indicate that MISHA is feasible, acceptable, and effective in reducing perceived stress among students in Switzerland. Future research is needed with different populations, for example, in students with high stress levels or compared to active controls. Trial Registration: German Clinical Trials Register DRKS 00030004; https://drks.de/search/en/trial/DRKS00030004 %M 38922677 %R 10.2196/54945 %U https://mhealth.jmir.org/2024/1/e54945 %U https://doi.org/10.2196/54945 %U http://www.ncbi.nlm.nih.gov/pubmed/38922677 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54029 %T Development of an Artificial Intelligence–Based Tailored Mobile Intervention for Nurse Burnout: Single-Arm Trial %A Cho,Aram %A Cha,Chiyoung %A Baek,Gumhee %+ College of Nursing & Graduate Program in System Health Science and Engineering, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, Hellen #202, Seoul, 03760, Republic of Korea, 82 0232772883, chiyoung@ewha.ac.kr %K artificial intelligence %K burnout %K mobile app %K nurses %K nurse %K mHealth %K mobile health %K app %K apps %K applications %K usability %K satisfaction %K effectiveness %K tailored %K mind-body %K meditation %K mindfulness %K ACT %K algorithm %K algorithms %K occupational health %K digital health %K recommender %K optimization %K acceptance and commitment therapy %K job %K worker %K workers %K stress %K employee %K employees %D 2024 %7 21.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Nurse burnout leads to an increase in turnover, which is a serious problem in the health care system. Although there is ample evidence of nurse burnout, interventions developed in previous studies were general and did not consider specific burnout dimensions and individual characteristics. Objective: The objectives of this study were to develop and optimize the first tailored mobile intervention for nurse burnout, which recommends programs based on artificial intelligence (AI) algorithms, and to test its usability, effectiveness, and satisfaction. Methods: In this study, an AI-based mobile intervention, Nurse Healing Space, was developed to provide tailored programs for nurse burnout. The 4-week program included mindfulness meditation, laughter therapy, storytelling, reflective writing, and acceptance and commitment therapy. The AI algorithm recommended one of these programs to participants by calculating similarity through a pretest consisting of participants’ demographics, research variables, and burnout dimension scores measured with the Copenhagen Burnout Inventory. After completing a 4-week program, burnout, job stress, stress response using the Stress Response Inventory Modified Form, the usability of the app, coping strategy by the coping strategy indicator, and program satisfaction (1: very dissatisfied; 5: very satisfied) were measured. The AI recognized the recommended program as effective if the user’s burnout score reduced after the 2-week program and updated the algorithm accordingly. After a pilot test (n=10), AI optimization was performed (n=300). A paired 2-tailed t test, ANOVA, and the Spearman correlation were used to test the effect of the intervention and algorithm optimization. Results: Nurse Healing Space was implemented as a mobile app equipped with a system that recommended 1 program out of 4 based on similarity between users through AI. The AI algorithm worked well in matching the program recommended to participants who were most similar using valid data. Users were satisfied with the convenience and visual quality but were dissatisfied with the absence of notifications and inability to customize the program. The overall usability score of the app was 3.4 out of 5 points. Nurses’ burnout scores decreased significantly after the completion of the first 2-week program (t=7.012; P<.001) and reduced further after the second 2-week program (t=2.811; P=.01). After completing the Nurse Healing Space program, job stress (t=6.765; P<.001) and stress responses (t=5.864; P<.001) decreased significantly. During the second 2-week program, the burnout level reduced in the order of participation (r=–0.138; P=.04). User satisfaction increased for both the first (F=3.493; P=.03) and second programs (F=3.911; P=.02). Conclusions: This program effectively reduced burnout, job stress, and stress responses. Nurse managers were able to prevent nurses from resigning and maintain the quality of medical services using this AI-based program to provide tailored interventions for nurse burnout. Thus, this app could improve qualitative health care, increase employee satisfaction, reduce costs, and ultimately improve the efficiency of the health care system. %M 38905631 %R 10.2196/54029 %U https://www.jmir.org/2024/1/e54029 %U https://doi.org/10.2196/54029 %U http://www.ncbi.nlm.nih.gov/pubmed/38905631 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50086 %T Gamification Approach to Provide Support About the Deferral Experience in Blood Donation: Design and Feasibility Study %A Espinoza Chamorro,Roberto %A Santos,Luciano H O %A Mori,Yukiko %A Liu,Chang %A Yamamoto,Goshiro %A Kuroda,Tomohiro %+ Graduate School of Informatics, Kyoto University, 36-1 Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan, 81 075 753 7531, rech91@outlook.com %K blood donation %K deferral experience %K Theory of Planned Behavior %K Self-Determination Theory %K gamification %K ICT design %K motivation %K patient education %K prototype %K feasibility %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Multiple studies have examined the impact of deferral on the motivation of prospective blood donors, proposing various policies and strategies to support individuals who undergo this experience. However, existing information and communications technology systems focused on blood donation have not yet integrated these ideas or provided options to assist with the deferral experience. Objective: This study aims to propose an initial gamified design aimed at mitigating the impact of the deferral experience by addressing the drivers of awareness and knowledge, interaction and validation, and motivation. Additionally, the study explores the feasibility of implementing such a system for potential users. Methods: We conducted a literature review focusing on the dynamics of motivation and intention related to blood donation, as well as the deferral situation and its impact on citizens. Through this review, we identified weak donor identity, lack of knowledge, and reduced motivation as key factors requiring support from appropriate interventions. These factors were then defined as our key drivers. Taking these into account, we proposed a gamification approach that incorporates concepts from the MDA framework. The aim is to stimulate the aforementioned drivers and expand the concept of contribution and identity in blood donation. For a preliminary evaluation, we designed a prototype to collect feedback on usability, usefulness, and interest regarding a potential implementation of our proposed gamification approach. Results: Among the participants, a total of 11 citizens interacted with the app and provided feedback through our survey. They indicated that interacting with the app was relatively easy, with an average score of 4.13 out of 5 when considering the 11 tasks of interaction. The SUS results yielded a final average score of 70.91 from the participants’ answers. Positive responses were received when participants were asked about liking the concept of the app (3.82), being likely to download it (3.55), and being likely to recommend it to others (3.64). Participants expressed positivity about the implementation of the design but also highlighted current shortcomings and suggested possible improvements in both functionality and usability. Conclusions: Although deferral is a common issue in blood donation, there is a missed opportunity in existing ICT services regarding how to effectively handle such experiences. Our proposed design and implementation seem to have captured the interest of prospective users due to its perceived positive usefulness and potential. However, further confirmation is needed. Improving the design of activities that currently rely heavily on extrinsic motivation elements and integrating more social components to create an enhanced activity loop for intrinsic motivation could further increase the value of the proposed project. Future research could involve conducting a more specialized and longitudinal design evaluation with a larger sample size. %M 38875005 %R 10.2196/50086 %U https://humanfactors.jmir.org/2024/1/e50086 %U https://doi.org/10.2196/50086 %U http://www.ncbi.nlm.nih.gov/pubmed/38875005 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50939 %T Assessing the Utility, Impact, and Adoption Challenges of an Artificial Intelligence–Enabled Prescription Advisory Tool for Type 2 Diabetes Management: Qualitative Study %A Yoon,Sungwon %A Goh,Hendra %A Lee,Phong Ching %A Tan,Hong Chang %A Teh,Ming Ming %A Lim,Dawn Shao Ting %A Kwee,Ann %A Suresh,Chandran %A Carmody,David %A Swee,Du Soon %A Tan,Sarah Ying Tse %A Wong,Andy Jun-Wei %A Choo,Charlotte Hui-Min %A Wee,Zongwen %A Bee,Yong Mong %+ Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore, 65 66013198, sungwon.yoon@duke-nus.edu.sg %K clinical decision support system %K artificial intelligence %K endocrinology %K diabetes management %K human factors %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The clinical management of type 2 diabetes mellitus (T2DM) presents a significant challenge due to the constantly evolving clinical practice guidelines and growing array of drug classes available. Evidence suggests that artificial intelligence (AI)–enabled clinical decision support systems (CDSSs) have proven to be effective in assisting clinicians with informed decision-making. Despite the merits of AI-driven CDSSs, a significant research gap exists concerning the early-stage implementation and adoption of AI-enabled CDSSs in T2DM management. Objective: This study aimed to explore the perspectives of clinicians on the use and impact of the AI-enabled Prescription Advisory (APA) tool, developed using a multi-institution diabetes registry and implemented in specialist endocrinology clinics, and the challenges to its adoption and application. Methods: We conducted focus group discussions using a semistructured interview guide with purposively selected endocrinologists from a tertiary hospital. The focus group discussions were audio-recorded and transcribed verbatim. Data were thematically analyzed. Results: A total of 13 clinicians participated in 4 focus group discussions. Our findings suggest that the APA tool offered several useful features to assist clinicians in effectively managing T2DM. Specifically, clinicians viewed the AI-generated medication alterations as a good knowledge resource in supporting the clinician’s decision-making on drug modifications at the point of care, particularly for patients with comorbidities. The complication risk prediction was seen as positively impacting patient care by facilitating early doctor-patient communication and initiating prompt clinical responses. However, the interpretability of the risk scores, concerns about overreliance and automation bias, and issues surrounding accountability and liability hindered the adoption of the APA tool in clinical practice. Conclusions: Although the APA tool holds great potential as a valuable resource for improving patient care, further efforts are required to address clinicians’ concerns and improve the tool’s acceptance and applicability in relevant contexts. %M 38869934 %R 10.2196/50939 %U https://humanfactors.jmir.org/2024/1/e50939 %U https://doi.org/10.2196/50939 %U http://www.ncbi.nlm.nih.gov/pubmed/38869934 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56373 %T An App-Based Physical Activity Intervention in Community-Dwelling Chinese-, Tagalog-, and Vietnamese-Speaking Americans: Single-Arm Intervention Study %A Nguyen,Antony %A Yu,Filmer %A Park,Linda G %A Fukuoka,Yoshimi %A Wong,Ching %A Gildengorin,Ginny %A Nguyen,Tung T %A Tsoh,Janice Y %A Jih,Jane %+ Division of General Internal Medicine, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, United States, 1 4158857563, jane.jih@ucsf.edu %K physical activity %K mHealth %K mobile health %K mobile app %K Asian Americans %K physical activity tracker %K mobile phone %K app %K apps %K application %K applications %K app-based %K intervention %K interventions %K community-dwelling %K tracker %K trackers %K pilot study %K feasibility %K acceptability %K cultural %K culturally %K linguistic %K linguistically %K evidence-based %K community-based %K sociodemographic %K lifestyle %K Chinese %K Vietnamese %K Filipino %K adult %K adults %K multicomponent %K multilingual %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity is associated with adverse health outcomes among Asian Americans, who exhibit the least adherence to physical activity guidelines compared with other racial and ethnic groups. Mobile app–based interventions are a promising approach to promote healthy behaviors. However, there is a lack of app-based interventions focused on improving physical activity among Asian Americans whose primary language is not English. Objective: This pilot study aimed to assess the feasibility and acceptability of a 5-week intervention using a culturally and linguistically adapted, evidence-based mobile phone app with an accelerometer program, to promote physical activity among Chinese-, Tagalog-, or Vietnamese-speaking Americans. Methods: Participants were recruited through collaborations with community-based organizations. The intervention was adapted from a 12-month physical activity randomized controlled trial involving the app and accelerometer for English-speaking adults. Sociodemographic characteristics, lifestyle factors, and physical measurements were collected at the baseline visit. A 7-day run-in period was conducted to screen for the participants who could wear a Fitbit One (Fitbit LLC) accelerometer and complete the app’s daily step diary. During the 4-week intervention period, participants wore the accelerometer and reported their daily steps in the app. Participants also received daily messages to reinforce key contents taught during an in-person educational session, remind them to input steps, and provide tailored feedback. Feasibility measures were the percentage of eligible participants completing the run-in period and the percentage of participants who used the app diary for at least 5 out of 7 days during the intervention period. We conducted poststudy participant interviews to explore overall intervention acceptability. Results: A total of 19 participants were enrolled at the beginning of the study with a mean age of 47 (SD 13.3; range 29-70) years, and 58% (n=11) of them were female. Of the participants, 26% (n=5) were Chinese, 32% (n=6) were Vietnamese, and 42% (n=8) were Filipino. All participants met the run-in criteria to proceed with the intervention. Adherence to the app diary ranged from 74% (n=14) in week 2 to 95% (n=18) in week 4. The daily average steps per week from accelerometers increased each week from 8451 (SD 3378) steps during the run-in period to 10,930 (SD 4213) steps in week 4. Participants reported positive experiences including an increased motivation to walk and the enjoyment of being able to monitor their physical activity. Conclusions: This is the first pilot study of a multicomponent intervention and evidence-based mobile phone app to promote physical activity among Asian Americans who use apps in traditional Chinese, Tagalog, or Vietnamese, which demonstrated high feasibility and acceptability. Future work focused on multilingual mobile apps to address disparities in physical inactivity among Asian Americans should be considered. %M 38857065 %R 10.2196/56373 %U https://formative.jmir.org/2024/1/e56373 %U https://doi.org/10.2196/56373 %U http://www.ncbi.nlm.nih.gov/pubmed/38857065 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55918 %T Telemedicine With Wearable Technologies in Patients Undergoing Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T-Cell Therapy (TEL-HEMATO Study): Prospective Noninterventional Single-Center Study %A Hurtado,Lidia %A Gonzalez Concepcion,Melinda %A Flix-Valle,Aida %A Ruiz-Romeo,Marina %A Gonzalez-Rodriguez,Sonia %A Peña,Marta %A Paviglianiti,Annalisa %A Pera Jambrina,Maria Angeles %A Sureda,Anna %A Ochoa-Arnedo,Cristian %A Mussetti,Alberto %+ Clinical Hematology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Avinguda de la Granvia de l’Hospitalet, 199, Barcelona, 08908, Spain, 34 622188475, amussetti@iconcologia.net %K hematology %K hematopoietic cell transplantation %K telemedicine %K wearables %K chimeric antigen receptor T %K CART %K wearable %K hematopoietic %K transplantation %K transplant %K pilot study %K hematological %K HCT %K telehealth %K therapy %K device %K quality of life %K digital health %K smartphone %K app %K patient %K teenager %K youth %K noninterventional %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with hematological malignancies receiving hematopoietic cell transplantation (HCT) or chimeric antigen receptor (CAR) T-cell therapy are at risk of developing serious clinical complications after discharge. Objective: The aim of the TEL-HEMATO study was to improve our telehealth platform for the follow-up of patients undergoing HCT or CAR T-cell therapy during the first 3 months after discharge with the addition of wearable devices. Methods: Eleven patients who received autologous (n=2) or allogeneic (n=5) HCT or CAR T-cell therapy (n=4) for hematological malignancies were screened from November 2022 to July 2023. Two patients discontinued the study after enrollment. The telehealth platform consisted of the daily collection of vital signs, physical symptoms, and quality of life assessment up to 3 months after hospital discharge. Each patient received a clinically validated smartwatch (ScanWatch) and a digital thermometer, and a dedicated smartphone app was used to collect these data. Daily revision of the data was performed through a web-based platform by a hematologist or a nurse specialized in HCT and CAR T-cell therapy. Results: Vital signs measured through ScanWatch were successfully collected with medium/high adherence: heart rate was recorded in 8/9 (89%) patients, oxygen saturation and daily steps were recorded in 9/9 (100%) patients, and sleeping hours were recorded in 7/9 (78%) patients. However, temperature recorded manually by the patients was associated with lower compliance, which was recorded in 5/9 (55%) patients. Overall, 5/9 (55%) patients reported clinical symptoms in the app. Quality of life assessment was completed by 8/9 (89%) patients at study enrollment, which decreased to 3/9 (33%) at the end of the third month. Usability was considered acceptable through ratings provided on the System Usability Scale. However, technological issues were reported by the patients. Conclusions: While the addition of wearable devices to a telehealth clinical platform could have potentially synergic benefits for HCT and CAR T-cell therapy patient monitoring, noncomplete automation of the platform and the absence of a dedicated telemedicine team still represent major limitations to be overcome. This is especially true in our real-life setting where the target population generally comprises patients of older age with a low digital education level. %M 38833696 %R 10.2196/55918 %U https://formative.jmir.org/2024/1/e55918 %U https://doi.org/10.2196/55918 %U http://www.ncbi.nlm.nih.gov/pubmed/38833696 %0 Journal Article %@ 2292-9495 %I %V 11 %N %P e54983 %T Designing a Smartphone-Based Pulse Oximeter for Children in South Africa (Phefumla Project): Qualitative Analysis of Human-Centered Design Workshops With Health Care Workers %A Ilhan,Elif I %A Jola,Lucia N %A van der Zalm,Marieke M %A Bernstein,Mike %A Goussard,Pierre %A Redfern,Andrew %A Hesseling,Anneke C %A Hoddinott,Graeme %A McCollum,Eric D %A King,Carina %K pediatrics %K human-centered design %K participatory design %K pulse oximeter %K South Africa %K smartphone %K mobile phone %D 2024 %7 30.5.2024 %9 %J JMIR Hum Factors %G English %X Background: Pulse oximeters noninvasively measure blood oxygen levels, but these devices have rarely been designed for low-resource settings and are inconsistently available at outpatient clinics. Objective: The Phefumla project aims to develop and validate a pediatric smartphone-based pulse oximeter designed specifically for this context. We present the process of human-centered oximeter design with health care workers in South Africa. Methods: We purposively sampled 19 health care workers from 5 clinics in Khayelitsha, Cape Town. Using a human-centered design approach, we conducted participatory workshops with four activities with health care workers: (1) they received 3D-printed prototypes of potential oximeter designs to provide feedback; (2) we demonstrated on dolls how they would use the novel oximeter; (3) they used pile sorting to rank design features and suggest additional features they desired; and (4) they designed their preferred user interface using a whiteboard, marker, and magnetized features that could be repositioned. We audio recorded the workshops, photographed outputs, and took detailed field notes. Analysis involved iterative review of these data to describe preferences, identify key design updates, and provide modifications. Results: Participants expressed a positive sentiment toward the idea of a smartphone pulse oximeter and suggested that a pediatric device would address an important gap in outpatient care. Specifically, participants expressed a preference for the prototype that they felt enabled more diversity in the way it could be used. There was a strong tendency to prioritize pragmatic design features, such as robustness, which was largely dictated by health care worker context. They also added features that would allow the oximeter device to serve other clinical functions in addition to oxygen saturation measurement, such as temperature and respiratory rate measurements. Conclusions: Our end user–centered rapid participatory approach led to tangible design changes and prompted design discussions that the team had not previously considered. Overall, health care workers prioritized pragmatism for pediatric pulse oximeter device design. %R 10.2196/54983 %U https://humanfactors.jmir.org/2024/1/e54983 %U https://doi.org/10.2196/54983 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56607 %T Impact of an Automated Population-Level Cirrhosis Screening Program Using Common Pathology Tests on Rates of Cirrhosis Diagnosis and Linkage to Specialist Care (CAPRISE): Protocol for a Pilot Prospective Single-Arm Intervention Study %A Flores,Joan Ericka %A Trambas,Christina %A Jovanovic,Natasha %A Thompson,Alexander J %A Howell,Jessica %+ Department of Gastroenterology, St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy VIC 3065, Fitzroy, 3065, Australia, 61 0392312211, ericka.flores@svha.org.au %K noninvasive tests %K cirrhosis %K population health %K screening %K liver cirrhosis %K liver %K compensated %K risk factor %K pathology %K population based %K liver screening %K prevalence %K hepatocellular carcinoma %K transient elastography %K FibroScan %D 2024 %7 22.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with compensated cirrhosis receive the greatest benefit from risk factor modification and prevention programs to reduce liver decompensation and improve early liver cancer detection. Blood-based liver fibrosis algorithms such as the Aspartate Transaminase–to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) index are calculated using routinely ordered blood tests and are effective screening tests to exclude cirrhosis in people with chronic liver disease, triaging the need for further investigations to confirm cirrhosis and linkage to specialist care. Objective: This pilot study aims to evaluate the impact of a population screening program for liver cirrhosis (CAPRISE [Cirrhosis Automated APRI and FIB-4 Screening Evaluation]), which uses automated APRI and FIB-4 calculation and reporting on routinely ordered blood tests, on monthly rates of referral for transient elastography, cirrhosis diagnosis, and linkage to specialist care. Methods: We have partnered with a large pathology service in Victoria, Australia, to pilot a population-level liver cirrhosis screening package, which comprises (1) automated calculation and reporting of APRI and FIB-4 on routinely ordered blood tests; (2) provision of brief information about liver cirrhosis; and (3) a web link for transient elastography referral. APRI and FIB-4 will be prospectively calculated on all community-ordered pathology results in adults attending a single pathology service. This single-center, prospective, single-arm, pre-post study will compare the monthly rates of transient elastography (FibroScan) referral, liver cirrhosis diagnosis, and the proportion linked to specialist care in the 6 months after intervention to the 6 months prior to the intervention. Results: As of January 2024, in the preintervention phase of this study, a total of 120,972 tests were performed by the laboratory. Of these tests, 78,947 (65.3%) tests were excluded, with the remaining 42,025 (34.7%) tests on 37,872 individuals meeting inclusion criteria with APRI and FIB-4 being able to be calculated. Of these 42,025 tests, 1.3% (n=531) had elevated APRI>1 occurring in 446 individuals, and 2.3% (n=985) had elevated FIB-4>2.67 occurring in 816 individuals. Linking these data with FibroScan referral and appointment attendance is ongoing and will continue during the intervention phase, which is expected to commence on February 1, 2024. Conclusions: We will determine the feasibility and effectiveness of automated APRI and FIB-4 reporting on the monthly rate of transient elastography referrals, liver cirrhosis diagnosis, and linkage to specialist care. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000295640; https://tinyurl.com/58dv9ypp International Registered Report Identifier (IRRID): DERR1-10.2196/56607 %M 38776541 %R 10.2196/56607 %U https://www.researchprotocols.org/2024/1/e56607 %U https://doi.org/10.2196/56607 %U http://www.ncbi.nlm.nih.gov/pubmed/38776541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50398 %T Exploring the Potential of an Eye Tissue Donor Reporting App in Enhancing the Procurement of Corneal Donors: Mixed Methods Observational Study %A Szkodny,Dominika %A Wróblewska-Czajka,Ewa %A Stryja,Mikołaj %A Gara,Filip %A Wylęgała,Edward %+ Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, Panewnicka 65, Katowice, 40-570, Poland, 48 32 605 35 55, dominikacholewa1@gmail.com %K eye donor %K corneal transplant %K donor shortage %K mHealth %K mobile health %K app %K apps %K applications %K application %K tissue procurement %K organ %K procurement %K donor %K donors %K donation %K transplant %K transplantation %K transplants %K usability %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K interview %K interviews %K survey %K surveys %K questionnaire %K questionnaires %K reporting %D 2024 %7 15.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The availability of donated eye tissue saves and enhances vision in transplant recipients; however, the current demand for tissue surpasses the available supply. Corneal donor shortages lead to increased wait times, delayed surgeries, prolonged visual impairment, and increased inconvenience to patients requiring eye tissue transplantation. A web-based application was previously developed to facilitate easy and intuitive submission of potential donor information. Objective: The primary objectives of this study were to assess health care professionals’ attitudes toward the potential application and evaluate its effectiveness based on user feedback and donor registrations through the application. Methods: Researchers used a mixed methods approach, commencing with a literature review to identify challenges associated with donor procurement. Stakeholder interviews were conducted to gauge health care professionals’ perspectives regarding the application. User feedback was collected through questionnaires, surveys, and interviews to assess the application’s usability and impact. An assessment of the reported potential donors and questionnaire responses were analyzed. Results: The final version of the application successfully reported 24 real cornea donors. Among 64 health care providers who used the application to communicate about potential donors, 32 of them submitted trial entries exclusively for testing purposes. The remaining 8 health care professionals reported potential donors; however, these individuals did not meet the donor qualification criteria. The majority of participants found the application user-friendly and expressed their readiness to use it in the future. Positive ratings were assigned to the layout, appearance, purpose, and specific features of the application. Respondents highlighted the automatic sending of notifications via SMS text messages and the integration of all necessary documents for donor qualification and tissue collection as the most valuable functions of the application. Conclusions: The study indicates that donor reporting applications offer promising solutions to enhance tissue donor procurement. This application streamlined the reporting process, reduced paperwork, facilitated communication, and collected valuable data for analysis. %M 38748474 %R 10.2196/50398 %U https://formative.jmir.org/2024/1/e50398 %U https://doi.org/10.2196/50398 %U http://www.ncbi.nlm.nih.gov/pubmed/38748474 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53756 %T Self-Selected Versus Assigned Target to Reduce Smartphone Use and Improve Mental Health: Protocol for a Randomized Controlled Trial %A Sharma,Kamal Kant %A Somasundaram,Jeeva %A Sachdeva,Ashish %+ Max Institute of Healthcare Management, Indian School of Business, Knowledge City, Sector 81, Sahibzada Ajit Singh Nagar, Punjab, 140306, India, 91 01724591831, ashish_sachdeva@isb.edu %K screen time %K monetary incentives %K target selection %K mental health %K mobile phone %D 2024 %7 6.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smartphones have become integral to people’s lives, with a noticeable increase in the average screen time, both on a global scale and, notably, in India. Existing research links mobile consumption to sleep problems, poor physical and mental health, and lower subjective well-being. The comparative effectiveness of monetary incentives given for self-selected versus assigned targets on reducing screen time and thereby improving mental health remains unanswered. Objective: This study aims to assess the impact of monetary incentives and target selection on mobile screen time reduction and mental health. Methods: We designed a 3-armed randomized controlled trial conducted with employees and students at an educational institution in India. The study is conducted digitally over 12 weeks, including baseline (2 weeks), randomization (1 week), intervention (5 weeks), and postintervention (4 week) periods. We emailed the employees and students to inquire about their interest in participation. Those who expressed interest received detailed study information and consent forms. After securing consent, participants were asked to complete the initial survey and provide their mobile screen time during the baseline period. At the beginning of the intervention period, the participants were randomly allocated into 1 of 3 study groups in a 2:2:1 ratio (self-selected vs assigned vs control). Participants in the self-selected group were presented with 3 target options: 10%, 20%, and 30%, and they were asked to self-select a target to reduce their mobile screen time from their baseline average mobile screen time. Participants in the assigned group were given a target to reduce their mobile screen time from their baseline average mobile screen time. The assigned target was set as the average of the targets selected by participants in the self-selected group. During the intervention period, participants in the self-selected and assigned group were eligible to receive a monetary incentive of INR (Indian Rupee) 50 (US $0.61) per day for successfully attaining their target. Participants in the control group neither received nor selected a target for reducing their mobile screen time and did not receive any monetary incentives during the intervention period. All participants received information regarding the advantages of reducing mobile screen time. As an incentive, all participants would receive INR 500 (US $6.06) upon completion of the study and a chance to win 1 of 2 lotteries valued at INR 5000 (US $60.55) for consistently sharing their mobile screen time data. Results: Currently, the study intervention is being rolled out. Enrollment occurred between August 21, 2023, and September 2, 2023; data collection concluded in November 2023. We expect that results will be available by early 2024. Conclusions: The monetary incentives and self-selected versus assigned targets might be effective interventions in reducing mobile screen time among working professionals and students. Trial Registration: AsPredicted 142497; https://aspredicted.org/hr3nn.pdf International Registered Report Identifier (IRRID): DERR1-10.2196/53756 %M 38709546 %R 10.2196/53756 %U https://www.researchprotocols.org/2024/1/e53756 %U https://doi.org/10.2196/53756 %U http://www.ncbi.nlm.nih.gov/pubmed/38709546 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51201 %T An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial %A Wunsch,Kathrin %A Fiedler,Janis %A Hubenschmid,Sebastian %A Reiterer,Harald %A Renner,Britta %A Woll,Alexander %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721608 ext 45431, kathrin.wunsch@kit.edu %K mobile app %K telemedicine %K behavior change %K health behavior %K family %K primary prevention %K exercise %K diet %K food and nutrition %K randomized controlled trial %K accelerometer %K wearable electronic devices %K social-cognitive determinants %K just-in-time adaptive intervention %K digital intervention %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps. Objective: The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family–based setting. Methods: A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2). Results: Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30). Conclusions: Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts. Trial Registration: German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415 International Registered Report Identifier (IRRID): RR2-10.2196/20534 %M 38669071 %R 10.2196/51201 %U https://mhealth.jmir.org/2024/1/e51201 %U https://doi.org/10.2196/51201 %U http://www.ncbi.nlm.nih.gov/pubmed/38669071 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52090 %T An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial %A Bizier,Andre %A Jones,Arielle %A Businelle,Michael %A Kezbers,Krista %A Hoeppner,Bettina B %A Giordano,Thomas P %A Thai,Jessica M %A Charles,Jacqueline %A Montgomery,Audrey %A Gallagher,Matthew W %A Cheney,Marshall K %A Zvolensky,Michael %A Garey,Lorra %+ University of Houston, 3695 Cullen Blvd, Fred J. Heyne Building, Suite 126, Houston, TX, United States, 1 7137438056, llgarey@uh.edu %K smoking cessation %K Black %K HIV %K anxiety sensitivity %K mobile health %K mHealth %K just-in-time adaptive intervention %K mobile phone %D 2024 %7 24.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black adults who smoke and have HIV experience immense stressors (eg, racial discrimination and HIV stigma) that impede smoking cessation success and perpetuate smoking-related health disparities. These stressors also place Black adults who smoke and have HIV at an increased risk of elevated interoceptive stress (eg, anxiety and uncomfortable bodily sensations) and smoking to manage symptoms. In turn, this population is more likely to smoke to manage interoceptive stress, which contributes to worse HIV-related outcomes in this group. However, no specialized treatment exists to address smoking cessation, interoceptive stress, and HIV management for Black smokers with HIV. Objective: This study aims to test a culturally adapted and novel mobile intervention that targets combustible cigarette smoking, HIV treatment engagement and adherence, and anxiety sensitivity (a proxy for difficulty and responsivity to interoceptive stress) among Black smokers with HIV (ie, Mobile Anxiety Sensitivity Program for Smoking and HIV [MASP+]). Various culturally tailored components of the app are being evaluated for their ability to help users quit smoking, manage physiological stress, and improve health care management. Methods: This study is a pilot randomized controlled trial in which Black combustible cigarette smokers with HIV (N=72) are being recruited and randomly assigned to use either (1) the National Cancer Institute’s QuitGuide app or (2) MASP+. Study procedures include a web-based prescreener; active intervention period for 6 weeks; smartphone-based assessments, including daily app-based ecological momentary assessments for 6 weeks (4 ecological momentary assessments each day); a video-based qualitative interview using Zoom Video Communications software at week 6 for participants in all study conditions; and smartphone-based follow-up assessments at 0, 1, 2 (quit date), 3, 4, 5, 6, and 28 weeks postbaseline (26 weeks postquitting date). Results: Primary outcomes include biochemically verified 7-day point prevalence of abstinence, HIV-related quality of life, use of antiretroviral therapy, and HIV care appointment adherence at 26 weeks postquitting date. Qualitative data are also being collected and assessed to obtain feedback that will guide further tailoring of app content and evaluation of efficacy. Conclusions: The results of this study will determine whether the MASP+ app serves as a successful aid for combustible cigarette smoking cessation, HIV treatment engagement, and physiological stress outcomes among Black people with HIV infection. If successful, this study will provide evidence for the efficacy of a new means of addressing major mental and physical health difficulties for this high-risk population. If the results are promising, the data from this study will be used to update and tailor the MASP+ app for testing in a fully powered randomized controlled trial that will evaluate its efficacy in real-world behavioral health and social service settings. Trial Registration: ClinicalTrials.gov NCT05709002; https://clinicaltrials.gov/study/NCT05709002 International Registered Report Identifier (IRRID): PRR1-10.2196/52090 %M 38657227 %R 10.2196/52090 %U https://www.researchprotocols.org/2024/1/e52090 %U https://doi.org/10.2196/52090 %U http://www.ncbi.nlm.nih.gov/pubmed/38657227 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49982 %T Problems and Barriers Related to the Use of mHealth Apps From the Perspective of Patients: Focus Group and Interview Study %A Giebel,Godwin Denk %A Abels,Carina %A Plescher,Felix %A Speckemeier,Christian %A Schrader,Nils Frederik %A Börchers,Kirstin %A Wasem,Jürgen %A Neusser,Silke %A Blase,Nikola %+ Institute for Health Care Management and Research, Universität Duisburg-Essen, Weststadt-Carree, Thea-Leymann-Straße 9, Essen, 45127, Germany, 49 20118 ext 33180, godwin.giebel@medman.uni-due.de %K mobile health %K mHealth %K mHealth app %K patient %K problems %K barriers %K digital health applications %K DiGA %K app %K barrier %K mobile app %K health care system %K economic outcome %K context %K mobile phone %D 2024 %7 23.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered. Objective: The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients. Methods: Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories (“validity,” “usability,” “technology,” “use and adherence,” “data privacy and security,” “patient-physician relationship,” “knowledge and skills,” “individuality,” “implementation,” and “costs”) identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology. Results: A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention. Conclusions: There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients. %M 38652508 %R 10.2196/49982 %U https://www.jmir.org/2024/1/e49982 %U https://doi.org/10.2196/49982 %U http://www.ncbi.nlm.nih.gov/pubmed/38652508 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55132 %T The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study %A Fan,Qiping %A Hoang,Minh-Nguyet %A DuBose,Logan %A Ory,Marcia G %A Vennatt,Jeswin %A Salha,Diana %A Lee,Shinduk %A Falohun,Tokunbo %+ Department of Public Health Sciences, Clemson University, 524 Edwards Hall, 201 Epsion Zeta Drive, Clemson, SC, 29634, United States, 1 864 656 3841, qipingfan0403@gmail.com %K evaluation %K usability %K family caregiver %K Alzheimer disease %K dementia %K digital health %K mobile phone %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The increasing prevalence of Alzheimer disease and Alzheimer disease–related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care. Objective: This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers. Methods: For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics. Results: Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ≥50 years (25/30, 83%), women (23/30, 77%), White (25/30, 83%), and financially stable (20/30, 67%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90% (27/30) rated the app overall positively. Most of the participants (21/30, 70%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration. Conclusions: The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population. %M 38630527 %R 10.2196/55132 %U https://aging.jmir.org/2024/1/e55132 %U https://doi.org/10.2196/55132 %U http://www.ncbi.nlm.nih.gov/pubmed/38630527 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54172 %T A Smartphone App to Support Self-Management for People Living With Sjögren's Syndrome: Qualitative Co-Design Workshops %A McCallum,Claire %A Campbell,Miglena %A Vines,John %A Rapley,Tim %A Ellis,Jason %A Deary,Vincent %A Hackett,Katie %+ Department of Social Work, Education and Community Wellbeing, Northumbria University, Coach Lane Campus West, Newcastle upon Tyne, NE7 7XA, United Kingdom, 44 191 215 6098, kate.hackett@northumbria.ac.uk %K self-management %K mobile health %K mHealth %K eHealth %K Sjögren's syndrome %K patient participation %K patient involvement %K fatigue %K chronic disease %K focus groups %K complex intervention development %K mobile phone %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sjögren's syndrome (SS) is the second most common autoimmune rheumatic disease, and the range of symptoms includes fatigue, dryness, sleep disturbances, and pain. Smartphone apps may help deliver a variety of cognitive and behavioral techniques to support self-management in SS. However, app-based interventions must be carefully designed to promote engagement and motivate behavior change. Objective: We aimed to explore self-management approaches and challenges experienced by people living with SS and produce a corresponding set of design recommendations that inform the design of an engaging, motivating, and evidence-based self-management app for those living with SS. Methods: We conducted a series of 8 co-design workshops and an additional 3 interviews with participants who were unable to attend a workshop. These were audio recorded, transcribed, and initially thematically analyzed using an inductive approach. Then, the themes were mapped to the Self-Determination Theory domains of competency, autonomy, and relatedness. Results: Participants experienced a considerable demand in the daily work required in self-managing their SS. The condition demanded unrelenting, fluctuating, and unpredictable mental, physical, and social efforts. Participants used a wide variety of techniques to self-manage their symptoms; however, their sense of competency was undermined by the complexity and interconnected nature of their symptoms and affected by interactions with others. The daily contexts in which this labor was occurring revealed ample opportunities to use digital health aids. The lived experience of participants showed that the constructs of competency, autonomy, and relatedness existed in a complex equilibrium with each other. Sometimes, they were disrupted by tensions, whereas on other occasions, they worked together harmoniously. Conclusions: An SS self-management app needs to recognize the complexity and overlap of symptoms and the complexities of managing the condition in daily life. Identifying techniques that target several symptoms simultaneously may prevent users from becoming overwhelmed. Including techniques that support assertiveness and communication with others about the condition, its symptoms, and users’ limitations may support users in their interactions with others and improve engagement in symptom management strategies. For digital health aids (such as self-management apps) to provide meaningful support, they should be designed according to human needs such as competence, autonomy, and relatedness. However, the complexities among the 3 Self-Determination Theory constructs should be carefully considered, as they present both design difficulties and opportunities. %M 38630530 %R 10.2196/54172 %U https://humanfactors.jmir.org/2024/1/e54172 %U https://doi.org/10.2196/54172 %U http://www.ncbi.nlm.nih.gov/pubmed/38630530 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48793 %T User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study %A Wahl,Kate J %A Brooks,Melissa %A Trenaman,Logan %A Desjardins-Lorimer,Kirsten %A Bell,Carolyn M %A Chokmorova,Nazgul %A Segall,Romy %A Syring,Janelle %A Williams,Aleyah %A Li,Linda C %A Norman,Wendy V %A Munro,Sarah %+ Department of Obstetrics and Gynecology, University of British Columbia, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada, 1 4165231923, kate.wahl@cw.bc.ca %K family planning %K abortion %K shared decision-making %K patient decision aid %K qualitative %K evaluation %K Canada %K health equity %D 2024 %7 16.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive—there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. Objective: We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. Methods: We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers’ decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy (“patient” participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. Results: A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. Conclusions: We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making. %M 38625731 %R 10.2196/48793 %U https://www.jmir.org/2024/1/e48793 %U https://doi.org/10.2196/48793 %U http://www.ncbi.nlm.nih.gov/pubmed/38625731 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54214 %T Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach %A Sobrinho,Andressa Crystine da Silva %A Gomes,Grace Angelica de Oliveira %A Bueno Júnior,Carlos Roberto %+ Faculty of Medicine of the University of São Paulo, Bandeirantes Avenue 9000, Ribeirão Preto, 14055-230, Brazil, 55 16988155152, andressa.sobrinho@usp.br %K information and communications technologies %K ICTs %K health care %K digital inclusion %K focus groups %K health promotion %K user %K usability %K health literacy %K digital competencies %K digital skills %K mobile phone %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeirão Prêto, São Paulo, Brazil, and involved 20 older adults of both genders who were aged ≥60 years and enrolled in the Physical Education Program for the Elderly at the University of São Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90% (18/20) of the participants owned smartphones. However, 20% (4/20) of the participants faced installation challenges and 30% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89% to 70.65%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. %M 38619865 %R 10.2196/54214 %U https://formative.jmir.org/2024/1/e54214 %U https://doi.org/10.2196/54214 %U http://www.ncbi.nlm.nih.gov/pubmed/38619865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49574 %T Development and Implementation of an eHealth Oncohematonootric Program: Descriptive, Observational, Prospective Cohort Pilot Study %A Sánchez-Quiñones,Beatriz %A Antón-Maldonado,Cristina %A Ibarra Vega,Nataly %A Martorell Mariné,Isabel %A Santamaria,Amparo %+ Hybrid Hematology Department, University Hospital Vinalopó, Calle Tonico Sansano Mora, 14, Alicante, Elche, 03293, Spain, 34 658981769, masantamaria@vinaloposalud.com %K Nootric app %K oncohematology patient %K physical-nutritional well-being %K multidisciplinary team %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In oncohematology, both the development of the disease and the side effects of antineoplastic treatment often take a toll on patients’ physical and nutritional well-being. In this era of digital transformation, we launched a pioneering project for oncohematologic patients to promote adherence to a healthy lifestyle and improve their physical and nutritional well-being. We aim to achieve this goal by involving doctors and nutritionists through the Nootric app. Objective: This study aims to assess the impact of the use of eHealth tools to facilitate nutrition and well-being in oncohematologic patients. We also aim to determine the usefulness of physical-nutritional management in improving tolerance to chemotherapy treatments within routine clinical practice. Methods: We designed a descriptive, observational, longitudinal, prospective cohort pilot study that included a total of 22 patients from March to May 2022 in the Vinalopó University Hospital. The inclusion criteria were adults over 18 years of age diagnosed with oncohematological pathology in active chemotherapy treatment. An action plan was created to generate alerts between the doctor and the nutritionist. In the beginning, the patients were trained to use the app and received education highlighting the importance of nutrition and physical exercise. Sociodemographic, clinical-biological-analytical (eg, malnutrition index), health care impact, usability, and patient adherence data were collected. Tolerance to chemotherapy treatment and its health care impact were evaluated. Results: We included 22 patients, 11 (50%) female and 11 (50%) male, ranging between 42 and 84 years of age. Among them, 13 (59%) were adherents to the program. The most frequent diseases were lymphoproliferative syndromes (13/22, 59%) and multiple myeloma (4/22, 18%). Moreover, 15 (68%) out of 22 patients received immunochemotherapy, while 7 (32%) out of 22 patients received biological treatment. No worsening of clinical-biological parameters was observed. Excluding dropouts and abandonments (n=9/22, 41%), the adherence rate was 81%, established by calculating the arithmetic mean of the adherence rates of 13 patients. No admission was observed due to gastrointestinal toxicity or discontinuation of treatment related to alterations in physical and nutritional well-being. In addition, only 5.5% of unscheduled consultations were increased due to incidents in well-being, mostly telematic (n=6/103 consultation are unscheduled). Additionally, 92% of patients reported an improvement in their nutritional habits (n=12/13), and up to 45% required adjustment of medical supportive treatment (n=5/11). There were no cases of grade 3 or greater gastrointestinal toxicity. All of this reflects improved tolerance to treatments. Patients reported a satisfaction score of 4.3 out of 5, while professionals rated their satisfaction at 4.8 out of 5. Conclusions: We demonstrated the usefulness of integrating new technologies through a multidisciplinary approach. The Nootric app facilitated collaboration among the medical team, nutritionists, and patients. It enabled us to detect health issues related to physical-nutritional well-being, anticipate major complications, and mitigate potentially avoidable risks. Consequently, there was a decrease in unscheduled visits and admissions related to this condition. %M 38588522 %R 10.2196/49574 %U https://formative.jmir.org/2024/1/e49574 %U https://doi.org/10.2196/49574 %U http://www.ncbi.nlm.nih.gov/pubmed/38588522 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54658 %T Understanding Adolescents’ Experiences With Menstrual Pain to Inform the User-Centered Design of a Mindfulness-Based App: Mixed Methods Investigation Study %A Gagnon,Michelle M %A Brilz,Alexandra R %A Alberts,Nicole M %A Gordon,Jennifer L %A Risling,Tracie L %A Stinson,Jennifer N %+ Department of Psychology and Health Studies, University of Saskatchewan, 9 Campus Drive, Arts 154, Saskatoon, SK, S7N5A2, Canada, 1 306 966 2052, michelle.gagnon@usask.ca %K adolescent health %K endometriosis %K pain management, biopsychosocial %K women’s health %K dysmenorrhea %K thematic analysis %K mHealth %K mobile health %K app %K apps %K applications %K applications %K attitude %K attitudes %K opinion %K opinion %K perception %K perceptions %K perspective %K perspectives %K interest %K intent %K intention %K survey %K surveys %K focus group %K focus groups %K content analysis %K mindfulness %K meditation %K menstrual %K menstruation %K experience %K experiences %K pain %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Digital interventions are increasingly popular for the provision of nonpharmacological pain interventions, but few exist for adolescents with menstrual pain. User-centered design involves incorporating users across phases of digital health intervention design, development, and implementation and leads to improved user engagement and outcomes. A needs assessment is the first step of this approach. Objective: The goal of this study was to conduct a needs assessment to understand menstrual pain management needs and preferences and mindfulness experiences, preferences, and knowledge of adolescents with menstrual pain to inform the future development of an app for managing menstrual pain. Methods: We used an explanatory sequential mixed method design that included a survey followed by focus groups. Adolescents aged 13-17 years completed a survey (n=111) and participated in focus groups (n=16). Data were analyzed using descriptive statistics and thematic content analysis and synthesized to provide specific recommendations based on adolescent responses. Results: Adolescents (n=111) who completed the survey reported a moderate understanding of mindfulness and menstrual pain. Over three-quarters (n=87, 78%) of participants practiced some form of mindfulness and 87% (n=97) of survey participants used nonpharmacological pain management strategies. Teens had a moderate perception that mindfulness could help their menstrual pain (mean 4.51/10, SD 2.45, with higher scores suggesting more interest). Themes were generated related to mindfulness experiences, menstrual pain knowledge and experiences, and app functionality. These themes underscored adolescents’ need for continued support and flexible access to mindfulness activities; their awareness of multiple influences to pain, with potential for further education in this area; and the need for menstrual pain–specific content, along with content relevant to typical day-to-day experiences of adolescents. Conclusions: Adolescents with menstrual pain have an interest in using a mindfulness app for pain but have unique needs that need to be addressed to ensure app engagement and relevance for this population. Concrete recommendations for future app development are provided. %M 38587886 %R 10.2196/54658 %U https://pediatrics.jmir.org/2024/1/e54658 %U https://doi.org/10.2196/54658 %U http://www.ncbi.nlm.nih.gov/pubmed/38587886 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54386 %T The Asthma App as a New Way to Promote Responsible Short-Acting Beta2-Agonist Use in People With Asthma: Results of a Mixed Methods Pilot Study %A van den Berg,Liselot N %A Hallensleben,Cynthia %A Vlug,Lisa AE %A Chavannes,Niels H %A Versluis,Anke %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2300 RC, Netherlands, 31 71 526 57 61, L.N.van_den_Berg@lumc.nl %K asthma %K short-acting beta2-agonist %K SABA overuse %K app %K eHealth %K feasibility %K usability %K mobile phone %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Approximately 262 million people worldwide are affected by asthma, and the overuse of reliever medication—specifically, short-acting beta2-agonist (SABA) overuse—is common. This can lead to adverse health effects. A smartphone app, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation. Objective: This pilot study aims to evaluate the feasibility and usability of the app. The preliminary effects of using the app after 3 months on decreasing asthma symptoms and improving quality of life were examined. Methods: A mixed methods study design was used. Quantitative data were collected using the app. Asthma symptoms (measured using the Control of Allergic Rhinitis and Asthma Test) and the triggers of these symptoms were collected weekly. Quality of life (36-Item Short-Form Health Survey) was assessed at baseline and after 3, 6, and 12 months. User experience (System Usability Scale) was measured at all time points, except for baseline. Furthermore, objective user data were collected, and qualitative interviews, focusing on feasibility and usability, were organized. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology framework. Qualitative data were analyzed using the Framework Method. Results: The baseline questionnaire was completed by 373 participants. The majority were female (309/373, 82.8%), with a mean age of 46 (SD 15) years, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 82.3 (SD 13.2; N=44) at 3 months. The Control of Allergic Rhinitis and Asthma Test score significantly improved at 3 months (18.5) compared with baseline (14.8; β=.189; SE 0.048; P<.001); however, the obtained score still indicated uncontrolled asthma. At 3 months, there was no significant difference in the quality of life. Owing to the high dropout rate, insufficient data were collected at 6 and 12 months and were, therefore, not further examined. User data showed that 335 users opened the app (250/335, 74.6%, were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (7506/13,081, 57.38%). Qualitative data (from a total of 4 participants; n=2, 50% female) showed that the participants found the app acceptable and clear. Three participants stated that gaining insight into asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist. Conclusions: The initial findings regarding the app’s feasibility and usability are encouraging. However, the notable dropout rate underscores the need for a cautious interpretation of the results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices. %M 38574348 %R 10.2196/54386 %U https://humanfactors.jmir.org/2024/1/e54386 %U https://doi.org/10.2196/54386 %U http://www.ncbi.nlm.nih.gov/pubmed/38574348 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e46979 %T Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach %A Dang,Thu Ha %A Wickramasinghe,Nilmini %A Forkan,Abdur Rahim Mohammad %A Jayaraman,Prem Prakash %A Burbury,Kate %A O’Callaghan,Clare %A Whitechurch,Ashley %A Schofield,Penelope %+ Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, John Street, Melbourne, 3122, Australia, 61 422703347, thuhadang@swin.edu.au %K cancer %K behavioral science %K design science research %K digital %K medication adherence %K mobile solution %K Safety and Adherence to Medication and Self-Care Advice in Oncology %K SAMSON %K mobile phone %D 2024 %7 3.4.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Medication nonadherence negatively impacts the health outcomes of people with cancer as well as health care costs. Digital technologies present opportunities to address this health issue. However, there is limited evidence on how to develop digital interventions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving medication adherence. Objective: The objective of this study was to co-design, develop, and preliminarily evaluate an innovative mobile health solution called Safety and Adherence to Medication and Self-Care Advice in Oncology (SAMSON) to improve medication adherence among people with cancer. Methods: Using the 4 cycles and 6 processes of design science research methodology, we co-designed and developed a medication adherence solution for people with cancer. First, we conducted a literature review on medication adherence in cancer and a systematic review of current interventions to address this issue. Behavioral science research was used to conceptualize the design features of SAMSON. Second, we conducted 2 design phases: prototype design and final feature design. Last, we conducted a mixed methods study on patients with hematological cancer over 6 weeks to evaluate the mobile solution. Results: The developed mobile solution, consisting of a mobile app, a web portal, and a cloud-based database, includes 5 modules: medication reminder and acknowledgment, symptom assessment and management, reinforcement, patient profile, and reporting. The quantitative study (n=30) showed that SAMSON was easy to use (21/27, 78%). The app was engaging (18/27, 67%), informative, increased user interactions, and well organized (19/27, 70%). Most of the participants (21/27, 78%) commented that SAMSON’s activities could help to improve their adherence to cancer treatments, and more than half of them (17/27, 63%) would recommend the app to their peers. The qualitative study (n=25) revealed that SAMSON was perceived as helpful in terms of reminding, supporting, and informing patients. Possible barriers to using SAMSON include the app glitches and users’ technical inexperience. Further needs to refine the solution were also identified. Technical improvements and design enhancements will be incorporated into the subsequent iteration. Conclusions: This study demonstrates the successful application of behavioral science research and design science research methodology to design and develop a mobile solution for patients with cancer to be more adherent. The study also highlights the importance of applying rigorous methodologies in developing effective and patient-centered digital intervention solutions. %M 38569178 %R 10.2196/46979 %U https://cancer.jmir.org/2024/1/e46979 %U https://doi.org/10.2196/46979 %U http://www.ncbi.nlm.nih.gov/pubmed/38569178 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48027 %T The Effectiveness of a Cell Phone eHealth App in Changing Knowledge, Stigmatizing Attitudes, and Intention to Seek Help Associated With Obsessive-Compulsive Disorder: Pilot Questionnaire Study %A Chaves,Antonio %A Arnáez,Sandra %A García-Soriano,Gemma %+ Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda Blasco Ibáñez, 21, Valencia, 46010, Spain, 34 963983389, gemma.garcia@uv.es %K obsessive-compulsive disorder %K OCD %K mental health literacy %K stigma %K app %K help-seeking intention %K seek help %K mobile phone %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obsessive-compulsive disorder (OCD) is a disabling disorder associated with high interference in people’s lives. However, patients with OCD either do not seek help or delay seeking help. Research suggests that this could be explained by poor mental health literacy about the disorder and the associated stigma. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a mental health mobile app, esTOCma, developed to improve knowledge about OCD and its treatment, increase help-seeking intention, and reduce stigmatizing attitudes and social distance associated with OCD. Methods: We used preintervention, postintervention, and 3-month follow-up assessments in this single-arm pilot intervention. Overall, 90 participants were recruited from the community using the snowball sampling method. We used esTOCma to defeat the “stigma monster” over the course of 10 missions. The participants completed the sociodemographic information and Obsessive-Compulsive Inventory–Revised at preassessment and an acceptability questionnaire at postassessment. All other measures were completed at the preassessment, postassessment, and 3-month follow-up (ie, the Spanish Mental Illness Stigma Attribution Questionnaire–27, the General Help-Seeking Questionnaire, the Social Distance Scale, and the Mental Health Literacy Questionnaire). Results: Of the 90 participants from the community that were assessed for eligibility, 86% (n=78) were allocated to intervention. Of these 78 participants, 79% (n=62) completed the game and answered the postintervention assessment (completer group). Overall, 69% (43/62) of the participants also completed the 3-month follow-up assessment. The participants completing the study were older (P=.003) and had a higher baseline knowledge of OCD (P=.05). The participants took an average of 13.64 (SD 10.50) days to complete the intervention, including the pre- and postassessments. The participants spent an average of 4.56 (SD 3.33) days completing the 10 missions included in the app. Each mission took a mean of between 2 (SD 3.01) and 9.35 (SD 3.06) minutes. The app was rated as useful or very useful by the vast majority of participants 90% (56/62). Moreover, 90% (56/62) of the participants reported that they had learned or learned a lot, and 98% (61/62) of the participants reported that they would recommend the app to a friend. Repeated measures ANOVA (43/62, 69%) showed that after the intervention participants showed an increased knowledge of mental health and intention to seek help as well as fewer stigmatizing attitudes and less social distance. Conclusions: Preliminary data show that esTOCma is a feasible and acceptable app, and after completing its 10 missions, there is an increase in the understanding of OCD and help-seeking intention along with a decrease in the social stigma and social distance associated with OCD that lasts for at least 3 months. The results support the potential of technology-based interventions to increase the intention to seek help and reduce the stigma associated with OCD. A larger, community-controlled study is also recommended. %M 38551629 %R 10.2196/48027 %U https://mhealth.jmir.org/2024/1/e48027 %U https://doi.org/10.2196/48027 %U http://www.ncbi.nlm.nih.gov/pubmed/38551629 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55742 %T User Friendliness and Perioperative Guidance Benefits of a Cataract Surgery Education App: Randomized Controlled Trial %A Gerbutavicius,Rokas %A Merle,David A %A Wolf,Armin %A Dimopoulos,Spyridon %A Kortuem,Karsten Ulrich %A Kortuem,Friederike Charlotte %+ Department for Ophthalmology, University of Tuebingen, Elfriede-Aulhorn-Str.7, Tuebingen, 72076, Germany, 49 70712988088, rokas.gerbutavicius@med.uni-tuebingen.de %K mHealth %K mobile health %K workflow optimization %K patient satisfaction %K health education %K educational background %K phacoemulsification %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cataract surgeries are among the most performed surgeries worldwide. A thorough patient education is essential to inform patients about the perioperative process and postoperative target results concerning the intraocular lens and objectives for visual outcomes. However, addressing all relevant aspects and questions is time-consuming. Mobile apps can facilitate this process for both patients and physicians and thus be beneficial. However, the success of such an app depends on its user friendliness and acceptance by patients. Objective: This study aimed to evaluate the user friendliness and acceptance of a cataract surgery education app on mobile devices among patients undergoing cataract surgery, the characteristics of patients who benefit the most from app use, and the influence of the app on patient satisfaction with treatment. Methods: All patients who underwent cataract surgery at an ophthalmological practice from August 2020 to July 2021 were invited to participate in this randomized controlled trial. Out of 493 invited patients, 297 (60.2%) were enrolled in this study. Patients were randomized into 3 different groups. Half of the patients were offered to participate in Group 1 with use of the “Patient Journey” app. However, if they decided not to use the app, they were included in Group 2 (app denial). The other half of the patients were included in Group 3 (control) with no use of the app and with information provided conventionally. The app provided general information on the ophthalmological center, surgeons, cataract, and treatment options. Different questionnaires were used in all 3 groups to evaluate satisfaction with the perioperative process. Group 1 evaluated the app. Demographic characteristics, such as age, gender, and educational degree, were assessed. Results: Group 1 included 77 patients (median age 69 years). Group 2 included 61 patients, and their median age was higher (median age 79 years). Group 3 included 159 patients (median age 74 years). There was no difference in satisfaction with the perioperative process and clinic between the 3 groups. Almost all app users appreciated the digital details provided for the organization and the information on the surgery. Age did not play a major role in appreciation of the app. Female patients tended to appreciate the information provided more than male patients. Patients who did not have a higher university degree experienced more benefits from the informational content of the app and were the most satisfied with the information. However, male patients and academics were in general more aware of technology and handled the app more easily. Conclusions: The app showed high user friendliness and acceptance, and could particularly benefit specific patient groups. App users demonstrated a noninferior high satisfaction with the treatment in the ophthalmological center in comparison with patients who were informed about the surgery only conventionally. %M 38551619 %R 10.2196/55742 %U https://formative.jmir.org/2024/1/e55742 %U https://doi.org/10.2196/55742 %U http://www.ncbi.nlm.nih.gov/pubmed/38551619 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49808 %T A Mobile Health App to Support Home-Based Aerobic Exercise in Neuromuscular Diseases: Usability Study %A Veneman,Tim %A Koopman,Fieke Sophia %A Oorschot,Sander %A Koomen,Pien G %A Nollet,Frans %A Voorn,Eric L %+ Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 56 64421, e.l.voorn@amsterdamumc.nl %K neuromuscular disorders %K endurance training %K home-based exercise %K eHealth %K tele-rehabilitation %K app %K exercise %K aerobic exercise %K mhealth %K mobile app %K neuromuscular disease %K usability %D 2024 %7 15.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Home-based aerobic exercise in people with neuromuscular diseases (NMDs) has benefits compared to exercise in the hospital or a rehabilitation center because traveling is often cumbersome due to mobility limitations, and societal costs are lower. Barriers to home-based aerobic exercise include reduced possibilities for monitoring and lack of motivation. To overcome these and other barriers, we developed a mobile health app: Keep on training with ReVi (hereafter referred to as ReVi). Objective: We aimed to determine the usability of the ReVi app. Methods: Patients followed a 4-month, polarized, home-based aerobic exercise program on a cycle or rowing ergometer, with 2 low-intensity sessions and 1 high-intensity session per week supported by the ReVi app. The app collected training data, including heart rate and ratings of perceived exertion, provided real-time feedback on reaching target intensity zones, and enabled monitoring via an online dashboard. Physiotherapists instructed patients on how to use the ReVi app and supervised them during their training program. Patients and physiotherapists separately evaluated usability with self-developed questionnaires, including 9 questions on a 5-point Likert scale, covering the usability elements efficiency, effectiveness, and satisfaction. Results: Twenty-nine ambulatory adult patients (n=19 women; mean age 50.4, SD 14.2 years) with 11 different slowly progressive NMDs participated. Both patients and physiotherapists (n=10) reported that the app, in terms of its efficiency, was easy to use and had a rapid learning curve. Sixteen patients (55%) experienced 1 or more technical issue(s) during the course of the exercise program. In the context of effectiveness, 23 patients (81%) indicated that the app motivated them to complete the program and that it helped them to exercise within the target intensity zones. Most patients (n=19, 70%) and physiotherapists (n=6, 60%) were satisfied with the use of the app. The median attendance rate was 88% (IQR 63%-98%), with 76% (IQR 69%-82%) of time spent within the target intensity zones. Four adverse events were reported, 3 of which were resolved without discontinuation of the exercise program. Conclusions: The usability of the ReVi app was high, despite the technical issues that occurred. Further development of the app to resolve these issues is warranted before broader implementation into clinical practice. %M 38488838 %R 10.2196/49808 %U https://humanfactors.jmir.org/2024/1/e49808 %U https://doi.org/10.2196/49808 %U http://www.ncbi.nlm.nih.gov/pubmed/38488838 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50926 %T Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking %A Anders,Carolin %A Moorthy,Preetha %A Svensson,Laura %A Müller,Julia %A Heinze,Oliver %A Knaup,Petra %A Wallwiener,Markus %A Deutsch,Thomas M %A Le,Thao-Vy %A Weinert,Lina %+ Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 622156 ext 34651, Carolin.Anders@med.uni-heidelberg.de %K mobile health %K mHealth %K usability %K breast cancer %K eye tracking %K user interface %K mixed methods %K mobile phone %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. Objective: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. Methods: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. Results: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app’s content regularly, and self-administration. In contrast to the app’s current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. Conclusions: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients’ feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy. %M 38441959 %R 10.2196/50926 %U https://humanfactors.jmir.org/2024/1/e50926 %U https://doi.org/10.2196/50926 %U http://www.ncbi.nlm.nih.gov/pubmed/38441959 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48883 %T Assessing the Effectiveness of STAPP@Work, a Self-Management Mobile App, in Reducing Work Stress and Preventing Burnout: Single-Case Experimental Design Study %A Demirel,Sevda %A Roke,Yvette %A Hoogendoorn,Adriaan W %A Hoefakker,Jamie %A Hoeberichts,Kirsten %A van Harten,Peter N %+ Expertise Center for Autism Spectrum Disorder, GGz Centraal, Boomgaardweg 12, Almere, 1326 AD, Netherlands, 31 41807329, S.demirel@ggzcentraal.nl %K mental health %K stress %K coping %K burnout %K stress management %K digital intervention %K health promotion %K mobile apps %K mobile health %K mHealth %K mental health professionals %D 2024 %7 29.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited. Objective: This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees. Methods: The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data. Results: After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=–0.38, 95% CI –0.67 to –0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=–0.31, 95% CI –0.51 to –0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment. Conclusions: The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism. %M 38275128 %R 10.2196/48883 %U https://www.jmir.org/2024/1/e48883 %U https://doi.org/10.2196/48883 %U http://www.ncbi.nlm.nih.gov/pubmed/38275128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52337 %T An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation %A Kwa,Zhi Yin %A Li,Jinqiu %A Loh,Dale Lincoln %A Lee,Yang Yang %A Liu,Guangyu %A Zhu,Lixia %A Pikkarainen,Minna %A He,Honggu %A Mali,Vidyadhar Padmakar %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, MD 11, 10 Medical Drive, Singapore, 117597, Singapore, 65 65167448, nurhhg@nus.edu.sg %K circumcision %K self-efficacy %K perioperative anxiety %K postoperative pain %K mobile phone %K postoperative %K pain %K anxiety %K distractions %K distraction %K perioperative %K interview %K interviews %K child %K children %K surgery %K surgical %K recovery %K health outcome %K health outcomes %K pediatric %K pediatrics %K content analysis %K emotional %K mobile health %K app %K apps %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps. Objective: This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers. Methods: Based on the review of the literature and previous studies, Bandura’s self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision. Results: The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis. Conclusions: ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404 %M 38363589 %R 10.2196/52337 %U https://formative.jmir.org/2024/1/e52337 %U https://doi.org/10.2196/52337 %U http://www.ncbi.nlm.nih.gov/pubmed/38363589 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e49549 %T Development of an App for Symptom Management in Women With Breast Cancer Receiving Maintenance Aromatase Inhibitors: Protocol for a Mixed Methods Feasibility Study %A Lund-Jacobsen,Trine %A Schwarz,Peter %A Martino,Gabriella %A Pappot,Helle %A Piil,Karin %+ Department of Endocrinology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 25318056, trine.lund-jacobsen@regionh.dk %K acceptability %K aromatase inhibitors %K breast cancer %K cancer %K chemotherapy %K disease %K feasibility %K inhibitor %K management %K mHealth %K postmenopausal %K psychosocial %K QoL %K quality of life %K radiation therapy %K symptom management %K symptom %K tool %K treatment %K usability %K user-friendliness %D 2024 %7 15.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with postmenopausal nonmetastatic estrogen receptor–positive breast cancer often experience a reduced quality of life after primary treatment. The disease and treatment trajectory consists of surgery followed by chemotherapy or radiation therapy. Upon this, maintenance hormone therapy with an aromatase inhibitor can result in several physical and psychosocial symptoms. Optimal symptom control during maintenance therapy is central to maintaining the patient’s quality of life. Objective: This study aims to (1) develop an electronic symptom management tool for patients with postmenopausal early breast cancer receiving maintenance aromatase inhibitors with an endocrine aspect and (2) assess the feasibility, acceptability, and usability of the pilot version of the Bone@BC app. Furthermore, longitudinally, symptom prevalence and quality of life for patients with postmenopausal nonmetastatic estrogen receptor–positive breast cancer will be explored. Methods: This study follows a multistage research plan. In stage 1, a systematic literature review to establish an overview of aromatase inhibitor–related symptoms reported by postmenopausal women with nonmetastatic estrogen receptor–positive breast cancer will be completed. In stage 2, a comprehensive overview of symptoms related to aromatase inhibitors (letrozole, exemestane, and anastrozole) will be performed (eg, by reviewing medical leaflets and guidelines). In stage 3, an electronic app with a user-friendly Patient Concern Inventory list to comprise symptoms and concerns will be developed. Last, in stage 4, a convergent mixed methods feasibility study of the pilot version of the Bone@BC app will be conducted. A total of 45 patients with postmenopausal nonmetastatic estrogen receptor–positive breast cancer will use the app daily for symptom identification and respond to 6 serial patient-reported outcome measurements for 12 weeks. Finally, semistructured interviews will be performed. The primary outcome includes consent rate, attrition rate, retention rates, technical issues, and adherence, assessed using preestablished criteria on feasibility and a mixed methods approach for exploring acceptability. A patient advisory board consisting of 5 women with breast cancer is recruited to include their perspectives and experiences in the planning, organization, implementation, and dissemination of the research throughout the project. Results: At the time of submitting this paper (January 2024), a total of 23 patients have been included in the stage 2 medical audit over the recruitment period of 3 months (November 2022 to February 2023), and 19 patients have been enrolled in stage 2, the semistructured patient interviews. Conclusions: This protocol describes a study investigating the feasibility, acceptability, and usability of the symptom management tool Bone@BC developed for patients with breast cancer with an endocrine aspect. Trial Registration: ClinicalTrails.gov NCT05367830; https://clinicaltrials.gov/ct2/show/NCT05367830 International Registered Report Identifier (IRRID): DERR1-10.2196/49549 %M 38358787 %R 10.2196/49549 %U https://www.researchprotocols.org/2024/1/e49549 %U https://doi.org/10.2196/49549 %U http://www.ncbi.nlm.nih.gov/pubmed/38358787 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50196 %T A Smartphone Food Record App Developed for the Dutch National Food Consumption Survey: Relative Validity Study %A Ocké,Marga %A Dinnissen,Ceciel Simone %A van den Bogaard,Coline %A Beukers,Marja %A Drijvers,José %A Sanderman-Nawijn,Eline %A van Rossum,Caroline %A Toxopeus,Ido %+ National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, Netherlands, 31 088 689 8989, ceciel.dinnissen@rivm.nl %K relative validity %K smartphone food record %K 24-hour dietary recall %K mobile app %K national food consumption surveys %K smartphone %K food %K food consumption %K app %K diet %K dietary intake %K nutrients %K survey %K mobile phone %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the Dutch National Food Consumption Survey, dietary intake has been assessed since 2003 through 24-hour dietary recalls using the GloboDiet software. A new self-administered smartphone food record app called DitEetIk! was developed for potential use in future surveys. Objective: This study aims to evaluate the data collected using the DitEetIk! app and its relative validity for food group, energy, and nutrient intake compared with the previous dietary assessment method (GloboDiet 24-hour dietary recalls). Methods: A total of 300 participants aged 18 to 79 years were recruited from a consumer panel. Participants were asked to keep a record of their consumption using the DitEetIk! app on 3 nonconsecutive days. Trained dietitians conducted a 24-hour dietary recall interview by telephone using the GloboDiet software (International Agency for Research on Cancer) regarding 1 of 3 DitEetIk! recording days. Nutrient intake was calculated using the NEVO database (version 2021/7.0). Relative validity was studied by comparing data from GloboDiet 24-hour dietary recalls and the DitEetIk app for the same day. Participants with implausible records, defined as days with energy intake of <0.6 or >3.0 basal metabolic rate, were excluded from the analyses. For 19 food groups and 29 nutrients, differences in median intake were assessed using the Wilcoxon signed rank test, and Spearman correlation coefficients were calculated. Bland-Altman plots with mean differences and 95% limits of agreement were created for energy intake and the contribution to energy intake from fat, carbohydrates, and protein. Results: A total of 227 participants completed a combination of a DitEetIk! app recording day and a 24-hour dietary recall interview for the same day. Of this group, 211 participants (n=104, 49.3% men and n=107, 50.7% women) had plausible recording days. Of all recorded food items, 12.8% (114/894) were entered via food barcode scanning, and 18.9% (169/894) were searched at the brand level. For 31% (5/16) of the food groups, the median intake assessed using the DitEetIk! app was >10% lower than that assessed using 24-hour dietary recalls; this was the case for fruit (P=.005), added fats (P=.001), milk and milk products (P=.02), cereal products (P=.01), and sauces (P<.001). This was also the case for 14% (4/29) of the nutrients (all P<.001). Regarding mean intake, differences were generally smaller. Regarding energy intake, the mean difference and 95% limits of agreement were 14 kcal (−1096 to 1124). Spearman correlation coefficients between intake assessed using the DitEetIk! app and 24-hour dietary recalls ranged from 0.48 to 0.88 (median 0.78) for food groups and from 0.58 to 0.90 (median 0.72) for nutrients. Conclusions: Compared with GloboDiet 24-hour dietary recalls, the DitEetIk! app assessed similar mean energy intake levels but somewhat lower median intake levels for several food groups and nutrients. %M 38335009 %R 10.2196/50196 %U https://mhealth.jmir.org/2024/1/e50196 %U https://doi.org/10.2196/50196 %U http://www.ncbi.nlm.nih.gov/pubmed/38335009 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e47177 %T SOMAScience: A Novel Platform for Multidimensional, Longitudinal Pain Assessment %A Gunsilius,Chloe Zimmerman %A Heffner,Joseph %A Bruinsma,Sienna %A Corinha,Madison %A Cortinez,Maria %A Dalton,Hadley %A Duong,Ellen %A Lu,Joshua %A Omar,Aisulu %A Owen,Lucy Long Whittington %A Roarr,Bradford Nazario %A Tang,Kevin %A Petzschner,Frederike H %+ Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Carney Institute for Brain Science, 4th floor, 164 Angell Street, Providence, RI, 02912, United States, 1 401 863 6272, chloe_zimmerman@brown.edu %K acute pain %K acute-chronic pain transition %K chronic pain %K clinical outcome measurement %K digital health %K ecological momentary assessment %K EMA %K ESM %K experience sampling methodology %K mHealth %K mobile health %K pain management %K pain self-management %K patient reported outcomes %K smartphone app %D 2024 %7 12.1.2024 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Chronic pain is one of the most significant health issues in the United States, affecting more than 20% of the population. Despite its contribution to the increasing health crisis, reliable predictors of disease development, progression, or treatment outcomes are lacking. Self-report remains the most effective way to assess pain, but measures are often acquired in sparse settings over short time windows, limiting their predictive ability. In this paper, we present a new mobile health platform called SOMAScience. SOMAScience serves as an easy-to-use research tool for scientists and clinicians, enabling the collection of large-scale pain datasets in single- and multicenter studies by facilitating the acquisition, transfer, and analysis of longitudinal, multidimensional, self-report pain data. Data acquisition for SOMAScience is done through a user-friendly smartphone app, SOMA, that uses experience sampling methodology to capture momentary and daily assessments of pain intensity, unpleasantness, interference, location, mood, activities, and predictions about the next day that provide personal insights into daily pain dynamics. The visualization of data and its trends over time is meant to empower individual users’ self-management of their pain. This paper outlines the scientific, clinical, technological, and user considerations involved in the development of SOMAScience and how it can be used in clinical studies or for pain self-management purposes. Our goal is for SOMAScience to provide a much-needed platform for individual users to gain insight into the multidimensional features of their pain while lowering the barrier for researchers and clinicians to obtain the type of pain data that will ultimately lead to improved prevention, diagnosis, and treatment of chronic pain. %M 38214952 %R 10.2196/47177 %U https://mhealth.jmir.org/2024/1/e47177 %U https://doi.org/10.2196/47177 %U http://www.ncbi.nlm.nih.gov/pubmed/38214952 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e45854 %T A Behaviorally Informed Mobile App to Improve the Nutritional Quality of Grocery Shopping (SwapSHOP): Feasibility Randomized Controlled Trial %A Piernas,Carmen %A Lee,Charlotte %A Hobson,Alice %A Harmer,Georgina %A Payne Riches,Sarah %A Noreik,Michaela %A Jebb,Susan A %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, 200 Woodstock Rd, Oxford, OX26GG, United Kingdom, 44 07752599266, carmen.piernas-sanchez@phc.ox.ac.uk %K swaps %K mobile app %K supermarket %K food purchases %K diet %K randomized controlled trial %K mobile phone %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Interventions targeting the nutritional quality of grocery shopping have the potential to help improve diet and health outcomes. Objective: This study aims to assess the feasibility and acceptability of receiving advice on healthier food purchases through SwapSHOP, a behaviorally informed smartphone app that allows users to scan barcodes of grocery products from the United Kingdom, providing nutritional information and personalized swap suggestions to encourage healthier purchases. Methods: We randomized adult volunteers in a 6-arm parallel-group controlled feasibility trial. Participants used the SwapSHOP app to record their grocery shopping during a 2-week run-in period and were individually randomized in a 3:1 ratio to either intervention or control arms within 3 strata related to a nutrient of concern of their choice: saturated fat (SFA), sugar, or salt. Participants randomized to the intervention received the SwapSHOP app with a healthier swap function, goal setting, and personalized feedback. Participants in the control group were instructed to use a simpler version of the app to log all their food purchases without receiving any guidance or advice. The primary outcome was the feasibility of progression to a full trial, including app use and follow-up rates at 6 weeks. The secondary outcomes included other feasibility outcomes, process and qualitative measures, and exploratory effectiveness outcomes to assess changes in the nutrient content of the purchased foods. Results: A total of 112 participants were randomized into 3 groups: SFA (n=38 intervention and n=13 control), sugar (n=40 intervention and n=15 control), and salt (n=5 intervention and n=1 control, not analyzed). The 2 progression criteria were met for SFA and sugar: 81% (30/37) and 87% (34/39) of intervention participants in the SFA and sugar groups, respectively, used the app to obtain healthier swaps, and 89% (68/76) of intervention participants and 96% (23/24) of control participants completed follow-up by scanning all purchases over the follow-up period. The process and qualitative outcomes suggested that the intervention was acceptable and has the potential to influence shopping behaviors. There were reductions of −0.56 g per 100 g (95% CI −1.02 to −0.19) in SFA and −1 g per 100 g (95% CI −1.97 to −0.03) in total sugars across all food purchases in the intervention groups. Conclusions: People were willing to use the SwapSHOP app to help reduce sugar and SFA (but not salt) in their grocery shopping. Adherence and follow-up rates suggest that a full trial is feasible. Given the suggestive evidence indicating that the intervention resulted in reductions in sugars and SFA, a definitive trial is necessary to target improvements in health outcomes. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN13022312; https://doi.org/10.1186/ISRCTN13022312 %M 38206671 %R 10.2196/45854 %U https://mhealth.jmir.org/2024/1/e45854 %U https://doi.org/10.2196/45854 %U http://www.ncbi.nlm.nih.gov/pubmed/38206671 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46284 %T Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care After Surgical Abortion (the FACTS Study Phase 3): Mixed Methods Prospective Pilot Study %A Gill,Roopan %A Ogilvie,Gina %A Norman,Wendy V %A Fitzsimmons,Brian %A Maher,Ciana %A Renner,Regina %+ Department of Obstetrics and Gynecology, University of Toronto, 123 Edward Street, Suite 1200, Toronto, ON, M5G1E2, Canada, 1 4169782216, roopan.gill@gmail.com %K mobile health %K mHealth %K digital health %K abortion %K human-centered design %K sexual and reproductive health %K qualitative research %K mixed methods %D 2024 %7 9.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In Canada, 1 in 3 women and people of gestational age undergo an abortion in their lifetime. Despite the liberal legal context, barriers continue to exist for women and people who can become pregnant to access this service. Objective: This study aims to (1) conduct a pilot study to demonstrate the feasibility and acceptability of myPostCare to support follow-up care after a procedural abortion; (2) use the findings to understand whether myPostCare has the potential to improve contraceptive behavior and knowledge, emotional well-being, and sexual health knowledge; and (3) develop a better understanding of how innovative mobile solutions can support integrative health programs in British Columbia with the goal of expanding to other sites across Canada. Methods: People of gestational age (aged 14-45 y) who underwent a procedural abortion were recruited from 2 urban abortion facilities in British Columbia. The participants completed a baseline quantitative survey and were provided access to myPostCare for up to 30 days. A follow-up quantitative survey was sent via email on day 30. Qualitative interviews were conducted to explore user satisfaction and usability of myPostCare. Responses to the survey questions were summarized using descriptive statistics, and the system usability scale (SUS) was scored according to the instructions. A secure analytics platform was implemented to obtain data on the overall use of the website by users. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the Women’s and Children’s Research Ethics Board. Results: Overall, 62 participants were recruited (average age 30 y); 40% (25/62) of the participants completed the exit surveys, and 24% (6/25) consented to participate in the semistructured interviews; 40 participants had undergone an immediate postabortion intrauterine device (IUD) insertion, and 22 did not have an IUD inserted. Participants were satisfied with myPostCare. The SUS average score was 81.5 (SD 9.7; median 82.5, IQR 77.5-87.5), indicating high usability of the tool. Overall, 88% (22/25) of the participants changed their contraceptive method to an IUD. Web-based analytics demonstrated that there were 61 unique visitors to the site, and the top pages visited were Postprocedure Care, Emotional Well-Being, and Contraception Explorer. The longest time spent on the website was 56 minutes. The overall email open rate was 80%, with a click rate of 36%. Conclusions: This study demonstrates that communities and individuals are important collaborators in developing a mobile innovation that facilitates access to high-quality patient-centered abortion care. Through the cocreation process, a digital platform such as myPostCare highlighted a gap in abortion care in Canada, particularly around follow-up support after a procedural abortion. %M 38194252 %R 10.2196/46284 %U https://formative.jmir.org/2024/1/e46284 %U https://doi.org/10.2196/46284 %U http://www.ncbi.nlm.nih.gov/pubmed/38194252 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50293 %T Dissemination Strategies for mHealth Apps: Systematic Review %A Moungui,Henri Claude %A Nana-Djeunga,Hugues Clotaire %A Anyiang,Che Frankline %A Cano,Mireia %A Ruiz Postigo,Jose Antonio %A Carrion,Carme %+ Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 672192283, henrimoungui@yahoo.fr %K mobile health %K mHealth %K mobile health apps %K mHealth apps %K dissemination %K marketing strategies %K digital marketing %K engagement %K onboarding %K systematic review %K systematic %K market %K marketing %K app %K apps %K adoption %K consumer %K mobile phone %D 2024 %7 5.1.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Among the millions of mobile apps in existence, thousands fall under the category of mobile health (mHealth). Although the utility of mHealth apps has been demonstrated for disease diagnosis, treatment data management, and health promotion strategies, to be effective they must reach and be used by their target audience. An appropriate marketing strategy can ensure that apps reach potential users and potentially convert them to actual users. Such a strategy requires definitions of target end users, communication channels, and advertising content, as well as a timeline for effectively reaching and motivating end users to adopt and maintain engagement with the mHealth app. Objective: The aim of this study was to identify strategies and elements that ensure that end users adopt and remain engaged with mHealth apps. Methods: A systematic search of the PubMed, PsycINFO, Scopus, and CINAHL databases was conducted for suitable studies published between January 1, 2018, and September 30, 2022. Two researchers independently screened studies for inclusion, extracted data, and assessed the risk of bias. The main outcome was dissemination strategies for mHealth apps. Results: Of the 648 papers retrieved from the selected databases, only 10 (1.5%) met the inclusion criteria. The marketing strategies used in these studies to inform potential users of the existence of mHealth apps and motivate download included both paid and unpaid strategies and used various channels, including social media, emails, printed posters, and face-to-face communication. Most of the studies reported a combination of marketing concepts used to advertise their mHealth apps. Advertising messages included instructions on where and how to download and install the apps. In most of the studies (6/10, 60%), instructions were oriented toward how to use the apps and maintain engagement with a health intervention. The most frequently used paid marketing platform was Facebook Ads Manager (2/10, 20%). Advertising performance was influenced by many factors, including but not limited to advertising content. In 1 (10%) of the 10 studies, animated graphics generated the greatest number of clicks compared with other image types. The metrics used to assess marketing strategy effectiveness were number of downloads; nonuse rate; dropout rate; adherence rate; duration of app use; and app usability over days, weeks, or months. Additional indicators such as cost per click, cost per install, and clickthrough rate were mainly used to assess the cost-effectiveness of paid marketing campaigns. Conclusions: mHealth apps can be disseminated via paid and unpaid marketing strategies using various communication channels. The effects of these strategies are reflected in download numbers and user engagement with mHealth apps. Further research could provide guidance on a framework for disseminating mHealth apps and encouraging their routine use. %M 38180796 %R 10.2196/50293 %U https://mhealth.jmir.org/2024/1/e50293 %U https://doi.org/10.2196/50293 %U http://www.ncbi.nlm.nih.gov/pubmed/38180796 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e47755 %T Usability of an App for Medical History Taking in General Practice From the Patients’ Perspective: Cross-Sectional Study %A Albrink,Klara %A Schröder,Dominik %A Joos,Carla %A Müller,Frank %A Noack,Eva Maria %+ Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany, 49 551 39 65745, evamaria.noack@med.uni-goettingen.de %K digitization %K application software %K usability %K mHealth %K history of present illness %K medical history taking %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A future shortage of physicians, especially in general practice, will result in an increasing workload for health care providers as a whole. Therefore, it is important to optimize patient-encounter processes to increase time efficiency related to visits. Utilizing digital tools to record patients’ medical histories prior to a consultation offers great potential to achieve this goal. The collected information can be stored into the practice’s electronic medical record, allowing for the general practitioner to review structured information of the patients’ complaints and related medical history beforehand, thereby saving time during the encounter. However, the low usability of new digital developments in this setting often hinders implementation. Objective: The aim of this study was to evaluate the usability of an app designed for medical history taking in general practice to capture the patients’ perspective. Methods: Between November 2021 and January 2022, we recruited 406 patients with acute complaints in one out-of-hour urgent care and seven general practice clinics. These study participants used the app during their waiting time and subsequently assessed its usability by completing the System Usability Scale (SUS), a robust and well-established 10-question survey measuring the perceived usability of products and technologies. Additionally, we collected general participant information, including age, sex, media usage, health literacy, and native language. Descriptive and inferential statistics were applied to identify patient characteristics associated with low or high SUS scores. Results: We analyzed data from 397 patients (56.7% female, 43.3% male). The mean total SUS score was 77.8 points; 54.4% (216/397) of participants had SUS scores of 80 points or higher, indicating high usability of the app. In a multiple linear regression predicting SUS score, male sex and higher age (65 years or older) were significantly negatively associated with the SUS score. Conversely, a higher health literacy score and German as the native language were significantly positively associated with the SUS score. Conclusions: Usability testing based on the SUS anticipates successful implementation of the app. However, not all patients will easily adapt to utilizing the app, as exemplified by the participants of older age in this study who reported lower perceived usability. Further research should examine these groups of people, identify the exact problems in operating such an app, and provide targeted solutions. Trial Registration: German Clinical Trials Register World Health Organization Trial Registration Data Set DRKS00026659; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00026659 %M 38180798 %R 10.2196/47755 %U https://humanfactors.jmir.org/2024/1/e47755 %U https://doi.org/10.2196/47755 %U http://www.ncbi.nlm.nih.gov/pubmed/38180798 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e47361 %T Exploring the Potential of a Behavior Theory–Informed Digital Intervention for Infant Fall Prevention: Mixed Methods Longitudinal Study %A Cooray,Nipuna %A Ho,Catherine %A Bestman,Amy %A Adams,Susan %A Nassar,Natasha %A Keay,Lisa %A Brown,Julie %+ The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, 2000, Australia, 61 468311723, ncooray@georgeinstitute.org.au %K child injury %K digital behavior change interventions %K user experience %K falls %K infant fall %K injury %K mobile app %K digital intervention %K users %K mixed methods longitudinal study %K behavior %K development %K fall risk %K fall prevention %K acceptability %K app %K children %K internet %K parents %K maternal, paternal %K accidents %K infancy %K infant %K accidental fall %K accidental falls %K infant behavior %K longitudinal design %K mixed methods %K parent %K mobile phone %D 2024 %7 3.1.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Falls are the most common hospitalized injury mechanism in children aged ≤1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success. Objective: This study aims to evaluate a behavior theory–informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children. Methods: Parents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention. Results: A total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. Conclusions: This study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app. %M 38170580 %R 10.2196/47361 %U https://pediatrics.jmir.org/2024/1/e47361 %U https://doi.org/10.2196/47361 %U http://www.ncbi.nlm.nih.gov/pubmed/38170580 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49353 %T User-Centered Design and Usability of a Culturally Adapted Virtual Survivorship Care App for Chinese Canadian Prostate Cancer Survivors: Qualitative Descriptive Study %A Young,Karen %A Xiong,Ting %A Lee,Rachel %A Banerjee,Ananya Tina %A Leslie,Myles %A Ko,Wellam Yu %A Pham,Quynh %+ Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto General Hospital, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 (416) 340 4800 ext 4765, q.pham@uhn.ca %K digital health %K virtual care %K digital therapeutics %K prostate cancer %K cancer survivorship %K user-centred design %K usability %K supportive care %K cultural adaptation %K Chinese Canadians %D 2024 %7 1.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cultural adaptations of digital health innovations are a growing field. However, digital health innovations can increase health inequities. While completing exploratory work for the cultural adaptation of the Ned Clinic virtual survivorship app, we identified structural considerations that provided a space to design digitally connected and collective care. Objective: This study used a community-based participatory research and user-centered design process to develop a cultural adaptation of the Ned Clinic app while designing to intervene in structural inequities. Methods: The design process included primary data collection and qualitative analysis to explore and distill design principles, an iterative design phase with a multidisciplinary team, and a final evaluation phase with participants throughout the design process as a form of member checking and validation. Results: Participants indicated that they found the final adapted prototype to be acceptable, appropriate, and feasible for their use. The changes made to adapt the prototype were not specifically culturally Chinese. Instead, we identified ways to strengthen connections between the survivor and their providers; improve accessibility to resources; and honor participants’ desires for relationality, accountability, and care. Conclusions: We grounded the use of user-centered design to develop a prototype design that supports the acts of caring through digital technology by identifying and designing to resist structures that create health inequities in the lives of this community of survivors. By designing for collective justice, we can provide accessible, feasible, and relational care with digital health through the application of Indigenous and Black feminist ways of being and knowing. %M 38163295 %R 10.2196/49353 %U https://humanfactors.jmir.org/2024/1/e49353 %U https://doi.org/10.2196/49353 %U http://www.ncbi.nlm.nih.gov/pubmed/38163295 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48335 %T Preferences in the Willingness to Download an mHealth App: Discrete Choice Experimental Study in Spain, Germany, and the Netherlands %A Folkvord,Frans %A Bol,Nadine %A Stazi,Giacomo %A Peschke,Lutz %A Lupiáñez-Villanueva,Francisco %+ Tilburg School of Humanities and Digital Sciences, Tilburg University, Warrandelaan, Tilburg, 5037 AB, Netherlands, 31 682240480, fransfolkvord@gmail.com %K mHealth adoption %K discrete choice task %K mobile apps %K self-monitoring %K willingness %K mobile health app %K mobile app %K mobile health %K mHealth %K adoption %K mHealth tools %K health care cost %K effectiveness %K mobile phone %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the adoption of mHealth is low, and only a limited number of studies have examined the intention to download mHealth apps. Objective: In this study, we investigated individuals’ preferences in the adoption of a health app. Methods: We conducted a discrete choice experimental study in 3 countries (Spain: n=800, Germany: n=800, and the Netherlands: n=416) with 4 different attributes and levels (ie, price: €1.99 vs €4.99 [a currency exchange rate of €1=US $1.09 is applicable] vs for free, data protection: data protection vs no information, recommendation: patients’ association vs doctors, and manufacturer: medical association vs pharmaceutical company). Participants were randomly assigned. For the analyses, we used the conditional logistic model separately for each country. Results: The results showed that price and data protection were considered important factors that significantly increased the probability to download an mHealth app. In general, the source of the recommendation and the manufacturer affected the probability to download the mHealth app less. However, in Germany and the Netherlands, we found that if the app was manufactured by a pharmaceutical company, the probability to download the mHealth app decreased. Conclusions: mHealth tools are highly promising to reduce health care costs and increase the effectiveness of traditional health interventions and therapies. Improving data protection, reducing costs, and creating sound business models are the major driving forces to increase the adoption of mHealth apps in the future. It is thereby essential to create trustworthy standards for mobile apps, whereby prices, legislation concerning data protection, and health professionals can have a leading role to inform the potential consumers. %M 38145470 %R 10.2196/48335 %U https://formative.jmir.org/2023/1/e48335 %U https://doi.org/10.2196/48335 %U http://www.ncbi.nlm.nih.gov/pubmed/38145470 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46910 %T Mobile Prenatal Education and Its Impact on Reducing Adverse Pregnancy Outcomes: Retrospective Real-World Study %A Hao,Jie %A Yang,Lin %A Wang,Yaxin %A Lan,Yushan %A Xu,Xiaowei %A Wang,Ziyang %A Li,Zanmei %A Ma,Liangkun %A Li,Jiao %A Zhang,Suhan %A Sun,Yin %+ Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China, 86 10 69151305, goldhill@163.com %K adverse pregnancy outcome %K mobile prenatal education %K pregnancy %K real-world study %K retrospective study %D 2023 %7 20.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pregnancy is a pivotal phase in a woman’s life, demanding special attention to ensure maternal and fetal health. Prenatal education plays a vital role in promoting healthy pregnancies and reducing adverse outcomes for pregnant women. Mobile prenatal education programs have gained traction due to their accessibility and timeliness, especially in light of finite health care resources and the constraints imposed by the COVID-19 pandemic. Objective: This study aims to develop and evaluate the effectiveness of a mobile-based prenatal education program in improving pregnancy outcomes. Methods: We developed a mobile-based prenatal education curriculum in collaboration with a multidisciplinary maternal care team from Peking Union Medical College Hospital (PUMCH) in Beijing, China. Data were retrospectively collected from 1941 pregnant women who had registered for the PUMCH mobile prenatal education program and subsequently delivered at PUMCH between May 2021 and August 2022. The study compared pregnancy outcomes between the completing group, which were pregnant women who had completed at least 1 course, and the noncompleting group. We also analyzed differences among course topics within the completing group and assessed course topic popularity among pregnant women. Results: The PUMCH mobile prenatal education curriculum consists of 436 courses across 9 topics. Out of the participants, a total of 1521 did not complete any courses, while 420 completed at least 1 course. Compared with the noncompleting group, pregnant women who completed courses exhibited a significant reduction in the risk of gestational diabetes mellitus, induced abortion, postpartum infection, fetal intrauterine distress, and neonatal malformation. Among those in the completing group, a total of 86% (361/420) started course completion during the first and second trimesters. Furthermore, completing courses related to topics of pregnancy psychology and pregnancy nutrition was associated with reduced risks of premature rupture of membranes and small for gestational age infants, respectively. Pregnancy psychology and postpartum recovery were the preferred topics among pregnant women. Conclusions: The study demonstrates the potential of mobile-based prenatal education programs in improving pregnancy outcomes and supporting health care providers in delivering effective prenatal education. The rise of mobile prenatal education presents an opportunity to improve maternal and child health outcomes. Further research and broader implementation of such programs are warranted to continually improve maternal and child health. %M 38117555 %R 10.2196/46910 %U https://mhealth.jmir.org/2023/1/e46910 %U https://doi.org/10.2196/46910 %U http://www.ncbi.nlm.nih.gov/pubmed/38117555 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41974 %T Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopedic Specialist Care: Co-Design Study %A Tacey,Alexander %A Behne,Jack %A Patten,Rhiannon K %A Ngo,Minh Truc %A Thomas,Rees %A Ancilleri,Jessica %A Bone,Chelsea %A Paredes Castro,Angela %A McCarthy,Helen %A Harkin,Katherine %A Gilmartin-Thomas,Julia FM %A Takla,Amir %A Downie,Calum %A Mulcahy,Jane %A Ball,Michelle %A Sharples,Jenny %A Dash,Sarah %A Lawton,Amy %A Wright,Breanna %A Sleeth,Peter %A Kostecki,Tina %A Sonn,Christopher %A McKenna,Michael J %A Apostolopoulos,Vasso %A Lane,Rebecca %A Said,Catherine M %A De Gori,Mary %A McAinch,Andrew %A Tran,Phong %A Levinger,Itamar %A Parker,Alexandra %A Woessner,Mary N %A Pascoe,Michaela %+ Institute for Health and Sport (iHeS), Victoria University, Ballarat Road, Footscray, Melbourne, 3011, Australia, 61 421 692 161, mary.woessner@vu.edu.au %K osteoarthritis %K web intervention %K eHealth %K orthopedic waitlist %K human-centered design %K self-management %K knee pain %K hip pain %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care. Objective: This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. Methods: The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63%; male: n=6, 38%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64%; male: n=4, 36%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80%; male: n=3, 20%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility. Results: Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category. Conclusions: Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial. %M 38064257 %R 10.2196/41974 %U https://formative.jmir.org/2023/1/e41974 %U https://doi.org/10.2196/41974 %U http://www.ncbi.nlm.nih.gov/pubmed/38064257 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46718 %T Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study %A Peven,Kimberly %A Wickham,Aidan P %A Wilks,Octavia %A Kaplan,Yusuf C %A Marhol,Andrei %A Ahmed,Saddif %A Bamford,Ryan %A Cunningham,Adam C %A Prentice,Carley %A Meczner,András %A Fenech,Matthew %A Gilbert,Stephen %A Klepchukova,Anna %A Ponzo,Sonia %A Zhaunova,Liudmila %+ Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, United Kingdom, 44 60396823, a_wickham@flo.health %K women's health %K symptom checkers %K symptom checker %K digital health %K chatbot %K accuracy %K eHealth apps %K mobile phone %K mobile health %K mHealth %K mobile health app %K polycystic ovary syndrome %K gynecology %K digital health tool %K endometriosis %K uterus %K uterine %K uterine fibroids %K vignettes %K clinical vignettes %D 2023 %7 5.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. Objective: This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. Methods: Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. Results: A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS. Conclusions: The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways. %M 38051574 %R 10.2196/46718 %U https://mhealth.jmir.org/2023/1/e46718 %U https://doi.org/10.2196/46718 %U http://www.ncbi.nlm.nih.gov/pubmed/38051574 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51423 %T User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study %A Pozuelo,Julia R %A Moffett,Bianca D %A Davis,Meghan %A Stein,Alan %A Cohen,Halley %A Craske,Michelle G %A Maritze,Meriam %A Makhubela,Princess %A Nabulumba,Christine %A Sikoti,Doreen %A Kahn,Kathleen %A Sodi,Tholene %A , %A van Heerden,Alastair %A O’Mahen,Heather A %+ Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, 641 Huntington Avenue, Boston, MA, 02115, United States, 1 617 432 1707, julia_ruizpozuelo@hms.harvard.edu %K depression %K adolescents %K mental health app %K behavioral activation %K user-centered design %K low- and middle-income countries %K mobile phone %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. Objective: This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. Methods: An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. Results: A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules (“episodes”) played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. Conclusions: The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention’s feasibility, acceptability, and efficacy in reducing depressive symptoms. %M 38032691 %R 10.2196/51423 %U https://formative.jmir.org/2023/1/e51423 %U https://doi.org/10.2196/51423 %U http://www.ncbi.nlm.nih.gov/pubmed/38032691 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41551 %T Predictive Dispatch of Volunteer First Responders: Algorithm Development and Validation %A Khalemsky,Michael %A Khalemsky,Anna %A Lankenau,Stephen %A Ataiants,Janna %A Roth,Alexis %A Marcu,Gabriela %A Schwartz,David G %+ Department of Management, Hadassah Academic College, ha-Neviim 37, Jerusalem, 9101001, Israel, 972 26291941, michaelkh@hac.ac.il %K volunteer %K emergency %K dispatch %K responder %K smartphone %K emergency response %K smartphone-based apps %K mobile phone apps %K first responders %K medical emergency %K dispatch algorithms %K dispatch decisions %K dispatch prediction %K smartphone app %K decision-making %K algorithm %K mobile health %K mHealth intervention %K mobile phone %D 2023 %7 28.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based emergency response apps are increasingly being used to identify and dispatch volunteer first responders (VFRs) to medical emergencies to provide faster first aid, which is associated with better prognoses. Volunteers’ availability and willingness to respond are uncertain, leading in recent studies to response rates of 17% to 47%. Dispatch algorithms that select volunteers based on their estimated time of arrival (ETA) without considering the likelihood of response may be suboptimal due to a large percentage of alerts wasted on VFRs with shorter ETA but a low likelihood of response, resulting in delays until a volunteer who will actually respond can be dispatched. Objective: This study aims to improve the decision-making process of human emergency medical services dispatchers and autonomous dispatch algorithms by presenting a novel approach for predicting whether a VFR will respond to or ignore a given alert. Methods: We developed and compared 4 analytical models to predict VFRs’ response behaviors based on emergency event characteristics, volunteers’ demographic data and previous experience, and condition-specific parameters. We tested these 4 models using 4 different algorithms applied on actual demographic and response data from a 12-month study of 112 VFRs who received 993 alerts to respond to 188 opioid overdose emergencies. Model 4 used an additional dynamically updated synthetic dichotomous variable, frequent responder, which reflects the responder’s previous behavior. Results: The highest accuracy (260/329, 79.1%) of prediction that a VFR will ignore an alert was achieved by 2 models that used events data, VFRs’ demographic data, and their previous response experience, with slightly better overall accuracy (248/329, 75.4%) for model 4, which used the frequent responder indicator. Another model that used events data and VFRs’ previous experience but did not use demographic data provided a high-accuracy prediction (277/329, 84.2%) of ignored alerts but a low-accuracy prediction (153/329, 46.5%) of responded alerts. The accuracy of the model that used events data only was unacceptably low. The J48 decision tree algorithm provided the best accuracy. Conclusions: VFR dispatch has evolved in the last decades, thanks to technological advances and a better understanding of VFR management. The dispatch of substitute responders is a common approach in VFR systems. Predicting the response behavior of candidate responders in advance of dispatch can allow any VFR system to choose the best possible response candidates based not only on ETA but also on the probability of actual response. The integration of the probability to respond into the dispatch algorithm constitutes a new generation of individual dispatch, making this one of the first studies to harness the power of predictive analytics for VFR dispatch. Our findings can help VFR network administrators in their continual efforts to improve the response times of their networks and to save lives. %M 38015602 %R 10.2196/41551 %U https://mhealth.jmir.org/2023/1/e41551 %U https://doi.org/10.2196/41551 %U http://www.ncbi.nlm.nih.gov/pubmed/38015602 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e48040 %T Development and Promotion of an mHealth App for Adolescents Based on the European Code Against Cancer: Retrospective Cohort Study %A Mallafré-Larrosa,Meritxell %A Papi,Ginevra %A Trilla,Antoni %A Ritchie,David %+ Association of European Cancer Leagues, Chaussée de Louvain 479, Brussels, 1030, Belgium, 32 2 256 2000, mmallafre7@gmail.com %K adolescent health %K cancer prevention %K digital health %K ECAC %K European Code Against Cancer %K health promotion %K mHealth %K mobile app %K mobile health %K NCD %K noncommunicable disease %K primary prevention %D 2023 %7 28.11.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Mobile health technologies, underpinned by scientific evidence and ethical standards, exhibit considerable promise and potential in actively engaging consumers and patients while also assisting health care providers in delivering cancer prevention and care services. The WASABY mobile app was conceived as an innovative, evidence-based mobile health tool aimed at disseminating age-appropriate messages from the European Code Against Cancer (ECAC) to adolescents across Europe. Objective: This study aims to assess the outcomes of the design, development, and promotion of the WASABY app through a 3-pronged evaluation framework that encompasses data on social media promotion, app store traffic, and user engagement. Methods: The WASABY app’s content, cocreated with cancer-focused civil society organizations across 6 European countries, drew upon scientific evidence from the ECAC. The app’s 10 modules were designed using the health belief model and a gamification conceptual framework characterized by spaced repetition learning techniques, refined through 2 rounds of testing. To evaluate the effectiveness of the app, we conducted a retrospective cohort study using the WASABY app’s user database registered from February 4 to June 30, 2021, using a 3-pronged assessment framework: social media promotion, app store traffic, and user engagement. Descriptive statistics and association analyses explored the relationship between sociodemographic variables and user performance analytics. Results: After extensive promotion on various social media platforms and subsequent traffic to the Apple App and Google Play stores, a sample of 748 users aged between 14 and 19 years was included in the study cohort. The selected sample exhibited a mean age of 16.08 (SD 1.28) years and was characterized by a predominant representation of female users (499/748, 66.7%). Most app users identified themselves as nonsmokers (689/748, 92.1%), reported either no or infrequent alcohol consumption (432/748, 57.8% and 250/748, 33.4%, respectively), and indicated being physically active for 1 to 5 hours per week (505/748, 67.5%). In aggregate, the app’s content garnered substantial interest, as evidenced by 40.8% (305/748) of users visiting each of the 10 individual modules. Notably, sex and smoking habits emerged as predictors of app completion rates; specifically, male and smoking users demonstrated a decreased likelihood of successfully completing the app’s content (odds ratio 0.878, 95% CI 0.809-0.954 and odds ratio 0.835, 95% CI 0.735-0.949, respectively). Conclusions: The development and promotion of the WASABY app presents a valuable case study, illustrating the effective dissemination of evidence-based recommendations on cancer prevention within the ECAC through an innovative mobile app aimed at European adolescents. The data derived from this study provide insightful findings for the implementation of Europe’s Beating Cancer Plan, particularly the creation of the EU Mobile App for Cancer Prevention. %M 38015612 %R 10.2196/48040 %U https://cancer.jmir.org/2023/1/e48040 %U https://doi.org/10.2196/48040 %U http://www.ncbi.nlm.nih.gov/pubmed/38015612 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48950 %T Think Aloud Testing of a Smartphone App for Lifestyle Change Among Persons at Risk of Type 2 Diabetes: Usability Study %A Lunde,Pernille %A Skoglund,Gyri %A Olsen,Cecilie Fromholt %A Hilde,Gunvor %A Bong,Way Kiat %A Nilsson,Birgitta Blakstad %+ Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, P44, PB 4, Street Olavs Plass, Oslo, 0130, Norway, 47 48063537, plunde@oslomet.no %K mHealth %K mobile phone app %K smartphone %K lifestyle %K usability %K diabetes %K diabetic %K mobile health %K smartphone %K app %K apps %K application %K applications %K think-aloud %K think aloud %K user experience %K mobile phone %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality worldwide and is considered a global epidemic. Despite the growing evidence on the effectiveness of mobile health interventions in the management of DM2, the evidence on the effect of mobile health interventions in prevention of DM2 is sparse. Therefore, we have developed an app aiming to promote initiation of behavioral change and adherence to healthy behavior. Before commencing a small-scale randomized controlled trial to assess the feasibility of using an app for initiation and adherence of healthy behavior in people at risk of DM2, testing the usability of the app in the target population is warranted. Objective: The aim of this study was to assess the usability of an app among people at risk of DM2. Methods: A qualitative study with the use of a think aloud (TA) procedure was conducted from April to November 2022. The TA procedure consisted of 10 problem-solving tasks and a semistructured interview which was carried out after the tasks. These interviews served to gain more in-depth knowledge of the users experience of the problem-solving tasks. The TA-sessions and the postactivity interviews were recorded and transcribed verbatim, and the data were coded and analyzed following the principles of thematic analysis. Results: In total, 7 people at risk of DM2 with a median age of 66 (range 41-75) years participated in this study. The analysis resulted in the following themes: (1) user interface design; and (2) suggestions for improvements of the functionality of the app. Conclusions: Overall, the participants were satisfied with the usability of the app. Through the TA-sessions, real time perspective on the appeal, relevance, and utility of the app were gained. Only minor changes to the functionality of the prototype app were reported as necessary to improve the usability of the app. Points of guidance from the participants in this study have been adopted and incorporated into the final design of the app now being assessed for feasibility in a small-scale randomized controlled trial. %M 37966894 %R 10.2196/48950 %U https://humanfactors.jmir.org/2023/1/e48950 %U https://doi.org/10.2196/48950 %U http://www.ncbi.nlm.nih.gov/pubmed/37966894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48671 %T A Community-Based, Mobile Electronic Medical Record System App for High-Quality, Integrated Antiretroviral Therapy in Lilongwe, Malawi: Design Process and Pilot Implementation %A Feldacker,Caryl %A Mugwanya,Raymond %A Irongo,Daniel %A Kathumba,Daneck %A Chiwoko,Jane %A Kitsao,Emmanuel %A Sippell,Kenn %A Wasunna,Beatrice %A Jonas,Kingsley %A Samala,Bernadette %A Mwakanema,Daniel %A Oni,Femi %A Jafa,Krishna %A Tweya,Hannock %+ Department of Global Health, University of Washington, HMC #359932, 325 9th Avenue, Seattle, WA, 98104-2499, United States, 1 206 744 8493, cfeld@uw.edu %K antiretroviral therapy %K differentiated service delivery %K digital innovations %K Malawi %K mobile electronic medical record systems %K monitoring and evaluation %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Differentiated service delivery (DSD) increases antiretroviral therapy (ART) access in sub-Saharan Africa by moving clients out of congested ART clinics to communities for care. However, DSD settings challenge provider adherence to complex, chronic care treatment guidelines and have burdensome systems for client monitoring and evaluation (M&E), reducing data for decision-making. Electronic medical record systems (EMRS) improve client outcomes and reduce M&E workload. Traditional EMRS cannot operate in most DSD settings with unreliable power and poor connectivity. Objective: This study aims to detail the human-centered design (HCD) process of developing a mobile EMRS for community-based DSD services in Lilongwe, Malawi. Methods: Lighthouse Trust (LT) operates 2 Ministry of Health (MoH) clinics in Lilongwe, Malawi, with a combined total of >35,000 ART clients. LT’s real-time, point-of-care EMRS collects complex client M&E data and provides decision-making support, ensuring adherence to integrated HIV and tuberculosis guidelines that optimize client and program outcomes. LT’s EMRS scaled to all large MoH ART clinics. LT also implements a nurse-led community-based ART program (NCAP), a DSD model to provide ART and rapid assessment for 2400 stable LT clients in the community. LT, alongside collaborators, from the University of Washington’s International Training and Education Center for Health and technology partner, Medic, used the open-source Community Health Toolkit (CHT) and HCD to develop an open-source, offline-first, mobile EMRS-like app, “community-based ART retention and suppression” (CARES). CARES aims to bring EMRS-like provider benefits to NCAP’s DSD clients. Results: CARES design took approximately 12 months and used an iterative process of highly participatory feedback sessions with provider, data manager, and M&E team inputs to ensure CARES optimization for the NCAP and LT settings. The CARES mobile EMRS prototype supports NCAP providers with embedded prompts and alerts to ensure adherence to integrated MoH ART guidelines, aiming to improve the quality of client care. CARES facilitates improved data quality and flow for NCAP M&E, aiming to reduce data gaps between community and clinic settings. The CARES pilot demonstrates the potential of a mobile, point-of-care EMRS-like app that could benefit NCAP clients, providers, and program teams with integrated client care and complete M&E data for decision-making. CARES challenges include app speed, search features to align longitudinal records, and CARES to EMRS integration that supports timely care alerts. Conclusions: Leveraging the CHT and HCD processes facilitated the design of a locally specified and optimized mobile app with the promise to bring EMRS-like benefits to DSD settings. Moving from the CARES prototype to routine NCAP implementation should result in improved client care and strengthened M&E while reducing workload. Our transparent and descriptive process shares the progress and pitfalls of the CARES design and development, helping others in this digital innovation area to learn from our experiences at this stage. %M 37948102 %R 10.2196/48671 %U https://formative.jmir.org/2023/1/e48671 %U https://doi.org/10.2196/48671 %U http://www.ncbi.nlm.nih.gov/pubmed/37948102 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e50038 %T Designing a Mobile e-Coaching App for Immigrant Informal Caregivers: Qualitative Study Using the Persuasive System Design Model %A Premanandan,Shweta %A Ahmad,Awais %A Cajander,Åsa %A Ågerfalk,Pär %A Dolezel,Michal %A van Gemert-Pijnen,Lisette %+ Department of Informatics and Media, Uppsala University, Ekonomikum (Plan 3), Kyrkogårdsgatan 10, Uppsala, 751 20, Sweden, 46 707689331, shweta.premanandan@im.uu.se %K e-coaching %K mobile health %K mHealth %K immigrant informal caregivers %K designing app %K persuasive system design %K user needs %K caregiver %K app %K design %K users %K aging %K development %K diversity %K language barrier %K inclusion %K training %K mental health %K mobile phone %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Informal caregivers are vital in caring for their family and friends at home who may have illnesses or disabilities. In particular, the demands for caregiving can be even more challenging for those with limited resources, support systems, and language barriers, such as immigrant informal caregivers. They face complex challenges in providing care for their relatives. These challenges can be related to sociocultural diversity, language barriers, and health care system navigation. Acknowledging the global context of the increasing number of immigrants is essential in designing inclusive mobile health apps. Objective: This study aims to investigate the needs of immigrant informal caregivers in Sweden and discuss the application of the Persuasive System Design Model (PSDM) to develop an e-coaching prototype. By addressing the unique challenges faced by immigrant informal caregivers, this study will contribute to the development of more effective and inclusive mobile health apps. Methods: The participants were considered immigrants and included in the study if they and their parents were born outside of Sweden. Through various channels, such as the National Association of Relatives, rehabilitation departments at municipalities, and immigrant groups, we recruited 13 immigrant informal caregivers. These immigrant informal caregivers were primarily women aged 18 to 40 years. Most participants belonged to the Middle Eastern region whereas some were from North Africa. However, all of them spoke Arabic. We used semistructured interviews to gather data from the participants in Arabic, which were translated into English. Data were analyzed using thematic analysis and discussed in relation to the extended PSDM. The needs of the caregivers were compared with the description of persuasive design principles, and a design principle was chosen based on the match. The PSDM was extended if the need description did not match any principles. Several brainstorming and prototyping sessions were conducted to design the mobile e-coaching app. Results: Immigrant informal caregivers have various needs in their caregiving role. They reported a need for training on the illness and future caregiving needs, assistance with understanding the Swedish language and culture, and help with accessing internet-based information and services. They also required recognition and appreciation for their efforts, additional informal support, and easy access to health care services, which can be important for their mental health. The PSDM was adapted to the informal caregiving context by adding “facilitating conditions” and “verbal encouragement” as additional persuasive design principles. This study also presents the subsequent mobile e-coaching app for immigrant informal caregivers in Sweden. Conclusions: This study revealed important immigrant informal caregivers’ needs based on which design suggestions for a mobile e-coaching app were presented. We also proposed an adapted PSDM, for the informal caregiving context. The adapted PSDM can be further used to design digital interventions for caregiving. %M 37943598 %R 10.2196/50038 %U https://mhealth.jmir.org/2023/1/e50038 %U https://doi.org/10.2196/50038 %U http://www.ncbi.nlm.nih.gov/pubmed/37943598 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50304 %T Creating an Intercultural User-Centric Design for a Digital Sexual Health Education App for Young Women in Resource-Poor Regions of Kenya: Qualitative Self-Extended Double Diamond Model for Requirements Engineering Analysis %A Soehnchen,Clarissa %A Rietz,Annika %A Weirauch,Vera %A Meister,Sven %A Henningsen,Maike %+ HealthCare Department, Fraunhofer Institute for Software and System Engineering, Speicherstraße 6, Dortmund, 44147, Germany, 49 2302926, clarissa.soehnchen@uni-wh.de %K sexual health information %K sexual health education %K sub-Saharan Africa %K women %K semistructured interviews %K requirements engineering analysis %K user-centered design %K youth, slum %K health education %K sexual health %K digital health %K stigmatization %K reproductive health services %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The stigmatization around sexual health due to culture, religious traditions, and norms leads to myths and a lack of available information and resources related to universal access to sexual and reproductive health services. Additional sexual health education not being part of the Kenya school curriculum leads to insufficient access to knowledge about safe contraception, menstruation, and female genital mutilation. A digital app could support and provide education and information for universal equal access, addressing United Nations Sustainable Development Goals 3, 4, and 5. Objective: The study targeted the requirements for establishing a reusable framework to develop a successful accessible web-based sexual health education app and the behavioral intention to use it to obtain sexual health information by mainly young women in Kenya. Methods: The double diamond model, with a problem room including the discover and define phases, enriched with cultural aspects and modeled to a self-expanded intercultural research model was used in a user-centered design thinking approach to develop a framework for requirements engineering analysis. For problem identification, semistructured pilot phase interviews based on Consolidated Criteria for Reporting Qualitative Research guidelines were conducted, followed by expert interviews for qualitative content analysis. A sample size of 12 pilot phase interviews and 5 expert interviews was determined using data saturation. The responses were coded and analyzed according to the affinity mapping method. Results: The requirements engineering analysis showed potential enablers of and barriers to the use of a digital sexual health education app. Through this qualitative study, a conservative cultural background, classic text communication, and the influence of social affiliation within society were identified as barriers, which should be enhanced through visual and auditory channels as well as a fictional character in the app. Conclusions: The developed intercultural research model provides an impetus to providing digital sexual health education, integrating culture-specific aspects in the design process, while focusing on cultural and religious stigmata. The reusable framework enables identifying and overcoming hurdles in providing information about taboo and intimate topics. The overall use of online education tools focusing on intimate topics is correlated with accessibility and understanding specific cultural needs while delivering content on a basic and comprehensive level. It helps the target user from a social conservative background and in resource-poor circumstances to benefit from a digital educational solution. %M 37921860 %R 10.2196/50304 %U https://formative.jmir.org/2023/1/e50304 %U https://doi.org/10.2196/50304 %U http://www.ncbi.nlm.nih.gov/pubmed/37921860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47374 %T Design, Development, and Evaluation of an mHealth App for Reporting of Side Effects During Cytostatic Treatment: Usability Test and Interview Study %A Hægermark,Emil Aale %A Kongshaug,Nina %A Raj,Sunil Xavier %A Hofsli,Eva %A Faxvaag,Arild %+ Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Olav Kyrres gate 9, Trondheim, 7491, Norway, 47 98069390, echaeger@stud.ntnu.no %K mobile health %K mHealth %K user-centered design %K usability testing %K cancer %K side effects %K cytostatic treatment %K intervention %K mobile app %K usability %K user interface %K user %K smartphone %K mobile phone %D 2023 %7 19.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Using mobile health (mHealth) interventions such as smartphone apps to deliver health services is an opportunity to engage patients more actively in their own treatment. Usability tests allow for the evaluation of a service by testing it out on the relevant users before implementation in clinical practice. Objective: The objective of this study was to design, develop, and evaluate the user interface of an app that would aid patients with cancer in reporting a more comprehensive summary of their side effects. Methods: The usability test was conducted by exposing patients with cancer to a prototype of an mHealth app that allowed for reporting of side effects from a chemotherapy regimen. After solving a set of 13 tasks, the test participants completed a system usability scale questionnaire and were interviewed using a semistructured interview guide. The interviews were later transcribed and analyzed. Results: The 10 test participants had a mean age of 56.5 (SD 7.11) years. The mean total task completion time for the task-solving session was 240.15 (SD 166.78) seconds. The calculated system usability scale score was 92.5. Most participants solved most of the tasks without any major issues. A minority reported having difficulties using apps on smartphones in general. One patient never achieved a meaningful interaction with our app prototype. Most of those who engaged with the app approved of features that calmed them down, made them more empowered, and put them in control. They preferred to report on side effects in a detailed and concise manner. App features that provided specific advice could provoke both fear and rational action. Conclusions: The user tests uncovered design flaws that allowed for subsequent refining of an app that has the potential to enhance the safety of patients undergoing home-based chemotherapy. However, a refined version of the app is unlikely to be of value to all patients. Some might not be able to use apps on smartphones in general, or their ability to use apps is impaired because of their disease. This finding should have implications for health care providers’ overall design of their follow-up service as the service must allow for all the patients to receive safe treatment whether they can use an mHealth app or not. %M 37856183 %R 10.2196/47374 %U https://formative.jmir.org/2023/1/e47374 %U https://doi.org/10.2196/47374 %U http://www.ncbi.nlm.nih.gov/pubmed/37856183 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e49471 %T Supporting Pain Self-Management in Patients With Cancer: App Development Based on a Theoretical and Evidence-Driven Approach %A Abahussin,Asma A %A West,Robert M %A Wong,David C %A Ziegler,Lucy E %A Allsop,Matthew J %+ Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Building 11, PO Box 10219, Riyadh, 11433, Saudi Arabia, 966 11 8052824, asmabahussin@ksu.edu.sa %K pain %K cancer %K behavior change %K capability, opportunity, motivation, and behavior model %K COM-B model %K Behavior Change Wheel %K BCW %K mobile health %K mHealth %K app %K pain self-management %K evidence-based %K intervention design %K theory %D 2023 %7 9.10.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: To inform the development of an intervention, it is essential to have a well-developed theoretical understanding of how an intervention causes change, as stated in the UK Medical Research Council guidelines for developing complex interventions. Theoretical foundations are often ignored in the development of mobile health apps intended to support pain self-management for patients with cancer. Objective: This study aims to systematically set a theory- and evidence-driven design for a pain self-management app and specify the app’s active features. Methods: The Behavior Change Wheel (BCW) framework, a step-by-step theoretical approach to the development of interventions, was adopted to achieve the aim of this study. This started by understanding and identifying sources of behavior that could be targeted to support better pain management. Ultimately, the application of the BCW framework guided the identification of the active contents of the app, which were characterized using the Behavior Change Technique Taxonomy version 1. Results: The theoretical analysis revealed that patients may have deficits in their capability, opportunity, and motivation that prevent them from performing pain self-management. The app needs to use education, persuasion, training, and enablement intervention functions because, based on the analysis, they were found the most likely to address the specified factors. Eighteen behavior change techniques were selected to describe precisely how the intervention functions can be presented to induce the desired change regarding the intervention context. In other words, they were selected to form the active contents of the app, potentially reducing barriers and serving to support patients in the self-management of pain while using the app. Conclusions: This study fully reports the design and development of a pain self-management app underpinned by theory and evidence and intended for patients with cancer. It provides a model example of the BCW framework application for health app development. The work presented in this study is the first systematic theory- and evidence-driven design for a pain app for patients with cancer. This systematic approach can support clarity in evaluating the intervention’s underlying mechanisms and support future replication. %M 37812491 %R 10.2196/49471 %U https://cancer.jmir.org/2023/1/e49471 %U https://doi.org/10.2196/49471 %U http://www.ncbi.nlm.nih.gov/pubmed/37812491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48395 %T HD-DRUM, a Tablet-Based Drumming Training App Intervention for People With Huntington Disease: App Development Study %A Metzler-Baddeley,Claudia %A Busse,Monica %A Drew,Cheney %A Pallmann,Philip %A Cantera,Jaime %A Ioakeimidis,Vasileios %A Rosser,Anne %+ Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Maindy Road, Cathays, Cardiff, CF24 4HQ, United Kingdom, 44 29 208 ext 70705, Metzler-BaddeleyC@cardiff.ac.uk %K Huntington disease %K electronic health %K intervention %K training application %K rhythm %K timing %K drumming %K movement %K cognition %K integrated knowledge translation %K gamification %K Template for Intervention Description and Replication (TIDieR) %K TIDieR %K mobile phone %D 2023 %7 6.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Huntington disease (HD) is a neurodegenerative condition that leads to progressive loss of cognitive-executive and motor functions, largely due to basal ganglia (BG) atrophy. Currently, there are no therapeutic interventions tailored to address executive and motor dysfunction in people with HD. Music-based interventions may aid executive abilities by compensating for impaired BG-reliant timing and rhythm generation using external rhythmic beats. Here, we applied an integrated knowledge translation (IKT) framework to co-design a tablet-based rhythmic drumming training app (HD-DRUM) to stimulate executive and motor abilities in people with HD. Objective: The primary aim was to develop the HD-DRUM app for at-home use that addressed the accessibility needs of people with HD and allowed for the quantification of performance improvements and adherence for controlled clinical evaluation. Methods: The IKT framework was applied to iteratively refine the design of HD-DRUM. This process involved 3 phases of knowledge user engagement and co-design: a web-based survey of people with HD (n=29) to inform about their accessibility needs, usability testing of tablet-based touch screens as hardware solutions, and usability testing of the design and build of HD-DRUM to meet the identified accessibility needs of people affected by HD and their clinicians (n=12). Results: The survey identified accessibility problems due to cognitive and motor control impairments such as difficulties in finding and navigating through information and using PC keyboards and mouses to interact with apps. Tablet-based touch screens were identified as feasible and accessible solutions for app delivery. Key elements to ensure that the app design and build met the needs of people with HD were identified and implemented. These included the facilitation of intuitive navigation through the app using large and visually distinctive buttons; the use of audio and visual cues as training guides; and gamification, positive feedback, and drumming to background music as a means to increase motivation and engagement. The co-design development process resulted in the proof-of-concept HD-DRUM app that is described here according to the Template for Intervention Description and Replication checklist. HD-DRUM can be used at home, allowing the quantification of performance improvements and adherence for clinical evaluation, matching of training difficulty to users’ performance levels using gamification, and future scale-up to reach a wide range of interested users. Conclusions: Applying an IKT-based co-design framework involving knowledge user engagement allowed for the iterative refinement of the design and build of the tablet-based HD-DRUM app intervention, with the aim of stimulating BG-reliant cognitive and motor functions. Mapping the intervention against the Template for Intervention Description and Replication framework to describe complex interventions allowed for the detailed description of the HD-DRUM intervention and identification of areas that required refinement before finalizing the intervention protocol. %M 37801351 %R 10.2196/48395 %U https://formative.jmir.org/2023/1/e48395 %U https://doi.org/10.2196/48395 %U http://www.ncbi.nlm.nih.gov/pubmed/37801351 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48372 %T Feasibility and Usability of a Mobile App–Based Interactive Care Plan for Migraine in a Community Neurology Practice: Development and Pilot Implementation Study %A Young,Nathan P %A Ridgeway,Jennifer L %A Haddad,Tufia C %A Harper,Sarah B %A Philpot,Lindsey M %A Christopherson,Laura A %A McColley,Samantha M %A Phillips,Sarah A %A Brown,Julie K %A Zimmerman,Kelly S %A Ebbert,Jon O %+ Integrated Community Specialty Practice, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 507 284 2844, young.nathan@mayo.edu %K migraine %K mobile app %K smartphone %K care model %K feasibility %K usability %K digital health %K remote monitoring %K care plan %K pilot %K mobile health %K mHealth %K mobile phone %K patient-reported outcomes %D 2023 %7 5.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Migraine is a common and major cause of disability, poor quality of life, and high health care use. Access to evidence-based migraine care is limited and projected to worsen. Novel mobile health app–based tools may effectively deliver migraine patient education to support self-management, facilitate remote monitoring and treatment, and improve access to care. The risk that such an intervention may increase the care team workload is a potential implementation barrier. Objective: This study aims to describe a novel electronic health record–integrated mobile app–based Migraine Interactive Care Plan (MICP) and evaluate its feasibility, usability, and impact on care teams in a community neurology practice. Methods: Consecutive enrollees between September 1, 2020, and February 16, 2022, were assessed in a single-arm observational study of usability, defined by 74.3% (127/171) completing ≥1 assigned task. Task response rates, rate and type of care team escalations, and patient-reported outcomes were summarized. Patients were prospectively recruited and randomly assigned to routine care with or without the MICP from September 1, 2020, to September 1, 2021. Feasibility was defined by equal to or fewer downstream face-to-face visits, telephone contacts, and electronic messages in the MICP cohort. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-square test was used for categorical variables for those with at least 3 months of follow-up. Results: A total of 171 patients were enrolled, and of these, 127 (74.3%) patients completed ≥1 MICP-assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient-confirmed understanding of the educational materials ranged from 26.6% (45/169) to 56.2% (95/169). Initial mean headache days per week was 4.54 (SD 2.06) days and declined to 2.86 (SD 1.87) days at week 26. The percentage of patients reporting favorable satisfaction increased from a baseline of 35% (20/57) to 83% (15/18; response rate of 42/136, 30.9% to 28/68, 41%) over the first 6 months. A total of 121 patients with MICP were compared with 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (13/121, 10.7%) compared with controls (26/62, 42%; P<.001). Conclusions: We describe the successful implementation of an electronic health record–integrated mobile app–based care plan for migraine in a community neurology practice. We observed fewer downstream face-to-face visits without increasing telephone calls, medication refills, or electronic messages. Our findings suggest that the MICP has the potential to improve patient access without increasing care team workload and the need for patient input from diverse populations to improve and sustain patient engagement. Additional studies are needed to assess its impact in primary care. %M 37796560 %R 10.2196/48372 %U https://formative.jmir.org/2023/1/e48372 %U https://doi.org/10.2196/48372 %U http://www.ncbi.nlm.nih.gov/pubmed/37796560 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49998 %T The Appa Health App for Youth Mental Health: Development and Usability Study %A Giovanelli,Alison %A Sanchez Karver,Tahilin %A Roundfield,Katrina D %A Woodruff,Sean %A Wierzba,Catherine %A Wolny,J %A Kaufman,Michelle R %+ Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA, 94143, United States, 1 8054050772, alison.giovanelli@ucsf.edu %K digital mental health %K youth mentoring %K cognitive behavioral therapy %K teenager %K adolescent %K mobile phone %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. Objective: The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa’s 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. Methods: The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers’ characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. Results: Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. Conclusions: Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program. %M 37792468 %R 10.2196/49998 %U https://formative.jmir.org/2023/1/e49998 %U https://doi.org/10.2196/49998 %U http://www.ncbi.nlm.nih.gov/pubmed/37792468 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e42851 %T The Effectiveness of a Neurofeedback-Assisted Mindfulness Training Program Using a Mobile App on Stress Reduction in Employees: Randomized Controlled Trial %A Min,Beomjun %A Park,Heyeon %A Kim,Johanna Inhyang %A Lee,Sungmin %A Back,Soyoung %A Lee,Eunhwa %A Oh,Sohee %A Yun,Je-Yeon %A Kim,Bung-Nyun %A Kim,Yonghoon %A Hwang,JungHyun %A Lee,Sanghyop %A Kim,Jeong-Hyun %+ Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 31 787 2025, retrial3@hanmail.net %K mindfulness %K neurofeedback %K stress %K resilience %K mobile app %K employee %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness-based training programs have consistently shown efficacy in stress reduction. However, questions regarding the optimal duration and most effective delivery methods remain. Objective: This research explores a 4-week neurofeedback-assisted mindfulness training for employees via a mobile app. The study’s core query is whether incorporating neurofeedback can amplify the benefits on stress reduction and related metrics compared with conventional mindfulness training. Methods: A total of 92 full-time employees were randomized into 3 groups: group 1 received mobile mindfulness training with neurofeedback assistance (n=29, mean age 39.72 years); group 2 received mobile mindfulness training without neurofeedback (n=32, mean age 37.66 years); and group 3 were given self-learning paper materials on stress management during their first visit (n=31, mean age 38.65 years). The primary outcomes were perceived stress and resilience scales. The secondary outcomes were mindfulness awareness, emotional labor, occupational stress, insomnia, and depression. Heart rate variability and electroencephalography were measured for physiological outcomes. These measurements were collected at 3 different times, namely, at baseline, immediately after training, and at a 4-week follow-up. The generalized estimating equation model was used for data analysis. Results: The 4-week program showed significant stress reduction (Wald χ22=107.167, P<.001) and improvements in psychological indices including resilience, emotional labor, insomnia, and depression. A significant interaction was observed in resilience (time × group, Wald χ42=10.846, P=.02). The post hoc analysis showed a statistically significant difference between groups 1 (least squares mean [LSM] 21.62, SE 0.55) and 3 (LSM 19.90, SE 0.61) at the posttraining assessment (P=.008). Group 1 showed a significant improvement (P<.001) at the posttraining assessment, with continued improvements through the 1-month follow-up assessment period (LSM 21.55, SE 0.61). Physiological indices were analyzed only for data of 67 participants (22 in group 1, 22 in group 2, and 23 in group 3) due to the data quality. The relaxation index (ratio of alpha to high beta power) from the right electroencephalography channel showed a significant interaction (time × group, Wald χ22=6.947, P=.03), with group 1 revealing the highest improvement (LSM 0.43, SE 0.15) compared with groups 2 (LSM –0.11, SE 0.10) and 3 (LSM 0.12, SE 0.10) at the 1-month follow-up assessment. Conclusions: The study demonstrated that the neurofeedback-assisted group achieved superior outcomes in resilience and relaxation during the 4-week mobile mindfulness program. Further research with larger samples and long-term follow-up is warranted. Trial Registration: ClinicalTrials.gov NCT03787407; https://clinicaltrials.gov/ct2/show/NCT03787407 %M 37788060 %R 10.2196/42851 %U https://mhealth.jmir.org/2023/1/e42851 %U https://doi.org/10.2196/42851 %U http://www.ncbi.nlm.nih.gov/pubmed/37788060 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44696 %T Health Care Providers’ Readiness to Adopt an Interactive 3D Web App in Consultations About Female Genital Mutilation/Cutting: Qualitative Evaluation of a Prototype %A Holuszko,Olivia May %A Abdulcadir,Jasmine %A Abbott,Daisy %A Clancy,Jennifer %+ School of Simulation & Visualisation, Glasgow School of Art, The Hub, Pacific Quay, Glasgow, G51 1EA, United Kingdom, 44 7401237315, oliviamayh@gmail.com %K FGM/C %K 3D %K interactive %K patients %K consultation %K web app %K health care provider %K female genital mutilation or cutting %K vulva %K anatomy %D 2023 %7 28.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Comprehensive and appropriate health care provision to women and girls with female genital mutilation or cutting (FGM/C) is lacking. Use of visuals in health care provider (HCP) consultations facilitates the communication of health information and its comprehension by patients. A web app featuring a 3D visualization of the genitourinary anatomy was developed to support HCPs in conferring clinical information about FGM/C to patients. Objective: The aim of this study was to explore HCP perspectives on the use of visuals in discussion about FGM/C with their patients as well as to obtain their feedback on whether an interactive 3D web app showing the genitourinary anatomy would be helpful in patient consultations about FGM/C, identifying key features that are relevant to their clinical practice. Methods: We evaluated the web app through a semistructured interview protocol with seven HCPs from various disciplines experienced in care for women and girls with FGM/C in migration-destination settings. Interviews were audio- and video-recorded for transcription, and were then analyzed thematically for contextualized data regarding HCPs’ willingness to use a 3D web app visualizing anatomy in FGM/C consultations with patients. Results: All but one of the seven participants expressed keen interest in using this web app and its 3D visuals of anatomy in FGM/C consultations with patients. Participants shared the common contexts for the use of visuals in health care for FGM/C and the concepts they are used to support, such as to help describe a patient’s genitals after FGM/C and reinforce an understanding of clitoral anatomy, to illustrate the process of defibulation, or to explain the physiological effects of FGM/C. Participants also highlighted the benefit of using visuals that patients can relate to, expressing approval for the ability to customize the vulva by FGM/C subtype, skin tone, and complexity of the visual shown in the web app. Despite critiques that the visualization may serve to perpetuate idealistic standards for how a vulva should look, participants largely agreed on the web app’s perceived usefulness to clinical practice and beyond. Conclusions: Evaluation of the web app developed in this study identified that digital tools with 3D models of the genitourinary anatomy that are accessible, informative, and customizable to any specific patient are likely to aid HCPs in communicating clinical information about FGM/C in consultations. Universal access to the web app may be particularly useful for HCPs with less experience in FGM/C. The app also prompts options for applications such as for personal use, in medical education, in patient medical records, or in legal settings. Further qualitative research with patients is required to confirm that adoption of the web app by HCPs in a consultation setting will indeed benefit patient care for women and girls with FGM/C. %M 37768712 %R 10.2196/44696 %U https://formative.jmir.org/2023/1/e44696 %U https://doi.org/10.2196/44696 %U http://www.ncbi.nlm.nih.gov/pubmed/37768712 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48585 %T mHealth Intervention for Vietnamese Living With Diabetes: Protocol for a Stepped Wedge Pilot Study %A Nguyen,Anna %A Nagykaldi,Zsolt %A Bui,Thanh %A Chen,Sixia %A Businelle,Michael %A Eschiti,Valerie %A Dwyer,Kathleen %+ Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, 1100 N Stonewall Avenue, Suite 412, Oklahoma City, OK, 73117, United States, 1 4052711491, anna-nguyen@ouhsc.edu %K Vietnamese %K type 2 diabetes %K diabetes self-management %K mobile health technology %K intervention study %K stepped wedge design %K mobile health %K intervention %K mobile app %K digital health %K diabetes %K self-management %K awareness %K mhealth %K implementation %D 2023 %7 28.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Evidence indicates participation in a diabetes self-management education and support program improves self-care behaviors and hemoglobin A1c. Language and cultural differences may be barriers to program participation resulting in ineffective self-management, but these factors can be addressed with appropriate interventions. Given the high health care costs associated with diabetes complications, we developed a multicomponent, culturally tailored Self-Management Mobile Health Intervention for US Vietnamese With Diabetes (SMart-D). Objective: This study aims to evaluate the SMart-D intervention’s feasibility, acceptability, and effectiveness with intentions to scale up the intervention in the future. This mixed methods study incorporates the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate the intervention. Methods: This stepped wedge randomized controlled pilot study will be conducted over 2 years in collaboration with primary care clinics. Eligible participants are patients with type 2 diabetes who are receiving health care from participating clinics. Clinics will be randomly assigned to an implementation date and will begin with patients enrolling in the control period while receiving standard care, then cross over to the intervention period where patients receive standard care plus the SMart-D intervention for over 12 weeks. Focus groups or interviews will be conducted with clinicians and patients after study completion. Qualitative data will be analyzed using NVivo. Outcomes on self-care behavior changes will be measured with the Summary of Diabetes Self-Care Activities scale and clinical changes will be measured using laboratory tests. A generalized linear mixed-effect model will be used to compute time effect, clustering effect, and the interaction of the control and intervention periods using SAS (version 9.4; SAS Institute). Results: We hypothesize that (1) at least 50% (n=5) of eligible clinics and 50% (n=40) of eligible patients who are invited will participate, and at least 70% (n=56) of patients will complete the program, and (2) patients who receive the intervention will have improved self-care behaviors and clinical test results with at least 75% (n=60) of the patients maintaining improved outcomes at follow-up visits compared with baseline, and participants will verbalize that the intervention is feasible and acceptable. As of August 2023, we enrolled 10 clinics and 60 patients. Baseline data results will be available by the end of 2023 and outcome data will be published in 2025. Conclusions: This is the first Vietnamese diabetes self-management education and support intervention that leverages mobile health technology to address the barriers of language and culture differences through collaboration with primary care clinics. This study will provide a better understanding of the implementation process, demonstrate the potential effectiveness of the intervention, accelerate the pace of moving evidence-based interventions to practice among the US Vietnamese population, and potentially provide a replicable implementation model that can be culturally adapted to other non-English speaking ethnic minorities. International Registered Report Identifier (IRRID): DERR1-10.2196/48585 %M 37768716 %R 10.2196/48585 %U https://www.researchprotocols.org/2023/1/e48585 %U https://doi.org/10.2196/48585 %U http://www.ncbi.nlm.nih.gov/pubmed/37768716 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49668 %T Mobile Phone Text Messages to Support People to Stop Smoking by Switching to Vaping: Codevelopment, Coproduction, and Initial Testing Study %A Sideropoulos,Vassilis %A Vangeli,Eleni %A Naughton,Felix %A Cox,Sharon %A Frings,Daniel %A Notley,Caitlin %A Brown,Jamie %A Kimber,Catherine %A Dawkins,Lynne %+ Department of Psychology & Human Development, IOE, UCL’s Faculty of Education and Society, University College London, 20 Bedford Way, London, WC1H 0AL, United Kingdom, 44 02035495417, v.sideropoulos@ucl.ac.uk %K coproduction %K SMS text messages %K e-cigarette %K smoking %K eHealth %K vaping %K mobile phone %K codevelopment %K text message %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS text messages are affordable, scalable, and effective smoking cessation interventions. However, there is little research on SMS text message interventions specifically designed to support people who smoke to quit by switching to vaping. Objective: Over 3 phases, with vapers and smokers, we codeveloped and coproduced a mobile phone SMS text message program. The coproduction paradigm allowed us to collaborate with researchers and the community to develop a more relevant, acceptable, and equitable SMS text message program. Methods: In phase 1, we engaged people who vape via Twitter and received 167 responses to our request to write SMS text messages for people who wish to quit smoking by switching to vaping. We screened, adjusted, refined, and themed the messages, resulting in a set of 95 that were mapped against the Capability, Opportunity, and Motivation–Behavior constructs. In phase 2, we evaluated the 95 messages from phase 1 via a web survey where participants (66/202, 32.7% woman) rated up to 20 messages on 7-point Likert scales on 9 constructs: being understandable, clear, believable, helpful, interesting, inoffensive, positive, and enthusiastic and how happy they would be to receive the messages. In phase 3, we implemented the final set of SMS text messages as part of a larger randomized optimization trial, in which 603 participants (mean age 38.33, SD 12.88 years; n=369, 61.2% woman) received SMS text message support and then rated their usefulness and frequency and provided free-text comments at the 12-week follow-up. Results: For phase 2, means and SDs were calculated for each message across the 9 constructs. Those with means below the neutral anchor of 4 or with unfavorable comments were discussed with vapers and further refined or removed. This resulted in a final set of 78 that were mapped against early, mid-, or late stages of quitting to create an order for the messages. For phase 3, a total of 38.5% (232/603) of the participants provided ratings at the 12-week follow-up. In total, 69.8% (162/232) reported that the SMS text messages had been useful, and a significant association between quit rates and usefulness ratings was found (χ21=9.6; P=.002). A content analysis of free-text comments revealed that the 2 most common positive themes were helpful (13/47, 28%) and encouraging (6/47, 13%) and the 2 most common negative themes were too frequent (9/47, 19%) and annoying (4/47, 9%). Conclusions: In this paper, we describe the initial coproduction and codevelopment of a set of SMS text messages to help smokers stop smoking by transitioning to vaping. We encourage researchers to use, further develop, and evaluate the set of SMS text messages and adapt it to target populations and relevant contexts. %M 37756034 %R 10.2196/49668 %U https://formative.jmir.org/2023/1/e49668 %U https://doi.org/10.2196/49668 %U http://www.ncbi.nlm.nih.gov/pubmed/37756034 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e44985 %T User-Centered Development of a Mobile App to Assess the Quality of Life of Patients With Cancer: Iterative Investigation and Usability Testing %A Beutter,Chantal N L %A Zeller,Katharina %A Martens,Uwe M %A Pfleiderer,Bettina %A Fegeler,Christian %+ MOLIT Institute gGmbH, Im Zukunftspark 10, Heilbronn, 74076, Germany, 49 7131 1334500, chantal.beutter@molit.eu %K quality of life %K cancer %K mHealth %K mobile health %K patient empowerment %K user-centered design %K user %K user centered %K design %K physical well-being %K well-being %K mental health %K monitoring %K development %K usability %D 2023 %7 26.9.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: The treatment for cancer can have a negative impact not only on physical well-being but also on mental health and the quality of life (QoL). Health apps enable the monitoring of different parameters, but to date, there are only few that support patients with cancer and none that focuses on the assessment of QoL. Furthermore, patients as stakeholders are often only integrated at the late stage of the development process, if at all. Objective: The aim of this research was to develop and evaluate a smartphone app (Lion-App) to enable patients with cancer to autonomously measure the QoL with an iterative, user-centered approach. Methods: Patients with cancer were involved in a 3-stage process from conceptualization to the point when the app was available on the tester’s private device. First, focus groups with members (N=21) of cancer support groups were conducted to understand their expectations and needs. Thereafter, individual tests were performed. After developing a prototype that incorporated findings from the focus groups, a second test cycle was conducted, followed by a beta test lasting 2 months. In our app, the QoL can be assessed via a patient diary and an integrated questionnaire. Through all stages, usability was evaluated using the modular extended version of the User Experience Questionnaire (UEQ+), including the calculation of a key performance indicator (KPI). If possible, the impact of sex on the results was evaluated. As part of the beta test, usage rates as well as age-dependent differences were also assessed. Results: A total of 21 participants took part in the initial 3 focus groups. In the subsequent usability testing (N=18), 17 (94%) participants rated their impression through the UEQ+, with a mean KPI of 2.12 (SD 0.64, range: –3 to 3). In the second usability test (N=14), the mean KPI increased to 2.28 (SD=0.49). In the beta test, the usage rate of 19 participants was evaluated, of whom 14 (74%) also answered the UEQ+ (mean KPI 1.78, SD 0.84). An influence of age on the number of questionnaire responses in Lion-App was observed, with a decrease in responses with increasing age (P=.02). Sex-dependent analyses were only possible for the first usability test and the beta test. The main adjustments based on user feedback were a restructuring of the diary as well as integration of a shorter questionnaire to assess the QoL. Conclusions: The iterative, user-centered approach for development and usability testing resulted in positive evaluations of Lion-App. Our app was rated as suitable for everyday use to monitor the QoL of patients with cancer. Initial results indicated that the sex and age of participants seem to play only a minor role. %M 37751285 %R 10.2196/44985 %U https://cancer.jmir.org/2023/1/e44985 %U https://doi.org/10.2196/44985 %U http://www.ncbi.nlm.nih.gov/pubmed/37751285 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e46738 %T Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study %A Böttinger,Melissa J %A Litz,Elena %A Gordt-Oesterwind,Katharina %A Jansen,Carl-Philipp %A Memmer,Nicole %A Mychajliw,Christian %A Radeck,Leon %A Bauer,Jürgen M %A Becker,Clemens %+ Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Bergheimer Str. 20, Heidelberg, 69115, Germany, 49 6221 54 8146, boettinger@nar.uni-heidelberg.de %K aged %K self-assessment %K mobile apps %K mobile health %K mHealth %K community-based participatory research %K co-creation %K comprehensive geriatric assessment %K mobile phone %D 2023 %7 26.9.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a preclinical stage, thereby facilitating preventive efforts and targeted intervention. For this purpose, a Life-integrated Self-Assessment (LiSA) tablet system will be developed through a structured co-creation process. Objective: This study aims to investigate older adults’ perceptions of different self-assessment domains, components affecting user experience, risks and benefits associated with LiSA, characteristics of potential LiSA users, and the LiSA concept in general. Methods: A total of 10 community-dwelling older adults aged ≥70 years were recruited. In total, 6 co-creation workshops were held and started with expert input followed by semistructured discussion rounds. Participants performed hands-on activities with a tablet, including testing of preinstalled self-assessment apps. All workshops were audio recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze the data following a deductive-inductive approach guided by the Optimized Honeycomb Model for user experience. Results: The group (mean age 77.8, SD 5.1 years) was heterogeneous in terms of previous technology experience and health status. The mean workshop duration was 2 hours (122.5, SD 4.43 min), and an average of 8 (SD 1.15) participants attended each workshop. A total of 11 thematic categories were identified, covering results on all research questions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activity and function and sensory and cognitive functions and requested additional features such as recommendations for actions or reminders. LiSA was perceived as empowering and a motivator to engage in active health care planning as well as enabling shared and informed decision-making. Concerns and barriers included the lack of technical competence, feelings of frustration, and fear of being left alone, with negative assessment results. In essence, participants expressed a positive attitude toward using LiSA repeatedly and identified it as an option to increase the chances of maintaining independence when growing older. Conclusions: The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion, LiSA should include relevant assessments capturing physical activity and function and sensory and cognitive functions as well as recommendations for actions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment. %M 37751274 %R 10.2196/46738 %U https://aging.jmir.org/2023/1/e46738 %U https://doi.org/10.2196/46738 %U http://www.ncbi.nlm.nih.gov/pubmed/37751274 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43186 %T Design Guidelines of Mobile Apps for Older Adults: Systematic Review and Thematic Analysis %A Gomez-Hernandez,Miguel %A Ferre,Xavier %A Moral,Cristian %A Villalba-Mora,Elena %+ Center for Biomedical Technology, Universidad Politécnica de Madrid, Campus Montegancedo, Pozuelo de Alarcón, 28223, Spain, 34 91067925, xavier.ferre@upm.es %K tablet %K smartphone %K older user %K design recommendations %K usability testing %K user experience design %K UX design %K design %K mobile app %K tool %K quality of life %K software %K training %K visual design %K older adults %K mobile phone %D 2023 %7 21.9.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are fundamental tools in today’s society for practical and social endeavors. However, these technologies are often not usable for older users. Given the increased use of mobile apps by this group of users and the impact that certain services may have on their quality of life, such as mobile health, personal finance, or online administrative procedures, a clear set of guidelines for mobile app designers is needed. Existing recommendations for older adults focus on investigations with certain groups of older adults or have not been extracted from experimental results. Objective: In this research work, we systematically reviewed the scientific literature that provided recommendations for the design of mobile apps based on usability testing with older adults and organized such recommendations into a meaningful set of design guidelines. Methods: We conducted a systematic literature review of journal and conference articles from 2010 to 2021. We included articles that carried out usability tests with populations aged >60 years and presented transferable guidelines on mobile software design, resulting in a final set of 40 articles. We then carried out a thematic analysis with 3 rounds of analysis to provide meaning to an otherwise diverse set of recommendations. At this stage, we discarded recommendations that were made by just 1 article, were based on a specific mobile app and were therefore nontransferrable, were based on other authors’ literature (as opposed to recommendations based on the results of usability tests), or were not sufficiently argued. With the remaining recommendations, we identified commonalities, wrote a faithful statement for each guideline, used a common language for the entire set, and organized the guidelines into categories, thereby giving shape to an otherwise diverse set of recommendations. Results: Among the 27 resulting guidelines, the rules Simplify and Increase the size and distance between interactive controls were transversal and of the greatest significance. The rest of the guidelines were divided into 5 categories (Help & Training, Navigation, Visual Design, Cognitive Load, and Interaction) and consequent subcategories in Visual Design (Layout, Icons, and Appearance) and Interaction (Input and Output). The recommendations were structured, explained in detail, and illustrated with applied examples extracted from the selected studies, where appropriate. We discussed the design implications of applying these guidelines, contextualized with relevant studies. We also discussed the limitations of the approach followed, stressing the need for further experimentation to gain a better understanding of how older adults use mobile apps and how to better design such apps with these users in mind. Conclusions: The compiled guidelines support the design of mobile apps that cater to the needs of older adults because they are based on the results of actual usability tests with users aged >60 years. %M 37733401 %R 10.2196/43186 %U https://mhealth.jmir.org/2023/1/e43186 %U https://doi.org/10.2196/43186 %U http://www.ncbi.nlm.nih.gov/pubmed/37733401 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51055 %T Preferences for and Experiences of an HIV-Prevention Mobile App Designed for Transmasculine People: Pilot Feasibility Trial and Qualitative Investigation %A Jones,Jeb %A Butler,Gareth %A Woody,Meaghan %A Castel,Amanda D %A Kulie,Paige %A Sheets,Martha %A Scheim,Ayden I %A Reisner,Sari L %A Valencia,Rachel %A Wang,Minglun %A Stekler,Joanne D %A Sullivan,Patrick S %A Stephenson,Rob %+ Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4047122275, jeb.jones@emory.edu %K transmasculine %K HIV %K mHealth %K preference %K prevention %K mobile app %K transgender %K STI %K meta-analyses %K app-based intervention %K cisgender %K sexual health %K sexual risk behavior %K smartphone %D 2023 %7 21.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Transmasculine people are at risk for HIV; yet few HIV prevention interventions have been developed for this population. We adapted an existing HIV prevention smartphone app for cisgender men who have sex with men to meet the sexual health needs of transmasculine people. Objective: This study aims to assess the acceptability of the adapted app, Transpire, among transmasculine people living in Atlanta, Georgia, and Washington, DC, via in-depth interviews of participants in a pilot feasibility trial. Methods: Participants used the Transpire app for 3 months as part of a pilot study of the app. Eligible participants were aged 18-34 years. There were no eligibility criteria with respect to race and ethnicity, and most participants were non-Hispanic White. At the end of the follow-up, participants were invited to participate in web-based in-depth interviews to discuss their experiences using the app and feedback on design and content. Interviews were transcribed and coded using a constant comparative approach. Three main themes were identified: sexual behavior, app experiences and feedback, and pre-exposure prophylaxis. Results: Overall, participants found the app acceptable and thought that it would be a useful tool for themselves and their peers. Participants reported appreciating having a comprehensive information source available to them on their phones and reported learning more about HIV, sexually transmitted infections, and pre-exposure prophylaxis via the app. They also reported appreciating the inclusive language that was used throughout the app. Although the app included some resources on mental health and substance use, participants reported that they would have appreciated more resources and information in these areas as well as more comprehensive information about other health concerns, including hormone therapy. Representative quotes are presented for each of the identified themes. Conclusions: There is a desire to have greater access to reliable sexual health information among transmasculine people. Mobile apps like Transpire are an acceptable intervention to increase access to this information and other resources. More evidence is needed, however, from more racially and ethnically diverse samples of transmasculine people. %M 37733430 %R 10.2196/51055 %U https://formative.jmir.org/2023/1/e51055 %U https://doi.org/10.2196/51055 %U http://www.ncbi.nlm.nih.gov/pubmed/37733430 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45490 %T A Diabetes Education App for People Living With Type 2 Diabetes: Co-Design Study %A Pienkowska,Anita %A Ang,Chin-Siang %A Mammadova,Maleyka %A Mahadzir,Muhammad Daniel Azlan %A Car,Josip %+ Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 50 Nanyang Ave, Singapore, 308232, Singapore, 65 69047022, anita.pienkowska@ntu.edu.sg %K diabetes %K health apps %K co-design %K chatbot %K type 2 diabetes %K self-management %K mobile health %K mHealth %K chronic disease %K digital education %K mobile phone %D 2023 %7 18.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 2 diabetes (T2D) is a growing global health concern, including in Singapore. Diabetes education programs have been shown to be effective in improving health outcomes and diabetes self-management skills. Mobile health apps have emerged as useful tools for diabetes education; however, their use and acceptance by the target population remain inconsistent. Therefore, end-user participation in the design and development of a mobile health app is crucial for designing an acceptable app that can improve outcomes for populations with a chronic disease. Objective: The objective of this study was to apply an end-user participatory approach to co-design a diabetes education app prototype for people living with T2D by exploring their perceptions, acceptance, and usability of an app prototype, as well as their diabetes experience and perspectives on digital diabetes education. Methods: A total of 8 people with T2D, who were recruited from diabetes management Facebook groups, participated in 4 web-based surveys via Qualtrics and 2 structured interviews via Zoom (Zoom Video Communications, Inc) between August 20, 2021, and January 28, 2022. Descriptive statistics and thematic analyses of the discussion and iterative feedback on the app prototype were used to assess the participants’ perceptions of living with T2D, attitudes toward digital diabetes education, and acceptance of the prototype. Results: Analyses of the surveys and interview data revealed 3 themes: challenges of living with T2D; validation, acceptability, and usability of the diabetes education app prototype; and perspectives on digital diabetes education. In the first theme, participants highlighted the importance of solitary accountability, translating knowledge into practice, and developing pragmatic self-consciousness. The second theme indicated that the diabetes education app prototype was acceptable, with information and appearance being key; revealed ambivalent and polarized opinions toward the chatbot; and confirmed potential impact of the app on diabetes self-management skills and practice. The third theme comprised the necessity of using a variety of information-seeking strategies and recommendations for desired content and app qualities, including accessibility, adaptability, autonomy, evidence-based design and content, gamification, guidance, integration, personalization, and up-to-date content. The findings were used to reiterate the app design. Conclusions: Despite a small sample size, the study demonstrated the feasibility of engaging and empowering people living with T2D to consider digital therapeutics for diabetes self-management skills and practice. Participants gave rather positive feedback on the design and content of the app prototype, with some recommendations for improvements. The findings suggest that incorporating end-user feedback into app design can lead to the creation of feasible and acceptable tools for diabetes education, potentially improving outcomes for populations with a chronic disease. Further research is needed to test the impact of the refined diabetes education app prototype on diabetes self-management skills and practice and quality of life. %M 37721799 %R 10.2196/45490 %U https://formative.jmir.org/2023/1/e45490 %U https://doi.org/10.2196/45490 %U http://www.ncbi.nlm.nih.gov/pubmed/37721799 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e45957 %T Development of an App for Tracking Family Engagement With Early Intervention Services: Focus Groups and Pilot Evaluation Study %A Wagner,Liliana %A Corona,Laura %A Khan,Nibraas %A Hooper,Madison %A Dixon,Alexa %A Munoz Lavanderos,Ambar %A Zheng,Zhaobo %A Sarkar,Nandan %A Sarkar,Nilanjan %A Warren,Zachary %+ Department of Pediatrics, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, United States, 1 615 936 5777, liliana.wagner@vumc.org %K mobile health %K early intervention %K families %K mobile phone %K autism %K focus groups %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Expedient access to early intervention (EI) systems has been identified as a priority for children with developmental delays, identified disabilities, and other special health care needs. Despite the mandated availability of EI, it remains challenging for families to navigate referral processes and establish appropriate services. Such challenges disproportionately affect families from traditionally underserved communities. Mobile health apps can improve clinical outcomes, increase accessibility to health services, and promote adherence to health-related interventions. Though promising, the implementation of apps within routine care is in its infancy, with limited research examining the components of what makes an effective app or how to reach families most impacted by inequities in health care delivery. Objective: In study 1, we conducted focus groups to access a broad range of perspectives on the process of navigating the EI system, with the dual goals of identifying ways in which a patient-facing app might facilitate this process and identifying barriers to use with traditionally underrepresented and underserved groups. In study 2, focus group findings informed the development of a patient-facing app, which was subsequently tested with a pilot sample of 5 families. Methods: In study 1, the focus groups included 29 participants from 4 shareholder groups. Targeted sampling was used to recruit participants from traditionally underrepresented groups. Focus group questions sought information about barriers families experience as they navigate the EI system, ideal features of a patient-facing app designed to track family engagement with the EI system, and potential barriers. Focus group procedures were informed by the Consolidated Framework for Implementation Research framework. In study 2, a pilot app was developed. The app was tested with a sample of 5 families of young children involved in the EI system. Families provided information on app functionality and usability. Results: Qualitative analysis revealed a desire for increased communication and information about the process of accessing EI services, potential utility of an app for communication purposes, and clear recommendations for app features. Insights from focus groups were used to inform the development of the Family on Track app and related implementation supports. App features included survey customization, timing and delivery of prompts, and questions related to barriers and service satisfaction. Implementation supports include a visual guide for app installation, resources related to common family questions, and availability of study personnel to guide families through installation and provide ongoing support. Field testing provided preliminary information about app usability, including identifying future directions. Conclusions: The results of this study could support the development of a new way for the EI system to communicate and connect with families, provide families with a means to communicate satisfaction and frustration, and access the supports they need to be active participants in their child’s care. %M 37698912 %R 10.2196/45957 %U https://humanfactors.jmir.org/2023/1/e45957 %U https://doi.org/10.2196/45957 %U http://www.ncbi.nlm.nih.gov/pubmed/37698912 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49806 %T Mobile Technology to Monitor and Support Health and Well-Being: Qualitative Study of Perspectives and Design Suggestions From Patients Undergoing Hematopoietic Cell Transplantation %A Caparso,Cinzia %A Ozkan,Gwynne %A Kluge,Maxwell %A Salim,Humza %A Khaghany,Aidan %A Blok,Amanda %A Choi,Sung Won %+ Department of Systems, Populations and Leadership Center for Improving Patient and Population Health, University of Michigan School of Nursing, 426 N Ingalls St., Ann Arbor, MI, 48014, United States, 1 586 219 1449, ccaparso@umich.edu %K hematopoietic stem cell transplantation %K bone marrow %K surgery %K surgical %K recovery %K mobile apps %K mHealth %K mobile health %K app %K apps %K qualitative research %K qualitative %K experience %K experiences %K perception %K perceptions %K stem cell %K stem cells %K transplant %K transplantation %K transplants %K hematopoietic %K positive psychology %K psychology %D 2023 %7 31.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, hematopoietic stem cell transplant (HCT) surpasses 22,000 procedures annually. Due to the demanding and time-intensive process of an HCT, patients and family care partners face unique challenges involving their health and well-being. Positive psychology interventions (PPIs) may offer potential solutions to help boost health and well-being. Objective: This study aimed to explore and understand patients’ experiences and perceptions about the use of the Roadmap 2.0 app, specifically its PPI features, during the acute phase of HCT. Methods: From an ongoing randomized controlled trial, HCT patients (n=17) were recruited to participate in semistructured qualitative interviews between October 2022 and January 2023 within a large academic medical center in the Midwestern states. Using a qualitative descriptive approach, interviews were conducted in person or via Zoom. The data were analyzed through constant comparative analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed. Results: The majority of the participants reported Roadmap 2.0 as easy to use and enjoyed the ability to track their health data (eg, steps, mood, sleep; 9/17). Regarding the use of PPIs during the acute phase of treatment, 88% of the participants reported interest in participating in PPIs, specifically the Pleasant Activity Scheduling (11/17) followed by Gratitude Journaling (7/17) activities. Additionally, participants provided recommendations on adapting Roadmap 2.0. The major recommendations were (1) “Working Together: Need for Dyadic Involvement,” (2) “Connectivity with Other Patients,” and (3) “Gap in Nutritional Support.” Participants (10/17) expressed the importance of caregiver involvement in activities beyond treatment-related management for maintaining healthy patient-caregiver dyadic relationships. They also expressed their desire for connectivity with other patients undergoing HCT, primarily for comparing experiences and discussing topics such as symptom management (8/17). Lastly, participants identified a gap in nutritional support during the HCT process and expressed interest in an intervention that could promote healthy eating through education and notification reminders (9/17). Conclusions: Participants openly expressed their eagerness to participate in research studies that foster connection and positive relationships with their caregivers as well as with other HCT patients. They emphasized the significance of having access to nutritional support or guidance and highlighted the potential benefits of using mobile technology to enhance these collective efforts. Trial Registration: ClinicalTrials.gov NCT04094844; https://clinicaltrials.gov/study/NCT04094844 International Registered Report Identifier (IRRID): RR2-10.2196/19288 %M 37651172 %R 10.2196/49806 %U https://formative.jmir.org/2023/1/e49806 %U https://doi.org/10.2196/49806 %U http://www.ncbi.nlm.nih.gov/pubmed/37651172 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e47183 %T Acceptability and Utility of a Smartphone App to Support Adolescent Mental Health (BeMe): Program Evaluation Study %A Prochaska,Judith J %A Wang,Yixin %A Bowdring,Molly A %A Chieng,Amy %A Chaudhary,Neha P %A Ramo,Danielle E %+ Stanford Prevention Research Center, Department of Medicine, Stanford University, 3180 Porter Drive Room A105, Palo Alto, CA, 94304-1212, United States, 1 650 724 3608, jpro@stanford.edu %K adolescents %K mobile app %K depression %K anxiety %K resilience %K digital intervention %K digital mental health %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people’s mental health. Objective: This study aimed to describe the BeMe app-based platform to support adolescents’ mental health and well-being and to examine app engagement, usability, and satisfaction. Methods: Adolescents in the United States, aged 13 to 20 years, were recruited via the web and enrolled between September 1 and October 31, 2022. App engagement, feature use, clinical functioning, and satisfaction with BeMe were examined for 30 days. BeMe provides content based on cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, and positive psychology; interactive activities; live text-based coaching; links to clinical services; and crisis support tools (digital and live). Results: The average age of the sample (N=13,421) was 15.04 (SD 1.7) years, and 56.72% (7612/13,421) identified with she/her pronouns. For the subsample that completed the in-app assessments, the mean scores indicated concern for depression (8-item Patient Health Questionnaire mean 15.68/20, SD 5.9; n=239), anxiety (7-item Generalized Anxiety Disorder Questionnaire mean 13.37/17, SD 5.0; n=791), and poor well-being (World Health Organization–Five Well-being Index mean 30.15/100, SD 16.1; n=1923). Overall, the adolescents engaged with BeMe for an average of 2.38 (SD 2.7) days in 7.94 (SD 24.1) sessions and completed 11.26 (SD 19.8) activities. Most adolescents engaged with BeMe’s content (12,270/13,421, 91.42%), mood ratings (13,094/13,421, 97.56%), and interactive skills (10,098/13,421, 75.24%), and almost one-fifth of the adolescents engaged with coaching (2539/13,421, 18.92%), clinical resources (2411/13,421, 17.96%), and crisis support resources (2499/13,421, 18.62%). Overall app engagement (total activities) was highest among female and gender-neutral adolescents compared with male adolescents (all P<.001) and was highest among younger adolescents (aged 13-14 years) compared with all other ages (all P<.001). Satisfaction ratings were generally high for content (eg, 158/176, 89.8% rated as helpful and 1044/1139, 91.66% improved coping self-efficacy), activities (5362/8468, 63.32% helpful and 4408/6072, 72.6% useful in coping with big feelings), and coaching (747/894, 83.6% helpful and 747/894, 83.6% improved coping self-efficacy). Engagement (total activities completed) predicted the likelihood of app satisfaction (P<.001). Conclusions: Many adolescents downloaded the BeMe app and completed multiple sessions and activities. Engagement with BeMe was higher among female and younger adolescents. Ratings of BeMe’s content, activities, and coaching were very positive for cognitive precursors aimed at reducing depression and anxiety and improving well-being. The findings will inform future app development to promote more sustained engagement, and future evaluations will assess the effects of BeMe on changes in mental health outcomes. %M 37639293 %R 10.2196/47183 %U https://mhealth.jmir.org/2023/1/e47183 %U https://doi.org/10.2196/47183 %U http://www.ncbi.nlm.nih.gov/pubmed/37639293 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45694 %T Sustainable Development for Mobile Health Apps Using the Human-Centered Design Process %A An,Qingfan %A Kelley,Marjorie M %A Hanners,Audra %A Yen,Po-Yin %+ Department of Community Medicine and Rehabilitation, Umeå University, Biology Building 3rd floor, Linnaeus väg 9, Umeå, 90736, Sweden, 46 0764550820, qingfan.an@umu.se %K mHealth %K mobile health %K apps %K human-centered design %K sociotechnical %K sustainability %K mobile technology %K speculative design %K mobile phone %D 2023 %7 25.8.2023 %9 Viewpoint %J JMIR Form Res %G English %X Well-documented scientific evidence indicates that mobile health (mHealth) apps can improve the quality of life, relieve symptoms, and restore health for patients. In addition to improving patients’ health outcomes, mHealth apps reduce health care use and the cost burdens associated with disease management. Currently, patients and health care providers have a wide variety of choices among commercially available mHealth apps. However, due to the high resource costs and low user adoption of mHealth apps, the cost-benefit relationship remains controversial. When compared to traditional expert-driven approaches, applying human-centered design (HCD) may result in more useable, acceptable, and effective mHealth apps. In this paper, we summarize current HCD practices in mHealth development studies and make recommendations to improve the sustainability of mHealth. These recommendations include consideration of factors regarding culture norms, iterative evaluations on HCD practice, use of novelty in mHealth app, and consideration of privacy and reliability across the entire HCD process. Additionally, we suggest a sociotechnical lens toward HCD practices to promote the sustainability of mHealth apps. Future research should consider standardizing the HCD practice to help mHealth researchers and developers avoid barriers associated with inadequate HCD practices. %M 37624639 %R 10.2196/45694 %U https://formative.jmir.org/2023/1/e45694 %U https://doi.org/10.2196/45694 %U http://www.ncbi.nlm.nih.gov/pubmed/37624639 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47220 %T Developing A Mobile App With a Human-Centered Design Lens to Improve Access to Mental Health Care (Mentallys Project): Protocol for an Initial Co-Design Process %A Vial,Stéphane %A Boudhraâ,Sana %A Dumont,Mathieu %A Tremblay,Melanie %A Riendeau,Sophie %+ Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, École de Design, Université du Québec à Montréal, 1440 rue Sanguinet, Montréal, QC, H2X 3X9, Canada, 1 514 987 3000 ext 3919, vial.stephane@uqam.ca %K co-design %K human-centered design %K e-mental health %K design expertise %K user engagement %K patient-centered design %K imaginary prototype %D 2023 %7 22.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Co-design is one of the human-centered design approaches that allows end users to significantly and positively impact the design of mental health technologies. It is a promising approach to foster user acceptance and engagement in digital mental health solutions. Surprisingly, there is a lack of understanding of what co-design is in this field. In this paper, co-design is approached as a cocreation process involving persons with a lived experience of mental health problems, health professionals, and design experts who lead and facilitate the overall creative process. Objective: This paper describes an initial co-design research protocol for the development of a mobile app that aims to improve access to mental health care. It highlights the characteristics of a co-design approach in e–mental health rooted in human-centered design and led by design experts alongside health experts. The paper focuses on the first steps (phase 1) of the co-design process of the ongoing Mentallys project. Methods: This Mentallys project will be located in Montréal (Quebec, Canada). The method approach will be based on the “method stories,” depicting the “making of” this project and reflecting adjustments needed to the protocol throughout the project in specific situations. Phase 1 of the process will focus on the desirability of the app. Targeted participants will include people with a lived experience of mental health problems, peer support workers and clinicians, and 3 facilitators (all design experts or researchers). Web-based sessions will be organized because of the COVID-19 pandemic, using Miro (RealtimeBoard Inc) and Zoom (Zoom Video Communications, Inc). Data collection will be based on the comments, thoughts, and new ideas of participants around the imaginary prototypes. Thematic analysis will be carried out after each session to inform a new version of the prototype. Results: We conducted 2 stages in phase 1 of the process. During stage 1, we explored ideas through group co-design workshops (divergent thinking). Six co-design workshops were held: 2 with only clinicians (n=7), 2 with peer support workers (n=5) and people with a lived experience of mental health problems (n=2), and 2 with all of them (n=14). A total of 6 facilitators participated in conducting activities in subgroups. During stage 2, ideas were refined through 10 dyad co-design sessions (convergent thinking). Stage 2 involved 3 participants (n=3) and 1 facilitator. Thematic analysis was performed after stage 1, while analytic questioning is being performed for stage 2. Both stages allowed several iterations of the prototypes. Conclusions: The design of the co-design process, the leadership of the design expertise throughout the process, and the different forms of co-design activities are key elements in this project. We highly recommend that health researchers partner with professional designers or design researchers who are familiar with co-design. International Registered Report Identifier (IRRID): DERR1-10.2196/47220 %M 37606978 %R 10.2196/47220 %U https://www.researchprotocols.org/2023/1/e47220 %U https://doi.org/10.2196/47220 %U http://www.ncbi.nlm.nih.gov/pubmed/37606978 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e45418 %T Acceptance and Usability of an Innovative mDentistry eHygiene Model Amid the COVID-19 Pandemic Within the US National Dental Practice-Based Research Network: Mixed Methods Study %A Xiao,Jin %A Kopycka-Kedzierawski,Dorota %A Ragusa,Patricia %A Mendez Chagoya,Luis Alberto %A Funkhouser,Kimberly %A Lischka,Tamara %A Wu,Tong Tong %A Fiscella,Kevin %A Kar,Kumari Saswati %A Al Jallad,Nisreen %A Rashwan,Noha %A Ren,Johana %A Meyerowitz,Cyril %A , %+ Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, Rochester, NY, 14618, United States, 1 585 275 4925, cyril_meyerowitz@urmc.rochester.edu %K teledentistry %K mDentistry %K oral diseases %K virtual visit %K intraoral camera %K COVID-19 %K pandemic response %K mobile phone %D 2023 %7 18.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Amid the COVID-19 pandemic and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care and ensure the safety of patients and dental health care personnel (DHCP). Objective: This study aims to assess the acceptance and usability of an innovative mDentistry eHygiene model amid the COVID-19 pandemic. Methods: This pilot study used a 2-stage implementation design to assess 2 critical components of an innovative mDentistry eHygiene model: virtual hygiene examination (eHygiene) and patient self-taken intraoral images (SELFIE), within the National Dental Practice-Based Research Network. Mixed methods (quantitative and qualitative) were used to assess the acceptance and usability of the eHygiene model. Results: A total of 85 patients and 18 DHCP participated in the study. Overall, the eHygiene model was well accepted by patients (System Usability Scale [SUS] score: mean 70.0, SD 23.7) and moderately accepted by dentists (SUS score: mean 51.3, SD 15.9) and hygienists (SUS score: mean 57.1, SD 23.8). Dentists and patients had good communication during the eHygiene examination, as assessed using the Dentist-Patient Communication scale. In the SELFIE session, patients completed tasks with minimum challenges and obtained diagnostic intraoral photos. Patients and DHCP suggested that although eHygiene has the potential to improve oral health care services, it should be used selectively depending on patients’ conditions. Conclusions: The study results showed promise for the 2 components of the eHygiene model. eHygiene offers a complementary modality for oral health data collection and examination in dental offices, which would be particularly useful during an infectious disease outbreak. In addition, patients being able to capture critical oral health data in their home could facilitate dental treatment triage and oral health self-monitoring and potentially trigger oral health–promoting behaviors. %M 37594795 %R 10.2196/45418 %U https://humanfactors.jmir.org/2023/1/e45418 %U https://doi.org/10.2196/45418 %U http://www.ncbi.nlm.nih.gov/pubmed/37594795 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45079 %T The Use of a Decision Support System (MyFood) to Assess Dietary Intake Among Free-Living Older Adults in Norway: Evaluation Study %A Severinsen,Frida %A Andersen,Lene Frost %A Paulsen,Mari Mohn %+ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Postboks 1046, Blindern, Oslo, 0317, Norway, 47 95772048, m.m.paulsen@medisin.uio.no %K dietary assessment %K malnutrition %K eHealth %K validation study %K older adults %K mobile phone %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The proportion of older adults in the world is constantly increasing, and malnutrition is a common challenge among the older adults aged ≥65 years. This poses a need for better tools to prevent, assess, and treat malnutrition among older adults. MyFood is a decision support system developed with the intention to prevent and treat malnutrition. Objective: This study aimed to evaluate the ability of the MyFood app to estimate the intake of energy, protein, fluids, and food and beverage items among free-living older adults aged ≥65 years, primarily at an individual level and secondarily at a group level. In addition, the aim was to measure the experiences of free-living older adults using the app. Methods: Participants were instructed to record their dietary intake in the MyFood app for 4 consecutive days. In addition, each participant completed two 24-hour recalls, which were used as a reference method to evaluate the dietary assessment function in the MyFood app. Differences in the estimations of energy, protein, fluid, and food groups were analyzed at both the individual and group levels, by comparing the recorded intake in MyFood with the 2 corresponding recalls and by comparing the mean of all 4 recording days with the mean of the 2 recalls, respectively. A short, study-specific questionnaire was used to measure the participants’ experiences with the app. Results: This study included 35 free-living older adults residing in Norway. Approximately half of the participants had ≥80% agreement between MyFood and the 24-hour recalls for energy intake on both days. For protein and fluids, approximately 60% of the participants had ≥80% agreement on the first day of comparison. Dinner was the meal with the lowest agreement between the methods, at both the individual and group levels. MyFood tended to underestimate the intake of energy, protein, fluid, and food items at both the individual and group levels. The food groups that achieved the greatest agreement between the 2 methods were eggs, yogurt, self-composed dinner, and hot beverages. All participants found the app easy to use, and 74% (26/35) of the participants reported that the app was easy to navigate. Conclusions: The results showed that the MyFood app tended to underestimate the participants’ dietary intake compared with the 24-hour recalls at both the individual and group levels. The app’s ability to estimate intake within food groups was greater for eggs, yogurt, and self-composed dinner than for spreads, mixed meals, vegetables, and snacks. The app was well accepted among the study participants and may be a useful tool among free-living older adults, given that the users are provided follow-up and support in how to record their dietary intake. %M 37535420 %R 10.2196/45079 %U https://mhealth.jmir.org/2023/1/e45079 %U https://doi.org/10.2196/45079 %U http://www.ncbi.nlm.nih.gov/pubmed/37535420 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e40891 %T Identification of the Needs and Preferences of Patients With Cancer for the Development of a Clinic App: Qualitative Study %A Weis,Joachim %A Wolf,Lucy Raphaela %A Boerries,Melanie %A Kassahn,Daniela %A Boeker,Martin %A Dresch,Carolin %+ Chair for Self-Help Research, Comprehensive Cancer Center, Medical Faculty, University Clinic Freiburg, Hugstetter Str. 49, Freiburg, 79106, Germany, 49 761270 ext 71561, joachim.weis@uniklinik-freiburg.de %K cancer %K mobile app %K mHealth %K mobile health %K needs assessment %K patient-centered care %K PROM %K patient-reported outcome measures %K qualitative methods %D 2023 %7 27.7.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Mobile health (mHealth) tools were developed during the past decades and are increasingly used by patients in cancer care too. Scientific research in the development of mHealth services is required in order to meet the various needs of patients and test usability. Objective: The aim of this study is to assess patients’ needs, preferences, and usability of an app (My University Clinic [MUC] app) developed by the Comprehensive Cancer Center Freiburg (CCCF) Germany. Methods: Based on a qualitative cross-sectional approach, we conducted semistructured interviews with patients with cancer, addressing their needs, preferences, and usability of the designed MUC app. Patients treated by the CCCF were recruited based on a purposive sampling technique focusing on age, sex, cancer diagnoses, and treatment setting (inpatient, outpatient). Data analysis followed the qualitative content analysis according to Kuckartz and was performed using computer-assisted software (MAXQDA). Results: For the interviews, 17 patients with cancer were selected, covering a broad range of sampling parameters. The results showed that patients expect benefits in terms of improved information about the disease and communication with the clinic staff. Demands for additional features were identified (eg, a list of contact persons and medication management). The most important concerns referred to data security and the potential restriction of personal contacts with health care professionals of the clinical departments of the CCCF. In addition, some features for improving the design of the MUC app with respect to usability or for inclusion of interacting tools were suggested by the patients. Conclusions: The results of this qualitative study were discussed within the multidisciplinary team and the MUC app providers. Patients’ perspectives and needs will be included in further development of the MUC app. There will be a second study phase in which patients will receive a test version of the MUC app and will be asked about their experiences with it. Trial Registration: Deutsches Register Klinischer Studien DRKS00022162; https://drks.de/search/de/trial/DRKS00022162 %M 37498653 %R 10.2196/40891 %U https://cancer.jmir.org/2023/1/e40891 %U https://doi.org/10.2196/40891 %U http://www.ncbi.nlm.nih.gov/pubmed/37498653 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40219 %T Co-design of an Augmented Reality Asthma Inhaler Educational Intervention for Children: Development and Usability Study %A O'Connor,Antonia %A Tai,Andrew %A Brinn,Malcolm %A Hoang,Amy Nguyen Thuc Hien %A Cataldi,Daniele %A Carson-Chahhoud,Kristin %+ Respiratory and Sleep Department, Women's and Children's Hospital, 72 King William Road, North Adelaide, Adelaide, 5006, Australia, 61 08 81617234, antonia.chan@sa.gov.au %K asthma %K asthma education %K pediatric %K pediatric asthma %K co-design %K usability %K development %K smartphone %K tablet %K augmented reality %K health education %K mobile app %K mobile phone %D 2023 %7 25.7.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Smartphone and tablet apps that deliver health care education have been identified as effective in improving patient knowledge and treatment adherence in asthma populations. Despite asthma being the most common chronic disease in pediatrics, there are few apps that are targeted specifically for children. Only half of children with asthma have acceptable control of their symptoms, and 40%-98% do not use their inhalers correctly. With children being increasingly connected to technology, there is an opportunity to improve asthma inhaler technique education by delivery via smartphone or tablet apps. Augmented reality (AR) technology was used in this study to capitalize on growing technological innovations. Digital health interventions that use a co-design process for development have the highest likelihood of successful uptake and effectiveness on their intended outcomes. Perceived usability also has been shown to improve the effectiveness of education as well as the acceptance of the intervention. Objective: The aims of this study were to describe the co-design process, development, and design outcomes of a smartphone or tablet app that incorporates AR technology to deliver asthma inhaler technique education to children with asthma. This study also aimed to provide a usability evaluation, using the System Usability Scale to inform our work and future research, and recommendations for others performing similar work. Methods: The development of the AR asthma inhaler technique education app was based on an iterative co-design process with likely end users (children with asthma, their caregivers, and health care professionals). This involved multiple stages: recruitment of end users for qualitative interviews and usability testing with a previously designed educational intervention, which used an AR-embedded smartphone or tablet app; ideation of content for a specific asthma inhaler technique education intervention with end users; development of the specific asthma inhaler intervention; and 2 further rounds of interviews and usability testing with the redesign of the initial prototype. Results: We included 16 participants aged 9-45 years. Using the co-design process, the AR asthma inhaler technique education app was designed, incorporating the preferences of end users. After iteration 1, animation was included based on the feedback provided. Iteration 2 feedback resulted in increased AR experiences and the removal of the requirement of a paper-based resource to trigger AR in the third iteration. Throughout all rounds, the ease of use of the app and the novel nature of the intervention were frequently described. The usability of the intervention overall was perceived to be excellent, and the mean System Usability Scale score of the intervention was found to be highest in the final round of evaluation (90.14). Conclusions: The results from this co-design process and usability evaluation will be used to develop a final AR asthma inhaler technique educational intervention, which will be evaluated in the clinical setting. International Registered Report Identifier (IRRID): RR2-10.1177/16094069211042229 %M 37490325 %R 10.2196/40219 %U https://pediatrics.jmir.org/2023/1/e40219 %U https://doi.org/10.2196/40219 %U http://www.ncbi.nlm.nih.gov/pubmed/37490325 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e46432 %T Designing a Collaborative Patient-Centered Digital Health Platform for Pediatric Diabetes Care in British Columbia: Formative Needs Assessment by Caregivers of Children and Youths Living With Type 1 Diabetes and Health Care Providers %A Abdulhussein,Fatema S %A Pinkney,Susan %A Görges,Matthias %A van Rooij,Tibor %A Amed,Shazhan %+ Department of Pediatrics, University of British Columbia, BC Children's Hospital, 4480 Oak Street K4-212, Vancouver, BC, V6H3N1, Canada, 1 604 875 2345 ext 2624, samed@cw.bc.ca %K application design %K challenge %K child %K design %K development %K diabetes %K diabetic %K digital health %K digital solution %K engagement %K feature %K needs assessment %K patient engagement %K patient need %K pediatric %K perception %K privacy %K secure %K security %K trust %K Type 1 diabetes %K Type 1 %K usage %K user centered %K user need %K youth %D 2023 %7 13.7.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Digital health apps are becoming increasingly available for people living with diabetes, yet data silos continue to exist. This requires health care providers (HCPs) and patients to use multiple digital platforms to access health data. Objective: In this study, we gathered the perspectives of caregivers of children and youths living with type 1 diabetes (T1D) and pediatric diabetes HCPs in the user-centered design of TrustSphere, a secure, single-point-of-access, integrative digital health platform. Methods: We distributed web-based surveys to caregivers of children and youths living with T1D and pediatric diabetes HCPs in British Columbia, Canada. Surveys were designed using ordinal scales and had free-text questions. Survey items assessed key challenges, perceptions about digital trust and security, and potential desirable features for a digital diabetes platform. Results: Similar challenges were identified between caregivers of children and youths living with T1D (n=99) and HCPs (n=49), including access to mental health support, integration of diabetes technology and device data, and the ability to collaborate on care plans with their diabetes team. Caregivers and HCPs identified potential features that directly addressed their challenges, such as more accessible diabetes data and diabetes care plans. Caregivers had more trust in sharing their child’s data digitally than HCPs. Most caregivers and HCPs stated that an integrative platform for T1D would support collaborative patient care. Conclusions: Caregiver and HCP perspectives gathered in this study will inform the early prototype of an integrative digital health platform. This prototype will be presented and iterated upon through a series of usability testing sessions with caregivers and HCPs to ensure the platform meets end users’ needs. %M 37440296 %R 10.2196/46432 %U https://pediatrics.jmir.org/2023/1/e46432 %U https://doi.org/10.2196/46432 %U http://www.ncbi.nlm.nih.gov/pubmed/37440296 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42970 %T A Novel Mobile App to Identify Patients With Multimorbidity in the Emergency Setting: Development of an App and Feasibility Trial %A Rosen,Claire Barthlow %A Roberts,Sanford Eugene %A Syvyk,Solomiya %A Finn,Caitlin %A Tong,Jason %A Wirtalla,Christopher %A Spinks,Hunter %A Kelz,Rachel Rapaport %+ Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA, 19104, United States, 1 2678472878, claire.rosen@pennmedicine.upenn.edu %K clinical operationalization %K delphi %K development %K emergency %K general surgery %K mHealth %K mobile app %K mobile app %K mobile health %K morbidity %K multimorbidity %K qualifying comorbidity set %K surgery %K usability %D 2023 %7 13.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Multimorbidity is associated with an increased risk of poor surgical outcomes among older adults; however, identifying multimorbidity in the clinical setting can be a challenge. Objective: We created the Multimorbid Patient Identifier App (MMApp) to easily identify patients with multimorbidity identified by the presence of a Qualifying Comorbidity Set and tested its feasibility for use in future clinical research, validation, and eventually to guide clinical decision-making. Methods: We adapted the Qualifying Comorbidity Sets’ claims-based definition of multimorbidity for clinical use through a modified Delphi approach and developed MMApp. A total of 10 residents input 5 hypothetical emergency general surgery patient scenarios, common among older adults, into the MMApp and examined MMApp test characteristics for a total of 50 trials. For MMApp, comorbidities selected for each scenario were recorded, along with the number of comorbidities correctly chosen, incorrectly chosen, and missed for each scenario. The sensitivity and specificity of identifying a patient as multimorbid using MMApp were calculated using composite data from all scenarios. To assess model feasibility, we compared the mean task completion by scenario to that of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS-NSQIP-SRC) using paired t tests. Usability and satisfaction with MMApp were assessed using an 18-item questionnaire administered immediately after completing all 5 scenarios. Results: There was no significant difference in the task completion time between the MMApp and the ACS-NSQIP-SRC for scenarios A (86.3 seconds vs 74.3 seconds, P=.85) or C (58.4 seconds vs 68.9 seconds,P=.064), MMapp took less time for scenarios B (76.1 seconds vs 87.4 seconds, P=.03) and E (20.7 seconds vs 73 seconds, P<.001), and more time for scenario D (78.8 seconds vs 58.5 seconds, P=.02). The MMApp identified multimorbidity with 96.7% (29/30) sensitivity and 95% (19/20) specificity. User feedback was positive regarding MMApp’s usability, efficiency, and usefulness. Conclusions: The MMApp identified multimorbidity with high sensitivity and specificity and did not require significantly more time to complete than a commonly used web-based risk-stratification tool for most scenarios. Mean user times were well under 2 minutes. Feedback was overall positive from residents regarding the usability and usefulness of this app, even in the emergency general surgery setting. It would be feasible to use MMApp to identify patients with multimorbidity in the emergency general surgery setting for validation, research, and eventual clinical use. This type of mobile app could serve as a template for other research teams to create a tool to easily screen participants for potential enrollment. %M 37440310 %R 10.2196/42970 %U https://formative.jmir.org/2023/1/e42970 %U https://doi.org/10.2196/42970 %U http://www.ncbi.nlm.nih.gov/pubmed/37440310 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46286 %T The Effectiveness of a Mobile Phone–Based Physical Activity Program for Treating Depression, Stress, Psychological Well-Being, and Quality of Life Among Adults: Quantitative Study %A Kim,Hyungsook %A Lee,Kikwang %A Lee,Ye Hoon %A Park,Yoonjung %A Park,Yonghyun %A Yu,Yeonwoo %A Park,Jaeyoung %A Noh,Sihyeon %+ Division of Global Sport Industry, Hankuk University of Foreign Studies, 81, Oedae-ro, Mohyeon-eup, Cheoin-gu, Gyeonggi-do, 17035, Republic of Korea, 82 31 330 4986, leeye22@o365.hufs.ac.kr %K depressive symptoms %K mobile intervention %K exercise %K internet-based fitness %K mental health %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Depression is a substantial global health problem, affecting >300 million people and resulting in 12.7% of all deaths. Depression causes various physical and cognitive problems, leading to a 5-year to 10-year decrease in life expectancy compared with the general population. Physical activity is known to be an effective, evidence-based treatment for depression. However, people generally have difficulties with participating in physical activity owing to limitations in time and accessibility. Objective: To address this issue, this study aimed to contribute to the development of alternative and innovative intervention methods for depression and stress management in adults. More specifically, we attempted to investigate the effectiveness of a mobile phone–based physical activity program on depression, perceived stress, psychological well-being, and quality of life among adults in South Korea. Methods: Participants were recruited and randomly assigned to the mobile phone intervention or waitlist group. Self-report questionnaires were used to assess variables before and after treatment. The treatment group used the program around 3 times per week at home for 4 weeks, with each session lasting about 30 minutes. To evaluate the program’s impact, a 2 (condition) × 2 (time) repeated-measures ANOVA was conducted, considering pretreatment and posttreatment measures along with group as independent variables. For a more detailed analysis, paired-samples 2-tailed t tests were used to compare pretreatment and posttreatment measurements within each group. Independent-samples 2-tailed t tests were conducted to assess intergroup differences in pretreatment measurements. Results: The study included a total of 68 adults aged between 18 and 65 years, who were recruited both through web-based and offline methods. Of these 68 individuals, 41 (60%) were randomly assigned to the treatment group and 27 (40%) to the waitlist group. The attrition rate was 10.2% after 4 weeks. The findings indicated that there is a significant main effect of time (F1,60=15.63; P=.003; ηp2=0.21) in participants’ depression scores, indicating that there were changes in depression level across time. No significant changes were observed in perceived stress (P=.25), psychological well-being (P=.35), or quality of life (P=.07). Furthermore, depression scores significantly decreased in the treatment group (from 7.08 to 4.64; P=.03; Cohen d=0.50) but not in the waitlist group (from 6.72 to 5.08; P=.20; Cohen d=0.36). Perceived stress score of the treatment group also significantly decreased (from 2.95 to 2.72; P=.04; Cohen d=0.46) but not in the waitlist group (from 2.82 to 2.74; P=.55; Cohen d=0.15). Conclusions: This study provided experimental evidence that mobile phone–based physical activity program affects depression significantly. By exploring the potential of mobile phone–based physical activity programs as a treatment option, this study sought to improve accessibility and encourage participation in physical activity, ultimately promoting better mental health outcomes for individuals with depression and stress. %M 37358905 %R 10.2196/46286 %U https://mhealth.jmir.org/2023/1/e46286 %U https://doi.org/10.2196/46286 %U http://www.ncbi.nlm.nih.gov/pubmed/37358905 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45852 %T A Digital Mental Health App Incorporating Wearable Biosensing for Teachers of Children on the Autism Spectrum to Support Emotion Regulation: Protocol for a Pilot Randomized Controlled Trial %A Palermo,Emma H %A Young,Amanda V %A Deswert,Sky %A Brown,Alyssa %A Goldberg,Miranda %A Sultanik,Evan %A Tan,Jessica %A Mazefsky,Carla A %A Brookman-Frazee,Lauren %A McPartland,James C %A Goodwin,Matthew S %A Pennington,Jeffrey %A Marcus,Steven C %A Beidas,Rinad S %A Mandell,David S %A Nuske,Heather J %+ Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Fl., Philadelphia, PA, 19104, United States, 1 215 746 6041, heather.nuske@pennmedicine.upenn.edu %K digital mental health %K just-in-time adaptive intervention augmentation %K JITAI %K autism %K heart rate tracking %K emotion dysregulation %K challenging behavior %K evidence-based strategies %K student progress monitoring %K mobile phone %D 2023 %7 26.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: As much as 80% of children on the autism spectrum exhibit challenging behaviors (ie, behaviors dangerous to the self or others, behaviors that interfere with learning and development, and behaviors that interfere with socialization) that can have a devastating impact on personal and family well-being, contribute to teacher burnout, and even require hospitalization. Evidence-based practices to reduce these behaviors emphasize identifying triggers (events or antecedents that lead to challenging behaviors); however, parents and teachers often report that challenging behaviors surface with little warning. Exciting recent advances in biometric sensing and mobile computing technology allow the measurement of momentary emotion dysregulation using physiological indexes. Objective: We present the framework and protocol for a pilot trial that will test a mobile digital mental health app, the KeepCalm app. School-based approaches to managing challenging behaviors in children on the autism spectrum are limited by 3 key factors: children on the autism spectrum often have difficulties in communicating their emotions; it is challenging to implement evidence-based, personalized strategies for individual children in group settings; and it is difficult for teachers to track which strategies are successful for each child. KeepCalm aims to address those barriers by communicating children’s stress to their teachers using physiological signaling (emotion dysregulation detection), supporting the implementation of emotion regulation strategies via smartphone pop-up notifications of top strategies for each child according to their behavior (emotion regulation strategy implementation), and easing the task of tracking outcomes by providing the child’s educational team with a tool to track the most effective emotion regulation strategies for that child based on physiological stress reduction data (emotion regulation strategy evaluation). Methods: We will test KeepCalm with 20 educational teams of students on the autism spectrum with challenging behaviors (no exclusion based on IQ or speaking ability) in a pilot randomized waitlist-controlled field trial over a 3-month period. We will examine the usability, acceptability, feasibility, and appropriateness of KeepCalm as primary outcomes. Secondary preliminary efficacy outcomes include clinical decision support success, false positives or false negatives of stress alerts, and the reduction of challenging behaviors and emotion dysregulation. We will also examine technical outcomes, including the number of artifacts and the proportion of time children are engaged in high physical movement based on accelerometry data; test the feasibility of our recruitment strategies; and test the response rate and sensitivity to change of our measures, in preparation for a future fully powered large-scale randomized controlled trial. Results: The pilot trial will begin by September 2023. Conclusions: Results will provide key data about important aspects of implementing KeepCalm in preschools and elementary schools and will provide preliminary data about its efficacy to reduce challenging behaviors and support emotion regulation in children on the autism spectrum. Trial Registration: ClinicalTrials.gov NCT05277194; https://www.clinicaltrials.gov/ct2/show/NCT05277194 International Registered Report Identifier (IRRID): PRR1-10.2196/45852 %M 37358908 %R 10.2196/45852 %U https://www.researchprotocols.org/2023/1/e45852 %U https://doi.org/10.2196/45852 %U http://www.ncbi.nlm.nih.gov/pubmed/37358908 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42382 %T A Transgender Health Information Resource: Participatory Design Study %A Morse,Brad %A Soares,Andrey %A Kwan,Bethany M %A Allen,Marvyn %A Lee,Rita S %A Desanto,Kristen %A Holliman,Brooke Dorsey %A Ytell,Kate %A Schilling,Lisa M %+ Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 8th Floor, Academic Office 1-Office 8219, 12631 E 17th Ave, Aurora, CO, 80045, United States, 1 303 724 2254, lisa.schilling@cuanschutz.edu %K lesbian, gay, bisexual, transgender, and queer %K LGBTQ %K transgender %K mobile app %K health information %K participatory design %K agile development %K mobile phone %D 2023 %7 15.6.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite the abundance of health information on the internet for people who identify as transgender and gender diverse (TGD), much of the content used is found on social media channels, requiring individuals to vet the information for relevance and quality. Objective: We developed a prototype transgender health information resource (TGHIR) delivered via a mobile app to provide credible health and wellness information for people who are TGD. Methods: We partnered with the TGD community and used a participatory design approach that included focus groups and co-design sessions to identify users’ needs and priorities. We used the Agile software development methodology to build the prototype. A medical librarian and physicians with expertise in transgender health curated a set of 97 information resources that constituted the foundational content of the prototype. To evaluate the prototype TGHIR app, we assessed the app with test users, using a single item from the System Usability Scale to assess feature usability, cognitive walk-throughs, and the user version of the Mobile Application Rating Scale to evaluate the app’s objective and subjective quality. Results: A total of 13 people who identified as TGD or TGD allies rated their satisfaction with 9 of 10 (90%) app features as good to excellent, and 1 (10%) of the features—the ability to filter to narrow TGHIR resources—was rated as okay. The overall quality score on the user version of the Mobile Application Rating Scale was 4.25 out of 5 after 4 weeks of use, indicating a good-quality mobile app. The information subscore received the highest rating, at 4.75 out of 5. Conclusions: Community partnership and participatory design were effective in the development of the TGHIR app, resulting in an information resource app with satisfactory features and overall high-quality ratings. Test users felt that the TGHIR app would be helpful for people who are TGD and their care partners. %M 37318836 %R 10.2196/42382 %U https://humanfactors.jmir.org/2023/1/e42382 %U https://doi.org/10.2196/42382 %U http://www.ncbi.nlm.nih.gov/pubmed/37318836 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44500 %T Acceptability of an mHealth App for Monitoring Perinatal and Postpartum Mental Health: Qualitative Study With Women and Providers %A Varma,Deepthi S %A Mualem,Maya %A Goodin,Amie %A Gurka,Kelly K %A Wen,Tony Soo-Tung %A Gurka,Matthew J %A Roussos-Ross,Kay %+ Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, United States, 1 352 294 5941, dvarma@ufl.edu %K perinatal mental health %K mobile health %K mHealth %K mobile apps %K ecological momentary assessment %K EMA %K mobile phone %D 2023 %7 7.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 15% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. Objective: This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. Methods: Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. Results: Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. Conclusions: The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population. %M 37285185 %R 10.2196/44500 %U https://formative.jmir.org/2023/1/e44500 %U https://doi.org/10.2196/44500 %U http://www.ncbi.nlm.nih.gov/pubmed/37285185 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44945 %T The Implementation of a GPS-Based Location-Tracking Smartphone App in South Africa to Improve Engagement in HIV Care: Randomized Controlled Trial %A Clouse,Kate %A Noholoza,Sandisiwe %A Madwayi,Sindiswa %A Mrubata,Megan %A Camlin,Carol S %A Myer,Landon %A Phillips,Tamsin K %+ Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN, 37240, United States, 1 615 343 5351, kate.clouse@vanderbilt.edu %K mobile health %K mHealth %K smartphone %K mobile phone %K HIV/AIDS %K South Africa %K pregnancy %D 2023 %7 19.5.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health interventions are common in public health settings in Africa, and our preliminary work showed that smartphones are increasing in South Africa. We developed a novel smartphone app—CareConekta—that used GPS location data to characterize personal mobility to improve engagement in HIV care among pregnant and postpartum women living with HIV in South Africa. The app also used the user’s location to map nearby clinics. Objective: We aimed to describe the feasibility, acceptability, and initial efficacy of using the app in a real-world setting. Methods: We conducted a prospective randomized controlled trial at a public sector clinic near Cape Town, South Africa. We enrolled 200 pregnant (third trimester) women living with HIV who owned a smartphone that met the required specifications. All participants installed the app, designed to collect 2 GPS heartbeats per day to geolocate the participant within a random 1-km fuzzy radius (for privacy). We randomized (1:1) participants to a control arm to receive the app with no additional support or an intervention arm to receive supportive phone calls, WhatsApp (Meta Platforms, Inc) messages, or both from the study team when traveling >50 km from the study area for >7 days. In addition to mobility data collected daily through the phone, participants completed questionnaires at enrollment and follow-up (approximately 6 months post partum). Results: A total of 7 participants were withdrawn at enrollment or shortly after because of app installation failure (6/200, 3%) or changing to an unsuitable phone (1/200, 0.50%). During the study period, no participant’s smartphone recorded at least 1 heartbeat per day, which was our primary feasibility measure. Of the 171 participants who completed follow-up, only half (91/171, 53.2%) reported using the same phone as that used at enrollment, with the CareConekta app still installed on the phone and GPS usually enabled. The top reasons reported for the lack of heartbeat data were not having mobile data, uninstalling the app, and no longer having a smartphone. Acceptability measures were positive, but participants at follow-up demonstrated a lack of understanding of the app’s purpose and function. The clinic finder was a popular feature. Owing to the lack of consistent GPS heartbeats throughout the study, we were unable to assess the efficacy of the intervention. Conclusions: Several key challenges impeded our study feasibility. Although the app was designed to reverse bill participants for any data use, the lack of mobile data was a substantial barrier to our study success. Participants reported purchasing WhatsApp data, which could not support the app. Problems with the web-based dashboard meant that we could not consistently monitor mobility. Our study provides important lessons about implementing an ambitious GPS-based study under real-world conditions in a limited-resource setting. Trial Registration: ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4190-x %M 37204838 %R 10.2196/44945 %U https://mhealth.jmir.org/2023/1/e44945 %U https://doi.org/10.2196/44945 %U http://www.ncbi.nlm.nih.gov/pubmed/37204838 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44855 %T Effectiveness of a Mindfulness Meditation App Based on an Electroencephalography-Based Brain-Computer Interface in Radiofrequency Catheter Ablation for Patients With Atrial Fibrillation: Pilot Randomized Controlled Trial %A He,Ying %A Tang,Zhijie %A Sun,Guozhen %A Cai,Cheng %A Wang,Yao %A Yang,Gang %A Bao,ZhiPeng %+ Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China, 86 15895903958, baozhipeng1219@163.com %K atrial fibrillation %K radiofrequency catheter ablation %K mindfulness meditation %K brain computer interface %K mHealth %K smartphone app %K randomized controlled trial %D 2023 %7 3.5.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF) can generate considerable physical and psychological discomfort under conscious sedation. App-based mindfulness meditation combined with an electroencephalography (EEG)-based brain-computer interface (BCI) shows promise as effective and accessible adjuncts in medical practice. Objective: This study aimed to investigate the effectiveness of a BCI-based mindfulness meditation app in improving the experience of patients with AF during RFCA. Methods: This single-center pilot randomized controlled trial involved 84 eligible patients with AF scheduled for RFCA, who were randomized 1:1 to the intervention and control groups. Both groups received a standardized RFCA procedure and a conscious sedative regimen. Patients in the control group were administered conventional care, while those in the intervention group received BCI-based app–delivered mindfulness meditation from a research nurse. The primary outcomes were the changes in the numeric rating scale, State Anxiety Inventory, and Brief Fatigue Inventory scores. Secondary outcomes were the differences in hemodynamic parameters (heart rate, blood pressure, and peripheral oxygen saturation), adverse events, patient-reported pain, and the doses of sedative drugs used in ablation. Results: BCI-based app–delivered mindfulness meditation, compared to conventional care, resulted in a significantly lower mean numeric rating scale (mean 4.6, SD 1.7 [app-based mindfulness meditation] vs mean 5.7, SD 2.1 [conventional care]; P=.008), State Anxiety Inventory (mean 36.7, SD 5.5 vs mean 42.3, SD 7.2; P<.001), and Brief Fatigue Inventory (mean 3.4, SD 2.3 vs mean 4.7, SD 2.2; P=.01) scores. No significant differences were observed in hemodynamic parameters or the amounts of parecoxib and dexmedetomidine used in RFCA between the 2 groups. The intervention group exhibited a significant decrease in fentanyl use compared to the control group, with a mean dose of 3.96 (SD 1.37) mcg/kg versus 4.85 (SD 1.25) mcg/kg in the control group (P=.003).The incidence of adverse events was lower in the intervention group (5/40) than in the control group (10/40), though this difference was not significant (P=.15). Conclusions: BCI-based app–delivered mindfulness meditation effectively relieved physical and psychological discomfort and may reduce the doses of sedative medication used in RFCA for patients with AF. Trial Registration: ClinicalTrials.gov NCT05306015; https://clinicaltrials.gov/ct2/show/NCT05306015 %M 37133926 %R 10.2196/44855 %U https://mhealth.jmir.org/2023/1/e44855 %U https://doi.org/10.2196/44855 %U http://www.ncbi.nlm.nih.gov/pubmed/37133926 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44462 %T Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study %A Johansen,Simon Kristoffer %A Kanstrup,Anne Marie %A Haseli,Kian %A Stenmo,Visti Hildebrandt %A Thomsen,Janus Laust %A Rathleff,Michael Skovdal %+ Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Fyrkildevej 7, 2nd floor, Aalborg East, 9220, Denmark, 45 60788895, skjohansen@dcm.aau.dk %K mobile health %K mHealth %K design %K patient physician relationship %K collaborative care %K shared decision-making %K adolescents %K parents %K knee pain %K patellofemoral pain %K Osgood Schlatter %K musculoskeletal %K general practice %K primary care %K mobile phone %D 2023 %7 28.4.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents’ self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, it remains unclear how mHealth apps should be designed to act as tools for supporting individual and collaborative management of adolescents’ knee pain in a general practice setting. Objective: The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents’ everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making. Methods: Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain. Results: Overall, 38% (9/24) young adults with chronic knee pain since adolescence, 25% (6/24) parents, and 38% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants’ roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making. Conclusions: An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 silver-bullet principles for consolidating mHealth core features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance. %M 37115609 %R 10.2196/44462 %U https://humanfactors.jmir.org/2023/1/e44462 %U https://doi.org/10.2196/44462 %U http://www.ncbi.nlm.nih.gov/pubmed/37115609 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37329 %T Evaluating Mobile Apps Targeting Older Adults: Descriptive Study %A Sweeney,Megan %A Barton,William %A Nebeker,Camille %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0811, United States, 1 858 534 7786, nebeker@ucsd.edu %K older adults %K mobile apps %K privacy %K data management, research ethics %K app %K aging %K environment %K safety %K smartphone %K personal information %K user knowledge %K user %K data %K data collection %K storage %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone use has increased dramatically and, in parallel, a market for mobile apps, including health apps, has emerged. The business model of targeted mobile app advertisements allows for the collection of personal and potentially sensitive information, often without user knowledge. Older adults comprise a rapidly growing demographic that is potentially vulnerable to exploitation by those accessing data collected via these apps. Objective: This research examined apps that claimed to be useful to older adults with a goal of (1) classifying the functionality of each app, (2) identifying whether a privacy policy existed and was accessible, and (3) evaluating evidence that could support claims of value to older adults. Methods: An environmental scan was conducted using the Google search engine and typing “apps for older adults.” The first 25 sites that this search returned comprised the primary data for this study. Data were organized by descriptive features of purpose (eg, health, finance, and utility), the existence of an electronically accessible privacy policy, price, and evidence supporting each recommended mobile app. Results: A total of 133 mobile apps were identified and promoted as being the best “apps for older adults.” Of these 133 mobile apps, 83% (n=110) included a privacy policy. Fewer apps designated in the “medical” category included a privacy policy than those classified otherwise. Conclusions: The results suggest that most mobile apps targeting older adults include a privacy policy. Research is needed to determine whether these privacy policies are readable, succinct, and incorporate accessible data use and sharing practices to mitigate potential risks, particularly when collecting potentially sensitive health information. %M 37103995 %R 10.2196/37329 %U https://formative.jmir.org/2023/1/e37329 %U https://doi.org/10.2196/37329 %U http://www.ncbi.nlm.nih.gov/pubmed/37103995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41321 %T Children’s and Caregivers’ Review of a Guided Imagery Therapy Mobile App Designed to Treat Children With Functional Abdominal Pain Disorders: Leveraging a Mixed Methods Approach With User-Centered Design %A Hollier,John M %A Strickland,Tiantá A %A Fordis,C Michael %A van Tilburg,Miranda AL %A Shulman,Robert J %A Thompson,Debbe %+ Texas Children's Hospital, 6701 Fannin St., Suite 1010.00, Houston, TX, 77030, United States, 1 832 824 3814, jmhollie@bcm.edu %K guided imagery therapy %K guided imagery %K psychotherapy %K disorders of gut-brain interaction %K functional abdominal pain disorders %K pediatric %K pain %K mobile app %K mobile health %K mHealth %K mixed methods research %K usability %K gamification %K user-centered design %K guided image therapy %K app prototype %K prototype %K feedback %K children %K child %K youths %K caregiver %K mobile phone %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Functional abdominal pain disorders (FAPDs) are highly prevalent and associated with substantial morbidity. Guided imagery therapy (GIT) is efficacious; however, barriers often impede patient access. Therefore, we developed a GIT mobile app as a novel delivery platform. Objective: Guided by user-centered design, this study captured the critiques of our GIT app from children with FAPDs and their caregivers. Methods: Children aged 7 to 12 years with Rome IV–defined FAPDs and their caregivers were enrolled. The participants completed a software evaluation, which assessed how well they executed specific app tasks: opening the app, logging in, initiating a session, setting the reminder notification time, and exiting the app. Difficulties in completing these tasks were tallied. After this evaluation, the participants independently completed a System Usability Scale survey. Finally, the children and caregivers were separately interviewed to capture their thoughts about the app. Using a hybrid thematic analysis approach, 2 independent coders coded the interview transcripts using a shared codebook. Data integration occurred after the qualitative and quantitative data were analyzed, and the collective results were summarized. Results: We enrolled 16 child-caregiver dyads. The average age of the children was 9.0 (SD 1.6) years, and 69% (11/16) were female. The System Usability Scale average scores were above average at 78.2 (SD 12.6) and 78.0 (SD 13.5) for the children and caregivers, respectively. The software evaluation revealed favorable usability for most tasks, but 75% (12/16) of children and 69% (11/16) of caregivers had difficulty setting the reminder notification. The children’s interviews confirmed the app’s usability as favorable but noted difficulty in locating the reminder notification. The children recommended adding exciting scenery and animations to the session screen. Their preferred topics were animals, beaches, swimming, and forests. They also recommended adding soft sounds related to the session topic. Finally, they suggested that adding app gamification enhancements using tangible and intangible rewards for listening to the sessions would promote regular use. The caregivers also assessed the app’s usability as favorable but verified the difficulty in locating the reminder notification. They preferred a beach setting, and theme-related music and nature sounds were recommended to augment the session narration. App interface suggestions included increasing the font and image sizes. They also thought that the app’s ability to relieve gastrointestinal symptoms and gamification enhancements using tangible and intangible incentives would positively influence the children’s motivation to use the app regularly. Data integration revealed that the GIT app had above-average usability. Usability challenges included locating the reminder notification feature and esthetics affecting navigation. Conclusions: Children and caregivers rated our GIT app’s usability favorably, offered suggestions to improve its appearance and session content, and recommended rewards to promote its regular use. Their feedback will inform future app refinements. %M 37074773 %R 10.2196/41321 %U https://formative.jmir.org/2023/1/e41321 %U https://doi.org/10.2196/41321 %U http://www.ncbi.nlm.nih.gov/pubmed/37074773 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43085 %T A Design-Led Theory of Change for a Mobile Game App (Go Nisha Go) for Adolescent Girls in India: Multimix Methodology Study %A Shankar,Lalita %A Dixit,Anvita %A Howard,Susan %+ Howard Delafield International LLP, 1101 30th St NW, Suite 500, Washington, DC, 20007, United States, 1 202 625 4364, lalita@howard-delafield.com %K Theory of Change %K social behavior change %K mobile game app %K digital innovation %K adolescent girls %K sexual and reproductive health %K India %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: India has one of the largest adolescent populations in the world. Yet adolescents, particularly adolescent girls, have limited access to correct sexual and reproductive health information and services. The context in which adolescent girls live is one of gender inequity where they contend with early marriage and early pregnancy and have few opportunities for quality education and labor force participation. The digital revolution has expanded the penetration of mobile phones across India, increasingly being used by adolescent girls. Health interventions are also moving onto digital platforms. Evidence has shown that applications of game elements and game-based learning can be powerful tools in behavior change and health interventions. This provides a unique opportunity, particularly for the private sector, to reach and empower adolescent girls directly with information, products, and services in a private and fun manner. Objective: The objective of this paper is to describe how a design-led Theory of Change (ToC) was formulated for a mobile game app that is not only underpinned by theories of various behavior change models but also identifies variables and triggers for in-game behavioral intentions that can be tracked and measured within the game and validated through a rigorous post-gameplay outcome evaluation. Methods: We describe the use of a multimix methodology to formulate a ToC informing behavioral frameworks and co-design approaches in our proof-of-concept product development journey. This process created a statement of hypothesis and “pathways to impact” with a continuous, cumulative, and iterative design process that included key stakeholders in the production of a smartphone app. With theoretical underpinnings of social behavior and modeling frameworks, systematic research, and other creative methods, we developed a design-led ToC pathway that can delineate complex and multidisciplinary outputs for measuring impact. Results: The statement of hypothesis that emerged posits that “If girls virtually experience the outcomes of choices that they make for their avatar in the mobile game, then they can make informed decisions that direct the course of their own life.” Four learning pathways (DISCOVER, PLAY, DECIDE, and ACT) are scaffolded on 3 pillars of evidence, engagement, and evaluation to support the ToC-led framework. It informs decision-making and life outcomes through game-based objectives and in-game triggers that offer direct access to information, products, and services. Conclusions: This approach of using a multimix methodology for identifying varied and multidisciplinary pathways to change is of particular interest to measuring the impact of innovations, especially digital products, that do not necessarily conform with traditional behavioral change models or standard co-design approaches. We also explain the benefits of using iterative and cumulative inputs to integrate ongoing user feedback, while identifying pathways to various impacts, and not limiting it to only the design and development phase. %M 37071463 %R 10.2196/43085 %U https://formative.jmir.org/2023/1/e43085 %U https://doi.org/10.2196/43085 %U http://www.ncbi.nlm.nih.gov/pubmed/37071463 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43861 %T Evaluation of an Electronic Care and Rehabilitation Planning Tool With Stroke Survivors With Aphasia: Usability Study %A Davoody,Nadia %A Eghdam,Aboozar %A Koch,Sabine %A Hägglund,Maria %+ Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, Stockholm, , Sweden, 46 (0)8 524 864 86, nadia.davoody@ki.se %K usability testing %K stroke %K aphasia %K eHealth %K rehabilitation %K co-design %K evaluation %K user-centered design %K effectiveness %K user satisfaction %K mobile phone %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patients with chronic illnesses with physical and cognitive disabilities, particularly stroke survivors with aphasia, are often not involved in design and evaluation processes. As a consequence, existing eHealth services often do not meet the needs of this group of patients, which has resulted in a digital divide. Objective: The aim of this study was to examine the effectiveness and user satisfaction of an electronic care and rehabilitation planning tool from the perspective of stroke survivors with aphasia. This would help us gain knowledge on how such a tool would need to be adapted for these patients for further development. Methods: Usability tests were conducted with 9 postdischarge stroke survivors with aphasia. Effectiveness was measured using task-based tests, and user satisfaction was studied through qualitative interviews at the end of each test. All tests were audio recorded, and each test lasted approximately 1 hour. The data were analyzed using qualitative content analysis. As the tool can be used by stroke survivors either independently or with some support from their next of kin or care professionals, the research group decided to divide the participants into 2 groups. Group 1 did not receive any support during the tests, and group 2 received some minor support from the moderator. Results: The results showed that the care and rehabilitation planning tool was not effective for stroke survivors with aphasia, as many participants in group 1 did not accomplish the tasks successfully. Despite several usability problems and challenges in using the tool because of patients’ disabilities, the participants were positive toward using the tool and found it useful for their care and rehabilitation journey. Conclusions: There is a need to involve patients with chronic illnesses more in the design and evaluation processes of health information systems and eHealth services. eHealth services and health information systems designed for this group of patients should be more adaptable and flexible to provide them with appropriate functionalities and features, meet their needs, and be useful and easy to use. In addition, the design and evaluation processes should be adapted, considering the challenges of this patient group. %M 37067848 %R 10.2196/43861 %U https://humanfactors.jmir.org/2023/1/e43861 %U https://doi.org/10.2196/43861 %U http://www.ncbi.nlm.nih.gov/pubmed/37067848 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40851 %T SNapp, a Tailored Smartphone App Intervention to Promote Walking in Adults of Low Socioeconomic Position: Development and Qualitative Pilot Study %A Vos,Anne L %A de Bruijn,Gert-Jan %A Klein,Michel C A %A Lakerveld,Jeroen %A Boerman,Sophie C %A Smit,Edith G %+ Amsterdam School of Communication Research, University of Amsterdam, Nieuwe Achtergracht 166, Amsterdam, 1018 WV, Netherlands, 31 0205253, a.l.vos@uva.nl %K cardiovascular disease %K physical activity %K walking %K smartphone %K mobile health %K mHealth %K mobile app %K behavior change techniques %K tailoring %K intervention development %K socioeconomic position %K mobile phone %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Adults of low socioeconomic position (SEP) are generally less physically active than those who are more socioeconomically advantaged, which increases their cardiovascular disease incidence risk. Moreover, individuals of low SEP are often less easily reached with physical activity (PA) interventions than individuals of higher SEP. Smartphone apps have been presented as a promising platform for delivering PA interventions to difficult-to-reach individuals of low SEP. Although PA apps are widely available, they are rarely based on health behavior theories and most predominantly offer generic PA advice. Consequently, it is unlikely that available apps are the most effective PA intervention tools. Objective: To respond to these areas for improvement, we developed SNapp, an app-based intervention encouraging adults of low SEP to increase PA by providing tailored coaching messages targeting walking behavior. This study aimed to describe SNapp’s stepwise development and pilot evaluation process. Methods: We applied a stepwise approach: analyzing the health problem, developing a program framework, developing tailoring assessments, writing tailored messages, automating the tailoring process, and implementing and evaluating the program in a qualitative pilot study (11 participants). Results: SNapp consisted of several elements. First, an app was developed to collect step count and geolocation data using smartphone sensor functionalities. In addition, a survey measure was created to assess users’ behavior change technique (BCT) preferences. These 3 data types were used to tailor SNapp’s coaching messages to stimulate walking. This allows SNapp to offer feedback on performance levels, contextually tailored prompts when users are near green spaces, and coaching content that aligns with individual BCT preferences. Finally, a server-based Python program that interacts with databases containing user data and tailored messages was built using Microsoft Azure to select and automatically send messages to users through Telegram messenger. Pilot study findings indicated that SNapp was rated positively, with participants reporting that its design, technical functioning, and message content were acceptable. Participants suggested additional functionalities that are worth considering for future updates. Conclusions: SNapp is an app-based intervention that aims to promote walking in adults of low SEP by offering tailored coaching messages. Its development is theory based, and it is among the first to incorporate contextualized feedback and content tailored to individual BCT preferences. The effectiveness of SNapp will be evaluated in a 12-month real-life parallel cluster-randomized controlled trial. %M 37067890 %R 10.2196/40851 %U https://formative.jmir.org/2023/1/e40851 %U https://doi.org/10.2196/40851 %U http://www.ncbi.nlm.nih.gov/pubmed/37067890 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42224 %T Development of Open Backend Structures for Health Care Professionals to Improve Participation in App Developments: Pilot Usability Study of a Medical App %A Dittrich,Florian %A Albrecht,Urs-Vito %A Scherer,Julian %A Becker,Sören L %A Landgraeber,Stefan %A Back,David Alexander %A Fessmann,Kai %A Haversath,Marcel %A Beck,Sascha %A Abbara-Czardybon,Mona %A Quitmann,Henning %A Harren,Anna Katharina %A Aitzetmüller,Matthias %A Klietz,Marie Luise %+ Department of Digital Medicine, Medical Faculty Ost-Westfalen-Lippe, Bielefeld University, Bielefeld, Germany, 49 521106867, urs-vito.albrecht@uni-bielefeld.de %K smartphone %K mHealth %K backend %K usability %K UX %K user experience %K mHealth %K mobile health %K health app %K mobile app %K app development %K no-code %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Efficient digitization in medicine still is in its infancy but undeniably has great potential for current and future challenges in health care. Thus far, the rollout of medical apps has not resulted in widespread use of smartphones in the German health care sector—the reasons for this have not been clarified so far. Nevertheless, the lack of user involvement in the development process and content creation might contribute to low acceptance of these products. Objective: This study aims to outline an approach to involve medical expertise without any coding knowledge for developing medical app content and functions. Methods: An end user–operable backend was built. Its usability was evaluated using a usability evaluation test protocol. The results of the usability tests were evaluated by the app development team, and the usability test was repeated for optimizing backend usability. In total, 40 criteria to measure the ease of app usage were defined a priori. The usability test comprised 20 tasks that had to be fulfilled. Usability tasks were analyzed for completion, dropout, and test duration. Due to the COVID-19 pandemic, digital videoconferencing platforms (Zoom and QuickTime Player) were used to complete usability questionnaires. Finally, several backend-based apps for several specialties (infectiology, plastic and reconstructive surgery, and orthopedics) were developed by health care professionals as prototypes. Results: Initial usability testing was conducted with 5 participants (4 men and 1 woman; mean age 39.2, SD 5.97 years). All of them could complete the assigned backend tasks with only a few workflow interruptions and some minor errors. After usability optimization, the workflow completion time decreased from 5.03 minutes to 3.50 minutes, indicating a time saving. The basic backend structure was clear to all test users and the handling was intuitive to learn. Some minor errors in the backend occurred during the test rounds. The apps developed using the aforementioned approach are in clinical use as a proof of concept. Conclusions: Backends offering operability for medical professionals might have great potential for app development in the mobile health sector. Sophisticated and time-saving usability are pivotal for the acceptance of medical software, as illustrated by the backend-based apps presented herein, which are in clinical use as a proof of concept. Basic interventions are essential and sufficient for adequate usability optimization. Practicable, well-structured software usability evaluation is possible based on the usability evaluation test protocol. %M 37052998 %R 10.2196/42224 %U https://formative.jmir.org/2023/1/e42224 %U https://doi.org/10.2196/42224 %U http://www.ncbi.nlm.nih.gov/pubmed/37052998 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43236 %T The Effect of a mHealth App (KENPO-app) for Specific Health Guidance on Weight Changes in Adults With Obesity and Hypertension: Pilot Randomized Controlled Trial %A Sakane,Naoki %A Suganuma,Akiko %A Domichi,Masayuki %A Sukino,Shin %A Abe,Keiko %A Fujisaki,Akiyoshi %A Kanazawa,Ai %A Sugimoto,Mamiko %+ Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan, 81 75 641 9161, nsakane@gf6.so-net.ne.jp %K obesity %K hypertension %K mobile health care app %K specific health guidance %K obese %K weight %K mHealth %K mobile health %K mobile app %K health app %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Commercial smartphone apps that promote self-monitoring of weight loss are widely available. The development of disease-specific apps has begun, but there is no app for specific health guidance (SHG) to prevent metabolic syndrome, type 2 diabetes, and cardiovascular diseases in middle-aged adults in Japan. Objective: This study aimed to determine the efficacy of an SHG mobile health app in facilitating weight loss in Japanese adults with obesity and hypertension. Methods: In a 12-week, statistician-blinded, randomized parallel controlled trial, 78 overweight and obese men aged 40-69 years were assigned in a 1:1 ratio to either the usual support plus KENPO-app group (intervention group) or the active control group. KENPO-app (release April 10, 2019; OMRON Healthcare Co., Ltd.) was developed by the study team and focus groups and uses behavior change techniques (ie, self-monitoring and goal-setting theory). This app was developed for SHG based on the four specific health checkups and guidance system in Japan: (1) focusing primarily on achieving the target (weight loss of ≥2 kg); (2) assessing healthy eating, exercise habits, smoking habits, relaxation, and self-weighing; (3) providing information on the results of specific health checkups; and (4) starting an intervention period of 6 months with the interim assessment at 3 months. The initial assessment explored the following: personality traits (4 types), health checkup data concerns (10 items), symptom concerns (10 items), and the aim of the intervention (weight loss, improving fitness, symptoms, laboratory data). Chatbot-supported health information on health and health behavior was selected from 392 quizzes based on app data and was provided to participants. The KENPO-app had chatbot-supported feedback and information provision combined with a self-monitoring tool (weight, steps, and blood pressure). Data on active exercise, healthy eating, and healthy lifestyle habits were obtained using a web-based self-administered questionnaire at baseline and 12 weeks. Results: The trial’s retention rate was 95% (74/78). The adherence to daily self-weighing, wearing the pedometer, and blood pressure monitoring in the KENPO-app group was significantly higher than those in the active control group. Compared with the active control group, the median body weight and BMI of the intervention group significantly decreased at 3 months (–0.4, IQR –2.0 to 0.6 kg vs –1.1, IQR –2.7 to –0.5 kg; P=.03; –0.1, IQR –0.6 to 0.3 kg vs –0.4, IQR –0.8 to –0.2 kg; P=.02, respectively). The intervention increased the percentage of participants who self-reported taking ≥8000 steps, eating vegetables before rice, eating slowly, and relaxing. Personality traits were associated with the degree of weight loss in the intervention group. Conclusions: The SHG-specific KENPO-app was feasible and induced modest but significant weight loss in adults with obesity. Trial Registration: University Hospital Medical Information Network Center UMIN000046263; https://tinyurl.com/bderys3b %M 37043287 %R 10.2196/43236 %U https://mhealth.jmir.org/2023/1/e43236 %U https://doi.org/10.2196/43236 %U http://www.ncbi.nlm.nih.gov/pubmed/37043287 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45920 %T Acceptability and Initial Adoption of the Heart Observation App for Infants With Congenital Heart Disease: Qualitative Study %A Hjorth-Johansen,Elin %A Børøsund,Elin %A Martinsen Østen,Ingeborg %A Holmstrøm,Henrik %A Moen,Anne %+ Neonatal Intensive Care Unit, Division of Children and Adolescent Medicine, Oslo University Hospital, E2 4th Floor, Sognsvannsveien 20, Oslo, 0372, Norway, 47 98676884, ehjorth@ous-hf.no %K congenital heart disease %K readiness for discharge %K mobile app %K follow-up, health services %K mHealth %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 1% of all infants are born with a congenital heart disease (CHD). Internationally CHD remains a major cause of infant death, some of which occur unexpectedly after a gradual deterioration at home. Many parents find it difficult to recognize worsening of symptoms. Objective: This study aims to report the acceptability and initial adoption of a mobile app, the Heart Observation app (HOBS), aiming to support parents’ understanding and management of their child’s condition and to increase quality in follow-up from health care professionals in complex health care services in Norway. Methods: A total of 9 families were interviewed on discharge from the neonatal intensive care unit and after 1 month at home. The infant’s primary nurse, community nurse, and cardiologist were also interviewed regarding their experiences about collaboration with the family. The interviews were analyzed inductively with thematic content analysis. Results: The analysis generated 4 main themes related to acceptability and adoption: (1) Individualize Initial Support, (2) Developing Confidence and Coping, (3) Normalize When Appropriate, and (4) Implementation in a Complex Service Pathway. The receptivity of parents to learn and attend in the intervention differs according to their present situation. Health care professionals emphasized the importance of adapting the introduction and guidance to parents’ receptivity to ensure comprehension, self-efficacy, and thereby acceptance before discharge (Individualize Initial Support). Parents perceived that HOBS served them well and nurtured confidence by teaching them what to be aware of. Health care professionals reported most parents as confident and informed. This potential effect increased the possibility of adoption (Developing Confidence and Coping). Parents expressed that HOBS was not an “everyday app” and wanted to normalize everyday life when appropriate. Health care professionals suggested differentiating use according to severity and reducing assessments after recovery to adapt the burden of assessments when appropriate (Normalize When Appropriate). Health care professionals’ attitude to implement HOBS in their services was positive. They perceived HOBS as useful to systemize guidance, to enhance communication regarding an infant’s condition, and to increase understanding of heart defects in health care professionals with sparse experience (Implementation in a Complex Service Pathway). Conclusions: This feasibility study shows that both parents and health care professionals found HOBS as a positive addition to the health care system and follow-up. HOBS was accepted and potentially useful, but health care professionals should guide parents initially to ensure comprehension and adapt timing to parents’ receptivity. By doing so, parents may be confident to know what to look for regarding their child’s health and cope at home. Differentiating between various diagnoses and severity is important to support normalization when appropriate. Further controlled studies are needed to assess adoption, usefulness, and benefits in the health care system. %M 37018028 %R 10.2196/45920 %U https://formative.jmir.org/2023/1/e45920 %U https://doi.org/10.2196/45920 %U http://www.ncbi.nlm.nih.gov/pubmed/37018028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43823 %T The Development of a Hypertension Prevention and Financial-Incentive mHealth Program Using a “No-Code” Mobile App Builder: Development and Usability Study %A Willms,Amanda %A Rhodes,Ryan E %A Liu,Sam %+ School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8392, awillms@uvic.ca %K mobile health %K mHealth %K usability study %K financial incentive %K physical activity %K mobile phone %K smartphone %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Regular physical activity (PA) is a key lifestyle component for hypertension prevention. Previous studies have shown that mobile health (mHealth) apps can be an effective tool for improving PA behaviors. However, adherence to and poor engagement with these apps is a challenge. A potential solution to overcome this challenge may be to combine financial incentives with innovative behavior theory, such as the Multiprocess Action Control (M-PAC) framework. Currently, there is a lack of PA financial incentive–driven M-PAC mHealth programs aimed at hypertension prevention. Objective: We aimed to describe the process of developing an 8-week mHealth PA and financial-incentive hypertension education program (Healthy Hearts) and to evaluate usability of the Healthy Hearts program. Methods: The first 2 stages of the Integrate, Design, Assess, and Share framework were used to guide the development of the Healthy Hearts program. The development process consisted of 2 phases. In phase 1, the research team met to discuss implementing the M-PAC framework to adopt an existing web-based hypertension prevention program to a mobile app. The app was developed using a no-code app development platform, Pathverse (Pathverse Inc), to help decrease overall development time. In phase 2, we created a prototype and conducted usability testing to evaluate lesson 1 of the Healthy Hearts program to further enhance the user experience. We used semistructured interviews and the mHealth App Usability Questionnaire to evaluate program acceptability and usability. Results: Intervention development among the research team successfully created an 8-week financial-incentive hypertension education program for adults aged 40-65 years who did not currently meet the Canadian Physical Activity Guidelines (<150 minutes of moderate to vigorous PA per week). This program lasted 8 weeks and comprised 25 lessons guided by the M-PAC framework. The program used various behavior change techniques to further support PA adherence. Usability testing of the first lesson was successful, with 6 participants recruited for 2 rounds of testing. Feedback was gathered to enhance the content, layout, and design of the Healthy Hearts program to prepare the mHealth program for feasibility testing. Results of round 1 of usability testing suggested that the content delivered in the lessons was long. Therefore, the content was divided into multiple lessons before round 2 of usability testing, where feedback was only on design preferences. A minimum viable product was created with these results. Conclusions: The iterative development process and the usability assessments suggested by the Integrate, Design, Assess, and Share framework enabled participants to provide valuable feedback on the content, design, and layout of the program before advancing to feasibility testing. Furthermore, the use of the “no-code” app development tool enabled our team to rapidly make changes to the app based on user feedback during the iterative design process. %M 37018038 %R 10.2196/43823 %U https://formative.jmir.org/2023/1/e43823 %U https://doi.org/10.2196/43823 %U http://www.ncbi.nlm.nih.gov/pubmed/37018038 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42967 %T Development of a Mobile App to Monitor the Effectiveness of a Hydrolyzed Cartilage Matrix Supplement on Joint Discomfort: Real-World Study %A Newman,Christie %A Adriaens,Els %A Virgilio,Nicolina %A Vleminckx,Sara %A de Pelsmaeker,Sara %A Prawitt,Janne %A F Silva,Catarina I %+ Rousselot BV, Meulestedekaai 81, Gent, 9000, Belgium, 31 61 271 0263, catarina.silva@rousselot.com %K digital tool %K hydrolyzed cartilage matrix %K hydrolyzed collagen %K chondroitin sulfate %K joint discomfort %K real-world study %K dietary supplement %K mobile application %D 2023 %7 3.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Joint discomfort is a widespread and growing problem in active adults. The rising interest in preventative nutrition has increased the demand for supplements reducing joint discomfort. Protocols assessing the effect of a nutritional intervention on health commonly involve a series of face-to-face meetings between participants and study staff that can weigh on resources, participant availabilities, and even increase dropout rates. Digital tools are increasingly added to protocols to facilitate study conduct, but fully digitally run studies are still scarce. With the increasing interest in real-world studies, the development of health apps for mobile devices to monitor study outcomes is of great importance. Objective: The purpose of this real-world study was to develop a specific mobile app, Ingredients for Life, to conduct a 100% digital study testing the effectiveness of a hydrolyzed cartilage matrix (HCM) supplement on joint discomfort in a heterogeneous group of healthy, active consumers. Methods: The Ingredients for Life mobile app using a visual analog scale was specifically developed to monitor the variation in joint pain after exercise by the study participants. A total of 201 healthy and physically active women and men (18-72 years old) with joint pain completed the study over a period of 16 weeks. Participants were randomly allocated to the study groups and did not receive any dietary or lifestyle advice. Each participant indicated one area of joint pain and logged the type and duration of their weekly activities. They received blinded study supplements and took a daily regimen of 1 g of HCM (HCM group) or 1 g of maltodextrin (placebo group) for 12 weeks while weekly logging joint pain scores in the app. This was followed by a 4-week washout period during which participants continued reporting their joint pain scores (until the end of week 16). Results: Joint pain was reduced within 3 weeks of taking a low dosage of HCM (1 g/day), regardless of gender, age group, and activity intensity when compared with the placebo group. After stopping supplementation, joint pain scores gradually increased but still remained significantly lower than those of the placebo group after 4 weeks of washout. The low dropout rate (<6% of participants, mainly in the placebo group) demonstrates that the digital study was well received by the study population. Conclusions: The digital tool allowed us to measure a heterogeneous group of active adults in a real-world setting (without any lifestyle intervention), thus promoting inclusivity and diversity. With low dropout rates, it demonstrates that mobile apps can generate qualitative, quantifiable, real-world data showcasing supplement effectiveness. The study confirmed that the oral intake of a low dose (1 g/day) of HCM led to a significant reduction of joint pain from 3 weeks after starting supplementation. %M 36848035 %R 10.2196/42967 %U https://formative.jmir.org/2023/1/e42967 %U https://doi.org/10.2196/42967 %U http://www.ncbi.nlm.nih.gov/pubmed/36848035 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43867 %T A Mobile Self-Management App (CanSelfMan) for Children With Cancer and Their Caregivers: Usability and Compatibility Study %A Mehdizadeh,Hamed %A Asadi,Farkhondeh %A Nazemi,Eslam %A Mehrvar,Azim %A Yazdanian,Azade %A Emami,Hassan %+ Health Information Technology Department, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Farah Abad Blvd,, Sari, 4818911916, Iran, 98 1133543246, hamed13sep@gmail.com %K Digital health %K eHealth %K Telehealth %K mHealth %K Mobile app %K self-management %K cancer %K child %K parent %K caregiver %K usability evaluation %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the increasing development of different smartphone apps in the health care domain, most of these apps lack proper evaluation. In fact, with the rapid development of smartphones and wireless communication infrastructure, many health care systems around the world are using these apps to provide health services for people without sufficient scientific efforts to design, develop, and evaluate them. Objective: The objective of this study was to evaluate the usability of CanSelfMan, a self-management app that provides access to reliable information to improve communication between health care providers and children with cancer and their parents/caregivers, facilitating remote monitoring and promoting medication adherence. Methods: We performed debugging and compatibility tests in a simulated environment to identify possible errors. Then, at the end of the 3-week period of using the app, children with cancer and their parents/caregivers filled out the User Experience Questionnaire (UEQ) to evaluate the usability of the CanSelfMan app and their level of user satisfaction. Results: During the 3 weeks of CanSelfMan use, 270 cases of symptom evaluation and 194 questions were recorded in the system by children and their parents/caregivers and answered by oncologists. After the end of the 3 weeks, 44 users completed the standard UEQ user experience questionnaire. According to the children’s evaluations, attractiveness (mean 1.956, SD 0.547) and efficiency (mean 1.934, SD 0.499) achieved the best mean results compared with novelty (mean 1.711, SD 0.481). Parents/caregivers rated efficiency at a mean of 1.880 (SD 0.316) and attractiveness at a mean of 1.853 (SD 0.331). The lowest mean score was reported for novelty (mean 1.670, SD 0.225). Conclusions: In this study, we describe the evaluation process of a self-management system to support children with cancer and their families. Based on the feedback and scores obtained from the usability evaluation, it seems that the children and their parents find CanSelfMan to be an interesting and practical idea to provide reliable and updated information on cancer and help them manage the complications of this disease. %M 36995746 %R 10.2196/43867 %U https://pediatrics.jmir.org/2023/1/e43867 %U https://doi.org/10.2196/43867 %U http://www.ncbi.nlm.nih.gov/pubmed/36995746 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43255 %T Overcoming Language Barriers in Paramedic Care With an App Designed to Improve Communication With Foreign-Language Patients: Nonrandomized Controlled Pilot Study %A Müller,Frank %A Schröder,Dominik %A Noack,Eva Maria %+ Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany, 49 55139 68193, evamaria.noack@med.uni-goettingen.de %K app %K emergency medical technicians %K language barriers %K limited language proficiency %K migrant %K paramedic %K prehospital emergency care %K refugee %K translator %D 2023 %7 23.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Communication across language barriers is a particular challenge for health care providers. In emergency medical services, interpreters are mostly not available on rescue scenes, which jeopardizes safe and high-quality medical care. In a cocreative process together with paramedics and software designers, we developed a fixed-phrase translation app with 600 phrases and 18 supported languages that supports paramedics when providing care to foreign-language patients. This paper reports on the results of a pilot study to evaluate the app’s effect on paramedic-patient communication. Objective: This study aims to gain insights into the efficacy and feasibility of a multilingual app that helps paramedics to communicate with patients who are not proficient in the local language. Methods: A 3-armed nonrandomized interventional pilot study was conducted in 4 rescue stations in the German Federal State of Lower Saxony: 3 rural areas and 1 in urban environment. The intervention group comprised rescue missions with patients with limited German language proficiency (LGP) with whom the app was used; control group 1 comprised LGP patients without app usage; and control group 2 consisted of rescue missions with German-speaking patients. For each rescue operation with LGP patients, paramedics filled out questionnaires about the communications with patients. From standardized Rescue Service Case Protocols, we extracted information on patient demographics (age and sex), clinical aspects (preliminary diagnosis and Glasgow Coma Scale), and rescue operation characteristics (time spent on emergency scene and additional dispatch of emergency physicians). The primary outcome was the paramedics’ perceived quality of communication with LGP patients. The secondary outcome was the ability to obtain necessary information from patients and the ability to provide important information to patients. A linear regression model was applied to assess the impact of the app on perceived communication, controlling demographic factors, and severity of illness. Results: A total of 22 LGP patients were recruited into the intervention group and 122 into control group 1. The control group 2 included 27,212 German-speaking patients. LGP patients were more than 2 decades younger than German-speaking patients. App usage among LGP patients was associated with higher perceived overall quality of communication (0.7 points on a 5-point Likert scale, P=.03). Applying a linear regression model controlling for age, sex, and Glasgow Coma Scale, the quality of communication was associated with an increase of 0.9 points (95% CI 0.2-1.6, P=.01). Compared to either German-speaking patients or LGP patients, paramedics spent 6-7 minutes longer on an emergency scene when the app was used (P=.24). Conclusions: The use of the app suggests a relevant improvement in communication with patients with limited proficiency in the locally spoken language in paramedic care. The small sample size and the lack of randomization reduce the generalizability of the findings. Trial Registration: German Clinical Trials Register DRKS00016719; https://drks.de/search/de/trial/DRKS00016719 %M 36951895 %R 10.2196/43255 %U https://formative.jmir.org/2023/1/e43255 %U https://doi.org/10.2196/43255 %U http://www.ncbi.nlm.nih.gov/pubmed/36951895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45095 %T Making Sense of Theories, Models, and Frameworks in Digital Health Behavior Change Design: Qualitative Descriptive Study %A Voorheis,Paula %A Bhuiya,Aunima R %A Kuluski,Kerry %A Pham,Quynh %A Petch,Jeremy %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 7058163180, paula.voorheis@mail.utoronto.ca %K behavioral science %K behavior change %K health behavior %K digital health %K mobile health %K theories %K models %K frameworks %D 2023 %7 15.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions are increasingly being designed to support health behaviors. Although digital health interventions informed by behavioral science theories, models, and frameworks (TMFs) are more likely to be effective than those designed without them, design teams often struggle to use these evidence-informed tools. Until now, little work has been done to clarify the ways in which behavioral science TMFs can add value to digital health design. Objective: The aim of this study was to better understand how digital health design leaders select and use TMFs in design practice. The questions that were addressed included how do design leaders perceive the value of TMFs in digital health design, what considerations do design leaders make when selecting and applying TMFs, and what do design leaders think is needed in the future to advance the utility of TMFs in digital health design? Methods: This study used a qualitative description design to understand the experiences and perspectives of digital health design leaders. The participants were identified through purposive and snowball sampling. Semistructured interviews were conducted via Zoom software. Interviews were audio-recorded and transcribed using Otter.ai software. Furthermore, 3 researchers coded a sample of interview transcripts and confirmed the coding strategy. One researcher completed the qualitative analysis using a codebook thematic analysis approach. Results: Design leaders had mixed opinions on the value of behavioral science TMFs in digital health design. Leaders suggested that TMFs added the most value when viewed as a starting point rather than the final destination for evidence-informed design. Specifically, these tools added value when they acted as a gateway drug to behavioral science, supported health behavior conceptualization, were balanced with expert knowledge and user-centered design principles, were complementary to existing design methods, and supported both individual- and systems-level thinking. Design leaders also felt that there was a considerable nuance in selecting the most value-adding TMFs. Considerations should be made regarding their source, appropriateness, complexity, accessibility, adaptability, evidence base, purpose, influence, audience, fit with team expertise, fit with team culture, and fit with external pressures. Design leaders suggested multiple opportunities to advance the use of TMFs. These included improving TMF reporting, design, and accessibility, as well as improving design teams' capacity to use TMFs appropriately in practice. Conclusions: When designing a digital health behavior change intervention, using TMFs can help design teams to systematically integrate behavioral insights. The future of digital health behavior change design demands an easier way for designers to integrate evidence-based TMFs into practice. %M 36920442 %R 10.2196/45095 %U https://www.jmir.org/2023/1/e45095 %U https://doi.org/10.2196/45095 %U http://www.ncbi.nlm.nih.gov/pubmed/36920442 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45218 %T Diagnostic Ability of a Smartphone App for Dry Eye Disease: Protocol for a Multicenter, Open-Label, Prospective, and Cross-sectional Study %A Nagino,Ken %A Okumura,Yuichi %A Yamaguchi,Masahiro %A Sung,Jaemyoung %A Nagao,Masashi %A Fujio,Kenta %A Akasaki,Yasutsugu %A Huang,Tianxiang %A Hirosawa,Kunihiko %A Iwagami,Masao %A Midorikawa-Inomata,Akie %A Fujimoto,Keiichi %A Eguchi,Atsuko %A Okajima,Yukinobu %A Kakisu,Koji %A Tei,Yuto %A Yamaguchi,Takefumi %A Tomida,Daisuke %A Fukui,Masaki %A Yagi-Yaguchi,Yukari %A Hori,Yuichi %A Shimazaki,Jun %A Nojiri,Shuko %A Morooka,Yuki %A Yee,Alan %A Miura,Maria %A Ohno,Mizu %A Inomata,Takenori %+ Department of Ophthalmology, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 358021228, tinoma@juntendo.ac.jp %K digital health %K digital therapeutics %K dry eye disease %K Japanese version of the Ocular Surface Disease Index %K maximum blink interval %K mobile health %K smartphone %K smartphone app %K tear film breakup time %K telemedicine %D 2023 %7 13.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dry eye disease (DED) is one of the most common ocular surface diseases. Numerous patients with DED remain undiagnosed and inadequately treated, experiencing various subjective symptoms and a decrease in quality of life and work productivity. A mobile health smartphone app, namely, the DEA01, has been developed as a noninvasive, noncontact, and remote screening device, in the context of an ongoing paradigm shift in the health care system, to facilitate a diagnosis of DED. Objective: This study aimed to evaluate the capabilities of the DEA01 smartphone app to facilitate a DED diagnosis. Methods: In this multicenter, open-label, prospective, and cross-sectional study, the test method will involve using the DEA01 smartphone app to collect and evaluate DED symptoms, based on the Japanese version of the Ocular Surface Disease Index (J-OSDI), and to measure the maximum blink interval (MBI). The standard method will then involve a paper-based J-OSDI evaluation of subjective symptoms of DED and tear film breakup time (TFBUT) measurement in an in-person encounter. We will allocate 220 patients to DED and non-DED groups, based on the standard method. The primary outcome will be the sensitivity and specificity of the DED diagnosis according to the test method. Secondary outcomes will be the validity and reliability of the test method. The concordance rate, positive and negative predictive values, and the likelihood ratio between the test and standard methods will be assessed. The area under the curve of the test method will be evaluated using a receiver operating characteristic curve. The internal consistency of the app-based J-OSDI and the correlation between the app-based J-OSDI and paper-based J-OSDI will be assessed. A DED diagnosis cutoff value for the app-based MBI will be determined using a receiver operating characteristic curve. The app-based MBI will be assessed to determine a correlation between a slit lamp–based MBI and TFBUT. Adverse events and DEA01 failure data will be collected. Operability and usability will be assessed using a 5-point Likert scale questionnaire. Results: Patient enrollment will start in February 2023 and end in July 2023. The findings will be analyzed in August 2023, and the results will be reported from March 2024 onward. Conclusions: This study may have implications in identifying a noninvasive, noncontact route to facilitate a diagnosis of DED. The DEA01 may enable a comprehensive diagnostic evaluation within a telemedicine setting and facilitate early intervention for undiagnosed patients with DED confronting health care access barriers. Trial Registration: Japan Registry of Clinical Trials jRCTs032220524; https://jrct.niph.go.jp/latest-detail/jRCTs032220524 International Registered Report Identifier (IRRID): PRR1-10.2196/45218 %M 36912872 %R 10.2196/45218 %U https://www.researchprotocols.org/2023/1/e45218 %U https://doi.org/10.2196/45218 %U http://www.ncbi.nlm.nih.gov/pubmed/36912872 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42145 %T Acceptability of a Health Care App With 3 User Interfaces for Older Adults and Their Caregivers: Design and Evaluation Study %A Kim,Joo Chan %A Saguna,Saguna %A Åhlund,Christer %+ Division of Computer Science, Department of Computer Science, Electrical and Space Engineering, Luleå University of Technology, Forskargatan 1, Skellefteå, 931 77, Sweden, 46 722254785, joo.chan.kim@ltu.se %K Internet of Things %K health monitoring %K older adults %K augmented reality %K user experience %K independent living %K design study %K mobile phone %D 2023 %7 8.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The older population needs solutions for independent living and reducing the burden on caregivers while maintaining the quality and dignity of life. Objective: The aim of this study was to design, develop, and evaluate an older adult health care app that supports trained caregivers (ie, formal caregivers) and relatives (ie, informal caregivers). We aimed to identify the factors that affect user acceptance of interfaces depending on the user’s role. Methods: We designed and developed an app with 3 user interfaces that enable remote sensing of an older adult’s daily activities and behaviors. We conducted user evaluations (N=25) with older adults and their formal and informal caregivers to obtain an overall impression of the health care monitoring app in terms of user experience and usability. In our design study, the participants had firsthand experience with our app, followed by a questionnaire and individual interview to express their opinions on the app. Through the interview, we also identified their views on each user interface and interaction modality to identify the relationship between the user’s role and their acceptance of a particular interface. The questionnaire answers were statistically analyzed, and we coded the interview answers based on keywords related to a participant’s experience, for example, ease of use and usefulness. Results: We obtained overall positive results in the user evaluation of our app regarding key aspects such as efficiency, perspicuity, dependability, stimulation, and novelty, with an average between 1.74 (SD 1.02) and 2.18 (SD 0.93) on a scale of −3.0 to 3.0. The overall impression of our app was favorable, and we identified that “simple” and “intuitive” were the main factors affecting older adults’ and caregivers’ preference for the user interface and interaction modality. We also identified a positive user acceptance of the use of augmented reality by 91% (10/11) of the older adults to share information with their formal and informal caregivers. Conclusions: To address the need for a study to evaluate the user experience and user acceptance by older adults as well as both formal and informal caregivers regarding the user interfaces with multimodal interaction in the context of health monitoring, we designed, developed, and conducted user evaluations with the target user groups. Our results through this design study show important implications for designing future health monitoring apps with multiple interaction modalities and intuitive user interfaces in the older adult health care domain. %M 36884275 %R 10.2196/42145 %U https://humanfactors.jmir.org/2023/1/e42145 %U https://doi.org/10.2196/42145 %U http://www.ncbi.nlm.nih.gov/pubmed/36884275 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e38506 %T Impact of an eHealth Smartphone App on Quality of Life and Clinical Outcome of Patients With Hand and Foot Eczema: Prospective Randomized Controlled Intervention Study %A Weigandt,Wanja Alexander %A Schardt,Yannic %A Bruch,Aimee %A Herr,Raphael %A Goebeler,Matthias %A Benecke,Johannes %A Schmieder,Astrid %+ Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Josef-Schneider Strasse 2, Würzburg, 97080, Germany, 49 931 201 26234, schmieder_a@ukw.de %K hand and foot eczema %K eHealth %K mobile health %K mHealth %K telemedicine %K disease management %K smartphone app %K mobile phone %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic hand and foot eczema is a polyetiological dermatological condition. Patients experience pain, itching, and sleep disturbances and have a reduced quality of life. Skin care programs and patient education can improve the clinical outcome. eHealth devices offer a new opportunity to better inform and monitor patients. Objective: This study aimed to systematically analyze the effect of a monitoring smartphone app combined with patient education on the quality of life and clinical outcome of patients with hand and foot eczema. Methods: Patients in the intervention group received an educational program; attended study visits on weeks 0, 12, and 24; and had access to the study app. Patients in the control group attended the study visits only. The primary end point was a statistically significant reduction in Dermatology Life Quality Index, pruritus, and pain at weeks 12 and 24. The secondary end point was a statistically significant reduction in the modified Hand Eczema Severity Index (HECSI) score at weeks 12 and 24. This is an interim analysis at week 24 of the 60-week randomized controlled study. Results: In total, 87 patients were included in the study and randomized to the intervention group (n=43, 49%) or control group (n=44, 51%). Of the 87 patients, 59 (68%) completed the study visit at week 24. There were no significant differences between the intervention and control groups regarding quality of life, pain, itch, activity, and clinical outcome at weeks 12 and 24. Subgroup analysis revealed that, compared with the control group, the intervention group with an app use frequency of fewer than once every 5 weeks had a significant improvement in the Dermatology Life Quality Index at weeks 12 (P=.001) and 24 (P=.05), in pain measured on a numeric rating scale at weeks 12 (P=.02) and 24 (P=.02), and in the HECSI score at week 12 (P=.02). In addition, the HECSI scores assessed on the basis of pictures taken by the patients of their hands and feet correlated strongly with the HECSI scores recorded by physicians during regular personal visits (r=0.898; P=.002) even when the quality of the images was not that good. Conclusions: An educational program combined with a monitoring app that connects patients with their treating dermatologists can improve quality of life if the app is not used too frequently. In addition, telemedical care can at least partially replace personal care in patients with hand and foot eczema because the analysis of the pictures taken by the patients correlates strongly with that of the in vivo images. A monitoring app such as the one presented in this study has the potential to improve patient care and should be implemented in daily practice. Trial Registration: Deutsches Register Klinischer Studien DRKS00020963; https://drks.de/search/de/trial/DRKS00020963 %M 36881465 %R 10.2196/38506 %U https://mhealth.jmir.org/2023/1/e38506 %U https://doi.org/10.2196/38506 %U http://www.ncbi.nlm.nih.gov/pubmed/36881465 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e41088 %T Development of a Secondary Prevention Smartphone App for Students With Unhealthy Alcohol Use: Results From a Qualitative Assessment %A Bertholet,Nicolas %A Schmutz,Elodie %A Cunningham,John A %A McNeely,Jennifer %A Gmel,Gerhard %A Daeppen,Jean-Bernard %A Grazioli,Véronique S %+ Addiction Medicine Unit, Department of Psychiatry, Lausanne University Hospital, Bugnon 23 A, Lausanne, 1011, Switzerland, 41 0213148400, Nicolas.Bertholet@chuv.ch %K app %K alcohol-related secondary prevention %K university students %K tertiary students %K qualitative %K alcohol %K mHealth %K mobile app %K smartphone %K mobile phone %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population. Objective: This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population. Methods: The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ≥18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing. Results: The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: “General Acceptance of the App,” “Importance of the Targeted and Relevant App Content,” “Importance of Credibility,” “Importance of the App Usability,” “Importance of a Simple and Attractive Design,” “Importance of Notifications to Ensure App Use over Time.” Besides a general acceptance of the app, these themes reflected participants’ recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved. Conclusions: Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time. Trial Registration: ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4145-2 %M 36881448 %R 10.2196/41088 %U https://humanfactors.jmir.org/2023/1/e41088 %U https://doi.org/10.2196/41088 %U http://www.ncbi.nlm.nih.gov/pubmed/36881448 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43296 %T Combining Experience Sampling and Mobile Sensing for Digital Phenotyping With m-Path Sense: Performance Study %A Niemeijer,Koen %A Mestdagh,Merijn %A Verdonck,Stijn %A Meers,Kristof %A Kuppens,Peter %+ Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Tiensestraat 102, Post box 3717, Leuven, 3000, Belgium, 32 16 37 2580, koen.niemeijer@kuleuven.be %K digital phenotyping %K mobile health %K mHealth %K mobile sensing %K passive sensing %K ambulatory assessment %K experience sampling %K ecological momentary assessment %K smartphones %K mobile phone %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The experience sampling methodology (ESM) has long been considered as the gold standard for gathering data in everyday life. In contrast, current smartphone technology enables us to acquire data that are much richer, more continuous, and unobtrusive than is possible via ESM. Although data obtained from smartphones, known as mobile sensing, can provide useful information, its stand-alone usefulness is limited when not combined with other sources of information such as data from ESM studies. Currently, there are few mobile apps available that allow researchers to combine the simultaneous collection of ESM and mobile sensing data. Furthermore, such apps focus mostly on passive data collection with only limited functionality for ESM data collection. Objective: In this paper, we presented and evaluated the performance of m-Path Sense, a novel, full-fledged, and secure ESM platform with background mobile sensing capabilities. Methods: To create an app with both ESM and mobile sensing capabilities, we combined m-Path, a versatile and user-friendly platform for ESM, with the Copenhagen Research Platform Mobile Sensing framework, a reactive cross-platform framework for digital phenotyping. We also developed an R package, named mpathsenser, which extracts raw data to an SQLite database and allows the user to link and inspect data from both sources. We conducted a 3-week pilot study in which we delivered ESM questionnaires while collecting mobile sensing data to evaluate the app’s sampling reliability and perceived user experience. As m-Path is already widely used, the ease of use of the ESM system was not investigated. Results: Data from m-Path Sense were submitted by 104 participants, totaling 69.51 GB (430.43 GB after decompression) or approximately 37.50 files or 31.10 MB per participant per day. After binning accelerometer and gyroscope data to 1 value per second using summary statistics, the entire SQLite database contained 84,299,462 observations and was 18.30 GB in size. The reliability of sampling frequency in the pilot study was satisfactory for most sensors, based on the absolute number of collected observations. However, the relative coverage rate—the ratio between the actual and expected number of measurements—was below its target value. This could mostly be ascribed to gaps in the data caused by the operating system pushing away apps running in the background, which is a well-known issue in mobile sensing. Finally, some participants reported mild battery drain, which was not considered problematic for the assessed participants’ perceived user experience. Conclusions: To better study behavior in everyday life, we developed m-Path Sense, a fusion of both m-Path for ESM and Copenhagen Research Platform Mobile Sensing. Although reliable passive data collection with mobile phones remains challenging, it is a promising approach toward digital phenotyping when combined with ESM. %M 36881444 %R 10.2196/43296 %U https://formative.jmir.org/2023/1/e43296 %U https://doi.org/10.2196/43296 %U http://www.ncbi.nlm.nih.gov/pubmed/36881444 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e39055 %T Critical Criteria and Countermeasures for Mobile Health Developers to Ensure Mobile Health Privacy and Security: Mixed Methods Study %A Rezaee,Rita %A Khashayar,Mahboobeh %A Saeedinezhad,Saeed %A Nasiri,Mahdi %A Zare,Sahar %+ Health Information Management Research Center (HIMRC), Kashan University of Medical Sciences, 5th of Qotb -e Ravandi Blvd Kashan, Kashan, 87159-73449, Iran, 98 31 55548883, zare.sahar89@gmail.com %K telemedicine %K mobile apps %K privacy %K computer security, confidentiality %K mHealth %K mobile health %D 2023 %7 2.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the importance of the privacy and confidentiality of patients’ information, mobile health (mHealth) apps can raise the risk of violating users’ privacy and confidentiality. Research has shown that many apps provide an insecure infrastructure and that security is not a priority for developers. Objective: This study aims to develop and validate a comprehensive tool to be considered by developers for assessing the security and privacy of mHealth apps. Methods: A literature search was performed to identify papers on app development, and those papers reporting criteria for the security and privacy of mHealth were assessed. The criteria were extracted using content analysis and presented to experts. An expert panel was held for determining the categories and subcategories of the criteria according to meaning, repetition, and overlap; impact scores were also measured. Quantitative and qualitative methods were used for validating the criteria. The validity and reliability of the instrument were calculated to present an assessment instrument. Results: The search strategy identified 8190 papers, of which 33 (0.4%) were deemed eligible. A total of 218 criteria were extracted based on the literature search; of these, 119 (54.6%) criteria were removed as duplicates and 10 (4.6%) were deemed irrelevant to the security or privacy of mHealth apps. The remaining 89 (40.8%) criteria were presented to the expert panel. After calculating impact scores, the content validity ratio (CVR), and the content validity index (CVI), 63 (70.8%) criteria were confirmed. The mean CVR and CVI of the instrument were 0.72 and 0.86, respectively. The criteria were grouped into 8 categories: authentication and authorization, access management, security, data storage, integrity, encryption and decryption, privacy, and privacy policy content. Conclusions: The proposed comprehensive criteria can be used as a guide for app designers, developers, and even researchers. The criteria and the countermeasures presented in this study can be considered to improve the privacy and security of mHealth apps before releasing the apps into the market. Regulators are recommended to consider an established standard using such criteria for the accreditation process, since the available self-certification of developers is not reliable enough. %M 36862494 %R 10.2196/39055 %U https://mhealth.jmir.org/2023/1/e39055 %U https://doi.org/10.2196/39055 %U http://www.ncbi.nlm.nih.gov/pubmed/36862494 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40463 %T Iterative Development, Validation, and Certification of a Smartphone System to Assess Neonatal Jaundice: Development and Usability Study %A Aune,Anders %A Vartdal,Gunnar %A Jimenez Diaz,Gabriela %A Gierman,Lobke Marijn %A Bergseng,Håkon %A Darj,Elisabeth %+ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Olav Kyrres gate 9, Trondheim, 7030, Norway, 47 95034601, a.aune@ntnu.no %K neonatal jaundice %K neonatal hyperbilirubinemia %K newborns %K mobile app %K design %K validation %K regulatory processes %K mobile health %K mHealth %K mobile phone %D 2023 %7 28.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Medical device development is an area facing multiple challenges, resulting in a high number of products not reaching the clinical setting. Neonatal hyperbilirubinemia, manifesting as neonatal jaundice (NNJ), is an important cause of newborn morbidity and mortality. It is important to identify infants with neonatal hyperbilirubinemia at an early stage, but currently there is a lack of tools that are both accurate and affordable. Objective: This study aimed to develop a novel system to assess the presence of NNJ. The device should provide accurate results, be approved as a medical device, be easy to use, and be produced at a price that is affordable even in low-resource settings. Methods: We used an iterative approach to develop a smartphone-based system to detect the presence of NNJ. We performed technical development, followed by clinical and usability testing in parallel, after which we initiated the regulatory processes for certification. We updated the system in each iteration, and the final version underwent a clinical validation study on healthy term newborns aged 1 to 15 days before all documentation was submitted for conformity assessment to obtain Conformité Européenne (CE) certification. We developed a system that incorporates a smartphone app, a color calibration card, and a server. Results: Three iterations of the smartphone-based system were developed; the final version was approved as a medical device after complying with Medical Device Regulation guidelines. A total of 201 infants were included in the validation study. Bilirubin values using the system highly correlated with total serum or plasma bilirubin levels (r=0.84). The system had a high sensitivity (94%) to detect severe jaundice, defined as total serum or plasma bilirubin >250 µmol/L, and maintained a high specificity (71%). Conclusions: Our smartphone-based system has a high potential as a tool for identifying NNJ. An iterative approach to product development, conducted by working on different tasks in parallel, resulted in a functional and successful product. By adhering to the requirements for regulatory approval from the beginning of the project, we were able to develop a market-ready mobile health solution. %M 36853753 %R 10.2196/40463 %U https://pediatrics.jmir.org/2023/1/e40463 %U https://doi.org/10.2196/40463 %U http://www.ncbi.nlm.nih.gov/pubmed/36853753 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 8 %N %P e38592 %T App Design Features Important for Diabetes Self-management as Determined by the Self-Determination Theory on Motivation: Content Analysis of Survey Responses From Adults Requiring Insulin Therapy %A Fu,Helen N C %A Wyman,Jean F %A Peden-McAlpine,Cynthia J %A Draucker,Claire Burke %A Schleyer,Titus %A Adam,Terrence J %+ Center for Biomedical Informatics, Regenstrief Institute, 1101 West 10th Street, Indianapolis, IN, 46202, United States, 1 317 274 9480, hnfu@iu.edu %K diabetes app %K mobile health %K mHealth %K diabetes %K diabetic %K health app %K self-management %K motivation %K competence %K autonomy %K connectivity %K self-determination theory %K insulin %K glycemic control %K glucose %K blood sugar %K design %K user need %K qualitative %K randomized trial %D 2023 %7 24.2.2023 %9 Original Paper %J JMIR Diabetes %G English %X Background: Using a diabetes app can improve glycemic control; however, the use of diabetes apps is low, possibly due to design issues that affect patient motivation. Objective: This study aimed to describes how adults with diabetes requiring insulin perceive diabetes apps based on 3 key psychological needs (competence, autonomy, and connectivity) described by the Self-Determination Theory (SDT) on motivation. Methods: This was a qualitative analysis of data collected during a crossover randomized laboratory trial (N=92) testing 2 diabetes apps. Data sources included (1) observations during app testing and (2) survey responses on desired app features. Guided by the SDT, coding categories included app functions that could address psychological needs for motivation in self-management: competence, autonomy, and connectivity. Results: Patients described design features that addressed needs for competence, autonomy, and connectivity. To promote competence, electronic data recording and analysis should help patients track and understand blood glucose (BG) results necessary for planning behavior changes. To promote autonomy, BG trend analysis should empower patients to set safe and practical personalized behavioral goals based on time and the day of the week. To promote connectivity, app email or messaging function could share data reports and communicate with others on self-management advice. Additional themes that emerged are the top general app designs to promote positive user experience: patient-friendly; automatic features of data upload; voice recognition to eliminate typing data; alert or reminder on self-management activities; and app interactivity of a sound, message, or emoji change in response to keeping or not keeping BG in the target range. Conclusions: The application of the SDT was useful in identifying motivational app designs that address the psychological needs of competence, autonomy, and connectivity. User-centered design concepts, such as being patient-friendly, differ from the SDT because patients need a positive user experience (ie, a technology need). Patients want engaging diabetes apps that go beyond data input and output. Apps should be easy to use, provide personalized analysis reports, be interactive to affirm positive behaviors, facilitate data sharing, and support patient-clinician communication. %M 36826987 %R 10.2196/38592 %U https://diabetes.jmir.org/2023/1/e38592 %U https://doi.org/10.2196/38592 %U http://www.ncbi.nlm.nih.gov/pubmed/36826987 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37987 %T Mobile Phone Apps for HIV Prevention Among College-Aged Black Women in Atlanta: Mixed Methods Study and User-Centered Prototype %A Tesema,Naomi %A Guillaume,Dominique %A Francis,Sherilyn %A Paul,Sudeshna %A Chandler,Rasheeta %+ Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 727 7980, dguilla@emory.edu %K Black women %K HIV prevention %K mobile health %K mHealth app %K mobile technology %K reproductive health %K women’s health %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Black women in college are disproportionately affected by HIV diagnoses. Mobile apps can facilitate the innovative delivery of accurate HIV and sexual and reproductive health information. However, mobile health interventions are severely underused in this population. Objective: We aimed to quantitatively and qualitatively explore the perspectives of college-aged Black women on using a mobile health app for HIV prevention and sexual and reproductive health. The data obtained from Black women were used to design preliminary mobile app wireframes and features. Methods: This explanatory, sequential mixed methods study took place from 2019 to 2020 and targeted Black women who were enrolled in college or who had recently graduated from college. Convenience sampling was used during the quantitative phase, followed by purposive sampling in the qualitative phase. A cross-sectional web-based survey evaluating the willingness to use a mobile app for HIV prevention was conducted in the quantitative phase. Descriptive statistics were used for all variables. A separate focus group discussion was conducted with Black women in college to expand on the quantitative results. Focus group discussions explored their perceptions on HIV and health content delivered through a mobile app along with potential features that participants desired within the app. Using the data obtained, we selected the primary features for the app prototype. Results: In total, we enrolled 34 participants in the survey, with 6 participating in focus group discussions. Over half of the respondents reported a willingness to use an app that contained pre-exposure prophylaxis content. Women who claimed recent sexual activity reported being more likely to use an app feature that would allow them to order an at-home HIV testing kit than their non–sexually active counterparts. The emerging themes from the focus group session were Black women’s health concerns, HIV risk, sources of health information, and preferred app features. The content in our prototype included speaking with a specialist, HIV and pre-exposure prophylaxis information, holistic wellness, and features promoting engagement and retention. Conclusions: The results of our study guided the design of wireframes for an app prototype targeting HIV prevention in college-aged Black women. The rapid growth of mobile devices in Black communities, coupled with high rates of smartphone ownership among Black youth, makes mobile health interventions a promising strategy for addressing sexual and reproductive health disparities. Participants in our sample were willing to use a culturally appropriate and gender-considerate app for their sexual health needs. Our findings indicate that Black women in college may be excellent candidates for mobile app–based interventions. %M 36821362 %R 10.2196/37987 %U https://formative.jmir.org/2023/1/e37987 %U https://doi.org/10.2196/37987 %U http://www.ncbi.nlm.nih.gov/pubmed/36821362 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44468 %T Clinic-Integrated Smartphone App (JomPrEP) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Mixed Methods Evaluation of Usability and Acceptability %A Shrestha,Roman %A Altice,Frederick L %A Khati,Antoine %A Azwa,Iskandar %A Gautam,Kamal %A Gupta,Sana %A Sullivan,Patrick Sean %A Ni,Zhao %A Kamarulzaman,Adeeba %A Phiphatkunarnon,Panyaphon %A Wickersham,Jeffrey A %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road Unit 1101, Storrs, CT, 06269, United States, 1 8604862834, roman.shrestha@uconn.edu %K men who have sex with men %K mHealth %K HIV prevention %K pre-exposure prophylaxis %K mobile phone %K Malaysia %K MSM %K mobile health %K HIV %K prevention %K usability %K acceptability %K sexual minority %K gay %K homosexual %D 2023 %7 16.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: HIV disproportionately affects men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, including in health care settings, mobile health (mHealth) platforms have the potential to open new frontiers in HIV prevention. Objective: We developed an innovative, clinic-integrated smartphone app called JomPrEP, which provides a virtual platform for Malaysian MSM to engage in HIV prevention services. In collaboration with the local clinics in Malaysia, JomPrEP offers a range of HIV prevention (ie, HIV testing and pre-exposure prophylaxis [PrEP]) and other support services (eg, referral to mental health support) without having to interface face to face with clinicians. This study evaluated the usability and acceptability of JomPrEP to deliver HIV prevention services for MSM in Malaysia. Methods: In total, 50 PrEP-naive MSM without HIV in Greater Kuala Lumpur, Malaysia, were recruited between March and April 2022. Participants used JomPrEP for a month and completed a postuse survey. The usability of the app and its features were assessed using self-report and objective measures (eg, app analytics, clinic dashboard). Acceptability was evaluated using the System Usability Scale (SUS). Results: The participants’ mean age was 27.9 (SD 5.3) years. Participants used JomPrEP for an average of 8 (SD 5.0) times during 30 days of testing, with each session lasting an average of 28 (SD 38.9) minutes. Of the 50 participants, 42 (84%) ordered an HIV self-testing (HIVST) kit using the app, of whom 18 (42%) ordered an HIVST more than once. Almost all participants (46/50, 92%) initiated PrEP using the app (same-day PrEP initiation: 30/46, 65%); of these, 16/46 (35%) participants chose PrEP e-consultation via the app (vs in-person consultation). Regarding PrEP dispensing, 18/46 (39%) participants chose to receive their PrEP via mail delivery (vs pharmacy pickup). The app was rated as having high acceptability with a mean score of 73.8 (SD 10.1) on the SUS. Conclusions: JomPrEP was found to be a highly feasible and acceptable tool for MSM in Malaysia to access HIV prevention services quickly and conveniently. A broader, randomized controlled trial is warranted to evaluate its efficacy on HIV prevention outcomes among MSM in Malaysia. Trial Registration: ClinicalTrials.gov NCT05052411; https://clinicaltrials.gov/ct2/show/NCT05052411 International Registered Report Identifier (IRRID): RR2-10.2196/43318 %M 36795465 %R 10.2196/44468 %U https://mhealth.jmir.org/2023/1/e44468 %U https://doi.org/10.2196/44468 %U http://www.ncbi.nlm.nih.gov/pubmed/36795465 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40836 %T Improving Children’s Sleep Habits Using an Interactive Smartphone App: Community-Based Intervention Study %A Yoshizaki,Arika %A Murata,Emi %A Yamamoto,Tomoka %A Fujisawa,Takashi X %A Hanaie,Ryuzo %A Hirata,Ikuko %A Matsumoto,Sayuri %A Mohri,Ikuko %A Taniike,Masako %+ Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, 2-2-D5 Yamadaoka, Suita, Osaka, 5650871, Japan, 81 6 6879 3863, arika@kokoro.med.osaka-u.ac.jp %K infant sleep %K app %K mHealth %K mobile health %K behavioral intervention %K sleep health %K social implementation %K mobile phone %D 2023 %7 10.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sleep problems are quite common among young children and are often a challenge for parents and a hinderance to children’s development. Although behavioral therapy has proven effective in reducing sleep problems in children, a lack of access to professionals who can provide effective support is a major barrier for many caregivers. Therefore, pediatric sleep experts have begun developing apps and web-based services for caregivers. Despite the substantial influence of cultural and familial factors on children’s sleep, little effort has gone into developing cultural or family-tailored interventions. Objective: This study aimed to examine the effectiveness of the interactive smartphone app “Nenne Navi,” which provides culturally and family-tailored suggestions for improving sleep habits in young Japanese children through community-based long-term trials. The study also aimed to investigate the association between app-driven improvements in sleep and mental development in children. Methods: This study adopted a community-based approach to recruit individuals from the Higashi-Osaka city (Japan) who met ≥1 of the following eligibility criteria for sleep problems: sleeping after 10 PM, getting <9 hours of nighttime sleep, and experiencing frequent nighttime awakenings. A total of 87 Japanese caregivers with young children (mean 19.50, SD 0.70 months) were recruited and assigned to the app use group (intervention group) or the video-only group (control group). Both groups received educational video content regarding sleep health literacy. The caregivers in the intervention group used the app, which provides family-tailored suggestions, once per month for 1 year. Results: A total of 92% (33/36) of the caregivers in the app use group completed 1 year of the intervention. The participants’ overall evaluation of the app was positive. The wake-up time was advanced (base mean 8:06 AM; post mean 7:48 AM; F1,65=6.769; P=.01 and sleep onset latency was decreased (base mean 34.45 minutes; post mean 20.05 minutes; F1,65=23.219; P<.001) significantly in the app use group at the 13th month compared with the video-only group. Moreover, multiple regression analysis showed that decreased social jetlag (β=−0.302; P=.03) and increased sleep onset latency SD (β=.426; P=.02) in children predicted a significant enhancement in the development of social relationships with adults. At 6 months after the completion of the app use, all the caregivers reported continuation of the new lifestyle. Conclusions: The present findings suggest that the app “Nenne Navi” has high continuity in community use and can improve sleep habits in young Japanese children and that interventions for sleep habits of young children may lead to the enhancement of children’s social development. Future studies must focus on the effectiveness of the app in other regions with different regional characteristics and neuroscientific investigations on how changes in sleep impact brain development. %M 36641237 %R 10.2196/40836 %U https://mhealth.jmir.org/2023/1/e40836 %U https://doi.org/10.2196/40836 %U http://www.ncbi.nlm.nih.gov/pubmed/36641237 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38894 %T The Cultural Adaption of a Sobriety Support App for Alaska Native and American Indian People: Qualitative Feasibility and Acceptability Study %A Trinidad,Susan Brown %A Shane,Aliassa L %A Guinn,Tiffany R %A Apok,Charlene R %A Collier,Ann F %A Avey,Jaedon P %A Donovan,Dennis M %+ Department of Bioethics and Humanities, School of Medicine, University of Washington, Box 357120, Seattle, WA, 98195-7120, United States, 1 206 543 2508, sbtrini@uw.edu %K alcohol misuse %K sobriety support %K peer support %K smartphone app %K community reinforcement approach %K mobile phone %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite high rates of alcohol abstinence, Alaska Native and American Indian (ANAI) people experience a disproportionate burden of alcohol-related morbidity and mortality. Multiple barriers to treatment exist for this population, including a lack of culturally relevant resources; limited access to or delays in receiving treatment; and privacy concerns. Many ANAI people in the state of Alaska, United States, live in sparsely populated rural areas, where treatment access and privacy concerns regarding peer-support programs may be particularly challenging. In addition, prior research demonstrates that many ANAI people prefer a self-management approach to sobriety, rather than formal treatment. Taken together, these factors suggest a potential role for a culturally adapted smartphone app to support ANAI people interested in changing their behavior regarding alcohol use. Objective: This study was the first phase of a feasibility and acceptability study of a culturally tailored version of an off-the-shelf smartphone app to aid ANAI people in managing or reducing their use of alcohol. The aim of this qualitative needs assessment was to gather insights and preferences from ANAI people and health care providers serving ANAI people to guide feature development, content selection, and cultural adaptation before a pilot test of the smartphone app with ANAI people. Methods: From October 2018 to September 2019, we conducted semistructured interviews with 24 ANAI patients aged ≥21 years and 8 providers in a tribal health care organization in south-central Alaska. Results: Participants generally endorsed the usefulness of a smartphone app for alcohol self-management. They cited anonymity, 24/7 access, peer support, and patient choice as key attributes of an app. The desired cultural adaptations included ANAI- and land-themed design elements, cultural content (eg, stories from elders), and spiritual resources. Participants considered an app especially useful for rural-dwelling ANAI people, as well as those who lack timely access to treatment services or prefer to work toward managing their alcohol use outside the clinical setting. Conclusions: This needs assessment identified key features, content, and cultural adaptations that are being implemented in the next phase of the study. In future work, we will determine the extent to which these changes can be accommodated in a commercially available app, the feasibility of implementation, and the acceptability of the culturally adapted version of the app among ANAI users. %M 36473107 %R 10.2196/38894 %U https://formative.jmir.org/2023/1/e38894 %U https://doi.org/10.2196/38894 %U http://www.ncbi.nlm.nih.gov/pubmed/36473107 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43241 %T Promoting Hand Hygiene During the COVID-19 Pandemic: Parallel Randomized Trial for the Optimization of the Soapp App %A Baretta,Dario %A Amrein,Melanie Alexandra %A Bäder,Carole %A Ruschetti,Gian Giacomo %A Rüttimann,Carole %A Del Rio Carral,Maria %A Fabian,Carlo %A Inauen,Jennifer %+ Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 31 684 58 96, dario.baretta@unibe.ch %K COVID-19 %K hand hygiene %K behavior change intervention %K Multiphase Optimization Strategy %K MOST %K smartphone apps %K motivation %K habit %K social norm %K mobile phone %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19 and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and, thereby, prevent the spread of COVID-19. However, randomized trials are largely absent during a pandemic; therefore, there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. This study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app for promoting hand hygiene in the context of the COVID-19 pandemic. Objective: This study aimed to identify the most effective combination and sequence of 3 theory- and evidence-based intervention modules (habit, motivation, and social norms) for promoting hand hygiene. To this end, 9 versions of Soapp were developed (conditions), and 2 optimization criteria were defined: the condition with the largest increase in hand hygiene at follow-up and condition with the highest engagement, usability, and satisfaction based on quantitative and qualitative analyses. Methods: This study was a parallel randomized trial with 9 intervention conditions defined by the combination of 2 intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants from the Swiss general population (N=232; randomized). Randomization was performed using Qualtrics (Qualtrics International Inc), and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, which was assessed using an electronic diary. The secondary outcomes were user engagement, usability, and satisfaction assessed at follow-up. Nine participants were further invited to participate in semistructured exit interviews. A set of ANOVAs was performed to test the main hypotheses, whereas a thematic analysis was performed to analyze the qualitative data. Results: The results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect between time and intervention condition. Similarly, no between-group differences in engagement, usability, and satisfaction emerged. Seven themes (eg, “variety and timeliness of the task load” and “social interaction”) were found in the thematic analysis. Conclusions: The effectiveness of Soapp in promoting hand hygiene laid the foundation for the next evaluation phase of the app. More generally, the study supported the value of digital interventions in pandemic contexts. The findings showed no differential effect of intervention conditions involving different combinations and sequences of the habit, motivation, and social norms modules on hand hygiene, engagement, usability, and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. Trial Registration: ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/ct2/show/NCT04830761 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-055971 %M 36599056 %R 10.2196/43241 %U https://mhealth.jmir.org/2023/1/e43241 %U https://doi.org/10.2196/43241 %U http://www.ncbi.nlm.nih.gov/pubmed/36599056 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40373 %T Virtual Digital Psychotherapist App–Based Treatment in Patients With Methamphetamine Use Disorder (Echo-APP): Single-Arm Pilot Feasibility and Efficacy Study %A Chen,Tianzhen %A Chen,Liyu %A Li,Shuo %A Du,Jiang %A Su,Hang %A Jiang,Haifeng %A Wu,Qianying %A Zhang,Lei %A Bao,Jiayi %A Zhao,Min %+ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wan Ping Road, Shanghai, Shanghai, 200030, China, 86 2134773146, drminzhao@smhc.org.cn %K tablet %K Android program %K substance use disorder %K methamphetamine use disorder %K digital agent %K virtual digital human %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Substance use disorder is one of the severe public health problems worldwide. Inequitable resources, discrimination, and physical distances limit patients’ access to medical help. Automated conversational agents have the potential to provide in-home and remote therapy. However, automatic dialogue agents mostly use text and other methods to interact, which affects the interaction experience, treatment immersion, and clinical efficacy. Objective: The aim of this paper is to describe the design and development of Echo-APP, a tablet-based app with the function of a virtual digital psychotherapist, and to conduct a pilot study to explore the feasibility and preliminary efficacy results of Echo-APP for patients with methamphetamine use disorder. Methods: Echo-APP is an assessment and rehabilitation program developed for substance use disorder (SUD) by a team of clinicians, psychotherapists, and computer experts. The program is available for Android tablets. In terms of assessment, the focus is on the core characteristics of SUD, such as mood, impulsivity, treatment motivation, and craving level. In terms of treatment, Echo-APP provides 10 treatment units, involving awareness of addiction, motivation enhancement, emotion regulation, meditation, etc. A total of 47 patients with methamphetamine dependence were eventually enrolled in the pilot study to receive a single session of the Echo-APP–based motivational enhancement treatment. The outcomes were assessed before and after the patients’ treatment, including treatment motivation, craving levels, self-perception on the importance of drug abstinence, and their confidence in stopping the drug use. Results: In the pilot study, scores on the Stages of Change Readiness and Treatment Eagerness Scale and the questionnaire on motivation for abstaining from drugs significantly increased after the Echo-APP–based treatment (P<.001, Cohen d=–0.60), while craving was reduced (P=.01, Cohen d=0.38). Patients’ baseline Generalized Anxiety Disorder-7 assessment score (β=3.57; P<.001; 95% CI 0.80, 2.89) and Barratt Impulsiveness Scale (BIS)–motor impulsiveness score (β=–2.10; P=.04; 95% CI –0.94, –0.02) were predictive of changes in the patients’ treatment motivation during treatment. Moreover, patients’ baseline Generalized Anxiety Disorder-7 assessment score (β=–1.607; P=.03; 95% CI –3.08, –0.14), BIS—attentional impulsivity score (β=–2.43; P=.004; 95% CI –4.03, –0.83), and BIS—nonplanning impulsivity score (β=2.54; P=.002; 95% CI 0.98, 4.10) were predictive of changes in craving scores during treatment. Conclusions: Echo-APP is a practical, accepted, and promising virtual digital psychotherapist program for patients with methamphetamine dependence. The preliminary findings lay a good foundation for further optimization of the program and the promotion of large-scale randomized controlled clinical studies for SUD. %M 36719727 %R 10.2196/40373 %U https://mhealth.jmir.org/2023/1/e40373 %U https://doi.org/10.2196/40373 %U http://www.ncbi.nlm.nih.gov/pubmed/36719727 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41660 %T Loss-Framed Adaptive Microcontingency Management for Preventing Prolonged Sedentariness: Development and Feasibility Study %A Choi,Woohyeok %A Lee,Uichin %+ School of Computing, Korea Advanced Institute of Science & Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea, 82 42 350 3544, uclee@kaist.edu %K contingency management %K incentive %K sedentary behavior %K sedentariness %K behavior change %K health promotion %K financial incentives %K health intervention %K user compliance %K incentive-based intervention %K mobile phone %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A growing body of evidence shows that financial incentives can effectively reinforce individuals’ positive behavior change and improve compliance with health intervention programs. A critical factor in the design of incentive-based interventions is to set a proper incentive magnitude. However, it is highly challenging to determine such magnitudes as the effects of incentive magnitude depend on personal attitudes and contexts. Objective: This study aimed to illustrate loss-framed adaptive microcontingency management (L-AMCM) and the lessons learned from a feasibility study. L-AMCM discourages an individual’s adverse health behaviors by deducting particular expenses from a regularly assigned budget, where expenses are adaptively estimated based on the individual’s previous responses to varying expenses and contexts. Methods: We developed a mobile health intervention app for preventing prolonged sedentary lifestyles. This app delivered a behavioral mission (ie, suggesting taking an active break for a while) with an incentive bid when 50 minutes of uninterrupted sedentary behavior happened. Participants were assigned to either the fixed (ie, deducting the monotonous expense for each mission failure) or adaptive (ie, deducting varying expenses estimated by the L-AMCM for each mission failure) incentive group. The intervention lasted 3 weeks. Results: We recruited 41 participants (n=15, 37% women; fixed incentive group: n=20, 49% of participants; adaptive incentive group: n=21, 51% of participants) whose mean age was 24.0 (SD 3.8; range 19-34) years. Mission success rates did not show statistically significant differences by group (P=.54; fixed incentive group mean 0.66, SD 0.24; adaptive incentive group mean 0.61, SD 0.22). The follow-up analysis of the adaptive incentive group revealed that the influence of incentive magnitudes on mission success was not statistically significant (P=.18; odds ratio 0.98, 95% CI 0.95-1.01). On the basis of the qualitative interviews, such results were possibly because the participants had sufficient intrinsic motivation and less sensitivity to incentive magnitudes. Conclusions: Although our L-AMCM did not significantly affect users’ mission success rate, this study configures a pioneering work toward adaptively estimating incentives by considering user behaviors and contexts through leveraging mobile sensing and machine learning. We hope that this study inspires researchers to develop incentive-based interventions. %M 36705949 %R 10.2196/41660 %U https://mhealth.jmir.org/2023/1/e41660 %U https://doi.org/10.2196/41660 %U http://www.ncbi.nlm.nih.gov/pubmed/36705949 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 0 %N %P e0 %T Improvements in Glycemic Control and Depressive Symptoms Among Adults With Type 2 Diabetes: Retrospective Study %A Venkatesan,Aarathi %A Zimmermann,Gretchen %A Rawlings,Kelly %A Ryan,Claudia %A Voelker,Louise %A Edwards,Caitlyn %+ Vida Health, 100 Montgomery St #750, San Francisco, CA, 94104, United States, 1 (415) 989 1017, caitlyn.edwards@vida.com %K type 2 diabetes %K digital health %K diabetes intervention %K diabetes %K diabetic %K health app %K coaching %K patient education %K mobile health %K mHealth %K app-based %K health coaching %K hemoglobin A1c %K HbA1c %K depression %K depressive %K anxiety %K mental health %K glycemic control %K diabetes management %K health management %K digital health intervention %D 2023 %7 13.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of diabetes remains high, with traditional lifestyle interventions demonstrating limited success in improving diabetes-related outcomes, particularly among individuals with diabetes-related mental health comorbidities. Digital health interventions provide the ability to ease the sustained and rigorous self-management needs associated with diabetes care and treatment. Current interventions though, are plagued by small sample sizes, underpowered pilot studies, and immense heterogeneity in program intervention, duration, and measured outcomes. Objective: Therefore, this work aimed to evaluate the effectiveness of a mobile health diabetes management program on measures of glycemic control in a high-risk population with type 2 diabetes (hemoglobin A1c [HbA1c] ≥8.0%), utilizing a sample of 1128 participants who provided baseline and follow-up data. The sustainability of this change in glycemic control was examined in a subset of participants (n=455) at 6 months and 1 year following program enrollment. A secondary analysis examined changes in glycemic control among a subset of participants with self-reported mild-to-moderate depression at baseline. Methods: This study utilized a single-arm, retrospective design. Participants were enrolled in the Vida Health Diabetes Management Program. This app-based intervention utilized one-on-one remote sessions with a health coach, registered dietitian nutritionist, and/or a certified diabetes care and education specialist and structured lessons and tools related to diabetes management and self-care. Participants provided baseline (–365 to 21 days of program enrollment) as well as follow-up (at least 90 days following program enrollment) HbA1c values. Paired t tests were used to evaluate changes in HbA1c between baseline and follow-up time points. The 8-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale were utilized to assess self-reported depressive and anxiety symptoms, respectively. Paired t tests and linear regression modeling accounting for pertinent covariates were used to evaluate changes in mental health symptom acuity and their relationship with changes in glycemic control. Results: We observed a significant decrease in HbA1c of –1.35 points between baseline (mean 9.84, SD 1.64) and follow-up (mean 8.48, SD 1.77; t=22.56, P<.001) among this large, high-risk sample. This decrease was sustained up to 1 year following program enrollment. Additionally, a significant relationship between improvements in depressive symptom acuity and improvements in HbA1c was observed (β=–0.74, P=.03). Conclusions: This study demonstrates clinically meaningful improvements in glycemic control among participants enrolled in the Vida Health Diabetes Management Program. Additionally, this work presents one of the largest studied samples of participants enrolled in a digital health diabetes management program to date. %R 10.2196/41880 %U https://formative.jmir.org/2023/0/e0/ %U https://doi.org/10.2196/41880 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 15 %N %P e38078 %T Co-design of the Transgender Health Information Resource: Web-Based Participatory Design %A Morse,Brad %A Soares,Andrey %A Ytell,Kate %A DeSanto,Kristen %A Allen,Marvyn %A Holliman,Brooke Dorsey %A Lee,Rita S %A Kwan,Bethany M %A Schilling,Lisa M %+ Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, 1890 North Revere Court | Mailstop F443, Aurora, CO, 80045, United States, 1 3037245138, brad.morse@cuanschutz.edu %K transgender %K gender diverse %K participatory design %K web-based design %K co-design %K health information resource %K smartphone %K app %K mobile phone %D 2023 %7 10.1.2023 %9 Original Paper %J J Particip Med %G English %X Background: There is an urgent and unmet need for accessible and credible health information within the transgender and gender-diverse (TGD) community. Currently, TGD individuals often seek and must find relevant resources by vetting social media posts. A resource that provides accessible and credible health-related resources and content via a mobile phone app may have a positive impact on and support the TGD population. Objective: COVID-19 stay-at-home orders forced a shift in the methods used in participatory design. In this paper, we aimed to describe the web-based participatory methods used to develop the Transgender Health Information Resource. We also described and characterized the web-based engagement that occurred during a single session of the overall design process. Methods: We planned and conducted web-based design sessions to replace the proposed in-person sessions. We used web-based collaborative tools, including Zoom (Zoom Video Communications), Mural (Mural), REDCap (Research Electronic Data Capture; Vanderbilt University), and Justinmind (Justinmind), to engage the participants in the design process. Zoom was used as an integrated platform for design activities. Mural was used to perform exercises, such as free listing, brainstorming, and grouping. REDCap allowed us to collect survey responses. Justinmind was used to create prototypes that were shared and discussed via Zoom. Recruitment was led by one of our community partners, One Colorado, who used private Facebook groups in which web-based flyers were dispersed. The design process took place in several workshops over a period of 10 months. We described and characterized engagement during a single design session by tracking the number of influential interactions among participants. We defined an influential interaction as communication, either verbal or web-based content manipulation, that advanced the design process. Results: We presented data from a single design session that lasted 1 hour and 48 minutes and included 4 participants. During the session, there were 301 influential interactions, consisting of 79 verbal comments and 222 web-based content manipulations. Conclusions: Web-based participatory design can elicit input and decisions from participants to develop a health information resource, such as a mobile app user interface. Overall, participants were highly engaged. This approach maintained the benefits and fidelity of traditional in-person design sessions, mitigated deficits, and exploited the previously unconsidered benefits of web-based methods, such as enhancing the ability to participate for those who live far from academic institutions. The web-based approach to participatory design was an efficient and feasible methodological design approach. %M 36626222 %R 10.2196/38078 %U https://jopm.jmir.org/2023/1/e38078 %U https://doi.org/10.2196/38078 %U http://www.ncbi.nlm.nih.gov/pubmed/36626222 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43263 %T Medical Student Experiences of Engaging in a Psychological Flexibility Skill Training App for Burnout and Well-being: Pilot Feasibility Study %A Ditton,Elizabeth %A Knott,Brendon %A Hodyl,Nicolette %A Horton,Graeme %A Walker,Frederick Rohan %A Nilsson,Michael %+ Centre for Rehab Innovations, University of Newcastle, University Drive, Callaghan, 2300, Australia, 61 2 404 20738, elizabeth.ditton@uon.edu.au %K medical students %K burnout prevention %K app %K feasibility %K intervention engagement %K psychological flexibility %K acceptance and commitment therapy %K mobile phone %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical students are at higher risk of burnout than the general population. Interventions that facilitate adaptive coping behaviors (eg, Psychological Flexibility) in the context of inherent stressors associated with medical training could mitigate burnout risk and improve well-being. Delivering these interventions using smartphone apps offers advantages such as accessibility, scalability, mitigation of time and stigma barriers, and facilitation of individual tailoring (individualization). There is a need for feasibility trials with medical students in this emerging field. Formal evaluations of user experiences of app-based psychological skill training are required to identify barriers to and facilitators of engagement and optimize intervention development before implementation in efficacy trials and real-world settings. Objective: This study aimed to assess the feasibility of delivering an individualized Psychological Flexibility skill training intervention (Acceptance and Commitment Training [ACTraining]) to medical students using an app-based delivery format. We further aimed to explore how formal evaluation of user experiences might inform and guide the development of this app before implementation in an efficacy trial and future research involving app-delivered psychological skill training for medical students. Methods: This single-arm study was an early-phase feasibility trial of a stand-alone ACTraining app conducted with a sample of Australian medical students (n=11). We collected app usability and user experience data across a broad range of domains (eg, perceived helpfulness and relevance, learning experiences, and self-efficacy) using self-report questionnaires (quantitative and qualitative) and behavioral engagement outcomes. Results: Behavioral engagement data demonstrated that the app delivered the assessment procedures and individualized ACTraining intervention to medical students as intended. The subjective feedback provided by students who actively engaged with the app was generally positive across several indicators, including usability, perceived relevance and helpfulness, accessibility, maintenance of privacy, and opportunity for self-reflection. Disengagement from the app was an identified challenge throughout the trial. Participant feedback identified several factors that may have affected engagement, such as time, expectations regarding app interface functioning, and individual differences in confidence and self-efficacy when implementing skills. Conclusions: This study reports user experience data that have been largely absent from the literature on digital psychological interventions for medical students. Our findings demonstrate the preliminary feasibility of an app-delivered ACTraining intervention for medical student well-being and burnout and support the value of future assessment of the efficacy of this approach with larger samples. We consider subjective feedback from medical students in relation to observed engagement and propose how this information might be used to inform the development of this app and future research in this nascent field. %M 36626191 %R 10.2196/43263 %U https://formative.jmir.org/2023/1/e43263 %U https://doi.org/10.2196/43263 %U http://www.ncbi.nlm.nih.gov/pubmed/36626191 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42416 %T Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation %A Young,Stephanie Ruth %A Lattie,Emily Gardiner %A Berry,Andrew B L %A Bui,Lynn %A Byrne,Greg Joseph %A Yoshino Benavente,Julia Noelani %A Bass,Michael %A Gershon,Richard C %A Wolf,Michael S %A Nowinski,Cindy J %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, Chicago, IL, 60611, United States, 1 (312) 503 1725, stephanieruth.young@northwestern.edu %K human-centered design %K mobile health %K mHealth %K usability %K cognitive screening %K older adults %K mobile phone %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Annual cognitive screening in adults aged >65 years can improve early detection of cognitive impairment, yet less than half of all cases are identified in primary care. Time constraints in primary care settings present a major barrier to routine screening. A remote cognitive screener completed on a patient’s own smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: We described the iterative design and proposed the implementation of a remote cognitive screening app, MyCog Mobile, to be completed on a patient’s smartphone before an annual wellness visit. The research questions were as follows: What would motivate primary care clinicians and clinic administrators to implement a remote cognitive screening process? How might we design a remote cognitive screener to fit well with existing primary care workflows? What would motivate an older adult patient to complete a cognitive screener on a smartphone before a primary care visit? How might we optimize the user experience of completing a remote cognitive screener on a smartphone for older adults? Methods: To address research questions 1 and 2, we conducted individual interviews with clinicians (n=5) and clinic administrators (n=3). We also collaborated with clinic administrators to create user journey maps of their existing and proposed MyCog Mobile workflows. To address research questions 3 and 4, we conducted individual semistructured interviews with cognitively healthy older adults (n=5) and solicited feedback from a community stakeholder panel (n=11). We also tested and refined high-fidelity prototypes of the MyCog Mobile app with the older adult interview participants, who rated the usability on the Simplified System Usability Scale and After-Scenario Questionnaire. Results: Clinicians and clinic administrators were motivated to adopt a remote cognitive screening process if it saved time in their workflows. Findings from interviews and user journey mapping informed the proposed implementation and core functionality of MyCog Mobile. Older adult participants were motivated to complete cognitive screeners to ensure that they were cognitively healthy and saw additional benefits to remote screening, such as saving time during their visit and privacy. Older adults also identified potential challenges to remote smartphone screening, which informed the user experience design of the MyCog Mobile app. The average rating across prototype versions was 91 (SD 5.18) on the Simplified System Usability Scale and 6.13 (SD 8.40) on the After-Scenario Questionnaire, indicating above-average usability. Conclusions: Through an iterative, human-centered design process, we developed a viable remote cognitive screening app and proposed an implementation strategy for primary care settings that was optimized for multiple stakeholders. The next steps include validating the cognitive screener in clinical and healthy populations and piloting the finalized app in a community primary care clinic. %M 36626223 %R 10.2196/42416 %U https://formative.jmir.org/2023/1/e42416 %U https://doi.org/10.2196/42416 %U http://www.ncbi.nlm.nih.gov/pubmed/36626223 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40837 %T Co-design and Development of EndoSMS, a Supportive Text Message Intervention for Individuals Living With Endometriosis: Mixed Methods Study %A Sherman,Kerry Anne %A Pehlivan,Melissa Jade %A Singleton,Anna %A Hawkey,Alexandra %A Redfern,Julie %A Armour,Mike %A Dear,Blake %A Duckworth,Tanya Jane %A Ciccia,Donna %A Cooper,Michael %A Parry,Kelly Ann %A Gandhi,Esther %A Imani,Sara A %+ Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Balaclava Rd, Sydney, 2109, Australia, 61 9850 6874, kerry.sherman@mq.edu.au %K text message %K intervention %K co-design %K development %K endometriosis %K SMS %K mHealth %K self-management %K mobile phone %D 2022 %7 9.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Endometriosis, which affects 1 in 10 people assigned female at birth, is a chronic systemic inflammatory disease with a high symptom burden and adverse socioemotional impacts. There is a need for an accessible, cost-effective, and low-burden intervention to support individuals in managing their endometriosis condition. Objective: This study aimed to co-design and evaluate the acceptability, readability, and quality of a bank of supportive SMS text messages (EndoSMS) for individuals with endometriosis. Methods: In phase 1 of this mixed method design, 17 consumer representatives (individuals with endometriosis) participated across three 3-hour web-based (Zoom, Zoom Video Communications, Inc) focus groups. The transcripts were encoded and analyzed thematically. In phase 2, consumer representatives (n=14) and health care professionals (n=9) quantitatively rated the acceptability, readability, and appropriateness of the developed text messages in a web-based survey. All the participants initially completed a background survey assessing sociodemographic and medical factors. Results: Consumer representatives demonstrated diverse sociodemographic characteristics (Mage=33.29), varying in location (metropolitan vs rural or regional), employment, and relationship and educational statuses. Participants reached a consensus regarding the delivery of 4 SMS text messages per week, delivered randomly throughout the week and in one direction (ie, no reply), with customization for the time of day and use of personal names. Seven main areas of unmet need for which participants required assistance were identified, which subsequently became the topic areas for the developed SMS text messages: emotional health, social support, looking after and caring for your body, patient empowerment, interpersonal issues, general endometriosis information, and physical health. Through a web-based survey, 371 co-designed SMS text messages were highly rated by consumers and health care professionals as clear, useful, and appropriate for individuals with endometriosis. Readability indices (Flesch-Kincaid scale) indicated that the SMS text messages were accessible to individuals with a minimum of 7th grade high school education. Conclusions: On the basis of the needs and preferences of a diverse consumer representative group, we co-designed EndoSMS, a supportive SMS text message program for individuals with endometriosis. The initial evaluation of the SMS text messages by consumer representatives and health professionals suggested the high acceptability and suitability of the developed SMS text messages. Future studies should further evaluate the acceptability and effectiveness of EndoSMS in a broader population of individuals with endometriosis. %M 36485029 %R 10.2196/40837 %U https://formative.jmir.org/2022/12/e40837 %U https://doi.org/10.2196/40837 %U http://www.ncbi.nlm.nih.gov/pubmed/36485029 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e42553 %T A Text-Based Smoking Cessation Intervention for Sexual and Gender Minority Groups: Protocol for a Feasibility Trial %A Tami-Maury,Irene %A Klaff,Rebecca %A Hussin,Allison %A Smith,Nathan Grant %A Chang,Shine %A McNeill,Lorna %A Reitzel,Lorraine R %A Shete,Sanjay %A Abroms,Lorien C %+ School of Public Health, The University of Texas Health Science Center at Houston, Reuel A Stallones Building, 6th Fl, 1200 Pressler Street, Houston, TX, 77030, United States, 1 713 500 9174, irene.tami@uth.tmc.edu %K smoking cessation %K sexual and gender minorities %K LGBTQ+ %K SMS text messaging %K mobile health %K mHealth %D 2022 %7 9.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking among sexual and gender minority (SGM) groups, which include lesbian, gay, bisexual, transgender, and queer individuals, has been reported to be highly prevalent. This is attributed to several factors, including minority-specific stress and targeted tobacco marketing. Therefore, this population is at an increased risk for tobacco-related diseases. SMS text messaging programs have been found to be effective for smoking cessation and appeal to traditionally hard-to-reach populations over other interventions. It has also been suggested that targeted and tailored interventions could be more effective among SGM smokers because they can be designed to assure a safe, validating health care environment that enhances receptivity to cessation. Objective: The aim of this study is to develop SmokefreeSGM, a text-based smoking cessation program tailored to and tested among SGM smokers. Methods: The study consists of three phases, culminating in a feasibility trial. In Phase 1, our research team will collaborate with a Community Advisory Board to develop and pretest the design of SmokefreeSGM. In Phase 2, the tailored text messaging program will be beta tested among 16 SGM smokers. Our research team will use a mixed-methods approach to collect and analyze data from participants who will inform the refinement of SmokefreeSGM. In Phase 3, a feasibility trial will be conducted among 80 SGM smokers either enrolled in SmokefreeSGM or SmokefreeTXT, the original text-based program developed by the National Cancer Institute for the general population. Our research team will examine recruitment, retention, and smoking abstinence rates at 1-, 3-, and 6-month follow-up. Additionally, a qualitative interview will be conducted among 32 participants to evaluate the feasibility and acceptability of the programs (SmokefreeSGM and SmokefreeTXT). Results: This study received approval from The University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects to begin research on August 21, 2020. Recruitment for the beta testing of SmokefreeSGM (Phase 2) began in January 2022. We estimate that the feasibility trial (Phase 3) will begin in September 2022 and that results will be available in December 2023. Conclusions: Findings from this research effort will help reduce tobacco-related health disparities among SGM smokers by determining the feasibility and acceptability of SmokefreeSGM, an SGM-tailored smoking cessation intervention. Trial Registration: ClinicalTrials.gov NCT05029362; https://clinicaltrials.gov/ct2/show/NCT05029362 International Registered Report Identifier (IRRID): DERR1-10.2196/42553 %M 36485022 %R 10.2196/42553 %U https://www.researchprotocols.org/2022/12/e42553 %U https://doi.org/10.2196/42553 %U http://www.ncbi.nlm.nih.gov/pubmed/36485022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e41628 %T Design of a Patient Voice App Experience for Heart Failure Management: Usability Study %A Barbaric,Antonia %A Munteanu,Cosmin %A Ross,Heather %A Cafazzo,Joseph A %+ Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto General Hospital - RFE Building, 4th floor, 190 Elizabeth St, Toronto, ON, M5G2C4, Canada, 1 416 340 4800 ext 4765, antonia.barbaric@mail.utoronto.ca %K heart failure %K self-management %K digital therapeutics %K voice-activated technology %K smart speaker %K usability study %K formative evaluation %K mobile phone %K smartphone %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital therapeutics (DTx) in the prevention and management of medical conditions has increased through the years, with an estimated 44 million people using one as part of their treatment plan in 2021, nearly double the number from the previous year. DTx are commonly accessed through smartphone apps, but offering these treatments through additional platforms can improve the accessibility of these interventions. Voice apps are an emerging technology in the digital health field; not only do they have the potential to improve DTx adherence, but they can also create a better user experience for some user groups. Objective: This research aimed to identify the acceptability and feasibility of offering a voice app for a chronic disease self-management program. The objective of this project was to design, develop, and evaluate a voice app of an already-existing smartphone-based heart failure self-management program, Medly, to be used as a case study. Methods: A voice app version of Medly was designed and developed through a user-centered design process. We conducted a usability study and semistructured interviews with patients with heart failure (N=8) at the Peter Munk Cardiac Clinic in Toronto General Hospital to better understand the user experience. A Medly voice app prototype was built using a software development kit in tandem with a cloud computing platform and was verified and validated before the usability study. Data collection and analysis were guided by a mixed methods triangulation convergence design. Results: Common themes were identified in the results of the usability study, which involved 8 participants with heart failure. Almost all participants (7/8, 88%) were satisfied with the voice app and felt confident using it, although half of the participants (4/8, 50%) were unsure about using it in the future. Six main themes were identified: changes in physical behavior, preference between voice app and smartphone, importance of music during voice app interaction, lack of privacy concerns, desired reassurances during voice app interaction, and helpful aids during voice app interaction. These findings were triangulated with the quantitative data, and it concluded that the main area for improvement was related to the ease of use; design changes were then implemented to better improve the user experience. Conclusions: This work offered preliminary insight into the acceptability and feasibility of a Medly voice app. Given the recent emergence of voice apps in health care, we believe that this research offered invaluable insight into successfully deploying DTx for chronic disease self-management using this technology. %M 36472895 %R 10.2196/41628 %U https://formative.jmir.org/2022/12/e41628 %U https://doi.org/10.2196/41628 %U http://www.ncbi.nlm.nih.gov/pubmed/36472895 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41658 %T Outcomes of a Comprehensive Mobile Smoking Cessation Program With Nicotine Replacement Therapy in Adult Smokers: Pilot Randomized Controlled Trial %A Marler,Jennifer D %A Fujii,Craig A %A Utley,MacKenzie T %A Balbierz,Daniel J %A Galanko,Joseph A %A Utley,David S %+ Pivot Health Technologies Inc., 1010 Commercial St., Suite C, San Carlos, CA, 94070, United States, 1 4157577696, marler@pivot.co %K smoking cessation %K digital health %K smartphone %K digital sensor %K carbon monoxide %K breath sensor %K biofeedback %K mobile apps %K health promotion %K app %K mobile phone %D 2022 %7 24.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cigarette smoking remains the leading cause of preventable illness and death, underscoring ongoing need for evidence-based solutions. Pivot, a US Clinical Practice Guideline–based mobile smoking cessation program, comprises a personal carbon monoxide breath sensor; a smartphone app; in-app, text-based human-provided coaching; nicotine replacement therapy; and a moderated web-based community. Promising Pivot cohort studies have established the foundation for comparative assessment. Objective: This study aimed to compare engagement, retention, attitudes toward quitting smoking, smoking behavior, and participant feedback between Pivot and QuitGuide, a US Clinical Practice Guideline–based smoking cessation smartphone app from the National Cancer Institute. Methods: In this remote pilot randomized controlled trial, cigarette smokers in the United States were recruited on the web and randomized to Pivot or QuitGuide. Participants were offered 12 weeks of free nicotine replacement therapy. Data were self-reported via weekly web-based questionnaires for 12 weeks and at 26 weeks. Outcomes included engagement and retention, attitudes toward quitting smoking, smoking behavior, and participant feedback. The primary outcome was self-reported app openings at 12 weeks. Cessation outcomes included self-reported 7- and 30-day point prevalence abstinence (PPA), abstinence from all tobacco products, and continuous abstinence at 12 and 26 weeks. PPA and continuous abstinence were biovalidated via breath carbon monoxide samples. Results: Participants comprised 188 smokers (94 Pivot and 94 QuitGuide): mean age 46.4 (SD 9.2) years, 104 (55.3%) women, 128 (68.1%) White individuals, and mean cigarettes per day 17.6 (SD 9.0). Engagement via mean “total app openings through 12 weeks” (primary outcome) was Pivot, 157.9 (SD 210.6) versus QuitGuide, 86.5 (SD 66.3; P<.001). Self-reported 7-day PPA at 12 and 26 weeks was Pivot, 35% (33/94) versus QuitGuide, 28% (26/94; intention to treat [ITT]: P=.28) and Pivot, 36% (34/94) versus QuitGuide, 27% (25/94; ITT: P=.12), respectively. Self-reported 30-day PPA at 12 and 26 weeks was Pivot, 29% (27/94) versus QuitGuide, 22% (21/94; ITT: P=.32) and Pivot, 32% (30/94) versus QuitGuide, 22% (21/94; ITT: P=.12), respectively. The biovalidated abstinence rate at 12 weeks was Pivot, 29% (27/94) versus QuitGuide, 13% (12/94; ITT: P=.008). Biovalidated continuous abstinence at 26 weeks was Pivot, 21% (20/94) versus QuitGuide, 10% (9/94; ITT: P=.03). Participant feedback, including ease of setup, impact on smoking, and likelihood of program recommendation were favorable for Pivot. Conclusions: In this randomized controlled trial comparing the app-based smoking cessation programs Pivot and QuitGuide, Pivot participants had higher engagement and biovalidated cessation rates and more favorable user feedback at 12 and 26 weeks. These findings support Pivot as an effective, durable mobile smoking cessation program. Trial Registration: ClinicalTrials.gov NCT04955639; https://clinicaltrials.gov/ct2/show/NCT04955639 %M 36257323 %R 10.2196/41658 %U https://mhealth.jmir.org/2022/11/e41658 %U https://doi.org/10.2196/41658 %U http://www.ncbi.nlm.nih.gov/pubmed/36257323 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e32757 %T First-time Mothers’ Understanding and Use of a Pregnancy and Parenting Mobile App (The Baby Buddy App): Qualitative Study Using Appreciative Inquiry %A Bailey,Elizabeth %A Nightingale,Samantha %A Thomas,Nicky %A Coleby,Dawn %A Deave,Toity %A Goodenough,Trudy %A Ginja,Samuel %A Lingam,Raghu %A Kendall,Sally %A Day,Crispin %A Coad,Jane %+ School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Queens Medical Centre, Derby Rd, Lenton, Nottingham, NG7 2UH, United Kingdom, 44 07717416441, jane.coad@nottingham.ac.uk %K pregnancy %K antenatal support %K antenatal education %K communication %K digital %K pregnancy apps %K mobile phone %D 2022 %7 21.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Internationally, there is increasing emphasis on early support for pregnant women to optimize the health and development of mothers and newborns. To increase intervention reach, digital and app-based interventions have been advocated. There are growing numbers of pregnancy health care apps with great variation in style, function, and objectives, but evidence about impact on pregnancy well-being and behavior change following app interaction is lacking. This paper reports on the qualitative arm of the independent multicomponent study exploring the use and outcomes of first-time mothers using the Baby Buddy app, a pregnancy and parenting support app, available in the National Health Service App Library and developed by a UK child health and well-being charity, Best Beginnings. Objective: This study aims to understand when, why, and how first-time mothers use the Baby Buddy app and the perceived benefits and challenges. Methods: This paper reports on the qualitative arm of an independent, longitudinal, mixed methods study. An Appreciative Inquiry qualitative approach was used with semistructured interviews (17/60, 28%) conducted with new mothers, either by telephone or in a focus group setting. First-time mothers were recruited from 3 study sites from across the United Kingdom. Consistent with the Appreciative Inquiry approach, mothers were prompted to discuss what worked well and what could have been better regarding their interactions with the app during pregnancy. Thematic analysis was used, and findings are presented as themes with perceived benefits and challenges. Results: The main benefit, or what worked well, for first-time mothers when using the app was being able to access new information, which they felt was reliable and easy to find. This led to a feeling of increased confidence in the information they accessed, thus supporting family and professional communication. The main challenge was the preference for face-to-face information with a health care professional, particularly around specific issues that they wished to discuss in depth. What could have been improved included that there were some topics that some mothers would have preferred in more detail, but in other areas, they felt well-informed and thus did not feel a need to seek additional information via an app. Conclusions: Although this study included a small sample, it elicited rich data and insights into first-time mothers’ app interactions. The findings suggest that easily accessible pregnancy information, which is perceived as reliable, can support first-time mothers in communicating with health care professionals. Face-to-face contact with professionals was preferred, particularly to discuss specific and personalized needs. Further studies on maternal and professional digital support preferences after the COVID-19 global pandemic and how they facilitate antenatal education and informed decision-making are recommended, particularly because digital solutions remain as a key element in pregnancy and early parenting care. International Registered Report Identifier (IRRID): RR2-10.1017/S1463423618000294 %M 36409530 %R 10.2196/32757 %U https://mhealth.jmir.org/2022/11/e32757 %U https://doi.org/10.2196/32757 %U http://www.ncbi.nlm.nih.gov/pubmed/36409530 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41455 %T Examining the Use of Mobile Technology to Deliver Tailored Sexual Assault Prevention in a Classroom Environment in the Military: Development and Usability Study %A Eckhoff,Randall %A Boyce,Matthew %A Watkins,Rebecca Lee %A Kan,Marni %A Scaglione,Nichole %A Pound,Leah %A Root,Meghan %+ RTI International, 3040 East Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC, 27709, United States, 1 919 961 0990, reckhoff@rti.org %K research techniques %K mobile technology %K tablet %K iPad %K restricted %K resource limited %K Wi-Fi %K tailored learning %K military %K data security %D 2022 %7 16.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in mobile technology over the last 10 years have expanded its use in scientific research. However, there are challenges in creating a reliable system for intervention content delivery and data collection in an environment with limited internet connectivity and limited staffing capacity. The Sexual Communication and Consent (SCC) study used tablets to provide individualized Sexual Assault Prevention and Response training in a classroom environment that was both technologically and support staff limited. Objective: We developed the SCC Basic Military Training app and a separate Sexual Assault Response Coordinator app to support individualized training within the new SCC program. This paper presents the functionality, protocols, challenges, and feasibility of deploying mobile technology in an educational environment in the military with limited resources. Methods: We developed both mobile apps targeting the Apple iOS ecosystem. The Basic Military Training app provided a screening instrument that routed the trainee into 1 of 5 specific intervention programs. Over 2 days of basic military training set 2 weeks apart, trainees received a combined 6 hours of program-specific tablet training, combined with universal, interactive classroom training, led by qualified instructors. The Sexual Assault Response Coordinator app, used to deliver supplemental content to a subgroup of trainees, was made available for voluntary and private use at the Sexual Assault Response Coordinator’s office on base. All anonymous data were manually transferred onto laptops, where the data were aggregated into files and securely transferred to the project staff for analysis. The study was conducted at the Lackland Air Force Base, Joint Base San Antonio, with 9196 trainees providing the data. Results: A total of 7742 trainees completed both the sessions of the SCC program and a series of evaluative assessments. Some trainees did not receive day 2 training, and only received day 1 training because the COVID-19 pandemic shortened the study period. Of the 190 SCC classes taught, only one class was unable to complete tablet training because of Apple licensing–related technology failure. The 360 study tablets were distributed across 3 classrooms (120 per classroom) and were handled at least 16,938 times with no reports of breakage or requiring replacement. Wi-Fi access limitations exacerbated the complexity of Apple licensing revalidation and the secure transfer of data from the classroom to project personnel. The instructor staff’s limited technical knowledge to perform certain technical tasks was challenging. Conclusions: The results demonstrated the feasibility of deploying a mobile app for tablet-based training in a military educational environment. Although successful, the study was not without technical challenges. This paper gives examples of technical lessons learned and recommendations for conducting the study differently, with the aim that the knowledge gained may be helpful to other researchers encountering similar requirements. %M 36383404 %R 10.2196/41455 %U https://mhealth.jmir.org/2022/11/e41455 %U https://doi.org/10.2196/41455 %U http://www.ncbi.nlm.nih.gov/pubmed/36383404 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e38886 %T A New Approach to Enhancing Engagement in eHealth Apps %A Oakley-Girvan,Ingrid %A Docherty,John P %+ Research, Value and Strategy, Medable Inc, 525 University Ave, Suite A70, Palo Alto, CA, 94301, United States, 1 877 820 6259, Ingrid@medable.com %K user engagement %K eHealth %K attrition %K adherence %K apps %K app design %K user experience %D 2022 %7 9.11.2022 %9 Viewpoint %J Interact J Med Res %G English %X This viewpoint presents a 3-phase conceptual model of the process of user engagement with eHealth apps. We also describe how knowledge gleaned from psychosocial, behavioral, and cognitive science can be incorporated into this model to enhance user engagement with an eHealth app in each phase of the engagement process. %M 36279587 %R 10.2196/38886 %U https://www.i-jmr.org/2022/2/e38886 %U https://doi.org/10.2196/38886 %U http://www.ncbi.nlm.nih.gov/pubmed/36279587 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e33638 %T The Receptivity to Safety-Related Mobile Apps Among Commercial Fishing Captains: Descriptive Exploratory Study %A Bulzacchelli,Maria T %A Bellantoni,Jenna M %A McCue,Leigh %A Dzugan,Jerry %+ Krieger School of Arts and Sciences, Johns Hopkins University, 3505 North Charles Street, Room 202, Baltimore, MD, 21218, United States, 1 410 516 8340, mbulzac1@jhu.edu %K mobile app %K mobile device %K mobile phone %K smartphone %K safety %K workplace safety %K occupational safety %K mobile health %K mHealth %K commercial fishing %K cross-sectional study %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps addressing a variety of workplace safety issues have proliferated over the last decade as mobile technology has advanced and smartphone ownership has increased. Workplace safety interventions are often designed for a specific work site. However, some of the most dangerous jobs are ones in which workers frequently change field locations, such as commercial fishing. Mobile apps may be particularly suitable for delivering safety interventions to these workers. Objective: We sought to gauge the potential for using mobile apps to deliver safety interventions to commercial fishing workers. The purpose of this paper is to describe how fishermen use their mobile devices during fishing operations and identify any mobile apps they already use for safety. Methods: Participants comprised commercial fishing captains who already owned an iOS or Android smartphone or tablet. They completed a questionnaire that asked about their current mobile device use and their use of safety-related mobile apps, in addition to questions about their fishing operations. We performed descriptive analyses of the data. Results: A total of 61 participants completed the questionnaire. The most common types of mobile devices participants reported owning were iPhones (n=36, 59%) and Android phones (n=24, 39%). Most participants (n=53, 87%) reported using their mobile device for both work and personal purposes, including while out at sea (n=52, 85%). Over half of the participants reported that they had either safety-related apps (n=17, 28%) or apps that help them with their work (n=35, 57%). The types of apps most frequently mentioned were apps for weather, wind, tides, and navigation. Conclusions: The results of this study indicate that some commercial fishing captains who own a mobile device are receptive to using safety-related apps for work. Apps that help avoid hazards by monitoring environmental conditions and apps optimized for use on smartphones may be most likely to be adopted and used. Overall, these results suggest that mobile apps are a promising avenue for improving safety among workers in commercial fishing and similar occupations. %M 36346649 %R 10.2196/33638 %U https://formative.jmir.org/2022/11/e33638 %U https://doi.org/10.2196/33638 %U http://www.ncbi.nlm.nih.gov/pubmed/36346649 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e38951 %T The Effects of an Exposure-Based Mobile App on Symptoms of Posttraumatic Stress Disorder in Veterans: Pilot Randomized Controlled Trial %A McLean,Carmen %A Davis,C Adrian %A Miller,Madeleine %A Ruzek,Josef %A Neri,Eric %+ National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 6504935000, carmen.mclean4@va.gov %K posttraumatic stress disorder %K veteran’s health %K exposure therapy %K cognitive behavioral therapy %K mHealth %K mobile apps %K self-management %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Barriers to accessing in-person care can prevent veterans with posttraumatic stress disorder (PTSD) from receiving trauma-focused treatments such as exposure therapy. Mobile apps may help to address unmet need for services by offering tools for users to self-manage PTSD symptoms. Renew is a mobile mental health app that focuses on exposure therapy and incorporates a social support function designed to promote user engagement. Objective: We examined the preliminary efficacy of Renew with and without support from a research staff member compared with waitlist among 93 veterans with clinically significant PTSD symptoms. We also examined the impact of study staff support on participant engagement with the app. Methods: In a pilot randomized controlled trial, we compared Renew with and without support from a research staff member (active use condition) with waitlist (delayed use condition) over 6 weeks. Participants were recruited through online advertisements. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) was used to measure PTSD symptoms at pre, post, and 6-week follow-up. Usage data were collected to assess engagement with Renew. Results: Results indicated a small effect size (d=–0.39) favoring those in the active use conditions relative to the delayed use condition, but the between-group difference was not significant (P=.29). There were no differences on indices of app engagement between the 2 active use conditions. Exploratory analyses found that the number of support persons users added to the app, but not the number of support messages received, was positively correlated with app engagement. Conclusions: Findings suggest Renew may hold promise as a self-management tool to reduce PTSD symptoms in veterans. Involving friends and family in mobile mental health apps may help bolster engagement with no additional cost to public health systems. Trial Registration: ClinicalTrials.gov NCT04155736; https://clinicaltrials.gov/ct2/show/NCT04155736 %M 36331540 %R 10.2196/38951 %U https://mhealth.jmir.org/2022/11/e38951 %U https://doi.org/10.2196/38951 %U http://www.ncbi.nlm.nih.gov/pubmed/36331540 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 11 %P e41482 %T Development of the First Episode Digital Monitoring mHealth Intervention for People With Early Psychosis: Qualitative Interview Study With Clinicians %A Stefancic,Ana %A Rogers,R Tyler %A Styke,Sarah %A Xu,Xiaoyan %A Buchsbaum,Richard %A Nossel,Ilana %A Cabassa,Leopoldo J %A Stroup,T Scott %A Kimhy,David %+ Department of Psychiatry, Icahn School of Medicine, One Gustave L Levy Place, Box 1230, New York, NY, 10029, United States, 1 212 659 8752, david.kimhy@mssm.edu %K first-episode psychosis %K early psychosis %K coordinated specialty care %K mental health treatment %K shared decision-making %K mobile health %K smartphone apps %K qualitative %K digital psychiatry %K mobile phone %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into real-world clinical care has been limited despite the broad availability of smartphone-based apps targeting mental health care. Most apps developed for treatment of individuals with psychosis have focused primarily on encouraging self-management skills of patients via practicing cognitive behavioral techniques learned during face-to-face clinical sessions (eg, challenging dysfunctional thoughts and relaxation exercises), reminders to engage in health-promoting activities (eg, exercising, sleeping, and socializing), or symptom monitoring. In contrast, few apps have sought to enhance the clinical encounter itself to improve shared decision-making (SDM) and therapeutic relationships with clinicians, which have been linked to positive clinical outcomes. Objective: This qualitative study sought clinicians’ input to develop First Episode Digital Monitoring (FREEDoM), an app-based mHealth intervention. FREEDoM was designed to improve the quality, quantity, and timeliness of clinical and functional data available to clinicians treating patients experiencing first-episode psychosis (FEP) to enhance their therapeutic relationship and increase SDM. Methods: Following the app’s initial development, semistructured qualitative interviews were conducted with 11 FEP treatment providers at 3 coordinated specialty care clinics to elicit input on the app’s design, the data report for clinicians, and planned usage procedures. We then generated a summary template and conducted matrix analysis to systematically categorize suggested adaptations to the evidence-based intervention using dimensions of the Framework for Reporting Adaptations and Modifications‐Enhanced (FRAME) and documented the rationale for adopting or rejecting suggestions. Results: The clinicians provided 31 suggestions (18 adopted and 13 rejected). Suggestions to add or refine the content were most common (eg, adding questions in the app). Adaptations to context were most often related to plans for implementing the intervention, how the reported data were displayed to clinicians, and with whom the reports were shared. Reasons for suggestions primarily included factors related to health narratives and priorities of the patients (eg, focus on the functional impact of symptoms vs their severity), providers’ clinical judgment (eg, need for clinically relevant information), and organizations’ mission and culture. Reasons for rejecting suggestions included requests for data and procedures beyond the intervention’s scope, concerns regarding dilution of the intervention’s core components, and concerns about increasing patient burden while using the app. Conclusions: FREEDoM focuses on a novel target for the deployment of mHealth technologies in the treatment of FEP patients—the enhancement of SDM and improvement of therapeutic relationships. This study illustrates the use of the FRAME, along with methods and tools for rapid qualitative analysis, to systematically track adaptations to the app as part of its development process. Such adaptations may contribute to enhanced acceptance of the intervention by clinicians and a higher likelihood of integration into clinical care. Trial Registration: ClinicalTrials.gov NCT04248517; https://tinyurl.com/tjuyxvv6 %M 36331539 %R 10.2196/41482 %U https://mental.jmir.org/2022/11/e41482 %U https://doi.org/10.2196/41482 %U http://www.ncbi.nlm.nih.gov/pubmed/36331539 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e38048 %T The Virtual Inclusive Digital Health Intervention Design to Promote Health Equity (iDesign) Framework for Atrial Fibrillation: Co-design and Development Study %A Isakadze,Nino %A Molello,Nancy %A MacFarlane,Zane %A Gao,Yumin %A Spaulding,Erin M %A Commodore Mensah,Yvonne %A Marvel,Francoise A %A Khoury,Shireen %A Marine,Joseph E %A Michos,Erin D %A Spragg,David %A Berger,Ronald D %A Calkins,Hugh %A Cooper,Lisa A %A Martin,Seth S %+ Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe St/Halsted 500, Baltimore, MD, 21287, United States, 1 410 955 5999, nisakad1@jh.edu %K atrial fibrillation %K digital health intervention %K human-centered design %K health equity %K smartphone %K mobile application %K cardiac %K cardiology %K virtual meeting %K virtual health %K medication adherence %K health equity %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Smartphone ownership and mobile app use are steadily increasing in individuals of diverse racial and ethnic backgrounds living in the United States. Growing adoption of technology creates a perfect opportunity for digital health interventions to increase access to health care. To successfully implement digital health interventions and engage users, intervention development should be guided by user input, which is best achieved by the process of co-design. Digital health interventions co-designed with the active engagement of users have the potential to increase the uptake of guideline recommendations, which can reduce morbidity and mortality and advance health equity. Objective: We aimed to co-design a digital health intervention for patients with atrial fibrillation, the most common cardiac arrhythmia, with patient, caregiver, and clinician feedback and to describe our approach to human-centered design for building digital health interventions. Methods: We conducted virtual meetings with patients with atrial fibrillation (n=8), their caregivers, and clinicians (n=8). We used the following 7 steps in our co-design process: step 1, a virtual meeting focused on defining challenges and empathizing with problems that are faced in daily life by individuals with atrial fibrillation and clinicians; step 2, a virtual meeting focused on ideation and brainstorming the top challenges identified during the first meeting; step 3, individualized onboarding of patients with an existing minimally viable version of the atrial fibrillation app; step 4, virtual prototyping of the top 3 ideas generated during ideation; step 5, further ranking by the study investigators and engineers of the ideas that were generated during ideation but were not chosen as top-3 solutions to be prototyped in step 4; step 6, ongoing engineering work to incorporate top-priority features in the app; and step 7, obtaining further feedback from patients and testing the atrial fibrillation digital health intervention in a pilot clinical study. Results: The top challenges identified by patients and caregivers included addressing risk factor modification, medication adherence, and guidance during atrial fibrillation episodes. Challenges identified by clinicians were complementary and included patient education, addressing modifiable atrial fibrillation risk factors, and remote atrial fibrillation episode management. Patients brainstormed more than 30 ideas to address the top challenges, and the clinicians generated more than 20 ideas. Ranking of the ideas informed several novel or modified features aligned with the Theory of Health Behavior Change, features that were geared toward risk factor modification; patient education; rhythm, symptom, and trigger correlation for remote atrial fibrillation management; and social support. Conclusions: We co-designed an atrial fibrillation digital health intervention in partnership with patients, caregivers, and clinicians by virtually engaging in collaborative creation through the design process. We summarize our experience and describe a flexible approach to human-centered design for digital health intervention development that can guide innovative clinical investigators. %M 36315217 %R 10.2196/38048 %U https://humanfactors.jmir.org/2022/4/e38048 %U https://doi.org/10.2196/38048 %U http://www.ncbi.nlm.nih.gov/pubmed/36315217 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e38387 %T Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches %A Jarman,Hannah K %A McLean,Siân A %A Rodgers,Rachel %A Fuller-Tyszkiewicz,Matthew %A Paxton,Susan %A O'Gorman,Beth %A Harris,Emily %A Shatte,Adrian %A Bishop,Katie %A Baumann,Tahlia %A Mahoney,Danielle %A Daugelat,Melissa-Claire %A Yager,Zali %+ School of Psychology, Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 3 9251 7777, h.jarman@deakin.edu.au %K eating disorders %K app-based intervention %K lived experience %K design thinking %K interviews %K young women %K co-design %K mobile health %K mHealth %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. Objective: To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. Methods: In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user’s personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. Results: Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. Conclusions: Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population. %M 36315225 %R 10.2196/38387 %U https://formative.jmir.org/2022/10/e38387 %U https://doi.org/10.2196/38387 %U http://www.ncbi.nlm.nih.gov/pubmed/36315225 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e39189 %T Lessons and Reflections From an Extended Co-design Process Developing an mHealth App With and for Older Adults: Multiphase, Mixed Methods Study %A Tong,Catherine %A Kernoghan,Alison %A Lemmon,Kassandra %A Fernandes,Paige %A Elliott,Jacobi %A Sacco,Veronica %A Bodemer,Sheila %A Stolee,Paul %+ School of Public Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567, catherine.tong@uwaterloo.ca %K mobile health %K mHealth %K older adults %K health care providers %K co-design %K user experience or UX design %K qualitative %K apps %K elderly %K health care %K care provider %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Aging %G English %X Background: There are many mobile health (mHealth) apps for older adult patients, but research has found that broadly speaking, mHealth still fails to meet the specific needs of older adult users. Others have highlighted the need to embed users in the mHealth design process in a fulsome and meaningful way. Co-design has been widely used in the development of mHealth apps and involves stakeholders in each phase of the design and development process. The involvement of older adults in the co-design processes is variable. To date, co-design approaches have tended toward embedding the stakeholders in early phases (eg, predesign and generative) but not throughout. Objective: The aim of this study was to reflect on the processes and lessons learned from engaging in an extended co-design process to develop an mHealth app for older adults, with older users contributing at each phase. This study aimed to design an mHealth tool to assist older adults in coordinating their care with health care professionals and caregivers. Methods: Our work to conceptualize, develop, and test the mHealth app consisted of 4 phases: phase 1, consulting stakeholders; phase 2, app development and co-designing with older adults; phase 3, field-testing with a smaller sample of older adult volunteer testers; and phase 4, reflecting, internally, on lessons learned from this process. In each phase, we drew on qualitative methods, including in-depth interviews and focus groups, all of which were analyzed in NVivo 11, using team-based thematic analysis. Results: In phase 1, we identified key features that older adults and primary care providers wanted in an app, and each user group identified different priority features (older adults principally sought support to use the mHealth app, whereas primary care providers prioritized recoding illnesses, immunizations, and appointments). Phases 2 and 3 revealed significant mismatches between what the older adult users wanted and what our developers were able and willing to deliver. We were unable to craft the app that our consultations recommended, which the older adult field testers asked for. In phase 4, we reflected on our abilities to embed the voices and perspectives of older adults throughout the project when working with a developer not familiar with or committed to the core principles of co-design. We draw on this challenging experience to highlight several recommendations for those embarking on a co-design process that includes developers and IT vendors, researchers, and older adult users. Conclusions: Although our final mHealth app did not reflect all the needs and wishes of our older adult testers, our consultation process identified key features and contextual information essential for those developing apps to support older adults in managing their health and health care. %M 36306166 %R 10.2196/39189 %U https://aging.jmir.org/2022/4/e39189 %U https://doi.org/10.2196/39189 %U http://www.ncbi.nlm.nih.gov/pubmed/36306166 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36049 %T Telehealth Movement-to-Music to Increase Physical Activity Participation Among Adolescents With Cerebral Palsy: Pilot Randomized Controlled Trial %A Lai,Byron %A Vogtle,Laura %A Young,Raven %A Craig,Mary %A Kim,Yumi %A Gowey,Marissa %A Swanson-Kimani,Erin %A Davis,Drew %A Rimmer,James H %+ Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, 5 Dearth, McWane 5601, Birmingham, AL, 35209, United States, 1 205 638 9790 ext 8, blai@uabmc.edu %K exercise %K developmental disability %K cerebral palsy %K telemedicine %K telerehabilitation %K therapy %K mobile phone %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents with cerebral palsy (CP) who have mobility limitations have almost no access to inexpensive and enjoyable home-based programs that can be disseminated on a large scale to help them independently manage their health through participation in leisure-time physical activity (LTPA). Objective: The primary aim of this study was to determine the preliminary efficacy of the early adoption phase of an adult Movement-to-Music (M2M) program with behavioral telecoaching for increasing LTPA and activity participation compared with a waitlist control group in adolescents with CP. The secondary aim was to explore the effects of the program on perceived levels of pain and fatigue. The tertiary aim was to qualitatively evaluate the factors that influenced adherence and develop a theory that would inform the development of a more targeted M2M telehealth program for this group. Methods: This randomized controlled trial piloted a 4-week M2M program with weekly behavioral telecoaching among 58 adolescents with CP who walked or used wheelchairs. The participants were randomized into one of 2 groups: M2M or control, which maintained their daily activities. M2M included videos that participants were asked to complete 3 times each week at home (asynchronous training). Adherence to video minutes was objectively measured using cloud-based analytics. Changes in activity and LTPA participation were measured before and after the intervention using the Children’s Assessment of Participation and Enjoyment total domain scores and active physical recreation domain scores, respectively. Perceived pain and fatigue were measured using the National Institutes of Health Neuro-QoL short forms. The changes in scores were compared between the groups using analysis of covariance. A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. Results: A total of 58 people were enrolled, of which 49 (84%) completed the primary outcome follow-up assessment. The mean adherence to the prescribed exercise video minutes across all 4 weeks was 68%, starting from 90% in week 1 and gradually declining to 43% in week 4. Mean adherence to coaching calls was 91%. Analysis of covariance revealed a statistically significant difference between the pre- to postchange scores for Children’s Assessment of Participation and Enjoyment Active Physical Recreation–Intensity domain scores in favor of the intervention group (F1,47=8.76; P=.005; effect size=0.17, also known as volume of LTPA). The qualitative findings highlighted 5 critical factors that influenced participants’ adherence to the program: caregiver support, video elements, suitable exercises, music, and behavioral coaching. Conclusions: This project determined that adolescents with CP responded well to an M2M telehealth program that could enhance their LTPA levels. This paper describes a theory in which adherence to a telehealth LTPA program can be optimized through functional and age-specific modifications for adolescents with CP. Trial Registration: ClinicalTrials.gov NCT04264390; https://clinicaltrials.gov/ct2/show/NCT04264390 %M 36306154 %R 10.2196/36049 %U https://formative.jmir.org/2022/10/e36049 %U https://doi.org/10.2196/36049 %U http://www.ncbi.nlm.nih.gov/pubmed/36306154 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 7 %N 2 %P e40066 %T Accuracy of Fully Automated 3D Imaging System for Child Anthropometry in a Low-Resource Setting: Effectiveness Evaluation in Malakal, South Sudan %A Leidman,Eva %A Jatoi,Muhammad Ali %A Bollemeijer,Iris %A Majer,Jennifer %A Doocy,Shannon %+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States, 1 4049085125, eleidman@jhu.edu %K mobile health %K mHealth %K child nutrition %K anthropometry %K 3D imaging %K imaging %K accuracy %K measurement %K child stature %K software %K algorithm %K automated %K device %K child health %K pediatric health %K height %K length %K arm circumference %D 2022 %7 21.10.2022 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Adoption of 3D imaging systems in humanitarian settings requires accuracy comparable with manual measurement notwithstanding additional constraints associated with austere settings. Objective: This study aimed to evaluate the accuracy of child stature and mid–upper arm circumference (MUAC) measurements produced by the AutoAnthro 3D imaging system (third generation) developed by Body Surface Translations Inc. Methods: A study of device accuracy was embedded within a 2-stage cluster survey at the Malakal Protection of Civilians site in South Sudan conducted between September 2021 and October 2021. All children aged 6 to 59 months within selected households were eligible. For each child, manual measurements were obtained by 2 anthropometrists following the protocol used in the 2006 World Health Organization Child Growth Standards study. Scans were then captured by a different enumerator using a Samsung Galaxy 8 phone loaded with a custom software, AutoAnthro, and an Intel RealSense 3D scanner. The scans were processed using a fully automated algorithm. A multivariate logistic regression model was fit to evaluate the adjusted odds of achieving a successful scan. The accuracy of the measurements was visually assessed using Bland-Altman plots and quantified using average bias, limits of agreement (LoAs), and the 95% precision interval for individual differences. Key informant interviews were conducted remotely with survey enumerators and Body Surface Translations Inc developers to understand challenges in beta testing, training, data acquisition and transmission. Results: Manual measurements were obtained for 539 eligible children, and scan-derived measurements were successfully processed for 234 (43.4%) of them. Caregivers of at least 10.4% (56/539) of the children refused consent for scan capture; additional scans were unsuccessfully transmitted to the server. Neither the demographic characteristics of the children (age and sex), stature, nor MUAC were associated with availability of scan-derived measurements; team was significantly associated (P<.001). The average bias of scan-derived measurements in cm was −0.5 (95% CI −2.0 to 1.0) for stature and 0.7 (95% CI 0.4-1.0) for MUAC. For stature, the 95% LoA was −23.9 cm to 22.9 cm. For MUAC, the 95% LoA was −4.0 cm to 5.4 cm. All accuracy metrics varied considerably by team. The COVID-19 pandemic–related physical distancing and travel policies limited testing to validate the device algorithm and prevented developers from conducting in-person training and field oversight, negatively affecting the quality of scan capture, processing, and transmission. Conclusions: Scan-derived measurements were not sufficiently accurate for the widespread adoption of the current technology. Although the software shows promise, further investments in the software algorithms are needed to address issues with scan transmission and extreme field contexts as well as to enable improved field supervision. Differences in accuracy by team provide evidence that investment in training may also improve performance. %M 38875695 %R 10.2196/40066 %U https://biomedeng.jmir.org/2022/2/e40066 %U https://doi.org/10.2196/40066 %U http://www.ncbi.nlm.nih.gov/pubmed/38875695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40452 %T The Family Level Assessment of Screen Use–Mobile Approach: Development of an Approach to Measure Children’s Mobile Device Use %A Perez,Oriana %A Kumar Vadathya,Anil %A Beltran,Alicia %A Barnett,R Matthew %A Hindera,Olivia %A Garza,Tatyana %A Musaad,Salma M %A Baranowski,Tom %A Hughes,Sheryl O %A Mendoza,Jason A %A Sabharwal,Ashutosh %A Veeraraghavan,Ashok %A O'Connor,Teresia M %+ United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates St, Houston, TX, 77030, United States, 1 713 798 6782, teresiao@bcm.edu %K screen time %K mobile media apps %K children %K mobile phone use %K tablet use %K mobile phone %D 2022 %7 21.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a strong association between increased mobile device use and worse dietary habits, worse sleep outcomes, and poor academic performance in children. Self-report or parent-proxy report of children’s screen time has been the most common method of measuring screen time, which may be imprecise or biased. Objective: The objective of this study was to assess the feasibility of measuring the screen time of children on mobile devices using the Family Level Assessment of Screen Use (FLASH)–mobile approach, an innovative method that leverages the existing features of the Android platform. Methods: This pilot study consisted of 2 laboratory-based observational feasibility studies and 2 home-based feasibility studies in the United States. A total of 48 parent-child dyads consisting of a parent and child aged 6 to 11 years participated in the pilot study. The children had to have their own or shared Android device. The laboratory-based studies included a standardized series of tasks while using the mobile device or watching television, which were video recorded. Video recordings were coded by staff for a gold standard comparison. The home-based studies instructed the parent-child dyads to use their mobile device as they typically use it over 3 days. Parents received a copy of the use logs at the end of the study and completed an exit interview in which they were asked to review their logs and share their perceptions and suggestions for the improvement of the FLASH-mobile approach. Results: The final version of the FLASH-mobile approach resulted in user identification compliance rates of >90% for smartphones and >80% for tablets. For laboratory-based studies, a mean agreement of 73.6% (SD 16.15%) was achieved compared with the gold standard (human coding of video recordings) in capturing the target child’s mobile use. Qualitative feedback from parents and children revealed that parents found the FLASH-mobile approach useful for tracking how much time their child spends using the mobile device as well as tracking the apps they used. Some parents revealed concerns over privacy and provided suggestions for improving the FLASH-mobile approach. Conclusions: The FLASH-mobile approach offers an important new research approach to measure children’s use of mobile devices more accurately across several days, even when the child shares the device with other family members. With additional enhancement and validation studies, this approach can significantly advance the measurement of mobile device use among young children. %M 36269651 %R 10.2196/40452 %U https://formative.jmir.org/2022/10/e40452 %U https://doi.org/10.2196/40452 %U http://www.ncbi.nlm.nih.gov/pubmed/36269651 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35926 %T A Smartphone Physical Activity App for Patients in Alcohol Treatment: Single-Arm Feasibility Trial %A Abrantes,Ana M %A Meshesha,Lidia Z %A E Blevins,Claire %A Battle,Cynthia L %A Lindsay,Clifford %A Marsh,Eliza %A Feltus,Sage %A Buman,Matthew %A Agu,Emmanuel %A Stein,Michael %+ Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, United States, 1 4014556440, Ana_Abrantes@Brown.edu %K alcohol use disorder %K AUD %K physical activity %K smartphone app %K Fitbit %K feasibility study %K mobile phone %D 2022 %7 19.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD) is a significant public health concern worldwide. Alcohol consumption is a leading cause of death in the United States and has a significant negative impact on individuals and society. Relapse following treatment is common, and adjunct intervention approaches to improve alcohol outcomes during early recovery continue to be critical. Interventions focused on increasing physical activity (PA) may improve AUD treatment outcomes. Given the ubiquity of smartphones and activity trackers, integrating this technology into a mobile app may be a feasible, acceptable, and scalable approach for increasing PA in individuals with AUD. Objective: This study aims to test the Fit&Sober app developed for patients with AUD. The goals of the app were to facilitate self-monitoring of PA engagement and daily mood and alcohol cravings, increase awareness of immediate benefits of PA on mood and cravings, encourage setting and adjusting PA goals, provide resources and increase knowledge for increasing PA, and serve as a resource for alcohol relapse prevention strategies. Methods: To preliminarily test the Fit&Sober app, we conducted an open pilot trial of patients with AUD in early recovery (N=22; 13/22, 59% women; mean age 43.6, SD 11.6 years). At the time of hospital admission, participants drank 72% of the days in the last 3 months, averaging 9 drinks per drinking day. The extent to which the Fit&Sober app was feasible and acceptable among patients with AUD during early recovery was examined. Changes in alcohol consumption, PA, anxiety, depression, alcohol craving, and quality of life were also examined after 12 weeks of app use. Results: Participants reported high levels of satisfaction with the Fit&Sober app. App metadata suggested that participants were still using the app approximately 2.5 days per week by the end of the intervention. Pre-post analyses revealed small-to-moderate effects on increase in PA, from a mean of 5784 (SD 2511) steps per day at baseline to 7236 (SD 3130) steps per day at 12 weeks (Cohen d=0.35). Moderate-to-large effects were observed for increases in percentage of abstinent days (Cohen d=2.17) and quality of life (Cohen d=0.58) as well as decreases in anxiety (Cohen d=−0.71) and depression symptoms (Cohen d=−0.58). Conclusions: The Fit&Sober app is an acceptable and feasible approach for increasing PA in patients with AUD during early recovery. A future randomized controlled trial is necessary to determine the efficacy of the Fit&Sober app for long-term maintenance of PA, ancillary mental health, and alcohol outcomes. If the efficacy of the Fit&Sober app could be established, patients with AUD would have a valuable adjunct to traditional alcohol treatment that can be delivered in any setting and at any time, thereby improving the overall health and well-being of this population. Trial Registration: ClinicalTrials.gov NCT02958280; https://www.clinicaltrials.gov/ct2/show/NCT02958280 %M 36260381 %R 10.2196/35926 %U https://formative.jmir.org/2022/10/e35926 %U https://doi.org/10.2196/35926 %U http://www.ncbi.nlm.nih.gov/pubmed/36260381 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e39301 %T Older Wheelchair Users Recommend Age-Friendly Design Improvements to a Wheelchair Maintenance App: Mixed Methods Development Study %A Boccardi,Alyssa %A Wu,Fangzheng %A Pearlman,Jon %A Mhatre,Anand %+ Occupational Therapy Division, Ohio State University Wexner Medical Center, 453 W 10th Ave, Columbus, OH, 43210, United States, 1 (614) 688 2081, anand.mhatre@osumc.edu %K aging %K older adults %K maintenance %K mobile phone %K repair %K smartphone %K wheelchair %D 2022 %7 18.10.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Wheelchair part failures have doubled over the past decade. Preventative wheelchair maintenance reduces wheelchair failures and prevents user consequences. We are developing a smartphone app called WheelTrak, which alerts users when maintenance is required, to encourage maintenance practices and compliance. Objective: This mixed methods study aimed to develop a wheelchair maintenance app using broad stakeholder advice and investigate older adults’ interaction experience with the app and their perceived barriers to and facilitators of maintenance. Methods: Interviews were conducted with stakeholders, including mobility device users, to generate needs statements and app specifications. The app was designed in 2 stages. Stage 1 involved the development of the app according to the specifications and evaluation of the app interface by lead users. Stage 2 included the revision of the app screens and manual functionality testing. Usability testing and semistructured interviews were conducted with older wheelchair and scooter users. The System Usability Scale was used to measure app usability. Results: Interviews with power and manual wheelchair users (37/57, 65%), wheelchair service providers (15/57, 26%), manufacturers (2/57, 4%), seating and mobility researchers (1/57, 2%), and insurance plan providers (2/57, 4%) informed the needs and specifications of the app technology. The 2-stage development process delivered a fully functional app that met the design specifications. In total, 12 older adults (mean age 74.2, SD 9.1 years; n=10, 83% women; and n=2, 17% men) participated in the usability testing study. Of the 12 participants, 9 (75%) agreed to use WheelTrak for preventative maintenance. WheelTrak scored an average System Usability Scale score of 60.25 (SD 16). Four overarching themes were identified: WheelTrak app improvements, barriers to maintenance, consequences related to mobility device failure, and smart technology use and acceptance. Older adults preferred the simplicity, readability, personalization, and availability of educational resources in the app. Barriers to maintenance pertained to health issues and lack of maintenance knowledge among older adults. Facilitators of maintenance included notification for maintenance, app connectivity with the service provider, reporting of device failure, and the presence of a caregiver for maintenance. Conclusions: This study highlighted age-friendly design improvements to the app, making it easy to be used and adopted by older wheelchair users. The WheelTrak app has close to average system usability. Additional usability testing will be conducted following app revision in the future. %M 36256830 %R 10.2196/39301 %U https://aging.jmir.org/2022/4/e39301 %U https://doi.org/10.2196/39301 %U http://www.ncbi.nlm.nih.gov/pubmed/36256830 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e37772 %T Mobile App Prototype in Older Adults for Postfracture Acute Pain Management: User-Centered Design Approach %A Tran-Nguyen,Kevin %A Berger,Caroline %A Bennett,Roxanne %A Wall,Michelle %A Morin,Suzanne N %A Rajabiyazdi,Fateme %+ Department of Systems and Computer Engineering, Carleton University, 1125 Colonel By Dr, Ottawa, ON, Canada, 1 (613) 520 2600 ext 8229, fateme.rajabiyazdi@carleton.ca %K older adults %K mobile app %K skeletal fracture %K usability %K patient-centered %K human-centered design %K digital health %K eHealth %K mobile health %K mHealth %K acute pain self-management %K mobile phone %D 2022 %7 17.10.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Postfracture acute pain is often inadequately managed in older adults. Mobile health (mHealth) technologies can offer opportunities for self-management of pain; however, insufficient apps exist for acute pain management after a fracture, and none are designed for an older adult population. Objective: This study aims to design, develop, and evaluate an mHealth app prototype using a human-centered design approach to support older adults in the self-management of postfracture acute pain. Methods: This study used a multidisciplinary and user-centered design approach. Overall, 7 stakeholders (ie, 1 clinician-researcher specialized in internal medicine, 2 user experience designers, 1 computer science researcher, 1 clinical research assistant researcher, and 2 pharmacists) from the project team, together with 355 external stakeholders, were involved throughout our user-centered development process that included surveys, requirement elicitation, participatory design workshops, mobile app design and development, mobile app content development, and usability testing. We completed this study in 3 phases. We analyzed data from prior surveys administered to 305 members of the Canadian Osteoporosis Patient Network and 34 health care professionals to identify requirements for designing a low-fidelity prototype. Next, we facilitated 4 participatory design workshops with 6 participants for feedback on content, presentation, and interaction with our proposed low-fidelity prototype. After analyzing the collected data using thematic analysis, we designed a medium-fidelity prototype. Finally, to evaluate our medium-fidelity prototype, we conducted usability tests with 10 participants. The results informed the design of our high-fidelity prototype. Throughout all the phases of this development study, we incorporated inputs from health professionals to ensure the accuracy and validity of the medical content in our prototypes. Results: We identified 3 categories of functionalities necessary to include in the design of our initial low-fidelity prototype: the need for support resources, diary entries, and access to educational materials. We then conducted a thematic analysis of the data collected in the design workshops, which revealed 4 themes: feedback on the user interface design and usability, requests for additional functionalities, feedback on medical guides and educational materials, and suggestions for additional medical content. On the basis of these results, we designed a medium-fidelity prototype. All the participants in the usability evaluation tests found the medium-fidelity prototype useful and easy to use. On the basis of the feedback and difficulties experienced by participants, we adjusted our design in preparation for the high-fidelity prototype. Conclusions: We designed, developed, and evaluated an mHealth app to support older adults in the self-management of pain after a fracture. The participants found our proposed prototype useful for managing acute pain and easy to interact with and navigate. Assessment of the clinical outcomes and long-term effects of our proposed mHealth app will be evaluated in the future. %M 36251348 %R 10.2196/37772 %U https://aging.jmir.org/2022/4/e37772 %U https://doi.org/10.2196/37772 %U http://www.ncbi.nlm.nih.gov/pubmed/36251348 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40869 %T An Evaluation of a Mobile App for Chronic Low Back Pain Management: Prospective Pilot Study %A Browne,Jonathan D %A Vaninetti,Michael %A Giard,David %A Kostas,Konstantinos %A Dave,Ankur %+ Ascension Illinois, Alexian Brothers Medical Center, Eberle Building, Suite 610, 800 Biesterfield Rd, Elk Grove Village, IL, 60007, United States, 1 630 379 9815, ankur.dave@ascension.org %K back pain %K chronic pain %K mobile %K app %K multidisciplinary care %K biopsychosocial %K self-management %K mHealth %K mobile health %K mobile app %D 2022 %7 13.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic low back pain is challenging to manage due to multidisciplinary considerations. It has substantial socioeconomic impacts and cannot be simply treated with pharmacotherapy, nonsurgical intervention, or spine surgery. Medical consensus recommends optimizing conservative self-management therapies (eg, home exercise, wellness strategies, yoga, etc) as first-line treatment options for chronic low back pain. However, access to these modalities is often limited and secondary to cost, convenience, and ease of use. Mobile health apps have emerged as a cost-effective and accessible option for chronic low back pain self-management. Established in-person pain programs can provide the structure for an optimal mobile app adaptation. PainNavigator (PainNavigator, Inc) is an example of a mobile app that is based on an Ascension-Illinois group–based pain program—Pain Rehabilitation Outpatient-Camp. Objective: This was a prospective pilot clinical trial that evaluated the PainNavigator platform’s utility in low back pain management to inform future trial development. Methods: A total of 75 participants who used PainNavigator were studied. Pain, Enjoyment, and General Activity (PEG-3) scale scores and scores from a brief anxiety and depression scale based on the Patient Health Questionnaire-4 (PHQ-4) were obtained at baseline and following program completion. The PEG-3 total score was used, in addition to individual items—Average Pain, Pain Effect on Enjoyment, and Pain Effect on Activity. The PHQ-4 total score was also used, in addition to other individual items, including Felt Depressed, Loss of Interest, Felt Anxious, and Difficult to Control Worry. Paired sample t tests (2-tailed) compared mean differences in scores from before and after participants received the intervention. Results: The analysis found that PEG-3 (n=27) and PHQ-4 (n=27) total scores were significantly lower upon the completion of PainNavigator (P<.001 and P=.001, respectively). The findings showed a 36% reduction in PEG-3 total scores, a 40% reduction in pain intensity, and a 40% reduction in PHQ-4 total scores. Scores for individual PEG-3 scale and PHQ-4 items also significantly decreased. All PEG-3 measures had large effect sizes. The PHQ-4 total score and Difficult to Control Worry item had large effect sizes, while the other three measures had medium effect sizes. Conclusions: These findings show that PainNavigator has clinical significance in managing chronic low back pain and can be easily utilized to improve patient care. All PEG-3 scale and PHQ-4 measures significantly improved following the use of the platform, supporting the multidimensional, biopsychosocial approach to low back pain management. Differences in effect sizes may inform quality improvement investigations, such as optimizing features that impact measures with only medium effect sizes. This feasibility study demonstrates an effective protocol, and it will inform future, more extensive randomized controlled trials. %M 36227637 %R 10.2196/40869 %U https://formative.jmir.org/2022/10/e40869 %U https://doi.org/10.2196/40869 %U http://www.ncbi.nlm.nih.gov/pubmed/36227637 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39764 %T Evaluating the Feasibility of a Digital Therapeutic Program for Patients With Cancer During Active Treatment: Pre-Post Interventional Study %A Gudmundsson,G Haukur %A Mészáros,Judit %A Björnsdóttir,Ágústa E %A Ámundadóttir,María L %A Thorvardardottir,Gudrun E %A Magnusdottir,Erna %A Helgadottir,Halla %A Oddsson,Saemundur %+ Medical and Research Department, Sidekick Health, Oberwallstraße 6, Berlin, 10117, Germany, 49 1744789708, judit@sidekickhealth.com %K cancer %K lifestyle %K quality of life %K mobile app %K digital therapeutics %K self-management %K physical activity %K mobile phone %D 2022 %7 13.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing evidence shows that lifestyle interventions can improve the symptoms, quality of life (QoL), and even overall survival of patients with cancer. Digital therapeutics (DTx) can help implement behavioral modifications and empower patients through education, lifestyle support, and remote symptom monitoring. Objective: We aimed to test the feasibility of a DTx program for patients with cancer, as measured by engagement, retention, and acceptability. In addition, we explored the effects of the program on cancer-related QoL. Methods: We conducted a 4-week single-arm trial in Iceland, where DTx was delivered through a smartphone app. The intervention consisted of patient education about mindfulness, sleep, stress, and nutrition; lifestyle coaching; and the completion of daily missions for tracking physical activity and exercise, reporting patient-reported outcomes (PROs), practicing mindfulness, and logging healthy food intake. Information on program engagement and retention, step goal attainment, as well as PROs were collected throughout the study. QoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 at baseline and follow-up. Results: In total, 30 patients with cancer undergoing active therapy were enrolled, and 29 registered in the app (23 female, 18 with breast cancer; mean age 52.6, SD 11.5 years). Overall, 97% (28/29) of participants were active in 3 of the 4 weeks and completed the pre- and postprogram questionnaires. The weekly active days (median) were 6.8 (IQR 5.8-6.8), and 72% (21/29) of participants were active at least 5 days a week. Users interacted with the app on average 7.7 (SD 1.9) times per day. On week 1, all 29 participants used the step counter and logged an average of 20,306 steps; 21 (72%) participants reached their step goals of at least 3000 steps per day. On week 4, of the 28 active users, 27 (96%) were still logging their steps, with 19 (68%) reaching their step goals. Of the 28 participants who completed the satisfaction questionnaire, 25 (89%) were likely to recommend the program, 23 (82%) said the program helped them deal with the disease, and 24 (86%) said it helped them remember their medication. QoL assessment showed that the average global health status, functioning, and symptom burden remained stable from baseline to follow-up. In all, 50% (14/28) of participants reported less pain, and the average pain score decreased from 31 (SD 20.1) to 22.6 (SD 23.2; P=.16). There was no significant change in PROs on the quality of sleep, energy, and stress levels from the first to the last week. Conclusions: The high retention, engagement, and acceptability found in this study demonstrate that multidisciplinary DTx is feasible for patients with cancer. A longer, full-scale randomized controlled trial is currently being planned to evaluate the efficacy of the intervention. %M 36227639 %R 10.2196/39764 %U https://formative.jmir.org/2022/10/e39764 %U https://doi.org/10.2196/39764 %U http://www.ncbi.nlm.nih.gov/pubmed/36227639 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e36987 %T Behavior Change App for Self-management of Gestational Diabetes: Design and Evaluation of Desirable Features %A Kytö,Mikko %A Koivusalo,Saila %A Ruonala,Antti %A Strömberg,Lisbeth %A Tuomonen,Heli %A Heinonen,Seppo %A Jacucci,Giulio %+ Helsinki University Hospital IT Management, Helsinki University Hospital, Paciuksenkatu 25, Helsinki, 00270, Finland, 358 94711, mikko.kyto@hus.fi %K gestational diabetes %K mobile app %K features %K behavior change %K digital health %K eHealth %K telehealth %K self-tracking %K self-management %K personalized health care %D 2022 %7 12.10.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Gestational diabetes (GDM) has considerable and increasing health effects as it raises both the mother’s and the offspring’s risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and sufficient physical activity. Although telemedicine interventions providing weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control among women with GDM, apps without extensive input from health care professionals are limited and have not been shown to be effective. Different features in personalization and support have been proposed to increase the efficacy of GDM apps, but the knowledge of how these features should be designed is lacking. Objective: The aim of this study is to investigate how GDM apps should be designed, considering the desirable features based on the previous literature. Methods: We designed an interactive GDM prototype app that provided example implementations of desirable features, such as providing automatic and personalized suggestions and social support through the app. Women with GDM explored the prototype and provided feedback in semistructured interviews. Results: We identified that (1) self-tracking data in GDM apps should be extended with written feedback, (2) habits and goals should be highly customizable to be useful, (3) the app should have different functions to provide social support, and (4) health care professionals should be notified through the app if something unusual occurs. In addition, we found 2 additional themes. First, basic functionalities that are fast to learn by women with GDM who have recently received the diagnosis should be provided, but there should also be deeper features to maintain interest for women with GDM at a later stage of pregnancy. Second, as women with GDM may have feelings of guilt, the app should have a tolerance for and a supporting approach to unfavorable behavior. Conclusions: The feedback on the GDM prototype app supported the need for desirable features and provided new insights into how these features should be incorporated into GDM apps. We expect that following the proposed designs and feedback will increase the efficacy of GDM self-management apps. Trial Registration: ClinicalTrials.gov NCT03941652; https://clinicaltrials.gov/ct2/show/NCT03941652 %M 36222806 %R 10.2196/36987 %U https://humanfactors.jmir.org/2022/4/e36987 %U https://doi.org/10.2196/36987 %U http://www.ncbi.nlm.nih.gov/pubmed/36222806 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36818 %T Separating Features From Functionality in Vaccination Apps: Computational Analysis %A Shaw Jr,George %A Nadkarni,Devaki %A Phann,Eric %A Sielaty,Rachel %A Ledenyi,Madeleine %A Abnowf,Razaan %A Xu,Qian %A Arredondo,Paul %A Chen,Shi %+ Public Health Sciences, School of Data Science, University of North Carolina, 9201 University City Blvd., Charlotte, NC, 28223-0001, United States, 1 704 562 0021, gshaw11@uncc.edu %K vaccines %K mobile health %K mHealth %K principal component analysis %K PCA %K k-means clustering %K information exchange %K mobile phone %D 2022 %7 11.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Some latest estimates show that approximately 95% of Americans own a smartphone with numerous functions such as SMS text messaging, the ability to take high-resolution pictures, and mobile software apps. Mobile health apps focusing on vaccination and immunization have proliferated in the digital health information technology market. Mobile health apps have the potential to positively affect vaccination coverage. However, their general functionality, user and disease coverage, and exchange of information have not been comprehensively studied or evaluated computationally. Objective: The primary aim of this study is to develop a computational method to explore the descriptive, usability, information exchange, and privacy features of vaccination apps, which can inform vaccination app design. Furthermore, we sought to identify potential limitations and drawbacks in the apps’ design, readability, and information exchange abilities. Methods: A comprehensive codebook was developed to conduct a content analysis on vaccination apps’ descriptive, usability, information exchange, and privacy features. The search and selection process for vaccination-related apps was conducted from March to May 2019. We identified a total of 211 apps across both platforms, with iOS and Android representing 62.1% (131/211) and 37.9% (80/211) of the apps, respectively. Of the 211 apps, 119 (56.4%) were included in the final study analysis, with 42 features evaluated according to the developed codebook. The apps selected were a mix of apps used in the United States and internationally. Principal component analysis was used to reduce the dimensionality of the data. Furthermore, cluster analysis was used with unsupervised machine learning to determine patterns within the data to group the apps based on preselected features. Results: The results indicated that readability and information exchange were highly correlated features based on principal component analysis. Of the 119 apps, 53 (44.5%) were iOS apps, 55 (46.2%) were for the Android operating system, and 11 (9.2%) could be found on both platforms. Cluster 1 of the k-means analysis contained 22.7% (27/119) of the apps; these were shown to have the highest percentage of features represented among the selected features. Conclusions: We conclude that our computational method was able to identify important features of vaccination apps correlating with end user experience and categorize those apps through cluster analysis. Collaborating with clinical health providers and public health officials during design and development can improve the overall functionality of the apps. %M 36222791 %R 10.2196/36818 %U https://formative.jmir.org/2022/10/e36818 %U https://doi.org/10.2196/36818 %U http://www.ncbi.nlm.nih.gov/pubmed/36222791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37605 %T Development of a Web-Based System to Report Medication-Related Adverse Effects: Design and Usability Study %A Lim,Renly %A Thornton,Christopher %A Stanek,Jan %A Ellett,Lisa Kalisch %A Thiessen,Myra %+ Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Level 6, Playford Building, Frome Road, Adelaide, 5000, Australia, 61 883022307, renly.lim@unisa.edu.au %K adverse drug reaction %K adverse drug event %K digital health %K eHealth %K medication safety %K mHealth %K participatory design %K patient reported outcomes %K telehealth %D 2022 %7 7.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Medicine use is the most common intervention in health care. The frequency with which medicines are used means medication-related problems are very common. One common type of medication-related problems is adverse drug events, which are unintended and harmful effects associated with use of medicines. Reporting of adverse drug events to regulatory authorities is important for evaluation of safety of medicines; however, these adverse effects are frequently unreported due to various factors, including lack of consumer-friendly reporting tools. Objective: The aim of this study was to develop a user-friendly digital tool for consumers to report medication-related adverse effects. Methods: The project consisted of 3 parts: (1) content development, including a systematic literature search; (2) iterative system development; and (3) usability testing. The project was guided by participatory design principles, which suggest involving key stakeholders throughout the design process. The first 2 versions were developed as a mobile app and were tested with end users in 2 workshops. The third version was developed as a web application and was tested with consumers who were taking regular medicines. Consumers were asked to complete a modified version of the mHealth app usability questionnaire (MAUQ), an 18-item questionnaire with each item scored using a 7-point Likert scale ranging from 0 (strongly disagree) to 7 (strongly agree). The MAUQ assessed 3 subscales including ease of use (5 items), interface and satisfaction (7 items), and usefulness (6 items). Continuous variables were reported as mean (SD) values, whereas categorical variables were presented as frequencies (percentages). Data analysis was conducted in Microsoft Excel. Results: The content for the system was based on a systematic literature search and short-listing of questions, followed by feedback from project team members and consumers. Feedback from consumers in the 2 workshops were incorporated to improve the functionality, visual design, and stability of the third (current) version. The third version of the system was tested with 26 consumers. A total of 79% (N=307/390) of all responses on the MAUQ were scored 6 or 7, indicating that users generally strongly agree with the usability of the system. When looking at the individual domains, the system had an average score of 6.3 (SD 0.9) for “ease of use,” 6.3 (SD 0.8) for “interface and satisfaction,” and 5.2 (SD 1.4) for “usefulness.” Conclusions: The web-based system for medicine adverse effects reporting is a user-friendly tool developed using an iterative participatory design approach. Future research includes further improving the system, particularly the usefulness of the system, as well as testing the scalability and performance of the system in practice. %M 36206034 %R 10.2196/37605 %U https://formative.jmir.org/2022/10/e37605 %U https://doi.org/10.2196/37605 %U http://www.ncbi.nlm.nih.gov/pubmed/36206034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37474 %T Acceptability and Usability of a Reward-Based Mobile App for Opioid Treatment Settings: Mixed Methods Pilot Study %A Proctor,Steven L %A Rigg,Khary K %A Tien,Allen Y %+ Thriving Mind South Florida, 7205 Corporate Center Drive, Suite 200, Miami, FL, 33126, United States, 1 305 858 3335, sproctor@thrivingmind.org %K opioids %K contingency management %K mHealth %K digital health %K mobile app %K innovation %K opioid use disorder %K recovery %K acceptability %D 2022 %7 5.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Contingency management is an evidence-based yet underutilized approach for opioid use disorder (OUD). Reasons for limited adoption in real-world practice include ethical, moral, and philosophical concerns regarding use of monetary incentives, and lack of technological innovation. In light of surging opioid overdose deaths, there is a need for development of technology-enabled solutions leveraging the power of contingency management in a way that is viewed by both patients and providers as acceptable and feasible. Objective: This mixed methods pilot study sought to determine the perceived acceptability and usability of PROCare Recovery, a reward-based, technology-enabled recovery monitoring smartphone app designed to automate contingency management by immediately delivering micropayments to patients for achieving recovery goals via smart debit card with blocking capabilities. Methods: Participants included patients receiving buprenorphine for OUD (n=10) and licensed prescribers (n=5). Qualitative interviews were conducted by 2 PhD-level researchers via video conferencing to explore a priori hypotheses. Thematic analysis of interviews was conducted and synthesized into major themes. Results: Participants were overwhelmingly in favor of microrewards (eg, US $1) to incentivize treatment participation (up to US $150 monthly). Participants reported high acceptability of the planned debit card spending restrictions (blocking cash withdrawals and purchases at bars or liquor stores, casinos or online gambling). Quantitative data revealed a high level of perceived usability of the PROCare Recovery app. Conclusions: Patients and providers alike appear receptive to microfinancial incentives in standard OUD treatment practices. Further pilot testing of PROCare is underway to determine acceptability, feasibility, and preliminary effectiveness in a rigorous randomized controlled trial. %M 36197705 %R 10.2196/37474 %U https://formative.jmir.org/2022/10/e37474 %U https://doi.org/10.2196/37474 %U http://www.ncbi.nlm.nih.gov/pubmed/36197705 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e38740 %T Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework %A Dhinagaran,Dhakshenya Ardhithy %A Martinengo,Laura %A Ho,Moon-Ho Ringo %A Joty,Shafiq %A Kowatsch,Tobias %A Atun,Rifat %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Rd69047142, Clinical Sciences Building Level 18, Singapore, 308232, Singapore, 65 69047142, lorainne.tudor.car@ntu.edu.sg %K conceptual framework %K conversational agent %K chatbot %K mobile health %K mHealth %K digital health %K mobile phone %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Conversational agents (CAs), also known as chatbots, are computer programs that simulate human conversations by using predetermined rule-based responses or artificial intelligence algorithms. They are increasingly used in health care, particularly via smartphones. There is, at present, no conceptual framework guiding the development of smartphone-based, rule-based CAs in health care. To fill this gap, we propose structured and tailored guidance for their design, development, evaluation, and implementation. Objective: The aim of this study was to develop a conceptual framework for the design, evaluation, and implementation of smartphone-delivered, rule-based, goal-oriented, and text-based CAs for health care. Methods: We followed the approach by Jabareen, which was based on the grounded theory method, to develop this conceptual framework. We performed 2 literature reviews focusing on health care CAs and conceptual frameworks for the development of mobile health interventions. We identified, named, categorized, integrated, and synthesized the information retrieved from the literature reviews to develop the conceptual framework. We then applied this framework by developing a CA and testing it in a feasibility study. Results: The Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER) conceptual framework includes 8 iterative steps grouped into 3 stages, as follows: design, comprising defining the goal, creating an identity, assembling the team, and selecting the delivery interface; development, including developing the content and building the conversation flow; and the evaluation and implementation of the CA. They were complemented by 2 cross-cutting considerations—user-centered design and privacy and security—that were relevant at all stages. This conceptual framework was successfully applied in the development of a CA to support lifestyle changes and prevent type 2 diabetes. Conclusions: Drawing on published evidence, the DISCOVER conceptual framework provides a step-by-step guide for developing rule-based, smartphone-delivered CAs. Further evaluation of this framework in diverse health care areas and settings and for a variety of users is needed to demonstrate its validity. Future research should aim to explore the use of CAs to deliver health care interventions, including behavior change and potential privacy and safety concerns. %M 36194462 %R 10.2196/38740 %U https://mhealth.jmir.org/2022/10/e38740 %U https://doi.org/10.2196/38740 %U http://www.ncbi.nlm.nih.gov/pubmed/36194462 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39497 %T Using Wake-Up Tasks for Morning Behavior Change: Development and Usability Study %A Oh,Kyue Taek %A Ko,Jisu %A Shin,Jaemyung %A Ko,Minsam %+ Department of Human-Computer Interaction, Hanyang University, Ansan, Republic of Korea, 82 314001071, minsam@hanyang.ac.kr %K health app design %K morning behavior change %K wake-up task %K mobile alarm %K productivity %D 2022 %7 21.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early morning behaviors between waking up and beginning daily work can develop into productive habits. However, sleep inertia limits the level of human ability immediately after waking, lowering a person’s motivation and available time for productive morning behavior. Objective: This study explores a design for morning behavior change using a wake-up task, a simple assignment the user needs to finish before alarm dismissal. Specifically, we set two research objectives: (1) exploring key factors that relate to morning behavior performance, including the use of wake-up tasks in an alarm app and (2) understanding the general practice of affecting morning behavior change by implementing wake-up tasks. Methods: We designed and implemented an apparatus that provides wake-up task alarms and facilities for squat exercises. We recruited 36 participants to perform squat exercises in the early morning using the wake-up tasks for 2 weeks. First, we conducted a generalized estimating equation (GEE) analysis for the first research objective. Next, we conducted a thematic analysis of the postsurvey answers to identify key themes about morning behavior change with the wake-up tasks for the second objective. Results: The use of wake-up tasks was significantly associated with both the completion of the target behavior (math task: P=.005; picture task: P<.001) and the elapsed time (picture task: P=.08); the time to alarm dismissal was significantly related to the elapsed time to completion (P<.001). Moreover, the theory of planned behavior (TPB) variables, common factors for behavior change, were significant, but their magnitudes and directions differed slightly from the other domains. Furthermore, the survey results reveal how the participants used the wake-up tasks and why they were effective for morning behavior performance. Conclusions: The results reveal the effectiveness of wake-up tasks in accomplishing the target morning behavior and address key factors for morning behavior change, such as (1) waking up on time, (2) escaping from sleep inertia, and (3) quickly starting the desired target behavior. %M 36129742 %R 10.2196/39497 %U https://formative.jmir.org/2022/9/e39497 %U https://doi.org/10.2196/39497 %U http://www.ncbi.nlm.nih.gov/pubmed/36129742 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e35316 %T Patient Perspectives on Using a Smartphone App to Support Home-Based Exercise During Physical Therapy Treatment: Qualitative Study %A Arensman,Remco %A Kloek,Corelien %A Pisters,Martijn %A Koppenaal,Tjarco %A Ostelo,Raymond %A Veenhof,Cindy %+ Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Rijnzathe 16, De Meern, 3454PV, Netherlands, 31 306866103, r.m.arensman-2@umcutrecht.nl %K patient perspectives %K mobile health %K mHealth %K home-based exercise %K adherence %K low back pain %K physical therapy %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Home-based exercise is an important part of physical therapy treatment for patients with low back pain. However, treatment effectiveness depends heavily on patient adherence to home-based exercise recommendations. Smartphone apps designed to support home-based exercise have the potential to support adherence to exercise recommendations and possibly improve treatment effects. A better understanding of patient perspectives regarding the use of smartphone apps to support home-based exercise during physical therapy treatment can assist physical therapists with optimal use and implementation of these apps in clinical practice. Objective: The aim of this study was to investigate patient perspectives on the acceptability, satisfaction, and performance of a smartphone app to support home-based exercise following recommendations from a physical therapist. Methods: Using an interpretivist phenomenology approach, 9 patients (4 males and 5 females; aged 20-71 years) with nonspecific low back pain recruited from 2 primary care physical therapy practices were interviewed within 2 weeks after treatment ended. An interview guide was used for the interviews to ensure that different aspects of the patients’ perspectives were discussed. The Physitrack smartphone app was used to support home-based exercise as part of treatment for all patients. Data were analyzed using the “Framework Method” to assist with interpretation of the data. Results: Data analysis revealed 11 categories distributed among the 3 themes “acceptability,” “satisfaction,” and “performance.” Patients were willing to accept the app as part of treatment when it was easy to use, when it benefited the patient, and when the physical therapist instructed the patient in its use. Satisfaction with the app was determined by users’ perceived support from the app when exercising at home and the perceived increase in adherence. The video and text instructions, reminder functions, and self-monitor functions were considered the most important aspects for performance during treatment. The patients did not view the Physitrack app as a replacement for the physical therapist and relied on their therapist for instructions and support when needed. Conclusions: Patients who use an app to support home-based exercise as part of treatment are accepting of the app when it is easy to use, when it benefits the patient, and when the therapist instructs the patient in its use. Physical therapists using an app to support home-based exercise can use the findings from this study to effectively support their patients when exercising at home during treatment. %M 36098993 %R 10.2196/35316 %U https://humanfactors.jmir.org/2022/3/e35316 %U https://doi.org/10.2196/35316 %U http://www.ncbi.nlm.nih.gov/pubmed/36098993 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39718 %T Development of a Mobile App for Self-Care Against COVID-19 Using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) Model: Methodological Study %A Saeidnia,Hamid Reza %A Kozak,Marcin %A Ausloos,Marcel %A Herteliu,Claudiu %A Mohammadzadeh,Zahra %A Ghorbi,Ali %A Karajizadeh,Mehrdad %A Hassanzadeh,Mohammad %+ Department of Knowledge and Information Science, Tarbiat Modares University, Tehran-Ashrafi Esfahani Highway- After Paul Hemmat, Tehran, 6931753865, Iran, 98 09394464224, hamidrezasaednia@gmail.com %K self-care %K mobile app %K ADDIE model %K COVID-19 %K underdeveloped countries %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps have been shown to play an important role in the management, care, and prevention of infectious diseases. Thus, skills for self-care—one of the most effective ways to prevent illness—can be improved through mobile health apps. Objective: This study aimed to design, develop, and evaluate an educational mobile-based self-care app in order to help the self-prevention of COVID-19 in underdeveloped countries. We intended the app to be easy to use, quick, and inexpensive. Methods: In 2020 and 2021, we conducted a methodological study. Using the ADDIE (analysis, design, development, implementation, and evaluation) educational model, we developed a self-care management mobile app. According to the ADDIE model, an effective training and performance support tool is built through the 5 phases that comprise its name. There were 27 participants who conducted 2 evaluations of the mobile app’s usability and impact using the mobile health app usability and self-care inventory scales. The study design included pre- and posttesting. Results: An Android app called MyShield was developed. The results of pre- and posttests showed that on a scale from 0 to 5, MyShield scored a performance average of 4.17 in the physical health dimension and an average of 3.88 in the mental well-being dimension, thereby showing positive effects on self-care skills. MyShield scored highly on the “interface and satisfaction,” “ease of use,” and “usefulness” components. Conclusions: MyShield facilitates learning self-care skills at home, even during quarantine, increasing acquisition of information. Given its low development cost and the ADDIE educational design on which it is based, the app can be helpful in underdeveloped countries. Thus, low-income countries—often lacking other tools—can use the app as an effective tool for fighting COVID-19, if it becomes a standard mobile app recommended by the government. %M 36054441 %R 10.2196/39718 %U https://formative.jmir.org/2022/9/e39718 %U https://doi.org/10.2196/39718 %U http://www.ncbi.nlm.nih.gov/pubmed/36054441 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e32795 %T Design, Development, and Testing of BEST4Baby, an mHealth Technology to Support Exclusive Breastfeeding in India: Pilot Study %A Ma,Tony %A Chang,Katie %A Alyusuf,Amal %A Bajracharya,Elina %A Washio,Yukiko %A Kelly,Patricia J %A Bellad,Roopa M %A Mahantashetti,Niranjana S %A Charantimath,Umesh %A Short,Vanessa L %A Lalakia,Parth %A Jaeger,Frances %A Goudar,Shivaprasad %A Derman,Richard %+ Benten Technologies, Inc, 9408 Grant Avenue, Suite 206, Manassas, VA, 20110-1816, United States, 1 703 662 5858 ext 143, tonyma@bententech.com %K mobile health %K mHealth %K peer counselors %K breastfeeding %K rural %K usability %K low- and middle-income countries %K agile %K task shifting %K user-centered design %K mobile phone %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries. Objective: This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices. Methods: A user-centered design process with an agile development methodology was used. The approach involved stakeholders and mothers who were trained to serve as PCs to guide BEST4Baby’s design and development, including the app’s content and features. PCs were engaged through focus groups with interactive wireframes. During the 24-month pilot study period, we conducted a feasibility test of the BEST4Baby app with 22 PCs who supported home visits with mothers residing in rural India. The intervention protocol required PCs to provide education and follow mothers using the BEST4Baby app, with 9 scheduled home visits from the late prenatal stage to 6 months post partum. BEST4Baby’s usability from the PCs’ perspective was assessed using the translated System Usability Scale (SUS). Results: The findings of this study align with best practices in user-centered design (ie, understanding user experience, including context with iterative design with stakeholders) to address EBF barriers. This led to the cultural tailoring and contextual alignment of an evidence-based World Health Organization breastfeeding program with an iterative design and agile development of the BEST4Baby app. A total of 22 PCs tested and rated the BEST4Baby app as highly usable, with a mean SUS score of 85.3 (SD 9.1), placing it over the 95th percentile for SUS scores. The approach translated into a highly usable BEST4Baby app for use by PCs in breastfeeding counseling, which also statistically increased EBF practices. Conclusions: The findings suggest that BEST4Baby was highly usable and accepted by mothers serving as PCs to support other mothers in their EBF practices and led to positive outcomes in the intervention group’s EBF rates. The pilot study demonstrated that using the specially designed BEST4Baby app was an important support tool for mothers to serve as PCs during the 9 home visits. Trial Registration: Clinicaltrials.gov NCT03533725; https://clinicaltrials.gov/ct2/show/NCT03533725 %M 36074546 %R 10.2196/32795 %U https://formative.jmir.org/2022/9/e32795 %U https://doi.org/10.2196/32795 %U http://www.ncbi.nlm.nih.gov/pubmed/36074546 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34303 %T mHealth Physical Activity Intervention for Individuals With Spinal Cord Injury: Planning and Development Processes %A Lawrason,Sarah Victoria Clewes %A Brown-Ganzert,Lynda %A Campeau,Lysa %A MacInnes,Megan %A Wilkins,C J %A Martin Ginis,Kathleen Anne %+ School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, 1147 Research Rd, Kelowna, BC, V1V 1V7, Canada, 1 250 807 9187, svcl11@mail.ubc.ca %K exercise %K stakeholder participation %K spinal cord injuries %K telemedicine %K mobile apps %K mobile phone %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Interventions to support physical activity participation among individuals with spinal cord injury (SCI) are required given this population’s low levels of physical activity and extensive barriers to quality physical activity experiences. Objective: This study aimed to develop a mobile health intervention, called SCI Step Together, to improve the quantity and quality of physical activity among individuals with SCI who walk. Methods: Our overarching methodological framework was the Person-Based approach. This included the following 4 steps: conduct primary and secondary research (step 1); design intervention objectives and features (step 2a); conduct behavioral analysis and theory (step 2b); create a logic model (step 3); and complete the SCI Step Together program content and integrated knowledge translation (IKT; step 4), which occurred throughout development. The partnership approach was informed by the SCI IKT Guiding Principles. Three end users pilot-tested the app and participated in the interviews. Results: Step 1 identified issues to be addressed when designing intervention objectives and features (step 2a) and features were mapped onto the Behavior Change Wheel (step 2b) to determine the behavior change techniques (eg, action planning) to be included in the app. The logic model linked the mechanisms of action to self-determination theory (steps 2/3). Interviews with end users generated recommendations for the technology (eg, comparing physical activity levels with guidelines), trial (eg, emailing participants’ worksheets), and intervention content (eg, removing graded tasks; step 4). Conclusions: Using the SCI IKT Guiding Principles to guide partner engagement and involvement ensured that design partners had shared decision-making power in intervention development. Equal decision-making power maximizes the meaningfulness of the app for end users. Future research will include testing the acceptability, feasibility, and engagement of the program. Partners will be involved throughout the research process. Trial Registration: ClinicalTrials.gov: NCT05063617; https://clinicaltrials.gov/ct2/show/NCT05063617 %M 35984695 %R 10.2196/34303 %U https://formative.jmir.org/2022/8/e34303 %U https://doi.org/10.2196/34303 %U http://www.ncbi.nlm.nih.gov/pubmed/35984695 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 3 %P e35203 %T A Gender Lens on User Quality Ratings From Young Teenagers Assessing the Sun Safe App: Comparing Responses From Co-researchers and Participants of Pilot Intervention Studies %A Clare,Isabelle M %A Francis,Jacinta %A Gamage,Nisali %A Nguyen,Rebecca %A Gorman,Shelley %+ Telethon Kids Institute, University of Western Australia, Level 7, Perth Children's Hospital, 15 Hospital Drive, Nedlands, Perth, 6052, Australia, 61 8 6319 1747, Shelley.Gorman@telethonkids.org.au %K app development %K co-design %K sun exposure %K sun protection %K teenager %K uMARS %K UV index %K vitamin D %K young adolescents %K sunburn %K adolescent %K smartphone %K gender %K sun %K protection %K app %K engagement %K sunburn %K risk %K melanoma %K decision-making %D 2022 %7 18.8.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 39475809 %R 10.2196/35203 %U https://derma.jmir.org/2022/3/e35203 %U https://doi.org/10.2196/35203 %U http://www.ncbi.nlm.nih.gov/pubmed/39475809 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38737 %T A “No-Code” App Design Platform for Mobile Health Research: Development and Usability Study %A Liu,Sam %A La,Henry %A Willms,Amanda %A Rhodes,Ryan E %+ School of Exercise Science, Physical and Health Education, University of Victoria, McKinnon Building 124, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8392, samliu@uvic.ca %K app development %K behavior change technique %K health promotion %K mobile health %K mobile application %K application development %K design platform %K platform development %K no-code mHealth app %K no-code app %K no-code %K end user %K participatory research %K Pathverse %K agile %K hybrid-agile %K software design %K software development %K software developer %K computer science %K BCT %K behavior change %K research tool %K research instrument %K digital platform %K mHealth %K mobile app %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A challenge facing researchers conducting mobile health (mHealth) research is the amount of resources required to develop mobile apps. This can be a barrier to generating relevant knowledge in a timely manner. The recent rise of “no-code” software development platforms may overcome this challenge and enable researchers to decrease the cost and time required to develop mHealth research apps. Objective: We aimed to describe the development process and the lessons learned to build Pathverse, a no-code mHealth app design platform. Methods: The study took place between November 2019 and December 2021. We used a participatory research framework to develop the mHealth app design platform. In phase 1, we worked with researchers to gather key platform feature requirements and conducted an exploratory literature search to determine needs related to this platform. In phase 2, we used an agile software framework (Scrum) to develop the platform. Each development sprint cycle was 4 weeks in length. We created a minimum viable product at the end of 7 sprint cycles. In phase 3, we used a convenience sample of adults (n=5) to gather user feedback through usability and acceptability testing. In phase 4, we further developed the platform based on user feedback, following the V-model software development process. Results: Our team consulted end users (ie, researchers) and utilized behavior change technique taxonomy and behavior change models (ie, the multi-process action control framework) to guide the development of features. The first version of the Pathverse platform included features that allowed researchers to (1) design customized multimedia app content (eg, interactive lessons), (2) set content delivery logic (eg, only show new lessons when completing the previous lesson), (3) implement customized participant surveys, (4) provide self-monitoring tools, (5) set personalized goals, and (6) customize app notifications. Usability and acceptability testing revealed that researchers found the platform easy to navigate and that the features were intuitive to use. Potential improvements include the ability to deliver adaptive interventions and add features such as community group chat. Conclusions: To our knowledge, Pathverse is the first no-code mHealth app design platform for developing mHealth interventions for behavior. We successfully used behavior change models and the behavior change technique taxonomy to inform the feature requirements of Pathverse. Overall, the use of a participatory framework, combined with the agile and hybrid-agile software development process, enabled our team to successfully develop the Pathverse platform. %M 35980740 %R 10.2196/38737 %U https://formative.jmir.org/2022/8/e38737 %U https://doi.org/10.2196/38737 %U http://www.ncbi.nlm.nih.gov/pubmed/35980740 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e34588 %T Intervention Mapping of a Gamified Therapy Prescription App for Children With Disabilities: User-Centered Design Approach %A Johnson,Rowan W %A White,Becky K %A Gucciardi,Daniel F %A Gibson,Noula %A Williams,Sian A %+ Therapy Services, Ability WA, 106 Bradford Street, Coolbinia, Perth, 6069, Australia, 61 1300106106, rowan.johnson@abilitywa.com.au %K neurodevelopmental disability %K mobile health %K self-determination theory %K gamification %K physiotherapy %K occupational therapy %K speech pathology %K behavior change %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Mobile health (mHealth) apps for children are increasing in availability and scope. Therapy (physiotherapy, speech pathology, and occupational therapy) prescription apps to improve home or school program adherence work best when developed to be highly engaging for children and when they incorporate behavior change techniques (BCTs) within their design. Objective: The aim of this study was to describe the development of a user-centered therapy prescription app for children (aged 6-12 years) with neurodevelopmental disabilities (eg, cerebral palsy, autism spectrum disorder, and intellectual disability) incorporating intervention mapping (IM) and gamified design. Methods: We used an iterative, user-centered app development model incorporating the first 3 steps of IM. We conducted a needs analysis with user feedback from our previous mHealth app study, a literature review, and a market audit. Change objectives were then specified in alignment with the psychological needs of autonomy, competence, and relatedness identified in self-determination theory. From these objectives, we then selected BCTs, stipulating parameters for effectiveness and how each BCT would be operationalized. A gamification design was planned and implemented focusing on maximizing engagement in children. In total, 2 rounds of consultations with parents, teachers, and therapists and 1 round of prototype app testing with children were conducted to inform app development, with a final iteration developed for further testing. Results: The IM process resulted in the specification of app elements, self-determination theory–informed BCTs, that were embedded into the app design. The gamification design yielded the selection of a digital pet avatar with a fantasy anime visual theme and multiple layers of incentives earned by completing prescribed therapy activities. Consultation groups with professionals working with children with disabilities (4 therapists and 3 teachers) and parents of children with disabilities (n=3) provided insights into the motivation of children and the pragmatics of implementing app-delivered therapy programs that informed the app development. User testing with children with disabilities (n=4) highlighted their enthusiasm for the app and the need for support in the initial phase of learning the app. App quality testing (Mobile Application Rating Scale-user version) with the children yielded means (out of 5) of 4.5 (SD 0.8) for engagement, 3.3 (SD 1.6) for function, 3.3 (SD 1.7) for aesthetics, and 4.3 (SD 1.1) for subjective quality. Conclusions: mHealth apps designed for children can be greatly enhanced with a systematic yet flexible development process considering the specific contextual needs of the children with user-centered design, addressing the need for behavior change using the IM process, and maximizing engagement with gamification and strong visual design. %M 35943782 %R 10.2196/34588 %U https://pediatrics.jmir.org/2022/3/e34588 %U https://doi.org/10.2196/34588 %U http://www.ncbi.nlm.nih.gov/pubmed/35943782 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35599 %T Development and Use of a Cardiac Clinical Guideline Mobile App in Australia: Acceptability and Multi-Methods Study %A Matthews,Stacey %A Atkins,Brooke %A Walton,Natalie %A Mitchell,Julie-Anne %A Jennings,Garry %A Buttery,Amanda K %+ National Heart Foundation of Australia, Level 2, 850 Collins street, Melbourne, 3008, Australia, 61 03 9321 1593, stacey.matthews@heartfoundation.org.au %K mHealth %K mobile heath %K apps %K app %K guideline %K cardiovascular disease %K atrial fibrillation %K heart failure %K heart %K cardiac %K cardiovascular %K acute coronary syndrome %K smartphone %K implementation %K digital health %K develop %K evaluate %K evaluation %K Australia %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Implementation of clinical guidelines into routine practice remains highly variable. Strategies to increase guideline uptake include developing digital tools and mobile apps for use in clinical practice. The National Heart Foundation of Australia in collaboration with the Cardiac Society of Australia and New Zealand published 3 key cardiac clinical guidelines, including the Australian clinical guidelines for the (1) prevention and detection of atrial fibrillation, (2) detection and management of heart failure, and (3) management of acute coronary syndromes. To improve access and uptake for health care providers, we developed the Smart Heart Guideline App. Objective: This study aims to evaluate the acceptability, implementation, and usability of an Australian-specific cardiac guidelines mobile app. Methods: We used an iterative multiple methods development and implementation approach. First, we conducted a cross-sectional web-based survey with end users (n=504 health professionals) in 2017 to determine the acceptability of an Australian-specific cardiac clinical guidelines mobile app. Second, the Smart Heart Guidelines app was created using a design, user testing, and revision process. The app includes interactive algorithms and flowcharts to inform diagnosis and management at the point of care. The freely available app was launched in October 2019 on iOS and Android operating systems and promoted and implemented using multiple methods. Third, data from 2 annual national cross-sectional general practitioner (GP) surveys in 2019 and 2020 were evaluated to understand the awareness and use of the clinical guidelines and the app. Fourth, data from the app stores were analyzed between October 1, 2019, and June 30, 2021, to evaluate usage. Results: Most health professionals surveyed (447/504, 89%) reported accessing resources electronically, and most (318/504, 63%) reported that they would use an Australian-specific cardiac guidelines app. GPs surveyed in 2019 were aware of the heart failure (159/312, 51%) and atrial fibrillation (140/312, 45%) guidelines, and in 2020, a total of 34 of 189 (18%) reported that they were aware of the app. The app was downloaded 11,313 times (7483, 66% from the Apple App Store; 3830, 34% from Google Play) during the first 20-month period. Most downloads (6300/7483, 84%) were a result of searching for the app in the stores. Monthly download rates varied. App Store data showed that people used the app twice (on average 2.06 times) during the 20 months. Many (3256/3830, 85%) Android users deleted the app. Conclusions: Health professionals supported the development of the Smart Heart Guidelines app. Although initial downloads were promising, the frequency of using the app was low and deletion rates were high. Further evaluation of users’ experience of the most and least useful components of the app is needed. %M 35930350 %R 10.2196/35599 %U https://formative.jmir.org/2022/8/e35599 %U https://doi.org/10.2196/35599 %U http://www.ncbi.nlm.nih.gov/pubmed/35930350 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35268 %T Just-in-Time Prompts for Running, Walking, and Performing Strength Exercises in the Built Environment: 4-Week Randomized Feasibility Study %A Sporrel,Karlijn %A Wang,Shihan %A Ettema,Dick D F %A Nibbeling,Nicky %A Krose,Ben J A %A Deutekom,Marije %A de Boer,Rémi D D %A Simons,Monique %+ Human Geography and Spatial Planning, Utrecht University, Princetonlaan 8a, Utrecht, 3584 CB, Netherlands, 31 642514287, k.sporrel@uu.nl %K just-in-time interventions %K context-based %K prompts %K reminders %K physical activity %K mobile health %K mHealth %K exercise application %K Fogg Behavior Model %K user experience %K engagement %K feasibility study %K mobile phone %D 2022 %7 1.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: App-based mobile health exercise interventions can motivate individuals to engage in more physical activity (PA). According to the Fogg Behavior Model, it is important that the individual receive prompts at the right time to be successfully persuaded into PA. These are referred to as just-in-time (JIT) interventions. The Playful Active Urban Living (PAUL) app is among the first to include 2 types of JIT prompts: JIT adaptive reminder messages to initiate a run or walk and JIT strength exercise prompts during a walk or run (containing location-based instruction videos). This paper reports on the feasibility of the PAUL app and its JIT prompts. Objective: The main objective of this study was to examine user experience, app engagement, and users’ perceptions and opinions regarding the PAUL app and its JIT prompts and to explore changes in the PA behavior, intrinsic motivation, and the perceived capability of the PA behavior of the participants. Methods: In total, 2 versions of the closed-beta version of the PAUL app were evaluated: a basic version (Basic PAUL) and a JIT adaptive version (Smart PAUL). Both apps send JIT exercise prompts, but the versions differ in that the Smart PAUL app sends JIT adaptive reminder messages to initiate running or walking behavior, whereas the Basic PAUL app sends reminder messages at randomized times. A total of 23 participants were randomized into 1 of the 2 intervention arms. PA behavior (accelerometer-measured), intrinsic motivation, and the perceived capability of PA behavior were measured before and after the intervention. After the intervention, participants were also asked to complete a questionnaire on user experience, and they were invited for an exit interview to assess user perceptions and opinions of the app in depth. Results: No differences in PA behavior were observed (Z=−1.433; P=.08), but intrinsic motivation for running and walking and for performing strength exercises significantly increased (Z=−3.342; P<.001 and Z=−1.821; P=.04, respectively). Furthermore, participants increased their perceived capability to perform strength exercises (Z=2.231; P=.01) but not to walk or run (Z=−1.221; P=.12). The interviews indicated that the participants were enthusiastic about the strength exercise prompts. These were perceived as personal, fun, and relevant to their health. The reminders were perceived as important initiators for PA, but participants from both app groups explained that the reminder messages were often not sent at times they could exercise. Although the participants were enthusiastic about the functionalities of the app, technical issues resulted in a low user experience. Conclusions: The preliminary findings suggest that the PAUL apps are promising and innovative interventions for promoting PA. Users perceived the strength exercise prompts as a valuable addition to exercise apps. However, to be a feasible intervention, the app must be more stable. %M 35916693 %R 10.2196/35268 %U https://formative.jmir.org/2022/8/e35268 %U https://doi.org/10.2196/35268 %U http://www.ncbi.nlm.nih.gov/pubmed/35916693 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37738 %T An mHealth Intervention to Improve Pre-Exposure Prophylaxis Knowledge Among Young Black Women in Family Planning Clinics: Development and Usability Study %A Johnson,Amy K %A Haider,Sadia %A Nikolajuk,Katie %A Kuhns,Lisa M %A Ott,Emily %A Motley,Darnell %A Hill,Brandon %A Hirschhorn,Lisa %+ Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, 225 E Chicago Box 161, Chicago, IL, 60611, United States, 1 3122277733, akjohnson@luriechildrens.org %K mHealth %K adolescent health %K young Black women %K pre-exposure prophylaxis %K HIV %K mobile health %K PrEP %K mobile app %D 2022 %7 28.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Young Black women between the ages of 18 and 24 years are disproportionately impacted by HIV, yet they have a low self-perception of HIV risk and limited exposure to prevention strategies. Pre-exposure prophylaxis (PrEP) is a safe and effective biomedical HIV prevention strategy for those at risk for HIV infection, but uptake has been slow among cisgender women. Family planning clinics are a primary source of health care access for young women, providing an ideal opportunity to integrate PrEP information and care into existing clinic practices. Objective: The aim of this study was to use a multistage, community-engaged process to develop a mobile health app and to evaluate the feasibility and acceptability of the app. Methods: Using user-centered design, the In the Loop app was developed in collaboration with a community advisory board of young Black women. This study employed a multistage design, which included community-engaged app development, user testing, and evaluation of the app’s feasibility and acceptability. A pre- and postdesign was used to assess the impact of the app on PrEP knowledge immediately after app use. Descriptive statistics (eg, mean, SD, and percentage values) were used to describe the sample, and Wilcoxon matched-pairs signed-ranks test was used to detect changes in PrEP knowledge before and immediately after using the app. Results: A total of 50 sexually active, young Black women, aged 18-24 (mean 21, SD 1.9) years, were enrolled in this study. Analysis comparing scores before and immediately after use of the app revealed a significant increase in PrEP content knowledge scores on a 7-item true or false scale (z=–6.04, P<.001). Overall, participants considered the In the Loop app feasible and acceptable to use while waiting for a family planning visit. The majority of participants (n=46, 92%) agreed that they would recommend In the Loop to friends to learn more about PrEP. Participants rated the overall quality of the app 4.3 on a 1-5 scale (1=very poor and 5=very good). Of 50 participants, 40 (80%) agreed that the app was easy to use, and 48 (96%) agreed that they found the information in the app easy to understand. Finally, 40 (80%) agreed that they had enjoyed using the app while waiting for their family planning visit. Conclusions: Our findings suggest that young Black women waiting for family planning visits found the In the Loop app to be feasible and acceptable. This study demonstrates the value of engaging young Black women in the app design process. As family planning clinics are a primary source of health care access for young women, they provide an ideal setting to integrate PrEP information and care into existing clinic practices. Next steps in the development of the In the Loop app include implementing user-suggested improvements and conducting efficacy testing in a randomized controlled trial to determine the app’s impact on PrEP uptake. %M 35900830 %R 10.2196/37738 %U https://formative.jmir.org/2022/7/e37738 %U https://doi.org/10.2196/37738 %U http://www.ncbi.nlm.nih.gov/pubmed/35900830 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e34423 %T Detection of Potential Arbovirus Infections and Pregnancy Complications in Pregnant Women in Jamaica Using a Smartphone App (ZIKApp): Pilot Evaluation Study %A Ruiz-Burga,Elisa %A Bruijning-Verhagen,Patricia %A Palmer,Paulette %A Sandcroft,Annalisa %A Fernandes,Georgina %A de Hoog,Marieke %A Bryan,Lenroy %A Pierre,Russell %A Bailey,Heather %A Giaquinto,Carlo %A Thorne,Claire %A Christie,Celia D C %A , %+ Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, 30 Guilford St,, London, WC1N 1EH, United Kingdom, 44 02079052396, e.burga@ucl.ac.uk %K mHealth %K digital health %K arbovirus %K pregnancy %K adherence %K compliance %K low- and middle-income countries %K LMIC %K maternal health %K pregnancy complications %K prenatal care %K pregnancy outcomes %K mobile phone %D 2022 %7 27.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing evidence of the benefits of mobile health technology, which include symptom tracking apps for research, surveillance, and prevention. No study has yet addressed arbovirus symptom tracking in pregnancy. Objective: This study aimed to evaluate the use of a smartphone app (ZIKApp) to self-report arbovirus symptoms and pregnancy complications and to assess compliance with daily symptom diaries during pregnancy in a cohort of women in an arbovirus-endemic, subtropical, middle-income country (Jamaica). Methods: Pregnant women aged ≥16 years, having a smartphone, and planning on giving birth at the recruiting center were enrolled between February 2020 and July 2020. ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arbovirus infection and pregnancy complications. Sociodemographic, epidemiological, and obstetric information was collected at enrollment, with additional review of medical records, and users’ perception was collected through an exit survey. Descriptive analyses and logistic regression analysis of possible factors associated with diary adherence were performed. Results: Of the 173 women enrolled, 157 (90.8%) used ZIKApp for a median duration of 155 (IQR 127-173) days until pregnancy end, 6 (3.5%) used the app for <7 days, and 10 (5.8%) exited the study early. For each successive 30-day period from enrollment up to 150 days after enrollment, of these 157 women, 121 (77.1%) to 129 (82.2%) completed their daily symptom diary; 50 (31.8%) to 56 (35.7%) did so on the same day. Overall, 31.8% (50/157) of the women had good adherence to diary reporting (ie, they completed the task on the same day or 2 to 3 days later for ≥80% of the days enrolled). There were 3-fold higher odds of good adherence for participants aged >34 years versus those aged 25 to 29 years (adjusted odds ratio 3.14, 95% CI 1.10-8.98) and 2-fold higher odds for women with tertiary versus secondary education (adjusted odds ratio 2.26, 95% CI 1.06-4.83). Of the 161 women who ever made a diary entry, 5454 individual symptom reports were made (median 17 per woman; IQR 4-42; range 0-278); 9 (5.6%) women reported symptom combinations triggering a potential arbovirus episode (none had an adverse pregnancy outcome) and 55 (34.2%) reported painful uterine contractions or vaginal bleeding, mainly in the month before delivery. Overall, 51.8% (71/137) of the women rated the app as an excellent experience and were less likely to be poor diary adherers (P=.04) and 99.3% (138/139) reported that the app was easy to understand and use. Conclusions: This pilot found a high adherence to ZIKApp. It demonstrated the feasibility and usability of the app in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arbovirus infections in pregnancy and to optimize maternal care. %M 35896029 %R 10.2196/34423 %U https://formative.jmir.org/2022/7/e34423 %U https://doi.org/10.2196/34423 %U http://www.ncbi.nlm.nih.gov/pubmed/35896029 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37706 %T Developing an mHealth App for Empowering Cancer Survivors With Disabilities: Co-design Study %A Adler,Rachel F %A Morales,Paulina %A Sotelo,Jocelyn %A Magasi,Susan %+ Department of Computer Science, Northeastern Illinois University, 5500 N Saint Louis Ave, Chicago, IL, 60625, United States, 1 7734424710, r-adler@neiu.edu %K user-centered design %K co-design %K mobile health %K mHealth %K cancer survivors %K disabilities %D 2022 %7 26.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The transition from active treatment to long-term cancer survivorship leaves the needs of many cancer survivors unaddressed as they struggle with physical, cognitive, psychological, and social consequences of cancer and its treatment. The lack of guidance after treatment has forced cancer survivors to manage long-term effects on their own, which has an impact on their overall health, quality of life, and social participation. Mobile health (mHealth) interventions can be used to promote self-management and evidence-informed education. Objective: This study aims to design an mHealth app for cancer survivors with disabilities that will offer interventions to improve their quality of life and increase their self-efficacy to manage cancer as a chronic condition. Methods: We organized 3 co-design workshops with cancer survivors (n=5). These workshops included persona development based on data from 25 interviews with cancer survivors with disabilities; prototype ideation, where we sketched ideas for the prototype; and prototype development, where participants critiqued, and suggested improvements for, the wireframes. Results: These workshops helped us to define the challenges that cancer survivors with disabilities face as well as important considerations when designing an mHealth app for cancer survivors with disabilities, such as the need for including flexibility, engagement, socialization, and a minimalistic design. We also outline guidelines for other researchers to follow when planning their own co-design workshops, which include allowing more time for discussion among participants, having small participant groups, keeping workshops engaging and inclusive, and letting participants dream big. Conclusions: Using a co-design process aided us in developing a prototype of an mHealth app for cancer survivors with disabilities as well as a list of guidelines that other researchers can use to develop their own co-design workshops and design their app. Furthermore, working together with cancer survivors ensured that the design team had a deeper sense of empathy toward the target users and kept the focus on our ultimate goal: creating something that cancer survivors would want to use and benefit from. Future work will include usability testing of a high-fidelity prototype based on the results of these workshops. %M 35881439 %R 10.2196/37706 %U https://formative.jmir.org/2022/7/e37706 %U https://doi.org/10.2196/37706 %U http://www.ncbi.nlm.nih.gov/pubmed/35881439 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e31529 %T Development of a Connected Sensor System in Colorectal Surgery: User-Centered Design Case Study %A Schwartz-Lasfargues,Christel %A Roux-Gendron,Camille %A Edomskis,Pim %A Marque,Isabelle %A Bayon,Yves %A Lange,Johan F %A Faucheron,Jean Luc %A Trilling,Bertrand %+ Public Health Department, CHU Grenoble Alpes, Pavillon Taillefer, Grenoble, 38700, France, 33 476767961, imarque1@chu-grenoble.fr %K user-centered design %K usability %K formative evaluation %K medical device %K innovation %K Internet of Things %K IoT %K colorectal surgery %K colorectal anastomotic leakage %K mobile phone %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A successful innovative medical device is not only technically challenging to develop but must also be readily usable to be integrated into health care professionals’ daily practice. Through a user-centered design (UCD) approach, usability can be improved. However, this type of approach is not widely implemented from the early stages of medical device development. Objective: The case study presented here shows how UCD may be applied at the very early stage of the design of a disruptive medical device used in a complex hospital environment, while no functional device is available yet. The device under study is a connected sensor system to detect colorectal anastomotic leakage, the most detrimental complication following colorectal surgery, which has a high medical cost. We also aimed to provide usability guidelines for the initial design of other innovative medical devices. Methods: UCD was implemented by actively involving health care professionals and all the industrial partners of the project. The methodology was conducted in 2 European hospitals: Grenoble-Alpes University Hospital (France) and Erasmus Medical Center Rotterdam (the Netherlands). A total of 6 elective colorectal procedures and 5 ward shifts were observed. In total, 4 workshops were conducted with project partners and clinicians. A formative evaluation was performed based on 5 usability tests using nonfunctional prototype systems. The case study was completed within 12 months. Results: Functional specifications were defined for the various components of the medical device: device weight, size, design, device attachment, and display module. These specifications consider the future integration of the medical device into current clinical practice (for use in an operating room and patient follow-up inside the hospital) and interactions between surgeons, nurses, nurse assistants, and patients. By avoiding irrelevant technical development, this approach helps to promote cost-effective design. Conclusions: This paper presents the successful deployment over 12 months of a UCD methodology for the design of an innovative medical device during its early development phase. To help in reusing this methodology to design other innovative medical devices, we suggested best practices based on this case. %M 35802406 %R 10.2196/31529 %U https://humanfactors.jmir.org/2022/3/e31529 %U https://doi.org/10.2196/31529 %U http://www.ncbi.nlm.nih.gov/pubmed/35802406 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36392 %T Assessing the Views and Needs of People at High Risk of Gestational Diabetes Mellitus for the Development of Mobile Health Apps: Descriptive Qualitative Study %A Duan,Beibei %A Liu,Zhe %A Liu,Weiwei %A Gou,Baohua %+ School of Nursing, Capital Medical University, No. 10, Xi Tou tiao, You'an Men Wai, Feng tai District, Beijing, 100069, China, 86 13581694127, lwwhlxy@ccmu.edu.cn %K gestational diabetes mellitus %K high-risk groups %K mobile health %K mHealth %K applications %K user-centered design %K qualitative research %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early prevention of gestational diabetes mellitus (GDM) can reduce the incidence of not only GDM, but also adverse perinatal pregnancy outcomes. Moreover, it is of great significance to prevent or reduce the occurrence of type 2 diabetes. Mobile health (mHealth) apps can help pregnant women effectively prevent GDM by providing risk prediction, lifestyle support, peer support, professional support, and other functions. Before designing mHealth apps, developers must understand the views and needs of pregnant women, and closely combine users’ needs to develop app functions, in order to better improve user experience and increase the usage rate of these apps in the future. Objective: The objective of this study was to understand the views of the high-risk population of gestational diabetes mellitus on the development of mobile health apps and the demand for app functions, so as to provide a basis for the development of gestational diabetes mellitus prevention apps. Methods: Fifteen pregnant women with at least one risk factor for gestational diabetes were recruited from July to September 2021, and were interviewed via a semistructured interview using the purpose sampling method. The transcribed data were analyzed by the traditional content analysis method, and themes were extracted. Results: Respondents wanted to develop user-friendly and fully functional mobile apps for the prevention of gestational diabetes mellitus. Pregnant women's requirements for app function development include: personalized customization, accurate information support, interactive design, practical tool support, visual presentation, convenient professional support, peer support, reasonable reminder function, appropriate maternal and infant auxiliary function, and differentiated incentive function.These function settings can encourage pregnant women to improve or maintain healthy living habits during their use of the app Conclusions: This study discusses the functional requirements of target users for gestational diabetes mellitus prevention apps, which can provide reference for the development of future applications. %M 35802414 %R 10.2196/36392 %U https://formative.jmir.org/2022/7/e36392 %U https://doi.org/10.2196/36392 %U http://www.ncbi.nlm.nih.gov/pubmed/35802414 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e33541 %T Development of a Maternal and Child mHealth Intervention With Aboriginal and Torres Strait Islander Mothers: Co-design Approach %A Perkes,Sarah Jane %A Huntriss,Belinda %A Skinner,Noelene %A Leece,Bernise %A Dobson,Rosie %A Mattes,Joerg %A Hall,Kerry %A Bonevski,Billie %+ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, South Australia, 5042, Australia, 61 451994827, sarah.perkes@newcastle.edu.au %K mHealth %K co-design %K Aboriginal and Torres Strait Islander %K mother %K baby %K young children %K mobile phone %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite their growing popularity, there are very few mobile health (mHealth) interventions for Aboriginal and Torres Strait Islander people that are culturally safe and evidence based. A co-design approach is considered a suitable methodology for developing health interventions with Aboriginal and Torres Strait Islander people. Objective: The aim of this study was to co-design an mHealth intervention to improve health knowledge, health behaviors, and access to health services for women caring for young Aboriginal and Torres Strait Islander children. Methods: Aboriginal researchers led engagement and recruitment with health services and participants in 3 Aboriginal and Torres Strait Islander communities in New South Wales, Australia. Focus groups and interviews were facilitated by researchers and an app developer to gather information on 3 predetermined themes: design characteristics, content modules, and features and functions. Findings from the co-design led to the development of an intervention prototype. Theories of health behavior change were used to underpin intervention components. Existing publicly available evidence-based information was used to develop content. Governance was provided by an Aboriginal advisory group. Results: In total, 31 mothers and 11 health professionals participated in 8 co-design focus groups and 12 interviews from June 2019 to September 2019. The 6 design characteristics identified as important were credibility, Aboriginal and Torres Strait Islander designs and cultural safety, family centeredness, supportive, simple to use, and confidential. The content includes 6 modules for women’s health: Smoke-free families, Safe drinking, Feeling good, Women’s business, Eating, and Exercising. The content also includes 6 modules for children’s health: Breathing well; Sleeping; Milestones; Feeding and eating; Vaccinations and medicines; and Ears, eyes, and teeth. In addition, 6 technology features and functions were identified: content feed, social connection, reminders, rewards, communication with health professionals, and use of videos. Conclusions: An mHealth intervention that included app, Facebook page, and SMS text messaging modalities was developed based on the co-design findings. The intervention incorporates health behavior change theory, evidence-based information, and the preferences of Aboriginal and Torres Strait Islander women and health professionals. A pilot study is now needed to assess the acceptability and feasibility of the intervention. %M 35802404 %R 10.2196/33541 %U https://formative.jmir.org/2022/7/e33541 %U https://doi.org/10.2196/33541 %U http://www.ncbi.nlm.nih.gov/pubmed/35802404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37933 %T Chinese Version of the Mobile Health App Usability Questionnaire: Translation, Adaptation, and Validation Study %A Shan,Yi %A Ji,Meng %A Xie,Wenxiu %A Li,Rongying %A Qian,Xiaobo %A Zhang,Xiaomin %A Hao,Tianyong %+ School of Foreign Studies, Nantong University, Number 9, Seyuan Road, Nantong, 226019, China, 86 15558121896, victorsyhz@hotmail.com %K mHealth app %K usability %K Chinese version of MAUQ %K improved translation %K validity %K stability %K reliability %K cross-cultural adaptability %K mobile phone %D 2022 %7 6.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The usability of mobile health (mHealth) apps needs to be effectively evaluated before they are officially approved to be used to deliver health interventions. To this end, the mHealth App Usability Questionnaire (MAUQ) has been designed and proved valid and reliable in assessing the usability of mHealth apps. However, this English questionnaire needs to be translated into other languages, adapted, and validated before being utilized to evaluate the usability of mHealth apps. Objective: This study aims to improve, further adapt, and validate the Chinese version of the MAUQ (C-MAUQ; interactive for patients) on Left-handed Doctor, one of the most popular “reaching out to patients” interactive mHealth apps with chatbot function in China, to test the reliability and cross-cultural adaptability of the questionnaire. Methods: The MAUQ (interactive for patients) has been translated into Chinese and validated for its reliability on Good Doctor, one of the most influential “reaching out to patients” mHealth apps without chatbot function in China. After asking for the researchers’ approval to use this Chinese version, we adjusted and further adapted the C-MAUQ by checking it against the original English version and improving its comprehensibility, readability, idiomaticity, and cross-cultural adaptability. Following a trial survey completed by 50 respondents on wenjuanxing, the most popular online questionnaire platform in China, the improved version of the C-MAUQ (I-C-MAUQ) was finally used to evaluate the usability of Left-handed Doctor through an online questionnaire survey (answered by 322 participants) on wenjuanxing, to test its internal consistency, reliability, and validity. Results: The I-C-MAUQ still retained the 21 items and 3 dimensions of the original MAUQ: 8 items for usability and satisfaction, 6 items for system information arrangement, and 7 items for efficiency. The translation problems in the C-MAUQ, including (1) redundancy, (2) incompleteness, (3) misuse of parts of speech, (4) choice of inappropriate words, (5) incomprehensibility, and (6) cultural difference–induced improper translation, were improved. As shown in the analysis of data obtained through the online survey, the I-C-MAUQ had a better internal consistency (ie, the correlation coefficient between the score of each item and the total score of the questionnaire determined within the range of 0.861-0.938; P<.01), reliability (Cronbach α=.988), and validity (Kaiser–Meyer–Olkin=0.973), compared with the C-MAUQ. It was effectively used to test the usability of Left-handed Doctor, eliciting over 80% of informants’ positive attitudes toward this mHealth app. Conclusions: The I-C-MAUQ is highly reliable and valid for Left-handed Doctor, and suitable for testing the usability of interactive mHealth apps used by patients in China. This finding further confirms the cross-cultural validity, reliability, and adaptability of the MAUQ. We identified certain factors influencing the perceived usability of mHealth apps, including users’ age, gender, education, profession, and possibly previous experience with mHealth apps and the chatbot function of such apps. Most notably, we found a wider acceptance of this new technology among young Chinese female college students who were more engaged in the interaction with health care chatbots. The age-, gender-, and profession-induced preference for new digital health interventions in China aligns with the findings in other similar studies in America and Malaysia. This preference identifies areas for further research on the social, cultural, and gender adaptation of health technologies. %M 35793132 %R 10.2196/37933 %U https://formative.jmir.org/2022/7/e37933 %U https://doi.org/10.2196/37933 %U http://www.ncbi.nlm.nih.gov/pubmed/35793132 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37291 %T Optimization of the Chronic Kidney Disease–Peritoneal Dialysis App to Improve Care for Patients on Peritoneal Dialysis in Northeast Thailand: User-Centered Design Study %A Lukkanalikitkul,Eakalak %A Kongpetch,Sawinee %A Chotmongkol,Wijittra %A Morley,Michael G %A Anutrakulchai,Sirirat %A Srichan,Chavis %A Thinkhamrop,Bandit %A Chunghom,Theenatchar %A Wiangnon,Pongsai %A Thinkhamrop,Wilaiphorn %A Morley,Katharine E %+ Massachusetts General Hospital Center for Global Health, Harvard Medical School, 125 Nashua St. Suite 722, Boston, MA, 02114, United States, 1 617 726 2000, kemorley@mgh.harvard.edu %K peritoneal %K dialysis %K peritoneum %K mobile health %K mHealth %K rapid cycle process improvement methodology %K home monitoring %K near-field communication %K monitor %K kidney %K rapid cycle improvement %K quality improvement %K process improvement %K methodology %K nephrology %K nephrologist %K internal medicine %K computer program %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K usability %K interface %K metric capture %K barrier %K renal %K mobile phone %D 2022 %7 6.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of peritoneal dialysis (PD) in Thailand is increasing rapidly in part because of Thailand’s Peritoneal Dialysis First policy. PD is a home-based renal replacement therapy in which patients with chronic kidney disease perform up to 4 exchanges of dialysate fluid per day in the peritoneal cavity. Overhydration is one of the most common complications in patients on PD and is associated with increased morbidity and mortality. To monitor hydration status, patients collect hydration metrics, including body weight, blood pressure, urine output, and ultrafiltration volume, from each dialysis cycle and enter this information into a PD logbook. This information is reviewed bimonthly at PD clinic appointments. The chronic kidney disease-PD (CKD-PD) app with near-field communication (NFC) and optical character recognition (OCR) was developed to automate hydration metric collection. The information was displayed in the app for self-monitoring and uploaded to a database for real-time monitoring by the PD clinic staff. Early detection and treatment of overhydration could potentially reduce the morbidity and mortality related to overhydration. Objective: This study aims to identify usability issues and technology adoption barriers for the CKD-PD app with NFC and OCR and a monitoring system and to use this information to make rapid cycle improvements. Methods: A multidisciplinary team of nephrologists, PD clinic nurses, computer programmers, and engineers trained and observed 2 groups of 5 participants in the use of the CKD-PD app with NFC and OCR and a monitoring system. The participants were observed using technology in their homes in 3 phases. The data collected included the Unified Theory of Acceptance and Use of Technology questionnaire, think-aloud observation, user ratings, completion of hydration metrics, and upload of hydration metrics to the central database. These results were used by the team between phases to improve the functionality and usefulness of the app. Results: The CKD-PD app with NFC and OCR and a monitoring system underwent 3 rapid improvement cycles. Issues were identified regarding the usability of the NFC and OCR data collection, app stability, user interface, hydration metric calculation, and display. NFC and OCR improved hydration metric capture; however, issues remained with their usability. App stability and user interface issues were corrected, and hydration metrics were successfully uploaded by the end of phase 3. Participants’ scores on technology adoption decreased but were still high, and there was enthusiasm for the self-monitoring and clinical communication features. Conclusions: Our rapid cycle process improvement methodology identified and resolved key barriers and usability issues for the CKD-PD app with NFC and OCR and a monitoring system. We believe that this methodology can be accomplished with limited training in data collection, statistical analysis, and funding. %M 35793137 %R 10.2196/37291 %U https://formative.jmir.org/2022/7/e37291 %U https://doi.org/10.2196/37291 %U http://www.ncbi.nlm.nih.gov/pubmed/35793137 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36091 %T Development of a WeChat-based Mobile Messaging Smoking Cessation Intervention for Chinese Immigrant Smokers: Qualitative Interview Study %A Jiang,Nan %A Rogers,Erin S %A Cupertino,Paula %A Zhao,Xiaoquan %A Cartujano-Barrera,Francisco %A Lyu,Joanne Chen %A Hu,Lu %A Sherman,Scott E %+ Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, Rm #17-54, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org %K smoking cessation %K text messaging %K mobile health %K Chinese American %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking remains a major public health issue among Chinese immigrants. Smoking cessation programs that focus on this population are scarce and have a limited population-level impact due to their low reach. Mobile messaging interventions have the potential to reach large audiences and expand smokers’ access to smoking cessation treatment. Objective: This study describes the development of a culturally and linguistically appropriate mobile messaging smoking cessation intervention for Chinese immigrant smokers delivered via WeChat, the most frequently used social media platform among Chinese people globally. Methods: This study had 2 phases. In phase 1, we developed a mobile message library based on social cognitive theory and the US Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We culturally adapted messages from 2 social cognitive theory-based text messaging smoking cessation programs (SmokefreeTXT and Decídetexto). We also developed new messages targeting smokers who were not ready to quit smoking and novel content addressing Chinese immigrant smokers’ barriers to quitting and common misconceptions related to willpower and nicotine replacement therapy. In phase 2, we conducted in-depth interviews with 20 Chinese immigrant smokers (including 7 women) in New York City between July and August 2021. The interviews explored the participants’ smoking and quitting experiences followed by assessment of the text messages. Participants reviewed 17 text messages (6 educational messages, 3 self-efficacy messages, and 8 skill messages) via WeChat and rated to what extent the messages enhanced their motivation to quit, promoted confidence in quitting, and increased awareness about quitting strategies. The interviews sought feedback on poorly rated messages, explored participant preferences for content, length, and format, discussed their concerns with WeChat cessation intervention, and solicited recommendations for frequency and timing of messages. Results: Overall, participants reported that the messages enhanced their motivation to quit, offered encouragement, and made them more informed about how to quit. Participants particularly liked the messages about the harms of smoking and strategies for quitting. They reported barriers to applying some of the quitting strategies, including coping with stress and staying abstinent at work. Participants expressed strong interest in the WeChat mobile messaging cessation intervention and commented on its potential to expand their access to smoking cessation treatment. Conclusions: Mobile messages are well accepted by Chinese immigrant smokers. Research is needed to assess the feasibility, acceptability, and efficacy of WeChat mobile messaging smoking cessation interventions for promoting abstinence among Chinese immigrant smokers. %M 35771603 %R 10.2196/36091 %U https://formative.jmir.org/2022/6/e36091 %U https://doi.org/10.2196/36091 %U http://www.ncbi.nlm.nih.gov/pubmed/35771603 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e35997 %T Innovative App (ExoDont) and Other Conventional Methods to Improve Patient Compliance After Minor Oral Surgical Procedures: Pilot, Nonrandomized, and Prospective Comparative Study %A Sybil,Deborah %A Krishna,Meenakshi %A Shrivastava,Priyanshu Kumar %A Singh,Shradha %A Khan,Imran %+ Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, Maulana Mohammad Ali Jauhar Marg, Jamia Nagar, Delhi, 110025, India, 91 9958756661, ikhan3@jmi.ac.in %K ExoDont %K mHealth %K mobile health %K Android app %K dental extraction %K postoperative %K oral surgery %K dentistry %K teledentistry %K mobile app %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Postoperative care is influenced by various factors such as compliance, comprehension, retention of instructions, and other unaccounted elements. It is imperative that patients adhere to the instructions and prescribed regimen for smooth and placid healing. ExoDont, an Android-based mobile health app, was designed to ensure a smooth postoperative period for patients after a dental extraction. Besides providing postoperative instructions at defined intervals, the app also sends drug reminders as an added advantage over other available, conventional methods. Objective: The aim of this study was to compare the compliance rate of individuals with respect to the prescribed regimen and postoperative instructions. Additionally, we aimed to assess any changes in the postoperative complication rate of patients assigned to 3 categories: the verbal, verbal plus written, and ExoDont app-based delivery groups. Methods: We conducted a pilot, nonrandomized, and prospective comparative study in which patients after tooth extraction were assigned to 3 groups—verbal (Group A), verbal plus written (Group B), and ExoDont app-based delivery (Group C)—based on the eligibility criteria, and a 1-week follow-up was planned to obtain the responses regarding compliance and postoperative complications from the participants. Results: In total, 90 patients were recruited and equally divided into 3 groups. Compliance to prescribed drug was found to be the highest in Group C, where of the 30 participants, 25 (83%) and 28 (93%) followed the entire course of antibiotics and analgesics, respectively. For postoperative instructions, higher compliance was observed in Group C in relation to compliance to diet restrictions (P=.001), not rinsing for 24 hours (P<.001), and warm saline rinses after 24 hours (P=.001). However, the difference was not significant for smoking restrictions (P=.07) and avoiding alcohol (P=.16). Moreover, the difference in postoperative complication rate was not statistically significant among the 3 groups (P=.31). Conclusions: As evident from the results, it is anticipated that the ExoDont app will be helpful in circumventing the unaccounted possibilities of missing the prescribed dosage and postoperative instructions and ensuring the smooth recovery of patients after dental extraction. However, future studies are required to establish this app-based method of delivery of postoperative instructions as a viable option in routine clinical practice. %M 35763332 %R 10.2196/35997 %U https://periop.jmir.org/2022/1/e35997 %U https://doi.org/10.2196/35997 %U http://www.ncbi.nlm.nih.gov/pubmed/35763332 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33849 %T Co-created Mobile Apps for Palliative Care Using Community-Partnered Participatory Research: Development and Usability Study %A Al-Mondhiry,Jafar %A D'Ambruoso,Sarah %A Pietras,Christopher %A Strouse,Thomas %A Benzeevi,Dikla %A Arevian,Armen C %A Wells,Kenneth B %+ Division of Medical Oncology, Department of Medicine, University of Southern California, Keck School of Medicine, 1441 Eastlake Ave., NTT 3440, Los Angeles, CA, 90089, United States, 1 717 919 2250, Jafar.AlMondhiry@med.usc.edu %K mobile phone %K mobile apps %K mobile health %K mHealth %K eHealth %K digital health %K palliative care %K quality of life %K survivorship %K patient advocacy %K oncology %K patient-reported outcomes %K PRO %K community-partnered participatory research %K CPPR %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Open design formats for mobile apps help clinicians and stakeholders bring their needs to direct, co-creative solutions. Palliative care for patients with advanced cancers requires intensive monitoring and support and remains an area in high need for innovation. Objective: This study aims to use community-partnered participatory research to co-design and pretest a mobile app that focuses on palliative care priorities of clinicians and patients with advanced cancer. Methods: In-person and teleconference workshops were held with patient and family stakeholders, researchers, and clinicians in palliative care and oncology. Question prompts, written feedback, semistructured interviews, and facilitated group discussions identified the core palliative care needs. Using Chorus, a no-code app-building platform, a mobile app was co-designed with the stakeholders. A pretest with 11 patients was conducted, with semistructured interviews of clinician and patient users for feedback. Results: Key themes identified from the focus groups included needs for patient advocacy and encouragement, access to vetted information, patient-clinician communication support, and symptom management. The initial prototype, My Wellness App, contained a weekly wellness journal to track patient-reported symptoms, goals, and medication use; information on self-management of symptoms; community resources; and patient and caregiver testimonial videos. Initial pretesting identified value in app-based communication for clinicians, patients, and caregivers, with suggestions for improving user interface, feedback and presentation of symptom reports, and gamification and staff coordinators to support patient app engagement. Conclusions: The development of a mobile app using community-partnered participatory research is a low-technology and feasible intervention for palliative care. Iterative redesign and user interface expertise may improve implementation. %M 35737441 %R 10.2196/33849 %U https://formative.jmir.org/2022/6/e33849 %U https://doi.org/10.2196/33849 %U http://www.ncbi.nlm.nih.gov/pubmed/35737441 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e31011 %T Assessing the Risk Factors For Diagnosed Symptomatic Dry Eye Using a Smartphone App: Cross-sectional Study %A Kasetsuwan,Ngamjit %A Suwan-Apichon,Olan %A Lekhanont,Kaevalin %A Chuckpaiwong,Varintorn %A Reinprayoon,Usanee %A Chantra,Somporn %A Puangsricharern,Vilavun %A Pariyakanok,Lalida %A Prabhasawat,Pinnita %A Tesavibul,Nattaporn %A Chaidaroon,Winai %A Tananuvat,Napaporn %A Hirunpat,Chakree %A Prakairungthong,Nauljira %A Sansanayudh,Wiwan %A Chirapapaisan,Chareenun %A Phrueksaudomchai,Pakornkit %+ Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Rama 4 Rd Pathum Wan, Pathumwan District, Bangkok, 10330, Thailand, 66 22564000 ext 81875, ngamjitk@gmail.com %K blink rate %K dry eye %K smartphone application %K maximum blink interval %K prevalence %K mHealth %K epidemiology %K screening %K risk factors %K symptoms %K ophthalmology %K vision %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dry eye (DE) is a chronic inflammatory disease of the ocular surface of the eye that affects millions of people throughout the world. Smartphone use as an effective health care tool has grown exponentially. The “Dry eye or not?” app was created to evaluate the prevalence of symptomatic DE, screen for its occurrence, and provide feedback to users with symptomatic DE throughout Thailand. Objective: The purpose of this study was to compare the prevalence of symptomatic dry eye (DE), blink rate, maximum blink interval (MBI), and best spectacle-corrected visual acuity (BSCVA) between people with and without symptomatic DE and to identify risk factors for symptomatic DE in Thailand. Methods: This cross-sectional study sourced data from the “Dry eye or not?” smartphone app between November 2019 and July 2020. This app collected demographic data, Ocular Surface Disease Index (OSDI) score, blink rate, MBI, BSCVA, and visual display terminal (VDT) use data. The criterion for symptomatic DE was OSDI score ≥13. Results: The prevalence of symptomatic DE among individuals using this smartphone app in Thailand was 85.8% (8131/9482), with the Northeastern region of Thailand having the highest prevalence, followed by the Northern region. Worse BSCVA (median 0.20, IQR 0.40; P=.02), increased blink rate (median 18, IQR 16; P<.001), reduced MBI (median 8.90, IQR 10.80; P<.001), female sex (adjusted OR 1.83; 95% CI 1.59-2.09; P<.001), more than 6 hours of VDT use (adjusted OR 1.59; 95% CI 1.15-2.19; P=.004), and lower than bachelor’s degree (adjusted OR 1.30; 95% CI 1.03-1.64; P=.02) were significantly associated with symptomatic DE. An age over 50 years (adjusted OR 0.77; 95% CI 0.60-0.99) was significantly less associated with symptomatic DE (P=.04). Conclusions: This smartphone DE app showed that the prevalence of symptomatic DE in Thailand was 85.8%. Signs and risk factors could be also evaluated with this smartphone DE app. Screening for DE by this app may allow for the development of strategic plans for health care systems in Thailand. %M 35731569 %R 10.2196/31011 %U https://mhealth.jmir.org/2022/6/e31011 %U https://doi.org/10.2196/31011 %U http://www.ncbi.nlm.nih.gov/pubmed/35731569 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e29856 %T Tailoring Mobile Data Collection for Intervention Research in a Challenging Context: Development and Implementation in the Malakit Study %A Lambert,Yann %A Galindo,Muriel %A Suárez-Mutis,Martha %A Mutricy,Louise %A Sanna,Alice %A Garancher,Laure %A Cairo,Hedley %A Hiwat,Helene %A Bordalo Miller,Jane %A Gomes,José Hermenegildo %A Marchesini,Paola %A Adenis,Antoine %A Nacher,Mathieu %A Vreden,Stephen %A Douine,Maylis %+ Centre d’Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Avenue des Flamboyants, Cayenne, 97300, French Guiana, 594 594 39 48 64, yann.lambert@ch-cayenne.fr %K malaria %K Guiana Shield %K information system %K mobile data collection %K Open Data Kit %K ODK %D 2022 %7 16.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: An interventional study named Malakit was implemented between April 2018 and March 2020 to address malaria in gold mining areas in French Guiana, in collaboration with Suriname and Brazil. This innovative intervention relied on the distribution of kits for self-diagnosis and self-treatment to gold miners after training by health mediators, referred to in the project as facilitators. Objective: This paper aims to describe the process by which the information system was designed, developed, and implemented to achieve the monitoring and evaluation of the Malakit intervention. Methods: The intervention was implemented in challenging conditions at five cross-border distribution sites, which imposed strong logistical constraints for the design of the information system: isolation in the Amazon rainforest, tropical climate, and lack of reliable electricity supply and internet connection. Additional constraints originated from the interaction of the multicultural players involved in the study. The Malakit information system was developed as a patchwork of existing open-source software, commercial services, and tools developed in-house. Facilitators collected data from participants using Android tablets with ODK (Open Data Kit) Collect. A custom R package and a dashboard web app were developed to retrieve, decrypt, aggregate, monitor, and clean data according to feedback from facilitators and supervision visits on the field. Results: Between April 2018 and March 2020, nine facilitators generated a total of 4863 form records, corresponding to an average of 202 records per month. Facilitators’ feedback was essential for adapting and improving mobile data collection and monitoring. Few technical issues were reported. The median duration of data capture was 5 (IQR 3-7) minutes, suggesting that electronic data capture was not taking more time from participants, and it decreased over the course of the study as facilitators become more experienced. The quality of data collected by facilitators was satisfactory, with only 3.03% (147/4849) of form records requiring correction. Conclusions: The development of the information system for the Malakit project was a source of innovation that mirrored the inventiveness of the intervention itself. Our experience confirms that even in a challenging environment, it is possible to produce good-quality data and evaluate a complex health intervention by carefully adapting tools to field constraints and health mediators’ experience. Trial Registration: ClinicalTrials.gov NCT03695770; https://clinicaltrials.gov/ct2/show/NCT03695770 %M 35708763 %R 10.2196/29856 %U https://formative.jmir.org/2022/6/e29856 %U https://doi.org/10.2196/29856 %U http://www.ncbi.nlm.nih.gov/pubmed/35708763 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38283 %T Assessing the Initial Validity of the PortionSize App to Estimate Dietary Intake Among Adults: Pilot and Feasibility App Validation Study %A Saha,Sanjoy %A Lozano,Chloe Panizza %A Broyles,Stephanie %A Martin,Corby K %A Apolzan,John W %+ Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, 70808, United States, 1 2257632827, john.apolzan@pbrc.edu %K dietary assessment %K eating %K food intake %K energy intake %K portion size %K mHealth %K digital health %K eHealth %K nutrition %K food groups %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurately assessing dietary intake can promote improved nutrition. The PortionSize app (Pennington Biomedical Research Center) was designed to quantify and provide real-time feedback on the intake of energy, food groups, saturated fat, and added sugar. Objective: This study aimed to assess the preliminary feasibility and validity of estimating food intake via the PortionSize app among adults. Methods: A total of 15 adults (aged 18-65 years) were recruited and trained to quantify the food intake from a simulated meal by using PortionSize. Trained personnel prepared 15 simulated meals and covertly weighed (weigh back) the amount of food provided to participants as well as food waste. Equivalence tests (±25% bounds) were performed to compare PortionSize to the weigh back method. Results: Participants were aged a mean of 28 (SD 12) years, and 11 were female. The mean energy intake estimated with PortionSize was 742.9 (SD 328.2) kcal, and that estimated via weigh back was 659.3 (SD 190.7) kcal (energy intake difference: mean 83.5, SD 287.5 kcal). The methods were not equivalent in estimating energy intake (P=.18), and PortionSize overestimated energy intake by 83.5 kcal (12.7%) at the meal level. Estimates of portion sizes (gram weight; P=.01), total sugar (P=.049), fruit servings (P=.01), and dairy servings (P=.047) from PortionSize were equivalent to those estimated via weigh back. PortionSize was not equivalent to weigh back with regard to estimates for carbohydrate (P=.10), fat (P=.32), vegetable (P=.37), grain (P=.31), and protein servings (P=.87). Conclusions: Due to power limitations, the equivalence tests had large equivalence bounds. Though preliminary, the results of this small pilot study warrant the further adaptation, development, and validation of PortionSize as a means to estimate energy intake and provide users with real-time and actionable dietary feedback. %M 35704355 %R 10.2196/38283 %U https://formative.jmir.org/2022/6/e38283 %U https://doi.org/10.2196/38283 %U http://www.ncbi.nlm.nih.gov/pubmed/35704355 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e39198 %T Authors’ Response to: Additional Measurement Approaches for Sleep Disturbances. Comment on “Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study” %A Carney,Colleen E %A Carmona,Nicole E %+ Toronto Metropolitan University, Jorgenson Hall, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 4169795000 ext 552177, ccarney@ryerson.ca %K youth %K sleep %K technology %K mHealth %K self-management %K adolescents %K young adults %K mobile phone %K smartphone %K polysomnography %D 2022 %7 13.6.2022 %9 Letter to the Editor %J JMIR Form Res %G English %X %M 35699990 %R 10.2196/39198 %U https://formative.jmir.org/2022/6/e39198 %U https://doi.org/10.2196/39198 %U http://www.ncbi.nlm.nih.gov/pubmed/35699990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38075 %T Interest in HIV Prevention Mobile Phone Apps: Focus Group Study With Sexual and Gender Minority Persons Living in the Rural Southern United States %A Jones,Jeb %A Edwards,O Winslow %A Merrill,Leland %A Sullivan,Patrick S %A Stephenson,Rob %+ Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 4047122275, jeb.jones@emory.edu %K men who have sex with men %K transgender persons %K nonbinary persons %K mHealth %K mobile app %K HIV %K pre-exposure prophylaxis %K PrEP %K sexually transmitted infection testing %K STI testing %K HIV testing %K mobile phone %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions, including smartphone apps, have been found to be an effective means of increasing the uptake of HIV prevention tools, including HIV and sexually transmitted infection (STI) tests and pre-exposure prophylaxis. However, most HIV prevention mHealth apps tested in the United States have been tested among populations living in areas surrounding urban centers. Owing to reduced access to broadband internet and reliable cellular data services, it remains unclear how accessible and effective these interventions will be in rural areas. In addition, gay and bisexual men who have sex with men and gender minority populations in rural areas experience enhanced stigma when compared with their more urban counterparts, and these experiences might affect their willingness and interest in mHealth apps. Objective: This study aimed to conduct online focus groups with men who have sex with men and transgender and gender diverse populations in the rural southern United States to assess their interest in mHealth HIV prevention apps and the features that they would be the most interested in using. Methods: Focus group participants were recruited from a larger pool of sexual and gender minority respondents to a web-based research survey. The participants indicated that they would be willing to participate in an online focus group discussion. Focus groups were conducted via secure Zoom (Zoom Video Communications Inc) videoconferencing. During the focus group discussions, participants were asked to discuss their experiences with HIV and STI prevention and how these experiences were affected by living in a rural area. They were then shown screenshots of a new app to promote HIV and STI prevention among rural populations and asked to provide their opinions on the app’s features. The transcripts of the discussions were reviewed and coded using a constant comparative approach. Results: A total of 6 focus groups were conducted with 26 participants. Most participants were cisgender gay and bisexual men who have sex with men (19/26, 73%); the remaining participants were transgender men (2/26, 8%), were nonbinary people (2/26, 8%), or had multiple gender identities (3/26, 12%). Participants reported numerous barriers to accessing HIV and STI prevention services and accurate information about HIV and STI prevention options. Overall, the participants reported a high degree of interest in mHealth interventions for HIV and STI prevention and suggested several recommendations for the features of an app-based intervention that would be the most useful for rural residents. Conclusions: These focus group discussions indicate that rural residence is not a major barrier to mHealth HIV and STI prevention intervention implementation and that there is a high degree of interest in these approaches to HIV and STI prevention. %M 35699980 %R 10.2196/38075 %U https://formative.jmir.org/2022/6/e38075 %U https://doi.org/10.2196/38075 %U http://www.ncbi.nlm.nih.gov/pubmed/35699980 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35959 %T Additional Measurement Approaches for Sleep Disturbances. Comment on “A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study” %A Tsai,Wan-Tong %A Liu,Tzung-Liang %+ Chung Shan Medical University, No 110, Sec 1, Jianguo N Rd, South District, Taichung City, 40201, Taiwan, 886 968938360, science.tsai@gmail.com %K youth %K sleep %K technology %K mHealth %K self-management %K adolescents %K young adults %K mobile phone %K smartphone %K polysomnography %D 2022 %7 13.6.2022 %9 Letter to the Editor %J JMIR Form Res %G English %X %M 35700003 %R 10.2196/35959 %U https://formative.jmir.org/2022/6/e35959 %U https://doi.org/10.2196/35959 %U http://www.ncbi.nlm.nih.gov/pubmed/35700003 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e34191 %T Electronic Health Record–Based Recruitment and Retention and Mobile Health App Usage: Multisite Cohort Study %A Coughlin,Janelle W %A Martin,Lindsay M %A Zhao,Di %A Goheer,Attia %A Woolf,Thomas B %A Holzhauer,Katherine %A Lehmann,Harold P %A Lent,Michelle R %A McTigue,Kathleen M %A Clark,Jeanne M %A Bennett,Wendy L %+ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive Suite 100, Baltimore, MD, 21224, United States, 1 410 550 7988, jwilder3@jhmi.edu %K mHealth %K mobile apps %K recruitment %K engagement %K retention %K timing of eating %K timing of sleep %K obesity %K EHR %D 2022 %7 10.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: To address the obesity epidemic, there is a need for novel paradigms, including those that address the timing of eating and sleep in relation to circadian rhythms. Electronic health records (EHRs) are an efficient way to identify potentially eligible participants for health research studies. Mobile health (mHealth) apps offer available and convenient data collection of health behaviors, such as timing of eating and sleep. Objective: The aim of this descriptive analysis was to report on recruitment, retention, and app use from a 6-month cohort study using a mobile app called Daily24. Methods: Using an EHR query, adult patients from three health care systems in the PaTH clinical research network were identified as potentially eligible, invited electronically to participate, and instructed to download and use the Daily24 mobile app, which focuses on eating and sleep timing. Online surveys were completed at baseline and 4 months. We described app use and identified predictors of app use, defined as 1 or more days of use, versus nonuse and usage categories (ie, immediate, consistent, and sustained) using multivariate regression analyses. Results: Of 70,661 patients who were sent research invitations, 1021 (1.44%) completed electronic consent forms and online baseline surveys; 4 withdrew, leaving a total of 1017 participants in the analytic sample. A total of 53.79% (n=547) of the participants were app users and, of those, 75.3% (n=412), 50.1% (n=274), and 25.4% (n=139) were immediate, consistent, and sustained users, respectively. Median app use was 28 (IQR 7-75) days over 6 months. Younger age, White race, higher educational level, higher income, having no children younger than 18 years, and having used 1 to 5 health apps significantly predicted app use (vs nonuse) in adjusted models. Older age and lower BMI predicted early, consistent, and sustained use. About half (532/1017, 52.31%) of the participants completed the 4-month online surveys. A total of 33.5% (183/547), 29.3% (157/536), and 27.1% (143/527) of app users were still using the app for at least 2 days per month during months 4, 5, and 6 of the study, respectively. Conclusions: EHR recruitment offers an efficient (ie, high reach, low touch, and minimal participant burden) approach to recruiting participants from health care settings into mHealth research. Efforts to recruit and retain less engaged subgroups are needed to collect more generalizable data. Additionally, future app iterations should include more evidence-based features to increase participant use. %M 35687400 %R 10.2196/34191 %U https://www.jmir.org/2022/6/e34191 %U https://doi.org/10.2196/34191 %U http://www.ncbi.nlm.nih.gov/pubmed/35687400 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e31069 %T Viewing Mobile Health Technology Design Through the Lens of Amplification Theory %A Merid,Beza %A Robles,Maria Cielito %A Nallamothu,Brahmajee K %A Newman,Mark W %A Skolarus,Lesli E %+ School for the Future of Innovation in Society, Arizona State University, 1120 South Cady Mall, Tempe, AZ, 85281, United States, 1 (480) 727 8787, Beza.Merid@asu.edu %K mHealth %K digital health %K cardiovascular disease %K high blood pressure %K structural barriers to health %K racial health disparities %K Amplification Theory of Technology %D 2022 %7 10.6.2022 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Digital health interventions designed to promote health equity can be valuable tools in the delivery of health care to hardly served patient populations. But if the design of these technologies and the interventions in which they are deployed do not address the myriad structural barriers to care that minoritized patients, patients in rural areas, and patients who have trouble paying for care often face, their impact may be limited. Drawing on our mobile health (mHealth) research in the arena of cardiovascular care and blood pressure management, this viewpoint argues that health care providers and researchers should tend to structural barriers to care as a part of their digital health intervention design. Our 3-step predesign framework, informed by the Amplification Theory of Technology, offers a model that interventionists can follow to address these concerns. %M 35687411 %R 10.2196/31069 %U https://mhealth.jmir.org/2022/6/e31069 %U https://doi.org/10.2196/31069 %U http://www.ncbi.nlm.nih.gov/pubmed/35687411 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36052 %T A Web-Based, Provider-Driven Mobile App to Enhance Patient Care Coordination Between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study %A Plantinga,Laura C %A Hoge,Courtney %A Vandenberg,Ann E %A James,Kyle %A Masud,Tahsin %A Khakharia,Anjali %A Gray,Carol %A Jaar,Bernard G %A Lea,Janice P %A O'Donnell,Christopher M %A Mutell,Richard %+ Department of Medicine, Emory University, 1841 Clifton Road, Room 552, Atlanta, GA, 30329, United States, 1 4047273460, laura.plantinga@emory.edu %K dialysis %K hospitals %K physicians %K advanced practice providers %K nurses %K care coordination %K mobile app %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: We piloted a web-based, provider-driven mobile app (DialysisConnect) to fill the communication and care coordination gap between hospitals and dialysis facilities. Objective: This study aimed to describe the development and pilot implementation of DialysisConnect. Methods: DialysisConnect was developed iteratively with focus group and user testing feedback and was made available to 120 potential users at 1 hospital (hospitalists, advanced practice providers [APPs], and care coordinators) and 4 affiliated dialysis facilities (nephrologists, APPs, nurses and nurse managers, social workers, and administrative personnel) before the start of the pilot (November 1, 2020, to May 31, 2021). Midpilot and end-of-pilot web-based surveys of potential users were also conducted. Descriptive statistics were used to describe system use patterns, ratings of multiple satisfaction items (1=not at all; 3=to a great extent), and provider-selected motivators of and barriers to using DialysisConnect. Results: The pilot version of DialysisConnect included clinical information that was automatically uploaded from dialysis facilities, forms for entering critical admission and discharge information, and a direct communication channel. Although physicians comprised most of the potential users of DialysisConnect, APPs and dialysis nurses were the most active users. Activities were unevenly distributed; for example, 1 hospital-based APP recorded most of the admissions (280/309, 90.6%) among patients treated at the pilot dialysis facilities. End-of-pilot ratings of DialysisConnect were generally higher for users versus nonusers (eg, “I can see the potential value of DialysisConnect for my work with dialysis patients”: mean 2.8, SD 0.4, vs mean 2.3, SD 0.6; P=.02). Providers most commonly selected reduced time and energy spent gathering information as a motivator (11/26, 42%) and a lack of time to use the system as a barrier (8/26, 31%) at the end of the pilot. Conclusions: This pilot study found that APPs and nurses were most likely to engage with the system. Survey participants generally viewed the system favorably while identifying substantial barriers to its use. These results inform how best to motivate providers to use this system and similar systems and inform future pragmatic research in care coordination among this and other populations. %M 35687405 %R 10.2196/36052 %U https://formative.jmir.org/2022/6/e36052 %U https://doi.org/10.2196/36052 %U http://www.ncbi.nlm.nih.gov/pubmed/35687405 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35118 %T A Theory-Informed, Personalized mHealth Intervention for Adolescents (Mobile App for Physical Activity): Development and Pilot Study %A Domin,Alex %A Uslu,Arif %A Schulz,André %A Ouzzahra,Yacine %A Vögele,Claus %+ Research Group: Self-Regulation and Health, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Maison des Sciences Humaines, 11, Porte des Sciences, Esch-sur-Alzette, 4366, Luxembourg, 352 46 66 44 93, alex.domin@uni.lu %K mobile health %K physical activity %K app %K adolescents %K within-subject %K mHealth %K sedentary behavior %K behavior change techniques %K BCTs %K Fitbit %K mobile phone %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence suggests that physical activity (PA) during childhood and adolescence is crucial as it usually results in adequate PA levels in adulthood. Given the ubiquitous use of smartphones by adolescents, these devices may offer feasible means to reach young populations and deliver interventions aiming to increase PA participation and decrease sedentary time. To date, very few studies have reported smartphone-based interventions promoting PA for adolescents. In addition, most available fitness apps do not include the latest evidence-based content. Objective: This paper described the systematic development of a behavior change, theory-informed Mobile App for Physical Activity intervention with personalized prompts for adolescents aged 16 to 18 years. The within-subject trial results provided the first evidence of the general effectiveness of the intervention based on the outcomes step count, sedentary time, and moderate to vigorous PA (MVPA) minutes. The effectiveness of the intervention component personalized PA prompt was also assessed. Methods: A 4-week within-subject trial with 18 healthy adolescents aged 16 to 18 years was conducted (mean age 16.33, SD 0.57 years). After the baseline week, the participants used the Mobile App for Physical Activity intervention (Fitbit fitness tracker+app), which included a daily personalized PA prompt delivered via a pop-up notification. A paired 1-tailed t test was performed to assess the effectiveness of the intervention. Change-point analysis was performed to assess the effectiveness of a personalized PA prompt 30 and 60 minutes after prompt delivery. Results: The results showed that the intervention significantly reduced sedentary time in adolescents during the first week of the trial (t17=−1.79; P=.04; bootstrapped P=.02). This trend, although remaining positive, diminished over time. Our findings indicate that the intervention had no effect on metabolic equivalent of task–based MVPA minutes, although the descriptive increase may give reason for further investigation. Although the results suggested no overall change in heart rate–based MVPA minutes, the results from the change-point analyses suggest that the personalized PA prompts significantly increased heart rate per minute during the second week of the study (t16=1.84; P=.04; bootstrapped P=.04). There were no significant increases in participants’ overall step count; however, the personalized PA prompts resulted in a marginally significant increase in step counts per minute in the second week of the study (t17=1.35; P=.09; bootstrapped P=.05). Conclusions: The results of the trial provide preliminary evidence of the benefit of the Mobile App for Physical Activity intervention for modest yet significant reductions in participants’ sedentary time and the beneficial role of personalized PA prompts. These results also provide further evidence of the benefits and relative efficacy of personalized activity suggestions for inclusion in smartphone-based PA interventions. This study provides an example of how to guide the development of smartphone-based mobile health PA interventions for adolescents. %M 35687409 %R 10.2196/35118 %U https://formative.jmir.org/2022/6/e35118 %U https://doi.org/10.2196/35118 %U http://www.ncbi.nlm.nih.gov/pubmed/35687409 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34566 %T A Yoga Exercise App Designed for Patients With Axial Spondylarthritis: Development and User Experience Study %A Truong,Minh Tam %A Nwosu,Obioma Bertrand %A Gaytan Torres,Maria Elena %A Segura Vargas,Maria Paula %A Seifer,Ann-Kristin %A Nitschke,Marlies %A Ibrahim,Alzhraa A %A Knitza,Johannes %A Krusche,Martin %A Eskofier,Bjoern M %A Schett,Georg %A Morf,Harriet %+ Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 9131 8543023, harriet.morf@uk-erlangen.de %K spondylarthritis %K digital health application %K yoga %K usability %K patient empowerment %K mobile health %K mHealth %K health applications %K smartphone %K physical exercise %K wellness %K mobile phone %D 2022 %7 3.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Besides anti-inflammatory medication, physical exercise represents a cornerstone of modern treatment for patients with axial spondyloarthritis (AS). Digital health apps (DHAs) such as the yoga app YogiTherapy could remotely empower patients to autonomously and correctly perform exercises. Objective: This study aimed to design and develop a smartphone-based app, YogiTherapy, for patients with AS. To gain additional insights into the usability of the graphical user interface (GUI) for further development of the app, this study focused exclusively on evaluating users’ interaction with the GUI. Methods: The development of the app and the user experience study took place between October 2020 and March 2021. The DHA was designed by engineering students, rheumatologists, and patients with AS. After the initial development process, a pilot version of the app was evaluated by 5 patients and 5 rheumatologists. The participants had to interact with the app’s GUI and complete 5 navigation tasks within the app. Subsequently, the completion rate and experience questionnaire (attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty) were completed by the patients. Results: The results of the posttest questionnaires showed that most patients were already familiar with digital apps (4/5, 80%). The task completion rates of the usability test were 100% (5/5) for the tasks T1 and T2, which included selecting and starting a yoga lesson and navigating to an information page. Rheumatologists indicated that they were even more experienced with digital devices (2/5, 40% experts; 3/5, 60% intermediates). In this case, they scored task completion rates of 100% (5/5) for all 5 usability tasks T1 to T5. The mean results from the User Experience Questionnaire range from −3 (most negative) to +3 (most positive). According to rheumatologists’ evaluations, attractiveness (mean 2.267, SD 0.401) and stimulation (mean 2.250, SD 0.354) achieved the best mean results compared with dependability (mean 2.000, SD 0.395). Patients rated attractiveness at a mean of 2.167 (SD 0.565) and stimulation at a mean of 1.950 (SD 0.873). The lowest mean score was reported for perspicuity (mean 1.250, SD 1.425). Conclusions: The newly developed and tested DHA YogiTherapy demonstrated moderate usability among rheumatologists and patients with rheumatic diseases. The app can be used by patients with AS as a complementary treatment. The initial evaluation of the GUI identified significant usability problems that need to be addressed before the start of a clinical evaluation. Prospective trials are also needed in the second step to prove the clinical benefits of the app. %M 35657655 %R 10.2196/34566 %U https://formative.jmir.org/2022/6/e34566 %U https://doi.org/10.2196/34566 %U http://www.ncbi.nlm.nih.gov/pubmed/35657655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36068 %T Development of a Peer Support Mobile App and Web-Based Lesson for Adolescent Mental Health (Mind Your Mate): User-Centered Design Approach %A Birrell,Louise %A Furneaux-Bate,Ainsley %A Debenham,Jennifer %A Spallek,Sophia %A Newton,Nicola %A Chapman,Catherine %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building (G02), Sydney, 2006, Australia, 61 286279003, louise.birrell@sydney.edu.au %K mobile health %K depression %K anxiety %K psychosocial support system %K alcohol drinking %K adolescent %K digital technology %K mobile intervention %K intervention %K social %K economic %K development %K mind your mate %K app %K application %K mHealth %K mobile phone %D 2022 %7 27.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital technologies and mobile interventions are possible tools for prevention initiatives to target the substantial social and economic impacts that anxiety, mood, and substance use disorders have on young people. Objective: This paper described the design and development of the Mind your Mate program, a smartphone app and introductory classroom lesson enhancing peer support around the topics of anxiety, depression, and substance use for adolescents. Methods: The development of Mind your Mate was an iterative process conducted in collaboration with adolescents (n=23), experts, school staff, and software developers. The development process consisted of 3 stages: scoping; end-user consultations, including a web-based survey and 2 focus groups with 23 adolescents (mean age 15.9, SD 0.6 years); and app development and beta-testing. Results: This process resulted in a smartphone peer support app and introductory classroom lesson aimed at empowering adolescents to access evidence-based information and tools to better support peers regarding mental health and substance use–related issues. The program contains links to external support services and encourages adolescents to reach out for help if they are concerned about themselves or a friend. Conclusions: The Mind your Mate program was developed in collaboration with a number of key stakeholders in youth mental health, including adolescents. The resulting program has the potential to be taken to scale to aid prevention efforts for youth mental health and substance use. The next step is to conduct a randomized controlled trial testing the feasibility, acceptability, and efficacy of the program. %M 35622401 %R 10.2196/36068 %U https://formative.jmir.org/2022/5/e36068 %U https://doi.org/10.2196/36068 %U http://www.ncbi.nlm.nih.gov/pubmed/35622401 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36824 %T Emergency Telemedicine Mobile Ultrasounds Using a 5G-Enabled Application: Development and Usability Study %A Berlet,Maximilian %A Vogel,Thomas %A Gharba,Mohamed %A Eichinger,Joseph %A Schulz,Egon %A Friess,Helmut %A Wilhelm,Dirk %A Ostler,Daniel %A Kranzfelder,Michael %+ Department of Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr 22, Munich, 81675, Germany, 49 89 4140 ext 5088, michael.kranzfelder@tum.de %K 5G %K telemedicine %K telehealth %K eHealth %K digital health %K digital medicine %K mobile ultrasound %K ultrasound %K imaging %K digitalized medicine %K emergency care %K emergency %K ambulance %K slicing %K diagnostic %K diagnosis %K image quality %K field test %D 2022 %7 26.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digitalization affects almost every aspect of modern daily life, including a growing number of health care services along with telemedicine applications. Fifth-generation (5G) mobile communication technology has the potential to meet the requirements for this digitalized future with high bandwidths (10 GB/s), low latency (<1 ms), and high quality of service, enabling wireless real-time data transmission in telemedical emergency health care applications. Objective: The aim of this study is the development and clinical evaluation of a 5G usability test framework enabling preclinical diagnostics with mobile ultrasound using 5G network technology. Methods: A bidirectional audio-video data transmission between the ambulance car and hospital was established, combining both 5G-radio and -core network parts. Besides technical performance evaluations, a medical assessment of transferred ultrasound image quality and transmission latency was examined. Results: Telemedical and clinical application properties of the ultrasound probe were rated 1 (very good) to 2 (good; on a 6 -point Likert scale rated by 20 survey participants). The 5G field test revealed an average end-to-end round trip latency of 10 milliseconds. The measured average throughput for the ultrasound image traffic was 4 Mbps and for the video stream 12 Mbps. Traffic saturation revealed a lower video quality and a slower video stream. Without core slicing, the throughput for the video application was reduced to 8 Mbps. The deployment of core network slicing facilitated quality and latency recovery. Conclusions: Bidirectional data transmission between ambulance car and remote hospital site was successfully established through the 5G network, facilitating sending/receiving data and measurements from both applications (ultrasound unit and video streaming). Core slicing was implemented for a better user experience. Clinical evaluation of the telemedical transmission and applicability of the ultrasound probe was consistently positive. %M 35617009 %R 10.2196/36824 %U https://formative.jmir.org/2022/5/e36824 %U https://doi.org/10.2196/36824 %U http://www.ncbi.nlm.nih.gov/pubmed/35617009 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37118 %T A Mobile App for Children With Asthma to Monitor Indoor Air Quality (AirBuddy): Development and Usability Study %A Kim,Sunyoung %A Stanton,Kaitlyn %A Park,Yunoh %A Thomas,Stephen %+ Rutgers, The State University of New Jersey, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 8489327585, shallyya@gmail.com %K asthma %K children %K indoor air quality %K mobile app %K smartphone %K mHealth %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Indoor air quality is an important environmental factor that triggers and exacerbates asthma, the most common chronic disease in children. A mobile app to monitor indoor air quality could help occupants keep their indoor air quality clean. However, no app is available that allows children to monitor and improve their indoor air quality. Objective: Previously, we conducted a series of user-centered design studies to identify user needs and design requirements toward creating a mobile app that helps children with asthma to engage in monitoring and improving indoor air quality as part of their asthma management. Based on the findings from these studies, we created AirBuddy, a child-friendly app that visualizes air quality indoors and outdoors. Methods: This paper reports on the findings from a field deployment with 7 pediatric asthma patients, where we evaluated AirBuddy’s usability and usefulness in real-world settings by conducting weekly semistructured interviews for 8 weeks. Results: All participants positively responded to the usefulness and usability of AirBuddy, which we believe is thanks to the iterative, user-centered design approach that allowed us to identify and address potential usability issues early on and throughout the design process. Conclusions: This project contributes to the field of mHealth app design for children by demonstrating how a user-centered design process can lead to the development of digital devices that are more acceptable and relevant to target users’ needs. %M 35604753 %R 10.2196/37118 %U https://formative.jmir.org/2022/5/e37118 %U https://doi.org/10.2196/37118 %U http://www.ncbi.nlm.nih.gov/pubmed/35604753 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34509 %T Development and Feasibility of a Mobile Asthma App for Children and Their Caregivers: Mixed Methods Study %A Iio,Misa %A Sato,Miori %A Narita,Masami %A Yamamoto-Hanada,Kiwako %A Oishi,Taku %A Kishino,Ai %A Kawaguchi,Takahiro %A Nishi,Rin %A Nagata,Mayumi %A Ohya,Yukihiro %+ College of Nursing, Kanto Gakuin University, 1-50-1 Mutsuurahigashi, Kanazawa-ward, Yokohama, 236-8503, Japan, 81 45 786 5641, misaiio@kanto-gakuin.ac.jp %K children %K caregivers %K asthma %K mobile app %K feasibility %K health app %K mHealth %K pediatric %K usability %K mobile phone %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health apps can support the self-management of pediatric asthma. Previous studies on mobile apps for children aged >7 years with asthma are limited, and most reports on asthma apps do not consider interactions between the children and their caregivers. Therefore, we developed an asthma app for children aged 0-12 years and their caregivers based on the results of our previous study regarding user needs. Objective: The aim of this study was to evaluate the feasibility of a developed mobile app for children with asthma and their caregivers and to modify and complete the app according to the feasibility results. Methods: We recruited children diagnosed with persistent asthma by an allergy specialist at 2 children’s hospitals, 1 university hospital, 2 general hospitals, and 1 pediatric clinic. Thereafter, the app usage was assessed, and questionnaires were administered. This study used convergent mixed methods, including providing user feedback about the pediatric asthma app, completing questionnaire surveys regarding preferences, and obtaining quantitative data about app usage. Quantitative data were analyzed based on the ratings provided for the app features used by the participants, and the usage of the app features was analyzed using descriptive statistics. Qualitative data were analyzed via a descriptive qualitative research analysis and were used to identify codes from the content-characteristic words. Results: In total, 30 pairs of children aged 2-12 years and their caregivers responded to the 3-month survey, and 20 pairs of children aged 4-12 years and their caregivers responded to the 6-month survey. In the 3- and 6-month surveys, “record” was the most commonly used feature by both caregivers and children. The average access logs per month among the 20 pairs ranged from 50 to 79 in the 6-month survey. The number of access logs decreased over time. In the qualitative results, app utilization difficulties were identified for 6 categories: record, preparing, alert settings, change settings, mobile phone owner, and display and motivation. Regarding app feasibility, 60% (12/20) of the caregivers strongly agreed or agreed for all evaluation items, while 63% (7/11) of the children strongly agreed or agreed for 6 items, excluding satisfaction. In the qualitative results, feasibility evaluation of the app was classified into 3 categories: high feasibility of the app, improvement points for the app, and personal factors preventing app utilization. Based on the results of the feasibility analysis, the final version of the app was modified and completed. Conclusions: The app feasibility among children with asthma and their caregivers was generally good. Children aged 7-12 years used elements such as record, quiz, and manga. This app can support the continuous self-management of pediatric asthma. However, efforts must be taken to maintain and improve the app quality. Trial Registration: UMIN Clinical Trials Registry UMIN000039058; https://tinyurl.com/3na9zyf8 %M 35594073 %R 10.2196/34509 %U https://formative.jmir.org/2022/5/e34509 %U https://doi.org/10.2196/34509 %U http://www.ncbi.nlm.nih.gov/pubmed/35594073 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e37521 %T Technology Acceptance and Usability of a Mobile App to Support the Workflow of Health Care Aides Who Provide Services to Older Adults: Pilot Mixed Methods Study %A Miguel Cruz,Antonio %A Lopez Portillo,Hector Perez %A Daum,Christine %A Rutledge,Emily %A King,Sharla %A Liu,Lili %+ Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 1-45 Corbett Hall, 8205 114 Street, Edmonton, AB, T6G 2G4, Canada, 1 7804926461, miguelcr@ualberta.ca %K usability %K technology acceptance %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K older adults %K caregivers %K health care aides %K mobile phone %D 2022 %7 18.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Health care aides are unlicensed support personnel who provide direct care, personal assistance, and support to people with health conditions. The shortage of health care aides has been attributed to recruitment challenges, high turnover, an aging population, the COVID-19 pandemic, and low retention rates. Mobile apps are among the many information communication technologies that are paving the way for eHealth solutions to help address this workforce shortage by enhancing the workflow of health care aides. In collaboration with Clinisys EMR Inc, we developed a mobile app (Mobile Smart Care System [mSCS]) to support the workflow of health care aides who provide services to older adult residents of a long-term care facility. Objective: The purpose of this study was to investigate the technology acceptance and usability of a mobile app in a real-world environment, while it is used by health care aides who provide services to older adults. Methods: This pilot study used a mixed methods design: sequential mixed methods (QUANTITATIVE, qualitative). Our study included a pre– and post–paper-based questionnaire with no control group (QUAN). Toward the end of the study, 2 focus groups were conducted with a subsample of health care aides (qual, qualitative description design). Technology acceptance and usability questionnaires used a 5-point Likert scale ranging from disagree (1) to agree (5). The items included in the questionnaires were validated in earlier research as having high levels of internal consistency for the Unified Theory of Acceptance and Use of Technology constructs. A total of 60 health care aides who provided services to older adults as part of their routine caseloads used the mobile app for 1 month. Comparisons of the Unified Theory of Acceptance and Use of Technology constructs’ summative scores at pretest and posttest were calculated using a paired t test (2-tailed). We used the partial least squares structural regression model to determine the factors influencing mobile app acceptance and usability for health care aides. The α level of significance for all tests was set at P≤.05 (2-tailed). Results: We found that acceptance of the mSCS was high among health care aides, performance expectancy construct was the strongest predictor of intention to use the mSCS, intention to use the mSCS predicted usage behavior. The qualitative data support the quantitative findings and showed health care aides’ strong belief that the mSCS was useful, portable, and reliable, although there were still opportunities for improvement, especially with regard to the mSCS user interface. Conclusions: Overall, these results support the assertion that mSCS technology acceptance and usability are high among health care aides. In other words, health care aides perceived that the mSCS assisted them in addressing their workflow issues. %M 35583930 %R 10.2196/37521 %U https://aging.jmir.org/2022/2/e37521 %U https://doi.org/10.2196/37521 %U http://www.ncbi.nlm.nih.gov/pubmed/35583930 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e38181 %T Early Detection of Neurodevelopmental Disorders of Toddlers and Postnatal Depression by Mobile Health App: Observational Cross-sectional Study %A Denis,Fabrice %A Maurier,Laura %A Carillo,Kevin %A Ologeanu-Taddei,Roxana %A Septans,Anne-Lise %A Gepner,Agnes %A Le Goff,Florian %A Desbois,Madhu %A Demurger,Baptiste %A Silber,Denise %A Zeitoun,Jean-David %A Assuied,Guedalia Peretz %A Bonnot,Olivier %+ Institut Inter-Regional Jean Bernard, ELSAN, 9 Rue Beauverger, Le Mans, 72000, France, 33 0684190480, f.denis@ilcgroupe.fr %K early detection %K NDD %K neurodevelopmental disorder %K ASD %K autism spectrum disorder %K PND %K postnatal depression %K mHealth %K mobile health %K real-world study %K autism %K parenting %K pediatric %K children %K mobile phone %K smartphone %K mobile health app %K digital health intervention %K digital product %K algorithm %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Delays in the diagnosis of neurodevelopmental disorders (NDDs) in toddlers and postnatal depression (PND) in mothers are major public health issues. In both cases, early intervention is crucial. Objective: We aimed to assess if a mobile app named Malo can reduce delay in the recognition of NDD and PND. Methods: We performed an observational, cross-sectional, data-based study in a population of young parents with a minimum of 1 child under 3 years of age at the time of inclusion and using Malo on a regular basis. We included the first 4000 users matching the criteria and agreeing to participate between November 11, 2021, and January 14, 2022. Parents received monthly questionnaires via the app, assessing skills on sociability, hearing, vision, motricity, language of their infants, and possible autism spectrum disorder. Mothers were also requested to answer regular questionnaires regarding PND, from 4-28 weeks after childbirth. When any patient-reported outcomes matched predefined criteria, an in-app notification was sent to the user, recommending the booking of an appointment with their family physician or pediatrician. The main outcomes were the median age of the infant at the time of notification for possible NDD and the median time of PND notifications after childbirth. One secondary outcome was the relevance of the NDD notification for a consultation as assessed by the physicians. Results: Among 4242 children assessed by 5309 questionnaires, 613 (14.5%) had at least 1 disorder requiring a consultation. The median age of notification for possible autism spectrum, vision, audition, socialization, language, or motor disorders was 11, 9, 17, 12, 22, and 4 months, respectively. The sensitivity of the alert notifications of suspected NDDs as assessed by the physicians was 100%, and the specificity was 73.5%. Among 907 mothers who completed a PND questionnaire, highly probable PND was detected in 151 (16.6%) mothers, and the median time of detection was 8-12 weeks. Conclusions: The algorithm-based alert suggesting NDD was highly sensitive with good specificity as assessed by real-life practitioners. The app was also efficient in the early detection of PND. Our results suggest that the regular use of this multidomain familial smartphone app would permit the early detection of NDD and PND. Trial Registration: ClinicalTrials.gov NCT04958174; https://clinicaltrials.gov/ct2/show/NCT04958174 %M 35576565 %R 10.2196/38181 %U https://mhealth.jmir.org/2022/5/e38181 %U https://doi.org/10.2196/38181 %U http://www.ncbi.nlm.nih.gov/pubmed/35576565 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35065 %T A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study %A Buss,Vera Helen %A Varnfield,Marlien %A Harris,Mark %A Barr,Margo %+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 7, Surgical, Treatment and Rehabilitation Service, 296 Herston Road, Herston, 4029, Australia, 61 732533603, vera.buss@csiro.au %K mobile health %K behavior change intervention %K primary prevention %K health promotion %K cardiovascular disease %K diabetes mellitus, type 2 %K mobile phone %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective: This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods: The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results: The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. Conclusions: We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing. %M 35536603 %R 10.2196/35065 %U https://humanfactors.jmir.org/2022/2/e35065 %U https://doi.org/10.2196/35065 %U http://www.ncbi.nlm.nih.gov/pubmed/35536603 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e36284 %T Sociotechnical Factors Affecting Patients’ Adoption of Mobile Health Tools: Systematic Literature Review and Narrative Synthesis %A Jacob,Christine %A Sezgin,Emre %A Sanchez-Vazquez,Antonio %A Ivory,Chris %+ University of Applied Sciences Northwestern Switzerland, Riggenbachstrasse 16, 13b, Olten, 4600, Switzerland, 41 798769376, christine.k.jacob@gmail.com %K telemedicine %K smartphone %K mobile phone %K electronic health record %K public health practice %K technology %K perception %K health education %K mHealth %K mobile health %K telehealth %K eHealth %K patients %D 2022 %7 5.5.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) tools have emerged as a promising health care technology that may contribute to cost savings, better access to care, and enhanced clinical outcomes; however, it is important to ensure their acceptance and adoption to harness this potential. Patient adoption has been recognized as a key challenge that requires further exploration. Objective: The aim of this review was to systematically investigate the literature to understand the factors affecting patients’ adoption of mHealth tools by considering sociotechnical factors (from technical, social, and health perspectives). Methods: A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the MEDLINE, PubMed, Cochrane Library, and SAGE databases for studies published between January 2011 and July 2021 in the English language, yielding 5873 results, of which 147 studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with thematic analysis and narrative synthesis of emergent themes. Results: The technical factors affecting patients’ adoption of mHealth tools were categorized into six key themes, which in turn were divided into 20 subthemes: usefulness, ease of use, data-related, monetary factors, technical issues, and user experience. Health-related factors were categorized into six key themes: the disease or health condition, the care team’s role, health consciousness and literacy, health behavior, relation to other therapies, integration into patient journey, and the patients’ insurance status. Social and personal factors were divided into three key clusters: demographic factors, personal characteristics, and social and cultural aspects; these were divided into 19 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions: This review builds on the growing body of research that investigates patients’ adoption of mHealth services and highlights the complexity of the factors affecting adoption, including personal, social, technical, organizational, and health care aspects. We recommend a more patient-centered approach by ensuring the tools’ fit into the overall patient journey and treatment plan, emphasizing inclusive design, and warranting comprehensive patient education and support. Moreover, empowering and mobilizing clinicians and care teams, addressing ethical data management issues, and focusing on health care policies may facilitate adoption. %M 35318189 %R 10.2196/36284 %U https://mhealth.jmir.org/2022/5/e36284 %U https://doi.org/10.2196/36284 %U http://www.ncbi.nlm.nih.gov/pubmed/35318189 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35094 %T Persuasive Design Techniques and App Design Recommendations to Improve Health Workforce Capability in Rural Health Professionals: What Do Users Want and How Does an App Help? %A Pit,Sabrina %A Ramsden,Robyn %A Tan,Aaron JH %A Payne,Kristy %A Barr,James %A Eames,Benjamin %A Edwards,Mike %A Colbran,Richard %+ New South Wales Rural Doctors Network, 1/53 Cleary Street, Hamilton, 2308, Australia, 61 429455720, sabrina.pit@sydney.edu.au %K health %K wellness %K mobile apps %K persuasive strategies %K behavior change %K review %K health workforce %K capability %K career %K employment %K rural %K workforce planning %K mHealth %K mobile health %K digital health %K health professional %K user experience %K health application %K task support %K social support %K dialog support %D 2022 %7 2.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health professionals’ perceptions of persuasive design techniques for use in technological solutions to improve health workforce capability have not been previously explored. Objective: This study aims to explore rural health professionals’ perceptions of health workforce capability and persuasive design techniques; and translate these into recommendations for designing a health workforce capability app to increase their impact and usefulness. Methods: Qualitative interviews with 13 rural health professionals were conducted. Subsequently, 32 persuasive techniques were used as a framework to deductively analyze the data. Persuasive design technique domains were Primary Task Support, Dialog Support, System Credibility Support, Social Support, and Cialdini’s Principles of Persuasion. Results: Persuasive design techniques can be applied across the factors that influence health workforce capability including health and personal qualities; competencies and skills; values, attitudes, and motivation; and factors that operate outside of work and at the team, organizational, and labor market levels. The majority of the 32 persuasive design techniques were reflected in the data from the interviews and led to recommendations as to how these could be translated into practice, with the exception of scarcity. Many suggestions and persuasive design techniques link back to the need for tailored and localized solutions such as the need for country-specific–based evidence, the wish for localized communities of practice, learning from other rural health professionals, and referral pathways to other clinicians. Participants identified how persuasive design techniques can optimize the user experience to help meet rural health professionals needs for more efficient systems to improve patient access to care, quality care, and to enable working in interprofessional team-based care. Social inclusion plays a vital role for health professionals, indicating the importance of the Social Support domain of persuasive techniques. Overall, health professionals were open to self-monitoring of their work performance and some professionals used wearables to monitor their health. Conclusions: Rural health professionals’ perceptions of health workforce capability informed which persuasive design techniques can be used to optimize the user experience of an app. These were translated into recommendations for designing a health workforce capability app to increase likelihood of adoption. This study has also contributed to the further validation of the Persuasive Systems Design model through empirically aligning elements of the model to increase persuasive system content and functionality with real-world applied data, in this case the health workforce capability of rural health professionals. Our findings confirm that these techniques can be used to develop a future prototype of an app that may assist health professionals in improving or maintaining their health workforce capability which in turn may increase recruitment and retention in rural areas. Health professionals need to be central during the design phase. Interventions are needed to provide a supportive environment to rural and remote health professionals to increase their rural health workforce capability. %M 35499866 %R 10.2196/35094 %U https://humanfactors.jmir.org/2022/2/e35094 %U https://doi.org/10.2196/35094 %U http://www.ncbi.nlm.nih.gov/pubmed/35499866 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e31815 %T The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design %A Robertson,Michael C %A Cox-Martin,Emily %A Shegog,Ross %A Markham,Christine M %A Fujimoto,Kayo %A Durand,Casey P %A Brewster,Abenaa %A Lyons,Elizabeth J %A Liao,Yue %A Flores,Sara A %A Basen-Engquist,Karen M %+ Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, United States, 1 409 772 3030, mcrobert@utmb.edu %K cancer survivors %K exercise %K mindfulness %K Acceptance and Commitment Therapy %K behavioral sciences %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. Objective: The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. Methods: This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening–physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. Results: The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening–physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). Conclusions: Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness. %M 35486425 %R 10.2196/31815 %U https://cancer.jmir.org/2022/2/e31815 %U https://doi.org/10.2196/31815 %U http://www.ncbi.nlm.nih.gov/pubmed/35486425 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e29292 %T Communicating Treatment-Related Symptoms Using Passively Collected Data and Satisfaction/Loyalty Ratings: Exploratory Study %A Kudel,Ian %A Perry,Toni %+ Varian, a Siemens Healthineers Company, 3100 Hansen Way, Palo Alto, CA, 94304, United States, 1 518 902 8554, ian.kudel@varian.com %K electronic patient-reported outcomes %K ePRO %K cancer %K symptoms %K health-related quality of life %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Electronic patient-reported outcomes’ real time communication of treatment-related symptoms is increasingly associated with better outcomes including longer survival and less health care resource use, but the primary method of collecting this information, static questionnaires, has not evolved. Objective: The aim of this paper is to describe the use of Noona’s three methods of communicating treatment-related symptoms, which are as follows: (1) Noona symptom questionnaires (NSQ), which incorporate branching logic; (2) a diary; and (3) secure messaging, the last two of which have NSQ reporting functionality. It also aims to explore, using multivariable analyses, whether patients find value using these features. Methods: Noona users (N=1081) who have an active account for more than 30 days, who responded to the satisfaction/loyalty item, and who were undergoing active cancer treatment (systemic or radiotherapy) in the United States were included in this study. All study data were collected via software embedded within Noona code. This includes metadata, patient activities (measured in clicks), and responses to a satisfaction/loyalty question (“How likely are you to recommend Noona to another patient”) displayed on the Noona home page. Results: Noona users expressed a high degree of satisfaction/loyalty when asked to rate how likely they would recommend Noona to another patient. Multivariable analyses indicate small but significant effects for some of the analyses. Use of NSQs were significantly related to satisfaction/loyalty, users of NSQs had significantly higher satisfaction/loyalty than those who did not use any, and secure communication use was significantly higher for those who rated the app highly compared to those who did not. These relationships will likely be further explicated with the use of satisfaction/loyalty questions that focus specifically on feature use. Conclusions: Noona is well liked by respondents, and exploratory multivariable analyses demonstrate the potential for using passively and minimally invasive data to demonstrate value. %M 35175206 %R 10.2196/29292 %U https://cancer.jmir.org/2022/2/e29292 %U https://doi.org/10.2196/29292 %U http://www.ncbi.nlm.nih.gov/pubmed/35175206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32990 %T Design and Evaluation of a Smartphone Medical Guidance App for Outpatients of Large-Scale Medical Institutions: Retrospective Observational Study %A Teramoto,Kei %A Kuwata,Shigeki %+ Tottori University Hospital, Nishi-cho, 36-1, Yonago, 6838504, Japan, 81 859 38 7482, kei@tottori-u.ac.jp %K mHealth %K outpatient clinics %K electronic medical records %K COVID-19 %K EHR %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The greatest stressor for outpatients is the waiting time before an examination. If the patient is able to use their smartphone to check in with reception, the patient can wait for their examination at any location, and the burden of waiting can be reduced. Objective: This study aimed to report the system design and postintroductory outcomes of the Tori RinRin (TR2) system that was developed to reduce outpatient burden imposed by wait times before examination. Methods: The TR2 system was introduced at Tottori University Hospital, a large medical facility that accepts a daily average of 1500 outpatients. The system, which links the hospital’s electronic medical record database with patients’ mobile devices, has the following functions: (1) GPS-based examination check-in processing and (2) sending appointment notification messages via a cloud notification service. In order to evaluate the usefulness of the TR2 system, we surveyed the utilization rate of the TR2 system among outpatients, implemented a user questionnaire, and polled the average time required for patients to respond to call notifications about their turn. Results: The 3-month average of TR2 users 9 months after the TR 2 system introduction was 17.9% (14,536/81,066). In an investigation of 363 subjects, the mean examination call message response time using the TR2 system was 31 seconds (median 14 seconds). Among 166 subjects who responded to a user survey, 86.7% (144/166) said that the system helped reduce the burden of waiting time. Conclusions: The app allowed 17.9% of outpatients at a large medical facility to check in remotely and wait for examinations anywhere. Hence, it is effective in preventing the spread of infection, especially during pandemics such as that of coronavirus disease. The app reported in this study is beneficial for large medical facilities striving to reduce outpatient burden imposed by wait times. %M 34818208 %R 10.2196/32990 %U https://formative.jmir.org/2022/4/e32990 %U https://doi.org/10.2196/32990 %U http://www.ncbi.nlm.nih.gov/pubmed/34818208 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 2 %P e36675 %T Managing Diabetes Using Mobiab: Long-Term Case Study of the Impact of a Mobile App on Self-management %A Burda,Václav %A Mráz,Miloš %A Schneider,Jakub %A Novák,Daniel %+ Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Karlovo namesti 13, Prague, 12135, Czech Republic, 420 224357666, burdavac@fel.cvut.cz %K diabetes mellitus %K self-management %K mobile app %K case study %K long-term data %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: This paper describes the development of a mobile app for diabetes mellitus (DM) control and self-management and presents the results of long-term usage of this system in the Czech Republic. DM is a chronic disease affecting large numbers of people worldwide, and this number is continuously increasing. There is massive potential to increase adherence to self-management of DM with the use of smartphones and digital therapeutics interventions. Objective: This study aims to describe the process of development of a mobile app, called Mobiab, for DM management and to investigate how individual features are used and how the whole system benefits its long-term users. Using at least 1 year of daily records from users, we analyzed the impact of the app on self-management of DM. Methods: We have developed a mobile app that serves as an alternative form to the classic paper-based protocol or diary. The development was based on cooperation with both clinicians and people with DM. The app consists of independent individual modules. Therefore, the user has the possibility to use only selected features that they find useful. Mobiab was available free of charge on Google Play Store from mid-2014 until 2019. No targeted recruitment was performed to attract users. Results: More than 500 users from the Czech Republic downloaded and signed up for the mobile app. Approximately 80% of the users used Mobiab for less than 1 week. The rest of the users used it for a longer time and 8 of the users produced data that were suitable for long-term analysis. Additionally, one of the 8 users provided their medical records, which were compared with the gathered data, and the improvements in their glucose levels and overall metabolic stability were consistent with the way in which the mobile app was used. Conclusions: The results of this study showed that the usability of a DM-centered self-management smartphone mobile app and server-based systems could be satisfactory and promising. Nonetheless, some better ways of motivating people with diabetes toward participation in self-management are needed. Further studies involving a larger number of participants are warranted to assess the effect on long-term diabetes management. %M 35442201 %R 10.2196/36675 %U https://diabetes.jmir.org/2022/2/e36675 %U https://doi.org/10.2196/36675 %U http://www.ncbi.nlm.nih.gov/pubmed/35442201 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e33992 %T Use of Mobile Apps in Heart Failure Self-management: Qualitative Study Exploring the Patient and Primary Care Clinician Perspective %A Bezerra Giordan,Leticia %A Ronto,Rimante %A Chau,Josephine %A Chow,Clara %A Laranjo,Liliana %+ Westmead Applied Research Centre, University of Sydney, Level 6, Block K, Entrance 10, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, 2145, Australia, 61 413461852, liliana.laranjo@sydney.edu.au %K mobile app %K mHealth %K heart failure %K self-management %K eHealth %K telehealth %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Mobile apps have the potential to support patients with heart failure and facilitate disease self-management, but this area of research is recent and rapidly evolving, with inconsistent results for efficacy. So far, most of the published studies evaluated the feasibility of a specific app or assessed the quality of apps available in app stores. Research is needed to explore patients’ and clinicians’ perspectives to guide app development, evaluation, and implementation into models of care. Objective: This study aims to explore the patient and primary care clinician perspective on the facilitators and barriers to using mobile apps, as well as desired features, to support heart failure self-management. Methods: This is a qualitative phenomenological study involving face-to-face semistructured interviews. Interviews were conducted in a general practice clinic in Sydney, Australia. Eligible participants were adult patients with heart failure and health care professionals who provided care to these patients at the clinic. Patients did not need to have previous experience using heart failure mobile apps to be eligible for this study. The interviews were audio-recorded, transcribed, and analyzed using inductive thematic data analysis in NVivo 12. Results: A total of 12 participants were interviewed: 6 patients (mean age 69 [SD 7.9] years) and 6 clinicians. The interviews lasted from 25 to 45 minutes. The main facilitators to the use of apps to support heart failure self-management were communication ability, personalized feedback and education, and automated self-monitoring. Patients mentioned that chat-like features and ability to share audio-visual information can be helpful for getting support outside of clinical appointments. Clinicians considered helpful to send motivational messages to patients and ask them about signs and symptoms of heart failure decompensation. Overall, participants highlighted the importance of personalization, particularly in terms of feedback and educational content. Automated self-monitoring with wireless devices was seen to alleviate the burden of tracking measures such as weight and blood pressure. Other desired features included tools to monitor patient-reported outcomes and support patients’ mental health and well-being. The main barriers identified were the patients’ unwillingness to engage in a new strategy to manage their condition using an app, particularly in the case of low digital literacy. However, clinicians mentioned this barrier could potentially be overcome by introducing the app soon after an exacerbation, when patients might be more willing to improve their self-management and avoid rehospitalization. Conclusions: The use of mobile apps to support heart failure self-management may be facilitated by features that increase the usefulness and utility of the app, such as communication ability in-between consultations and personalized feedback. Also important is facilitating ease of use by supporting automated self-monitoring through integration with wireless devices. Future research should consider these features in the co-design and testing of heart failure mobile apps with patients and clinicians. %M 35442205 %R 10.2196/33992 %U https://cardio.jmir.org/2022/1/e33992 %U https://doi.org/10.2196/33992 %U http://www.ncbi.nlm.nih.gov/pubmed/35442205 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e33725 %T Japanese Version of the Mobile App Rating Scale (MARS): Development and Validation %A Yamamoto,Kazumichi %A Ito,Masami %A Sakata,Masatsugu %A Koizumi,Shiho %A Hashisako,Mizuho %A Sato,Masaaki %A Stoyanov,Stoyan R %A Furukawa,Toshi A %+ Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Yoshida-Konoe-Cho, Sakyo, Kyoto, 606-8501, Japan, 81 75 753 9492, kazumichi_yamamoto@airwaystenosis.org %K mobile health apps %K MHAs %K mHealth %K mobile application %K mobile application rating scale %K MARS %K scale development %K mental health %K mobile health applications %D 2022 %7 14.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The number of mobile health (mHealth) apps continues to rise each year. Widespread use of the Mobile App Rating Scale (MARS) has allowed objective and multidimensional evaluation of the quality of these apps. However, no Japanese version of MARS has been made available to date. Objective: The purposes of this study were (1) to develop a Japanese version of MARS and (2) to assess the translated version’s reliability and validity in evaluating mHealth apps. Methods: To develop the Japanese version of MARS, cross-cultural adaptation was used using a universalist approach. A total of 50 mental health apps were evaluated by 2 independent raters. Internal consistency and interrater reliability were then calculated. Convergent and divergent validity were assessed using multitrait scaling analysis and concurrent validity. Results: After cross-cultural adaptation, all 23 items from the original MARS were included in the Japanese version. Following translation, back-translation, and review by the author of the original MARS, a Japanese version of MARS was finalized. Internal consistency was acceptable by all subscales of objective and subjective quality (Cronbach α=.78-.89). Interrater reliability was deemed acceptable, with the intraclass correlation coefficient (ICC) ranging from 0.61 to 0.79 for all subscales, except for “functionality,” which had an ICC of 0.40. Convergent/divergent validity and concurrent validity were also considered acceptable. The rate of missing responses was high in several items in the “information” subscale. Conclusions: A Japanese version of MARS was developed and shown to be reliable and valid to a degree that was comparable to the original MARS. This Japanese version of MARS can be used as a standard to evaluate the quality and credibility of mHealth apps. %M 35197241 %R 10.2196/33725 %U https://mhealth.jmir.org/2022/4/e33725 %U https://doi.org/10.2196/33725 %U http://www.ncbi.nlm.nih.gov/pubmed/35197241 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e32628 %T Process and Information Needs When Searching for and Selecting Apps for Smoking Cessation: Qualitative Study Using Contextual Inquiry %A Hendriks,Ylva %A Peek,Sebastiaan %A Kaptein,Maurits %A Bongers,Inge %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, Tilburg, 5000 LE, Netherlands, 31 13 466 4892, ylva.hendriks@tilburguniversity.edu %K mHealth and eHealth %K contextual inquiry %K decision-making %K mobile app search and selection %K apps for smoking cessation %K mobile apps %K mobile phone %D 2022 %7 14.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Hundreds of apps are available to support people in their quest to quit smoking. It has been hypothesized that selecting an app from a sizable volume without any aid can be overwhelming and difficult. However, little is known about how people choose apps for smoking cessation and what exactly people want to know about an app before choosing to install it. Understanding the decision-making process may ultimately be helpful in creating tools to help people meaningfully select apps. Objective: The aim of this study is to obtain insights into the process of searching and selecting mobile apps for smoking cessation and map the range of actions and the accompanying reasons during the search, focusing on the information needs and experiences of those who aim to find an app. Methods: Contextual inquiries were conducted with 10 Dutch adults wanting to quit smoking by using an app. During the inquiries, we observed people as they chose an app. In addition, 2 weeks later, there was a short semistructured follow-up interview over the phone. Through convenience and purposive sampling, we included participants differing in gender, age, and educational level. We used thematic analysis to analyze the transcribed interviews and leveraged a combination of video and audio recordings to understand what is involved in searching and selecting apps for smoking cessation. Results: The process of finding smoking cessation apps is comprehensive: participants explored, evaluated, and searched for information; imagined using functions; compared apps; assessed the trustworthiness of apps and information; and made several decisions while navigating the internet and app stores. During the search, the participants gained knowledge of apps and developed clearer ideas about their wishes and requirements. Confidence and trust in these apps to help quitting remained quite low or even decreased. Although the process was predominantly a positive experience, the whole process took time and energy and caused negative emotions such as frustration and disappointment for some participants. In addition, without the participants realizing it, errors in information processing occurred, which affected the choices they made. All participants chose an app with the explicit intention of using it. After 2 weeks, of the 10 participants, 6 had used the app, of whom only 1 extensively. Conclusions: Finding an app in the current app stores that contains functions and features expected to help in quitting smoking takes considerable time and energy, can be a negative experience, and is prone to errors in information processing that affect decision-making. Therefore, we advise the further development of decision aids, such as advanced filters, recommender systems and curated health app portals, and make a number of concrete recommendations for the design of such systems. %M 35436217 %R 10.2196/32628 %U https://humanfactors.jmir.org/2022/2/e32628 %U https://doi.org/10.2196/32628 %U http://www.ncbi.nlm.nih.gov/pubmed/35436217 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e29846 %T Online Support and Intervention for Child Anxiety (OSI): Development and Usability Testing %A Hill,Claire %A Reardon,Tessa %A Taylor,Lucy %A Creswell,Cathy %+ School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights Campus, Reading, RG6 6AL, United Kingdom, 44 0118 378 8579, claire.hill@reading.ac.uk %K user-centered design %K co-design %K usability testing %K internet-based treatment %K app %K CBT %K anxiety %K children %K mobile phone %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based treatments for child anxiety may help to increase access to evidence-based therapies; however, user engagement, uptake, and adherence within routine clinical practice remain as challenges. Involving the intended end users in the development process through user-centered design and usability testing is crucial for maximizing user engagement and adoption of internet-based treatments, but so far this has been lacking for internet-based treatments for child anxiety. Objective: The aim of this study is to develop an internet-based treatment for child anxiety through a process of user-centered design (phase 1) and usability testing (phase 2), based on an existing evidence-based, face-to-face, therapist-supported, parent-led cognitive behavioral therapy intervention. It is intended that the internet-based version of this treatment would consist of a parent website, case management system for clinicians, and mobile game app for children. Methods: Parents, children, and clinicians who were familiar with the face-to-face version of the treatment were recruited from 2 National Health Service clinics. In phase 1, participants participated in 3 workshops to gain feedback on the overall concept, explore their wants and needs for the websites and game, generate ideas on how the treatment may look, and gain feedback on initial mock-ups of the websites and game. In phase 2, participants attended 3 individual usability testing sessions where they were presented with working prototypes of the website or game and asked to perform a series of tasks on the website (parents and clinicians) or play the game (children). The frequency and details on usability errors were recorded. Participants were asked for their feedback on the website and game using a standardized usability questionnaire and semistructured interviews. The websites and game were iterated after each round of usability testing in response to this feedback. Results: In phase 1, participants approved the general concept and rated the initial mock-ups of the website and game positively. In phase 2, working prototypes were rated positively and usability errors declined across the iterations and were mainly cosmetic or minor issues relating to esthetic preference, with few issues regarding ability to navigate the website or technical issues affecting functionality. Feedback from the semistructured interviews further supported the positive response of participants to the website and game, and helped identify areas for improvement during the iteration process. The final iteration of the website and game are presented. Conclusions: Taking an iterative approach to development through user-centered design and usability testing has resulted in an internet-based treatment for child anxiety (Online Support and Intervention for child anxiety) that appears to meet the needs and expectations of the intended users (parents, children, and clinicians) and is easy and enjoyable to use. %M 35416781 %R 10.2196/29846 %U https://formative.jmir.org/2022/4/e29846 %U https://doi.org/10.2196/29846 %U http://www.ncbi.nlm.nih.gov/pubmed/35416781 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e29492 %T Designing a Framework for Remote Cancer Care Through Community Co-design: Participatory Development Study %A Aronoff-Spencer,Eliah %A McComsey,Melanie %A Chih,Ming-Yuan %A Hubenko,Alexandra %A Baker,Corey %A Kim,John %A Ahern,David K %A Gibbons,Michael Christopher %A Cafazzo,Joseph A %A Nyakairu,Pia %A Vanderpool,Robin C %A Mullett,Timothy W %A Hesse,Bradford W %+ Department of Health & Clinical Sciences, College of Health Sciences, University of Kentuck, Lexington, CA, United States, 1 8592297665, timothy.mullett@uky.edu %K cancer care %K distress screening %K human-centered design %K participatory design %K Appalachia %K mobile phone %D 2022 %7 12.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Recent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking. Objective: The aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders. Methods: We developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback. Results: We co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=–0.311; P=.76). Notable differences by patient and provider scoring and feedback were found. Conclusions: Participatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches. %M 35412457 %R 10.2196/29492 %U https://www.jmir.org/2022/4/e29492 %U https://doi.org/10.2196/29492 %U http://www.ncbi.nlm.nih.gov/pubmed/35412457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e35069 %T A Smart Mobile App to Simplify Medical Documents and Improve Health Literacy: System Design and Feasibility Validation %A Hendawi,Rasha %A Alian,Shadi %A Li,Juan %+ North Dakota State University, 1340 Administration Ave, Fargo, ND, 58105, United States, 1 701 231 9662, j.li@ndsu.edu %K health literacy %K knowledge graph %K natural language processing %K machine learning %K medical entity recognition %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with low health literacy experience more challenges in understanding instructions given by their health providers, following prescriptions, and understanding their health care system sufficiently to obtain the maximum benefits. People with insufficient health literacy have high risk of making medical mistakes, more chances of experiencing adverse drug effects, and inferior control of chronic diseases. Objective: This study aims to design, develop, and evaluate a mobile health app, MediReader, to help individuals better understand complex medical materials and improve their health literacy. Methods: MediReader is designed and implemented through several steps, which are as follows: measure and understand an individual’s health literacy level; identify medical terminologies that the individual may not understand based on their health literacy; annotate and interpret the identified medical terminologies tailored to the individual’s reading skill levels, with meanings defined in the appropriate external knowledge sources; evaluate MediReader using task-based user study and satisfaction surveys. Results: On the basis of the comparison with a control group, user study results demonstrate that MediReader can improve users’ understanding of medical documents. This improvement is particularly significant for users with low health literacy levels. The satisfaction survey showed that users are satisfied with the tool in general. Conclusions: MediReader provides an easy-to-use interface for users to read and understand medical documents. It can effectively identify medical terms that a user may not understand, and then, annotate and interpret them with appropriate meanings using languages that the user can understand. Experimental results demonstrate the feasibility of using this tool to improve an individual’s understanding of medical materials. %M 35363142 %R 10.2196/35069 %U https://formative.jmir.org/2022/4/e35069 %U https://doi.org/10.2196/35069 %U http://www.ncbi.nlm.nih.gov/pubmed/35363142 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33581 %T Mobile App Intervention on Reducing the Myeloproliferative Neoplasm Symptom Burden: Pilot Feasibility and Acceptability Study %A Win,Hninyee %A Russell,Samantha %A Wertheim,Betsy C %A Maizes,Victoria %A Crocker,Robert %A Brooks,Audrey J %A Mesa,Ruben %A Huberty,Jennifer %A Geyer,Holly %A Eckert,Ryan %A Larsen,Ashley %A Gowin,Krisstina %+ Department of Hematology, University of Arizona, 1501 N Campbell, Tucson, AZ, 85724, United States, 1 5206260662, gowink@email.arizona.edu %K myeloproliferative neoplasm %K mobile application %K symptom burden %K wellness %K self-management %K mobile phone %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Myeloproliferative neoplasms (MPNs) are a group of myeloid malignancies associated with significant symptom burden. Despite pharmacological advances in therapies, inadequate management of MPN symptoms results in reduced quality of life. Objective: This study aims to determine the feasibility of a 12-week global wellness mobile app intervention in decreasing MPN symptom burden. The University of Arizona Andrew Weil Center for Integrative Medicine’s global wellness mobile app, My Wellness Coach (MWC), guides patients to improve their health and well-being through facilitating behavior changes. Methods: Of the 30 patients enrolled in a 12-week intervention, 16 (53%) were retained through the final assessment. Feasibility was assessed by the ease of recruitment, participant adherence, and mobile app acceptability. App acceptability was measured using the user version of the Mobile Application Rating Scale. MPN symptom burden was measured at baseline and 12 weeks after the intervention. Results: Recruitment was efficient, with the participant goal reached within a 60-day period, suggestive of a demand for such an intervention. Adherence was less than the target within study design (75%), although similar to mobile device app use in other studies (53%). The app was deemed acceptable based on the mean user version of the Mobile Application Rating Scale 3-star rating by participants. Finally, there were statistically significant improvements in several MPN symptoms, quality of life, and total score on the Myeloproliferative Neoplasm Symptom Assessment Form surveys. Conclusions: Our 12-week intervention with the MWC app was feasible and was associated with a decrease in MPN symptom burden. Further investigation of the MWC app for use as a self-management strategy to reduce the symptom burden in patients with MPN is warranted. %M 35357315 %R 10.2196/33581 %U https://formative.jmir.org/2022/3/e33581 %U https://doi.org/10.2196/33581 %U http://www.ncbi.nlm.nih.gov/pubmed/35357315 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e33955 %T Using Distance Communication for the User-Centered Development of a Smartphone-Based Serious Game for Children With Type 1 Diabetes: Participatory Design Approach %A Nørlev,Jannie %A Derosche,Christina %A Sondrup,Katrine %A Hejlesen,Ole %A Hangaard,Stine %+ Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7E, Aalborg Øst, 9220, Denmark, 45 99409940, jannienoerlev@gmail.com %K type 1 diabetes %K children %K serious game %K distance communication %K user-centered approach %K evaluation %K playtest %K mobile phone %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The complications of type 1 diabetes (T1D) can be delayed or prevented in children with T1D who receive proper self-management education. Smartphone-based serious games are increasingly being used as an effective tool for teaching self-management. When developing a serious game, it is important that the development process be user-centered. Traditionally, different face-to-face methods have been used when children participate in the development process. However, face-to-face data collection is not always feasible. In such situations, distance communication can be used when developing a serious game. Objective: The objective of this study is to develop a user-centered smartphone-based serious game that teaches self-management focused on carbohydrate intake in children aged 8-14 years with T1D using distance communication in both the development and evaluation of the game. Methods: The development and evaluation of a smartphone-based serious game prototype was inspired by the Lean principles, and a user-centered approach was applied. The development process included 1 expert interview and design workshops with children with T1D. On the basis of the interview and design workshop results, a serious game prototype was developed using Microsoft PowerPoint. The evaluation of the serious game prototype included an interview with a dietitian and a playtest with children with T1D. All data were collected using distance communication. Results: A user-centered smartphone-based serious game prototype was developed and evaluated. The expert interview with the dietitian formed the basis for the learning outcomes in the game. Four children and their parents contributed to the preferences, needs, requirements, and ideas for selected parts of the game design. The dietitian evaluated the prototype positively and validated its content and accuracy. The serious game prototype was well-received by the children and their parents during the playtest. The serious game prototype was perceived as a useful and engaging way to learn. However, the difficulty level was not appropriate, and the information was too basic for participants who had been diagnosed over a year ago. The use of digital communication platforms did not cause any problems. Conclusions: The smartphone-based serious game prototype has the potential to be a useful and attractive tool for teaching disease self-management. The use of distance communication proved to be a useful approach in the development of a serious game. %M 35348466 %R 10.2196/33955 %U https://games.jmir.org/2022/1/e33955 %U https://doi.org/10.2196/33955 %U http://www.ncbi.nlm.nih.gov/pubmed/35348466 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e32340 %T Safety of Triage Self-assessment Using a Symptom Assessment App for Walk-in Patients in the Emergency Care Setting: Observational Prospective Cross-sectional Study %A Cotte,Fabienne %A Mueller,Tobias %A Gilbert,Stephen %A Blümke,Bibiana %A Multmeier,Jan %A Hirsch,Martin Christian %A Wicks,Paul %A Wolanski,Joseph %A Tutschkow,Darja %A Schade Brittinger,Carmen %A Timmermann,Lars %A Jerrentrup,Andreas %+ Charité Universitäsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 50, faco@gmx.de %K symptom checker %K emergency medicine %K app %K triage %K safety %K innovative %K eHealth %K artificial intelligence %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Increasing use of emergency departments (EDs) by patients with low urgency, combined with limited availability of medical staff, results in extended waiting times and delayed care. Technological approaches could possibly increase efficiency by providing urgency advice and symptom assessments. Objective: The purpose of this study is to evaluate the safety of urgency advice provided by a symptom assessment app, Ada, in an ED. Methods: The study was conducted at the interdisciplinary ED of Marburg University Hospital, with data collection performed between August 2019 and March 2020. This study had a single-center cross-sectional prospective observational design and included 378 patients. The app’s urgency recommendation was compared with an established triage concept (Manchester Triage System [MTS]), including patients from the lower 3 MTS categories only. For all patients who were undertriaged, an expert physician panel assessed the case to detect potential avoidable hazardous situations (AHSs). Results: Of 378 participants, 344 (91%) were triaged the same or more conservatively and 34 (8.9%) were undertriaged by the app. Of the 378 patients, 14 (3.7%) had received safe advice determined by the expert panel and 20 (5.3%) were considered to be potential AHS. Therefore, the assessment could be considered safe in 94.7% (358/378) of the patients when compared with the MTS assessment. From the 3 lowest MTS categories, 43.4% (164/378) of patients were not considered as emergency cases by the app, but could have been safely treated by a general practitioner or would not have required a physician consultation at all. Conclusions: The app provided urgency advice after patient self-triage that has a high rate of safety, a rate of undertriage, and a rate of triage with potential to be an AHS, equivalent to telephone triage by health care professionals while still being more conservative than direct ED triage. A large proportion of patients in the ED were not considered as emergency cases, which could possibly relieve ED burden if used at home. Further research should be conducted in the at-home setting to evaluate this hypothesis. Trial Registration: German Clinical Trial Registration DRKS00024909; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00024909 %M 35343909 %R 10.2196/32340 %U https://mhealth.jmir.org/2022/3/e32340 %U https://doi.org/10.2196/32340 %U http://www.ncbi.nlm.nih.gov/pubmed/35343909 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e28157 %T Designing a Cancer Prevention Collaborative Goal-Setting Mobile App for Non-Hispanic Black Primary Care Patients: An Iterative, Qualitative Patient-Led Process %A Resnick,Daniel %A Kearney,Matthew D %A Smith,Jazmine M %A Bautista,Allison %A Jones,Liz %A Schapira,Marilyn M %A Aysola,Jaya %+ Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, 19104, United States, 1 215 573 9475, jaysola@upenn.edu %K mHealth %K cancer prevention %K goal setting %K social networks %K health disparities %K primary care %K accessibility %K development %K feasibility %K mobile phone %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There remains a need to engage at-risk primary care populations in cancer prevention behaviors, yet primary care physicians often lack the time or resources to discuss these behaviors with their patients. Objective: The objective of this study is to evaluate the content, usability, and acceptability of a mobile app that leverages insights from goal-setting and social network literature to facilitate cancer prevention goal setting, tracking, and sharing between non-Hispanic Black primary care patients and their social ties. Methods: We recruited eligible non-Hispanic Black primary care patients (aged ≥18 years) from 2 practice sites in West Philadelphia, using nonprobabilistic purposive sampling. We conducted semistructured interviews with 5 to 7 participants over 3 weeks to solicit feedback on paper mock-ups of the app, iteratively adapting these mock-ups after each set of interviews. Thereafter, and informed by initial feedback, we created an electronic beta version of the app and sought acceptability and usability feedback from a different set of participants. Then, we conducted content analysis of all user responses to search for unifying themes on acceptability and usability of both the initial mock-ups and beta version of the app. We further assessed app usability using questions derived from the System Usability Scale. Results: A total of 33 non-Hispanic Black primary care patients participated in this study. The mean age was 49 (SD 13) years, and 26 (79%) out of 33 participants identified as female. Semistructured interviews revealed three primary generalizable insights from our target population: the framing of each goal and its relevance to cancer impacted the likelihood that the goal would be chosen, participants thought that sharing health goals with others facilitates health behaviors, and most participants found it motivating to see other users’ goal progress, while still collaborating with these users on their health goals. An overarching insight that permeated across each theme was the participants’ desire to customize and personalize the app. Usability testing revealed that 100% (33/33) of participants found the app easy to use, and 76% (25/33) of participants reported that they would like to use this app frequently. Conclusions: Cancer prevention in the modern era must include options that are accessible to all, but this does not mean that all options must be universal. This study’s iterative process led to the development of a cancer prevention mobile app that non-Hispanic Black primary care patients deemed usable and acceptable and yielded noteworthy insights about what intended end users value in setting and accomplishing health goals. %M 35323124 %R 10.2196/28157 %U https://formative.jmir.org/2022/3/e28157 %U https://doi.org/10.2196/28157 %U http://www.ncbi.nlm.nih.gov/pubmed/35323124 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e32212 %T Web-Based Versus Print-Based Physical Activity Intervention for Community-Dwelling Older Adults: Crossover Randomized Trial %A Pischke,Claudia R %A Voelcker-Rehage,Claudia %A Ratz,Tiara %A Peters,Manuela %A Buck,Christoph %A Meyer,Jochen %A von Holdt,Kai %A Lippke,Sonia %+ Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany, 49 211 81 ext 08599, ClaudiaRuth.Pischke@med.uni-duesseldorf.de %K physical activity %K older adults %K eHealth %K print-based intervention %K web-based intervention %K physical activity promotion %K healthy aging %K preferences %K randomized trial %K mobile phone %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Fewer than half of older German adults engage in the recommended levels of endurance training. Objective: The study aim is to compare the acceptance and effectiveness of two interventions for physical activity (PA) promotion among initially inactive community-dwelling older adults ≥60 years in a 9-month, crossover randomized trial. Methods: Participants were recruited in person and randomized to one of the following interventions for self-monitoring PA: a print-based intervention (PRINT: 113/242, 46.7%) or a web-based intervention (WEB: 129/242, 53.3%). Furthermore, 29.5% (38/129) of those in the web-based intervention group received a PA tracker in addition to WEB (WEB+). After randomization, the participants and researchers were not blinded. The participants’ baseline intervention preferences were retrospectively assessed. All the intervention groups were offered 10 weekly face-to-face group sessions. Afterward, participants could choose to stay in their group or cross over to one of the other groups, and group sessions were continued monthly for another 6 months. 3D accelerometers to assess PA and sedentary behavior (SB) at baseline (T0), 3-month follow-up (T1), and 9-month follow-up (T2) were used. Adherence to PA recommendations, attendance of group sessions, and intervention acceptance were assessed using self-administered paper-based questionnaires. Linear mixed models were used to calculate differences in moderate to vigorous PA (MVPA) and SB between time points and intervention groups. Results: Of the 242 initially recruited participants, 91 (37.6%) were randomized to the WEB group; 38 (15.7%) to the WEB+ group; and 113 (46.7%) to the PRINT group. Overall, 80.6% (195/242) of the participants completed T1. Only 0.4% (1/242) of the participants changed from the WEB group to the PRINT group and 6.2% (15/242) moved from the PRINT group to the WEB group (WEB-WEB: 103/249, (41.4%); PRINT-PRINT: 76/249, 30.5%) when offered to cross over at T1. Furthermore, 66.1% (160/242) of participants completed T2. MVPA in minutes per day increased between baseline and T1, but these within-group changes disappeared after adjusting for covariates. MVPA decreased by 9 minutes per day between baseline and T2 (βtime=−9.37, 95% CI −18.58 to −0.16), regardless of the intervention group (WEB vs PRINT: βgroup*time=−3.76, 95% CI −13.33 to 5.82, WEB+ vs PRINT: βgroup*time=1.40, 95% CI −11.04 to 13.83). Of the participants, 18.6% (38/204) met the PA recommendations at T0, 16.4% (26/159) at T1, and 20.3% (28/138) at T2. For SB, there were no significant group differences or group-by-time interactions at T1 or T2. Intervention acceptance was generally high. The use of intervention material was high to moderate at T1 and decreased by T2. Conclusions: There was little movement between intervention groups at T1 when given the choice, and participation was not associated with increases in PA or decreases in SB over time. Trial Registration: German Clinical Trials Register DRKS00016073; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016073 %M 35319484 %R 10.2196/32212 %U https://mhealth.jmir.org/2022/3/e32212 %U https://doi.org/10.2196/32212 %U http://www.ncbi.nlm.nih.gov/pubmed/35319484 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30606 %T Digital Prompts to Increase Engagement With the Headspace App and for Stress Regulation Among Parents: Feasibility Study %A Militello,Lisa %A Sobolev,Michael %A Okeke,Fabian %A Adler,Daniel A %A Nahum-Shani,Inbal %+ College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH, 43210, United States, 1 614 688 4248, militello.14@osu.edu %K Headspace %K engagement %K mHealth %K mindfulness %K mental health %K mobile phone %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the interrelated health of children and parents, strategies to promote stress regulation are critically important in the family context. However, the uptake of preventive mental health is limited among parents owing to competing family demands. Objective: In this study, we aim to determine whether it is feasible and acceptable to randomize digital prompts designed to engage parents in real-time brief mindfulness activities guided by a commercially available app. Methods: We conducted a 30-day pilot microrandomized trial among a sample of parents who used Android smartphones. Each day during a parent-specified time frame, participants had a 50% probability of receiving a prompt with a message encouraging them to engage in a mindfulness activity using a commercial app, Headspace. In the 24 hours following randomization, ecological momentary assessments and passively collected smartphone data were used to assess proximal engagement (yes or no) with the app and any mindfulness activity (with or without the app). These data were combined with baseline and exit surveys to determine feasibility and acceptability. Results: Over 4 months, 83 interested parents were screened, 48 were eligible, 16 were enrolled, and 10 were successfully onboarded. Reasons for nonparticipation included technology barriers, privacy concerns, time constraints, or change of mind. In total, 80% (8/10) of parents who onboarded successfully completed all aspects of the intervention. While it is feasible to randomize prompt delivery, only 60% (6/10) of parents reported that the timing of prompts was helpful despite having control over the delivery window. Across the study period, we observed higher self-reported engagement with Headspace on days with prompts (31/62, 50% of days), as opposed to days without prompts (33/103, 32% of days). This pattern was consistent for most participants in this study (7/8, 87%). The time spent using the app on days with prompts (mean 566, SD 378 seconds) was descriptively higher than on days without prompts (mean 225, SD 276 seconds). App usage was highest during the first week and declined over each of the remaining 3 weeks. However, self-reported engagement in mindfulness activities without the app increased over time. Self-reported engagement with any mindfulness activity was similar on days with (40/62, 65% of days) and without (65/103, 63% of days) prompts. Participants found the Headspace app helpful (10/10, 100%) and would recommend the program to others (9/10, 90%). Conclusions: Preliminary findings suggest that parents are receptive to using mindfulness apps to support stress management, and prompts are likely to increase engagement with the app. However, we identified several implementation challenges in the current trial, specifically a need to optimize prompt timing and frequency as a strategy to engage users in preventive digital mental health. %M 35311675 %R 10.2196/30606 %U https://formative.jmir.org/2022/3/e30606 %U https://doi.org/10.2196/30606 %U http://www.ncbi.nlm.nih.gov/pubmed/35311675 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34758 %T An Integrated, Multimodal, Digital Health Solution for Chronic Obstructive Pulmonary Disease: Prospective Observational Pilot Study %A Gelbman,Brian D %A Reed,Carol R %+ Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical Center, 635 Madison Avenue, Suite 1101, New York, NY, 10022, United States, 1 212 628 6611, Brg9001@med.cornell.edu %K COPD %K patient engagement %K mHealth %K digital health %K mobile phone %K telemedicine %K mobile apps %K remote monitoring %K spirometry %K pulse oximetry %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) affects millions of Americans and has a high economic impact partially due to frequent emergency room visits and hospitalizations. Advances in digital health have made it possible to collect data remotely from multiple devices to assist in managing chronic diseases such as COPD. Objective: In this pilot study, we evaluated the ability of patients with COPD to use the Wellinks mHealth platform to collect information from multiple modalities important to the management of COPD. We also assessed patient satisfaction and engagement with the platform. Methods: A single-site, observational, prospective pilot study (N=19) was conducted using the Wellinks platform in adults with COPD. All patients were aged over 30 years at screening, owned an iPhone, and were currently undergoing a treatment regimen that included nebulized therapy. Enrolled patients received a study kit consisting of the Flyp nebulizer, Smart One spirometer, the Nonin pulse oximeter, plus the Wellinks mHealth app, and training for all devices. For 8 weeks, participants were to enter daily symptoms and medication use manually; spirometry, nebulizer, and pulse oximeter data were automatically recorded. Data were sent to the attending physician in a monthly report. Patient satisfaction was measured via a 5-point scale and the Net Promoter Score (NPS) captured in interviews at the end of the observation period. Results: Average age of the patients was 79.6 (range 65-95) years. Participants (10 female; 9 male) had an average FEV1% (forced expiratory volume in 1 second as % of predicted for the patient) of 56.2% of predicted (range 23%-113%) and FEV1/forced vital capacity of 65%. COPD severity, as assessed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, was mild in 2 patients, moderate in 6, and severe/very severe in 11; 9 patients were on home oxygen. During this 8-week study, average use of the spirometer was 2.5 times/week, and the pulse oximeter 4.2 times/week. Medication use was manually documented 9.0 times/week, nebulizer use 1.9 times/week, and symptoms recorded 1.2 times/week on average. The correlation coefficients of home to office measurements for peak flow and FEV1 were high (r=0.94 and 0.96, respectively). Patients found the app valuable (13/16, 81%) and easy to use (15/16, 94%). The NPS was 59. Conclusions: This study demonstrates that our cohort of patients with COPD engaged with the Wellinks mHealth platform avidly and consistently over the 8-week period, and that patient satisfaction was high, as indicated by the satisfaction survey and the NPS of 59. In this small, selected sample, patients were both willing to use the technology and capable of doing so successfully regardless of disease severity, age, or gender. The Wellinks mHealth platform was considered useful and valuable by patients, and can assist clinicians in improved, timely decision making for better COPD management. %M 35142291 %R 10.2196/34758 %U https://formative.jmir.org/2022/3/e34758 %U https://doi.org/10.2196/34758 %U http://www.ncbi.nlm.nih.gov/pubmed/35142291 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e35799 %T Integrating Behavioral Science and Design Thinking to Develop Mobile Health Interventions: Systematic Scoping Review %A Voorheis,Paula %A Zhao,Albert %A Kuluski,Kerry %A Pham,Quynh %A Scott,Ted %A Sztur,Peter %A Khanna,Nityan %A Ibrahim,Mohamed %A Petch,Jeremy %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 7058163180, paula.voorheis@mail.utoronto.ca %K behavior change %K design thinking %K digital health %K health behavior %K mobile application %K mobile health %K mobile phone %K product design %K scoping review %K systems design %K telemedicine %K user-centered design %D 2022 %7 16.3.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) interventions are increasingly being designed to facilitate health-related behavior change. Integrating insights from behavioral science and design science can help support the development of more effective mHealth interventions. Behavioral Design (BD) and Design Thinking (DT) have emerged as best practice approaches in their respective fields. Until now, little work has been done to examine how BD and DT can be integrated throughout the mHealth design process. Objective: The aim of this scoping review was to map the evidence on how insights from BD and DT can be integrated to guide the design of mHealth interventions. The following questions were addressed: (1) what are the main characteristics of studies that integrate BD and DT during the mHealth design process? (2) what theories, models, and frameworks do design teams use during the mHealth design process? (3) what methods do design teams use to integrate BD and DT during the mHealth design process? and (4) what are key design challenges, implementation considerations, and future directions for integrating BD and DT during mHealth design? Methods: This review followed the Joanna Briggs Institute reviewer manual and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Studies were identified from MEDLINE, PsycINFO, Embase, CINAHL, and JMIR by using search terms related to mHealth, BD, and DT. Included studies had to clearly describe their mHealth design process and how behavior change theories, models, frameworks, or techniques were incorporated. Two independent reviewers screened the studies for inclusion and completed the data extraction. A descriptive analysis was conducted. Results: A total of 75 papers met the inclusion criteria. All studies were published between 2012 and 2021. Studies integrated BD and DT in notable ways, which can be referred to as “Behavioral Design Thinking.” Five steps were followed in Behavioral Design Thinking: (1) empathize with users and their behavior change needs, (2) define user and behavior change requirements, (3) ideate user-centered features and behavior change content, (4) prototype a user-centered solution that supports behavior change, and (5) test the solution against users’ needs and for its behavior change potential. The key challenges experienced during mHealth design included meaningfully engaging patient and public partners in the design process, translating evidence-based behavior change techniques into actual mHealth features, and planning for how to integrate the mHealth intervention into existing clinical systems. Conclusions: Best practices from BD and DT can be integrated throughout the mHealth design process to ensure that mHealth interventions are purposefully developed to effectively engage users. Although this scoping review clarified how insights from BD and DT can be integrated during mHealth design, future research is needed to identify the most effective design approaches. %M 35293871 %R 10.2196/35799 %U https://mhealth.jmir.org/2022/3/e35799 %U https://doi.org/10.2196/35799 %U http://www.ncbi.nlm.nih.gov/pubmed/35293871 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e33152 %T An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Co-design and User Testing Study %A Mueller,Emily L %A Cochrane,Anneli R %A Campbell,Madison E %A Nikkhah,Sarah %A Miller,Andrew D %+ Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, 705 Riley Hospital Dr, ROC 4340, Indianapolis, IN, 46202, United States, 1 312 399 0245, elmuelle@iu.edu %K child %K adolescent %K oncology %K supportive care %K mHealth %K mobile health %K cancer %K pediatrics %K children %K digital health %K health applications %K parent %K caregiver %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Caregivers face new challenges and tasks when their child is diagnosed with cancer, which can be overwhelming. Mobile technology has the capacity to provide immediate support at their fingertips to aid in tracking symptoms, managing medication, and planning for emergencies. Objective: The objective of this study is to engage directly with end users and proxies to co-design and create a mobile technology app to support caregivers in the medical management of their child with cancer. Methods: We engaged directly with caregivers of children with cancer and pediatric oncology nurse coordinators (proxy end users) to co-design and create the prototype of the Cope 360 mobile health app. Alpha testing was accomplished by walking the users through a series of predetermined tasks that encompassed all aspects of the app including tracking symptoms, managing medications, and planning or practicing for a medical emergency that required seeking care in the emergency department. Evaluation was accomplished through recorded semistructured interviews and quantitative surveys to capture demographic information and measure the system usability score. Interviews were transcribed and analyzed iteratively using NVivo (version 12; QSR International). Results: This study included 8 caregivers (aged 33-50 years) of children with cancer, with most children receiving chemotherapy, and 6 nurse coordinators, with 3 (50%) of them having 11 to 20 years of nursing experience. The mean system usability score given by caregivers was 89.4 (95% CI 80-98.8). Results were grouped by app function assessed with focus on specific attributes that were well received and those that required refinement. The major issues requiring refinement included clarity in the medical information and terminology, improvement in design of tasks, tracking of symptoms including adjusting the look and feel of certain buttons, and changing the visual graph used to monitor symptoms to include date anchors. Conclusions: The Cope 360 app was well received by caregivers of children with cancer but requires further refinement for clarity and visual representation. After refinement, testing among caregivers in a real-world environment is needed to finalize the Cope 360 app before its implementation in a randomized controlled trial. %M 35293867 %R 10.2196/33152 %U https://cancer.jmir.org/2022/1/e33152 %U https://doi.org/10.2196/33152 %U http://www.ncbi.nlm.nih.gov/pubmed/35293867 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32499 %T Analysis of Demographic Characteristics of Users of a Free Tobacco Cessation Smartphone App: Observational Study %A Fradkin,Nick %A Zbikowski,Susan M %A Christensen,Trevor %+ Office of Healthy and Safe Communities, Division of Prevention and Community Health, Washington State Department of Health, PO Box 47848, Olympia, WA, 98504-7848, United States, 1 602 326 3439, nfradkin@gmail.com %K mobile applications %K mHealth %K eHealth %K smartphone app %K tobacco %K smoking cessation %K public health %K smoking %K application %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco “quitline” services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. Objective: The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. Methods: This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. Results: Participants were primarily non-Hispanic White (978/1218, 80.3%), identified as female (780/1236, 63.1%), were between ages 25-54 years (903/1186, 76.1%), had at least some college education (836/1222, 68.4%), and reported a household income under US $50,000 (742/1055, 70.3%). Fewer respondents were from rural counties (359/1220, 29.4%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5%); were uninsured (147/1206, 12.2%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. Conclusions: A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups. %M 35262491 %R 10.2196/32499 %U https://publichealth.jmir.org/2022/3/e32499 %U https://doi.org/10.2196/32499 %U http://www.ncbi.nlm.nih.gov/pubmed/35262491 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e30872 %T Including the Public in Public eHealth: The Need for Community Participation in the Development of State-Sponsored COVID-19–Related Mobile Apps %A Idris,Muhammed Yassin %A Korin,Maya %A Araya,Faven %A Chowdhury,Sayeeda %A Medina,Patty %A Cruz,Larissa %A Hawkins,Trey-Rashad %A Brown,Humberto %A Claudio,Luz %+ Department of Medicine, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA, 30310, United States, 1 404 752 1500, myidris@msm.edu %K mobile apps %K COVID-19 %K CBPR %K digital health %K eHealth %K community health %K health disparities %D 2022 %7 9.3.2022 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The COVID-19 pandemic has overwhelmed health care systems worldwide, particularly in underresourced communities of color with a high prevalence of pre-existing health conditions. Many state governments and health care entities responded by increasing their capacity for telemedicine and disease tracking and creating mobile apps for dissemination of medical information. Our experiences with state-sponsored apps suggest that because many of these eHealth tools did not include community participation, they inadvertently contributed to widening digital health disparities. We propose that, as eHealth tools continue to expand as a form of health care, more attention needs to be given to their equitable distribution, accessibility, and usage. In this viewpoint collaboratively written by a minority-serving community-based organization and an eHealth academic research team, we present our experience participating in a community advisory board working on the dissemination of the COVID Alert NY mobile app to illustrate the importance of public participation in app development. We also provide practical recommendations on how to involve community representatives in the app development process. We propose that transparency and community involvement in the process of app development ultimately increases buy-in, trust, and usage of digital technology in communities where they are needed most. %M 35113793 %R 10.2196/30872 %U https://mhealth.jmir.org/2022/3/e30872 %U https://doi.org/10.2196/30872 %U http://www.ncbi.nlm.nih.gov/pubmed/35113793 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e26764 %T Benefits of mHealth Co-design for African American and Hispanic Adults: Multi-Method Participatory Research for a Health Information App %A Jackson,Devlon N %A Sehgal,Neil %A Baur,Cynthia %+ Department of Behavioral and Community Health, Center for Health Literacy, Center for Health Equity, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD, 20742, United States, 1 3014051464, djacks04@umd.edu %K mHealth app design %K health literacy %K health disparities %K health equity %K African Americans %K Hispanics %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Participatory research methodologies can provide insight into the use of mobile health (mHealth) apps, cultural preferences and needs, and health literacy issues for racial and ethnic groups, such as African Americans and Hispanics who experience health disparities. Objective: This methodological paper aims to describe a 1-year multi-method participatory research process that directly engaged English-speaking African American and bilingual or Spanish-speaking Hispanic adults in designing a prevention-focused, personalized mHealth, information-seeking smartphone app. We report design team participants’ experiences with the methods to show why our approach is valuable in producing apps that are more aligned with their needs. Methods: Three design sessions were conducted to inform the iteration of a prevention-focused, personalized mHealth, information-seeking app. The research team led sessions with 2 community member design teams. Design team participants described their goals, motives, and interests regarding prevention information using different approaches, such as collage and card sorting (design session 1), interaction with the app prototype (design session 2), and rating of cultural appropriateness strategies (design session 3). Results: Each design team had 5 to 6 participants: 2 to 3 male participants and 3 female participants aged between 30 and 76 years. Design team participants shared their likes and dislikes about the sessions and the overall experience of the design sessions. Both African American and Hispanic teams reported positive participation experience. The primary reasons included the opportunity for their views to be heard, collectively working together in the design process, having their apprehension about mHealth reduced, and an opportunity to increase their knowledge of how they could manage their health through mHealth. The feedback from each session informed the following design sessions and a community-engaged process. In addition, the specific findings for each design session informed the design of the app for both communities. Conclusions: This multi-method participatory research process revealed 4 key lessons learned and recommendations for future research in mHealth app design for African Americans and Hispanics. Lesson 1—community partnerships are key because they provide the chain of trust that helps African American and Hispanic participants feel comfortable participating in app research. Lesson 2—community-based participatory research principles continue to yield promising results to engage these populations in mHealth research. Lesson 3—interactive design sessions uncover participants’ needs and development opportunities for mHealth tools. Lesson 4—multiple design sessions with different methods provide an in-depth understanding of participants’ mHealth preferences and needs. Future developers should consider these methods and lessons to ensure health apps in the marketplace contribute to eliminating health disparities and achieving health equity. %M 35262496 %R 10.2196/26764 %U https://formative.jmir.org/2022/3/e26764 %U https://doi.org/10.2196/26764 %U http://www.ncbi.nlm.nih.gov/pubmed/35262496 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e30364 %T The Development of an mHealth Tool for Children With Long-term Illness to Enable Person-Centered Communication: User-Centered Design Approach %A Wiljén,Angelica %A Chaplin,John Eric %A Crine,Vanessa %A Jobe,William %A Johnson,Ensa %A Karlsson,Katarina %A Lindroth,Tomas %A Schwarz,Anneli %A Stenmarker,Margaretha %A Thunberg,Gunilla %A Öhlén,Joakim %A Nilsson,Stefan %+ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, 405 30, Sweden, 46 738538951, stefan.nilsson.4@gu.se %K children %K communication %K long-term illness %K mHealth %K pediatric care %K person-centered care %K symptom assessment %K universal design %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Children with long-term illnesses frequently experience symptoms that could negatively affect their daily lives. These symptoms are often underreported in health care. Despite a large number of mobile health (mHealth) tools, few are based on a theoretical framework or supported by scientific knowledge. Incorporating universal design when developing a product can promote accessibility and facilitate person-centered communication. Objective: The aim of this study is to identify the symptom-reporting needs of children with cancer and congenital heart defects that could be satisfied by using a mobile app. Another aim is to evaluate how the child might interact with the app by considering universal design principles and to identify parents’ views and health care professionals’ expectations and requirements for an mHealth tool. Methods: User-centered design is an iterative process that focuses on an understanding of the users. The adapted user-centered design process includes 2 phases with 4 stages. Phase 1 involved interviews with 7 children with long-term illnesses, 8 parents, and 19 health care professionals to determine their needs and wishes for support; a workshop with 19 researchers to deepen our understanding of the needs; and a workshop with developers to establish a preliminary tool to further investigate needs and behaviors. Phase 2 involved interviews with 10 children with long-term illnesses, 9 parents, and 21 health care professionals to evaluate the mock-up (prototype) of the mHealth tool. Data were synthesized using the interpretive description technique. Results: A total of 4 aspects of needs emerged from the synthesis of the data, as follows: different perspectives on provided and perceived support; the need for an easy-to-use, non–clinic-based tool to self-report symptoms and to facilitate communication; the need for safety by being in control and reaching the child’s voice; and a way of mapping the illness journey to facilitate recall and improve diagnostics. The children with long-term illnesses expressed a need to not only communicate about pain but also communicate about anxiety, fatigue, fear, and nausea. Conclusions: The findings of this study indicated that the PicPecc (Pictorial Support in Person-Centered Care for Children) app is a potential solution for providing communicative support to children with long-term illnesses dealing with multiple symptoms and conditions. The interview data also highlighted symptoms that are at risk of being overlooked if they are not included in the mobile app. Further studies are needed to include usability testing and evaluation in hospitals and home care settings. %M 35258466 %R 10.2196/30364 %U https://pediatrics.jmir.org/2022/1/e30364 %U https://doi.org/10.2196/30364 %U http://www.ncbi.nlm.nih.gov/pubmed/35258466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32669 %T A Tailored App for the Self-management of Musculoskeletal Conditions: Evidencing a Logic Model of Behavior Change %A Berry,Alice %A McClellan,Carey %A Wanless,Ben %A Walsh,Nicola %+ University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, United Kingdom, 44 117 32 87802, alice.berry@uwe.ac.uk %K musculoskeletal %K supported self-management %K behavior change %K digital health intervention %K behavior change wheel %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Musculoskeletal conditions such as joint pain are a growing problem, affecting 18.8 million people in the United Kingdom. Digital health interventions (DHIs) are a potentially effective way of delivering information and supporting self-management. It is vital that the development of such interventions is transparent and can illustrate how individual components work, how they link back to the theoretical constructs they are attempting to change, and how this might influence outcomes. getUBetter is a DHI developed to address the lack of personalized, supported self-management tools available to patients with musculoskeletal conditions by providing knowledge, skills, and confidence to navigate through a self-management journey. Objective: The aim of this study was to map a logic model of behavior change for getUBetter to illustrate how the content and functionality of the DHI are aligned with recognized behavioral theory, effective behavior change techniques, and clinical guidelines. Methods: A range of behavior change models and frameworks were used, including the behavior change wheel and persuasive systems design framework, to map the logic model of behavior change underpinning getUBetter. The three main stages included understanding the behavior the intervention is attempting to change, identifying which elements of the intervention might bring about the desired change in behavior, and describing intervention content and how this can be optimally implemented. Results: The content was mapped to 25 behavior change techniques, including information about health consequences, instruction on how to perform a behavior, reducing negative emotions, and verbal persuasion about capability. Mapping to the persuasive system design framework illustrated the use of a number of persuasive design principles, including tailoring, personalization, simulation, and reminders. Conclusions: This process enabled the proposed mechanisms of action and theoretical foundations of getUBetter to be comprehensively described, highlighting the key techniques used to support patients to self-manage their condition. These findings provide guidance for the ongoing evaluation of the effectiveness (including quality of engagement) of the intervention and highlight areas that might be strengthened in future iterations. %M 35258462 %R 10.2196/32669 %U https://formative.jmir.org/2022/3/e32669 %U https://doi.org/10.2196/32669 %U http://www.ncbi.nlm.nih.gov/pubmed/35258462 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29832 %T A Smartphone Serious Game for Adolescents (Grow It! App): Development, Feasibility, and Acceptance Study %A Dietvorst,Evelien %A Aukes,Michelle A %A Legerstee,Jeroen S %A Vreeker,Annabel %A Hrehovcsik,Micah M %A Keijsers,Loes %A Hillegers,Manon H J %+ Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Wytemaweg 8, Rotterdam, 3015 CN, Netherlands, 31 (0)107040209, m.hillegers@erasmusmc.nl %K ecological momentary assessment %K EMA %K serious game %K CBT %K depression %K internalizing problems %K adolescents %K high risk %K digital health %K mobile health %K mHealth %K game design %K app development %K mobile phone %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety and mood problems in adolescents often go unnoticed and may therefore remain untreated. Identifying and preventing the development of emotional problems requires monitoring and effective tools to strengthen adolescents' resilience, for example, by enhancing coping skills. Objective: This study describes the developmental process, feasibility, and acceptance of Grow It!, a multiplayer serious game app for adolescents aged 12-25 years. The app consists of the experience sampling method (ESM) to monitor thoughts, behaviors, and emotions in daily life to enhance self-insight and daily cognitive behavioral therapy–based challenges to promote adaptive coping. Methods: Our approach entails an iterative game design process combined with an agile method to develop the smartphone app. The incorporated game features (ie, challenges, chat functionality, and visual representation) in the Grow It! app were co-designed with adolescent end users to increase participant engagement and adherence. Results: The Grow It! app was delivered for Android and iOS in May 2020. Grow It! was offered to adolescents during the COVID-19 crisis between May and December 2020. Participants of the Grow It! COVID-19 study (sample 1: N=685; mean age 16.19, SD 3.11 years; 193/685, 28.2% boys; sample 2: N=1035; mean age 18.78, SD 3.51 years; 193/1035, 18.64% boys) completed 31.5% (13.2/42) to 49.5% (10.4/21) of challenges. Compliance of ESM was suboptimal (35.1/210, 16.7% to 32.5/105, 30.9%). Follow-up questionnaires indicated an overall score of the app of 7.1 out of 10. Moreover, 72.6% (278/383) to 75.6% (487/644) would recommend the app to friends. Conclusions: To our knowledge, Grow It! is the first gamified ESM app that both measures individual differences in emotional dynamics and offers an integrated cognitive behavioral therapy–based intervention. Our findings support the feasibility and acceptance, and therefore applicability, of the Grow It! app in adolescents. Further iterations of this serious game app will focus on the increase of compliance and on providing participants feedback through their personal mood profiles. %M 35238795 %R 10.2196/29832 %U https://formative.jmir.org/2022/3/e29832 %U https://doi.org/10.2196/29832 %U http://www.ncbi.nlm.nih.gov/pubmed/35238795 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30797 %T User-Centered Development and Testing of the Online Patient-Reported Outcomes, Burdens, and Experiences (PROBE) Survey and the myPROBE App and Integration With the Canadian Bleeding Disorder Registry: Mixed Methods Study %A Germini,Federico %A Borg Debono,Victoria %A Page,David %A Zuk,Victoria %A Kucher,Alexandra %A Cotoi,Chris %A Hobson,Nicholas %A Sevestre,Michael %A Skinner,Mark W %A Iorio,Alfonso %A , %+ Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 26771, germinif@mcmaster.ca %K health-related quality of life %K EQ-5D %K mobile app %K Patient-Reported Outcomes, Burdens, and Experiences (PROBE) %K hemophilia %K mobile health %K mHealth %K eHealth %K telehealth %K user-centered design %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Patient-Reported Outcomes, Burdens, and Experiences (PROBE) questionnaire is a tool for assessing the quality of life and disease burden in people living with hemophilia. Objective: The objectives of our study were (1) to assess the needs of relevant stakeholders involved in the use of PROBE, (2) to develop the software infrastructure needed to meet these needs, and (3) to test the usability of the final product. Methods: We conducted a series of semistructured interviews of relevant stakeholders, including PROBE investigators, people with hemophilia, and representatives of the sponsor. Based on these, we developed an online survey and a mobile app for iOS and Android. A user group evaluated the final product using the System Usability Scale (SUS) and an open feedback framework. Results: The online survey was updated, and the myPROBE app for mobile devices and a new application programming interface were developed. The app was tested and modified according to user feedback over multiple cycles. The final version of the app was released in July 2019. Seventeen users aged 23 to 67 years evaluated the final version of the app using the SUS. The median (first, third quartile) SUS score for the app was 85 (68, 88) out of 100. The newly introduced functionalities were as follows: (1) capability to longitudinally track repeated fillings of the questionnaire at different time points by the same participant (as opposed to anonymous completion); (2) linking of the questionnaire with hemophilia registries, starting with the Canadian Bleeding Disorders Registry as a proof of concept; (3) removing or adding questions as needed; and (4) sending notifications to the users (eg, reminders). A new secure database was built for securely storing personal information separately from the questionnaire data. The PROBE online survey is currently available in 96 countries and 34 languages. Conclusions: The online survey was updated successfully, and the myPROBE app was developed, with a SUS score of 85 (out of 100). The app has been released in 81 countries and 34 languages. This will facilitate data collection for research and advocacy purposes, and the use of this tool in everyday clinical practice. %M 35234648 %R 10.2196/30797 %U https://humanfactors.jmir.org/2022/1/e30797 %U https://doi.org/10.2196/30797 %U http://www.ncbi.nlm.nih.gov/pubmed/35234648 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e28697 %T Supporting Management of Noncommunicable Diseases With Mobile Health (mHealth) Apps: Experimental Study %A Kela,Neta %A Eytam,Eleanor %A Katz,Adi %+ Shamoon College of Engineering, 84 Jabotinsky St, Ashdod, 77245, Israel, 972 088519309, neta.kela@gmail.com %K mHealth %K digital health %K instrumentality %K aesthetics %K symbolic value %K preference %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Noncommunicable diseases (NCDs) are the leading global health problem in this century and are the principal causes of death and health care spending worldwide. Mobile health (mHealth) apps can help manage and prevent NCDs if people are willing to use them as supportive tools. Still, many people are reluctant to adopt these technologies. Implementing new apps could result in earlier intervention for many health conditions, preventing more serious complications. Objective: This research project aimed to test the factors that facilitate the adoption of mHealth apps by users with NCDs. We focused on determining, first, what user interface (UI) qualities and complexity levels appeal to users in evaluating mHealth apps. We also wanted to determine whether people prefer that the data collected by an mHealth app be analyzed using a physician or an artificial intelligence (AI) algorithm. The contribution of this work is both theoretical and practical. We examined users’ considerations when adopting mHealth apps that promote healthy lifestyles and helped them manage their NCDs. Our results can also help direct mHealth app UI designers to focus on the most appealing aspects of our findings. Methods: A total of 347 respondents volunteered to rate 3 models of mHealth apps based on 16 items that measured instrumentality, aesthetics, and symbolism. Respondents rated each model after reading 1 of 2 different scenarios. In one scenario, a physician analyzed the data, whereas, in the other, the data were analyzed by an AI algorithm. These scenarios tested the degree of trust people placed in AI algorithms versus the “human touch” of a human physician regarding analyzing data collected by an mHealth app. Results: As shown by the responses, the involvement of a human physician in the application had a significant effect (P<.001) on the perceived instrumentality of the simple model. The complex model with more controls was rated significantly more aesthetic when associated with a physician performing data analysis rather than an AI algorithm (P=.03). Conclusions: Generally, when participants found a human touch in the mHealth app (connection to a human physician who they assumed would analyze their data), they judged the app more favorably. Simple models were evaluated more positively than complex ones, and aesthetics and symbolism were salient predictors of preference. These trends suggest that designers and developers of mHealth apps should keep the designs simple and pay special attention to aesthetics and symbolic value. %M 35234653 %R 10.2196/28697 %U https://humanfactors.jmir.org/2022/1/e28697 %U https://doi.org/10.2196/28697 %U http://www.ncbi.nlm.nih.gov/pubmed/35234653 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30052 %T eDOL mHealth App and Web Platform for Self-monitoring and Medical Follow-up of Patients With Chronic Pain: Observational Feasibility Study %A Kerckhove,Nicolas %A Delage,Noémie %A Cambier,Sébastien %A Cantagrel,Nathalie %A Serra,Eric %A Marcaillou,Fabienne %A Maindet,Caroline %A Picard,Pascale %A Martiné,Gaelle %A Deleens,Rodrigue %A Trouvin,Anne-Priscille %A Fourel,Lauriane %A Espagne-Dubreuilh,Gaelle %A Douay,Ludovic %A Foulon,Stéphane %A Dufraisse,Bénédicte %A Gov,Christian %A Viel,Eric %A Jedryka,François %A Pouplin,Sophie %A Lestrade,Cécile %A Combe,Emmanuel %A Perrot,Serge %A Perocheau,Dominique %A De Brisson,Valentine %A Vergne-Salle,Pascale %A Mertens,Patrick %A Pereira,Bruno %A Djiberou Mahamadou,Abdoul Jalil %A Antoine,Violaine %A Corteval,Alice %A Eschalier,Alain %A Dualé,Christian %A Attal,Nadine %A Authier,Nicolas %+ Service de Pharmacologie médicale, Centre Hospitalier Universitaire de Clermont-Ferrand, 29 boulevard Joseph Girod, Clermont-Ferrand, 63000, France, 33 0473178414, nkerckhove@chu-clermontferrand.fr %K mHealth %K chronic pain %K feasibility study %K eHealth %K self-monitoring %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. Objective: We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. Methods: We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. Results: Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. Conclusions: This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. Trial Registration: ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694 %M 35234654 %R 10.2196/30052 %U https://formative.jmir.org/2022/3/e30052 %U https://doi.org/10.2196/30052 %U http://www.ncbi.nlm.nih.gov/pubmed/35234654 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e34477 %T Participatory Design of a Mobile App to Safeguard Mental Resilience in the Context of Drug Use in Young Adults: Multi-Method Study %A Ben-Yehuda,Ofri %A Dreazen,Efrat %A Koren,Danny %A Peleg,Mor %+ Department of Information Systems, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel, 972 048288509, morpeleg@is.haifa.ac.il %K mobile health %K mHealth %K eHealth %K telehealth %K mental health %K mental resilience %K participatory design %K mobile phone %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing mental health apps are largely not aimed at generally healthy young people who may be experimenting with addictive substances and mind-altering experiences. Objective: The aim of this study is to examine the interest and expectations of young people regarding a proposed smartphone app designed to help protect and promote mental health and resilience in the face of risks associated with substance use. Methods: The study was based on agile system development and had 3 empirical substudies. Our feasibility study (study 1) included an anonymous questionnaire that examined the potential interest of young people in this type of app. It was answered by 339 Israelis aged 18-30 years. The second part of the feasibility study was a pilot study with 1.2% (4/339) of the people who answered the questionnaire and expressed interest in participating in a focus group. They tested and refined the elements planned for the focus groups. Study 2 was a participatory design study involving 7 focus groups of 5 to 7 participants each (young people aged 18-35 years, n=38). Persona development, open discussion, and a Technology Acceptance Model questionnaire were used to elicit user expectations and requirements for the app and to understand the perceived usefulness and usability of the proposed features. Study 3 comprised in-depth interviews with experts in the field of youth mental health and drug use to enlist their professional opinion regarding the value of such an app and recommendations about the features it should include. Results: The mock-up for the proposed app had five key features: personalized assessment of risk for a drug-associated mental crisis, support for self-monitoring, useful information (eg, warning signs and first-aid guidelines), resilience-building exercises, and a support center. Participants rated highly the usefulness of all 5 main features and 96% (24/25) of the specific features we proposed within those main categories. The participants also suggested additional features as well as a new user persona we had not considered: the parents or family members of the young person. The focus groups rated highly the perceived usability of the app. Most of the experts saw value in all the main features and suggested specific knowledge sources for the app’s content. Finally, participants of both the feasibility study and the participatory design study expressed moderate to high interest in using the app for self-help and high interest in using the app to help friends. Conclusions: The findings provide preliminary encouraging support for the 5 main features suggested by the research team and reinforce recommendations for mobile health apps found in the literature. The findings emphasize the insight that this kind of app should be designed primarily for use by individuals seeking to help others. %M 35212631 %R 10.2196/34477 %U https://formative.jmir.org/2022/2/e34477 %U https://doi.org/10.2196/34477 %U http://www.ncbi.nlm.nih.gov/pubmed/35212631 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e23794 %T User-Centered Design to Enhance mHealth Systems for Individuals With Dexterity Impairments: Accessibility and Usability Study %A Chowdhary,Kuntal %A Yu,Daihua Xie %A Pramana,Gede %A Mesoros,Matthew %A Fairman,Andrea %A Dicianno,Brad Edward %A Parmanto,Bambang %+ Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6052 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K cellular phone %K mobile apps %K telemedicine %K adaptive mHealth %K rehabilitation %K self-care %K spinal cord injury %K spina bifida %K chronic disease %K persons with disability %K accessibility %K dexterity impairments %K mobile phone %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities. The Interactive Mobile Health and Rehabilitation (iMHere) system was developed to empower people with disabilities and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated the accessibility and usability of the system. Potential opportunities to improve and simplify the user interface were identified, and the iMHere modules were redesigned accordingly. Objective: In this study, we aim to evaluate the usability of the redesigned modules within the iMHere 1.0 app. Methods: We evaluated the original and redesigned iMHere modules—MyMeds and SkinCare. The Purdue Pegboard Test was administered to assess the participants’ dexterity levels. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess their efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred. Results: In total, 24 participants with disabilities and varying degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness when using the redesigned modules compared with the original modules. The participants also reported improved usability and preferred the redesigned modules. Conclusions: This study demonstrated that the iMHere system became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles. %M 35200144 %R 10.2196/23794 %U https://humanfactors.jmir.org/2022/1/e23794 %U https://doi.org/10.2196/23794 %U http://www.ncbi.nlm.nih.gov/pubmed/35200144 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e27501 %T Iterative Development of a Mobile Phone App to Support Community Health Volunteers During Cervical Cancer Screening in Western Kenya: Qualitative Study %A Stocks,Jacob %A Choi,Yujung %A Ibrahim,Saduma %A Huchko,Megan %+ Center for Global Reproductive Health, Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, United States, 1 919 681 7760, jacob_stocks@med.unc.edu %K mHealth %K cervical cancer screening %K Kenya %K HPV testing %K user-testing %K community health volunteers %K mobile phone %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To achieve the World Health Organization targets for cervical cancer elimination, low- and middle-income countries will need to develop innovative strategies to provide human papillomavirus (HPV)–based screening at a population level. Although mobile health (mHealth) interventions may help realize these goals by filling gaps in electronic specimen tracking and patient education, effective implementation of mHealth interventions is dependent upon context-specific development that is acceptable and usable by the target population. Detailed feedback should be gathered at the design and development stages to yield final products that reflect the needs, desires, and capabilities of target users. Objective: The aim of this study is to develop an mHealth app (mSaada) to support HPV-based screening in partnership with community health volunteers (CHVs) and program planners in western Kenya. Methods: A team of student programmers developed a prototype to meet previously identified gaps in screening: patient education, protocol support, data capture, and specimen tracking. The prototype was iteratively developed through 2 waves of in-person working sessions with quantitative (survey) and qualitative (in-depth interview) feedback. Research staff engaged key stakeholders from both urban and rural locations and with varying levels of experience in delivering screening services. During the sessions, participants completed simulation exercises and role-play activities to become familiar with the platform. Once feedback was gathered and synthesized after each wave of in-person data collection, developers implemented changes to improve mSaada functionality. Results: A total of 18 CHVs and clinicians participated in the in-person sessions. Participants found mSaada useful, easy to use, and would meet the needs of CHVs to provide HPV-based cervical cancer screening (electronic data capture, client education resources, and specimen tracking). They provided key feedback to enhance user experience, workflow, and sustainability. Key changes included altering the appearance of the wireframes, adding translation in additional local languages, changing potentially insensitive figures, alphabetizing lengthy dropdown menus, adding clinically relevant logic checks when entering data, and incorporating the ability to make real time edits to client records. They also made recommendations for additional features that might enhance mSaada’s impact at the facility and health system levels, specifically the inclusion of a report-generating tool consistent with the Ministry of Health standards. Conclusions: Using a process of iterative feedback with key stakeholders and rapid response from developers, we have developed a mobile app ready for pilot testing in HPV-based screening programs led by CHVs. %M 35200151 %R 10.2196/27501 %U https://formative.jmir.org/2022/2/e27501 %U https://doi.org/10.2196/27501 %U http://www.ncbi.nlm.nih.gov/pubmed/35200151 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e34117 %T Refinement of a Parent–Child Shared Asthma Management Mobile Health App: Human-Centered Design Study %A Sonney,Jennifer %A Cho,Emily E %A Zheng,Qiming %A Kientz,Julie A %+ Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, 1959 NE Pacific Street, Box 357262, Seattle, WA, 98195, United States, 1 206 685 2161, jsonney@uw.edu %K parent–child shared management %K school-age children %K asthma %K participatory design %K mHealth %K prototype %K usability %K family health informatics %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The school-age years, approximately ages 7 through 11, represent a natural transition when children begin assuming some responsibility for their asthma management. Previously, we designed a theoretically derived, tailored parent–child shared asthma management mobile health app prototype, Improving Asthma Care Together (IMPACT). Objective: The purpose of this study was to use human-centered design (HCD) to iteratively refine IMPACT to optimize user experience and incorporate evidence-based longitudinal engagement strategies. Methods: This study used a mixed methods design from December 2019 to April 2021. Our app refinement used the HCD process of research, ideation, design, evaluation, and implementation, including 6 cycles of design and evaluation. The design and evaluation cycles focused on core app functionality, child engagement, and overall refinement. Evaluation with parent–child dyads entailed in-person and remote concept testing and usability testing sessions, after which rapid cycle thematic analyses identified key insights that informed future design refinement. Results: Twelve parent–child dyads enrolled in at least one round of this study. Eight of the 12 child participants were male with a mean age of 9.9 (SD 1.6) years and all parent participants were female. Throughout evaluation cycles, dyads selected preferred app layouts, gamification concepts, and overall features with a final design prototype emerging for full-scale development and implementation. Conclusions: A theoretically derived, evidence-based shared asthma management app was co-designed with end users to address real-world pain points and priorities. An 8-week pilot study testing app feasibility, acceptability, and preliminary efficacy is forthcoming. %M 35175214 %R 10.2196/34117 %U https://pediatrics.jmir.org/2022/1/e34117 %U https://doi.org/10.2196/34117 %U http://www.ncbi.nlm.nih.gov/pubmed/35175214 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e29922 %T Evaluation of mHealth Apps for Diverse, Low-Income Patient Populations: Framework Development and Application Study %A Sharma,Shreya %A Gergen Barnett,Katherine %A Maypole,John (Jack) %A Grochow Mishuris,Rebecca %+ Boston University School of Medicine, 72 E Concord Street, Boston, MA, 02118, United States, 1 (617)358 9600, sshreya@bu.edu %K mobile health application %K apps %K mobile health %K diverse %K low-income %K mHealth %K framework %K chronic disease %K condition %K smoking cessation %K diabetes %K medication adherence %K safety net hospital %K personal %K self-management %K usability test %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of mobile technology or smartphones has grown exponentially in the United States, allowing more individuals than ever internet access. This access has been especially critical to households earning less than US $30,000, the majority of whom indicate that smartphones are their main source of internet access. The increasing ubiquity of smartphones and virtual care promises to offset some of the health disparities that cut through the United States. However, disparities cannot be addressed if the medical information offered though smartphones is not accessible or reliable. Objective: This study seeks to create a framework to review the strengths and weaknesses of mobile Health (mHealth) apps for diverse, low-income populations. Methods: Focusing on smoking cessation, diabetes management, and medication adherence as models of disease management, we describe the process for selecting, evaluating, and obtaining patient feedback on mHealth apps. Results: The top 2 scoring apps in each category were QuitNow! and Smoke Free-Quit Smoking Now for smoking cessation, Glucosio and MyNetDiary for diabetes management, and Medisafe and MyMeds for medication adherence. Conclusions: We believe that this framework will prove useful for future mHealth app development, and clinicians and patient advisory groups in connecting culturally, educationally, and socioeconomically appropriate mHealth apps with low-income, diverse communities and thus work to bridge health disparities. %M 35147502 %R 10.2196/29922 %U https://formative.jmir.org/2022/2/e29922 %U https://doi.org/10.2196/29922 %U http://www.ncbi.nlm.nih.gov/pubmed/35147502 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e33413 %T Persuasive Design Solutions for a Sustainable Workforce: Review of Persuasive Apps for Real-Time Capability Support for Rural Health Care Professionals %A Pit,Sabrina Winona %A Tan,Aaron J H %A Ramsden,Robyn %A Payne,Kristy %A Freihaut,Winona %A Hayes,Oliver %A Eames,Benjamin %A Edwards,Mike %A Colbran,Richard %+ New South Wales Rural Doctors Network, 1/53 Cleary St, Hamilton, 2303, Australia, 61 429455720, spit@nswrdn.com.au %K health %K wellness %K mobile apps %K persuasive strategies %K behavior change %K review %K health workforce %K capability %K career %K employment %K rural %K workforce planning %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a need to further investigate how persuasive design principles can change rural health professionals’ behaviors to look after their own health workforce capability. Several theories are used when developing apps to persuade people to change behavior, including the Persuasive System Design Model, consisting of primary task, dialogue, system credibility, and social support categories, and Cialdini’s principles of persuasion. These have not been analyzed yet in the field of health workforce capability. Objective: This study aims to determine the persuasive design techniques used in capability building–related apps and to provide recommendations for designing a health workforce app to increase their persuasiveness. Methods: A Python script was used to extract a total of 3060 apps from Google Play. Keywords centered around health workforce capability elements. App inclusion criteria were as follows: been updated since 2019, rated by users on average 4 and above, and more than 100,000 downloads. Next, 2 experts reviewed whether 32 persuasive strategies were used in the selected apps, and these were further analyzed by capability categories: competencies and skills, health and personal qualities, values and attitudes, and work organization. Results: In all, 53 mobile apps were systematically reviewed to identify the persuasive design techniques. The most common were surface credibility (n=48, 90.6%) and liking (n=48), followed by trustworthiness (n=43, 81.1%), reminders (n=38, 71.7%), and suggestion (n=30, 56.6%). The techniques in the social support domain were the least used across the different apps analyzed for health workforce capability, whereas those in the primary task support domain were used most frequently. The recommendations reflect learnings from our analysis. These findings provided insight into mobile app design principles relevant to apps used in improving health workforce capability. Conclusions: Our review showed that there are many persuasive design techniques that can assist in building health workforce capability. Additionally, several apps are available in the market that can assist in improving health workforce capability. There is, however, a specific lack of digital, real-time support to improve health workforce capability. Social support strategies through using social support persuasive design techniques will need to be integrated more prominently into a health workforce capability app. An app to measure and monitor health workforce capability scores can be used in conjunction with direct real-world person and real-time support to discuss and identify solutions to improve health workforce capability for rural and remote health professionals who are at high risk of burnout or leaving the rural health workforce. %M 35129447 %R 10.2196/33413 %U https://mhealth.jmir.org/2022/2/e33413 %U https://doi.org/10.2196/33413 %U http://www.ncbi.nlm.nih.gov/pubmed/35129447 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e30782 %T Evaluation of myCOPD Digital Self-management Technology in a Remote and Rural Population: Real-world Feasibility Study %A Cooper,Rowena %A Giangreco,Adam %A Duffy,Michelle %A Finlayson,Elaine %A Hamilton,Shellie %A Swanson,Mahri %A Colligan,Judith %A Gilliatt,Joanna %A McIvor,Mairi %A Sage,Elizabeth Kathryn %+ Department of Respiratory Medicine, National Health Service Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ, United Kingdom, 44 463 706294 ext 8823, beth.sage@nhs.scot %K digital self-management %K COPD %K remote and rural %K mobile health %K application %K chronic pulmonary obstructive disease %K rural communities %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic obstructive pulmonary disease (COPD) is a common, costly, and incurable respiratory disease affecting 1.2 million people in the United Kingdom alone. Acute COPD exacerbations requiring hospitalization place significant demands on health services, and the incidence of COPD in poor, remote, and rural populations is up to twice that of cities. Objective: myCOPD is a commercial, digital health, self-management technology designed to improve COPD outcomes and mitigate demands on health services. In this pragmatic real-world feasibility study, we aimed to evaluate myCOPD use and its clinical effectiveness at reducing hospitalizations, inpatient bed days, and other National Health Service (NHS) resource use. Methods: myCOPD engagement and NHS resource use was monitored for up to 1 year after myCOPD activation and was compared against health service use in the year prior to activation. A total of 113 participants from predominantly remote and rural communities were recruited via community-based care settings, including scheduled home visits, outpatient appointments, pulmonary rehabilitation, and phone or group appointments. There were no predetermined age, disease severity, geographical, or socioeconomic inclusion or exclusion criteria. Results: Out of 113 participants, 89 activated myCOPD (78.8%), with 56% (50/89) of those participants doing so on the day of enrollment and 90% (80/89) doing so within 1 month. There was no correlation between participant enrollment, activation, or myCOPD engagement and either age, socioeconomics, rurality, or COPD severity. Most active participants used at least one myCOPD module and entered their symptom scores at least once (79/89, 89%). A subgroup (15/89, 17%) recorded their symptom scores very frequently (>1 time every 5 days), 14 of whom (93%) also used four or five myCOPD modules. Overall, there were no differences in hospital admissions, inpatient bed days, or other health service use before or after myCOPD activation, apart from a modest increase in home visits. Subgroup analysis did, however, identify a trend toward reduced inpatient bed days and hospital admissions for those participants with very high myCOPD usage. Conclusions: Our results suggest that neither age, wealth, nor geographical location represent significant barriers to using myCOPD. This finding may help mitigate perceived risks of increased health inequalities associated with the use of digital health technologies as part of routine care provision. Despite high levels of activation, myCOPD did not reduce overall demands on health services, such as hospital admissions or inpatient bed days. Subgroup analysis did, however, suggest that very high myCOPD usage was associated with a moderate reduction in NHS resource use. Thus, although our study does not support implementation of myCOPD to reduce health service demands on a population-wide basis, our results do indicate that highly engaged patients may derive benefits. %M 35129453 %R 10.2196/30782 %U https://mhealth.jmir.org/2022/2/e30782 %U https://doi.org/10.2196/30782 %U http://www.ncbi.nlm.nih.gov/pubmed/35129453 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30989 %T Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study %A Jaffar,Aida %A Mohd-Sidik,Sherina %A Foo,Chai Nien %A Admodisastro,Novia %A Abdul Salam,Sobihatun Nur %A Ismail,Noor Diana %+ Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia, 60 3 9769 2541, sherina@upm.edu.my %K User-centered design %K mHealth app %K Digital intervention %K mHealth Development and Evaluation Framework %K Usability %K Acceptability %K Pelvic Floor Muscle Training %K Urinary incontinence %K Pregnancy %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. Methods: We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. Results: A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design–11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. Conclusions: The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study. %M 35113025 %R 10.2196/30989 %U https://humanfactors.jmir.org/2022/1/e30989 %U https://doi.org/10.2196/30989 %U http://www.ncbi.nlm.nih.gov/pubmed/35113025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e26891 %T An Android-Based Mobile App (ARVPredictor) for the Detection of HIV Drug-Resistance Mutations and Treatment at the Point of Care: Development Study %A Ongadi,Beatrice %A Lihana,Raphael %A Kiiru,John %A Ngayo,Musa %A Obiero,George %+ Centre for Biotechnology and Bioinformatics, University of Nairobi, Department of Biochemistry - CEBIB, P.O. Box 30197, Nairobi, 00100, Kenya, 254 728324324, betongadi@gmail.com %K database %K mobile Android app %K HIV/AIDS %K mutation %K pol gene %K protease %K reverse transcriptase %K integrase %K ARVPredictor %K mobile app %K mHealth %K HIV %K Android %K digital health %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV/AIDS remains one of the major global human health challenges, especially in resource-limited environments. By 2017, over 77.3 million people were infected with the disease, and approximately 35.4 million individuals had already died from AIDS-related illnesses. Approximately 21.7 million people were accessing ART with significant clinical outcomes. However, numerous challenges are experienced in the delivery and accurate interpretation of data on patients with HIV data by various health care providers at different care levels. Mobile health (mHealth) technology is progressively making inroads into the health sector as well as medical research. Different mobile devices have become common in health care settings, leading to rapid growth in the development of downloadable software specifically designed to fulfill particular health-related purposes. Objective: We developed a mobile-based app called ARVPredictor and demonstrated that it can accurately define HIV-1 drug-resistance mutations in the HIV pol gene for use at the point of care. Methods: ARVPredictor was designed using Android Studio with Java as the programming language and is compatible with both Android and iOS. The app system is hosted on Nginx Server, and network calls are built on PHP’s Laravel framework handled by the Retrofit Library. The DigitalOcean offers a high-performance and stable cloud computing platform for ARVPredictor. This mobile app is enlisted in the Google Play Store as an “ARVPredictor” and the source code is available under MIT permissive license at a GitHub repository. To test for agreement between the ARVPredictor and Stanford HIV Database in detecting HIV subtype and NNRT and NRTI mutations, a total of 100 known HIV sequences were evaluated. Results: The mobile-based app (ARVPredictor) takes in a set of sequences or known mutations (protease, reverse transcriptase and integrase). It then returns inferred levels of resistance to selected nucleoside, nonnucleoside protease, and integrase inhibitors for accurate HIV/AIDS management at the point of care. The ARVPredictor identified similar HIV subtypes in 98/100 sequences compared with the Stanford HIV Database (κ=0.98, indicating near perfect agreement). There were 89/100 major NNRTI and NRTI mutations identified by ARVPredictor, similar to the Stanford HIV Database (κ=0.89, indicating near perfect agreement). Eight mutations classified as major by the Stanford HIV Database were classified as others by ARVPredictor. Conclusions: The ARVPredictor largely agrees with the Stanford HIV Database in identifying both major and minor proteases, reverse transcriptase, and integrase mutations. The app can be conveniently used robustly at the point of care by HIV/AIDS care providers to improve the management of HIV infection. %M 35107425 %R 10.2196/26891 %U https://formative.jmir.org/2022/2/e26891 %U https://doi.org/10.2196/26891 %U http://www.ncbi.nlm.nih.gov/pubmed/35107425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e26033 %T Implementation of an mHealth App to Promote Engagement During HIV Care and Viral Load Suppression in Johannesburg, South Africa (iThemba Life): Pilot Technical Feasibility and Acceptability Study %A Lalla-Edward,Samanta Tresha %A Mashabane,Nonkululeko %A Stewart-Isherwood,Lynsey %A Scott,Lesley %A Fyvie,Kyle %A Duncan,Dana %A Haile,Betiel %A Chugh,Kamal %A Zhou,Yiyong %A Reimers,Jacob %A Pan,Matteus %A Venkatraman,Maya %A Stevens,Wendy %+ Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Sunnyside Office Park, 32 Princess of Wales Terrace, Parktown, 2193, South Africa, 27 0826172490, slallaedward@ezintsha.org %K HIV %K virological suppression %K mHealth %K digital health %K South Africa %K patient-centric %K disease management %K mobile phone %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: South Africa has the largest HIV treatment program worldwide. Retention in care and medication adherence remain problematic necessitating innovative solutions for improving HIV care. The increasing availability and use of mobile technology can support positive clinical outcomes for persons living with HIV. iThemba Life is a mobile health app designed with input from South African health professionals and patients, promoting engagement with HIV care through access to medical results. Objective: This study aimed to test the feasibility and acceptability of receiving HIV viral load (VL) results through the app and compare the time to HIV VL result return for study participants before and after app use. Methods: Using convenience sampling, adults having routine VL phlebotomy were recruited from 2 Johannesburg health facilities. After signed consent, the app was downloaded on their Android smartphones, phlebotomy was performed, and the sample barcode was scanned through their phone to link the sample and app. Participants received a notification of the result availability and logged into the app to view results, their explanation and recommended action. Results: Overall, 750 people were screened to enroll 500 participants. Of 750, 113 (15.1%) failed eligibility screening. 21.5% (137/637) had smartphone technical limitations preventing enrollment. Results were released to 92.2% (461/500) of participants’ phones. App technical issues and laboratory operational issues limited the number of released results. Approximately 78.1% (360/461) results were viewed in the app. Median time from notification of availability to result viewed being 15.5 hours (0.6; range 0-150 days). Turnaround time from phlebotomy to the result being received was 6 (range 1-167) days for users versus 56 days (range 10-430 days; P<.001) before app use. Overall, 4% (20/500) of participants received unsuppressed results (VL>1000 copies/mL). Turnaround time for unsuppressed results was 7 days for participants versus 37.5 days before app use (P<.001). The difference before and after app use in the suppressed and unsuppressed users for time from sample collection to result delivery was statistically significant. Of 20 participants, 12 (60%) returned for a confirmatory VL during the study period. The time from an unsuppressed VL to a confirmatory VL was 106 days for app users versus 203 days before app use (P<.001). Overall, 52.4% (262/500) of participants completed an exit survey; 23.2% (58/250) reported challenges in viewing their VL results. Moreover, 58% (35/60) reported that they overcame challenges with technical assistance from others, and 97.3% (255/262) wanted to continue using the app for VL results. Conclusions: Using iThemba Life for VL results was well-received despite limited smartphone access for some participants. App users received results 10 times sooner than before the app and 5 times sooner if their VL >1000 copies/mL. This increased notification speed led to participants wanting to continue using iThemba Life. %M 35107427 %R 10.2196/26033 %U https://formative.jmir.org/2022/2/e26033 %U https://doi.org/10.2196/26033 %U http://www.ncbi.nlm.nih.gov/pubmed/35107427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30360 %T Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study %A Trang,Kathy %A Le,Lam X %A Brown,Carolyn A %A To,Margaret Q %A Sullivan,Patrick S %A Jovanovic,Tanja %A Worthman,Carol M %A Giang,Le Minh %+ Global TIES for Children, New York University, 627 Broadway, New York City, NY, 10012, United States, 1 212 998 1212, kathytrang.kt@gmail.com %K men who have sex with men %K HIV %K mental disorder %K ecological momentary assessment %K mobile phone %K mHealth %K sexual minorities %K pilot projects %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people’s behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. Objective: This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs. Methods: Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants’ perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app. Results: Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions). Conclusions: Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM. %M 35084340 %R 10.2196/30360 %U https://formative.jmir.org/2022/1/e30360 %U https://doi.org/10.2196/30360 %U http://www.ncbi.nlm.nih.gov/pubmed/35084340 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e34309 %T Design and Evaluation of a Just-in-Time Adaptive Intervention (JITAI) to Reduce Sedentary Behavior at Work: Experimental Study %A Ismail,Tasnim %A Al Thani,Dena %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar, 974 44546374, tasnim.ismail95@gmail.com %K sedentary behavior %K persuasive technology %K behavior change %K physical activity %K adaptive intervention %D 2022 %7 26.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Employees in sedentary occupations tend to spend prolonged hours physically inactive. Physical inactivity is a main factor in the increase in the risks of a wide range of chronic diseases, including obesity, diabetes, hypertension, and heart disease. This has drawn researchers’ attention to investigate methods of increasing the level of activity of employees during working hours and in their daily lifestyle. Objective: The objective of this paper is to investigate the effectiveness of using personalized messages that include user information, user goals, daily routine, and the surrounding environment to increase the level of activity among employees. In this study, we hypothesize that sending context-aware motivational messages to workers in sedentary occupations after sitting for 40 minutes can break sedentary behavior and increase daily active time compared to static reminder messages. Methods: A 66-day between-group study using a mixed methods design approach was conducted with employees who are located in Qatar and spend most of their working day sedentary. The 58 participants used 2 different interventions: The control group (n=29, 50%) used a mobile app that only sends a static message after prolonged sitting (MotiFit Lite), and the intervention group (n=29, 50%) used a mobile app that sends context-aware personalized messages to promote physical activity (PA; MotiFit). Both apps log the received messages, the step count before and after the messages are sent, and the user response to the messages to obtain an idea of the impact of the messages. The study received approval from the Qatar Biomedical Research Institute’s institutional review board (IRB application #2019-10-037). Results: The questionnaires showed satisfaction of the designed apps’ subjective quality and perceived impact. The quantitative analysis showed a high level of engagement in the intervention group compared to the control group (P<.001). The results support the original hypothesis that using context-aware motivational messages can increase PA at work compared to static messages (P<.001). However, the analysis showed no significant impact of the message type on the overall activity level during the day (P=.06). Conclusions: Context-aware motivational messages motivate employees to increase their PA in the workplace. However, future research will further develop the analysis to investigate the impact on increasing the overall activity level during the day. %M 35080498 %R 10.2196/34309 %U https://formative.jmir.org/2022/1/e34309 %U https://doi.org/10.2196/34309 %U http://www.ncbi.nlm.nih.gov/pubmed/35080498 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33449 %T An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals With a Visible Difference: Mixed Methods Feasibility Study %A Zucchelli,Fabio %A Donnelly,Olivia %A Rush,Emma %A White,Paul %A Gwyther,Holly %A Williamson,Heidi %A , %+ Health and Applied Sciences, University of the West of England, Frenchay Campus, Bristol, BS16 1QY, United Kingdom, 44 7816449143, fabio.zucchelli@uwe.ac.uk %K mobile health %K acceptance and commitment therapy %K appearance %K mixed methods %K mobile phone %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps may offer a valuable platform for delivering evidence-based psychological interventions for individuals with atypical appearances, or visible differences, who experience psychosocial appearance concerns such as appearance-based social anxiety and body dissatisfaction. Before this study, researchers and stakeholders collaboratively designed an app prototype based on acceptance and commitment therapy (ACT), an evidence-based form of cognitive behavioral therapy that uses strategies such as mindfulness, clarification of personal values, and value-based goal setting. The intervention also included social skills training, an established approach for increasing individuals’ confidence in managing social interactions, which evoke appearance-based anxiety for many. Objective: In this study, the authors aim to evaluate the feasibility of an ACT-based app prototype via the primary objectives of user engagement and acceptability and the secondary feasibility objective of clinical safety and preliminary effectiveness. Methods: To address the feasibility objectives, the authors used a single-group intervention design with mixed methods in a group of 36 participants who have a range of visible differences. The authors collected quantitative data via measures of program use, satisfaction ratings, and changes over 3 time points spanning 12 weeks in outcomes, including selected ACT process measures (experiential avoidance, cognitive defusion, and valued action), scales of appearance concerns (appearance-based life disengagement, appearance-fixing behaviors, appearance self-evaluation, and fear of negative appearance evaluation), and clinical well-being (depression and anxiety). Semistructured exit interviews with a subsample of 12 participants provided qualitative data to give a more in-depth understanding of participants’ views and experiences of the program. Results: In terms of user engagement, adherence rates over 6 sessions aligned with the upper boundary of those reported across mobile mental health apps, with over one-third of participants completing all sessions over 12 weeks, during which a steady decline in adherence was observed. Time spent on sessions matched design intentions, and engagement frequencies highlighted semiregular mindfulness practice, mixed use of value-based goal setting, and high engagement with social skills training. The findings indicate a good overall level of program acceptability via satisfaction ratings, and qualitative interview findings offer positive feedback as well as valuable directions for revisions. Overall, testing for clinical safety and potential effectiveness showed encouraging changes over time, including favorable changes in appearance-related life disengagement, appearance-fixing behaviors, and selected ACT measures. No iatrogenic effects were indicated for depression or anxiety. Conclusions: An ACT-based mobile program for individuals struggling with visible differences shows promising proof of concept in addressing appearance concerns, although further revisions and development are required before further development and more rigorous evaluation. %M 35060908 %R 10.2196/33449 %U https://formative.jmir.org/2022/1/e33449 %U https://doi.org/10.2196/33449 %U http://www.ncbi.nlm.nih.gov/pubmed/35060908 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e32104 %T User Control of Personal mHealth Data Using a Mobile Blockchain App: Design Science Perspective %A Sengupta,Arijit %A Subramanian,Hemang %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, 11200 Southwest 8th Street, Miami, FL, 33199, United States, 1 3053481427, arijit.sengupta@fiu.edu %K blockchain %K mobile apps %K mining %K HIPAA %K personal health data %K data privacy preservation %K security %K accuracy %K transaction safety %D 2022 %7 20.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Integrating pervasive computing with blockchain’s ability to store privacy-protected mobile health (mHealth) data while providing Health Insurance Portability and Accountability Act (HIPAA) compliance is a challenge. Patients use a multitude of devices, apps, and services to collect and store mHealth data. We present the design of an internet of things (IoT)–based configurable blockchain with different mHealth apps on iOS and Android, which collect the same user’s data. We discuss the advantages of using such a blockchain architecture and demonstrate 2 things: the ease with which users can retain full control of their pervasive mHealth data and the ease with which HIPAA compliance can be accomplished by providers who choose to access user data. Objective: The purpose of this paper is to design, evaluate, and test IoT-based mHealth data using wearable devices and an efficient, configurable blockchain, which has been designed and implemented from the first principles to store such data. The purpose of this paper is also to demonstrate the privacy-preserving and HIPAA-compliant nature of pervasive computing-based personalized health care systems that provide users with total control of their own data. Methods: This paper followed the methodical design science approach adapted in information systems, wherein we evaluated prior designs, proposed enhancements with a blockchain design pattern published by the same authors, and used the design to support IoT transactions. We prototyped both the blockchain and IoT-based mHealth apps in different devices and tested all use cases that formed the design goals for such a system. Specifically, we validated the design goals for our system using the HIPAA checklist for businesses and proved the compliance of our architecture for mHealth data on pervasive computing devices. Results: Blockchain-based personalized health care systems provide several advantages over traditional systems. They provide and support extreme privacy protection, provide the ability to share personalized data and delete data upon request, and support the ability to analyze such data. Conclusions: We conclude that blockchains, specifically the consensus, hasher, storer, miner architecture presented in this paper, with configurable modules and software as a service model, provide many advantages for patients using pervasive devices that store mHealth data on the blockchain. Among them is the ability to store, retrieve, and modify ones generated health care data with a single private key across devices. These data are transparent, stored perennially, and provide patients with privacy and pseudoanonymity, in addition to very strong encryption for data access. Firms and device manufacturers would benefit from such an approach wherein they relinquish user data control while giving users the ability to select and offer their own mHealth data on data marketplaces. We show that such an architecture complies with the stringent requirements of HIPAA for patient data access. %M 35049504 %R 10.2196/32104 %U https://mhealth.jmir.org/2022/1/e32104 %U https://doi.org/10.2196/32104 %U http://www.ncbi.nlm.nih.gov/pubmed/35049504 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33716 %T Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation %A Hogan,Timothy P %A Etingen,Bella %A McMahon,Nicholas %A Bixler,Felicia R %A Am,Linda %A Wacks,Rachel E %A Shimada,Stephanie L %A Reilly,Erin D %A Frisbee,Kathleen L %A Smith,Bridget M %+ eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, United States, 1 781 687 3181, Timothy.Hogan@va.gov %K mobile health applications %K pain %K veterans %K usability %D 2022 %7 20.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Veterans Health Administration Pain Coach mobile health app was developed to support veterans with chronic pain. Objective: Our objective was to evaluate early user experiences with the Pain Coach app and preliminary impacts of app use on pain-related outcomes. Methods: Following a sequential, explanatory, mixed methods design, we mailed surveys to veterans at 2 time points with an outreach program in between and conducted semistructured interviews with a subsample of survey respondents. We analyzed survey data using descriptive statistics among veterans who completed both surveys and examined differences in key outcomes using paired samples t tests. We analyzed semistructured interview data using thematic analysis. Results: Of 1507 veterans invited and eligible to complete the baseline survey, we received responses from 393 (26.1%). These veterans received our outreach program; 236 (236/393, 60.1%) completed follow-up surveys. We conducted interviews with 10 app users and 10 nonusers. Among survey respondents, 10.2% (24/236) used Pain Coach, and 58% (14/24) reported it was easy to use, though interviews identified various app usability issues. Veterans who used Pain Coach reported greater pain self-efficacy (mean 23.1 vs mean 16.6; P=.01) and lower pain interference (mean 34.6 vs mean 31.8; P=.03) after (vs before) use. The most frequent reason veterans reported for not using the app was that their health care team had not discussed it with them (96/212, 45.3%). Conclusions: Our findings suggest that future efforts to increase adoption of Pain Coach and other mobile apps among veterans should include health care team endorsement. Our findings regarding the impact of Pain Coach use on outcomes warrant further study. %M 35049515 %R 10.2196/33716 %U https://formative.jmir.org/2022/1/e33716 %U https://doi.org/10.2196/33716 %U http://www.ncbi.nlm.nih.gov/pubmed/35049515 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e28300 %T A Transdiagnostic, Emotion Regulation App (Eda) for Children: Design, Development, and Lessons Learned %A Moltrecht,Bettina %A Patalay,Praveetha %A Bear,Holly Alice %A Deighton,Jessica %A Edbrooke-Childs,Julian %+ Evidence-based practice unit, Department of Clinical, Educational and Health Psychology, University College London, 4-8 Rodney Street, London, N19JH, United Kingdom, 44 0207794 ext 2313, bettina.moltrecht.16@ucl.ac.uk %K mHealth %K participatory design %K emotion regulation %K interdisciplinary development %K child mental health %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital interventions, including mobile apps, represent a promising means of providing effective mental health support to children and young people. Despite the increased availability of mental health apps, there is a significant gap for this age group, especially for children (aged 10-12 years). Research investigating the effectiveness and development process of child mental health apps is limited, and the field faces persistent issues in relation to low user uptake and engagement, which is assumed to be a result of limited user involvement in the design process. Objective: This study aims to present the development and design process of a new mental health app for children that targets their emotion regulation abilities. We describe the creation of a new interdisciplinary development framework to guide the design process and explain how each activity informed different app features. Methods: The first 2 stages of the framework used a variety of methods, including weekly classroom observations over a 6-month period (20 in total); public engagement events with the target group (N=21); synthesis of the existing evidence as part of a meta-analysis; a series of co-design and participatory workshops with young users (N=33), clinicians (N=7), researchers (N=12), app developers (N=1), and designers (N=2); and finally, testing of the first high-tech prototype (N=15). Results: For the interdisciplinary framework, we drew on methods derived from the Medical Research Council framework for complex interventions, the patient–clinician framework, and the Druin cooperative inquiry. The classroom observations, public engagement events, and synthesis of the existing evidence informed the first key pillars of the app and wireframes. Subsequently, a series of workshops shaped and reshaped the content and app features, including games, psychoeducational films, and practice modules. On the basis of the prototype testing sessions, we made further adjustments to improve the app. Conclusions: Although mobile apps could be highly suitable to support children’s mental health on a wider scale, there is little guidance on how these interventions could be designed and developed. The involvement of young users across different design activities is very valuable. We hope that our interdisciplinary framework and description of the used methods will be helpful to others who are hoping to develop mental health apps for children and young people. %M 35044312 %R 10.2196/28300 %U https://formative.jmir.org/2022/1/e28300 %U https://doi.org/10.2196/28300 %U http://www.ncbi.nlm.nih.gov/pubmed/35044312 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e33470 %T Developing a User-Centered Digital Clinical Decision Support App for Evidence-Based Medication Recommendations for Type 2 Diabetes Mellitus: Prototype User Testing and Validation Study %A Larsen,Kevin %A Akindele,Bilikis %A Head,Henry %A Evans,Rick %A Mehta,Purvi %A Hlatky,Quinn %A Krause,Brendan %A Chen,Sydney %A King,Dominic %+ Center for Advanced Clinical Solution, OptumHealth, Optum, 1325 Boylston St, Boston, MA, 02215, United States, 1 984 227 2621, bilikis.akindele@optum.com %K clinical decision support %K user-centered design %K user testing %K type 2 diabetes mellitus %K evidence-based guidelines %K validation %K workflows %K electronic health record %K decision support %K design %K diabetes %D 2022 %7 18.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Closing the gap between care recommended by evidence-based guidelines and care delivered in practice is an ongoing challenge across systems and delivery models. Clinical decision support systems (CDSSs) are widely deployed to augment clinicians in their complex decision-making processes. Despite published success stories, the poor usability of many CDSSs has contributed to fragmented workflows and alert fatigue. Objective: This study aimed to validate the application of a user-centered design (UCD) process in the development of a standards-based medication recommender for type 2 diabetes mellitus in a simulated setting. The prototype app was evaluated for effectiveness, efficiency, and user satisfaction. Methods: We conducted interviews with 8 clinical leaders with 8 rounds of iterative user testing with 2-8 prescribers in each round to inform app development. With the resulting prototype app, we conducted a validation study with 43 participants. The participants were assigned to one of two groups and completed a 2-hour remote user testing session. Both groups reviewed mock patient facts and ordered diabetes medications for the patients. The Traditional group used a mock electronic health record (EHR) for the review in Period 1 and used the prototype app in Period 2, while the Tool group used the prototype app during both time periods. The perceived cognitive load associated with task performance during each period was assessed with the National Aeronautics and Space Administration Task Load Index. Participants also completed the System Usability Scale (SUS) questionnaire and Kano Survey. Results: Average SUS scores from the questionnaire, taken at the end of 5 of the 8 user testing sessions, ranged from 68-86. The results of the validation study are as follows: percent adherence to evidence-based guidelines was greater with the use of the prototype app than with the EHR across time periods with the Traditional group (prototype app mean 96.2 vs EHR mean 72.0, P<.001) and between groups during Period 1 (Tool group mean 92.6 vs Traditional group mean 72.0, P<.001). Task completion times did not differ between groups (P=.23), but the Tool group completed medication ordering more quickly in Period 2 (Period 1 mean 130.7 seconds vs Period 2 mean 107.7 seconds, P<.001). Based on an adjusted α level owing to violation of the assumption of homogeneity of variance (Ps>.03), there was no effect on screens viewed and on perceived cognitive load (all Ps>.14). Conclusions: Through deployment of the UCD process, a point-of-care medication recommender app holds promise of improving adherence to evidence-based guidelines; in this case, those from the American Diabetes Association. Task-time performance suggests that with practice the T2DM app may support a more efficient ordering process for providers, and SUS scores indicate provider satisfaction with the app. %M 34784293 %R 10.2196/33470 %U https://humanfactors.jmir.org/2022/1/e33470 %U https://doi.org/10.2196/33470 %U http://www.ncbi.nlm.nih.gov/pubmed/34784293 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e24483 %T Co-design of a Smartphone App for People Living With Dementia by Applying Agile, Iterative Co-design Principles: Development and Usability Study %A Fox,Sarah %A Brown,Laura J E %A Antrobus,Steven %A Brough,David %A Drake,Richard J %A Jury,Francine %A Leroi,Iracema %A Parry-Jones,Adrian R %A Machin,Matthew %+ Division of Informatics, Imaging & Data Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 (0)7917 520637, matthew.machin@manchester.ac.uk %K agile %K dementia %K co-design %K cognition %K mHealth %K patient public involvement %K software development %K mobile phone %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The benefits of involving those with lived experience in the design and development of health technology are well recognized, and the reporting of co-design best practices has increased over the past decade. However, it is important to recognize that the methods and protocols behind patient and public involvement and co-design vary depending on the patient population accessed. This is especially important when considering individuals living with cognitive impairments, such as dementia, who are likely to have needs and experiences unique to their cognitive capabilities. We worked alongside individuals living with dementia and their care partners to co-design a mobile health app. This app aimed to address a gap in our knowledge of how cognition fluctuates over short, microlongitudinal timescales. The app requires users to interact with built-in memory tests multiple times per day, meaning that co-designing a platform that is easy to use, accessible, and appealing is particularly important. Here, we discuss our use of Agile methodology to enable those living with dementia and their care partners to be actively involved in the co-design of a mobile health app. Objective: The aim of this study is to explore the benefits of co-design in the development of smartphone apps. Here, we share our co-design methodology and reflections on how this benefited the completed product. Methods: Our app was developed using Agile methodology, which allowed for patient and care partner input to be incorporated iteratively throughout the design and development process. Our co-design approach comprised 3 core elements, aligned with the values of patient co-design and adapted to meaningfully involve those living with cognitive impairments: end-user representation at research and software development meetings via a patient proxy; equal decision-making power for all stakeholders based on their expertise; and continuous user consultation, user-testing, and feedback. Results: This co-design approach resulted in multiple patient and care partner–led software alterations, which, without consultation, would not have been anticipated by the research team. This included 13 software design alterations, renaming of the product, and removal of a cognitive test deemed to be too challenging for the target demographic. Conclusions: We found patient and care partner input to be critical throughout the development process for early identification of design and usability issues and for identifying solutions not previously considered by our research team. As issues addressed in early co-design workshops did not reoccur subsequently, we believe this process made our product more user-friendly and acceptable, and we will formally test this assumption through future pilot-testing. %M 35029539 %R 10.2196/24483 %U https://mhealth.jmir.org/2022/1/e24483 %U https://doi.org/10.2196/24483 %U http://www.ncbi.nlm.nih.gov/pubmed/35029539 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32458 %T Leveraging a Consumer-Based Product to Develop a Cancer-Specific Mobile Meditation App: Prototype Development Study %A Huberty,Jennifer %A Bhuiyan,Nishat %A Neher,Taylor %A Joeman,Lynda %A Mesa,Ruben %A Larkey,Linda %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, United States, 1 480 406 2644, nbhuiyan@asu.edu %K cancer patients/survivors %K meditation %K mHealth %K app development %K qualitative research %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile meditation apps may offer a long-term, accessible, and effective solution for ongoing symptom management in cancer patients/survivors. However, there are currently no commercial cancer-specific meditation apps that reflect cancer specialist expertise, input from cancer patients/survivors, and features and content specific to cancer patients’/survivors’ needs. Objective: The aim of this study was to gain insight (via surveys, daily journals, and focus groups) from cancer patients/survivors, health care providers, and current subscribers of Calm (a consumer-based mobile meditation app) who were patients/survivors to develop a prototype of a mobile meditation app specifically designed for cancer patients/survivors. Methods: Participants were recruited via prior partnerships, word-of-mouth referrals, and recruitment posts on Facebook and Instagram. Cancer patients/survivors and health care providers were instructed to download and use the Calm app for at least 10 minutes a day for 7 days, complete an online daily journal for 7 days, and participate in a virtual focus group (one for cancer patients/survivors and one for providers). Current Calm subscribers who were cancer patients/survivors completed an online survey about different aspects of the Calm app and participated in a third virtual focus group. Data were qualitatively analyzed using a combination of deductive and inductive coding. Results: A total of 27 participants (11 cancer patients/survivors, 10 health care providers, 6 current Calm subscribers) completed the study. Similar themes and subthemes were found across surveys, daily journals, and focus groups, and fell into two major categories, content and functionality, with cancer-specific and noncancer-specific themes identified within each category. The majority of content preferences and suggestions that arose were cancer-specific, such as content related to negative emotions or feelings (eg, anxiety, grief, trauma/posttraumatic stress disorder, fear of recurrence, isolation), positive feelings and finding meaning (eg, gratitude, storytelling, acceptance), scenarios and experiences (eg, waiting, treatment-specific mediations), type and stage of cancer journey, and movement modifications. Some of the noncancer-specific themes under app content included sleep, music, and visualizations. In terms of app functionality, the majority of participants expressed interest in having a section/tab/area of the app that was specifically geared toward cancer patients/survivors. Preferences and suggestions for cancer-specific functionality features included options based on symptoms or journey, being able to communicate with other patients or survivors to share suggestions for specific meditations, and having an emergency toolkit for patients/survivors. Conclusions: Findings from cancer patients/survivors, health care providers, and current Calm subscribers who were patients/survivors to be incorporated into the development of the prototype fell into two major categories: (1) content of the app and (2) functionality of the app. The prototype’s form and function will be pilot-tested among 30 cancer patients/survivors in a 4-week study, and the resulting feasibility data will be used to inform the final app design and an efficacy study. %M 35029528 %R 10.2196/32458 %U https://formative.jmir.org/2022/1/e32458 %U https://doi.org/10.2196/32458 %U http://www.ncbi.nlm.nih.gov/pubmed/35029528 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32610 %T A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina %A Sanchez Antelo,Victoria %A Szwarc,Lucila %A Paolino,Melisa %A Saimovici,Diana %A Massaccesi,Silvia %A Viswanath,Kasisomayajula %A Arrossi,Silvina %+ Centro de Estudios de Estado y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante, 27, Ciudad Autónoma de Buenos Aires, C1173 AAA, Argentina, 54 11 4865 1707, silviarrossi@cedes.org %K mHealth %K mobile application %K counseling %K HPV test %K cervical cancer %K health belief model %K integrated behavioral model %K patient education %K Argentina %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) testing detects sexually transmitted infections with oncogenic types of HPV. For many HPV-positive women, this result has negative connotations. It produces anxiety, fear of cancer or death, and disease denial. Face-to-face counseling could present many difficulties in its implementation, but a counseling mobile app could be practical and may help HPV-positive women reduce the psychosocial impact of the result, improve their knowledge of HPV and cervical cancer, and increase adherence to follow-up. Objective: This study aims to understand HPV-tested women’s perceptions about an app as a tool to receive information and support to reduce the emotional impact of HPV-positive results. We investigated their preferences regarding app design, content, and framing. Methods: We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV-positive women aged 30 years and over and 4 focus groups (FGs) with women through a virtual platform (n=19). We shared a draft of the app's potential screens with a provisional label of the possible content, options menus, draft illustrations, and wording. This allowed us to give women understandable triggers to debate the concepts involved on each screen. The draft content and labels were developed drawing from the health belief model (HBM) and integrative behavioral model (IBM) variables and findings of mobile health literature. We used an FG guide to generate data for the information architecture (ie, how to organize contents into features). We carried out thematic analysis using constructs from the HBM and IBM to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing. Results: We found that participants required more information regarding the procedures they had received, what HPV-positive means, what the causes of HPV are, and its consequences on their sexuality. The women mentioned fear of the disease and stated they had concerns and misconceptions, such as believing that an HPV-positive result is a synonym for cancer. They accepted the app as a tool to obtain information and to reduce fears related to HPV-positive results. They would use a mobile app under doctor or health authority recommendation. The women did not agree with the draft organization of screens and contents. They believed the app should first offer information about HPV and then provide customized content according to the users’ needs. The app should provide information via videos with experts and testimonies of other HPV-positive women, and they suggested a medical appointment reminder feature. The app should also offer information through illustrations, or infographics, but not pictures or solely text. Conclusions: Providing information that meets women’s needs and counseling could be a method to reduce fears. A mobile app seems to be an acceptable and suitable tool to help HPV-positive women. %M 35023843 %R 10.2196/32610 %U https://formative.jmir.org/2022/1/e32610 %U https://doi.org/10.2196/32610 %U http://www.ncbi.nlm.nih.gov/pubmed/35023843 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32273 %T A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study %A Feldman,Amy G %A Moore,Susan %A Bull,Sheana %A Morris,Megan A %A Wilson,Kumanan %A Bell,Cameron %A Collins,Margaret M %A Denize,Kathryn M %A Kempe,Allison %+ Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO, 80045, United States, 1 720 777 5354, amy.feldman@childrenscolorado.org %K vaccinations %K transplantation %K mobile app %K agile development %K immunization %K mHealth %K mobile health %K children %K transplant recipients %K pediatric transplant recipients %K pediatrics %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group. Objective: The aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population. Methods: We used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app. Results: A new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant. Conclusions: Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant. %M 35023840 %R 10.2196/32273 %U https://formative.jmir.org/2022/1/e32273 %U https://doi.org/10.2196/32273 %U http://www.ncbi.nlm.nih.gov/pubmed/35023840 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30640 %T Toward Designs of Workplace Stress Management Mobile Apps for Frontline Health Workers During the COVID-19 Pandemic and Beyond: Mixed Methods Qualitative Study %A Chaudhry,Beenish Moalla %A Islam,Ashraful %A Matthieu,Monica %+ University of Louisiana at Lafayette, School of Computing and Informatics, 104 E University Circle, Lafayette, LA, 70508, United States, 1 4134616440, Beenish.chaudhry@louisiana.edu %K mental health %K stress %K mHealth %K frontline health worker %K design requirements %K pandemic %K COVID-19 %K design %K intervention %K burnout %K perspective %K need %K user design %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, mobile apps have been developed to prevent burnout, promote anxiety management, and provide health education to workers in various workplace settings. However, there remains a paucity of such apps for frontline health workers (FHWs), even though FHWs are the most susceptible to stress due to the nature of their jobs. Objective: The goal of this study was to provide suggestions for designing stress management apps to address workplace stressors of FHWs based on the understanding of their needs from FHWs’ own perspectives and theories of stress. Methods: A mixed methods qualitative study was conducted. Using a variety of search strings, we first collected 41 relevant web-based news articles published between December 2019 and May 2020 through the Google search engine. We then conducted a cross-sectional survey with 20 FHWs. Two researchers independently conducted qualitative analysis of all the collected data using a deductive followed by an inductive approach. Results: Prevailing uncertainty and fear of contracting the infection was causing stress among FHWs. Moral injury associated with seeing patients die from lack of care and lack of experience in handling various circumstances were other sources of stress. FHWs mentioned 4 coping strategies. Quick coping strategies such as walking away from stressful situations, entertainment, and exercise were the most common ways to mitigate the impact of stress at work. Peer support and counseling services were other popular methods. Building resilience and driving oneself forward using internal motivation were also meaningful ways of overcoming stressful situations. Time constraints and limited management support prevented FHWs from engaging in stress management activities. Conclusions: Our study identified stressors, coping strategies, and challenges with applying coping strategies that can guide the design of stress management apps for FHWs. Given that the pandemic is ongoing and health care crises continue, FHWs remain a vulnerable population in need of attention. %M 34806985 %R 10.2196/30640 %U https://formative.jmir.org/2022/1/e30640 %U https://doi.org/10.2196/30640 %U http://www.ncbi.nlm.nih.gov/pubmed/34806985 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e27192 %T Effect of an Integrative Mobile Health Intervention in Patients With Hypertension and Diabetes: Crossover Study %A Oh,Sang Woo %A Kim,Kyoung-Kon %A Kim,Sung Soo %A Park,Su Kyung %A Park,Sangshin %+ Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10326, Republic of Korea, 82 31 961 7490, osw6021@naver.com %K diabetes mellitus type 2 %K obesity %K hypertension %K mHealth %K mobile phone %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity, hypertension, and type 2 diabetes mellitus (T2DM) are worldwide epidemics that inflict burdens on both public health and health care costs. Self-management plays an important role in the proper management of these 3 chronic diseases, and in this context, mobile health (mHealth) can be a cost-effective self-management tool. Objective: The aim of this pilot study is to evaluate the effects of an integrative mHealth approach for obesity, hypertension, and T2DM on body fat, blood pressure, and blood glucose levels and demonstrate the clinical outcomes. The participants were patients aged 40 to 70 years who were treated for T2DM (hemoglobin A1c [HbA1c] above 6.0%) without insulin or hypertension and obesity, controlled with pharmacotherapy. Methods: This pilot study was performed using a controlled, randomized, 3-month, 2-period crossover design. A total of 37 participants were recruited from 2 university hospitals in South Korea. Integrative mHealth comprised 4 parts: self-measuring home devices for monitoring blood glucose and blood pressure; 2 smartphone apps, where one gathered lifestyle data, giving them feedback with health information, and the other provided drug information and reminders of the medication schedule; unmanned kiosks for official measurement of blood pressure and body composition; and web-based access to participants’ health information. Results: Data from the 32 participants were analyzed. Their mean HbA1c level was 7.5% (SD 0.8, ranging from 6.1% to 9.4%). Approximately 38% (12/32) of the participants had hypertension. BMIs of all participants except 1 were >23 kg/m2. The input rates of food intake and exercise to the smartphone app were very low (24.9% and 5.3%, respectively). On the contrary, the input rate of medicine intake was high (84.0%). Moreover, there was no significant difference in the input rate of taking medicine irrespective of whether the mHealth period was before or after the conventional treatment period (80.3% and 87.3%, respectively; P=.06). Among the 3 input functions of food intake, exercise, and medicine intake in smartphone apps, the input of medicine intake was a more helpful, easier to use, and better-designed function than the others. There were no significant differences in changes in body weight (−0.519 kg vs 0 kg), BMI (−0.133 kg/m2 vs −0.167 kg/m2), body composition (body fat −0.255% vs 0.172%), blood pressure (systolic −0.226 mm Hg vs −2.839 mm Hg), and HbA1c (−0.269% vs –0.009%) between the integrative mHealth and conventional treatment groups. However, in proportion to the elevation in the input rate of taking medicine, body fat mass (P=.04) and HbA1c (P=.03) were lower in the integrative mHealth group. Conclusions: Although smartphone apps can influence body fat and blood glucose levels, they have failed to show clinical improvement. A higher input rate of taking medicine was related to significantly lower body fat mass and HbA1c levels. %M 35014961 %R 10.2196/27192 %U https://mhealth.jmir.org/2022/1/e27192 %U https://doi.org/10.2196/27192 %U http://www.ncbi.nlm.nih.gov/pubmed/35014961 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e32785 %T An mHealth App-Based Self-management Intervention for Family Members of Pediatric Transplant Recipients (myFAMI): Framework Design and Development Study %A Adib,Riddhiman %A Das,Dipranjan %A Ahamed,Sheikh Iqbal %A Lerret,Stacee Marie %+ Department of Pediatrics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI, 53226, United States, 1 4142663944, slerret@mcw.edu %K pediatric patients %K transplant %K mobile health %K mHealth %K family self-management %K smartphone %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Solid-organ transplantation is the treatment of choice for children with end-stage organ failure. Ongoing recovery and medical management at home after transplant are important for recovery and transition to daily life. Smartphones are widely used and hold the potential for aiding in the establishment of mobile health (mHealth) protocols. Health care providers, nurses, and computer scientists collaboratively designed and developed mHealth family self-management intervention (myFAMI), a smartphone-based intervention app to promote a family self-management intervention for pediatric transplant patients’ families. Objective: This paper presents outcomes of the design stages and development actions of the myFAMI app framework, along with key challenges, limitations, and strengths. Methods: The myFAMI app framework is built upon a theory-based intervention for pediatric transplant patients, with aid from the action research (AR) methodology. Based on initially defined design motivation, the team of researchers collaboratively explored 4 research stages (research discussions, feedback and motivations, alpha testing, and deployment and release improvements) and developed features required for successful inauguration of the app in the real-world setting. Results: Deriving from app users and their functionalities, the myFAMI app framework is built with 2 primary components: the web app (for nurses’ and superadmin usage) and the smartphone app (for participant/family member usage). The web app stores survey responses and triggers alerts to nurses, when required, based on the family members’ response. The smartphone app presents the notifications sent from the server to the participants and captures survey responses. Both the web app and the smartphone app were built upon industry-standard software development frameworks and demonstrate great performance when deployed and used by study participants. Conclusions: The paper summarizes a successful and efficient mHealth app-building process using a theory-based intervention in nursing and the AR methodology in computer science. Focusing on factors to improve efficiency enabled easy navigation of the app and collection of data. This work lays the foundation for researchers to carefully integrate necessary information (from the literature or experienced clinicians) to provide a robust and efficient solution and evaluate the acceptability, utility, and usability for similar studies in the future. International Registered Report Identifier (IRRID): RR2-10.1002/nur.22010 %M 34780344 %R 10.2196/32785 %U https://nursing.jmir.org/2022/1/e32785 %U https://doi.org/10.2196/32785 %U http://www.ncbi.nlm.nih.gov/pubmed/34780344 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e22582 %T A Smartphone App for Attentional Bias Retraining in Smokers: Mixed Methods Pilot Study %A Choo,Carol C %A Tan,Yi Zhuang %A Zhang,Melvyn W B %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Level 18 Family Medicine and Primary Care, Singapore, 308322, Singapore, 65 63892000, melvynzhangweibin@gmail.com %K attentional bias retraining %K smartphone app %K mixed methods %K smoking %K mobile phone %D 2022 %7 3.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is a global health threat. Attentional bias influences smoking behaviors. Although attentional bias retraining has shown benefits and recent advances in technology suggest that attentional bias retraining can be delivered via smartphone apps, there is a paucity of research on this topic. Objective: This study aims to address this gap by exploring the use of attentional bias retraining via a novel smartphone app using a mixed methods pilot study. In the quantitative phase, it is hypothesized that participants in the training group who undertake attentional bias retraining via the app should have decreased levels of attentional bias, subjective craving, and smoking frequency, compared with those in the control group who do not undertake attentional bias retraining. The qualitative phase explores how the participants perceive and experience the novel app. Methods: In all, 10 adult smokers (3 females and 7 males) between the ages of 26 and 56 years (mean 34.4 years, SD 9.97 years) were recruited. The participants were randomly allocated to the training and control groups. In weeks 1 and 3, participants from both groups attempted the standard visual probe task and rated their smoking frequency and subjective craving. In week 2, the participants in the training group attempted the modified visual probe task. After week 3, participants from both groups were interviewed about their views and experiences of the novel app. Results: The results of the quantitative analysis did not support this study’s hypothesis. The qualitative data were analyzed using thematic analysis. The results yielded 5 themes: ease, helpfulness, unhelpful aspects, barriers, and refinement. Conclusions: Findings from the qualitative study were consistent with those from previous studies on health-related smartphone apps. The qualitative results were helpful in understanding the user perspectives and experiences of the novel app, indicating that future research in this innovative area is necessary. %M 34982037 %R 10.2196/22582 %U https://formative.jmir.org/2022/1/e22582 %U https://doi.org/10.2196/22582 %U http://www.ncbi.nlm.nih.gov/pubmed/34982037 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e31852 %T An Innovative App (ExoDont) for Postoperative Care of Patients After Tooth Extraction: Prototype Development and Testing Study %A Krishna,Meenakshi %A Sybil,Deborah %A Shrivastava,Priyanshu Kumar %A Premchandani,Shubhangi %A Kumar,Himanshu %A Kumar,Pintu %+ Faculty of Dentistry, Jamia Millia Islamia, Maulana Mohammad Ali Jauhar Marg, Jamia Nagar, New Delhi, 110025, India, 91 8340593862, priyanshushri25@gmail.com %K ExoDont %K Android app %K teledentistry %K mHealth %K tooth extraction %K postoperative %K dentistry %K dentist %K teeth %K dental surgery %K oral surgery %D 2021 %7 31.12.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The postoperative period is crucial for the initiation of healing and prevention of complications after any surgical procedure. Due to factors such as poor compliance, comprehension, and retention of instructions, and other unaccounted factors, the objectives of postoperative care are not always achieved. Therefore, an Android-based mobile health app (ExoDont) was developed to ensure a smooth postoperative period for patients after a dental extraction. The ExoDont app delivers reminders for postoperative instructions and drug intake at defined intervals, thus fostering self-reliance among patients in taking their prescribed dose of medication. Objective: The aim of this study is to design, develop, and validate ExoDont, an innovative app for improved adherence to postoperative instructions after tooth extraction. Methods: A postoperative treatment protocol was developed by a team of oral and maxillofacial surgeons and general dentists, following which the clinical and technological requirements of the app were determined along with the software engineers, graphic designers, and applications architect in the team. ExoDont was developed to provide timely reminders for medication and postoperative care. The app was field tested and validated using the User Version of the Mobile Application Rating Scale. Results: The ExoDont software design was divided into a 3-level architecture comprising a user interface application, logical layer, and database layer. The software architecture consists of an Android-based ExoDont app for patients and a web version of the admin panel. The testing and validation of the ExoDont app revealed that Perceived Impact received the highest mean score of all rated components (mean 4.6, SD 0.5), while Engagement received the lowest mean score (mean 3.5, SD 0.8). Conclusions: The testing and validation of the app support its usability and functionality, as well as its impact on users. The ExoDont app has been designed, keeping the welfare of patients in view, in a user-friendly manner that will help patients adhere to the prescribed drug regimen and ensure easy and efficient dissemination of postoperative instructions. It could play an instrumental role in fostering compliance among patients and significantly decrease the complication rate following dental extractions. %M 34982720 %R 10.2196/31852 %U https://periop.jmir.org/2021/2/e31852 %U https://doi.org/10.2196/31852 %U http://www.ncbi.nlm.nih.gov/pubmed/34982720 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e32575 %T A Mobile App With Multimodality Prehabilitation Programs for Patients Awaiting Elective Surgery: Development and Usability Study %A Wang,Tianyu %A Stanforth,Philip R %A Fleming,R Y Declan %A Wolf Jr,J Stuart %A Stanforth,Dixie %A Tanaka,Hirofumi %+ Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX, 78712, United States, 1 5122324801, htanaka@austin.utexas.edu %K mobile app %K prehabilitation %K perioperative care %K rehabilitation %K surgery %K perioperative %K elective surgery %K mobile health %K health applications %K health apps %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Complying with a prehabilitation program is difficult for patients who will undergo surgery, owing to transportation challenges and a limited intervention time window. Mobile health (mHealth) using smartphone apps has the potential to remove barriers and improve the effectiveness of prehabilitation. Objective: This study aimed to develop a mobile app as a tool for facilitating a multidisciplinary prehabilitation protocol involving blood flow restriction training and sport nutrition supplementation. Methods: The app was developed using “Appy Pie,” a noncoding app development platform. The development process included three stages: (1) determination of principles and requirements of the app through prehabilitation research team meetings; (2) app prototype design using the Appy Pie platform; and (3) app evaluation by clinicians and exercise and fitness specialists, technical professionals from Appy Pie, and non–team-member users. Results: We developed a prototype of the app with the core focus on a multidisciplinary prehabilitation program with accessory features to improve engagement and adherence to the mHealth intervention as well as research-focused features to evaluate the effects of the program on frailty status, health-related quality of life, and anxiety level among patients awaiting elective surgery. Evaluations by research members and random users (n=8) were consistently positive. Conclusions: This mobile app has great potential for improving and evaluating the effectiveness of the multidisciplinary prehabilitation intervention in the format of mHealth in future. %M 34967752 %R 10.2196/32575 %U https://periop.jmir.org/2021/2/e32575 %U https://doi.org/10.2196/32575 %U http://www.ncbi.nlm.nih.gov/pubmed/34967752 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e24792 %T Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial %A Koziol-McLain,Jane %A Wilson,Denise %A Vandal,Alain C %A Eruera,Moana %A Nada-Raja,Shyamala %A Dobbs,Terry %A Roguski,Michael %A Barbarich-Unasa,Te Wai %+ Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand, 64 211213474, jane.koziol-mclain@aut.ac.nz %K indigenous %K Māori %K young people %K relationships %K school %K mHealth %K smartphone app %K mobile phone %D 2021 %7 30.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or whānau (indigenous Māori extended family networks), to learn how to offer better support to taitamariki. Objective: The aim of our taitamariki- and Māori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome). Methods: We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the Māori subgroup. Results: The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71). Conclusions: This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous Māori–centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584 International Registered Report Identifier (IRRID): RR1-10.2196/24792 %M 34967750 %R 10.2196/24792 %U https://www.researchprotocols.org/2021/12/e24792 %U https://doi.org/10.2196/24792 %U http://www.ncbi.nlm.nih.gov/pubmed/34967750 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27033 %T Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study %A Shorey,Shefaly %A Tan,Thiam Chye %A , %A Mathews,Jancy %A Yu,Chun Yan %A Lim,Siew Hoon %A Shi,Luming %A Ng,Esperanza Debby %A Chan,Yiong Huak %A Law,Evelyn %A Chee,Cornelia %A Chong,Yap Seng %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294, nurssh@nus.edu.sg %K depression %K development %K education %K parent %K perinatal %K support %K telehealth %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child’s development. Given the rise in technology and parents’ preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles—the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development. %M 36260376 %R 10.2196/27033 %U https://www.jmir.org/2021/12/e27033 %U https://doi.org/10.2196/27033 %U http://www.ncbi.nlm.nih.gov/pubmed/36260376 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e30767 %T Perceptions of Older Men Using a Mobile Health App to Monitor Lower Urinary Tract Symptoms and Tamsulosin Side Effects: Mixed Methods Study %A Wang,Elizabeth Y %A Breyer,Benjamin N %A Lee,Austin W %A Rios,Natalie %A Oni-Orisan,Akinyemi %A Steinman,Michael A %A Sim,Ida %A Kenfield,Stacey A %A Bauer,Scott R %+ University of California San Francisco, 550 16th St, 6th floor, Box 1695, San Francisco, CA, 94121, United States, 1 4152214810 ext 24322, Scott.Bauer@ucsf.edu %K BPH %K mobile health %K mHealth %K telehealth %K telemedicine %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health (mHealth) apps may provide an efficient way for patients with lower urinary tract symptoms (LUTS) to log and communicate symptoms and medication side effects with their clinicians. Objective: The aim of this study was to explore the perceptions of older men with LUTS after using an mHealth app to track their symptoms and tamsulosin side effects. Methods: Structured phone interviews were conducted after a 2-week study piloting the daily use of a mobile app to track the severity of patient-selected LUTS and tamsulosin side effects. Quantitative and qualitative data were considered. Results: All 19 (100%) pilot study participants completed the poststudy interviews. Most of the men (n=13, 68%) reported that the daily questionnaires were the right length, with 32% (n=6) reporting that the questionnaires were too short. Men with more severe symptoms were less likely to report changes in perception of health or changes in self-management; 47% (n=9) of the men reported improved awareness of symptoms and 5% (n=1) adjusted fluid intake based on the questionnaire. All of the men were willing to share app data with their clinicians. Thematic analysis of qualitative data yielded eight themes: (1) orientation (setting up app, format, symptom selection, and side-effect selection), (2) triggers (routine or habit and symptom timing), (3) daily questionnaire (reporting symptoms, reporting side effects, and tailoring), (4) technology literacy, (5) perceptions (awareness, causation or relevance, data quality, convenience, usefulness, and other apps), (6) self-management, (7) clinician engagement (communication and efficiency), and (8) improvement (reference materials, flexibility, language, management recommendations, and optimize clinician engagement). Conclusions: We assessed the perceptions of men using an mHealth app to monitor and improve management of LUTS and medication side effects. LUTS management may be further optimized by tailoring the mobile app experience to meet patients’ individual needs, such as tracking a greater number of symptoms and integrating the app with clinicians’ visits. mHealth apps are likely a scalable modality to monitor symptoms and improve care of older men with LUTS. Further study is required to determine the best ways to tailor the mobile app and to communicate data to clinicians or incorporate data into the electronical medical record meaningfully. %M 34951599 %R 10.2196/30767 %U https://humanfactors.jmir.org/2021/4/e30767 %U https://doi.org/10.2196/30767 %U http://www.ncbi.nlm.nih.gov/pubmed/34951599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30268 %T Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design %A Adams,Zachary %A Grant,Miyah %A Hupp,Samantha %A Scott,Taylor %A Feagans,Amanda %A Phillips,Meredith Lois %A Bixler,Kristina %A Nallam,Phani Teja %A La Putt,Dorothy %+ Department of Psychiatry, Indiana University School of Medicine, 340 W 10th St., Indianapolis, IN, 46202, United States, 1 317 278 0591, zwadams@iu.edu %K mobile health %K user-centered design %K adolescents %K substance use disorders %K mental health %K mHealth %K cognitive behavioral therapy %K homework %K technology acceptance model %K trauma %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Treating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined. Objective: This study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns. Methods: Adolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality. Results: Participants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language. Conclusions: The novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes. %M 34951593 %R 10.2196/30268 %U https://formative.jmir.org/2021/12/e30268 %U https://doi.org/10.2196/30268 %U http://www.ncbi.nlm.nih.gov/pubmed/34951593 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e32794 %T Using Personalized Anchors to Establish Routine Meditation Practice With a Mobile App: Randomized Controlled Trial %A Stecher,Chad %A Sullivan,Mariah %A Huberty,Jennifer %+ College of Health Solutions, Arizona State University, 550 North 3rd Str, Phoenix, AZ, 85004, United States, 1 602 496 0957, chad.stecher@asu.edu %K mindfulness %K meditation %K mobile meditation app %K behavioral persistence %K habit formation %K randomized controlled trial %K mental health %K physical health %K app engagement %K routine %D 2021 %7 22.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical and mental health benefits can be attained from persistent, long-term performance of mindfulness meditation with a mobile meditation app, but in general, few mobile health app users persistently engage at a level necessary to attain the corresponding health benefits. Anchoring or pairing meditation with a mobile app to an existing daily routine can establish an unconsciously initiated meditation routine that may improve meditation persistence. Objective: The purpose of this study was to test the use of either personalized anchors or fixed anchors for establishing a persistent meditation app routine with the mobile app, Calm. Methods: We conducted a randomized controlled trial and randomly assigned participants to one of 3 study groups: (1) a personalized anchor (PA) group, (2) fixed anchor (FA) group, or (3) control group that did not use the anchoring strategy. All participants received app-delivered reminder messages to meditate for at least 10 minutes a day using the Calm app for an 8-week intervention period, and app usage data continued to be collected for an additional 8-week follow-up period to measure meditation persistence. Baseline, week 8, and week 16 surveys were administered to assess demographics, socioeconomic status, and changes in self-reported habit strength. Results: A total of 101 participants across the 3 study groups were included in the final analysis: (1) PA (n=56), (2) FA (n=49), and (3) control group (n=62). Participants were predominantly White (83/101, 82.2%), female (77/101, 76.2%), and college educated (ie, bachelor’s or graduate degree; 82/101, 81.2%). The FA group had a significantly higher average odds of daily meditation during the intervention (1.14 odds ratio [OR]; 95% CI 1.02-1.33; P=.04), and all participants experienced a linear decline in their odds of daily meditation during the 8-week intervention (0.96 OR; 95% CI 0.95-0.96; P<.001). Importantly, the FA group showed a significantly smaller decline in the linear trend of their odds of daily meditation during the 8-week follow-up (their daily trend increased by 1.04 OR from their trend during the intervention; 95% CI 1.01-1.06; P=.03). Additionally, those who more frequently adhered to their anchoring strategy during the intervention typically used anchors that occurred in the morning and showed a significantly smaller decline in their odds of daily meditation during the 8-week follow-up period (1.13 OR; 95% CI 1.02-1.35; P=.007). Conclusions: The FA group had more persistent meditation with the app, but participants in the FA or PA groups who more frequently adhered to their anchoring strategy during the intervention had the most persistent meditation routines, and almost all of these high anchorers used morning anchors. These findings suggest that the anchoring strategy can create persistent meditation routines with a mobile app. However, future studies should combine anchoring with additional intervention tools (eg, incentives) to help more participants successfully establish an anchored meditation routine. Trial Registration: ClinicalTrials.gov NCT04378530; https://clinicaltrials.gov/ct2/show/NCT04378530 %M 34941558 %R 10.2196/32794 %U https://mhealth.jmir.org/2021/12/e32794 %U https://doi.org/10.2196/32794 %U http://www.ncbi.nlm.nih.gov/pubmed/34941558 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e24114 %T Design and Development of a Suite of Intimate Partner Violence Screening and Safety Planning Web Apps: User-Centered Approach %A O'Campo,Patricia %A Velonis,Alisa %A Buhariwala,Pearl %A Kamalanathan,Janisha %A Hassan,Maha Awaiz %A Metheny,Nicholas %+ MAP Center for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5W 1W8, Canada, 1 4766304000, patricia.ocampo@unityhealth.to %K intimate partner violence %K web-based applications %K women %K user-centered design %D 2021 %7 21.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularity of mobile health (mHealth) technology has resulted in the development of numerous apps for almost every condition and disease management. mHealth and eHealth solutions for increasing awareness about, and safety around, intimate partner violence are no exception. These apps allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few apps, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness. Objective: The objective of this paper is to discuss the design of a suite of evidence-based mHealth and eHealth apps to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from a population of intended users. Methods: A user-centered approach with aspects of human-centered design was followed to design a suite of 3 app-based safety planning interventions. Results: This review of the design suite of app-based interventions revealed challenges faced and lessons learned that may inform future efforts to design evidence-based mHealth and eHealth interventions. Conclusions: Following a user-centered approach can be helpful in designing mHealth and eHealth interventions for marginalized and vulnerable populations, and led to novel insights that improved the design of our interventions. %M 34931998 %R 10.2196/24114 %U https://www.jmir.org/2021/12/e24114 %U https://doi.org/10.2196/24114 %U http://www.ncbi.nlm.nih.gov/pubmed/34931998 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e27991 %T The Extent of User Involvement in the Design of Self-tracking Technology for Bipolar Disorder: Literature Review %A Majid,Shazmin %A Reeves,Stuart %A Figueredo,Grazziela %A Brown,Susan %A Lang,Alexandra %A Moore,Matthew %A Morriss,Richard %+ School of Computer Science, Horizon Centre for Doctoral Training, University of Nottingham, Computer Science Building, Wollaton Rd, Nottingham, NG8 1BB, United Kingdom, 44 7713508981, shazmin.majid1@nottingham.ac.uk %K user-centered design %K participatory design %K human-computer interaction %K patient and public involvement %K self-monitoring technology %K bipolar disorder %K mobile phone %D 2021 %7 20.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: The number of self-monitoring apps for bipolar disorder (BD) is increasing. The involvement of users in human-computer interaction (HCI) research has a long history and is becoming a core concern for designers working in this space. The application of models of involvement, such as user-centered design, is becoming standardized to optimize the reach, adoption, and sustained use of this type of technology. Objective: This paper aims to examine the current ways in which users are involved in the design and evaluation of self-monitoring apps for BD by investigating 3 specific questions: are users involved in the design and evaluation of technology? If so, how does this happen? And what are the best practice ingredients regarding the design of mental health technology? Methods: We reviewed the available literature on self-tracking technology for BD and make an overall assessment of the level of user involvement in design. The findings were reviewed by an expert panel, including an individual with lived experience of BD, to form best practice ingredients for the design of mental health technology. This combines the existing practices of patient and public involvement and HCI to evolve from the generic guidelines of user-centered design and to those that are tailored toward mental health technology. Results: For the first question, it was found that out of the 11 novel smartphone apps included in this review, 4 (36%) self-monitoring apps were classified as having no mention of user involvement in design, 1 (9%) self-monitoring app was classified as having low user involvement, 4 (36%) self-monitoring apps were classified as having medium user involvement, and 2 (18%) self-monitoring apps were classified as having high user involvement. For the second question, it was found that despite the presence of extant approaches for the involvement of the user in the process of design and evaluation, there is large variability in whether the user is involved, how they are involved, and to what extent there is a reported emphasis on the voice of the user, which is the ultimate aim of such design approaches. For the third question, it is recommended that users are involved in all stages of design with the ultimate goal of empowering and creating empathy for the user. Conclusions: Users should be involved early in the design process, and this should not just be limited to the design itself, but also to associated research ensuring end-to-end involvement. Communities in health care–based design and HCI design need to work together to increase awareness of the different methods available and to encourage the use and mixing of the methods as well as establish better mechanisms to reach the target user group. Future research using systematic literature search methods should explore this further. %M 34931992 %R 10.2196/27991 %U https://mental.jmir.org/2021/12/e27991 %U https://doi.org/10.2196/27991 %U http://www.ncbi.nlm.nih.gov/pubmed/34931992 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e19543 %T Co-designing an Adaption of a Mobile App to Enhance Communication, Safety, and Well-being Among People Living at Home With Early-Stage Dementia: Protocol for an Exploratory Multiple Case Study %A Davies,Karen %A Cheraghi-Sohi,Sudeh %A Ong,Bie Nio %A Cheraghi-Sohi,Sudeh %A Perryman,Katherine %A Sanders,Caroline %+ National Institute for Health Research Patient Safety Research Translation Centre, University of Manchester, Oxford Rd, Manchester, United Kingdom, 44 1612767665, sudeh.cheraghi-sohi@manchester.ac.uk %K design research %K co-design %K dementia %K mobile app %K communication %K safety %K mobile phone %D 2021 %7 20.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a growing interest in using mobile apps to support communication, safety, and well-being. Evidence directly from people with dementia regarding the usability, usefulness, and relevance of mobile apps is limited. Objective: This paper describes the protocol of a study that will evaluate an app designed for supporting communication, safety, and well-being among people living with dementia. The study aims to understand if the app can enhance safety through improved communication among users. Methods: The study will use participatory qualitative methods over 3 cycles of evaluation with co-designers (service users, their families, and care practitioners). The study will be developed in partnership with a specialist home care service in England. Purposive case selection will be performed to ensure that the cases exemplify differences in experiences. The app will be evaluated in a walk-through workshop by people living with early-stage dementia and then trialed at home by up to 12 families in a try-out cycle. An amended version will be evaluated in a final walk-through workshop during cycle 3. Data will be collected from at least 4 data sources during the try-out phase and analyzed thematically. An explanatory multiple case study design will be used to synthesize and present the evidence from the three cycles, drawing on the Normalization Process Theory to support the interpretation of the findings. Results: The study is ready to be implemented, but it was paused to protect vulnerable individuals during the COVID-19 pandemic in 2020. The findings will be particularly relevant for understanding how to support vulnerable people living in the community during social distancing and the period following the pandemic as well as for providing insight into the challenges of social isolation that arise from living with dementia. Conclusions: Evaluating a mobile app for enhancing communication, safety, and well-being among people living with dementia contributes to the key ambitions enshrined in policy and practice—championing the use of digital technology and supporting people with dementia to live safely in their own homes. The study will involve co-designers living with dementia, so that the voices of service users can be used to highlight the benefits and challenges of assistive technology and shape the future development of apps that enhance safety by improving communication. International Registered Report Identifier (IRRID): PRR1-10.2196/19543 %M 34932011 %R 10.2196/19543 %U https://www.researchprotocols.org/2021/12/e19543 %U https://doi.org/10.2196/19543 %U http://www.ncbi.nlm.nih.gov/pubmed/34932011 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e29197 %T A Mobile App to Support Self-management of Chronic Kidney Disease: Development Study %A Markossian,Talar W %A Boyda,Jason %A Taylor,Jennifer %A Etingen,Bella %A Modave,François %A Price,Ron %A Kramer,Holly J %+ Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S First Avenue, Maywood, IL, 60153, United States, 1 7083279027, tmarkossian@luc.edu %K chronic kidney disease %K mobile app %K self-management %K mHealth %K mobile apps %K digital health %K kidney disease %K smartphone %D 2021 %7 15.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Chronic kidney disease (CKD) is a common and costly condition that is usually accompanied by multiple comorbidities including type 2 diabetes, hypertension, and obesity. Proper management of CKD can delay or prevent kidney failure and help mitigate cardiovascular disease risk, which increases as kidney function declines. Smart device apps hold potential to enhance patient self-management of chronic conditions including CKD. Objective: The objective of this study was to develop a mobile app to facilitate self-management of nondialysis-dependent CKD. Methods: Our stakeholder team included 4 patients with stage 3-4 nondialysis-dependent CKD; a kidney transplant recipient; a caretaker; CKD care providers (pharmacists, a nurse, primary care physicians, a nephrologist, and a cardiologist); 2 health services and CKD researchers; a researcher in biomedical informatics, nutrition, and obesity; a system developer; and 2 programmers. Focus groups and in-person interviews with the patients and providers were conducted using a focus group and interview guide based on existing literature on CKD self-management and the mobile app quality criteria from the Mobile App Rating Scale. Qualitative analytic methods including the constant comparative method were used to analyze the focus group and interview data. Results: Patients and providers identified and discussed a list of requirements and preferences regarding the content, features, and technical aspects of the mobile app, which are unique for CKD self-management. Requirements and preferences centered along themes of communication between patients and caregivers, partnership in care, self-care activities, adherence to treatment regimens, and self-care self-efficacy. These identified themes informed the features and content of our mobile app. The mobile app user can enter health data including blood pressure, weight, and blood glucose levels. Symptoms and their severity can also be entered, and users are prompted to contact a physician as indicated by the symptom and its severity. Next, mobile app users can select biweekly goals from a set of predetermined goals with the option to enter customized goals. The user can also keep a list of medications and track medication use. Our app includes feedback mechanisms where in-range values for health data are depicted in green and out-of-range values are depicted in red. We ensured that data entered by patients could be downloaded into a user-friendly report, which could be emailed or uploaded to an electronic health record. The mobile app also includes a mechanism that allows either group or individualized video chat meetings with a provider to facilitate either group support, education, or even virtual clinic visits. The CKD app also includes educational material on CKD and its symptoms. Conclusions: Patients with CKD and CKD care providers believe that a mobile app can enhance CKD self-management by facilitating patient-provider communication and enabling self-care activities including treatment adherence. %M 34914614 %R 10.2196/29197 %U https://humanfactors.jmir.org/2021/4/e29197 %U https://doi.org/10.2196/29197 %U http://www.ncbi.nlm.nih.gov/pubmed/34914614 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e26439 %T An Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) for Individuals With Coronary Heart Disease: Development and Usability Testing Analysis %A Chen,Yuling %A Ji,Meihua %A Wu,Ying %A Wang,Qingyu %A Deng,Ying %A Liu,Yong %A Wu,Fangqin %A Liu,Mingxuan %A Guo,Yiqiang %A Fu,Ziyuan %A Zheng,Xiaoying %+ School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069, China, 86 83911766, helenywu@vip.163.com %K mobile health %K health behavior %K system %K development %K usability %K coronary heart disease %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Death and disability from coronary heart disease (CHD) can be largely reduced by improving risk factor management. However, adhering to evidence-based recommendations is challenging and requires interventions at the level of the patient, provider, and health system. Objective: The aim of this study was to develop an Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) to facilitate adherence to health behaviors and preventive medications, and to test the usability of iCARE. Methods: We developed iCARE based on a user-centered design approach, which included 4 phases: (1) function design, (2) iterative design, (3) expert inspections and walkthroughs of the prototypes, and (4) usability testing with end users. The usability testing of iCARE included 2 stages: stage I, which included a task analysis and a usability evaluation (January to March 2019) of the iCARE patient app using the modified Health Information Technology Usability Survey (Health-ITUES); and stage II (June 2020), which used the Health-ITUES among end users who used the app for 6 months. The end users were individuals with a confirmed diagnosis of CHD from 2 university-affiliated hospitals in Beijing, China. Results: iCARE consists of a patient app, a care provider app, and a cloud platform. It has a set of algorithms that trigger tailored feedback and can send individualized interventions based on data from initial assessment and health monitoring via manual entry or wearable devices. For stage I usability testing, 88 hospitalized patients (72% [63/88] male; mean age 60 [SD 9.9] years) with CHD were included in the study. The mean score of the usability testing was 90.1 (interquartile range 83.3-99.0). Among enrolled participants, 90% (79/88) were satisfied with iCARE; 94% (83/88) and 82% (72/88) reported that iCARE was useful and easy to use, respectively. For stage II usability testing, 61 individuals with CHD (85% [52/61] male; mean age 53 [SD 8.2] years) who were from an intervention arm and used iCARE for at least six months were included. The mean total score on usability testing based on the questionnaire was 89.0 (interquartile distance: 77.0-99.5). Among enrolled participants, 89% (54/61) were satisfied with the use of iCARE, 93% (57/61) perceived it as useful, and 70% (43/61) as easy to use. Conclusions: This study developed an intelligent, individualized, evidence-based, and theory-driven app (iCARE) to improve patients’ adherence to health behaviors and medication management. iCARE was identified to be highly acceptable, useful, and easy to use among individuals with a diagnosis of CHD. Trial Registration: Chinese Clinical Trial Registry ChiCTR-INR-16010242; https://tinyurl.com/2p8bkrew %M 34898449 %R 10.2196/26439 %U https://mhealth.jmir.org/2021/12/e26439 %U https://doi.org/10.2196/26439 %U http://www.ncbi.nlm.nih.gov/pubmed/34898449 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32450 %T The Life Goals Self-Management Mobile App for Bipolar Disorder: Consumer Feasibility, Usability, and Acceptability Study %A Ryan,Kelly A %A Smith,Shawna N %A Yocum,Anastasia K %A Carley,Isabel %A Liebrecht,Celeste %A Navis,Bethany %A Vest,Erica %A Bertram,Holli %A McInnis,Melvin G %A Kilbourne,Amy M %+ Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C, Ann Arbor, MI, 48105, United States, 1 734 936 5524, karyan@umich.edu %K self-management %K app %K bipolar disorder %K symptom management %K mental health %K feasibility %K usability %K acceptability %K intervention %K bipolar %K coping %K survey %K engagement %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Life Goals is an evidence-based self-management intervention that assists individuals with bipolar disorder (BD) by aligning BD symptom coping strategies with their personal goals. The intervention can be availed via in-person and telephonic sessions, and it has been recently developed as an individualized, customizable mobile app. Objective: We examined the feasibility, usability, and acceptability of the Life Goals self-management app among individuals diagnosed with BD who used the app for up to 6 months. Methods: A total of 28 individuals with BD used the Life Goals app on their personal smartphone for 6 months. They completed key clinical outcome measurements of functioning, disability, and psychiatric symptoms at baseline, 3 months, and 6 months, in addition to a poststudy survey about usability and satisfaction. Results: Participants used the app for a median of 25 times (IQR 13-65.75), and for a longer time during the first 3 months of the study. The modules on depression and anxiety were the most frequently used, accounting for 35% and 22% of total usage, respectively. Overall, the study participants found the app useful (15/25, 60%) and easy to use (18/25, 72%), and they reported that the screen displayed the material adequately (22/25, 88%). However, less than half of the participants found the app helpful in managing their health (10/25, 40%) or in making progress on their wellness goals (9/25, 36%). Clinical outcomes showed a trend for improvements in mental and physical health and mania-related well-being. Conclusions: The Life Goals app showed feasibility of use among individuals with BD. Higher user engagement was observed in the initial 3 months with users interested more frequently in the mood modules than other wellness modules. Participants reported acceptability with the ease of app use and satisfaction with the app user interface, but the app showed low success in encouraging self-management within this small sample. The Life Goals app is a mobile health technology that can provide individuals with serious mental illness with more flexible access to evidence-based treatments. %M 34898452 %R 10.2196/32450 %U https://formative.jmir.org/2021/12/e32450 %U https://doi.org/10.2196/32450 %U http://www.ncbi.nlm.nih.gov/pubmed/34898452 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e31353 %T A Personalized Approach Bias Modification Smartphone App (“SWiPE”) to Reduce Alcohol Use: Open-Label Feasibility, Acceptability, and Preliminary Effectiveness Study %A Manning,Victoria %A Piercy,Hugh %A Garfield,Joshua Benjamin Bernard %A Clark,Stuart Gregory %A Andrabi,Mah Noor %A Lubman,Dan Ian %+ Turning Point, Eastern Health, 110 Church St, Richmond, Melbourne, 3121, Australia, 61 0428337961, victoria.manning@monash.edu %K alcohol %K hazardous alcohol use %K alcohol use disorder %K approach bias modification %K cognitive bias modification %K smartphone app %K ehealth %K mobile phone app %K mhealth %K digital health %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approach bias modification (ApBM), a computerized cognitive intervention that trains people to “avoid” alcohol-related images and “approach” nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement. Objective: We examined the feasibility, acceptability, and preliminary effectiveness of “SWiPE,” a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) who wanted to reduce their alcohol use. Methods: In this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training. Results: We recruited 1309 participants (mean age 47.0, SD 10.0 years; 758/1309, 57.9% female; mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9); 31.2% (409/1309) completed ≥8 sessions; and 34.8% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87; P<.001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t454=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t435=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t435=12.44; P<.001). For the 19.4% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline (P<.001). Conclusions: The findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking sample of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000638932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID): RR2-10.2196/21278 %M 34890355 %R 10.2196/31353 %U https://mhealth.jmir.org/2021/12/e31353 %U https://doi.org/10.2196/31353 %U http://www.ncbi.nlm.nih.gov/pubmed/34890355 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e31092 %T Long-Term Effectiveness of a Decision Support App (Pink Journey) for Women Considering Breast Reconstruction Surgery: Pilot Randomized Controlled Trial %A Fang,Su-Ying %A Lin,Pin-Jun %A Kuo,Yao-Lung %+ Department of Nursing, College of Medicine, National Cheng Kung University, Number 1, University Road, Tainan, 701, Taiwan, 886 62353535 ext 6271, suying@ncku.edu.tw %K breast cancer %K breast reconstruction surgery %K decision aid %K decision support %K mHealth %K app %K women %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Various kinds of breast reconstruction (BR) options, including implants and autologous, and surgery techniques, including traditional and endoscope assisted, can be used to perform surgery. All options have their own advantages and disadvantages. Women decide on an option depending on the values and preferences they emphasize. Lacking knowledge about BR or having decision difficulties during the treatment decision process makes women experience more decision regret, psychological distress, and poor body image. Delivering decision support with a values clarification exercise using eHealth approaches would be beneficial for patient outcomes. Objective: This study aims to examine the effects of a decision support app on decision-making quality and psychological morbidity for women considering BR surgery. Methods: This randomized controlled trial included women who were over 20 years of age and were newly diagnosed with breast cancer and candidates for mastectomy. Women having an option for breast conservation were excluded. After being referred from the outpatient physician, the women provided consent and completed the baseline assessment. Women allocated to the control group (CG) received usual care and were provided with a pamphlet with information about types of surgery and the advantages and disadvantages of different surgery types. Women allocated to the intervention group (IG) were given the same pamphlet and guided to use the Pink Journey app to support their decision. Then they were also prompted to discuss the opinions with their significant others. Finally, the decision-making process of using the app was printed out for women that they could take home. Decision conflict, anxiety, and depression were measured at baseline. At 1 week after the intervention (T1) and at 1 month (T2), 8 months (T3), and 12 months (T4) after surgery, the women completed decision conflict, decision regret, anxiety, depression, and body image scales. An intention-to-treat analysis was performed. Results: From February 2018 to July 2019, 96 women were randomly assigned to the CG (n=48) or the IG (n=48). Results revealed that body image distress declined significantly for the IG but increased for the CG. The interaction of time and group also reached significance, indicating a significant decrease in body image distress from baseline in the IG compared with the CG after the 12th month (T4) follow-up (β=–2.25, standard error=1.01, P=.027). However, there was no significant difference in decision conflict (P=.21-.87), decision regret (P=.44-.55), anxiety (P=.26-.33), and depression (P=.20-.75), indicating that the decrease in these outcomes in the IG was not greater than those in the CG. Conclusions: Although we found no effect on decision conflict, decision regret, anxiety, and depression, a decision aid that combines surgery information and values clarification can help women reduce their body image distress. Trial Registration: ClinicalTrials.gov NCT04190992; https://clinicaltrials.gov/ct2/show/NCT04190992 %M 34890354 %R 10.2196/31092 %U https://mhealth.jmir.org/2021/12/e31092 %U https://doi.org/10.2196/31092 %U http://www.ncbi.nlm.nih.gov/pubmed/34890354 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e26185 %T The Effects of the ManageHF4Life Mobile App on Patients With Chronic Heart Failure: Randomized Controlled Trial %A Dorsch,Michael P %A Farris,Karen B %A Rowell,Brigid E %A Hummel,Scott L %A Koelling,Todd M %+ Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI, 48109, United States, 1 734 647 1452, mdorsch@med.umich.edu %K mHealth %K remote monitoring %K self-management %K self-care %K heart failure %K medical therapy %K mobile app %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The successful management of heart failure (HF) involves guideline-based medical therapy as well as self-management behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. Objective: The aim of this paper was to evaluate the efficacy of enhanced self-management via a mobile app intervention on health-related quality of life, self-management, and HF readmissions. Methods: A single-center randomized controlled trial was performed. Participants older than 45 years and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group (“app group”) used a mobile app, and the intervention prompted daily self-monitoring and promoted self-management. The control group (“no-app group”) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire score and recurrent HF admissions. Results: A total of 83 participants were enrolled and completed all baseline assessments. Baseline characteristics were similar between the groups except for the prevalence of ischemic HF. The app group had a reduced MLHFQ at 6 weeks (mean 37.5, SD 3.5 vs mean 48.2, SD 3.7; P=.04) but not at 12 weeks (mean 44.2, SD 4 vs mean 45.9, SD 4; P=.78), compared to the no-app group. There was no effect of the app on the SCHFI at 6 or 12 weeks. The time to first HF readmission was not statistically different between the app group and the no-app group (app group 11/42, 26% vs no-app group 12/41, 29%; hazard ratio 0.89, 95% CI 0.39-2.02; P=.78) over 12 weeks. Conclusions: The adaptive mobile app intervention, which focused on promoting self-monitoring and self-management, improved the MLHFQ at 6 weeks but did not sustain its effects at 12 weeks. No effect was seen on HF self-management measured by self-report. Further research is needed to enhance engagement in the app for a longer period and to determine if the app can reduce HF readmissions in a larger study. Trial Registration: ClinicalTrials.gov NCT03149510; https://clinicaltrials.gov/ct2/show/NCT03149510 %M 34878990 %R 10.2196/26185 %U https://mhealth.jmir.org/2021/12/e26185 %U https://doi.org/10.2196/26185 %U http://www.ncbi.nlm.nih.gov/pubmed/34878990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e33123 %T A Multimodal Messaging App (MAAN) for Adults With Autism Spectrum Disorder: Mixed Methods Evaluation Study %A Hijab,Mohamad Hassan Fadi %A Al-Thani,Dena %A Banire,Bilikis %+ Division of Information and Computer Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, 34110, Qatar, 974 50677321, mhhijab@hbku.edu.qa %K autism %K assistive technology %K mobile app %K social and communication skills %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with autism spectrum disorder (ASD) often exhibit difficulties in social and communication skills. For more than 30 years, specialists, parents, and caregivers have used techniques, such as applied behavioral analysis, augmentative and alternative communication, and the picture exchange communication system to support the social and communication skills of people with ASD. Even though there are many techniques devised to enhance communication, these techniques are not considered in existing social media apps for people with ASD. Objective: This study aimed to investigate the effect of adding accessibility features, such as text-to-speech (TTS), speech-to-text (STT), and communication symbols (CS), to a messaging app (MAAN). We hypothesized that these accessibility features can enhance the social and communication skills of adults with ASD. We also hypothesized that usage of this app can reduce social loneliness in adults with ASD. Methods: Semistructured interviews were conducted with 5 experts working in fields related to ASD to help design the app. Seven adults with ASD participated in the study for a period of 10 to 16 weeks. Data logs of participants’ interactions with the app were collected. Additionally, 6 participants’ parents and 1 caregiver were asked to complete a short version of the Social and Emotional Loneliness Scale for Adults (SELSA-S) questionnaire to compare pre-post study results. The Mobile Application Rating Scale: user version questionnaire was also used to evaluate the app’s usability. Following the study, interviews were conducted with participants to discuss their experiences with the app. Results: The SELSA-S questionnaire results showed no change in the family subscale; however, the social loneliness subscale showed a difference between prestudy and poststudy. The Wilcoxon signed-rank test indicated that poststudy SELSA-S results were statistically significantly higher than prestudy results (z=−2.047; P=.04). Point-biserial correlation indicated that the SELSA-S rate of change was strongly related to usage of the TTS feature (r=0.708; P=.04) and CS feature (r=−0.917; P=.002), and moderately related to usage of the STT feature (r=0.428; P=.17). Lastly, we adopted grounded theory to analyze the interview data, and the following 5 categories emerged: app support, feature relevance, user interface design, overall feedback, and recommendations. Conclusions: This study discusses the potential for improving the communication skills of adults with ASD through special features in mobile messaging apps. The developed app aims to support the inclusion and independent life of adults with ASD. The study results showed the importance of using TTS, STT, and CS features to enhance social and communication skills, as well as reduce social loneliness in adults with ASD. %M 34878998 %R 10.2196/33123 %U https://formative.jmir.org/2021/12/e33123 %U https://doi.org/10.2196/33123 %U http://www.ncbi.nlm.nih.gov/pubmed/34878998 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e28102 %T The Application of Human-Centered Design Approaches in Health Research and Innovation: A Narrative Review of Current Practices %A Göttgens,Irene %A Oertelt-Prigione,Sabine %+ Department of Primary and Community Care, Radboud University Medical Center, Postbus 9101, Nijmegen, 6500 HB, Netherlands, 31 0243613110, irene.gottgens@radboudumc.nl %K human-centered design %K design thinking %K user-centered design %K design-based research %K methodology %K review %K mobile phone %D 2021 %7 6.12.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Human-centered design (HCD) approaches to health care strive to support the development of innovative, effective, and person-centered solutions for health care. Although their use is increasing, there is no integral overview describing the details of HCD methods in health innovations. Objective: This review aims to explore the current practices of HCD approaches for the development of health innovations, with the aim of providing an overview of the applied methods for participatory and HCD processes and highlighting their shortcomings for further research. Methods: A narrative review of health research was conducted based on systematic electronic searches in the PubMed, CINAHL, Embase, Cochrane Library, Web of Science, PsycINFO, and Sociological Abstracts (2000-2020) databases using keywords related to human-centered design, design thinking (DT), and user-centered design (UCD). Abstracts and full-text articles were screened by 2 reviewers independently based on predefined inclusion criteria. Data extraction focused on the methodology used throughout the research process, the choice of methods in different phases of the innovation cycle, and the level of engagement of end users. Results: This review summarizes the application of HCD practices across various areas of health innovation. All approaches prioritized the user’s needs and the participatory and iterative nature of the design process. The design processes comprised several design cycles during which multiple qualitative and quantitative methods were used in combination with specific design methods. HCD- and DT-based research primarily targeted understanding the research context and defining the problem, whereas UCD-based work focused mainly on the direct generation of solutions. Although UCD approaches involved end users primarily as testers and informants, HCD and DT approaches involved end users most often as design partners. Conclusions: We have provided an overview of the currently applied methodologies and HCD guidelines to assist health care professionals and design researchers in their methodological choices. HCD-based techniques are challenging to evaluate using traditional biomedical research methods. Previously proposed reporting guidelines are a step forward but would require a level of detail that is incompatible with the current publishing landscape. Hence, further development is needed in this area. Special focus should be placed on the congruence between the chosen methods, design strategy, and achievable outcomes. Furthermore, power dimensions, agency, and intersectionality need to be considered in co-design sessions with multiple stakeholders, especially when including vulnerable groups. %M 34874893 %R 10.2196/28102 %U https://mhealth.jmir.org/2021/12/e28102 %U https://doi.org/10.2196/28102 %U http://www.ncbi.nlm.nih.gov/pubmed/34874893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25305 %T A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study %A Marques,Marta M %A Matos,Marcela %A Mattila,Elina %A Encantado,Jorge %A Duarte,Cristiana %A Teixeira,Pedro J %A Stubbs,R James %A Sniehotta,Falko F %A Ermes,Miikka %A Harjumaa,Marja %A Leppänen,Juha %A Välkkynen,Pasi %A Silva,Marlene N %A Ferreira,Cláudia %A Carvalho,Sérgio %A Palmeira,Lara %A Horgan,Graham %A Heitmann,Berit Lilienthal %A Evans,Elizabeth H %A Palmeira,António L %+ Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Rua do Instituto Bacteriológico, nº 5 l, Lisbon, 1150-190, Portugal, 351 218803105, mmarques@nms.unl.pt %K mHealth %K behavior change techniques %K weight management %K motivation %K self-regulation %K emotion regulation %K self-monitoring %K user testing %K logic models %D 2021 %7 3.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union’s Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their body weight in the preceding 12 months before enrollment into the intervention. Objective: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. Methods: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit. Results: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep. Conclusions: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance. %M 34870602 %R 10.2196/25305 %U https://www.jmir.org/2021/12/e25305 %U https://doi.org/10.2196/25305 %U http://www.ncbi.nlm.nih.gov/pubmed/34870602 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e31559 %T Evaluation of a Language Translation App in an Undergraduate Medical Communication Course: Proof-of-Concept and Usability Study %A Herrmann-Werner,Anne %A Loda,Teresa %A Zipfel,Stephan %A Holderried,Martin %A Holderried,Friederike %A Erschens,Rebecca %+ Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr 5, Tuebingen, 72076, Germany, 49 7071 29 73719, anne.herrmann-werner@med.uni-tuebingen.de %K undergraduate medical students %K translation app %K simulation %K physician-patient communication %K mHealth %K mobile applications %K digital health %K app development %K language translation %K translation apps %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Language barriers in medical encounters pose risks for interactions with patients, their care, and their outcomes. Because human translators, the gold standard for mitigating language barriers, can be cost- and time-intensive, mechanical alternatives such as language translation apps (LTA) have gained in popularity. However, adequate training for physicians in using LTAs remains elusive. Objective: A proof-of-concept pilot study was designed to evaluate the use of a speech-to-speech LTA in a specific simulated physician-patient situation, particularly its perceived usability, helpfulness, and meaningfulness, and to assess the teaching unit overall. Methods: Students engaged in a 90-min simulation with a standardized patient (SP) and the LTA iTranslate Converse. Thereafter, they rated the LTA with six items—helpful, intuitive, informative, accurate, recommendable, and applicable—on a 7-point Likert scale ranging from 1 (don’t agree at all) to 7 (completely agree) and could provide free-text responses for four items: general impression of the LTA, the LTA’s benefits, the LTA’s risks, and suggestions for improvement. Students also assessed the teaching unit on a 6-point scale from 1 (excellent) to 6 (insufficient). Data were evaluated quantitatively with mean (SD) values and qualitatively in thematic content analysis. Results: Of 111 students in the course, 76 (68.5%) participated (59.2% women, age 20.7 years, SD 3.3 years). Values for the LTA’s being helpful (mean 3.45, SD 1.79), recommendable (mean 3.33, SD 1.65) and applicable (mean 3.57, SD 1.85) were centered around the average of 3.5. The items intuitive (mean 4.57, SD 1.74) and informative (mean 4.53, SD 1.95) were above average. The only below-average item concerned its accuracy (mean 2.38, SD 1.36). Students rated the teaching unit as being excellent (mean 1.2, SD 0.54) but wanted practical training with an SP plus a simulated human translator first. Free-text responses revealed several concerns about translation errors that could jeopardize diagnostic decisions. Students feared that patient-physician communication mediated by the LTA could decrease empathy and raised concerns regarding data protection and technical reliability. Nevertheless, they appreciated the LTA’s cost-effectiveness and usefulness as the best option when the gold standard is unavailable. They also reported wanting more medical-specific vocabulary and images to convey all information necessary for medical communication. Conclusions: This study revealed the feasibility of using a speech-to-speech LTA in an undergraduate medical course. Although human translators remain the gold standard, LTAs could be valuable alternatives. Students appreciated the simulated teaching and recognized the LTA’s potential benefits and risks for use in real-world clinical settings. To optimize patients’ and health care professionals’ experiences with LTAs, future investigations should examine specific design options for training interventions and consider the legal aspects of human-machine interaction in health care settings. %M 34860678 %R 10.2196/31559 %U https://mhealth.jmir.org/2021/12/e31559 %U https://doi.org/10.2196/31559 %U http://www.ncbi.nlm.nih.gov/pubmed/34860678 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e26370 %T Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing %A Counson,Isabelle %A Bartholomew,Alexandra %A Crawford,Joanna %A Petrie,Katherine %A Basarkod,Geetanjali %A Moynihan,Victoria %A Pires,Josie %A Cohen,Rachel %A Glozier,Nicholas %A Harvey,Samuel %A Sanatkar,Samineh %+ Black Dog Institute, Hospital Road, Randwick, 2031, Australia, 1 02 9382 4368, s.sanatkar@unsw.edu.au %K digital mental health %K mHealth apps %K help-seeking %K junior physicians %K co-design %K user-centered design %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. Objective: This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. Methods: A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were—needs assessment, on the basis of interviews with 12 junior physicians; prototype development with user experience feedback from 2 junior physicians; evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype; and redesign, including user experience workshops with 51 junior physicians. Results: Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians’ needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops. Conclusions: This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale. %M 34860662 %R 10.2196/26370 %U https://formative.jmir.org/2021/12/e26370 %U https://doi.org/10.2196/26370 %U http://www.ncbi.nlm.nih.gov/pubmed/34860662 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e27208 %T Walking and Daily Affect Among Sedentary Older Adults Measured Using the StepMATE App: Pilot Randomized Controlled Trial %A Bisson,Alycia N %A Sorrentino,Victoria %A Lachman,Margie E %+ Psychiatry Department, Brigham and Women’s Hospital, Room 394, 221 Longwood Ave, Boston, MA, 02115, United States, 1 5082598151, alyciansullivan@brandeis.edu %K physical activity %K fitness technology %K intervention %K behavioral science %K aging %K mobile phone %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although fitness technology can track and encourage increases in physical activity, few smartphone apps are based on behavior change theories. Apps that do include behavioral components tend to be costly and often do not include strategies to help those who are unsure of how to increase their physical activity. Objective: The aim of this pilot study is to test the efficacy of a new app, StepMATE, for increasing daily walking in a sample of inactive adults and to examine daily relationships between walking and self-reported mood and energy. Methods: The participants were middle-aged and older adults aged ≥50 years (mean 61.64, SD 7.67 years). They were randomly assigned to receive either a basic, pedometer-like version of the app or a version with supports to help them determine where, when, and with whom to walk. Of the 96 participants randomized to 1 of 2 conditions, 87 (91%) completed pretest assessments and 81 (84%) successfully downloaded the app. Upon downloading the app, step data from the week prior were automatically recorded. The participants in both groups were asked to set a daily walking goal, which they could change at any point during the intervention. They were asked to use the app as much as possible over the next 4 weeks. Twice per day, pop-up notifications assessed mood and energy levels. Results: Although one group had access to additional app features, both groups used the app in a similar way, mainly using just the walk-tracking feature. Multilevel models revealed that both groups took significantly more steps during the 4-week study than during the week before downloading the app (γ=0.24; P<.001). During the study, the participants in both groups averaged 5248 steps per day compared with an average of 3753 steps per day during the baseline week. Contrary to predictions, there were no differences in step increases between the two conditions. Cognition significantly improved from pre- to posttest (γ=0.17; P=.02). Across conditions, on days in which the participants took more steps than average, they reported better mood and higher energy levels on the same day and better mood on the subsequent day. Daily associations among walking, mood, and energy were significant for women but not for men and were stronger for older participants (those aged ≥62 years) than for the younger participants. Conclusions: Both groups increased their steps to a similar extent, suggesting that setting and monitoring daily walking goals was sufficient for an initial increase and maintenance of steps. Across conditions, walking had benefits for positive mood and energy levels, particularly for women and older participants. Further investigations should identify other motivating factors that could lead to greater and more sustained increases in physical activity. Trial Registration: ClinicalTrials.gov NCT03124537; https://clinicaltrials.gov/ct2/show/NCT03124537 %M 34855609 %R 10.2196/27208 %U https://mhealth.jmir.org/2021/12/e27208 %U https://doi.org/10.2196/27208 %U http://www.ncbi.nlm.nih.gov/pubmed/34855609 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e31985 %T Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis %A Cruz-Martínez,Roberto Rafael %A Wentzel,Jobke %A Bente,Britt Elise %A Sanderman,Robbert %A van Gemert-Pijnen,Julia EWC %+ Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Cubicus Bldg, 10, De Zul, Enschede, 7522 NJ, Netherlands, 31 683186149, r.cruzmartinez@utwente.nl %K eHealth %K self-management %K self-care %K cardiovascular diseases %K value sensitive design %K values %K content analysis %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients’ fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. Objective: This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. Methods: Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. Results: In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients’ values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. Conclusions: Positively, existing eHealth technologies could be connected with CVD patients’ values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions. %M 34855608 %R 10.2196/31985 %U https://cardio.jmir.org/2021/2/e31985 %U https://doi.org/10.2196/31985 %U http://www.ncbi.nlm.nih.gov/pubmed/34855608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30053 %T A Conversational Artificial Intelligence Agent for a Mental Health Care App: Evaluation Study of Its Participatory Design %A Danieli,Morena %A Ciulli,Tommaso %A Mousavi,Seyed Mahed %A Riccardi,Giuseppe %+ Speech and Interactive Signal Lab, Department of Engineering and Computer Science, Università degli Studi di Trento, Via Sommarive 5, Povo di Trento, Trento, 38123, Italy, 39 0461282087, morena.danieli@unitn.it %K mental health care %K conversational AI %K mHealth %K personal health care agents %K participatory design %K psychotherapy %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps for mental health are available on the market. Although they seem to be promising for improving the accessibility of mental health care, little is known about their acceptance, design methodology, evaluation, and integration into psychotherapy protocols. This makes it difficult for health care professionals to judge whether these apps may help them and their patients. Objective: Our aim is to describe and evaluate a protocol for the participatory design of mobile apps for mental health. In this study, participants and psychotherapists are engaged in the early phases of the design and development of the app empowered by conversational artificial intelligence (AI). The app supports interventions for stress management training based on cognitive behavioral theory. Methods: A total of 21 participants aged 33-61 years with mild to moderate levels of stress, anxiety, and depression (assessed by administering the Italian versions of the Symptom Checklist-90-Revised, Occupational Stress Indicator, and Perceived Stress Scale) were assigned randomly to 2 groups, A and B. Both groups received stress management training sessions along with cognitive behavioral treatment, but only participants assigned to group A received support through a mobile personal health care agent, designed for mental care and empowered by AI techniques. Psychopathological outcomes were assessed at baseline (T1), after 8 weeks of treatment (T2), and 3 months after treatment (T3). Focus groups with psychotherapists who administered the therapy were held after treatment to collect their impressions and suggestions. Results: Although the intergroup statistical analysis showed that group B participants could rely on better coping strategies, group A participants reported significant improvements in obsessivity and compulsivity and positive distress symptom assessment. The psychotherapists’ acceptance of the protocol was good. In particular, they were in favor of integrating an AI-based mental health app into their practice because they could appreciate the increased engagement of patients in pursuing their therapy goals. Conclusions: The integration into practice of an AI-based mobile app for mental health was shown to be acceptable to both mental health professionals and users. Although it was not possible in this experiment to show that the integration of AI-based conversational technologies into traditional remote psychotherapy significantly decreased the participants’ levels of stress and anxiety, the experimental results showed significant trends of reduction of symptoms in group A and their persistence over time. The mental health professionals involved in the experiment reported interest in, and acceptance of, the proposed technology as a promising tool to be included in a blended model of psychotherapy. %M 34855607 %R 10.2196/30053 %U https://formative.jmir.org/2021/12/e30053 %U https://doi.org/10.2196/30053 %U http://www.ncbi.nlm.nih.gov/pubmed/34855607 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e26597 %T Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study %A Chudyk,Anna M %A Ragheb,Sandra %A Kent,David %A Duhamel,Todd A %A Hyra,Carole %A Dave,Mudra G %A Arora,Rakesh C %A Schultz,Annette SH %+ Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, CR3023-369 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada, 1 7783876969, anna.chudyk@umanitoba.ca %K cardiac surgery %K perioperative care %K enhanced recovery protocols %K mobile app %K smartphone app %K mHealth %K development %K patient and public involvement %K patient engagement in research %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective: The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods: Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results: The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions: Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users. %M 34851299 %R 10.2196/26597 %U https://periop.jmir.org/2021/2/e26597 %U https://doi.org/10.2196/26597 %U http://www.ncbi.nlm.nih.gov/pubmed/34851299 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28678 %T Preferences for Using a Mobile App in Sickle Cell Disease Self-management: Descriptive Qualitative Study %A Mayo-Gamble,Tilicia L %A Quasie-Woode,Delores %A Cunningham-Erves,Jennifer %A Rollins,Margo %A Schlundt,David %A Bonnet,Kemberlee %A Murry,Velma McBride %+ Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, 501 Forest Dr, PO Box 8015, Statesboro, GA, 30458, United States, 1 912 478 1249, tmayogamble@georgiasouthern.edu %K sickle cell disease %K digital technology %K rural %K mHealth app %K patient-centered technology %K mobile health %K health outcomes %K hematology %K mobile phone %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with sickle cell disease (SCD) and their caregivers may benefit from technology-based resources to improve disease self-management. Objective: This study explores the preferences regarding a mobile health (mHealth) app to facilitate self-management in adults with SCD and their caregivers living in urban and rural communities. Methods: Five community listening sessions were conducted in 2 urban and rural communities among adults with SCD and their caregivers (N=43). Each session comprised 4 to 15 participants. Participants were asked questions on methods of finding information about SCD self-care, satisfaction with current methods for finding SCD management information, support for SCD management, important features for development of an mHealth app, and areas of benefit for using an mHealth app for SCD self-management. An inductive-deductive content analysis approach was implemented to identify the critical themes. Results: Seven critical themes emerged, including the current methods for receiving self-management information, desired information, recommendations for communicating sickle cell self-management information, challenges of disease management, types of support received for disease management, barriers to and facilitators of using an mHealth app, and feature preferences for an mHealth app. In addition, we found that the participants were receptive to using mHealth apps in SCD self-management. Conclusions: This study expands our knowledge on the use of mHealth technology to reduce information access barriers pertaining to SCD. The findings can be used to develop a patient-centered, user-friendly mHealth app to facilitate disease self-management, thus increasing access to resources for families of patients with SCD residing in rural communities. %M 34851295 %R 10.2196/28678 %U https://formative.jmir.org/2021/11/e28678 %U https://doi.org/10.2196/28678 %U http://www.ncbi.nlm.nih.gov/pubmed/34851295 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e28652 %T An App-Based Mindfulness-Based Self-compassion Program to Support Caregivers of People With Dementia: Participatory Feasibility Study %A Goodridge,Donna %A Reis,Nathan %A Neiser,Jenna %A Haubrich,Tim %A Westberg,Bev %A Erickson-Lumb,Laura %A Storozinski,Jo %A Gonzales,Cesar %A Michael,Joanne %A Cammer,Allison %A Osgood,Nathaniel %+ Department of Medicine, University of Saskatchewan, Room E1216, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 2Z4, Canada, 1 3069664209, donna.goodridge@usask.ca %K virtual support programs %K caregivers %K dementia %K mindfulness %K self-compassion %K mobile health %K mobile applications %K elderly %K older adults %K usability %K feasibility %K smartphone app %K mobile phone %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: The number of persons with dementia is steadily growing, as is the number of individuals supporting persons with dementia. Primary caregivers of persons with dementia are most often family members or spouses of the persons with dementia, and they are more likely to experience increased stress and other negative effects than individuals who are not primary caregivers. Although in-person support groups have been shown to help buffer the negative impacts of caregiving, some caregivers live in isolated or rural communities and are unable to make the burdensome commitment of traveling to cities. Using an interdisciplinary approach, we developed a mobile smartphone support app designed for primary caregivers of persons with dementia, with the goal of reducing caregiver burden and easing stress. The app features a 12-week intervention, largely rooted in mindfulness-based self-compassion (MBSC), because MBSC has been linked to minimizing stress, depression, and anxiety. Objective: The primary objectives of our program are twofold: to explore the feasibility of a 12-week mobile support program and to conduct an initial efficacy evaluation of changes in perceived caregiver burden, coping styles, and emotional well-being of caregivers before and after the program. Methods: Our feasibility study used a 2-phase participatory pretest and posttest design, focusing on acceptability, demand, practicality, implementation, and efficacy. At phase I, we recruited 57 primary caregivers of persons with dementia (mean age 76.3, SD 12.9 years), comprising spouses (21/57, 37%), children (21/57, 37%), and friends or relatives (15/57, 26%) of persons with dementia, of whom 29 (51%) completed all measures at both pre- and postprogram. The content of the program featured a series of MBSC podcasts. Our primary outcome measure was caregiver burden, with secondary outcome measures including coping styles and emotional well-being. Daily ecological momentary assessments enabled us to ask participants, “How are you feeling today?” Phase II of our study involved semistructured follow-up interviews with most participants (n=21) who completed phase I. Results: Our findings suggest that our app or program meets the feasibility criteria examined. Notably, participants generally accepted the program and believed it could be a useful resource. Emotional well-being increased significantly (P=.04), and emotion-based coping significantly decreased (P=.01). Participants generally considered the app or program to be a helpful resource. Conclusions: Although there were no significant changes in caregiver burden, we were encouraged by the increased emotional well-being of our participants following the completion of our program. We also conclude that our app or program demonstrated feasibility (ie, acceptability, practicality, implementation, and efficacy) and can provide a much-needed resource for primary caregivers of persons with dementia. In the subsequent version of the program, we will respond to participant feedback by incorporating web-based weekly sessions and incorporating an outcome measure of self-compassion. %M 34842530 %R 10.2196/28652 %U https://aging.jmir.org/2021/4/e28652 %U https://doi.org/10.2196/28652 %U http://www.ncbi.nlm.nih.gov/pubmed/34842530 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30495 %T Patients’ Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study %A Shewchuk,Brittany %A Green,Lee A %A Barber,Tanya %A Miller,Jean %A Teare,Sylvia %A Campbell-Scherer,Denise %A Mrklas,Kelly J %A Li,Linda C %A Marlett,Nancy %A Wasylak,Tracy %A Lopatina,Elena %A McCaughey,Deirdre %A Marshall,Deborah A %+ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3C58 Health Research Innovation Centre, 3230 Hospital Drive, Calgary, AB, T2N 4Z6, Canada, 1 403 210 6377, damarsha@ucalgary.ca %K mobile health %K mHealth %K app %K self-management %K osteoarthritis %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In a previous study, a prototype mobile health (mHealth) app was co-designed with patients, family physicians, and researchers to enhance self-management and optimize conservative management for patients with mild to moderate knee osteoarthritis (OA). Objective: This study aims to evaluate the overall usability, quality, and effectiveness of the mHealth app prototype for aiding knee OA self-management from the perspectives of patients with OA and health care providers (HCPs). Methods: Using methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth app prototype that was codeveloped with patients and HCPs. We recruited adult patients aged ≥20 years with early knee OA (n=18) who experienced knee pain on most days of the month at any time in the past and HCPs (n=7) to participate. In the qualitative assessment, patient and HCP perspectives were elicited on the likeability and usefulness of app features and functionalities and the perceived impact of the app on patient-HCP communication. The quantitative assessment involved evaluating the app using usability, quality, and effectiveness metrics. Patient baseline assessments included a semistructured interview and survey to gather demographics and assess the quality of life (European Quality-of-Life 5-Dimension 5-Level Questionnaire [EQ-5D-5L]) and patient activation (patient activation measure [PAM]). Following the 6-week usability trial period, a follow-up survey assessed patients’ perceptions of app usability and quality and longitudinal changes in quality of life and patient activation. Semistructured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate the usability and quality of the app prototype. Results: Interviews with patients and HCPs revealed overall positive impressions of the app prototype features and functionalities related to likeability and usefulness. Between the baseline and follow-up patient assessments, the mean EQ-5D-5L scores improved from 0.77 to 0.67 (P=.04), and PAM scores increased from 80.4 to 87.9 (P=.01). Following the 6-week evaluation, patients reported a mean System Usability Scale (SUS) score of 57.8, indicating marginal acceptability according to SUS cutoffs. The mean number of goals set during the usability period was 2.47 (SD 3.08), and the mean number of activities completed for knee OA self-management during the study period was 22.2 (SD 17.8). Spearman rank correlation (rs) calculations revealed that the follow-up PAM scores were weakly correlated (rs=−0.32) with the number of goals achieved and the number (rs=0.19) of activities performed during the 6-week usability period. HCPs reported a mean SUS score of 39.1, indicating unacceptable usability. Conclusions: This evidence-based and patient-centered app prototype represents a potential use of mHealth for improving outcomes and enhancing conservative care by promoting patient activation and patient-HCP communication regarding OA management. However, future iterations of the app prototype are required to address the limitations related to usability and quality. %M 34842526 %R 10.2196/30495 %U https://formative.jmir.org/2021/11/e30495 %U https://doi.org/10.2196/30495 %U http://www.ncbi.nlm.nih.gov/pubmed/34842526 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29214 %T mHealth-Based Health Promotion Intervention to Improve Use of Maternity Care Services Among Women in Rural Southwestern Uganda: Iterative Development Study %A Atukunda,Esther Cathyln %A Matthews,Lynn T %A Musiimenta,Angella %A Mugyenyi,Godfrey Rwambuka %A Mugisha,Samuel %A Ware,Norma C %A Obua,Celestino %A Siedner,Mark J %+ Mbarara University of Science and Technology, Faculty of Medicine, Plot 11-18, Kabale Road, P O Box 1410, Mbarara City, Uganda, 256 702949832, eatukunda@must.ac.ug %K mHealth app %K app development %K messaging %K health education %K health promotion %K mobile phone %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Antenatal care (ANC) prevents perinatal morbidity and mortality, but use of these services in Uganda remains low and maternal mortality rates are among the highest in the world. There is growing evidence that mobile health (mHealth) approaches improve timely communication of health-related information and produce positive health behavior change as well as health outcomes. However, there are limited data to guide development of such interventions in settings where ANC attendance and uptake of skilled maternity care are low. Objective: The aim of this study is to develop a novel patient-centered mHealth intervention to encourage and support women to use maternity care services in Mbarara district, southwestern Uganda. Methods: Using an iterative development approach, we conducted formative stakeholder interviews with 30 women and 5 health care providers (HCPs) to identify preferred key ANC topics and characterize the preferred messaging intervention; developed content for SMS text messaging and audio messaging with the help of 4 medical experts based on the identified topics; designed an app prototype through partnership with an mHealth development company; and pilot-tested the prototype and sought user experiences and feedback to refine the intervention through 3 sets of iterative interviews, a focus group discussion, and 5 cognitive interviews. Qualitative data were coded and analyzed using NVivo (version 12.0; QSR International). Results: Of the 75 women who completed interviews during the development of the prototype, 39 (52%) had at least a primary education and 75 (100%) had access to a mobile phone. The formative interviews identified 20 preferred perinatal health topics, ranging from native medicine use to comorbid disorders and danger signs during pregnancy. In all, 6 additional topics were identified by the interviewed HCPs, including birth preparedness, skilled delivery, male partner’s involvement, HCP interaction, immunization, and caring for the baby. Positive audio messaging and SMS text messaging content without authoritative tones was developed as characterized by the interviewed women. The postpilot iterative interviews and focus group discussion revealed a preference for customized messaging, reflecting an individual need to be included and connected. The women preferred short, concise, clear actionable messages that guided, supported, and motivated them to keep alert and seek professional help. Complementary weekly reminders to the women’s significant others were also preferred to encourage continuity or prompt the needed social support for care seeking. Conclusions: We used an iterative approach with diffuse stakeholders to develop a patient-centered audio messaging and SMS text messaging app designed to communicate important targeted health-related information and support rural pregnant women in southwestern Uganda. Involving both HCPs and end users in developing and formulating the mHealth intervention allowed us to tailor the intervention characteristics to the women’s preferences. Future work will address the feasibility, acceptability, and effectiveness of this design approach. %M 34842541 %R 10.2196/29214 %U https://formative.jmir.org/2021/11/e29214 %U https://doi.org/10.2196/29214 %U http://www.ncbi.nlm.nih.gov/pubmed/34842541 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e26397 %T A Mobile Intervention for Self-Efficacious and Goal-Directed Smartphone Use in the General Population: Randomized Controlled Trial %A Keller,Jan %A Roitzheim,Christina %A Radtke,Theda %A Schenkel,Konstantin %A Schwarzer,Ralf %+ Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany, 49 30 8385 4906, jan.keller@fu-berlin.de %K problematic smartphone use %K smartphone unlocks %K smartphone time %K behavior change %K self-efficacy %K action planning %K digital detox %K time-out %K randomized controlled trial %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People spend large parts of their everyday life using their smartphones. Despite various advantages of the smartphone for daily life, problematic forms of smartphone use exist that are related to negative psychological and physiological consequences. To reduce problematic smartphone use, existing interventions are oftentimes app-based and include components that help users to monitor and restrict their smartphone use by setting timers and blockers. These kinds of digital detox interventions, however, fail to exploit psychological resources, such as through promoting self-efficacious and goal-directed smartphone use. Objective: The aim of this study is to evaluate the theory-based smartphone app “Not Less But Better” that was developed to make people aware of psychological processes while using the smartphone and to support them in using their smartphone in accordance with their goals and values. Methods: In a randomized controlled trial, effects of a 20-day intervention app consisting of five 4-day training modules to foster a goal-directed smartphone use were evaluated. In the active control condition (treatment as usual), participants received a digital detox treatment and planned daily time-outs of at least 1 hour per day. Up to a 3-week follow-up, self-reported problematic smartphone use, objectively measured daily smartphone unlocks, time of smartphone use, self-efficacy, and planning towards goal-directed smartphone use were assessed repeatedly. Linear 2-level models tested intervention effects. Mediation models served to analyze self-efficacy and planning as potential mechanisms of the intervention. Results: Out of 232 enrolled participants, 110 (47.4%; 55 participants in each condition) provided data at postintervention and 88 (37.9%; 44 participants in each condition) at 3-week follow-up. Both conditions manifested substantial reductions in problematic smartphone use and in the amount of time spent with the smartphone. The number of daily unlocks did not change over time. Further, modelling changes in self-efficacy as a mediator between the intervention and problematic smartphone use at follow-up fit well to the data and showed an indirect effect (b=–0.09; 95% bias-corrected bootstrap CI –0.26 to –0.01), indicating that self-efficacy was an important intervention mechanism. Another mediation model revealed an indirect effect from changes in planning via smartphone unlocks at postintervention on problematic smartphone use at follow-up (b=–0.029, 95% bias-corrected bootstrap CI –0.078 to –0.003). Conclusions: An innovative, theory-based intervention app on goal-directed smartphone use has been found useful in lowering problematic smartphone use and time spent with the smartphone. However, observed reductions in both outcomes were not superior to the active control condition (ie, digital detox treatment). Nonetheless, the present findings highlight the importance in promoting self-efficacy and planning goal-directed smartphone use to achieve improvements in problematic smartphone use. This scalable intervention app appears suitable for practical use and as an alternative to common digital detox apps. Future studies should address issues of high attrition by adding just-in-time procedures matched to smartphone users’ needs. Trial Registration: German Clinical Trials Register DRKS00017606; https://tinyurl.com/27c9kmwy %M 34817388 %R 10.2196/26397 %U https://mhealth.jmir.org/2021/11/e26397 %U https://doi.org/10.2196/26397 %U http://www.ncbi.nlm.nih.gov/pubmed/34817388 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e32351 %T The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data %A Montgomery,Robert M %A Boucher,Eliane M %A Honomichl,Ryan D %A Powell,Tyler A %A Guyton,Sharelle L %A Bernecker,Samantha L %A Stoeckl,Sarah Elizabeth %A Parks,Acacia C %+ Happify Health, 51 E 12th St 5th floor, New York, NY, 10003, United States, 1 917 261 6933, robmontgomery@happify.com %K digital mental health %K digital health %K mobile apps %K mobile health %K internet-based intervention %K happiness %K subjective well-being %K anxiety %K cardiovascular health %K high blood pressure %K high cholesterol %K diabetes %K cardiovascular disease risk %K real-world data %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions. Objective: The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2). Methods: Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks’ exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time. Results: Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well. Conclusions: This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD. %M 34806986 %R 10.2196/32351 %U https://cardio.jmir.org/2021/2/e32351 %U https://doi.org/10.2196/32351 %U http://www.ncbi.nlm.nih.gov/pubmed/34806986 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29128 %T A Two-Minute Walking Test With a Smartphone App for Persons With Multiple Sclerosis: Validation Study %A van Oirschot,Pim %A Heerings,Marco %A Wendrich,Karine %A den Teuling,Bram %A Dorssers,Frank %A van Ee,René %A Martens,Marijn Bart %A Jongen,Peter Joseph %+ Orikami Digital Health Products, Ridderstraat 29, Nijmegen, 6511 TM, Netherlands, 31 24 301 0100, pim@mssherpa.nl %K multiple sclerosis %K relapsing remitting %K mobility %K mobile phone %K 2-Minute Walking Test %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Walking disturbances are a common dysfunction in persons with multiple sclerosis (MS). The 2-Minute Walking Test (2MWT) is widely used to quantify walking speed. We implemented a smartphone-based 2MWT (s2MWT) in MS sherpa, an app for persons with MS. When performing the s2MWT, users of the app are instructed to walk as fast as safely possible for 2 minutes in the open air, while the app records their movement and calculates the distance walked. Objective: The aim of this study is to investigate the concurrent validity and test-retest reliability of the MS sherpa s2MWT. Methods: We performed a validation study on 25 persons with relapsing-remitting MS and 79 healthy control (HC) participants. In the HC group, 21 participants were matched to the persons with MS based on age, gender, and education and these followed the same assessment schedule as the persons with MS (the HC-matched group), whereas 58 participants had a less intense assessment schedule to determine reference values (the HC-normative group). Intraclass correlation coefficients (ICCs) were determined between the distance measured by the s2MWT and the distance measured using distance markers on the pavement during these s2MWT assessments. ICCs were also determined for test-retest reliability and derived from 10 smartphone tests per study participant, with 3 days in between each test. We interviewed 7 study participants with MS regarding their experiences with the s2MWT. Results: In total, 755 s2MWTs were completed. The adherence rate for the persons with MS and the participants in the HC-matched group was 92.4% (425/460). The calculated distance walked on the s2MWT was, on average, 8.43 m or 5% (SD 18.9 m or 11%) higher than the distance measured using distance markers (n=43). An ICC of 0.817 was found for the concurrent validity of the s2MWT in the combined analysis of persons with MS and HC participants. Average ICCs of 9 test-retest reliability analyses of the s2MWT for persons with MS and the participants in the HC-matched group were 0.648 (SD 0.150) and 0.600 (SD 0.090), respectively, whereas the average ICC of 2 test-retest reliability analyses of the s2MWT for the participants in the HC-normative group was 0.700 (SD 0.029). The interviewed study participants found the s2MWT easy to perform, but they also expressed that the test results can be confronting and that a pressure to reach a certain distance can be experienced. Conclusions: The high correlation between s2MWT distance and the conventional 2MWT distance indicates a good concurrent validity. Similarly, high correlations underpin a good test-retest reliability of the s2MWT. We conclude that the s2MWT can be used to measure the distance that the persons with MS walk in 2 minutes outdoors near their home, from which both clinical studies and clinical practice can benefit. %M 34787581 %R 10.2196/29128 %U https://formative.jmir.org/2021/11/e29128 %U https://doi.org/10.2196/29128 %U http://www.ncbi.nlm.nih.gov/pubmed/34787581 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e28956 %T Designing Better Exposure Notification Apps: The Role of Persuasive Design %A Oyibo,Kiemute %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K contact tracing app %K exposure notification app %K COVID Alert %K COVID-19 %K persuasive technology %K behavior change %D 2021 %7 16.11.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: Digital contact tracing apps have been deployed worldwide to limit the spread of COVID-19 during this pandemic and to facilitate the lifting of public health restrictions. However, due to privacy-, trust-, and design-related issues, the apps are yet to be widely adopted. This calls for an intervention to enable a critical mass of users to adopt them. Objective: The aim of this paper is to provide guidelines to design contact tracing apps as persuasive technologies to make them more appealing and effective. Methods: We identified the limitations of the current contact tracing apps on the market using the Government of Canada’s official exposure notification app (COVID Alert) as a case study. Particularly, we identified three interfaces in the COVID Alert app where the design can be improved. The interfaces include the no exposure status interface, exposure interface, and diagnosis report interface. We propose persuasive technology design guidelines to make them more motivational and effective in eliciting the desired behavior change. Results: Apart from trust and privacy concerns, we identified the minimalist and nonmotivational design of exposure notification apps as the key design-related factors that contribute to the current low uptake. We proposed persuasive strategies such as self-monitoring of daily contacts and exposure time to make the no exposure and exposure interfaces visually appealing and motivational. Moreover, we proposed social learning, praise, and reward to increase the diagnosis report interface’s effectiveness. Conclusions: We demonstrated that exposure notification apps can be designed as persuasive technologies by incorporating key persuasive features, which have the potential to improve uptake, use, COVID-19 diagnosis reporting, and compliance with social distancing guidelines. %M 34783673 %R 10.2196/28956 %U https://publichealth.jmir.org/2021/11/e28956 %U https://doi.org/10.2196/28956 %U http://www.ncbi.nlm.nih.gov/pubmed/34783673 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e25192 %T Developing and Demonstrating the Viability and Availability of the Multilevel Implementation Strategy for Syncope Optimal Care Through Engagement (MISSION) Syncope App: Evidence-Based Clinical Decision Support Tool %A Amin,Shiraz %A Gupta,Vedant %A Du,Gaixin %A McMullen,Colleen %A Sirrine,Matthew %A Williams,Mark V %A Smyth,Susan S %A Chadha,Romil %A Stearley,Seth %A Li,Jing %+ Department of Medicine, Washington University School of Medicine, 600 S Taylor Ave, 00155K, Campus Box 8005, St. Louis, MO, 63110, United States, 1 314 273 9386, l.jing@wustl.edu %K cardiology %K medical diagnosis %K medicine %K mobile applications %K prognostics and health %K syncope %D 2021 %7 16.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Syncope evaluation and management is associated with testing overuse and unnecessary hospitalizations. The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Syncope Guideline aims to standardize clinical practice and reduce unnecessary services. The use of clinical decision support (CDS) tools offers the potential to successfully implement evidence-based clinical guidelines. However, CDS tools that provide an evidence-based differential diagnosis (DDx) of syncope at the point of care are currently lacking. Objective: With input from diverse health systems, we developed and demonstrated the viability of a mobile app, the Multilevel Implementation Strategy for Syncope optImal care thrOugh eNgagement (MISSION) Syncope, as a CDS tool for syncope diagnosis and prognosis. Methods: Development of the app had three main goals: (1) reliable generation of an accurate DDx, (2) incorporation of an evidence-based clinical risk tool for prognosis, and (3) user-based design and technical development. To generate a DDx that incorporated assessment recommendations, we reviewed guidelines and the literature to determine clinical assessment questions (variables) and likelihood ratios (LHRs) for each variable in predicting etiology. The creation and validation of the app diagnosis occurred through an iterative clinician review and application to actual clinical cases. The review of available risk score calculators focused on identifying an easily applied and valid evidence-based clinical risk stratification tool. The review and decision-making factors included characteristics of the original study, clinical variables, and validation studies. App design and development relied on user-centered design principles. We used observations of the emergency department workflow, storyboard demonstration, multiple mock review sessions, and beta-testing to optimize functionality and usability. Results: The MISSION Syncope app is consistent with guideline recommendations on evidence-based practice (EBP), and its user interface (UI) reflects steps in a real-world patient evaluation: assessment, DDx, risk stratification, and recommendations. The app provides flexible clinical decision making, while emphasizing a care continuum; it generates recommendations for diagnosis and prognosis based on user input. The DDx in the app is deemed a pragmatic model that more closely aligns with real-world clinical practice and was validated using actual clinical cases. The beta-testing of the app demonstrated well-accepted functionality and usability of this syncope CDS tool. Conclusions: The MISSION Syncope app development integrated the current literature and clinical expertise to provide an evidence-based DDx, a prognosis using a validated scoring system, and recommendations based on clinical guidelines. This app demonstrates the importance of using research literature in the development of a CDS tool and applying clinical experience to fill the gaps in available research. It is essential for a successful app to be deliberate in pursuing a practical clinical model instead of striving for a perfect mathematical model, given available published evidence. This hybrid methodology can be applied to similar CDS tool development. %M 34783669 %R 10.2196/25192 %U https://www.jmir.org/2021/11/e25192 %U https://doi.org/10.2196/25192 %U http://www.ncbi.nlm.nih.gov/pubmed/34783669 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e16824 %T Developing a Management Guide (the DemPower App) for Couples Where One Partner Has Dementia: Nonrandomized Feasibility Study %A Lasrado,Reena %A Bielsten,Therese %A Hann,Mark %A Schumm,James %A Reilly,Siobhan Theresa %A Davies,Linda %A Swarbrick,Caroline %A Dowlen,Robyn %A Keady,John %A Hellström,Ingrid %+ Social Care & Society, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1613067884, reena.lasrado@manchester.ac.uk %K dementia guide %K self-management for couples with dementia %K dementia self-help %K dementia app %K dementia resource %K feasibility study %K nonrandomized study %K dementia intervention %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Promoting the health and well-being of couples where one partner has dementia is an overlooked area of care practice. Most postdiagnostic services currently lack a couple-centered approach and have a limited focus on the couple relationship. To help address this situation, we developed a tablet-based self-management guide (DemPower) focused on helping couples enhance their well-being and relationship quality. Objective: The aim of this study is to investigate the feasibility and acceptability of the DemPower app. Methods: A nonrandomized feasibility design was used to evaluate the DemPower intervention over 3 months among couples where a partner had a diagnosis of dementia. The study recruited 25 couples in the United Kingdom and 19 couples in Sweden. Outcome measures were obtained at baseline and postintervention. The study process and interventions were evaluated at various stages. Results: The study was completed by 48% (21/44) of couples where one partner had dementia, of whom 86% (18/21) of couples accessed all parts of the DemPower app. Each couple spent an average of 8 hours (SD 3.35 hours) using the app during the study period. In total, 90% (19/21) of couples reported that all sections of DemPower were useful in addressing various aspects of daily life and helped to focus on how they interacted in their relationship. Of the 4 core subjects on which the DemPower app was structured, home and neighborhood received the highest number of visits. Couples used activity sections more often than the core subject pages. The perception of DemPower’s utility varied with each couple’s lived experience of dementia, geographic location, relationship dynamics, and opportunities for social interaction. A 5.2-point increase in the dementia quality of life score for people with dementia and a marginal increase in the Mutuality scale (+1.23 points) for caregiver spouses were found. Design and navigational challenges were reported in the DemPower app. Conclusions: The findings suggest that the DemPower app is a useful resource for couples where one partner has dementia and that the implementation of the app requires the support of memory clinics to reach couples at early diagnosis. Trial Registration: ISRCTN Registry ISRCTN10122979; http://www.isrctn.com/ISRCTN10122979 %M 34783666 %R 10.2196/16824 %U https://aging.jmir.org/2021/4/e16824 %U https://doi.org/10.2196/16824 %U http://www.ncbi.nlm.nih.gov/pubmed/34783666 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e32521 %T Smartband-Based Automatic Smoking Detection and Real-time Mindfulness Intervention: Protocol for a Feasibility Trial %A Horvath,Mark %A Grutman,Aurora %A O'Malley,Stephanie S %A Gueorguieva,Ralitza %A Khan,Nashmia %A Brewer,Judson A %A Garrison,Kathleen A %+ Department of Psychiatry, Yale School of Medicine, 1 Church Street #730, New Haven, CT, 06510, United States, 1 4152608618, kathleen.garrison@yale.edu %K smartband %K smartphone %K smoking %K mindfulness %K craving %K mHealth %D 2021 %7 16.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking is the leading cause of preventable death in the United States. Smoking cessation interventions delivered by smartphone apps are a promising tool for helping smokers quit. However, currently available smartphone apps for smoking cessation have not exploited their unique potential advantages to aid quitting. Notably, few to no available apps use wearable technologies, most apps require users to self-report their smoking, and few to no apps deliver treatment automatically contingent upon smoking. Objective: This pilot trial tests the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver brief mindfulness interventions in real time to reduce smoking. Methods: Daily smokers (N=100, ≥5 cigarettes per day) wear a smartband for 60 days to monitor and detect smoking, notify them about their smoking events in real time, and deliver real-time brief mindfulness exercises triggered by detected smoking events or targeted at predicted smoking events. Smokers set a quit date at 30 days. A three-step intervention to reduce smoking is tested. First, participants wear a smartband to monitor and detect smoking, and notify them of smoking events in real time to bring awareness to smoking and triggers for 21 days. Next, a “mindful smoking” exercise is triggered by detected smoking events to bring a clear recognition of the actual effects of smoking for 7 days. Finally, after their quit date, a “RAIN” (recognize, allow, investigate, nonidentification) exercise is delivered to predicted smoking events (based on the initial 3 weeks of tracking smoking data) to help smokers learn to work mindfully with cravings rather than smoke for 30 days. The primary outcomes are feasibility measures of treatment fidelity, adherence, and acceptability. The secondary outcomes are smoking rates at end of treatment. Results: Recruitment for this trial started in May 2021 and will continue until November 2021 or until enrollment is completed. Data monitoring and management are ongoing for enrolled participants. The final 60-day end of treatment data is anticipated in January 2022. We expect that all trial results will be available in April 2022. Conclusions: Findings will provide data and information on the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver real-time brief mindfulness interventions, and whether the intervention warrants additional testing for smoking cessation. Trial Registration: ClinicalTrials.gov NCT03995225; https://clinicaltrials.gov/ct2/show/NCT03995225 International Registered Report Identifier (IRRID): DERR1-10.2196/32521 %M 34783663 %R 10.2196/32521 %U https://www.researchprotocols.org/2021/11/e32521 %U https://doi.org/10.2196/32521 %U http://www.ncbi.nlm.nih.gov/pubmed/34783663 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e26212 %T A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp %A Whale,Katie %A Beasant,Lucy %A Wright,Anne J %A Yardley,Lucy %A Wallace,Louise M %A Moody,Louise %A Joinson,Carol %+ Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, United Kingdom, 44 0117 4147995, katie.whale@bristol.ac.uk %K incontinence %K urinary incontinence %K digital intervention %K child health %K pediatric %K pediatric incontinence %K smartphone %K intervention development %K mobile phone %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. Objective: This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. Methods: URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. Results: Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. Conclusions: The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life. %M 34779780 %R 10.2196/26212 %U https://pediatrics.jmir.org/2021/4/e26212 %U https://doi.org/10.2196/26212 %U http://www.ncbi.nlm.nih.gov/pubmed/34779780 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e27896 %T Using Co-design in Mobile Health System Development: A Qualitative Study With Experts in Co-design and Mobile Health System Development %A Noorbergen,Tyler J %A Adam,Marc T P %A Teubner,Timm %A Collins,Clare E %+ School of Information and Physical Sciences, College of Engineering, Science and Environment, University of Newcastle, ES214, Es Building, Callaghan, 2308, Australia, 61 249215197, marc.adam@newcastle.edu.au %K co-design %K mHealth %K guidelines %K qualitative study %K mobile phone %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development. Objective: Despite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems. Methods: Tapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development. Results: The contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact. Conclusions: System designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research. %M 34757323 %R 10.2196/27896 %U https://mhealth.jmir.org/2021/11/e27896 %U https://doi.org/10.2196/27896 %U http://www.ncbi.nlm.nih.gov/pubmed/34757323 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e26424 %T Acceptance of an Informational Antituberculosis Chatbot Among Korean Adults: Mixed Methods Research %A Kim,Agnes Jihae %A Yang,Jisun %A Jang,Yihyun %A Baek,Joon Sang %+ Department of Human Environment and Design, Yonsei University, Samsung Hall, 7th Fl., Yonsei-ro 50, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2123 3137, joonsbaek@yonsei.ac.kr %K tuberculosis %K chatbot %K technology acceptance model %K mobile phone %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tuberculosis (TB) is a highly infectious disease. Negative perceptions and insufficient knowledge have made its eradication difficult. Recently, mobile health care interventions, such as an anti-TB chatbot developed by the research team, have emerged in support of TB eradication programs. However, before the anti-TB chatbot is deployed, it is important to understand the factors that predict its acceptance by the population. Objective: This study aims to explore the acceptance of an anti-TB chatbot that provides information about the disease and its treatment to people vulnerable to TB in South Korea. Thus, we are investigating the factors that predict technology acceptance through qualitative research based on the interviews of patients with TB and homeless facility personnel. We are then verifying the extended Technology Acceptance Model (TAM) and predicting the factors associated with the acceptance of the chatbot. Methods: In study 1, we conducted interviews with potential chatbot users to extract the factors that predict user acceptance and constructed a conceptual framework based on the TAM. In total, 16 interviews with patients with TB and one focus group interview with 10 experts on TB were conducted. In study 2, we conducted surveys of potential chatbot users to validate the extended TAM. Survey participants were recruited among late-stage patients in TB facilities and members of web-based communities sharing TB information. A total of 123 responses were collected. Results: The results indicate that perceived ease of use and social influence were significantly predictive of perceived usefulness (P=.04 and P<.001, respectively). Perceived usefulness was predictive of the attitude toward the chatbot (P<.001), whereas perceived ease of use (P=.88) was not. Behavioral intention was positively predicted by attitude toward the chatbot and facilitating conditions (P<.001 and P=.03, respectively). The research model explained 55.4% of the variance in the use of anti-TB chatbots. The moderating effect of TB history was found in the relationship between attitude toward the chatbot and behavioral intention (P=.01) and between facilitating conditions and behavioral intention (P=.02). Conclusions: This study can be used to inform future design of anti-TB chatbots and highlight the importance of services and the environment that empower people to use the technology. %M 34751667 %R 10.2196/26424 %U https://mhealth.jmir.org/2021/11/e26424 %U https://doi.org/10.2196/26424 %U http://www.ncbi.nlm.nih.gov/pubmed/34751667 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e32847 %T Mechanisms of Smartphone Apps for Cigarette Smoking Cessation: Results of a Serial Mediation Model From the iCanQuit Randomized Trial %A Bricker,Jonathan B %A Levin,Michael %A Lappalainen,Raimo %A Mull,Kristin %A Sullivan,Brianna %A Santiago-Torres,Margarita %+ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, United States, 1 2066675074, jbricker@fredhutch.org %K mediation %K engagement %K digital %K mHealth: smartphone %K acceptance %K smoking %K cessation %K app %K randomized controlled trial %K model %K intervention %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Engagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy. Objective: This study aimed to test a serial mediation model of an Acceptance and Commitment Therapy (ACT) smartphone intervention for smoking cessation. Methods: In this randomized controlled trial, participants (N=2415) from 50 US states were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison smartphone intervention (QuitGuide). Their engagement with the apps (primary measure: number of logins) was measured during the first 3 months, ACT processes were measured at baseline and 3 months (acceptance of internal cues to smoke, valued living), and smoking cessation was measured at 12 months with 87% follow-up retention. Results: There was a significant serial mediation effect of iCanQuit on smoking cessation through multiple indicators of intervention engagement (ie, total number of logins, total number of minutes used, and total number of unique days of use) and in turn through increases in mean acceptance of internal cues to smoke from baseline to 3 months. Analyses of the acceptance subscales showed that the mediation was through acceptance of physical sensations and emotions, but not acceptance of thoughts. There was no evidence that the effect of the iCanQuit intervention was mediated through changes in valued living. Conclusions: In this first study of serial mediators underlying the efficacy of smartphone apps for smoking cessation, our results suggest the effect of the iCanQuit ACT-based smartphone app on smoking cessation was mediated through multiple indicators of engagement and in turn through increases in the acceptance of physical sensations and emotions that cue smoking. Trial Registration: Clinical Trials.gov NCT02724462; https://clinicaltrials.gov/ct2/show/NCT02724462 %M 34751662 %R 10.2196/32847 %U https://mhealth.jmir.org/2021/11/e32847 %U https://doi.org/10.2196/32847 %U http://www.ncbi.nlm.nih.gov/pubmed/34751662 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e29815 %T App Designs and Interactive Features to Increase mHealth Adoption: User Expectation Survey and Experiment %A Lazard,Allison J %A Babwah Brennen,J Scott %A Belina,Stephanie P %+ Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, 384 Carroll Hall, Chapel Hill, NC, 27599, United States, 1 3173317807, lazard@unc.edu %K smartphone %K interactive design %K mobile apps %K preventive health %K mental models %K prototypicality %K attention %K affordances %D 2021 %7 4.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the ubiquity of smartphones, there is little guidance for how to design mobile health apps to increase use. Specifically, knowing what features users expect, grab their attention, encourage use (via predicted use or through positive app evaluations), and signal beneficial action possibilities can guide and focus app development efforts. Objective: We investigated what features users expect and how the design (prototypicality) impacts app adoption. Methods: In a web-based survey, we elicited expectations, including presence and placement, for 12 app features. Thereafter, participants (n=462) viewed 2 health apps (high prototypicality similar to top downloaded apps vs low prototypicality similar to research interventions) and reported willingness to download, attention, and predicted use of app features. Participants rated both apps (high and low) for aesthetics, ease of use, usefulness, perceived affordances, and intentions to use. Results: Most participants (425/462, 92%) expected features for navigation or personal settings (eg, menu) in specific regions (eg, top corners). Features with summary graphs or statics were also expected by many (395-396 of 462, 86%), with a center placement expectation. A feature to “share with friends” was least expected among participants (203/462, 44%). Features fell into 4 unique categories based on attention and predicted use, including essential features with high (>50% or >231 of 462) predicted use and attention (eg, calorie trackers), flashy features with high attention but lower predicted use (eg, links to specific diets), functional features with modest attention and low use (eg, settings), and mundane features with low attention and use (eg, discover tabs). When given a choice, 347 of 462 (75%) participants would download the high-prototypicality app. High prototypicality apps (vs low) led to greater aesthetics, ease of use, usefulness, and intentions, (for all, P<.001). Participants thought that high prototypicality apps had more perceived affordances. Conclusions: Intervention designs that fail to meet a threshold of mHealth expectations will be dismissed as less usable or beneficial. Individuals who download health apps have shared expectations for features that should be there, as well as where these features should appear. Meeting these expectations can improve app evaluations and encourage use. Our typology should guide presence and placement of expected app features to signal value and increase use to impact preventive health behaviors. Features that will likely be used and are attention-worthy—essential, flashy, and functional—should be prioritized during app development. %M 34734829 %R 10.2196/29815 %U https://mhealth.jmir.org/2021/11/e29815 %U https://doi.org/10.2196/29815 %U http://www.ncbi.nlm.nih.gov/pubmed/34734829 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25749 %T A Mobile App to Enhance Behavioral Activation Treatment for Substance Use Disorder: App Design, Use, and Integration Into Treatment in the Context of a Randomized Controlled Trial %A Paquette,Catherine E %A Rubalcava,Dillon T %A Chen,Yun %A Anand,Deepika %A Daughters,Stacey B %+ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599-3270, United States, 1 919 962 9924, daughter@unc.edu %K substance use disorder %K smartphone app %K mHealth %K behavioral activation %K mobile phone %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Group-based formats typically used in low-resource substance use disorder (SUD) treatment settings result in little individual attention to help reinforce and guide skill use, which may contribute to poor posttreatment outcomes. Smartphone apps offer a convenient, user-friendly, and cost-effective tool that can extend the reach of effective SUD treatments. A smartphone app was developed and integrated into a group-based, brief behavioral activation (BA) treatment for SUD to increase engagement in treatment skills outside clinician-administered sessions. Objective: This study aims to describe the features of the app and its use and integration into treatment, report the participants’ self-reported feasibility and acceptability of the app, and discuss challenges and provide recommendations for future smartphone app integration into behavioral treatments for SUD. Methods: A total of 56 individuals recruited from intensive outpatient SUD treatment received a smartphone-enhanced BA treatment, the Life Enhancement Treatment for Substance Use. Self-reported weekly app use and reasons for nonuse were assessed at posttreatment and at 1- and 3-month follow-ups. In addition, 2-tailed t tests and chi-square tests compared the self-reported use of each app component and overall app use over time. Results: Participant feedback suggested that the integration of the smartphone app into the Life Enhancement Treatment for Substance Use was feasible and well accepted, and participants found the app useful for planning value-based activities outside of sessions. Self-reported app engagement decreased over the follow-up period: 72% (39/54) of participants reported using the app at posttreatment, decreasing to 69% (37/54) at the 1-month follow-up and 37% (20/54) at the 3-month follow-up. Participants reported forgetting to use the app as a primary reason for nonuse. Conclusions: This study provides support for the feasibility and acceptability of smartphone-enhanced BA treatment, offering promise for future research testing the integration of technology into SUD treatment. Design decisions may help streamline smartphone integration into treatment, for example, allowing participants to download the treatment app on their own phones or use a low-cost study smartphone (or offering both options). Long-term app engagement may be increased via built-in reminders, alerts, and in-app messages. Trial Registration: ClinicalTrials.gov NCT02707887; https://clinicaltrials.gov/ct2/show/study/NCT02707887 %M 34730535 %R 10.2196/25749 %U https://formative.jmir.org/2021/11/e25749 %U https://doi.org/10.2196/25749 %U http://www.ncbi.nlm.nih.gov/pubmed/34730535 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25392 %T A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study %A Carmona,Nicole E %A Usyatynsky,Aleksandra %A Kutana,Samlau %A Corkum,Penny %A Henderson,Joanna %A McShane,Kelly %A Shapiro,Colin %A Sidani,Souraya %A Stinson,Jennifer %A Carney,Colleen E %+ Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 416 979 5000 ext 552177, ccarney@ryerson.ca %K youth %K sleep %K technology %K mHealth %K self-management %K adolescents %K young adults %K mobile phone %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Sleep disturbance and its daytime sequelae, which comprise complex, transdiagnostic sleep problems, are pervasive problems in adolescents and young adults (AYAs) and are associated with negative outcomes. Effective interventions must be both evidence based and individually tailored. Some AYAs prefer self-management and digital approaches. Leveraging these preferences is helpful, given the dearth of AYA treatment providers trained in behavioral sleep medicine. We involved AYAs in the co-design of a behavioral, self-management, transdiagnostic sleep app called DOZE (Delivering Online Zzz’s with Empirical Support). Objective: This study tests the feasibility and acceptability of DOZE in a community AYA sample aged 15-24 years. The secondary objective is to evaluate sleep and related outcomes in this nonclinical sample. Methods: Participants used DOZE for 4 weeks (2 periods of 2 weeks). They completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Measures of acceptability and credibility were completed at baseline and end point. Google Analytics was used to understand the patterns of app use to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and quality of life at baseline and end point. Results: In total, 83 participants created a DOZE account, and 51 completed the study. During the study, 2659 app sessions took place with an average duration of 3:02 minutes. AYAs tracked most days in period 1 (mean 10.52, SD 4.87) and period 2 (mean 9.81, SD 6.65), with a modal time of 9 AM (within 2 hours of waking). DOZE was appraised as highly acceptable (mode≥4) on the items “easy to use,” “easy to understand,” “time commitment,” and “overall satisfaction” and was rated as credible (mode≥4) at baseline and end point across all items (logic, confident it would work, confident recommending it to a friend, willingness to undergo, and perceived success in treating others). The most common goals set were decreasing schedule variability (34/83, 41% of participants), naps (17/83, 20%), and morning lingering in bed (16/83, 19%). AYAs accessed tips on difficulty winding down (24/83, 29% of participants), being a night owl (17/83, 20%), difficulty getting up (13/83, 16%), and fatigue (13/83, 16%). There were significant improvements in morning lingering in bed (P=.03); total wake time (P=.02); sleep efficiency (P=.002); total sleep time (P=.03); and self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy (P=.01). Conclusions: Our results support the feasibility, acceptability, credibility, and preliminary efficacy of DOZE. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, which is consistent with research suggesting that AYAs prefer autonomy in their health care choices and produce good results when given tools that support their autonomy. Trial Registration: ClinicalTrials.gov NCT03960294; https://clinicaltrials.gov/ct2/show/NCT03960294 %M 34723820 %R 10.2196/25392 %U https://formative.jmir.org/2021/11/e25392 %U https://doi.org/10.2196/25392 %U http://www.ncbi.nlm.nih.gov/pubmed/34723820 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e20739 %T Use of a Mobile App for the Process Evaluation of an Intervention in Health Care: Development and Usability Study %A Chin,Winnie Szu Yun %A Kurowski,Alicia %A Gore,Rebecca %A Chen,Guanling %A Punnett,Laura %A , %+ Division of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Ave, Room LW711, Boston, MA, 02215, United States, 1 617 632 5602, winnies_chin@dfci.harvard.edu %K mobile apps %K usability testing %K user experience design %K mobile phone %K mhealth %K iterative testing %K participatory research %K user demographics %K worker participation %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Process evaluation measures the context in which an outcome was or was not achieved through the ongoing monitoring of operations. Mobile apps are a potentially less burdensome tool for collecting these metrics in real time from participants. Research-driven apps are not always developed while paying attention to their usability for target users. Usability testing uncovers gaps in researchers’, developers’, and users’ mental models of what an efficient, effective, and satisfying product looks like and facilitates design improvement. Models may vary by user demographics. Objective: This study describes the development of a mobile app for collecting process evaluation metrics in an intervention study with health care workers that uses feedback at multiple stages to refine the app design, quantify usage based on workers' overall adoption of the app and the app's specific function, and compare the demographic and job characteristics of end users. Methods: An app was developed to evaluate the Center for Promotion of Health in the New England Workplace Healthy Workplace Participatory Program, which trains teams to develop solutions for workforce health obstacles. Labor-management health and safety committee members, program champions, and managers were invited to use the app. An accompanying website was available for team facilitators. The app’s 4 functions were meeting creation, postmeeting surveys, project time logs, and chat messages. Google Analytics recorded screen time. Two stages of pilot tests assessed functionality and usability across different device software, hardware, and platforms. In stage 1, student testers assessed the first functional prototype by performing task scenarios expected from end users. Feedback was used to fix issues and inform further development. In stage 2, the app was offered to all study participants; volunteers completed task scenarios and provided feedback at deployment. End user data for 18 months after deployment were summarized and compared by user characteristics. Results: In stage 1, functionality problems were documented and fixed. The System Usability Scale scores from 7 student testers corresponded to good usability (mobile app=72.9; website=72.5), whereas 15 end users rated usability as ok (mobile app=64.7; website=62.5). Predominant usability themes from student testers were flexibility and efficiency and visibility of system status; end users prioritized flexibility andefficiency and recognition rather than recall. Both student testers and end users suggested useful features that would have resulted in the large-scale restructuring of the back end; these were considered for their benefits versus cost. In stage 2, the median total use time over 18 months was 10.9 minutes (IQR 23.8) and 14.5 visits (IQR 12.5). There were no observable patterns in use by demographic characteristics. Conclusions: Occupational health researchers developing a mobile app should budget for early and iterative testing to find and fix problems or usability issues, which can increase eventual product use and prevent potential gaps in data. %M 34709186 %R 10.2196/20739 %U https://formative.jmir.org/2021/10/e20739 %U https://doi.org/10.2196/20739 %U http://www.ncbi.nlm.nih.gov/pubmed/34709186 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e26233 %T A Mobile Health Salt Reduction Intervention for People With Hypertension: Results of a Feasibility Randomized Controlled Trial %A Payne Riches,Sarah %A Piernas,Carmen %A Aveyard,Paul %A Sheppard,James P %A Rayner,Mike %A Albury,Charlotte %A Jebb,Susan A %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865 289300, susan.jebb@phc.ox.ac.uk %K salt reduction %K behavior change %K mobile health %K mHealth %K smartphone app %K mobile phone %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A high-salt diet is a risk factor for hypertension and cardiovascular disease; therefore, reducing dietary salt intake is a key part of prevention strategies. There are few effective salt reduction interventions suitable for delivery in the primary care setting, where the majority of the management and diagnosis of hypertension occurs. Objective: The aim of this study is to assess the feasibility of a complex behavioral intervention to lower salt intake in people with elevated blood pressure and test the trial procedures for a randomized controlled trial to investigate the intervention’s effectiveness. Methods: This feasibility study was an unblinded, randomized controlled trial of a mobile health intervention for salt reduction versus an advice leaflet (control). The intervention was developed using the Behavior Change Wheel and comprised individualized, brief advice from a health care professional with the use of the SaltSwap app. Participants with an elevated blood pressure recorded in the clinic were recruited through primary care practices in the United Kingdom. Primary outcomes assessed the feasibility of progression to a larger trial, including follow-up attendance, fidelity of intervention delivery, and app use. Secondary outcomes were objectively assessed using changes in salt intake (measured via 24-hour urine collection), salt content of purchased foods, and blood pressure. Qualitative outcomes were assessed using the think-aloud method, and the process outcomes were evaluated. Results: A total of 47 participants were randomized. All progression criteria were met: follow-up attendance (45/47, 96%), intervention fidelity (25/31, 81%), and app use (27/31, 87%). There was no evidence that the intervention significantly reduced the salt content of purchased foods, salt intake, or blood pressure; however, this feasibility study was not powered to detect changes in secondary outcomes. Process and qualitative outcomes demonstrated that the trial design was feasible and the intervention was acceptable to both individuals and practitioners and positively influenced salt intake behaviors. Conclusions: The intervention was acceptable and feasible to deliver within primary care; the trial procedures were practicable, and there was sufficient signal of potential efficacy to change salt intake. With some improvements to the intervention app, a larger trial to assess intervention effectiveness for reducing salt intake and blood pressure is warranted. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 20910962; https://www.isrctn.com/ISRCTN20910962 %M 34673535 %R 10.2196/26233 %U https://mhealth.jmir.org/2021/10/e26233 %U https://doi.org/10.2196/26233 %U http://www.ncbi.nlm.nih.gov/pubmed/34673535 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e23968 %T Need for Cognition Among Users of Self-Monitoring Systems for Physical Activity: Survey Study %A Halttu,Kirsi %A Oinas-Kukkonen,Harri %+ Oulu Advanced Research on Service and Information Systems Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, P.O. Box 3000, Oulu, FI-90014, Finland, 358 458601190, kirsi.halttu@oulu.fi %K self-monitoring %K wearables %K physical activity tracking %K mHealth %K need for cognition %K persuasive design %K tailoring %K user research %K mobile phone %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Need for cognition (NFC) is among the most studied personality traits in psychology. Despite its apparent relevance for engaging with technology and the use of information, it has not been studied in the context of self-monitoring systems and wearables for health. This study is the first to explore the relationship between NFC and commercial self-monitoring systems among healthy users. Objective: This study aims to explore the effect of NFC levels on the selection of self-monitoring systems and evaluation of system features of self-monitoring and feedback, as well as perceived credibility and perceived persuasiveness. We also assessed perceived behavior change in the form of self-reported activity after adopting the system. Methods: Survey data were collected in October 2019 among university students and personnel. The invitation to respond to the questionnaire was addressed to those who had used a digital system to monitor their physical activity for at least two months. The web-based questionnaire comprised the following 3 parts: details of system use, partially randomly ordered theoretical measurement items, and user demographics. The data were analyzed using structural equation modeling. The effect of NFC was assessed both as 3 groups (low, moderate, and high) and as a continuous moderator variable. Results: In all, 238 valid responses to the questionnaire were obtained. Individuals with high NFC reported all tested system features with statistically significantly higher scores. The NFC also had some effect on system selection. Hypothesized relationships with perceived credibility gained support in a different way for individuals with low and high NFC; for those with low NFC, credibility increased the persuasiveness of the system, but this effect was absent among individuals with high NFC. For users with high NFC, credibility was related to feedback and self-monitoring and perhaps continuously evaluated during prolonged use instead of being a static system property. Furthermore, the relationship between perceived persuasiveness and self-reported activity after adopting the system had a large effect size (Cohen f2=0.355) for individuals with high NFC, a small effect size for individuals with moderate NFC (Cohen f2=0.107), and a nonsignificant path (P=.16) for those with low NFC. We also detected a moderating effect of NFC in two paths on perceived persuasiveness but only among women. Our research model explained 59.2%, 63.9%, and 47.3% of the variance in perceived persuasiveness of the system among individuals with low, moderate, and high NFC, respectively. Conclusions: The system choices of individuals seem to reflect their intrinsic motivations to engage with rich data, and commercial systems might themselves be a tailoring strategy. Important characteristics of the system, such as perceived credibility, have different roles depending on the NFC levels. Our data demonstrate that NFC as a trait that differentiates information processing has several implications for the selection, design, and tailoring of self-monitoring systems. %M 34647894 %R 10.2196/23968 %U https://formative.jmir.org/2021/10/e23968 %U https://doi.org/10.2196/23968 %U http://www.ncbi.nlm.nih.gov/pubmed/34647894 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e24865 %T A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study %A Cruz,Flávia Oliveira de Almeida Marques da %A Faria,Edison Tostes %A Ghobad,Pabblo Cardelino %A Alves,Leandro Yukio Mano %A Reis,Paula Elaine Diniz dos %+ Interdisciplinary Laboratory of Research Applied to Clinical Practice in Oncology, School of Health Sciences, University of Brasilia (UnB), Darcy Ribeiro s/n - Asa Norte, Brasilia, 70910-900, Brazil, 55 61998552290, flavinhaoliveira5@hotmail.com %K mobile applications %K health education %K nursing care %K oncology nursing %K educational technology %K breast neoplasms %K radiation therapy %D 2021 %7 13.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps targeting women with breast cancer can facilitate access to information, improve well-being, and record reports of treatment-related symptoms. However, it is important to confirm the benefits of these apps before they are used as a tool in clinical care. Objective: The aim of this study was to evaluate the functionality and the usability of a mobile app created to guide and monitor patients with breast cancer undergoing radiation therapy. Methods: The evaluation process of the mobile app was performed in 2 steps with 8 professionals, including nurses, physician, medical physicists, and communication networks engineer. The first step was the focus group, which allowed obtaining suggestions proposed by the participants regarding the improvement of the mobile app. The second step was the individual filling in of an evaluation tool to obtain objective measures about the mobile app. A minimum concordance index of 80% was considered to ensure the adequacy of the material. Results: After the mobile app was evaluated by 8 professionals, only 1 item of the evaluation tool, that is, concerning the potentiality of the app to be used by users of different educational levels, obtained a concordance index <80%. Conclusions: The mobile app titled “AMOR Mama” was considered suitable, which suggests its contribution to an educational health technology to guide and monitor patients with breast cancer undergoing radiation therapy. More studies with this target population should be carried out to assess the performance and quality of the mobile app during its use. %M 34643531 %R 10.2196/24865 %U https://www.jmir.org/2021/10/e24865 %U https://doi.org/10.2196/24865 %U http://www.ncbi.nlm.nih.gov/pubmed/34643531 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e26358 %T Integration of mHealth Information and Communication Technologies Into the Clinical Settings of Hospitals in Sub-Saharan Africa: Qualitative Study %A Ogundaini,Oluwamayowa Oaikhena %A de la Harpe,Retha %A McLean,Nyx %+ Department of Information Technology, Faculty of Informatics and Design, Cape Peninsula University of Technology, District Six Campus, Hanover Street, 7925, Cape Town, 8000, South Africa, 27 735989341, ogundainio@cput.ac.za %K mHealth %K health care professionals %K co-design %K hospitals %K ActAD model %K work activity %K Sub-Saharan Africa %K referrals %K VULA mobile app %K WhatsApp %K mobile phone %D 2021 %7 13.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a rapid uptake of mobile-enabled technologies in lower- and upper-middle–income countries because of its portability, ability to reduce mobility, and facilitation of communication. However, there is limited empirical evidence on the usefulness of mobile health (mHealth) information and communication technologies (ICTs) to address constraints associated with the work activities of health care professionals at points of care in hospital settings. Objective: This study aims to explore opportunities for integrating mHealth ICTs into the work activities of health care professionals at points of care in clinical settings of hospitals in Sub-Saharan Africa. Thus, the research question is, “How can mHealth ICTs be integrated into the work activities of health care professionals at points of care in hospital settings?” Methods: A qualitative approach was adopted to understand the work activities and points at which mHealth ICTs could be integrated to support health care professionals. The techniques of inquiry were semistructured interviews and co-design activities. These techniques were used to ensure the participation of frontline end users and determine how mHealth ICTs could be integrated into the point of care in hospital settings. Purposive and snowball sampling techniques were used to select tertiary hospitals and participants for this study from South Africa and Nigeria. A total of 19 participants, including physicians, nurses, and hospital managers, were engaged in the study. Ethical clearance was granted by the University research committee and the respective hospitals. The data collected were sorted and interpreted using thematic analysis and Activity Analysis and Development model. Results: The findings show that mHealth ICTs are suitable at points where health care professionals consult with patients in the hospital clinics, remote communication is needed, and management of referrals and report writing are required. It was inferred that mHealth ICTs could be negatively disruptive, and some participants perceived the use of mobile devices while engaging with patients as unprofessional. These findings were informed by the outcomes of the interplay between human attributes and technology capabilities during the transformation of the motives of work activity into the intended goal, which is enhanced service delivery. Conclusions: The opportunities to integrate mHealth ICTs into clinical settings depend on the inefficiencies of interaction moments experienced by health care professionals at points of care during patient consultation, remote communication, referrals, and report writing. Thus, the timeliness of mHealth ICTs to address constraints experienced by health care professionals during work activities should take into consideration the type of work activity and the contextual factors that may result in contradictions in relation to technology features. This study contributes toward the design of mHealth ICTs by industry vendors and its usability evaluation for the work activity outcomes of health care professionals. %M 34643540 %R 10.2196/26358 %U https://mhealth.jmir.org/2021/10/e26358 %U https://doi.org/10.2196/26358 %U http://www.ncbi.nlm.nih.gov/pubmed/34643540 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e23663 %T A Mobile App (FallSA) to Identify Fall Risk Among Malaysian Community-Dwelling Older Persons: Development and Validation Study %A Singh,Devinder Kaur Ajit %A Goh,Jing Wen %A Shaharudin,Muhammad Iqbal %A Shahar,Suzana %+ Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, 60 392897000, devinder@ukm.edu.my %K fall risk %K self-screening %K mobile app %K older person %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent falls prevention guidelines recommend early routine fall risk assessment among older persons. Objective: The purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons. Methods: FallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively. Results: The findings of our study showed that FallSA had a high acceptance level with 80% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P<.001) and agreement (k=.516, P<.001) with acceptable sensitivity (80.4%) and specificity (71.1%). FallSA also had good reliability (intraclass correlation .948; 95% CI .921-.966) and an internal consistency (α=.948, P<.001). FallSA score demonstrated a moderate to strong discriminative ability in classifying fallers and nonfallers. FallSA had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82% and specificity of 64%, and area under the curve of 0.802. Conclusions: These results suggest that FallSA is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA to self-screen for falls and thereafter to seek early prevention intervention. %M 34636740 %R 10.2196/23663 %U https://mhealth.jmir.org/2021/10/e23663 %U https://doi.org/10.2196/23663 %U http://www.ncbi.nlm.nih.gov/pubmed/34636740 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28136 %T An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study %A Kruglova,Katya %A O'Connell,Siobhan Bernadette Laura %A Dawadi,Shrinkhala %A Gelgoot,Eden Noah %A Miner,Skye A %A Robins,Stephanie %A Schinazi,Joy %A Zelkowitz,Phyllis %+ Lady Davis Institute for Medical Research, Jewish General Hospital, Ludmer Research & Training Bldg, Montreal, QC, H3A 1A1, Canada, 1 514 340 8222, phyllis.zelkowitz@mcgill.ca %K mHealth app %K mHealth development process %K infertility %K intervention design %K mobile phone %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process. Objective: This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment. Methods: To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app’s content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app’s content based on participants’ feedback and searched for partners to disseminate the app to the broader public. Results: This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00. Conclusions: By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps. %M 34636741 %R 10.2196/28136 %U https://formative.jmir.org/2021/10/e28136 %U https://doi.org/10.2196/28136 %U http://www.ncbi.nlm.nih.gov/pubmed/34636741 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e27478 %T Adaptation and Assessment of a Text Messaging Smoking Cessation Intervention in Vietnam: Pilot Randomized Controlled Trial %A Jiang,Nan %A Nguyen,Nam %A Siman,Nina %A Cleland,Charles M %A Nguyen,Trang %A Doan,Hue Thi %A Abroms,Lorien C %A Shelley,Donna R %+ Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, Room #17-54, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org %K smoking cessation %K text messaging %K mHealth %K mobile health %K low- and middle-income country %K smoking %K developing countries %K SMS %K Vietnam %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text message (ie, short message service, SMS) smoking cessation interventions have demonstrated efficacy in high-income countries but are less well studied in low- and middle-income countries, including Vietnam. Objective: The goal of the research is to assess the feasibility, acceptability, and preliminary efficacy of a fully automated bidirectional SMS cessation intervention adapted for Vietnamese smokers. Methods: The study was conducted in 3 phases. In phase 1, we adapted the SMS library from US-based SMS cessation programs (ie, SmokefreeTXT and Text2Quit). The adaptation process consisted of 7 focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and assess message preferences. In phase 2, we conducted a single-arm pilot test of the SMS intervention with 40 smokers followed by in-depth interviews with 10 participants to inform additional changes to the SMS library. In phase 3, we conducted a 2-arm pilot randomized controlled trial (RCT) with 100 smokers. Participants received either the SMS program (intervention; n=50) or weekly text assessment on smoking status (control; n=50). The 6-week SMS program consisted of a 2-week prequit period and a 4-week postquit period. Participants received 2 to 4 automated messages per day. The main outcomes were engagement and acceptability which were assessed at 6 weeks (end of intervention). We assessed biochemically confirmed smoking abstinence at 6 weeks and 12 weeks. Postintervention in-depth interviews explored user experiences among a random sample of 16 participants in the intervention arm. Results: Participants in both arms reported high levels of engagement and acceptability. Participants reported using the program for an average of 36.4 (SD 3.4) days for the intervention arm and 36.0 (SD 3.9) days for the control arm. Four of the 50 participants in the intervention arm (8%) reset the quit date and 19 (38%) texted the keyword TIPS. The majority of participants in both arms reported that they always or usually read the text messages. Compared to the control arm, a higher proportion of participants in the intervention arm reported being satisfied with the program (98% [49/50] vs 82% [41/50]). Biochemically verified abstinence was higher in the intervention arm at 6 weeks (20% [10/50] vs 2% [1/50]; P=.01), but the effect was not significant at 12 weeks (12% [6/50] vs 6% [3/50]; P=.49). In-depth interviews conducted after the RCT suggested additional modifications to enhance the program including tailoring the timing of messages, adding more opportunities to interact with the program, and placing a greater emphasis on messages that described the harms of smoking. Conclusions: The study supported the feasibility and acceptability of an SMS program adapted for Vietnamese smokers. Future studies need to assess whether, with additional modifications, the program is associated with prolonged abstinence. Trial Registration: ClinicalTrials.gov NCT03219541; https://clinicaltrials.gov/ct2/show/NCT03219541 %M 34623318 %R 10.2196/27478 %U https://mhealth.jmir.org/2021/10/e27478 %U https://doi.org/10.2196/27478 %U http://www.ncbi.nlm.nih.gov/pubmed/34623318 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e23204 %T Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach %A Mauka,Wilhellmuss %A Mbotwa,Christopher %A Moen,Kåre %A Lichtwarck,Hanne Ochieng %A Haaland,Inga %A Kazaura,Method %A Leyna,Germana H %A Leshabari,Melkizedeck T %A Mmbaga,Elia J %+ Department of Behavioural Science, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, United Republic of Tanzania, 255 763225717, wilhemauka@yahoo.com %K mHealth application %K participatory design %K HIV %K pre-exposure prophylaxis %K Africa %K female sex workers %K sex and gender minorities %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration: International Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570 %M 34617904 %R 10.2196/23204 %U https://formative.jmir.org/2021/10/e23204 %U https://doi.org/10.2196/23204 %U http://www.ncbi.nlm.nih.gov/pubmed/34617904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e27358 %T A Novel Mobile App (“CareFit”) to Support Informal Caregivers to Undertake Regular Physical Activity From Home During and Beyond COVID-19 Restrictions: Co-design and Prototype Development Study %A Egan,Kieren J %A Hodgson,William %A Dunlop,Mark D %A Imperatore,Gennaro %A Kirk,Alison %A Maguire,Roma %+ Department of Computer and Information Science, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 0141 548 3138, kieren.egan@strath.ac.uk %K physical activity %K Android %K COVID-19 %K intervention %K co-design %K exercise %K app %K development %K support %K caregiver %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings. %M 34406969 %R 10.2196/27358 %U https://formative.jmir.org/2021/10/e27358 %U https://doi.org/10.2196/27358 %U http://www.ncbi.nlm.nih.gov/pubmed/34406969 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27787 %T Smartphone Technology to Empower People Experiencing Homelessness: Secondary Analysis %A Thurman,Whitney %A Semwal,Monika %A Moczygemba,Leticia R %A Hilbelink,Mark %+ School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78701, United States, 1 5126573855, wthurman@utexas.edu %K homelessness %K self-management %K smartphone technology %K social needs %K mobile phone %D 2021 %7 29.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United States, the number of people experiencing homelessness has continually increased over the last 3 years. Homelessness is associated with poor health, and people experiencing homelessness are often burdened with high rates of chronic and mental health conditions, functional limitations, and cognitive impairment. Despite the high burden of chronic illness and functional limitations, there is limited literature exploring self-management among homeless populations. Objective: This study aims to investigate how access to smartphone technology facilitates self-management, including the attainment of social needs within the context of homelessness. Methods: A secondary analysis of 33 exit interviews from 2 feasibility studies related to mobile health interventions among people experiencing homelessness was conducted. Iterative thematic analysis was used to identify themes representative of participants’ experiences using smartphone technology. Results: Collectively, participants revealed not only how the context of homelessness constrained their ability to engage in activities necessary to self-manage health and meet social needs but also how consistent and predictable access to the tools available through a smartphone changed their behaviors and outlook. The global theme of empowered by technology was identified and defined as how having a smartphone with a plan for unlimited text, calling, data, and transportation allowed participants to navigate homelessness and facilitated self-management. Conclusions: People experiencing homelessness used the tools on a smartphone to make decisions, take action, solve problems, and use the resources—skills necessary for fulfilling tasks required for effective self-management. Further, consistent access to smartphone technology and transportation empowered participants to meet the requirements for the attainment of social needs. %M 34586073 %R 10.2196/27787 %U https://www.jmir.org/2021/9/e27787 %U https://doi.org/10.2196/27787 %U http://www.ncbi.nlm.nih.gov/pubmed/34586073 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e25558 %T Development of Digital Health Messages for Rural Populations in Tanzania: Multi- and Interdisciplinary Approach %A Holst,Christine %A Isabwe,Ghislain Maurice Norbert %A Sukums,Felix %A Ngowi,Helena %A Kajuna,Flora %A Radovanović,Danica %A Mansour,Wisam %A Mwakapeje,Elibariki %A Cardellichio,Peter %A Ngowi,Bernard %A Noll,Josef %A Winkler,Andrea Sylvia %+ Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postbox 1130, Blindern, Oslo, 0318, Norway, 47 48234044, christine.holst@medisin.uio.no %K digital health %K eHealth %K mHealth %K Tanzania %K health education %K HIV/AIDS %K tuberculosis %K cysticercosis %K tapeworm %K anthrax %K mobile phone %D 2021 %7 22.9.2021 %9 Tutorial %J JMIR Mhealth Uhealth %G English %X Background: Health workers have traditionally delivered health promotion and education to rural communities in the Global South in paper leaflet formats or orally. With the rise of digital technologies, health promotion and education can be provided in innovative and more effective formats, which are believed to have a higher impact on disease prevention and treatment. Objective: The aim of this tutorial is to illustrate how a multi- and interdisciplinary approach can be applied in the design process of digital health messages for use in the Global South. Methods: The multi- and interdisciplinary team of the Non-discriminating access for Digital Inclusion (DigI) project digitalized and customized available government-approved paper-based health promotion messages into a screen-suitable format. The team worked closely together and used its diverse expertise to develop digital health messages with disease-specific content in Tanzania’s national language (Swahili) as well as English. The development process included the following phases: a local needs assessment; identification of government-approved health promotion materials in a nondigital format; identification of key health messages; creation of a practical and engaging story, easy to understand for the general public; drafting of a storyboard for an animated video with review, feedback, and revisions; forward and backward translation; audio recording of the story in both languages; finalization and presentation of the animations; development of relevant questions related to the health messages in each domain; and development of web and mobile apps to access the digital health messages. Results: Between 2017 and 2019, we developed key health messages, quizzes, and animated health videos to address HIV/AIDS, tuberculosis, Taenia solium cysticercosis and taeniasis, and anthrax, all of which are of public health importance in Tanzania. Feedback from local stakeholders and test users was included in various phases of the process. The 4 videos and other content are available in local information spots on a digital health platform (DigI platform), established by the DigI project, in both Tanzanian Swahili and English. Conclusions: Our methodological multi- and interdisciplinary approach ensures that the digital health messages for the public are clear, high quality, and align with the government’s objectives for health promotion. It also demonstrates the diversity of scientific disciplines required when collaborating on a digital health project. We recommend this approach to be applied to the development of other digital health messages for a wide range of diseases. International Registered Report Identifier (IRRID): RR2-10.2196/25128 %M 34550081 %R 10.2196/25558 %U https://mhealth.jmir.org/2021/9/e25558 %U https://doi.org/10.2196/25558 %U http://www.ncbi.nlm.nih.gov/pubmed/34550081 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27447 %T Designing an Indoor Air Quality Monitoring App for Asthma Management in Children: User-Centered Design Approach %A Kim,Sunyoung %A Park,Yunoh %A Ackerman,Matthew K %+ School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, United States, 1 848 932 7585, sunyoung.kim@rutgers.edu %K asthma %K children %K indoor air quality %K mobile app %K smartphone %K user-centered design %D 2021 %7 22.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Indoor air pollution is a well-known risk factor that triggers and exacerbates asthma, the most common pediatric chronic disease. Using a mobile app to monitor indoor air quality could be promising in engaging children in keeping their indoor air quality clean and healthy as secondary environmental prevention for asthma management. However, no app is available to allow children to monitor, assess, and improve their indoor air quality. Objective: This study aims to design a mobile app that encourages children to monitor indoor air quality and track their asthma conditions through a user-centered, iterative design approach. Methods: We reviewed existing apps for indoor air quality monitoring or asthma management for children and conducted two sets of semistructured interviews with 12 children with asthma. We then iteratively created prototypes and evaluated and revised them. Results: Participants raised a series of outstanding questions on the prototype features and content that described their needs and perspectives, which informed the final designs. Following the identified requirements and recommendations, we developed two versions of the app: AirBuddy for presenting concrete information for indoor air quality and AirPet for gamifying the practice of monitoring indoor air quality. Conclusions: By following an iterative, user-centered design process, we developed two versions of an app to encourage children with asthma to monitor indoor air quality and track their asthma condition. The user-centered design approach revealed two crucial aspects that require deeper consideration when creating a child-friendly app, including balancing brevity and expressivity and considering the longitudinal effects of gamification. As a next step, we plan to conduct a longitudinal deployment study to evaluate the real-world effects of our apps. %M 34550080 %R 10.2196/27447 %U https://formative.jmir.org/2021/9/e27447 %U https://doi.org/10.2196/27447 %U http://www.ncbi.nlm.nih.gov/pubmed/34550080 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e25878 %T Barriers and Facilitators Associated With App-Based Treatment for Female Urinary Incontinence: Mixed Methods Evaluation %A Wessels,Nienke J %A Loohuis,Anne M M %A van der Worp,Henk %A Abbenhuis,Linde %A Dekker,Janny %A Berger,Marjolein Y %A van Gemert-Pijnen,Julia E W C %A Blanker,Marco H %+ Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, FA21, PO Box 196, Groningen, , Netherlands, 31 05 03616746, n.j.wessels@umcg.nl %K mHealth %K female %K mixed methods %K primary health care %K urinary incontinence %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: App-based treatment for urinary incontinence is a proven effective and cost-effective alternative to care as usual, but successful implementation requires that we identify and address the barriers and facilitators associated with app use. Objective: The goal of the research was to explore the factors influencing app-based treatment for urinary incontinence and identify which barriers or facilitators are associated with treatment success or failure. Methods: We used a sequential explanatory mixed methods design to connect the results of a randomized controlled trial with data from semistructured interviews. This previous RCT had shown the noninferiority of app-based treatment compared with care as usual for urinary incontinence over 4 months. Participants who reported success or failure with app-based treatment, as measured by the change in International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form symptom score, were selected for telephone interview by purposive sampling (n=17). This study reports mainly on the qualitative component of our mixed methods study. Qualitative analyses were conducted in two ways. First, we analyzed the qualitative data of all interviewed participants and discussed the relationships between the main themes. Second, the experiences between the success (n=9) and failure group (n=8) were compared and contrasted to explore factors that were positively or negatively associated with the quantitative effect of app-based treatment. These factors were then interpreted as barriers to and facilitators of successful app-based treatment. Results: Four interrelated themes were identified as affecting the app based treatment effect: adherence, personal factors, app factors, and awareness. Qualitative analyses of the relationships between the themes showed that adherence-related factors directly influenced treatment effect in both a positive and negative matter. In turn, adherence was also positively and negatively influenced by the other 3 themes. Additionally, awareness was positively influenced by the treatment effect. Within these themes, several factors were identified that acted as barriers (eg, unrealistic expectation of time investment and interfering personal circumstances), facilitators (eg, strict integration of exercises and prior pelvic floor muscle therapy), or both (eg, personality traits and increased awareness of symptoms). Conclusions: This study shows that the effect of app-based treatment for urinary incontinence is mainly influenced by adherence, which in turn is affected by personal factors, app-based factors, and awareness. The identified factors could function as both facilitators and barriers depending on the user and interaction with other themes. Insight into these facilitators and barriers could lead to improved implementation and increased treatment effectiveness by targeting women most likely to benefit and through further development of the app. International Registered Report Identifier (IRRID): RR2-10.1002/nau.23507 %M 34533466 %R 10.2196/25878 %U https://mhealth.jmir.org/2021/9/e25878 %U https://doi.org/10.2196/25878 %U http://www.ncbi.nlm.nih.gov/pubmed/34533466 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e23916 %T An mHealth-Based Intervention for Adolescents With Type 1 Diabetes and Their Parents: Pilot Feasibility and Efficacy Single-Arm Study %A Holtz,Bree %A Mitchell,Katharine M %A Holmstrom,Amanda J %A Cotten,Shelia R %A Dunneback,Julie K %A Jimenez-Vega,Jose %A Ellis,Deborah A %A Wood,Michael A %+ Department of Advertising and Public Relations, Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, 48824, United States, 1 5178844537, bholtz@msu.edu %K mobile health (mHealth) %K adolescents %K type 1 diabetes %K mobile phone %K parent-adolescent %K chronic disease %K feasibility %K diabetes management %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Type 1 diabetes (T1D) affects more than 165,000 individuals younger than 20 years in the United States of America. The transition from parent management to parent-child team management, with the child taking on increased levels of self-care, can be stressful and is associated with a deterioration in self-management behaviors. Therefore, a mobile app intervention, MyT1DHero, was designed to facilitate diabetes-specific positive parent-adolescent communication and improve diabetes-related outcomes. The MyT1DHero intervention links an adolescent with T1D and their parent through 2 separate app interfaces and is designed to promote positive communication regarding T1D management. Objective: The aim of this pilot study was to determine (1) the initial efficacy of the MyT1DHero intervention in improving diabetes outcomes in adolescents, specifically the hemoglobin A1c (HbA1c) levels, diabetes care adherence, and quality of life, and (2) the adolescents’ overall satisfaction with this intervention. Methods: This pilot study included 30 adolescent-parent pairs who used the MyT1DHero app in a 12-week single-arm clinical trial. Participants were recruited from the local pediatric endocrinology subspecialty clinic via snowball sampling. HbA1c levels, diabetes care adherence, quality of life, family conflict, and satisfaction levels were measured and analyzed using paired sample two-sided t tests and linear regression analyses. Results: The final analysis included 25 families. The mean age of the adolescents was 12.28 (SD 1.62) years. Half of the participants (13/25) reported a diabetes diagnosis of less than 5 years. After 12 weeks of the intervention, diabetes care adherence significantly improved (before the study: mean 3.87 [SD 0.59]; after the study: mean 4.19 [SD 0.65]; t21=–2.52, P=.02, d=0.52) as did quality of life (before the study: mean 4.02 [SD 0.84]; after the study: mean 4.27 [SD 0.73]; t24=2.48, P=.01, d=0.32). HbA1c levels (before the study: mean 8.94 [SD 1.46]; after the study: mean 8.87 [SD 1.29]; t24=0.67, P=.51, d=0.04) and family conflict (before the study: mean 2.45 [SD 0.55]; after the study: mean 2.61 [SD 0.45]; t23=0.55, P=.14, d=0.32) changed in the hypothesized direction, but the change was not significant. However, higher use of the mobile app was associated with more improvement in HbA1c levels (F1,20=9.74, P<.005; R2=0.33). Overall, the adolescents were satisfied with the app intervention. Conclusions: In a 12-week pilot study of the mobile app intervention designed to facilitate parent-adolescent communication for improving diabetes outcomes, significant benefits were demonstrated in self-care adherence and quality of life. A randomized controlled trial with a longer intervention is needed to replicate these findings and to determine the stability of the intervention effects. Trial Registration: ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628 %M 34519670 %R 10.2196/23916 %U https://mhealth.jmir.org/2021/9/e23916 %U https://doi.org/10.2196/23916 %U http://www.ncbi.nlm.nih.gov/pubmed/34519670 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26434 %T Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach %A Salim,Hani %A Lee,Ping Yein %A Sharif-Ghazali,Sazlina %A Cheong,Ai Theng %A Wong,Jasmine %A Young,Ingrid %A Pinnock,Hilary %A , %+ NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Old Medical School, Doorway 3, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 0131 650 94, hilary.pinnock@ed.ac.uk %K asthma %K self-management %K design sprint %K health literacy %K mobile phone %D 2021 %7 9.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). Objective: The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. Methods: We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. Results: The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. Conclusions: This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing. %M 34499039 %R 10.2196/26434 %U https://www.jmir.org/2021/9/e26434 %U https://doi.org/10.2196/26434 %U http://www.ncbi.nlm.nih.gov/pubmed/34499039 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27985 %T Technology Acceptance Among Patients With Hemophilia in Hong Kong and Their Expectations of a Mobile Health App to Promote Self-management: Survey Study %A Cheung,Yin Ting %A Lam,Pok Hong %A Lam,Teddy Tai-Ning %A Lam,Henry Hon Wai %A Li,Chi Kong %+ School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Rm 801, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, New Territories, Hong Kong SAR, Hong Kong, 852 39436833, yinting.cheung@cuhk.edu.hk %K mobile health %K mHealth %K patients %K expectations %K hemophilia %K chronic diseases %K rare diseases %K self-management %D 2021 %7 9.9.2021 %9 Short Paper %J JMIR Form Res %G English %X Background: The lifelong management of hemophilia is demanding and complex. In July 2019, we published a review in the Journal of Medical Internet Research, summarizing telehealth interventions that facilitate monitoring of bleeding events and promoting the appropriate use of clotting factors among patients with hemophilia. This work has led to the development of a community program that aims to harness technology to promote self-management among patients with hemophilia in Hong Kong. Objective: Before the inception of this program, we conducted a cross-sectional survey to evaluate the patients’ level of technology acceptance and identify their expectations of the use of mobile technology for self-management of hemophilia. Methods: In total, 56 participants (75% adult patients and 25% parents of pediatric patients; 87.5% with moderate to severe disease) were recruited from a local nongovernmental organization that serves patients with hemophilia. They rated their perceived confidence and acceptance in using the new mobile technology (score 1 to 5 for each item, with a higher score indicating better acceptance) using a structured questionnaire (adapted from the Technology Acceptance Model). They also identified the top features that they perceived to be the most important components of a mobile app for the self-management of hemophilia. The Mann–Whitney U test was used to compare technology acceptance scores across subgroups of different clinical and socioeconomic characteristics. Results: In general, the participants considered themselves skilled in using mobile apps (mean 4.3, 95% CI 4.1-4.5). They were willing to learn to use the new mobile app to organize their bleeding records (mean 4.0, 95% CI 3.7-4.3) and to manage their health (mean 4.2, 95% CI 4.1-4.5). Participants who lived in public housing (a surrogate marker for lower socioeconomic status in Hong Kong) reported lower technology acceptance than those who lived in private housing (P=.04). The most important features identified by the participants concerned documenting of infusion logs (n=49, 87.5%), bleeding events (n=48, 85.7%), and the secure delivery of the bleeding information to health care professionals (n=40, 71.4%). Conclusions: It is encouraging to infer that patients with hemophilia in Hong Kong are receptive to the use of mobile health technology. The findings of this survey are applicable in designing the key features of a patient-centered, multimodal program harnessing mobile technology to promote self-management among patients with hemophilia. Future studies should evaluate participants’ acceptability and perceived usability of the mobile app via user metrics and assess clinical and humanistic outcomes of this program. %M 34499034 %R 10.2196/27985 %U https://formative.jmir.org/2021/9/e27985 %U https://doi.org/10.2196/27985 %U http://www.ncbi.nlm.nih.gov/pubmed/34499034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25364 %T Presentation, Treatment, and Natural Course of Severe Symptoms of Urinary Tract Infections Measured by a Smartphone App: Observational and Feasibility Study %A Vellinga,Akke %A Farrell,Karen %A Fallon,Roisin %A Hare,Daniel %A Sutton-Fitzpatrick,Una %A Cormican,Martin %+ School of Medicine, National University of Ireland Galway, 1 Distillery Road, Galway, H91TK33, Ireland, 353 91495194, akke.vellinga@nuigalway.ie %K urinary tract infections %K general practice %K smartphone application %K mobile phone %D 2021 %7 3.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Urinary tract infections (UTIs) are one of the most common conditions in women. Current information on the presentation, management, and natural course of the infection is based on paper diaries filled out and subsequently posted by patients. Objective: The aim of this study is to explore the feasibility of a smartphone app to assess the natural course and management of UTIs. Methods: A smartphone app was developed to collect data from study participants presenting with symptoms of UTI in general practice. After initial demographic and treatment information, symptom severity was recorded by the patient after a reminder on their smartphone, which occurred twice daily for a period of 7 days or until symptom resolution. Results: A total of 181 women aged 18-76 years downloaded the smartphone app. The duration of symptoms was determined from the results of 178 participants. All patients submitted a urine sample, most patients were prescribed an antibiotic (163/181, 90.1%), and 38.7% (70/181) of the patients had a positive culture. Moderately bad or worse symptoms lasted a mean of 3.8 (SD 3.2; median 4) days, and 70.2% (125/178) of the patients indicated that they were cured on day 4 after consultation. This compares with other research assessing symptom duration and management of UTIs using paper diaries. Patients were very positive about the usability of the smartphone app and often found the reminders supportive. On the basis of the feedback and the analysis of the data, some suggestions for improvement were made. Conclusions: Smartphone diaries for symptom scores over the course of infections are an efficient and acceptable means of collecting data in research. %M 34477567 %R 10.2196/25364 %U https://www.jmir.org/2021/9/e25364 %U https://doi.org/10.2196/25364 %U http://www.ncbi.nlm.nih.gov/pubmed/34477567 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28320 %T Implementing mHealth-Enabled Integrated Care for Complex Chronic Patients With Osteoarthritis Undergoing Primary Hip or Knee Arthroplasty: Prospective, Two-Arm, Parallel Trial %A Colomina,Jordi %A Drudis,Reis %A Torra,Montserrat %A Pallisó,Francesc %A Massip,Mireia %A Vargiu,Eloisa %A Nadal,Nuria %A Fuentes,Araceli %A Ortega Bravo,Marta %A Miralles,Felip %A Barbé,Ferran %A Torres,Gerard %A de Batlle,Jordi %A , %+ Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida (IRBLleida), Rovira Roure 80, Lleida, 25198, Spain, 34 645624734, jordidebatlle@gmail.com %K mHealth %K osteoarthritis %K arthroplasty %K health plan implementation %K chronic disease %K mobile phone %D 2021 %7 2.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness. Objective: This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)–enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty. Methods: As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio. Results: A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness. Conclusions: Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery. %M 34473068 %R 10.2196/28320 %U https://www.jmir.org/2021/9/e28320 %U https://doi.org/10.2196/28320 %U http://www.ncbi.nlm.nih.gov/pubmed/34473068 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e27662 %T Exercise Management Using a Mobile App in Patients With Parkinsonism: Prospective, Open-Label, Single-Arm Pilot Study %A Kim,Aram %A Yun,Seo Jung %A Sung,Kwan-Sik %A Kim,Yeonju %A Jo,Ju Young %A Cho,Hanseul %A Park,Kyudong %A Oh,Byung-Mo %A Seo,Han Gil %+ Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 220721659, hgseo80@gmail.com %K Parkinsonian disorders %K exercise %K mobile apps %K mhealth %K Parkinson %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients with parkinsonism have higher inactivity levels than the general population, and this results in increased comorbidities. Although exercise has benefits for motor function and quality of life (QOL) in patients with parkinsonism, these patients face many barriers to exercise participation, such as lack of motivation, fatigue, depression, and time constraints. Recently, the use of mobile apps has been highlighted as a remote exercise management strategy for patients with chronic diseases. Objective: This study aimed to evaluate the effects of home-based exercise management with a customized mobile app on the exercise amount, physical activity, and QOL of patients with parkinsonism. Methods: This was a prospective, open-label, single-arm pilot study. The therapist installed the app in the smartphones of the participants and educated them on how to use the app. The therapist developed an individualized multimodal exercise program that consisted of stretching, strengthening, aerobic, balance and coordination, and oral-motor and vocal exercises. Participants were encouraged to engage in an 8-week home-based exercise program delivered through a customized app. The alarm notifications of the app provided reminders to exercise regularly at home. The primary outcome was the exercise amount. The secondary outcomes were assessed using the International Physical Activity Questionnaire (IPAQ), Parkinson’s Disease Questionnaire-39 (PDQ-39), and Geriatric Depression Scale (GDS). The usability of the customized app was assessed using a self-report questionnaire. Results: A total of 21 participants with parkinsonism completed the intervention and assessment between September and December 2020 (mean age: 72 years; women: 17/21, 81%; men: 4/21, 19%). The participants reported a significant increase in the total amount of exercise (baseline: mean 343.33, SD 206.70 min/week; 8-week follow-up: mean 693.10, SD 373.45 min/week; P<.001) and in the amount of each exercise component, including stretching, strengthening, balance and coordination, and oral-motor and vocal exercise after 8 weeks. Analysis of the secondary outcomes revealed significant improvements in the IPAQ (P=.006), PDQ-39 (P=.02), and GDS (P=.04) scores. The usability of the program with the mobile app was verified based on the positive responses such as “intention to use” and “role expectation for rehabilitation.” Conclusions: Exercise management with a customized mobile app may be beneficial for improving exercise adherence, physical activity levels, depression management, and QOL in patients with parkinsonism. This remotely supervised technology-based, reinforcing, and multimodal exercise management strategy is recommended for use in patients with parkinsonism. In addition, this program proved useful as an alternative exercise management strategy during the COVID-19 pandemic when patients with Parkinson disease were less physically active than before and showed aggravation of symptoms. However, additional clinical trials are needed to evaluate the efficacy of this exercise program in a large population and to confirm its disease-modifying effects. %M 34463635 %R 10.2196/27662 %U https://mhealth.jmir.org/2021/8/e27662 %U https://doi.org/10.2196/27662 %U http://www.ncbi.nlm.nih.gov/pubmed/34463635 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e22608 %T Development of a Mobile Health App (TOGETHERCare) to Reduce Cancer Care Partner Burden: Product Design Study %A Oakley-Girvan,Ingrid %A Davis,Sharon Watkins %A Kurian,Allison %A Rosas,Lisa G %A Daniels,Jena %A Palesh,Oxana Gronskaya %A Mesia,Rachel J %A Kamal,Arif H %A Longmire,Michelle %A Divi,Vasu %+ Medable Inc, 525 University Avenue, Suite A 70, Palo Alto, CA, 94301, United States, 1 408 656 2948, ingrid@medable.com %K cancer %K oncology %K mHealth %K caregiver %K cancer survivor %K mobile app %K smartphone %K feasibility %K caregiver burden %K symptom reporting %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. Objective: We aimed to develop a mobile app incorporating user preferences to enable cancer survivors’ care partners to monitor the survivors’ health and to provide care partner resources. Methods: An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. Results: Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient’s health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. Conclusions: TOGETHERCare, a novel mobile app, was developed with user input to track the care partner’s health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. Trial Registration: ClinicalTrials.gov NCT04018677; https://clinicaltrials.gov/ct2/show/NCT04018677 %M 34398787 %R 10.2196/22608 %U https://formative.jmir.org/2021/8/e22608 %U https://doi.org/10.2196/22608 %U http://www.ncbi.nlm.nih.gov/pubmed/34398787 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e22784 %T Experiences of Children With Osteogenesis Imperfecta in the Co-design of the Interactive Assessment and Communication Tool Sisom OI: Secondary Analysis of Qualitative Design Sessions %A Siedlikowski,Maia %A Curiale,Lianna %A Rauch,Frank %A Tsimicalis,Argerie %+ Ingram School of Nursing, McGill University, 680 Sherbrooke West, Suite #1800 Room 1835, Montreal, QC, H3A 2M7, Canada, 1 514 770 6069, argerie.tsimicalis@mcgill.ca %K child health %K symptom assessment %K communication %K mobile applications %K software %D 2021 %7 10.8.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Children with osteogenesis imperfecta (OI) experience a diversity of symptoms that expose them to difficult physical, mental, and social challenges. Sisom (DHealth) is an interactive assessment and communication tool designed to help children aged 6-12 years with chronic conditions express their symptoms. Recently, the co-design of the Sisom OI paper prototype was launched by seeking the perspectives of end users, including children with OI and their clinicians. Objective: The aim of this study is to describe the experiences that children with OI were prompted to share with researchers during the co-design of the Sisom OI paper prototype. Methods: A secondary analysis of qualitative data was conducted at a university-affiliated, pediatric, orthopedic hospital. The data sources consisted of interview transcripts, drawings, field notes, and observations derived from interviewing 12 children with OI who participated in the co-design of the Sisom OI paper prototype. The themes and subthemes identified from the data sources were generated using qualitative description. Results: Three themes were identified. The first, Relating to Others, described the balance between feeling different versus feeling similar to other children. The subthemes were Common OI Experience, Feeling Different, and Feeling Just Like Others. The second, Relating to Their Condition, described children’s positive and negative interactions with their own condition and health care. The subthemes were Understanding Their Condition, Special Relationship with the Hospital, and Difficult Treatments and Procedures. The third, Reflecting on Capabilities, described children’s recognition of their strengths and limitations. The subthemes were Perceiving Limitations, Overcoming Isolation, and Celebrating Strengths. Conclusions: This co-design process provided children with OI the space to not only contribute to the development of the end product but also eloquently describe their experiences. These findings, based on the descriptions given by the children themselves, offer us a unique understanding of what it means to grow up with OI. %M 34383677 %R 10.2196/22784 %U https://pediatrics.jmir.org/2021/3/e22784 %U https://doi.org/10.2196/22784 %U http://www.ncbi.nlm.nih.gov/pubmed/34383677 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24909 %T Mobile App (WHEELS) to Promote a Healthy Lifestyle in Wheelchair Users With Spinal Cord Injury or Lower Limb Amputation: Usability and Feasibility Study %A Hoevenaars,Dirk %A Holla,Jasmijn F M %A te Loo,Leonie %A Koedijker,Johan M %A Dankers,Sarah %A Houdijk,Han %A Visser,Bart %A Janssen,Thomas W J %A de Groot,Sonja %A Deutekom,Marije %A , %+ Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Blijdorplaan 15, Haarlem, 2015 CE, Netherlands, 31 621115227, jasmijn.holla@inholland.nl %K mHealth %K mobile app %K lifestyle %K usability %K feasibility %K wheelchair users %K spinal cord injury %K lower limb amputation %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining a healthy lifestyle is important for wheelchair users’ well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population. Objective: The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness. Methods: The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g). Results: Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57). Conclusions: The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale. %M 34379056 %R 10.2196/24909 %U https://formative.jmir.org/2021/8/e24909 %U https://doi.org/10.2196/24909 %U http://www.ncbi.nlm.nih.gov/pubmed/34379056 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 8 %P e29184 %T A Worker-Centered Personal Health Record App for Workplace Health Promotion Using National Health Care Data Sets: Design and Development Study %A Park,Hyun Sang %A Kim,Kwang Il %A Chung,Ho-Young %A Jeong,Sungmoon %A Soh,Jae Young %A Hyun,Young Ho %A Kim,Hwa Sun %+ Digital Healthcare Department, BIT Computer Co. Ltd., BIT Building 33, Seocho-daero 74-gil, Seocho-gu, Seoul, 06621, Republic of Korea, 82 2 3486 1234 ext 507, hspark@bit.kr %K personal health record app %K workplace health promotion %K Fast Healthcare Interoperability Resources %K national health care data set %K human-centered design %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Personal health record (PHR) technology can be used to support workplace health promotion, and prevent social and economic losses related to workers’ health management. PHR services can not only ensure interoperability, security, privacy, and data quality, but also consider the user’s perspective in their design. Objective: Using Fast Healthcare Interoperability Resources (FHIR) and national health care data sets, this study aimed to design and develop an app for providing worker-centered, interconnected PHR services. Methods: This study considered the user’s perspective, using the human-centered design (HCD) methodology, to develop a PHR app suitable for occupational health. We developed a prototype after analyzing quantitative and qualitative data collected from workers and a health care professional group, after which we performed a usability evaluation. We structured workers’ PHR items based on the analyzed data, and ensured structural and semantic interoperability using FHIR, Systematized Nomenclature of Medicine–Clinical Terms (SNOMED-CT), and Logical Observation Identifiers Names and Codes (LOINC). This study integrated workers’ health information scattered across different Korean institutions through an interface method, and workers’ PHRs were managed through a cloud server, using Azure API for FHIR. Results: In total, 562 workers from industrial parks participated in the quantitative study. The preferred data items for PHR were medication, number of steps walked, diet, blood pressure, weight, and blood glucose. The preferred features were ability to access medical checkup results, health information content provision, consultation record inquiry, and teleconsultation. The worker-centered PHR app collected data on, among others, life logs, vital signs, and medical checkup results; offered health care services such as reservation and teleconsultation; and provided occupational safety and health information through material safety data sheet search and health questionnaires. The app reflected improvements in user convenience and app usability proposed by 19 participants (7 health care professionals and 12 end users) in the usability evaluation. The After-Scenario Questionnaire (ASQ) was evaluated with a mean score of 5.90 (SD 0.34) out of 7, and the System Usability Scale (SUS) was evaluated a mean score of 88.7 (SD 4.83) out of 100. Conclusions: The worker-centered PHR app integrates workers’ health information from different institutions and provides a variety of health care services from linked institutions through workers’ shared PHR. This app is expected to increase workers’ autonomy over their health information and support medical personnel’s decision making regarding workers’ health in the workplace. Particularly, the app will provide solutions for current major PHR challenges, and its design, which considers the user’s perspective, satisfies the prerequisites for its utilization in occupational health. %M 34346894 %R 10.2196/29184 %U https://medinform.jmir.org/2021/8/e29184 %U https://doi.org/10.2196/29184 %U http://www.ncbi.nlm.nih.gov/pubmed/34346894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24112 %T Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study %A Derksen,Marloes E %A Jaspers,Monique WM %A van Strijp,Sander %A Fransen,Mirjam P %+ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 5664494, m.e.derksen@amsterdamumc.nl %K think aloud %K heuristic evaluation %K usability %K mHealth %K game elements %K smoking prevention %K user-centered design %K mobile phone %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. %M 34346895 %R 10.2196/24112 %U https://formative.jmir.org/2021/8/e24112 %U https://doi.org/10.2196/24112 %U http://www.ncbi.nlm.nih.gov/pubmed/34346895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e30450 %T Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach %A Weber,Summer J %A Shearer,Elyse %A Mulvaney,Shelagh A %A Schmidt,Douglas %A Thompson,Chris %A Jones,Jessica %A Ahmad,Haseeb %A Coe,Martina %A Hull,Pamela C %+ Markey Cancer Center, University of Kentucky, 2365 Harrodsburg Rd, Suite A230, Lexington, KY, 40504-3381, United States, 1 859 323 9965, Pam.Hull@uky.edu %K WIC %K mobile technology %K maternal-child health %K childhood obesity %K nutrition %K government programs %K mobile app %K user-centered design %K low income %K women %K infant %K child %K formative %K development %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective: This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods: To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results: Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions: This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface. %M 34328432 %R 10.2196/30450 %U https://formative.jmir.org/2021/7/e30450 %U https://doi.org/10.2196/30450 %U http://www.ncbi.nlm.nih.gov/pubmed/34328432 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e31013 %T Practitioners’ and Policymakers’ Successes, Challenges, Innovations, and Learning in Promoting Children’s Well-being During COVID-19: Protocol for a Multinational Smartphone App Survey %A Davidson,Jennifer C %A Karadzhov,Dimitar %A Wilson,Graham %+ Institute for Inspiring Children's Futures, School of Social Work and Social Policy, University of Strathclyde, Curran Building, Level 6, 94 Cathedral Street, Glasgow, G4 0LG, United Kingdom, 44 141 444 8513, jennifer.davidson@strath.ac.uk %K mobile phones %K smartphone app %K qualitative %K mixed method %K international %K survey %K service providers %K policy %K practice %K children’s rights %K well-being %K COVID-19 %K pandemic %K app %K mHealth %K children %D 2021 %7 29.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The advent of COVID-19 abruptly thrust the health and safety of children and families into greater risk around the world. As regional and local governments, nongovernmental organizations, communities, families, and children grapple with the immediate public health impact of COVID-19, the rights and well-being of children, especially those who are already marginalized, have been overlooked. Those working with children have likely encountered unprecedented challenges and responded in innovative ways in efforts to address the needs and rights of all children. Objective: This paper presents a protocol for a large-scale, multinational study using a new smartphone app to capture the real-time experiences and perspectives of practitioners and policymakers supporting children and families during the COVID-19 pandemic around the globe in relation to a children’s human rights 4P framework of protection, provision, prevention, and participation. Methods: This protocol describes a mixed methods survey utilizing a custom-built iOS and Android smartphone app called the COVID 4P Log for Children’s Wellbeing, which was developed in close consultation with 17 international key partner organizations. Practitioners and policymakers working with and for children’s well-being across 29 countries and 5 continents were invited to download the app and respond to questions over the course of 8 weeks. The anticipated large amount of qualitative and quantitative response data will be analyzed using content analysis, descriptive statistics, and word frequencies. Results: Formal data collection took place from October 2020 until March 2021. Data analysis was completed in July 2021. Conclusions: The findings will directly inform the understanding of the ways in which COVID-19 has impacted practitioners’, managers’, and policymakers’ efforts to support children’s well-being in their practices, services, and policies, respectively. Innovative and ambitious in its scope and use of smartphone technology, this project also aims to inform and inspire future multinational research using app-based methodologies—the demand for which is likely to continue to dramatically rise in the COVID-19 era. Mitigating the risks of longitudinal remote data collection will help maximize the acceptability of the app, respondents’ sustained engagement, and data quality. International Registered Report Identifier (IRRID): DERR1-10.2196/31013 %M 34323850 %R 10.2196/31013 %U https://www.researchprotocols.org/2021/7/e31013 %U https://doi.org/10.2196/31013 %U http://www.ncbi.nlm.nih.gov/pubmed/34323850 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e23303 %T Acceptability of Intervention Design Factors in mHealth Intervention Research: Experimental Factorial Study %A Materia,Frank T %A Smyth,Joshua M %+ Division of Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, United States, 1 (816) 731 7123, ftmateria@cmh.edu %K mHealth %K acceptability %K implementation %K health behavior %K smartphone %K mobile phone %K wearable %D 2021 %7 26.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the growing interest in mobile health (mHealth), behavioral medicine researchers are increasingly conducting intervention studies that use mobile technology (eg, to support healthy behavior change). Such studies’ scientific premises are often sound, yet there is a dearth of implementational data on which to base mHealth research methodologies. Notably, mHealth approaches must be designed to be acceptable to research participants to support meaningful engagement, but little empirical data about design factors influencing acceptability in such studies exist. Objective: This study aims to evaluate the impact of two common design factors in mHealth intervention research—requiring multiple devices (eg, a study smartphone and wrist sensor) relative to requiring a single device and providing individually tailored feedback as opposed to generic content—on reported participant acceptability. Methods: A diverse US adult convenience sample (female: 104/255, 40.8%; White: 208/255, 81.6%; aged 18-74 years) was recruited to complete a web-based experiment. A 2×2 factorial design (number of devices×nature of feedback) was used. A learning module explaining the necessary concepts (eg, behavior change interventions, acceptability, and tailored content) was presented, followed by four vignettes (representing each factorial cell) that were presented to participants in a random order. The vignettes each described a hypothetical mHealth intervention study featuring different combinations of the two design factors (requiring a single device vs multiple devices and providing tailored vs generic content). Participants rated acceptability dimensions (interest, benefit, enjoyment, utility, confidence, difficulty, and overall likelihood of participating) for each study presented. Results: Reported interest, benefit, enjoyment, confidence in completing study requirements, and perceived utility were each significantly higher for studies featuring tailored (vs generic) content, and the overall estimate of the likelihood of participation was significantly higher. Ratings of interest, benefit, and perceived utility were significantly higher for studies requiring multiple devices (vs a single device); however, multiple device studies also had significantly lower ratings of confidence in completing study requirements, and participation was seen as more difficult and was associated with a lower estimated likelihood of participation. The two factors did not exhibit any evidence of statistical interactions in any of the outcomes tested. Conclusions: The results suggest that potential research participants are sensitive to mHealth design factors. These mHealth intervention design factors may be important for initial perceptions of acceptability (in research or clinical settings). This, in turn, may be associated with participant (eg, self) selection processes, differential compliance with study or treatment processes, or retention over time. %M 34309563 %R 10.2196/23303 %U https://mhealth.jmir.org/2021/7/e23303 %U https://doi.org/10.2196/23303 %U http://www.ncbi.nlm.nih.gov/pubmed/34309563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e26297 %T Development of a Mobile App for Ecological Momentary Assessment of Circadian Data: Design Considerations and Usability Testing %A Woolf,Thomas B %A Goheer,Attia %A Holzhauer,Katherine %A Martinez,Jonathan %A Coughlin,Janelle W %A Martin,Lindsay %A Zhao,Di %A Song,Shanshan %A Ahmad,Yanif %A Sokolinskyi,Kostiantyn %A Remayeva,Tetyana %A Clark,Jeanne M %A Bennett,Wendy %A Lehmann,Harold %+ Department of Physiology, Johns Hopkins University School of Medicine, 725 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 416 2643, twoolf@jhu.edu %K mhealth %K circadian %K sleep %K ecological momentary assessment %K timing of eating %K mobile applications %K habits %K body weight %K surveys and questionnaires %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Collecting data on daily habits across a population of individuals is challenging. Mobile-based circadian ecological momentary assessment (cEMA) is a powerful frame for observing the impact of daily living on long-term health. Objective: In this paper, we (1) describe the design, testing, and rationale for specifications of a mobile-based cEMA app to collect timing of eating and sleeping data and (2) compare cEMA and survey data collected as part of a 6-month observational cohort study. The ultimate goal of this paper is to summarize our experience and lessons learned with the Daily24 mobile app and to highlight the pros and cons of this data collection modality. Methods: Design specifications for the Daily24 app were drafted by the study team based on the research questions and target audience for the cohort study. The associated backend was optimized to provide real-time data to the study team for participant monitoring and engagement. An external 8-member advisory board was consulted throughout the development process, and additional test users recruited as part of a qualitative study provided feedback through in-depth interviews. Results: After ≥4 days of at-home use, 37 qualitative study participants provided feedback on the app. The app generally received positive feedback from test users for being fast and easy to use. Test users identified several bugs and areas where modifications were necessary to in-app text and instructions and also provided feedback on the engagement strategy. Data collected through the mobile app captured more variability in eating windows than data collected through a one-time survey, though at a significant cost. Conclusions: Researchers should consider the potential uses of a mobile app beyond the initial data collection when deciding whether the time and monetary expenditure are advisable for their situation and goals. %M 34296999 %R 10.2196/26297 %U https://formative.jmir.org/2021/7/e26297 %U https://doi.org/10.2196/26297 %U http://www.ncbi.nlm.nih.gov/pubmed/34296999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e25926 %T Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial %A Mhende,Josephine %A Bell,Sharrill A %A Cottrell-Daniels,Cherell %A Luong,Jackie %A Streiff,Micah %A Dannenfelser,Mark %A Hayat,Matthew J %A Spears,Claire Adams %+ Georgia State University, 140 Decatur Street, Suite 400, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K acceptability %K addiction %K African American %K cessation %K COVID-19 %K feasibility %K income %K low socioeconomic status %K mHealth %K mindfulness %K minority %K smoking %K SMS %K text messaging %K treatment %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program “iQuit Mindfully” was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of 93% in detecting and transmitting outdoor location (GPS) and environment data (ALPS sensors, OpenWeatherMap API), whereas the performance with iBeacon data was lower (82.3%). Behaviors were manifested mainly through hand (22.8%) and body movements (27.7%), and vocalizations (21.6%). Conclusions: The ChildSIDE app is an effective tool in collecting the behavior data of children with PIMD/SMID. The app showed high server/API performance in detecting outdoor location and environment data from sensors and an online API to the database with a performance rate above 93%. The results of the analysis and categorization of behaviors suggest a need for a system that uses motion capture and trajectory analyses for developing machine- or deep-learning algorithms to predict the needs of children with PIMD/SMID in the future. %M 34096878 %R 10.2196/28020 %U https://rehab.jmir.org/2021/2/e28020 %U https://doi.org/10.2196/28020 %U http://www.ncbi.nlm.nih.gov/pubmed/34096878 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e22748 %T App-Based Versus Standard Six-Minute Walk Test in Pulmonary Hypertension: Mixed Methods Study %A Salvi,Dario %A Poffley,Emma %A Tarassenko,Lionel %A Orchard,Elizabeth %+ Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Old Road Campus Research Building, Oxford, United Kingdom, 44 1865 617675, dario.salvi.work@gmail.com %K cardiology %K exercise test %K pulmonary hypertension %K mobile apps %K GPS %D 2021 %7 7.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pulmonary arterial hypertension (PAH) is a chronic disease of the pulmonary vasculature that can lead to heart failure and premature death. Assessment of patients with PAH includes performing a 6-minute walk test (6MWT) in clinics. We developed a smartphone app to compute the walked distance (6MWD) indoors, by counting U-turns, and outdoors, by using satellite positioning. Objective: The goal of the research was to assess (1) accuracy of the indoor 6MWTs in clinical settings, (2) validity and test-retest reliability of outdoor 6MWTs in the community, (3) compliance, usability, and acceptance of the app, and (4) feasibility of pulse oximetry during 6MWTs. Methods: We tested the app on 30 PAH patients over 6 months. Patients were asked to perform 3 conventional 6MWTs in clinic while using the app in the indoor mode and one or more app-based 6MWTs in outdoor mode in the community per month. Results: Bland-Altman analysis of 70 pairs of conventional versus app-based indoor 6MWDs suggests that the app is sometimes inaccurate (14.6 m mean difference, lower and upper limit of agreement: –133.35 m to 162.55 m). The comparison of 69 pairs of conventional 6MWDs and community-based outdoor 6MWDs within 7 days shows that community tests are strongly related to those performed in clinic (correlation 0.89), but the interpretation of the distance should consider that differences above the clinically significant threshold are not uncommon. Analysis of 89 pairs of outdoor tests performed by the same patient within 7 days shows that community-based tests are repeatable (intraclass correlation 0.91, standard error of measurement 36.97 m, mean coefficient of variation 12.45%). Questionnaires and semistructured interviews indicate that the app is usable and well accepted, but motivation to use it could be affected if the data are not used for clinical decision, which may explain low compliance in 52% of our cohort. Analysis of pulse oximetry data indicates that conventional pulse oximeters are unreliable if used during a walk. Conclusions: App-based outdoor 6MWTs in community settings are valid, repeatable, and well accepted by patients. More studies would be needed to assess the benefits of using the app in clinical practice. Trial Registration: ClinicalTrials.gov NCT04633538; https://clinicaltrials.gov/ct2/show/NCT04633538 %M 34096876 %R 10.2196/22748 %U https://mhealth.jmir.org/2021/6/e22748 %U https://doi.org/10.2196/22748 %U http://www.ncbi.nlm.nih.gov/pubmed/34096876 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e18167 %T Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation %A Salari,Raheleh %A R Niakan Kalhori,Sharareh %A GhaziSaeedi,Marjan %A Jeddi,Marjan %A Nazari,Mahin %A Fatehi,Farhad %+ Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, No17, FareDanesh Alley, Oods St., Eghelab Ave, Tehran, 1417653761, Iran, 98 2188982886, sh-rniakank@sina.tums.ac.ir %K type 2 diabetes %K mobile health %K mHealth %K mobile app, self-management %K behavior change %D 2021 %7 2.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As the use of smartphones and mobile apps is increasing, mobile health (mHealth) can be used as a cost-effective option to provide behavioral interventions aimed at educating and promoting self-management for chronic diseases such as diabetes. Although many mobile software apps have been developed for this purpose, they usually lack a theoretical foundation and do not follow the guidelines suggested for evidence-based practice. Therefore, this study aimed to develop a theory-based self-management app for people with type 2 diabetes and provide an app based on a needs assessment analysis. Objective: This paper describes the development and usability evaluation of a cloud-based and mobile-based diabetes self-management app designed to help people with diabetes change their health behavior and also enable remote monitoring by health care providers. Methods: The development of this mHealth solution comprises 3 phases. Phase I: feature extraction of the Android apps that had a user rating of 4 stars or more and review of papers related to mHealth for diabetes self-management were performed followed by seeking expert opinions about the extracted features to determine the essential features of the app. Phase II: design and implementation included selecting which behavioral change and structural theories were to be applied the app and design of the website. Phase III: evaluation of the usability and user experience of the mobile app by people with diabetes and the portal by health care providers using the User Experience Questionnaire. Results: The developed mobile app includes modules that support several features. A person’s data were entered or collected and viewed in the form of graphs and tables. The theoretical foundation of behavioral intervention is the transtheoretical model. Users were able to receive customized messages based on the behavioral change preparation stage using the Kreuter algorithm. The clinician’s portal was used by health care providers to monitor the patients. The results of the usability evaluation revealed overall user satisfaction with the app. Conclusions: Mobile- and cloud-based systems may be an effective tool for facilitating the modification of self-management of chronic care. The results of this study showed that the usability of mobile- and cloud-based systems can be satisfactory and promising. Given that the study used a behavioral model, assessment of the effectiveness of behavior change over time requires further research with long-term follow-up. %M 34076579 %R 10.2196/18167 %U https://www.jmir.org/2021/6/e18167 %U https://doi.org/10.2196/18167 %U http://www.ncbi.nlm.nih.gov/pubmed/34076579 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e19941 %T Motivating Adherence to Exercise Plans Through a Personalized Mobile Health App: Enhanced Action Design Research Approach %A Sun,Ruo-Ting %A Han,Wencui %A Chang,Hsin-Lu %A Shaw,Michael J %+ Department of Management Information Systems, National Chengchi University, 64, Sec 2, Chinan Rd,, Taipei, 116, Taiwan, 886 2 29393091 ext 81214, hlchang@nccu.edu.tw %K adherence %K mobile health %K motivation %K personality %K MBTI %K action design research %K mobile phone %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is a global issue that affects people’s health and productivity. With the advancement of mobile technologies, many apps have been developed to facilitate health self-management. However, few studies have examined the effectiveness of these mobile health (mHealth) apps in motivating exercise adherence. Objective: This study aims to demonstrate the enhanced action design research (ADR) process and improve the design of mHealth apps for exercise self-management. Specifically, we investigate whether sending motivational messages improves adherence to exercise plans, whether the motivational effect is affected by personality, the impact of message type and repetition, and the process of involving a field experiment in the design process and learning new design principles from the results. Methods: This formative research was conducted by proposing an enhanced ADR process. We incorporated a field experiment into the process to iteratively refine and evaluate the design until it converges into a final mHealth app. We used the Apple ResearchKit to develop the mHealth app and promoted it via trainers at their gyms. We targeted users who used the app for at least two months. Participants were randomly assigned to 1 of the 12 groups in a 2×3×2 factorial design and remained blinded to the assigned intervention. The groups were defined based on personality type (thinking or feeling), message type (emotional, logical, or none), and repetition (none or once). Participants with different personality types received tailored and repeated messages. Finally, we used the self-reported completion rate to measure participants’ adherence level to exercise plans. By analyzing users’ usage patterns, we could verify, correct, and enhance the mHealth app design principles. Results: In total, 160 users downloaded the app, and 89 active participants remained during the 2-month period. The results suggest a significant main effect of personality type and repetition and a significant interaction effect between personality type and repetition. The adherence rate of people with feeling personality types was 18.15% higher than that of people with thinking types. Emotional messages were more effective than logical messages in motivating exercise adherence. Although people received repeated messages, they were more likely to adhere to exercise plans. With repeated reminders, the adherence rates of people with thinking personality types were significantly improved by 27.34% (P<.001). Conclusions: This study contributes to the literature on mHealth apps. By incorporating a field experiment into the ADR process, we demonstrate the benefit of combining design science and field experiments. This study also contributes to the research on mHealth apps. The principles learned from this study can be applied to improve the effectiveness of mHealth apps. The app design can be considered a foundation for the development of more advanced apps for specific diseases, such as diabetes and asthma, in future research. %M 34076580 %R 10.2196/19941 %U https://mhealth.jmir.org/2021/6/e19941 %U https://doi.org/10.2196/19941 %U http://www.ncbi.nlm.nih.gov/pubmed/34076580 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24937 %T Multicultural Adaptation of Mighty Girls for Widespread Dissemination: Pilot Study, App Development and Usability Testing, and Gauging Parent Support With Focus Groups %A Norris,Anne E %A Thalasinos,Roxana Delcampo %A Hecht,Michael L %+ REAL Prevention, LLC, 817 Kingsbridge Dr, Oviedo, FL, 32765, United States, 1 4074161727, anne@real-prevention.com %K implementation science %K mobile apps %K peer influence %K early intervention %K adolescent health %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Taking evidence-based interventions to scale is a challenge for prevention science. Mighty Girls is an evidence-based sexual health intervention program that combines classroom sessions with novel, cutting-edge technology (digital puppetry). The program was developed for 7th grade Latinas, but US school and community demographics rarely allow interventions targeting a single ethnic group. Additionally, digital puppetry is costly to scale up, and parent disapproval often prevents successful dissemination of adolescent sexual health programs. Intervening steps along the scaling-up pathway are needed to adapt the program prior to scaling up for dissemination. Objective: The aims of this study were to create a multicultural adaptation of the Mighty Girls program using a mobile app that is less costly to disseminate and is acceptable to parents of 7th grade girls. Methods: This study used a three-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (nonprobability) sampling of low-income, multicultural, urban metropolitan groups (7th grade girls and their parents) within central Florida. Phase 1 involved two videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (N=14) and the other serving as a single-group pretest-posttest pilot study (N=23). Phase 2 involved development of a narrative cell phone app prototype, which was subjected to usability testing (N=25). App usability and engagement were assessed qualitatively (observation, focus group, open-ended questions) and quantitatively. Phase 3 used focus groups to assess parent support for the program (N=6). Qualitative data were analyzed using descriptive content analysis. Quantitative data were analyzed using descriptive statistics and paired t tests. Results: Qualitative findings supported classroom sessions being multicultural, and identified simple changes to improve engagement and learning. Quantitative findings from the second classroom session implementation pilot study indicated a significant pre-post difference in intention to delay sexual intercourse (P=.04). App usability and appeal were supported by a System Usability Scale score of 76 (exceeding 68 per the industry standard) and 83% (20/24) of participants agreeing they would recommend the app to friends. Parents (mothers) expressed only positive regard for program goals, and classroom session and app activities. Conclusions: This study adapted Mighty Girls into an engaging, easier-to-disseminate, multicultural program, termed Mighty Teens, that uses a narrative-generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. This study also provides evidence of the preliminary effectiveness of Mighty Teens classroom sessions. The sampling method and sample size were appropriate for adaptation, but research involving a more representative US sample is needed to confirm multicultural fit, parent receptivity, and program effectiveness. Study implications include integrating app use throughout the classroom sessions to build narrative-generating skills across the program and increasing the number of narratives produced, which should in turn increase the program’s behavior change potency. %M 34076578 %R 10.2196/24937 %U https://formative.jmir.org/2021/6/e24937 %U https://doi.org/10.2196/24937 %U http://www.ncbi.nlm.nih.gov/pubmed/34076578 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e22970 %T Using a Mobile App–Based Video Recommender System of Patient Narratives to Prepare Women for Breast Cancer Surgery: Development and Usability Study Informed by Qualitative Data %A Ormel,Ilja %A Onu,Charles C %A Magalhaes,Mona %A Tang,Terence %A Hughes,John B %A Law,Susan %+ Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Rd, Montréal, QC, H2T 1W1, Canada, 1 (514) 345 3511 ext 5060, ilja.ormel@mail.mcgill.ca %K qualitative research %K illness narratives %K experiential information %K breast cancer %K surgery %K tailored information %K recommender system %K patient information and communication %K mobile app %K mobile phone %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Women diagnosed with breast cancer are often bombarded with information. Such information overload can lead to misunderstandings and hamper women’s capacity for making informed decisions about their care. For women with breast cancer, this uncertainty is particularly severe in the period before surgery. Personalized narratives about others’ experiences can help patients better understand the disease course, the quality and type of care to be expected, the clinical decision-making processes, and the strategies for coping. Existing resources and eHealth apps rarely include experiential information, and no tools exist that tailor information for individual preferences and needs—offering the right information at the right time and in the right format. Combining high-quality experiential evidence with novel technical approaches may contribute to patient-centered solutions in this area. Objective: This study aims to design and seek preliminary feedback on a mobile app that will improve information access about surgery for patients with breast cancer, by drawing on a qualitative collection of personal narratives from a diverse sample of Canadian women and using video and audio recordings or audio recordings from the Canadian Health Experiences Research Network. Methods: In a previous study, we conducted in-depth interviews with 35 Canadian women and used video and audio recordings or audio recordings to collect stories about the lived experiences of breast cancer. The participants highlighted the need for more specific information between diagnosis and surgery that was relevant to their personal situations and preferences. They also wanted to learn from other women’s experiences. We worked with patients, clinicians, and informatics experts to develop a mobile app that provides access to tailored experiential information relevant to women’s personal situations and preferences. We completed focus groups and qualitative interviews, conducted a further analysis of the original qualitative data, designed novel software using artificial intelligence, and sought preliminary feedback from users on a new app via focus groups and a survey. Results: The secondary analysis of the breast cancer narratives revealed key themes and their interconnections relevant to the experience of surgery, including preparation, treatment decisions, aftercare, reconstruction, prostheses, lumpectomy and mastectomy, and complications. These themes informed the development of the structure and content of the app. We developed a recommender system within the app by using content matching (user and speaker profiles and user interests and video content) and collaborative filtering to identify clips marked as relevant by the user and by similar users. A 2-minute animated introductory video for users was developed. Pilot testing revealed generally positive responses regarding the content and value of this type of e-tool. Conclusions: Developing reliable, evidence-based tools and apps that are based on diverse collections of people’s experiences of illness offers a novel approach to help manage the plethora of information that women face after a diagnosis of breast cancer. %M 34076582 %R 10.2196/22970 %U https://formative.jmir.org/2021/6/e22970 %U https://doi.org/10.2196/22970 %U http://www.ncbi.nlm.nih.gov/pubmed/34076582 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25713 %T Use of eHealth Platforms and Apps to Support Monitoring and Management of Home-Quarantined Patients With COVID-19 in the Province of Trento, Italy: App Development and Implementation %A Gios,Lorenzo %A Crema Falceri,Giulia %A Micocci,Stefano %A Patil,Luigi %A Testa,Sara %A Sforzin,Simona %A Turra,Ettore %A Conforti,Diego %A Malfatti,Giulia %A Moz,Monica %A Nicolini,Andrea %A Guarda,Paolo %A Bacchiega,Alessandro %A Mion,Carlo %A Marchesoni,Michele %A Maimone,Rosa %A Molini,Pietro Benedetto %A Zanella,Alberto %A Osmani,Venet %A Mayora-Ibarra,Oscar %A Forti,Stefano %+ TrentinoSalute4.0 – Competence Center for Digital Health of the Province of Trento, Via Sommarive, 18. I-38123 POVO (TN), Trento, Italy, 39 3408340665, gios.lorenzo@gmail.com %K telemedicine %K telemonitoring %K quarantine management %K COVID-19 %K connected care %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Italy was the first country to largely experience the COVID-19 epidemic among other Western countries during the so-called first wave of the COVID-19 pandemic. Proper management of an increasing number of home-quarantined individuals created a significant challenge for health care authorities and professionals. This was especially true when considering the importance of remote surveillance to detect signs of disease progression and consequently regulate access to hospitals and intensive care units on a priority basis. Objective: In this paper, we report on an initiative promoted to cope with the first wave of the COVID-19 epidemic in the Spring/Summer of 2020, in the Autonomous Province of Trento, Italy. A purposefully built app named TreCovid19 was designed to provide dedicated health care staff with a ready-to-use tool for remotely monitoring patients with progressive symptoms of COVID-19, who were home-quarantined during the first wave of the epidemic, and to focus on those patients who, based on their self-reported clinical data, required a quick response from health care professionals. Methods: TreCovid19 was rapidly developed to facilitate the monitoring of a selected number of home-quarantined patients with COVID-19 during the very first epidemic wave. The app was built on top of an existing eHealth platform, already in use by the local health authority to provide home care, with the following functionalities: (1) to securely collect and link demographic and clinical information related to the patients and (2) to provide a two-way communication between a multidisciplinary health care team and home-quarantined patients. The system supported patients to self-assess their condition and update the multidisciplinary team on their health status. The system was used between March and June 2020 in the province of Trento. Results: A dedicated multidisciplinary group of health care professionals adopted the platform over a period of approximately 3 months (from March-end to June 2020) to monitor a total of 170 patients with confirmed COVID-19 during home quarantine. All patients used the system until the end of the initiative. The TreCovid19 system has provided useful insights of possible viability and impact of a technological–organizational asset to manage a potentially critical workload for the health care staff involved in the periodic monitoring of a relevant number of quarantined patients, notwithstanding its limitations given the rapid implementation of the whole initiative. Conclusions: The technological and organizational model adopted in response to the COVID-19 pandemic was developed and finalized in a relatively short period during the initial few weeks of the epidemic. The system successfully supported the health care staff involved in the periodic monitoring of an increasing number of home-quarantined patients and provided valuable data in terms of disease surveillance. %M 33909586 %R 10.2196/25713 %U https://formative.jmir.org/2021/5/e25713 %U https://doi.org/10.2196/25713 %U http://www.ncbi.nlm.nih.gov/pubmed/33909586 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 4 %N 2 %P e25679 %T A Digital Mobile Community App for Caregivers in Singapore: Predevelopment and Usability Study %A Lwin,May O %A Sheldenkar,Anita %A Panchapakesan,Chitra %+ Nanyang Technological University, 31 Nanyang Link, Singapore, Singapore, 65 67905966, chitrapk@ntu.edu.sg %K caregiving %K technological solution %K mobile application %K easy communication %K caregiver %K mobile app %K communication %K elderly %K aging population %K internet technology %K community network %K network %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Nursing %G English %X Background: With increasing life expectancy and aging populations, the global prevalence of chronic diseases and the long-term care required for people with comorbidities is rising. This has led to an ever-growing need for caregiving. Previous literature has shown that caregivers face problems of isolation and loneliness. However, many health organizations mainly focus their efforts on in-person community groups that require participants to meet physically. This is not always convenient or accessible for caregivers who are often juggling caring for their care recipient with family and work responsibilities. Objective: With medical advancements such as the proliferation of mobile phones and internet technology, caregivers may have opportunities for easier access to resources and support. Technological innovations could help empower the caregiving community to seek assistance for improving their quality of life at their convenience. A community network app called Caregivers’ Circle was conceptualized in response to the needs of the caregivers on a day-to-day caregiving journey. This paper traces the predevelopment inquiry and technical details of this app to provide a clear understanding of its implementation along with a usability study to gauge user opinion of the app within Singapore. Methods: A predevelopment survey was conducted to identify specific needs of caregivers and gaps in the currently available web-based community networks. The survey consisted of questions on demographical data, health-related issues of the care recipient, mental and physical health–related issues of the caregiver, digital media use, information seeking, and support. This pre–app development survey was completed by 103 caregivers. Qualitative enquiries were also conducted with caregivers within Singapore to identify issues related to caregiving, support provided, and what caregivers would want from a caregiving mobile app. Results: From the feedback garnered from the caregivers, the developers were able to identify several caregivers’ needs and gaps within the current support networks. This feedback was integrated into the mobile app called Caregivers’ Circle upon development. The features of this app include a public forum for community discussions, a marketplace to buy and sell items, care groups to hold private discussions with friends or other users of the app, and a friends feature to search and add new caregiving friends. Conclusions: In general, the caregivers liked the Caregivers’ Circle app and were confident that this app could help them have a better quality of life. The Caregivers’ Circle app is unique in its integrated approach. The integration of many features that caregivers need on a daily basis into an easy app can save their time as well as help them navigate their life smoothly. %M 34345796 %R 10.2196/25679 %U https://nursing.jmir.org/2021/2/e25679 %U https://doi.org/10.2196/25679 %U http://www.ncbi.nlm.nih.gov/pubmed/34345796 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e14851 %T Utilizing Lean Software Methods To Improve Acceptance of Global eHealth Initiatives: Results From the Implementation of the Basic Emergency Care App %A Rose,Christian %A Nichols,Taylor %A Hackner,Daniel %A Chang,Julia %A Straube,Steven %A Jooste,Willem %A Sawe,Hendry %A Tenner,Andrea %+ Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 4159159585, ccrose@stanford.edu %K lean %K eHealth %K emergency %K global health %K app development %K decision support %K primary survey %K mHealth %K Africa %K Tanzania %K low- and middle income countries %K LMIC %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health systems in low- and middle-income countries face considerable challenges in providing high-quality accessible care. eHealth has had mounting interest as a possible solution given the unprecedented growth in mobile phone and internet technologies in these locations; however, few apps or software programs have, as of yet, gone beyond the testing phase, most downloads are never opened, and consistent use is extremely rare. This is believed to be due to a failure to engage and meet local stakeholder needs and the high costs of software development. Objective: World Health Organization Basic Emergency Care course participants requested a mobile point-of-care adjunct to the primary course material. Our team undertook the task of developing this solution through a community-based participatory model in an effort to meet trainees’ reported needs and avoid some of the abovementioned failings. We aimed to use the well-described Lean software development strategy—given our familiarity with its elements and its ubiquitous use in medicine, global health, and software development—to complete this task efficiently and with maximal stakeholder involvement. Methods: From September 2016 through January 2017, the Basic Emergency Care app was designed and developed at the University of California San Francisco. When a prototype was complete, it was piloted in Cape Town, South Africa and Dar es Salaam, Tanzania—World Health Organization Basic Emergency Care partner sites. Feedback from this pilot shaped continuous amendments to the app before subsequent user testing and study of the effect of use of the app on trainee retention of Basic Emergency Care course material. Results: Our user-centered mobile app was developed with an iterative participatory approach with its first version available within 6 months and with high acceptance—95% of Basic Emergency Care Course participants felt that it was useful. Our solution had minimal direct costs and resulted in a robust infrastructure for subsequent assessment and maintenance and allows for efficient feedback and expansion. Conclusions: We believe that utilizing Lean software development strategies may help global health advocates and researchers build eHealth solutions with a process that is familiar and with buy-in across stakeholders that is responsive, rapid to deploy, and sustainable. %M 33882013 %R 10.2196/14851 %U https://formative.jmir.org/2021/5/e14851 %U https://doi.org/10.2196/14851 %U http://www.ncbi.nlm.nih.gov/pubmed/33882013 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26442 %T Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods Study %A Jácome,Cristina %A Almeida,Rute %A Pereira,Ana Margarida %A Amaral,Rita %A Mendes,Sandra %A Alves-Correia,Magna %A Vidal,Carmen %A López Freire,Sara %A Méndez Brea,Paula %A Araújo,Luís %A Couto,Mariana %A Antolín-Amérigo,Darío %A de la Hoz Caballer,Belén %A Barra Castro,Alicia %A Gonzalez-De-Olano,David %A Todo Bom,Ana %A Azevedo,João %A Leiria Pinto,Paula %A Pinto,Nicole %A Castro Neves,Ana %A Palhinha,Ana %A Todo Bom,Filipa %A Costa,Alberto %A Chaves Loureiro,Cláudia %A Maia Santos,Lilia %A Arrobas,Ana %A Valério,Margarida %A Cardoso,João %A Emiliano,Madalena %A Gerardo,Rita %A Cidrais Rodrigues,José Carlos %A Oliveira,Georgeta %A Carvalho,Joana %A Mendes,Ana %A Lozoya,Carlos %A Santos,Natacha %A Menezes,Fernando %A Gomes,Ricardo %A Câmara,Rita %A Rodrigues Alves,Rodrigo %A Moreira,Ana Sofia %A Bordalo,Diana %A Alves,Carlos %A Ferreira,José Alberto %A Lopes,Cristina %A Silva,Diana %A Vasconcelos,Maria João %A Teixeira,Maria Fernanda %A Ferreira-Magalhães,Manuel %A Taborda-Barata,Luís %A Cálix,Maria José %A Alves,Adelaide %A Almeida Fonseca,João %+ Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, Porto, 4200-450, Portugal, 351 225 513 622, cristinajacome.ft@gmail.com %K mHealth %K smartphone %K technology assessment %K medication adherence %K self-management %K gamification %K patient participation %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients’ asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring ≥4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app. %M 34032576 %R 10.2196/26442 %U https://mhealth.jmir.org/2021/5/e26442 %U https://doi.org/10.2196/26442 %U http://www.ncbi.nlm.nih.gov/pubmed/34032576 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e24449 %T Mobile Game Design Guide to Improve Gaming Experience for the Middle-Aged and Older Adult Population: User-Centered Design Approach %A Lee,Seyeon %A Oh,Hyunyoung %A Shi,Chung-Kon %A Doh,Young Yim %+ Graduate School of Culture Technology, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea, 82 42 350 2994, yydoh@kaist.ac.kr %K mobile games %K older adults %K middle-aged adults %K design guideline %K gaming experience %D 2021 %7 20.5.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The number of older adult gamers who play mobile games is growing worldwide. Earlier studies have reported that digital games provide cognitive, physical, and socioemotional benefits for older adults. However, current mobile games that understand older adults’ gameplay experience and reflect their needs are very scarce. Furthermore, studies that have analyzed older adults’ game experience in a holistic manner are rare. Objective: The purpose of this study was to suggest mobile game design guidelines for adults older than 50 years from a holistic gaming experience perspective. Adopting a human-centric approach, this study analyzes middle-aged and older adults’ gameplay experience and suggests practical design guides to increase accessibility and satisfaction. Methods: We organized a living laboratory project called the “Intergenerational Play Workshop.” In this workshop, 40 middle-aged and older adults (mean age 66.75 years, age range 50-85 years) played commercial mobile games of various genres with young adult partners for 1 month (8 sessions). Using a convergent parallel mixed-method design, we conducted a qualitative analysis of dialogue, game diaries, and behavioral observations during the workshop and a quantitative analysis of the satisfaction level of the game elements for the mobile games that they played. Results: This project was active from April 2019 to December 2021, and the data were collected at the workshops from July 1 to August 28, 2019. Based on the identified themes of positive and negative experiences from the qualitative data, we proposed 45 design guides under 3 categories: (1) cognitive and physical elements, (2) psychological and socioemotional elements, and (3) consumption contextual elements. Our empirical research could reaffirm the proposals from previous studies and provide new guidelines for improving the game design. In addition, we demonstrate how existing commercial games can be evaluated quantitatively by using the satisfaction level of each game’s elements and overall satisfaction level. Conclusions: The final guidelines were presented to game designers to easily find related information and enhance the overall understanding of the game experience of middle-aged and older adults. %M 34014175 %R 10.2196/24449 %U https://games.jmir.org/2021/2/e24449 %U https://doi.org/10.2196/24449 %U http://www.ncbi.nlm.nih.gov/pubmed/34014175 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26573 %T An App-Based Intervention to Support First Responders and Essential Workers During the COVID-19 Pandemic: Needs Assessment and Mixed Methods Implementation Study %A Vilendrer,Stacie %A Amano,Alexis %A Brown Johnson,Cati G %A Favet,Marissa %A Safaeinili,Nadia %A Villasenor,Jacqueline %A Shaw,Jonathan G %A Hertelendy,Attila J %A Asch,Steven M %A Mahoney,Megan %+ Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, Mail Code 5475, Stanford, CA, 94305, United States, 1 650 736 5211, staciev@stanford.edu %K COVID-19 %K pandemic %K health literacy %K social media %K quality improvement %K police %K emergency responders %K physicians %K disasters %K natural disasters %K health behavior %K literacy %K app %K intervention %K adoption %K accessibility %K usability %K support %K testing %D 2021 %7 20.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has created unprecedented challenges for first responders (eg, police, fire, and emergency medical services) and nonmedical essential workers (eg, workers in food, transportation, and other industries). Health systems may be uniquely suited to support these workers given their medical expertise, and mobile apps can reach local communities despite social distancing requirements. Formal evaluation of real-world mobile app–based interventions is lacking. Objective: We aimed to evaluate the adoption, acceptability, and appropriateness of an academic medical center–sponsored app-based intervention (COVID-19 Guide App) designed to support access of first responders and essential workers to COVID-19 information and testing services. We also sought to better understand the COVID-19–related needs of these workers early in the pandemic. Methods: To understand overall community adoption, views and download data of the COVID-19 Guide App were described. To understand the adoption, appropriateness, and acceptability of the app and the unmet needs of workers, semistructured qualitative interviews were conducted by telephone, by video, and in person with first responders and essential workers in the San Francisco Bay Area who were recruited through purposive, convenience, and snowball sampling. Interview transcripts and field notes were qualitatively analyzed and presented using an implementation outcomes framework. Results: From its launch in April 2020 to September 2020, the app received 8262 views from unique devices and 6640 downloads (80.4% conversion rate, 0.61% adoption rate across the Bay Area). App acceptability was mixed among the 17 first responders interviewed and high among the 10 essential workers interviewed. Select themes included the need for personalized and accurate information, access to testing, and securing personal safety. First responders faced additional challenges related to interprofessional coordination and a “culture of heroism” that could both protect against and exacerbate health vulnerability. Conclusions: First responders and essential workers both reported challenges related to obtaining accurate information, testing services, and other resources. A mobile app intervention has the potential to combat these challenges through the provision of disease-specific information and access to testing services but may be most effective if delivered as part of a larger ecosystem of support. Differentiated interventions that acknowledge and address the divergent needs between first responders and non–first responder essential workers may optimize acceptance and adoption. %M 33878023 %R 10.2196/26573 %U https://www.jmir.org/2021/5/e26573 %U https://doi.org/10.2196/26573 %U http://www.ncbi.nlm.nih.gov/pubmed/33878023 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e21177 %T Developing Messaging Content for a Physical Activity Smartphone App Tailored to Low-Income Patients: User-Centered Design and Crowdsourcing Approach %A Pathak,Laura Elizabeth %A Aguilera,Adrian %A Williams,Joseph Jay %A Lyles,Courtney Rees %A Hernandez-Ramos,Rosa %A Miramontes,Jose %A Cemballi,Anupama Gunshekar %A Figueroa,Caroline Astrid %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC 7400, Berkeley, CA, 94720, United States, 1 510 642 8564, aguila@berkeley.edu %K user centered design %K mHealth %K text messaging %K crowdsourcing %K mobile phone %D 2021 %7 19.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text messaging interventions can be an effective and efficient way to improve health behavioral changes. However, most texting interventions are neither tested nor designed with diverse end users, which could reduce their impact, and there is limited evidence regarding the optimal design methodology of health text messages tailored to low-income, low–health literacy populations and non-English speakers. Objective: This study aims to combine participant feedback, crowdsourced data, and researcher expertise to develop motivational text messages in English and Spanish that will be used in a smartphone app–based texting intervention that seeks to encourage physical activity in low-income minority patients with diabetes diagnoses and depression symptoms. Methods: The design process consisted of 5 phases and was iterative in nature, given that the findings from each step informed the subsequent steps. First, we designed messages to increase physical activity based on the behavior change theory and knowledge from the available evidence. Second, using user-centered design methods, we refined these messages after a card sorting task and semistructured interviews (N=10) and evaluated their likeability during a usability testing phase of the app prototype (N=8). Third, the messages were tested by English- and Spanish-speaking participants on the Amazon Mechanical Turk (MTurk) crowdsourcing platform (N=134). Participants on MTurk were asked to categorize the messages into overarching theoretical categories based on the capability, opportunity, motivation, and behavior framework. Finally, each coauthor rated the messages for their overall quality from 1 to 5. All messages were written at a sixth-grade or lower reading level and culturally adapted and translated into neutral Spanish by bilingual research staff. Results: A total of 200 messages were iteratively refined according to the feedback from target users gathered through user-centered design methods, crowdsourced results of a categorization test, and an expert review. User feedback was leveraged to discard unappealing messages and edit the thematic aspects of messages that did not resonate well with the target users. Overall, 54 messages were sorted into the correct theoretical categories at least 50% of the time in the MTurk categorization tasks and were rated 3.5 or higher by the research team members. These were included in the final text message bank, resulting in 18 messages per motivational category. Conclusions: By using an iterative process of expert opinion, feedback from participants that were reflective of our target study population, crowdsourcing, and feedback from the research team, we were able to acquire valuable inputs for the design of motivational text messages developed in English and Spanish with a low literacy level to increase physical activity. We describe the design considerations and lessons learned for the text messaging development process and provide a novel, integrative framework for future developers of health text messaging interventions. %M 34009130 %R 10.2196/21177 %U https://mhealth.jmir.org/2021/5/e21177 %U https://doi.org/10.2196/21177 %U http://www.ncbi.nlm.nih.gov/pubmed/34009130 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e25316 %T User-Centered Development of a Mobile App for Biopsychosocial Pain Assessment in Adults: Usability, Reliability, and Validity Study %A Lopes,Filipa %A Rodrigues,Mário %A Silva,Anabela G %+ Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-193, Portugal, 351 234247119 ext 27120, asilva@ua.pt %K pain assessment %K mobile app %K validity %K reliability %K usability %K mHealth %K pain %K user-centered design %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pain-related mobile apps targeting pain assessment commonly limit pain assessment to pain behaviors and physiological aspects. However, current guidelines state that pain assessment should follow the biopsychosocial model, clearly addressing biological, psychological, and social aspects of the pain experience. Existing reviews also highlight that pain specialists and end users are not commonly involved in the development process of mobile apps for pain assessment, negatively affecting the quality of the available apps. Objective: This study aimed to develop a mobile app for pain assessment (AvaliaDor) and assess its usability, validity, reliability, and measurement error in a sample of real patients with chronic pain recruited from a physiotherapy clinic. Methods: This study was divided into 2 phases: phase 1—development of the AvaliaDor app; and phase 2—assessment of the apps’ usability, reliability, measurement error, and validity. AvaliaDor was developed (phase 1) based on the literature and the recommendations of physiotherapists and patients with pain in cycles of evaluation, inclusion of recommendations, and reevaluation until no further changes were required. The final version of the app was then tested in patients with musculoskeletal pain attending a private physiotherapy practice (phase 2) who were asked to use the app twice on 2 consecutive days for reliability purposes. In addition, participants had to complete a set of paper-based scales (Brief Pain Inventory, painDETECT, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia), which were used to assess the validity (criterion validity and hypothesis testing) of the app, and the Post-Study System Usability Questionnaire was used to assess its usability. Results: The development process (phase 1) included 5 physiotherapists external to the research team and 5 patients with musculoskeletal pain, and it resulted in the creation of an app named AvaliaDor, which includes an assessment of pain intensity, location, and phenotype; associated disability; and the issues of pain catastrophizing and fear of movement. A total of 52 patients with pain (mean age 50.12 years, SD 11.71 years; 39 females) participated in phase 2 and used the app twice. The Pearson correlation coefficient between the scores on the paper-based scales and the app ranged between 0.81 and 0.93 for criterion validity and between 0.41 and 0.59 for hypothesis testing. Test-retest reliability was moderate to good (intraclass correlation coefficient between 0.67 and 0.90) and the score for usability was 1.16 (SD 0.27), indicating good usability. Conclusions: A mobile app named AvaliaDor was developed to assess the intensity, location, and phenotype of pain; associated disability; and the issues of pain catastrophizing and fear of movement in a user-centered design process. The app was shown to be usable, valid, and reliable for assessing pain from a biopsychosocial perspective in a heterogeneous group of patients with pain. Future work can explore the long-term use of AvaliaDor in clinical contexts and its advantages for the assessment and management of patients with pain. %M 33988515 %R 10.2196/25316 %U https://mhealth.jmir.org/2021/5/e25316 %U https://doi.org/10.2196/25316 %U http://www.ncbi.nlm.nih.gov/pubmed/33988515 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 2 %P e24669 %T Adapting a Person’s Home in 3D Using a Mobile App (MapIt): Participatory Design Framework Investigating the App’s Acceptability %A Guay,Manon %A Labbé,Mathieu %A Séguin-Tremblay,Noémie %A Auger,Claudine %A Goyer,Geneviève %A Veloza,Emily %A Chevalier,Natalie %A Polgar,Jan %A Michaud,François %+ School of Rehabilitation, Faculty of Medicine and Health Sciences, Sherbrooke University, 3001 12 Ave N Immeuble X1, Sherbrooke, QC, J1H 5N4, Canada, 1 819 780 2220 ext 45484, Manon.Guay@USherbrooke.ca %K occupational therapy %K mobile phone %K aging %K disability %K telehealth %K 3D visualization %K universal design %K built environment %K camera %K remote assessment %K assistive technology %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Home adaptation processes enhancing occupational engagement rely on identifying environmental barriers, generally during time-consuming home visits performed by occupational therapists (OTs). Relevance of a 3D model to the OT’s work has been attested, but a convenient and consumer-available technology to map the home environment in 3D is currently lacking. For instance, such a technology would support the exploration of home adaptations for a person with disability, with or without an OT visit. Objective: The aim of this study was to document the development and acceptability of a 3D mapping eHealth technology, optimizing its contribution to the OT’s work when conducting assessments in which home representations are essential to fit a person’s needs. Methods: A user-centered perspective, embedded in a participatory design framework where users are considered as research partners (not as just study participants), is reported. OTs, engineers, clinicians, researchers, and students, as well as the relatives of older adults contributed by providing ongoing feedback (eg, demonstrations, brainstorming, usability testing, questionnaires, prototyping). System acceptability, as per the Nielsen model, is documented by deductively integrating the data. Results: A total of 24 stakeholders contributed significantly to MapIt technology’s co-design over a span of 4 years. Fueled by the objective to enhance MapIt’s acceptability, 11 iterations lead to a mobile app to scan a room and produce its 3D model in less than 5 minutes. The app is available for smartphones and paired with computer software. Scanning, visualization, and automatic measurements are done on a smartphone equipped with a motion sensor and a camera with depth perception, and the computer software facilitates visualization, while allowing custom measurement of architectural elements directly on the 3D model. Stakeholders’ perception was favorable regarding MapIt’s acceptability, testifying to its usefulness (ie, usability and utility). Residual usability issues as well as concerns about accessibility and scan rendering still need to be addressed to foster its integration to a clinical context. Conclusions: MapIt allows to scan a room quickly and simply, providing a 3D model from images taken in real-world settings and to remotely but jointly explore home adaptations to enhance a person’s occupational engagement. %M 33973867 %R 10.2196/24669 %U https://rehab.jmir.org/2021/2/e24669 %U https://doi.org/10.2196/24669 %U http://www.ncbi.nlm.nih.gov/pubmed/33973867 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26163 %T A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping Approach %A Potzel,Anne Lotte %A Gar,Christina %A Seissler,Jochen %A Lechner,Andreas %+ Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstr. 1, Munich, 80336, Germany, 49 894 400 521 85, andreas.lechner@med.uni-muenchen.de %K mHealth %K diabetes prevention %K health behavior %K cardiometabolic disease %K gestational diabetes mellitus %K smartphone app %K intervention mapping %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is associated with an increased risk for the development of cardiometabolic diseases. Behavioral interventions can reduce this risk, but current solutions insufficiently address the requirements for such a program. The systematic development of a scalable mobile health (mHealth) promotion program for mothers during the first years post-GDM may contribute to solving this problem. Objective: The aim of this project was to systematically plan and develop a theory- and evidence-based mHealth intervention to change cardiometabolic risk behaviors in women during the first 5 years post-GDM that meets women’s expected standards of commercial health apps. Methods: The intervention mapping steps 1 to 4 structured the systematic planning and development of the mHealth program described in this paper. Steps 1 and 2 led to a theory- and evidence-based logic model of change for cardiometabolic health. Based on this model, the prevention program was designed (step 3) and produced (step 4) in cooperation with industrial partners to ensure a high technological standard of the resulting smartphone app for the iPhone (Apple Inc). Step 4 included a user study with women during the first 5 years post-GDM once a beta version of the app (“TRIANGLE”) was available. The user study comprised 2 test rounds of 1 week (n=5) and 4 weeks (n=6), respectively. The tests included validated questionnaires on user acceptance, user logs, and think-alouds with semistructured interviews. Results: The novel TRIANGLE app is among the first self-paced smartphone apps for individual habit change in the 3 lifestyle areas of physical activity, nutrition, and psychosocial well-being. The 3 core features—a challenge system, human coaching, and a library—address 11 behavioral determinants with 39 behavior change methods to support lifestyle changes. Participants in the user study showed a high acceptance, high perceived quality, and high perceived impact of the TRIANGLE app on their health behaviors. Participants tested the app regularly, used it intuitively, and suggested improvements. We then adapted the TRIANGLE app according to the insights from the user study before the full TRIANGLE program production. Conclusions: The intervention mapping approach was feasible to plan and develop an innovative and scalable smartphone solution for women during the first 5 years post-GDM. The resulting TRIANGLE intervention has the potential to support behavior change for cardiometabolic disease prevention. However, the app needs further refinement and testing in clinical trials. Intervention mapping steps 5 (implementation plan) and 6 (evaluation plan) may support the integration of the TRIANGLE intervention into routine care. Trial Registration: German Clinical Trials Register DRKS00012736; https://www.drks.de/DRKS00012736 %M 33973864 %R 10.2196/26163 %U https://mhealth.jmir.org/2021/5/e26163 %U https://doi.org/10.2196/26163 %U http://www.ncbi.nlm.nih.gov/pubmed/33973864 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e26673 %T Development of an mHealth App for Patients With Psoriasis Undergoing Biological Treatment: Participatory Design Study %A Trettin,Bettina %A Danbjørg,Dorthe Boe %A Andersen,Flemming %A Feldman,Steven %A Agerskov,Hanne %+ Centre for Innovative Medical Technology, Odense University Hospital, Kløvervænget 8C, entrance 101, 3rd fl, Odense, 5000, Denmark, 45 5164 0948, bettina.trettin@rsyd.dk %K mHealth %K psoriasis %K biologics %K participatory design %K teledermatology %K mobile phone %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: In Denmark, patients with psoriasis undergoing biological treatment have regular follow-ups, typically every 3 months. This may pose a challenge for patients who live far away from the hospital. Mobile health (mHealth) is a promising and reliable tool for the long-term management of patients with psoriasis undergoing biological treatment because the disease course can be properly monitored. Despite recent developments in mHealth, the full potential of teledermatology remains to be tapped by newer, more attractive forms of services focused on patients’ needs. Objective: This study aims to design and develop an mHealth app to support the self-management of patients with psoriasis using a participatory design. Methods: Using participatory design, we conducted 1 future workshop, 4 mock-up workshops, and 1 prototype test with patients and health care professionals to co-design a prototype. The process was iterative to ensure that all stakeholders would provide input into the design and outcome; this approach enabled continuous revision of the prototype until an acceptable solution was agreed upon. Data were analyzed according to the steps—plan, act, observe, and reflect—in the methodology of participatory design. Results: Health care professionals and patients emphasized the importance of a more patient-centered approach, focusing on the communication and maintenance of relationships. Patients perceived consultations to be impersonal and repetitive and wanted the opportunity to contribute to the agenda while attending a consultation. Patients also stated they would prefer not to attend visits in person every 3 months. On the basis of these findings, we designed an mHealth app that could replace in-person visits and support patients at in-person visits. Video consultations, self-monitoring, and registration of patient-reported outcome data were embedded in the app. Conclusions: Using participatory design facilitated mutual learning and democratic processes that gave end users a significant influence over the solution. Despite the advantages of using participatory design in developing mHealth solutions, organizational conditions may still represent a barrier to the optimization of solutions. %M 37632817 %R 10.2196/26673 %U https://derma.jmir.org/2021/1/e26673 %U https://doi.org/10.2196/26673 %U http://www.ncbi.nlm.nih.gov/pubmed/37632817 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e28668 %T A Breast Cancer Smartphone App to Navigate the Breast Cancer Journey: Mixed Methods Study %A Petrocchi,Serena %A Filipponi,Chiara %A Montagna,Giacomo %A Bonollo,Marta %A Pagani,Olivia %A Meani,Francesco %+ Department of Obstetrics and Gynecology, Centro di Senologia della Svizzera Italiana, Ente Ospedaliero Cantonale, Via Capelli 1, Viganello, 6962, Switzerland, 41 091 811 63 08, francesco.meani@eoc.ch %K breast cancer %K decision-making process %K breast cancer patient %K smartphone app %K empowerment %K breast cancer journey %K mobile app %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Several mobile apps have been designed for patients with a diagnosis of cancer. Unfortunately, despite the promising potential and impressive spread, their effectiveness often remains unclear. Most mobile apps are developed without any medical professional involvement and quality evidence-based assessment. Furthermore, they are often implemented in clinical care before any research is performed to confirm usability, appreciation, and clinical benefits for patients. Objective: We aimed to develop a new smartphone app (Centro di Senologia della Svizzera Italiana [CSSI]) specifically designed by breast care specialists and patients together to help breast cancer patients better understand and organize their journey through the diagnosis and treatment of cancer. We describe the development of the app and present assessments to evaluate its feasibility, usefulness, and capability to improve patient empowerment. Methods: A mixed method study with brief longitudinal quantitative data collection and subsequent qualitative semistructured interviews was designed. Twenty breast cancer patients participated in the study (mean age 51 years, SD 10 years). The usability of the app, the user experience, and empowerment were measured after 1 month. The semistructured interviews measured the utility of the app and the necessary improvements. Results: The app received good responses from the patients in terms of positive perception of the purpose of the app (7/20, 35%), organizing the cure path and being aware of the steps in cancer management (5/20, 25%), facilitating doctor-patient communication (4/20, 20%), and having detailed information about the resources offered by the hospital (2/20, 10%). Correlation and regression analyses showed that user experience increased the level of empowerment of patients (B=0.31, 95% CI 0.22-0.69; P=.009). The interviews suggested the need to constantly keep the app updated and to synchronize it with the hospital’s electronic agenda, and carefully selecting the best time to offer the tool to final users was considered crucial. Conclusions: Despite the very small number of participants in this study, the findings demonstrate the potential of the app and support a fully powered trial to evaluate the empowering effect of the mobile health app. More data will be gathered with an improved version of the app in the second phase involving a larger study sample. %M 33970120 %R 10.2196/28668 %U https://formative.jmir.org/2021/5/e28668 %U https://doi.org/10.2196/28668 %U http://www.ncbi.nlm.nih.gov/pubmed/33970120 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23809 %T Integrating User-Centered Design and Behavioral Science to Design a Mobile Intervention for Obesity and Binge Eating: Mixed Methods Analysis %A Graham,Andrea K %A Munson,Sean A %A Reddy,Madhu %A Neubert,Sarah W %A Green,Emilie A %A Chang,Angela %A Spring,Bonnie %A Mohr,David C %A Wildes,Jennifer E %+ Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 5266, andrea.graham@northwestern.edu %K obesity %K binge eating %K user-centered design %K mobile intervention %K engagement %K experimental therapeutics %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. Objective: This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating. Methods: A total of 22 adults (7/22, 32% non-Hispanic White; 8/22, 36% male) with self-reported obesity and recurrent binge eating (≥12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed. Results: Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82% (18/22) struggled with implementation, and 23% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82% (18/22) indicated the strategy was helpful, and 86% (19/22) planned to continue use. One-week average within-subject changes in weight (–2.2 [SD –5.0] pounds) and binge eating (–1.6 [SD –1.8] episodes) indicated small clinical improvement. Conclusions: Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions. %M 33970114 %R 10.2196/23809 %U https://formative.jmir.org/2021/5/e23809 %U https://doi.org/10.2196/23809 %U http://www.ncbi.nlm.nih.gov/pubmed/33970114 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25011 %T The Smartphone App haMSter for Tracking Patient-Reported Outcomes in People With Multiple Sclerosis: Protocol for a Pilot Study %A Altmann,Patrick %A Hinterberger,Werner %A Leutmezer,Fritz %A Ponleitner,Markus %A Monschein,Tobias %A Zrzavy,Tobias %A Zulehner,Gudrun %A Kornek,Barbara %A Lanzenberger,Rupert %A Berek,Klaus %A Rommer,Paulus Stefan %A Berger,Thomas %A Bsteh,Gabriel %+ Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria, 43 14040031450, gabriel.bsteh@meduniwien.ac.at %K mHealth %K mobile health %K remote monitoring %K patient-reported outcomes %K multiple sclerosis %K telemedicine %D 2021 %7 7.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Treatment and monitoring decisions in people with multiple sclerosis (MS) are based commonly on clinician-reported outcomes. These reflect physical and radiological disease activity and are the most relevant endpoints in clinical trials. Over the past few years, the number of studies evaluating so-called patient-reported outcomes (PROs) has been increasing. PROs are reports from patients concerning their own health perception. They are typically obtained by means of questionnaires and aim to quantify symptoms such as fatigue, depression, and sexual dysfunction. The emergence of PROs has made a tremendous contribution to understanding the individual impact of disease in people with MS and their health-related quality of life. However, the assessment of PROs consumes resources, including time and personnel. Thus, useful ways to conveniently introduce PROs into clinical practice are needed. Objective: We aim to provide a rationale and pilot study protocol for a mobile health (mHealth) solution named “haMSter” that allows for remote monitoring of PROs in people with MS. Methods: The core function of haMSter is to provide three scientifically validated PRO questionnaires relevant to MS for patients to fill out at home once a month. Thereby, longitudinal and remote documentation of PROs is enabled. A scoring algorithm graphically plots PRO scores over time and makes them available at the next visit. Results: The pilot study is currently ongoing and will evaluate adherence to this mHealth solution in 50 patients over a period of 6 months. Results from the haMSter pilot study are expected in 2021. Conclusions: haMSter is a novel mHealth-based solution for modern PRO research, which may constitute the first step in achieving the ability to integrate PROs in clinical practice. This allows for a more problem-oriented approach in monitoring visits, which addresses patient needs and ultimately saves time. Trial Registration: ClinicalTrials.gov NCT04555863; https://clinicaltrials.gov/ct2/show/NCT04555863 International Registered Report Identifier (IRRID): DERR1-10.2196/25011 %M 33960949 %R 10.2196/25011 %U https://www.researchprotocols.org/2021/5/e25011 %U https://doi.org/10.2196/25011 %U http://www.ncbi.nlm.nih.gov/pubmed/33960949 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e27173 %T Influences on the Uptake of Health and Well-being Apps and Curated App Portals: Think-Aloud and Interview Study %A Szinay,Dorothy %A Perski,Olga %A Jones,Andy %A Chadborn,Tim %A Brown,Jamie %A Naughton,Felix %+ School of Health Sciences, University of East Anglia, , Norwich , United Kingdom, 44 1603593064, d.szinay@uea.ac.uk %K behavior change %K health apps %K mHealth %K smartphone app %K framework analysis %K Capability, Opportunity, Motivation-Behavior model %K Theoretical Domains Framework %K think aloud %K mobile phone %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health and well-being smartphone apps can provide a cost-effective solution to addressing unhealthy behaviors. The selection of these apps tends to occur in commercial app stores, where thousands of health apps are available. Their uptake is often influenced by popularity indicators. However, these indicators are not necessarily associated with app effectiveness or evidence-based content. Alternative routes to app selection are increasingly available, such as via curated app portals, but little is known about people’s experiences of them. Objective: The aim of this study is to explore how people select health apps on the internet and their views on curated app portals. Methods: A total of 18 UK-based adults were recruited through social media and asked during an in-person meeting to verbalize their thoughts while searching for a health or well-being app on the internet on a platform of their choice. The search was then repeated on 2 curated health app portals: the National Health Service Apps Library and the Public Health England One You App portal. This was followed by semistructured interviews. Data were analyzed using framework analysis, informed by the Capability, Opportunity, Motivation-Behavior model and the Theoretical Domains Framework. Results: Searching for health and well-being apps on the internet was described as a minefield. App uptake appeared to be influenced by participants’ capabilities such as app literacy skills and health and app awareness, and opportunities including the availability of apps, app esthetics, the price of an app, and social influences. Motivation factors that seemed to affect the uptake were perceived competence, time efficiency, perceived utility and accuracy of an app, transparency about data protection, commitment and social identity, and a wide range of emotions. Social influences and the perceived utility of an app were highlighted as particularly important. Participants were not previously aware of curated portals but found the concept appealing. Curated health app portals appeared to engender trust and alleviate data protection concerns. Although apps listed on these were perceived as more trustworthy, their presentation was considered disappointing. This disappointment seemed to stem from the functionality of the portals, lack of user guidance, and lack of tailored content to an individual’s needs. Conclusions: The uptake of health and well-being apps appears to be primarily affected by social influences and the perceived utility of an app. App uptake via curated health app portals perceived as credible may mitigate concerns related to data protection and accuracy, but their implementation must better meet user needs and expectations. %M 33904827 %R 10.2196/27173 %U https://mhealth.jmir.org/2021/4/e27173 %U https://doi.org/10.2196/27173 %U http://www.ncbi.nlm.nih.gov/pubmed/33904827 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e27383 %T Results of a Culturally Tailored Smartphone-Delivered Physical Activity Intervention Among Midlife African American Women: Feasibility Trial %A Joseph,Rodney P %A Ainsworth,Barbara E %A Hollingshead,Kevin %A Todd,Michael %A Keller,Colleen %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N 3rd St, Phoenix, AZ, 85004, United States, 1 602 496 0772, rodney.joseph@asu.edu %K exercise %K physical activity %K minority health %K women’s health %K mHealth %K mobile phone %D 2021 %7 22.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular aerobic physical activity (PA) is an important component of healthy aging. However, only 27%-40% of African American women achieve national PA guidelines. Available data also show a clear decline in PA as African American women transition from young adulthood (ie, 25-44 years) into midlife. This decline in PA during midlife coincides with an increased risk for African American women developing cardiometabolic disease conditions, including obesity, type 2 diabetes, and cardiovascular disease. Thus, effective efforts are needed to promote PA among sedentary African American women during midlife. Objective: This study aims to examine the acceptability and feasibility of a culturally tailored, smartphone-delivered PA intervention, originally developed to increase PA among African American women aged 24-49 years, among a slightly older sample of midlife African American women aged 50-65 years. Methods: A single-arm pretest-posttest study design was implemented. In total, 20 insufficiently active African American (ie, ≤60 min per week of PA) women between the ages of 50-65 years participated in the 4-month feasibility trial. The Smart Walk intervention was delivered through the study Smart Walk smartphone app and text messages. Features available on the Smart Walk app include personal profile pages, multimedia PA promotion modules, discussion board forums, and an activity tracking feature that integrates with Fitbit activity monitors. Self-reported PA and social cognitive theory mediators targeted by the intervention (ie, self-regulation, behavioral capability, outcome expectations, self-efficacy, and social support) were assessed at baseline and at 4 months. Feasibility and acceptability were assessed using a postintervention satisfaction survey that included multiple-choice and open-ended questions evaluating participant perceptions of the intervention and suggestions for intervention improvement. Wilcoxon signed-rank tests were used to examine pre- and postintervention changes in the PA and social cognitive theory variables. The effect size estimates were calculated using the Pearson r test statistic. Results: Participants increased moderate-to-vigorous PA (median 30 minutes per week increase; r=0.503; P=.002) and reported improvements in 2 theoretical mediators (self-regulation: r=0.397; P=.01; behavioral capability: r=0.440; P=.006). Nearly all participants (14/15, 93% completing the satisfaction survey) indicated that they would recommend the intervention to a friend. Participants’ suggestions for improving the intervention included enhancing the intervention’s provisions of social support for PA. Conclusions: The results provide preliminary support for the feasibility of the smartphone-based approach to increase PA among midlife African American women. However, before larger-scale implementation among midlife African American women, enhancements to the social support components of the intervention are warranted. Trial Registration: ClinicalTrials.gov NCT04073355; https://clinicaltrials.gov/ct2/show/NCT04073355 %M 33885368 %R 10.2196/27383 %U https://mhealth.jmir.org/2021/4/e27383 %U https://doi.org/10.2196/27383 %U http://www.ncbi.nlm.nih.gov/pubmed/33885368 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e23784 %T Acceptance, Barriers, and Future Preferences of Mobile Health Among Patients Receiving Trauma and Orthopedic Surgical Care: Paper-Based Survey in a Prospective Multicenter Study %A Reinecke,Felix %A Dittrich,Florian %A Dudda,Marcel %A Stang,Andreas %A Polan,Christina %A Müller,Roman %A Beck,Paula %A Kauther,Max Daniel %+ Department of Orthopedics and Orthopedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrberger Straße, Building 37-38, Homburg, 66421, Germany, 49 68411624520, florian.dittrich@uks.eu %K smartphone %K mHealth %K app %K orthopedics %K trauma surgery %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones have become an essential part of everyday life and it is undeniable that apps offer enormous opportunities for dealing with future challenges in public health. Nevertheless, the exact patient requirements for medical apps in the field of orthopedic and trauma surgery are currently unknown. Objective: The aim of this study was to define target groups, evaluate patient requirements, and the potential and pitfalls regarding medical apps specific for patients receiving orthopedic and trauma surgical care. Methods: A prospective multicenter study was conducted between August 2018 and December 2019 at a German trauma center and 3 trauma surgery/orthopedic practices. A paper-based survey consisting of 15 questions evaluated information regarding smartphone and medical app usage behavior. In addition, suggested app functions were rated using Likert scales. Descriptive statistics and binary log-binomial regression were performed. Results: A total of 1055 questionnaires were included in our statistical analysis. Approximately 89.57% (945/1055) of the patients in this study owned a smartphone. Smartphone ownership probability decreased with every decade of life and increased with higher levels of education. Medical information was obtained via mobile web access by 62.65% (661/1055) of the patients; this correlated with smartphone ownership in regard to age and educational level. Only 11.18% (118/1055) of the patients reported previous medical app usage, and 3.50% (37/1055) of the patients received an app recommendation from a physician. More than half (594/1055, 56.30%) of the patients were unwilling to pay for a medical app. The highest rated app functions were information about medication, behavioral guidelines, and medical record archival. An improved treatment experience was reported through the suggested app features by 71.18% (751/1055) of the patients. Conclusions: Mobile devices are a widely used source of information for medical content, but only a minority of the population reported previous medical app usage. The main target group for medical apps among patients receiving orthopedic and trauma surgical care tends to be the younger population, which results in a danger of excluding fringe groups, especially the older adults. Education seems to be one of the most important pull factors to use smartphones or a mobile web connection to obtain health information. Medical apps primarily focusing on an optimized patient education and flow of information seem to have the potential to support patients in health issues, at least in their subjective perception. For future target group–oriented app developments, further evidence on the clinical application, feasibility, and acceptance of app usage are necessary in order to avoid patient endangerment and to limit socioeconomic costs. %M 33881401 %R 10.2196/23784 %U https://mhealth.jmir.org/2021/4/e23784 %U https://doi.org/10.2196/23784 %U http://www.ncbi.nlm.nih.gov/pubmed/33881401 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e19564 %T Usability of a Mobile App for Real-Time Assessment of Fatigue and Related Symptoms in Patients With Multiple Sclerosis: Observational Study %A Palotai,Miklos %A Wallack,Max %A Kujbus,Gergo %A Dalnoki,Adam %A Guttmann,Charles %+ Center for Neurological Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA, 02215, United States, 1 617 278 0613, palotai@bwh.harvard.edu %K multiple sclerosis %K fatigue %K depression %K mobile application %K mobile phone %K real-time assessment %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although fatigue is one of the most debilitating symptoms in patients with multiple sclerosis (MS), its pathogenesis is not well understood. Neurogenic, inflammatory, endocrine, and metabolic mechanisms have been proposed. Taking into account the temporal dynamics and comorbid mood symptoms of fatigue may help differentiate fatigue phenotypes. These phenotypes may reflect different pathogeneses and may respond to different mechanism-specific treatments. Although several tools have been developed to assess various symptoms (including fatigue), monitor clinical status, or improve the perceived level of fatigue in patients with MS, options for a detailed, real-time assessment of MS-related fatigue and relevant comorbidities are still limited. Objective: This study aims to present a novel mobile app specifically designed to differentiate fatigue phenotypes using circadian symptom monitoring and state-of-the-art characterization of MS-related fatigue and its related symptoms. We also aim to report the first findings regarding patient compliance and the relationship between compliance and patient characteristics, including MS disease severity. Methods: After developing the app, we used it in a prospective study designed to investigate the brain magnetic resonance imaging correlates of MS-related fatigue. In total, 64 patients with MS were recruited into this study and asked to use the app over a 2-week period. The app features the following modules: Visual Analogue Scales (VASs) to assess circadian changes in fatigue, depression, anxiety, and pain; daily sleep diaries (SLDs) to assess sleep habits and quality; and 10 one-time questionnaires to assess fatigue, depression, anxiety, sleepiness, physical activity, and motivation, as well as several other one-time questionnaires that were created to assess those relevant aspects of fatigue that were not captured by existing fatigue questionnaires. The app prompts subjects to assess their symptoms multiple times a day and enables real-time symptom monitoring through a web-accessible portal. Results: Of 64 patients, 56 (88%) used the app, of which 51 (91%) completed all one-time questionnaires and 47 (84%) completed all one-time questionnaires, VASs, and SLDs. Patients reported no issues with the usage of the app, and there were no technical issues with our web-based data collection system. The relapsing-remitting MS to secondary-progressive MS ratio was significantly higher in patients who completed all one-time questionnaires, VASs, and SLDs than in those who completed all one-time questionnaires but not all VASs and SLDs (P=.01). No other significant differences in demographics, fatigue, or disease severity were observed between the degrees of compliance. Conclusions: The app can be used with reasonable compliance across patients with relapsing-remitting and secondary-progressive MS irrespective of demographics, fatigue, or disease severity. %M 33861208 %R 10.2196/19564 %U https://mhealth.jmir.org/2021/4/e19564 %U https://doi.org/10.2196/19564 %U http://www.ncbi.nlm.nih.gov/pubmed/33861208 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e25668 %T Baby Buddy App for Breastfeeding and Behavior Change: Retrospective Study of the App Using the Behavior Change Wheel %A Musgrave,Loretta M %A Baum,Alison %A Perera,Nilushka %A Homer,Caroline SE %A Gordon,Adrienne %+ Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Building 10, Level 11, 235 Jones St, Ultimo NSW, 2006, Australia, 61 (02) 9514 5069, loretta.musgrave@uts.edu.au %K breastfeeding %K app %K digital health %K smartphone app %K behavior change wheel %K digital behavior change intervention %D 2021 %7 15.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Breastfeeding plays a major role in the health of mothers and babies and has the potential to positively shape an individual’s life both in the short and long term. In the United Kingdom (UK), although 81% of women initiate breastfeeding, only 1% of women breastfeed exclusively to 6 months as recommended by the World Health Organization. In the UK, women who are socially disadvantaged and younger are less likely to breastfeed at 6 to 8 weeks postpartum. One strategy that aims to improve these statistics is the Baby Buddy app, which has been designed and implemented by the UK charity Best Beginnings to be a universal intervention to help reduce health inequalities, including those in breastfeeding. Objective: This study aimed to retrospectively examine the development of Baby Buddy by applying the Behavior Change Wheel (BCW) framework to understand how it might increase breastfeeding self-efficacy, knowledge, and confidence. Methods: Retrospective application of the BCW was completed after the app was developed and embedded into maternity services. A three-stage process evaluation used triangulation methods and formalized tools to gain an understanding of the potential mechanisms and behaviors used in apps that are needed to improve breastfeeding rates in the UK. First, we generated a behavioral analysis by mapping breastfeeding barriers and enablers onto the Capability, Opportunity, and Motivation-Behavior (COM-B) system using documents provided by Best Beginnings. Second, we identified the intervention functions and policy categories used. Third, we linked these with the behavior change techniques identified in the app breastfeeding content using the Behavior Change Techniques Taxonomy (BCTTv1). Results: Baby Buddy is a well-designed platform that could be used to change breastfeeding behaviors. Findings from stage one showed that Best Beginnings had defined breastfeeding as a key behavior requiring support and demonstrated a thorough understanding of the context in which breastfeeding occurs, the barriers and enablers of breastfeeding, and the target actions needed to support breastfeeding. In stage two, Best Beginnings had used intervention and policy functions to address the barriers and enablers of breastfeeding. In stage three, Baby Buddy had been assessed for acceptability, practicability, effectiveness, affordability, safety, and equity. Several behavior change techniques that could assist women with decision making around breastfeeding (eg, information about health consequences and credible sources) and possibly affect attitudes and self-efficacy were identified. Of the 39 videos in the app, 19 (49%) addressed physical capabilities related to breastfeeding and demonstrated positive breastfeeding behaviors. Conclusions: Applying a theoretical framework retrospectively to a mobile app is possible and results in useful information to understand potential health benefits and to inform future development. Future research should assess which components and behavioral techniques in the app are most effective in changing behavior and supporting breastfeeding. %M 33856351 %R 10.2196/25668 %U https://mhealth.jmir.org/2021/4/e25668 %U https://doi.org/10.2196/25668 %U http://www.ncbi.nlm.nih.gov/pubmed/33856351 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e21586 %T Designing an App to Overcome Language Barriers in the Delivery of Emergency Medical Services: Participatory Development Process %A Noack,Eva Maria %A Schulze,Jennifer %A Müller,Frank %+ Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany, 49 55139 68193, evamaria.noack@med.uni-goettingen.de %K paramedic %K interpreter %K medical translation %K application software %K app %K digital communication tool %K foreign-language patients %K language barrier %K participatory design %K prehospital emergency care %K emergency medical service %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In emergencies, language barriers may have dangerous consequences for the patients. There have been some technical approaches to overcome language barriers in medical care but not yet in the prehospital emergency care setting. The use of digital technologies in health care is expanding rapidly. Involving end users at all stages of the development process may help to ensure such technologies are usable and can be implemented. Objective: We aimed to develop a digital communication tool that addresses paramedic needs in the specific circumstances of prehospital emergency care and helps paramedics to overcome language barriers when providing care to foreign-language patients. Methods: We actively engaged paramedics and software designers in an action-oriented, participatory, iterative development process, which included field observations, workshops, background conversations, questionnaires on rescue missions, studying the literature, and preliminary testing in the field. Results: With input from paramedics, we created an app with 600 fixed phrases supporting 18 languages. The app includes medical history–taking questions, phrases asking for consent, and phrases providing specific additional information. Children as patients, as well as their carers and other third parties, can be addressed with appropriate wording. All phrases can be played back audibly or displayed as text. The comprehensive content is grouped into categories and adapted to diverse scenarios, which makes the tool rapidly usable. The app includes a function to document patient responses and the conversation history. For evaluation in a clinical study, the app is run on a smartphone with extra speakers to be of use in noisy environments. The use of prototypes proved valuable to verify that the content, structure, and functions discussed in theory were of value and genuinely needed in practice and that the various device control elements were intuitive. Conclusions: The nature of the paramedic work environment places specific demands on the communication options used and need for such devices. The active involvement of paramedics in the development process allowed us to understand and subsequently consider their experience-based knowledge. Software designers could understand the paramedics’ work environment and consider respective needs in the menu navigation and design principles of the app. We argue that the development of any medical software product should actively involve both end users and developers in all phases of the development process. Providing the users with the opportunity to influence technology development ensures that the result is closer to their needs, which can be seen as crucial for successful implementation and sustainable use. Trial Registration: German Clinical Trials Register DRKS00016719; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016719 International Registered Report Identifier (IRRID): RR2-10.1186/s12913-020-05098-5 %M 33851933 %R 10.2196/21586 %U https://mhealth.jmir.org/2021/4/e21586 %U https://doi.org/10.2196/21586 %U http://www.ncbi.nlm.nih.gov/pubmed/33851933 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24976 %T Feasibility and Acceptability of a Smoking Cessation Smartphone App (My QuitBuddy) in Older Persons: Pilot Randomized Controlled Trial %A Peek,Jenny %A Hay,Karen %A Hughes,Pauline %A Kostellar,Adrienne %A Kumar,Subodh %A Bhikoo,Zaheerodin %A Serginson,John %A Marshall,Henry M %+ The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Level 2, Admin Building, Rode Rd, Chermside, 4032, Australia, 61 (07) 3139 6802, jenny.peek@health.qld.gov.au %K mHealth %K mobile apps %K motivation %K smartphone %K smoking cessation %K tobacco smoking %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although many smoking cessation smartphone apps exist, few have been independently evaluated, particularly in older populations. In 2017, of the 112 commercially available smoking cessation apps in Australia, only 6 were deemed to be of high quality, in that they partially adhered to Australian guidelines. Mobile health (mHealth) apps have the potential to modify smoking behavior at a relatively low cost; however, their acceptability in older smokers remains unknown. Rigorous scientific evaluation of apps is thus urgently needed to assist smokers and clinicians alike. Objective: We conducted a pilot randomized controlled trial to evaluate the feasibility of a large-scale trial to assess the use and acceptability of a high-quality smoking cessation app in older smokers. Methods: Adult inpatient and outpatient smokers with computer and smartphone access were recruited face to face and via telephone interviews from Metropolitan Hospitals in Brisbane, Australia. Participants were randomized 1:1 to the intervention (requested to download the “My QuitBuddy” smoking cessation app on their smartphone) or the control group (provided access to a tailored smoking cessation support webpage [Quit HQ]). The My QuitBuddy app is freely available from app stores and provides personalized evidenced-based smoking cessation support. Quit HQ offers regular email support over 12 weeks. No training or instructions on the use of these e-resources were given to participants. Outcomes at 3 months included recruitment and retention rates, use and acceptability of e-resource (User Version of the Mobile App Rating Scale [uMARS]), changes in quitting motivation (10-point scale), and self-reported smoking abstinence. Results: We randomized 64 of 231 potentially eligible individuals (27.7%). The mean age of participants was 62 (SD 8). Nicotine dependence was moderate (mean Heaviness of Smoking Index [HSI] 2.8 [SD 1.2]). At 3 months the retention rate was (58/64, 91%). A total of 15 of 31 participants in the intervention arm (48%) used the app at least once, compared with 10 of 33 (30%) in the control arm. uMARS scores for e-resource use and acceptability were statistically similar (P=.29). Motivation to quit was significantly higher in the intervention arm compared with the control arm (median 6 [IQR 4-8] versus 4 [IQR 4-5], respectively, P=.02). According to the intention-to-treat analysis, smoking abstinence was nonsignificantly higher in the intervention group (4/31 [13%], 95% CI 4%-30%, versus 2/33 [6%], 95% CI 1%-20%; P=.42). The estimated number needed to treat was 14. Conclusions: Internet and mHealth smoking cessation resources appear acceptable to a minority of older smokers. Smokers who engaged with the allocated e-resources rated them equally, and there were trends toward greater uptake, increased motivation, and higher abstinence rates in the app group; however, only the change in motivation reached statistical significance (median score 6 versus 4, respectively, P=.02). This results of this pilot study suggest that apps may improve quit outcomes in older adults who are willing to use them. Further research into user–app interactions should be undertaken to facilitate improvements in app design and consumer engagement. These favorable trends should be explored in larger trials with sufficient statistical power. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000159156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376849&isReview=true %M 33851923 %R 10.2196/24976 %U https://formative.jmir.org/2021/4/e24976 %U https://doi.org/10.2196/24976 %U http://www.ncbi.nlm.nih.gov/pubmed/33851923 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e23304 %T A Modular Mobile Health App for Personalized Rehabilitation Throughout the Breast Cancer Care Continuum: Development Study %A Lim,Ji Young %A Kim,Jong Kwang %A Kim,Yoon %A Ahn,So-Yeon %A Yu,Jonghan %A Hwang,Ji Hye %+ Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, Republic of Korea, 82 2 3410 2816, jhlee.hwang@samsung.com %K breast cancer %K mobile health %K rehabilitation %K cancer continuum %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although many mobile health (mHealth) apps have evolved as support tools for self-management of breast cancer, limited studies have developed a comprehensive app and described the algorithms for personalized rehabilitation throughout the breast cancer care continuum. Objective: This study aimed to develop a comprehensive mobile app and to describe an algorithm that adjusts personalized content to facilitate self-management throughout the breast cancer care continuum. Methods: The development process of the modular mHealth app included the following 4 steps: (1) organizing expert teams, (2) defining evidence-based fundamental content and modules, (3) classifying user information for algorithms to personalize the content, and (4) creating the app platform and connectivity to digital health care devices. Results: We developed a modular mHealth app service, which took 18 months, including a review of related literature and guidelines and the development of the app and connectivity to digital health care devices. A total of 11 functionalities were defined in the app with weekly analysis. The user information classification was formulated for personalized rehabilitation according to 5 key criteria: general user information, breast operation type, lymph node surgery type, chemotherapy and hormonal therapy use, and change in treatment after surgery. The main modules for personalized content included a self-monitoring screen, personalized health information, personalized exercise, and diet management. Conclusions: The strength of this study was the development of a comprehensive mHealth app and algorithms to adjust content based on user medical information for personalized rehabilitation during the breast cancer care continuum. %M 33847589 %R 10.2196/23304 %U https://formative.jmir.org/2021/4/e23304 %U https://doi.org/10.2196/23304 %U http://www.ncbi.nlm.nih.gov/pubmed/33847589 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e24271 %T A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study %A Bakogiannis,Constantinos %A Tsarouchas,Anastasios %A Mouselimis,Dimitrios %A Lazaridis,Charalampos %A Theofillogianakos,Efstratios K %A Billis,Antonios %A Tzikas,Stergios %A Fragakis,Nikolaos %A Bamidis,Panagiotis D %A Papadopoulos,Christodoulos E %A Vassilikos,Vassilios P %+ Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki, 54642, Greece, 30 2310892598, bakogianniscon@gmail.com %K mHealth %K heart failure %K smartphone app %K self-care %K COVID-19 %K patients %K caregivers %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)–based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease. Objective: The objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study. Methods: The development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure app [ThessHF app]) was evidence based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients’ quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients’ quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score and the hospitalization rate. Results: A systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4% (SD 7.2%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6% [SD 15.6%], P=.06) scores. The hospitalization rate for the follow-up duration was 3%. Conclusions: The need for telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF. %M 33847599 %R 10.2196/24271 %U https://mhealth.jmir.org/2021/4/e24271 %U https://doi.org/10.2196/24271 %U http://www.ncbi.nlm.nih.gov/pubmed/33847599 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e20461 %T A Physical Activity Mobile Game for Hematopoietic Stem Cell Transplant Patients: App Design, Development, and Evaluation %A Cerbas,Shannon %A Kelemen,Arpad %A Liang,Yulan %A Sik-Lanyi,Cecilia %A Van de Castle,Barbara %+ University of Maryland, Baltimore, 655 W Lombard St, Baltimore, MD, 21201, United States, 1 410 706 4812, liang@umaryland.edu %K cancer %K mobile app %K gamification %K bone marrow transplant %K alpha testing %K physical activity %D 2021 %7 13.4.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Physical activity mobile apps may encourage patients with cancer to increase exercise uptake, consequently decreasing cancer-related fatigue. While many fitness apps are currently available for download, most are not suitable for patients with cancer due to the unique barriers these patients face, such as fatigue, pain, and nausea. Objective: The aim of this study is to design, develop, and perform alpha testing of a physical activity mobile health game for hematopoietic stem cell transplant (HSCT) patients. The ultimate future goal of this project is to motivate HSCT patients to increase physical activity and provide them with a safe and fun way to exercise. Methods: A mobile health game called Walking Warrior was designed as a puzzle game where tiles are moved and matched. Walking Warrior interfaces with an open-source step counter and communicates with a central online MySQL database to record game play and walking performance. The game came to fruition after following an iterative process model with several prototypes. Game developers and bone marrow transplant nurses were recruited to perform an expert usability evaluation of the Walking Warrior prototype by completing a heuristic questionnaire and providing qualitative suggestions for improvement. Experts also made qualitative recommendations for improvements on speed, movement of tiles, appearance, and accuracy of the step counter. We recruited 5 additional usability evaluators who searched for and compared 4 open-source step counter programs, then qualitatively compared them for accuracy, robustness, cheat proofing, ease of use, and battery drain issues. Patient recruitment is planned at a later stage in this project. This paper only describes software design, development, and evaluation, rather than behavioral evaluation (ie, impact on physical activity), which is the long-term goal of this project. Results: Internal consistency and the instrument’s reliability evaluation results from 1 clinical expert and 4 technical experts were deemed excellent (Cronbach α=.933). A hierarchical cluster analysis of the questionnaire item responses for similarity/dissimilarity among the experts indicated that the two expert groups were not clustered into two separate groups in the dendrogram. This indicates that the item responses were not affected by profession. Factor analyses indicate that responses from the 40-item questionnaire were classified into five primary factors. The associated descriptive statistics for each of these categories were as follows (on a scale of 1 to 5): clarity and ease (median 4; mean 3.7, SD 0.45), appropriateness (median 4; mean 3.7, SD 0.49), game quality (median 3.5; mean 3.3, SD 0.42), motivation to walk (median 3; mean 3.1, SD 0.58), and mental effort (median 3.5; mean 3.1, SD 1.27). Conclusions: The evaluation from experts and clinicians provided qualitative information to further improve game design and development. Findings from the expert usability evaluation suggest the game’s assets of clarity, ease of use, appropriateness, quality, motivation to walk, and mental effort were all favorable. This mobile game could ultimately help patients increase physical activity as an aid to recovery. %M 37725560 %R 10.2196/20461 %U https://xmed.jmir.org/2021/2/e20461 %U https://doi.org/10.2196/20461 %U http://www.ncbi.nlm.nih.gov/pubmed/37725560 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25513 %T A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App %A Thornton,Louise %A Gardner,Lauren Anne %A Osman,Bridie %A Green,Olivia %A Champion,Katrina Elizabeth %A Bryant,Zachary %A Teesson,Maree %A Kay-Lambkin,Frances %A Chapman,Cath %A , %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building (G02), 160 City Road, Sydney, 2006, Australia, 61 286279012, lauren.gardner@sydney.edu.au %K mHealth %K mobile phone %K chronic disease %K adolescents %K health promotion %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The link between chronic diseases and the Big 6 lifestyle risk behaviors (ie, poor diet, physical inactivity, smoking, alcohol use, sedentary recreational screen time, and poor sleep) is well established. It is critical to target these lifestyle risk behaviors, as they often co-occur and emerge in adolescence. Smartphones have become an integral part of everyday life, and many adolescents already use mobile apps to monitor their lifestyle behaviors and improve their health. Smartphones may be a valuable platform for engaging adolescents with interventions to prevent key chronic disease risk behaviors. Objective: The aim of this paper is to describe the development, usability, and acceptability of the Health4Life app, a self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Methods: The development of the Health4Life app was an iterative process conducted in collaboration with adolescents and experts. The development process consisted of three stages: scoping the literature; end user consultations, which included a web-based survey (N=815; mean age 13.89, SD 0.89 years) and a focus group (N=12) among adolescents; and app development and beta testing. Following this development work, 232 adolescents were asked to rate the usability and acceptability of the app. Results: The process resulted in a self-monitoring smartphone app that allows adolescent users to track and set goals for the Big 6 health behaviors, using in-app rewards and notifications to enhance engagement. The overall adolescent feedback was positive in terms of user-friendly design, content, relevance, and helpfulness. Commonly identified areas for improvement were to increase interactive features and display recorded health behaviors differently to improve interpretability. Conclusions: The Health4Life app is a co-designed, self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Adolescents rated the app as highly acceptable and usable. The app has the potential to efficiently and effectively modify important risk factors for chronic disease among young people and is currently being evaluated in a world-first trial of 6640 secondary school students in 71 schools across Australia. %M 33843590 %R 10.2196/25513 %U https://formative.jmir.org/2021/4/e25513 %U https://doi.org/10.2196/25513 %U http://www.ncbi.nlm.nih.gov/pubmed/33843590 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e20424 %T A Smartphone-Based Self-management Intervention for Bipolar Disorder (LiveWell): User-Centered Development Approach %A Jonathan,Geneva K %A Dopke,Cynthia A %A Michaels,Tania %A Bank,Andrew %A Martin,Clair R %A Adhikari,Krina %A Krakauer,Rachel L %A Ryan,Chloe %A McBride,Alyssa %A Babington,Pamela %A Frauenhofer,Ella %A Silver,Jamilah %A Capra,Courtney %A Simon,Melanie %A Begale,Mark %A Mohr,David C %A Goulding,Evan H %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States, 1 3125031189, e-goulding@fsm.northwestern.edu %K behavioral intervention technology %K mHealth %K bipolar disorder %K depression %K illness management %K smartphone %K behavior change %K early warning signs %K self-management %K qualitative %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Bipolar disorder is a serious mental illness that results in significant morbidity and mortality. Pharmacotherapy is the primary treatment for bipolar disorder; however, adjunctive psychotherapy can help individuals use self-management strategies to improve outcomes. Yet access to this therapy is limited. Smartphones and other technologies have the potential to increase access to therapeutic strategies that enhance self-management while simultaneously providing real-time user feedback and provider alerts to augment care. Objective: This paper describes the user-centered development of LiveWell, a smartphone-based self-management intervention for bipolar disorder, to contribute to and support the ongoing improvement and dissemination of technology-based mental health interventions. Methods: Individuals with bipolar disorder first participated in a field trial of a simple smartphone app for self-monitoring of behavioral targets. To develop a complete technology-based intervention for bipolar disorder, this field trial was followed by design sessions, usability testing, and a pilot study of a smartphone-based self-management intervention for bipolar disorder. Throughout all phases of development, intervention revisions were made based on user feedback. Results: The core of the LiveWell intervention consists of a daily self-monitoring tool, the Daily Check-in. This self-monitoring tool underwent multiple revisions during the user-centered development process. Daily Check-in mood and thought rating scales were collapsed into a single wellness rating scale to accommodate user development of personalized scale anchors. These anchors are meant to assist users in identifying early warning signs and symptoms of impending episodes to take action based on personalized plans. When users identified personal anchors for the wellness scale, the anchors most commonly reflected behavioral signs and symptoms (40%), followed by cognitive (25%), mood (15%), physical (10%), and motivational (7%) signs and symptoms. Changes to the Daily Check-in were also made to help users distinguish between getting adequate sleep and keeping a regular routine. At the end of the pilot study, users reported that the Daily Check-in made them more aware of early warning signs and symptoms and how much they were sleeping. Users also reported that they liked personalizing their anchors and plans and felt this process was useful. Users experienced some difficulties with developing, tracking, and achieving target goals. Users also did not consistently follow up with app recommendations to contact providers when Daily Check-in data suggested they needed additional assistance. As a result, the human support roles for the technology were expanded beyond app use support to include support for self-management and clinical care communication. The development of these human support roles was aided by feedback on the technology's usability from the users and the coaches who provided the human support. Conclusions: User input guided the development of intervention content, technology, and coaching support for LiveWell. Users valued the provision of monitoring tools and the ability to personalize plans for staying well, supporting the role of monitoring and personalization as important features of digital mental health technologies. Users also valued human support of the technology in the form of a coach, and user difficulties with aspects of self-management and care-provider communication led to an expansion of the coach's support roles. Obtaining feedback from both users and coaches played an important role in the development of both the LiveWell technology and human support. Attention to all stakeholders involved in the use of mental health technologies is essential for optimizing intervention development. %M 33843607 %R 10.2196/20424 %U https://mental.jmir.org/2021/4/e20424 %U https://doi.org/10.2196/20424 %U http://www.ncbi.nlm.nih.gov/pubmed/33843607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24461 %T A Heart Rate Monitoring App (FibriCheck) for Atrial Fibrillation in General Practice: Pilot Usability Study %A Beerten,Simon Gabriël %A Proesmans,Tine %A Vaes,Bert %+ Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7 blok h - bus 7001, Leuven, 3000, Belgium, 32 16194050, simon.beerten@kuleuven.be %K atrial fibrillation %K smartphone app %K FibriCheck %K primary care %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Atrial fibrillation (AF) is a major risk factor for stroke. The current opportunistic screening procedure consists of pulse palpation and an electrocardiogram when an irregular rhythm is found. Smartphone apps that measure heart rhythm could be useful in increasing the detection of AF in a primary care setting. Objective: We conducted a pilot study with the smartphone app FibriCheck to assess whether the introduction of such an app is feasible. Methods: Four general practices across Flanders provided patient data for the study. Inclusion criteria for participants were aged 65 or older and a CHARGE-AF score of at least 10%. We excluded patients with known AF or a pacemaker. Participants were asked to measure at least twice a day with FibriCheck (for at least 14 days). They were provided the 36-Item Short Form Survey (SF-36) questionnaire both before and after the study, as well as different surveys concerning their user experience and general perception of technology. Results: There were 92 participants (36 women and 56 men). The study population was relatively homogenous concerning risk factors and medication use at baseline. During the study period, 5/86 (6%) participants were found to have AF (6 dropouts). The average study period was 23 days and the average number of measurements per day was 2.1. Patient compliance was variable, but high. On the whole, there were no appreciable changes in quality of life. The overall user experience and satisfaction were very high. Conclusions: FibriCheck is a relatively easy-to-use smartphone app to complement AF screening in primary care. Its implementation in this setting is certainly achievable, and one can expect high rates of patient compliance. Based on these results, a planned cluster randomized trial will be going ahead. Trial Registration: ClinicalTrials.gov NCT03509493; https://clinicaltrials.gov/ct2/show/NCT03509493 %M 33825692 %R 10.2196/24461 %U https://formative.jmir.org/2021/4/e24461 %U https://doi.org/10.2196/24461 %U http://www.ncbi.nlm.nih.gov/pubmed/33825692 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e23447 %T Postsecondary Student Engagement With a Mental Health App and Online Platform (Thought Spot): Qualitative Study of User Experience %A Wong,Howard W %A Lo,Brian %A Shi,Jenny %A Hollenberg,Elisa %A Abi-Jaoude,Alexxa %A Johnson,Andrew %A Chaim,Gloria %A Cleverley,Kristin %A Henderson,Joanna %A Levinson,Andrea %A Robb,Janine %A Voineskos,Aristotle %A Wiljer,David %+ UHN Digital, University Health Network, R. Fraser Elliott Building RFE 3-411, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 340 6322, david.wiljer@uhn.ca %K transition-aged youth %K qualitative study %K user experience %K help-seeking %K mental health %K postsecondary %K mobile apps %K adolescent %D 2021 %7 2.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is growing interest in using mobile apps and online tools to support postsecondary student mental health, but most of these solutions have suboptimal user engagement in real-world settings. Poor engagement can limit long-term effectiveness and usefulness of these tools. Previous literature has proposed several theories that link factors such as low usability and poor user-centered design to app disengagement. However, few studies provide direct evidence showing what factors contribute to suboptimal user engagement in the context of mobile mental health apps for postsecondary students. Objective: This study focuses on understanding postsecondary students’ attitudes and behaviors when using Thought Spot, a co-designed mental health app and online platform, to understand factors related to engagement and user experience. Methods: Students who were given access to Thought Spot for 6 months during a randomized trial of the intervention were invited to participate in one-on-one semistructured interviews. The interviews explored participants’ overall experiences and perceptions of the app, along with factors that affected their usage of various features. All interviews were recorded, and template analysis was used to analyze transcripts. Results: User satisfaction was mixed among users of Thought Spot. The degree of engagement with the app appeared to be affected by factors that can be grouped into 5 themes: (1) Students valued detailed, inclusive, and relevant content; (2) Technical glitches and a lack of integration with other apps affected the overall user experience and satisfaction with the app; (3) Using the app to support peers or family can increase engagement; (4) Crowdsourced information from peers about mental health resources drove user engagement, but was difficult to obtain; and (5) Users often turned to the app when they had an immediate need for mental health information, rather than using it to track mental health information over time. Conclusions: Content, user experience, user-centeredness, and peer support are important determinants of user engagement with mobile mental health apps among postsecondary students. In this study, participants disengaged when the app did not meet their expectations on these determinants. Future studies on user engagement should further explore the effectiveness of different features and the relative importance of various criteria for high-quality apps. Further focus on these issues may inform the creation of interventions that increase student engagement and align with their mental health needs. Trial Registration: ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6446 %M 33797395 %R 10.2196/23447 %U https://mental.jmir.org/2021/4/e23447 %U https://doi.org/10.2196/23447 %U http://www.ncbi.nlm.nih.gov/pubmed/33797395 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e22960 %T Effects of App-Based Transitional Care on the Self-Efficacy and Quality of Life of Patients With Spinal Cord Injury in China: Randomized Controlled Trial %A Liu,Ting %A Xie,Sumei %A Wang,Yingmin %A Tang,Jie %A He,Xiaokuo %A Yan,Tiebin %A Li,Kun %+ School of Nursing, Sun Yat-sen University, No 74 Zhong Shan Second Road, Guangzhou, 510080, China, 86 13822206519, likun22@mail.sysu.edu.cn %K spinal cord injury %K mobile app %K transitional care %K self-efficacy %K quality of life %D 2021 %7 1.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Spinal cord injury (SCI) severely impairs the physical and mental health of patients, decreasing their self-efficacy in coping with daily life and quality of life (QOL). In China, a large gap remains between the complex long-term health needs of SCI patients and the current community care system. With the prevalence of mobile terminals, the usage of mobile health apps has the potential to fill this gap by extending qualified medical resources to the families of SCI patients. Our team developed the app Together for the transitional care of home-dwelling SCI patients in China. Objective: This study aimed to evaluate the effects of app-based transitional care on the self-efficacy and QOL of SCI patients. Methods: Through a three-round Delphi process, an Android app was designed. Both medical staff and patients could access the app. Medical staff used it for providing remote transitional care to SCI patients. Patients used it to view transitional care time and send messages to medical staff. Thereafter, a multicenter and assessor-blinded randomized controlled trial was conducted. Participants (n=98) who had SCI and lived at home following discharge were recruited and randomly assigned to a study group (n=49) and control group (n=49) using a randomized number list in four research centers. Patients in both groups received systematic discharge education before discharge. The study group received five follow-ups conducted by trained nurses through the app, which had four core functions, namely remote assessment, health education, interdisciplinary referral, and patient interaction, at weeks 2, 4, 6, 8, and 12 following discharge. The control group received a routine telephone follow-up conducted by nurses at week 12 following discharge. The outcome measures were the Moorong Self-Efficacy Scale (MSES) and 36-item Short-Form Health Survey (SF-36) scores. Data were collected before discharge (T0) and at weeks 12 (T1) and 24 following discharge (T2). Differences between the groups were tested by repeated measures analysis of variance and simple effect analysis. Results: After the follow-up, the total MSES scores in the study group improved over time (T0=67.80, T1=71.90, and T2=76.29) and were higher than those in the control group (T2=64.49) at 24 weeks following discharge (simple effect analysis: F1=8.506, P=.004). Regarding the total SF-36 score, although it was higher in patients from the study group (T2=65.36) than those from the control group (T2=58.77) at 24 weeks following discharge, only time effects were significant (F2,95=6.671, P=.002) and neither the group effects nor the interaction effects influenced the change in QOL (group effects: F1,96=0.082, P=.78; interaction effects: F2,95=3.059, P=.052). Conclusions: This study confirmed that app-based transitional care improves the self-efficacy of SCI patients. Nevertheless, QOL improvement is not yet evident. Future investigations with larger sample sizes and longer observation periods are warranted to further verify the effects. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012317; http://www.chictr.org.cn/showproj.aspx?proj=19828 %M 33792555 %R 10.2196/22960 %U https://mhealth.jmir.org/2021/4/e22960 %U https://doi.org/10.2196/22960 %U http://www.ncbi.nlm.nih.gov/pubmed/33792555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21839 %T A Uniquely Targeted, Mobile App-Based HIV Prevention Intervention for Young Transgender Women: Adaptation and Usability Study %A Kuhns,Lisa M %A Hereth,Jane %A Garofalo,Robert %A Hidalgo,Marco %A Johnson,Amy K %A Schnall,Rebecca %A Reisner,Sari L %A Belzer,Marvin %A Mimiaga,Matthew J %+ Ann & Robert H Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, 225 E Chicago Avenue, Box 161, Chicago, IL, 60611, United States, 1 312 227 7760, lkuhns@luriechildrens.org %K transgender persons %K HIV %K mobile app %K mHealth %K mobile phone %D 2021 %7 31.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Young transgender women (YTW) are a key population for HIV-related risk reduction, yet very few interventions have been developed to meet their needs. Mobile health interventions with the potential for both efficacy and wide reach are a promising strategy to reduce HIV risk among YTW. Objective: This study aims to adapt an efficacious group-based intervention to a mobile app, Project LifeSkills, to reduce HIV risk among YTW, and to test its acceptability and usability. Methods: The group-based intervention was adapted to a mobile app, LifeSkills Mobile, with input from an expert advisory group and feedback from YTW collected during user-centered design sessions. A beta version of the app was then tested in a usability evaluation using a think-aloud protocol with debriefing interviews, recordings of screen activity, and assessments of usability via the Post-Study System Usability Questionnaire (PSSUQ) and the Health Information Technology Usability Evaluation Scale (Health-ITUES). Results: YTW (n=8; age: mean 24 years, SD 3 years; racial or ethnic minority: 7/8, 88%) provided feedback on the app prototype in design sessions and then tested a beta version of the app in a usability trial (n=10; age: mean 24 years, SD 3 years; racial or ethnic minority: 8/10, 80%). Both usability ratings (Health-ITUES: mean 4.59, SD 0.86; scale range: 1-5) and ratings for satisfaction and accessibility (PSSUQ: mean 4.64, SD 0.90; scale range 1-5) were in the good to excellent range. No functional bugs were identified, and all mobile activities were deployed as expected. Participant feedback from the usability interviews indicated very good salience of the intervention content among the focal population. Participants’ suggestions to further increase app engagement included adding animation, adding audio, and reducing the amount text. Conclusions: We conclude that the LifeSkills Mobile app is a highly usable and engaging mobile app for HIV prevention among YTW. %M 33787503 %R 10.2196/21839 %U https://www.jmir.org/2021/3/e21839 %U https://doi.org/10.2196/21839 %U http://www.ncbi.nlm.nih.gov/pubmed/33787503 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e18079 %T User-Centered Design Process of an mHealth App for Health Professionals: Case Study %A Saparamadu,Amarasinghe Arachchige Don Nalin Samandika %A Fernando,Piyum %A Zeng,Peizi %A Teo,Henry %A Goh,Andrew %A Lee,Joanne Mee Yin %A Lam,Choong Weng Leslie %+ MOH Holdings Private Limited, 1 Maritime Square, Singapore, 099253, Singapore, 65 84980484, samandika@icloud.com %K user-centered design %K participatory design %K mobile health applications %K mHealth %K smartphones %K health professionals %K healthcare %K human-computer interaction %K mobile phones %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: User-centered design processes are infrequently employed and not fully explored for building mobile health (mHealth) apps that are particularly targeted to health professionals as end users. The authors have used a user-centered design–based approach to build an mHealth app for health professionals, tasked to deliver medical laboratory-related information on a daily basis. Objective: Our objective is to generate a simple and functional user-centered design process for mHealth apps for health professionals. This paper presents the key learnings from design activities. Methods: A stratified random sample of doctors and nurses was recruited for the study. The design activities were planned in the following sequence: focus group discussion for situation analysis and information architecture, design activity 1 for wireframe designing, design activity 2 for wireframe testing, and user testing sessions 1 and 2. Results: The final design and functions of the app, information architecture, and interactive elements were largely influenced by the participatory design–based user-centered design activities. As a result of the design process, we could identify the mental models of processing requests for information and personal preferences based on the experience. These findings were directly or indirectly incorporated into the app design. Furthermore, finding alternative ways of working within time constraints and cultural barriers and the methods employed to manage the challenges of interdisciplinary discourse stood out among the lessons learned. Conclusions: We recommend a user-centered design process based on a participatory design approach in mHealth app design, enriched with focus group discussions where possible. %M 33769297 %R 10.2196/18079 %U https://mhealth.jmir.org/2021/3/e18079 %U https://doi.org/10.2196/18079 %U http://www.ncbi.nlm.nih.gov/pubmed/33769297 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24023 %T Development of a Smartphone App to Predict and Improve the Rates of Suicidal Ideation Among Transgender Persons (TransLife): Qualitative Study %A Dubov,Alex %A Fraenkel,Liana %A Goldstein,Zil %A Arroyo,Hansel %A McKellar,Derek %A Shoptaw,Steve %+ School of Behavioral Health, Loma Linda University, 11065 Campus Street, Loma Linda, CA, 92350, United States, 1 9095581900, adubov@llu.edu %K mobile health %K mHealth %K mobile app %K pilot study %K qualitative research %K user-centered design %K acceptability study %K health services for transgender persons %K suicide prevention %K mental health %K mobile phone %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Transgender people are at a high risk of suicidal ideation, suicide attempts, and deaths. Among transgender individuals, 77% and 41% engage in suicidal ideation and suicide attempt in their lifetime, respectively, which exceeds the general population rates (9.2% and 2.7%, respectively). Traditionally, suicide risk factors have been studied over a long period between measurements, making it difficult to understand the short-term variability in suicide risk. Mobile phone apps offer an opportunity to understand the immediate precursors of suicidality through the assessment of behaviors and moods in real time. This is the first study to use a mobile phone app (TransLife) to understand the short-term risk factors for suicide among transgender individuals. Objective: This study aims to beta test the usability of an evidence-informed mobile health (mHealth) suicide prevention phone app, TransLife. The primary aims are to obtain preliminary data on user engagement and satisfaction with the app, and to assess the feasibility of completing ecological momentary assessments (mood logs) within the app. Methods: We used qualitative methods and an exploratory research approach that combined naturalistic app use, focus groups, and semistructured phone interviews. The focus group was informed about the development of the prototype. We conducted a 3-week evaluation to determine engagement and obtain detailed user feedback about the app. After participation in the pilot, phone-based, semistructured, and audio-recorded exit interviews were conducted with the research participants. Results: In total, 16 transgender individuals participated in this study. On average, users logged in 4 (SD 2.7) times a week and spent approximately 5 (SD 3.5) minutes on the app per log-in. A total of 6 major themes emerged in this study. These themes focused on the app’s functionality, satisfaction with using the app, perceived ease of use, perceived safety of providing personal data within the app, trusting the app enough to share personal feelings, and features that make this app engaging. These themes suggest that TransLife is an engaging, useful, and acceptable mHealth intervention. Participants reported that the app was easy to use and understand, supported mental self-care, promoted self-awareness, and helped them identify triggers of negative moods. Conclusions: The results of this pilot study indicate that TransLife is an engaging, acceptable, and potentially effective mHealth intervention. Transgender participants reported many advantages of using TransLife, such as being able to track their mood, connecting to the community, and accessing local resources. This study provides initial support for the acceptability and usability of TransLife as an mHealth intervention designed for the transgender community. %M 33596181 %R 10.2196/24023 %U https://www.jmir.org/2021/3/e24023 %U https://doi.org/10.2196/24023 %U http://www.ncbi.nlm.nih.gov/pubmed/33596181 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e26355 %T Designing an mHealth Intervention for People With Visible Differences Based on Acceptance and Commitment Therapy: Participatory Study Gaining Stakeholders’ Input %A Zucchelli,Fabio %A Donnelly,Olivia %A Rush,Emma %A Smith,Harriet %A Williamson,Heidi %A , %+ The Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom, 44 11732 83882, fabio.zucchelli@uwe.ac.uk %K mobile health %K acceptance and commitment therapy %K appearance %K qualitative %K participatory design %K mobile phone %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Given their growing popularity, mobile health (mHealth) apps may offer a viable method of delivering psychological interventions for people with an atypical appearance (ie, visible difference) who struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible differences. We planned to design an ACT-based mHealth intervention (ACT It Out) for this population. Objective: The aim of this study is to gain key stakeholder input from user representatives and psychological clinicians to optimize the intervention’s design for future development and uptake. To do so, we explored considerations relating to mHealth as a delivery platform for adults with visible differences and elicited stakeholders’ design preferences and ideas based on initial author-created content. Methods: Within a participatory design framework, we used a mix of qualitative methods, including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all analyzed using template analysis. A total of 6 user representatives and 8 clinicians were recruited for this study. Results: Our findings suggest that there are likely to be strengths and challenges of mHealth as an intervention platform for the study population, with key concerns being user safeguarding and program adherence. Participants expressed design preferences toward relatable human content, interactive and actionable features, flexibility of use, accessibility, and engaging content. Conclusions: The findings offer valuable design directions for ACT It Out and related interventions, emphasizing the need to carefully guide users through the intervention while acknowledging the limited time and space that mHealth affords. %M 33759791 %R 10.2196/26355 %U https://formative.jmir.org/2021/3/e26355 %U https://doi.org/10.2196/26355 %U http://www.ncbi.nlm.nih.gov/pubmed/33759791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24850 %T A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study %A Prochaska,Judith J %A Vogel,Erin A %A Chieng,Amy %A Kendra,Matthew %A Baiocchi,Michael %A Pajarito,Sarah %A Robinson,Athena %+ Stanford Prevention Research Center, School of Medicine, Stanford University, Medical School Office Building, X316, 1265 Welch Road, Stanford, CA, 94305, United States, 1 650 724 3608, jpro@stanford.edu %K artificial intelligence %K conversational agent %K chatbot %K addiction %K substance misuse %K treatment %K acceptability %K feasibility %K craving %K psychoeducation %K psychotherapeutic %K mobile phone %D 2021 %7 23.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Misuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers to accessing care. Woebot is a mental health digital solution informed by cognitive behavioral therapy and built upon an artificial intelligence–driven platform to deliver tailored content to users. In a previous 2-week randomized controlled trial, Woebot alleviated depressive symptoms. Objective: This study aims to adapt Woebot for the treatment of substance use disorders (W-SUDs) and examine its feasibility, acceptability, and preliminary efficacy. Methods: American adults (aged 18-65 years) who screened positive for substance misuse without major health contraindications were recruited from online sources and flyers and enrolled between March 27 and May 6, 2020. In a single-group pre/postdesign, all participants received W-SUDs for 8 weeks. W-SUDs provided mood, craving, and pain tracking and modules (psychoeducational lessons and psychotherapeutic tools) using elements of dialectical behavior therapy and motivational interviewing. Paired samples t tests and McNemar nonparametric tests were used to examine within-subject changes from pre- to posttreatment on measures of substance use, confidence, cravings, mood, and pain. Results: The sample (N=101) had a mean age of 36.8 years (SD 10.0), and 75.2% (76/101) of the participants were female, 78.2% (79/101) were non-Hispanic White, and 72.3% (73/101) were employed. Participants’ W-SUDs use averaged 15.7 (SD 14.2) days, 12.1 (SD 8.3) modules, and 600.7 (SD 556.5) sent messages. About 94% (562/598) of all completed psychoeducational lessons were rated positively. From treatment start to end, in-app craving ratings were reduced by half (87/101, 86.1% reporting cravings in the app; odds ratio 0.48, 95% CI 0.32-0.73). Posttreatment assessment completion was 50.5% (51/101), with better retention among those who initially screened higher on substance misuse. From pre- to posttreatment, confidence to resist urges to use substances significantly increased (mean score change +16.9, SD 21.4; P<.001), whereas past month substance use occasions (mean change −9.3, SD 14.1; P<.001) and scores on the Alcohol Use Disorders Identification Test-Concise (mean change −1.3, SD 2.6; P<.001), 10-item Drug Abuse Screening Test (mean change −1.2, SD 2.0; P<.001), Patient Health Questionnaire-8 item (mean change 2.1, SD 5.2; P=.005), Generalized Anxiety Disorder-7 (mean change −2.3, SD 4.7; P=.001), and cravings scale (68.6% vs 47.1% moderate to extreme; P=.01) significantly decreased. Most participants would recommend W-SUDs to a friend (39/51, 76%) and reported receiving the service they desired (41/51, 80%). Fewer felt W-SUDs met most or all of their needs (22/51, 43%). Conclusions: W-SUDs was feasible to deliver, engaging, and acceptable and was associated with significant improvements in substance use, confidence, cravings, depression, and anxiety. Study attrition was high. Future research will evaluate W-SUDs in a randomized controlled trial with a more diverse sample and with the use of greater study retention strategies. Trial Registration: ClinicalTrials.gov NCT04096001; http://clinicaltrials.gov/ct2/show/NCT04096001. %M 33755028 %R 10.2196/24850 %U https://www.jmir.org/2021/3/e24850 %U https://doi.org/10.2196/24850 %U http://www.ncbi.nlm.nih.gov/pubmed/33755028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24667 %T A Mobile Patient-Facing App for Tracking Patient-Reported Outcomes in Head and Neck Cancer Survivors: Single-Arm Feasibility Study %A Teckie,Sewit %A Solomon,Jeffrey %A Kadapa,Karthik %A Sanchez,Keisy %A Orner,David %A Kraus,Dennis %A Kamdar,Dev P %A Pereira,Lucio %A Frank,Douglas %A Diefenbach,Michael %+ Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 130 East 77th Street, New York, NY, 10010, United States, 1 212 434 2919, steckie@northwell.edu %K mHealth %K ePROs %K head and neck cancer %K mobile phone %D 2021 %7 19.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with head and neck cancer (HNC) frequently experience disease-related symptoms and treatment adverse effects that impact their overall quality of life. Cancer-specific mobile health apps for patient-related outcomes allow patients to communicate with their clinicians and proactively track their symptoms, which have been shown to improve clinical management and disease outcomes. Objective: The purpose of this study was to evaluate the feasibility of LogPAL, a novel iPhone-based mobile health app designed to help HNC survivors track and manage their posttreatment symptoms. Methods: Patients who completed curative treatment for HNC in the preceding 24 months were recruited from 2 clinical sites within a single institution. Upon enrollment, participants completed a brief sociodemographic survey, downloaded the app onto their iPhone devices, and were asked to complete a series of biweekly questionnaires (based on the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) via the app for an 8-week study period. The primary feasibility endpoints included retention (retaining >80% of the enrolled participants for the duration of the study period), adherence (>50% of the participants completing 100% of the questionnaires over the study period), and usability (a mean system usability scale [SUS] score >68). Additional postintervention questions were collected to assess perceived usefulness, acceptance, and overall satisfaction. Results: Between January and October 2019, 38 participants were enrolled in the study. Three participants dropped out, and 3 were classified as nonusers. The remaining 32 (87%) were eligible for analysis. Their mean age was 57.8 (SD 12.3) years (range 24-77 years, 81% [26/32] male). Overall, 375 of 512 (73.2%) questionnaires were completed, with 17 (53%) of the 32 participants adherent. Participant-reported usability was acceptable; the mean SUS score was 71.9 (95% CI 64.3-79.5) with high satisfaction of LogPAL usefulness and likelihood to recommend to other cancer survivors. Conclusions: This single-arm prospective pilot study showed that LogPAL is a feasible, regularly used, accepted app for HNC survivors, justifying a full-scale pilot. Based on the findings from this study, future iterations will aim to improve usability and test intervention efficacy. %M 33739291 %R 10.2196/24667 %U https://formative.jmir.org/2021/3/e24667 %U https://doi.org/10.2196/24667 %U http://www.ncbi.nlm.nih.gov/pubmed/33739291 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 1 %P e19519 %T Using a Web-Based App to Deliver Rehabilitation Strategies to Persons With Chronic Conditions: Development and Usability Study %A Richardson,Julie %A Letts,Lori %A Sinclair,Susanne %A Chan,David %A Miller,Jordan %A Donnelly,Catherine %A Smith-Turchyn,Jenna %A Wojkowski,Sarah %A Gravesande,Janelle %A Loyola Sánchez,Adalberto %+ School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main Street West, IAHS Room 403, Hamilton, ON, L8S 1C7, Canada, 1 905 525 9140 ext 27811, jrichard@mcmaster.ca %K rehabilitation %K physiotherapy %K occupational therapy %K self-management %K function %K web-based application %K usability %K user-centered design %D 2021 %7 18.3.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. Objective: This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. Methods: The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. Results: The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ≥45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. Conclusions: We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps. %M 33734090 %R 10.2196/19519 %U https://rehab.jmir.org/2021/1/e19519 %U https://doi.org/10.2196/19519 %U http://www.ncbi.nlm.nih.gov/pubmed/33734090 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24726 %T eHealth Program to Reduce Hospitalizations Due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Retrospective Study %A van Buul,Amanda R %A Derksen,Caroline %A Hoedemaker,Ouke %A van Dijk,Oscar %A Chavannes,Niels H %A Kasteleyn,Marise J %+ Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands, 31 715297550, a.r.van_buul@lumc.nl %K COPD %K eHealth %K exacerbations %K hospitalizations %K mHealth %D 2021 %7 18.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. eHealth interventions might improve outcomes and decrease costs. Objective: This study aimed to evaluate the effect of an eHealth program on COPD hospitalizations and exacerbations. Methods: This was a real-world study conducted from April 2018 to December 2019 in the Bravis Hospital, the Netherlands. An eHealth program (EmmaCOPD) was offered to COPD patients at risk of exacerbations. EmmaCOPD consisted of an app that used questionnaires (to monitor symptoms) and a step counter (to monitor the number of steps) to detect exacerbations. Patients and their buddies received feedback when their symptoms worsened or the number of steps declined. Generalized estimating equations were used to compare the number of days admitted to the hospital and the total number of exacerbations 12 months before and (max) 18 months after the start of EmmaCOPD. We additionally adjusted for the potential confounders of age, sex, COPD severity, and inhaled corticosteroid use. Results: The 29 included patients had a mean forced expiratory volume in 1 second of 45.5 (SD 17.7) %predicted. In the year before the intervention, the median total number of exacerbations was 2.0 (IQR 2.0-3.0). The median number of hospitalized days was 8.0 days (IQR 6.0-16.5 days). Afterwards, there was a median 1.0 (IQR 0.0-2.0) exacerbation and 2.0 days (IQR 0.0-4.0 days) of hospitalization. After initiation of EmmaCOPD, both the number of hospitalized days and total number of exacerbations decreased significantly (incidence rate ratio 0.209, 95% CI 0.116-0.382; incidence rate ratio 0.310, 95% CI 0.219-0.438). Adjustment for confounders did not affect the results. Conclusions: The eHealth program seems to reduce the number of total exacerbations and number of days of hospitalization due to exacerbations of COPD. %M 33734091 %R 10.2196/24726 %U https://formative.jmir.org/2021/3/e24726 %U https://doi.org/10.2196/24726 %U http://www.ncbi.nlm.nih.gov/pubmed/33734091 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e15032 %T An 11-Item Measure of User- and Human-Centered Design for Personal Health Tools (UCD-11): Development and Validation %A Witteman,Holly O %A Vaisson,Gratianne %A Provencher,Thierry %A Chipenda Dansokho,Selma %A Colquhoun,Heather %A Dugas,Michele %A Fagerlin,Angela %A Giguere,Anik MC %A Haslett,Lynne %A Hoffman,Aubri %A Ivers,Noah M %A Légaré,France %A Trottier,Marie-Eve %A Stacey,Dawn %A Volk,Robert J %A Renaud,Jean-Sébastien %+ Université Laval, 1050, avenue de la Médecine, Quebec City, QC, Canada, 1 418 656 2131, holly.witteman@fmed.ulaval.ca %K patient-centered care %K patient participation %K health services research %K validation studies as topic %K surveys and questionnaires %K humans %K user-centred design, human-centred design %K user-centered design %K human-centered design %K co-design %K instrument %K scale %K index %K patient and public involvement %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Researchers developing personal health tools employ a range of approaches to involve prospective users in design and development. Objective: The aim of this paper was to develop a validated measure of the human- or user-centeredness of design and development processes for personal health tools. Methods: We conducted a psychometric analysis of data from a previous systematic review of the design and development processes of 348 personal health tools. Using a conceptual framework of user-centered design, our team of patients, caregivers, health professionals, tool developers, and researchers analyzed how specific practices in tool design and development might be combined and used as a measure. We prioritized variables according to their importance within the conceptual framework and validated the resultant measure using principal component analysis with Varimax rotation, classical item analysis, and confirmatory factor analysis. Results: We retained 11 items in a 3-factor structure explaining 68% of the variance in the data. The Cronbach alpha was .72. Confirmatory factor analysis supported our hypothesis of a latent construct of user-centeredness. Items were whether or not: (1) patient, family, caregiver, or surrogate users were involved in the steps that help tool developers understand users or (2) develop a prototype, (3) asked their opinions, (4) observed using the tool or (5) involved in steps intended to evaluate the tool, (6) the process had 3 or more iterative cycles, (7) changes between cycles were explicitly reported, (8) health professionals were asked their opinion and (9) consulted before the first prototype was developed or (10) between initial and final prototypes, and (11) a panel of other experts was involved. Conclusions: The User-Centered Design 11-item measure (UCD-11) may be used to quantitatively document the user/human-centeredness of design and development processes of patient-centered tools. By building an evidence base about such processes, we can help ensure that tools are adapted to people who will use them, rather than requiring people to adapt to tools. %M 33724194 %R 10.2196/15032 %U https://www.jmir.org/2021/3/e15032 %U https://doi.org/10.2196/15032 %U http://www.ncbi.nlm.nih.gov/pubmed/33724194 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e20890 %T An mHealth App (Speech Banana) for Auditory Training: App Design and Development Study %A Ratnanather,J Tilak %A Bhattacharya,Rohit %A Heston,Margo B %A Song,Joanne %A Fernandez,Lindsey R %A Lim,Hong Seo %A Lee,Seung-Wook %A Tam,Edric %A Yoo,Sungho %A Bae,Seung-Ho %A Lam,Inez %A Jeon,Hyoung Won %A Chang,Son A %A Koo,Ja-Won %+ Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 31 787 7402, speechbanana@jhu.edu %K speech therapy %K mobile phone %K computers, handheld %K cochlear implants %K hearing aids %D 2021 %7 15.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the growing adult population using electronic hearing devices such as cochlear implants or hearing aids, there is an increasing worldwide need for auditory training (AT) to promote optimal device use. However, financial resources and scheduling conflicts make clinical AT infeasible. Objective: To address this gap between need and accessibility, we primarily aimed to develop a mobile health (mHealth) app called Speech Banana for AT. The app would be substantially more affordable and portable than clinical AT; would deliver a validated training model that is reflective of modern techniques; and would track users’ progress in speech comprehension, providing greater continuity between periodic in-person visits. To improve international availability, our secondary aim was to implement the English language training model into Korean as a proof of concept for worldwide usability. Methods: A problem- and objective-centered Design Science Research Methodology approach was adopted to develop the Speech Banana app. A review of previous literature and computer-based learning programs outlined current AT gaps, whereas interviews with speech pathologists and users clarified the features that were addressed in the app. Past and present users were invited to evaluate the app via community forums and the System Usability Scale. Results: Speech Banana has been implemented in English and Korean languages for iPad and web use. The app comprises 38 lessons, which include analytic exercises pairing visual and auditory stimuli, and synthetic quizzes presenting auditory stimuli only. During quizzes, users type the sentence heard, and the app provides visual feedback on performance. Users may select a male or female speaker and the volume of background noise, allowing for training with a range of frequencies and signal-to-noise ratios. There were more than 3200 downloads of the English iPad app and almost 100 downloads of the Korean app; more than 100 users registered for the web apps. The English app received a System Usability Scale rating of “good” from 6 users, and the Korean app received a rating of “OK” from 16 users. Conclusions: Speech Banana offers AT accessibility with a validated curriculum, allowing users to develop speech comprehension skills with the aid of a mobile device. This mHealth app holds potential as a supplement to clinical AT, particularly in this era of global telemedicine. %M 33720025 %R 10.2196/20890 %U https://mhealth.jmir.org/2021/3/e20890 %U https://doi.org/10.2196/20890 %U http://www.ncbi.nlm.nih.gov/pubmed/33720025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e18325 %T Cognitive Bias Modification Training to Improve Implicit Vitality in Patients With Breast Cancer: App Design Using a Cocreation Approach %A Wolbers,Roos %A Bode,Christina %A Siemerink,Ester %A Siesling,Sabine %A Pieterse,Marcel %+ Centre for eHealth and Wellbeing Research, University of Twente, P.O. Box 217, Enschede, 7500 AE, Netherlands, 31 534896044, c.bode@utwente.nl %K breast cancer %K cognitive bias modification %K eHealth %K fatigue %K oncology %K psychology %K vitality %D 2021 %7 10.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: More than 50% of all patients with breast cancer experience fatigue symptoms during and after their treatment course. Recent evidence has shown that fatigue is partly driven by cognitive biases such as the self-as-fatigued identity bias, which may be corrected with computer-based cognitive bias modification (CBM) techniques. Objective: The aim of this study was to design a CBM-training app by adopting a cocreation approach. Methods: Semistructured interviews were conducted with 7 health care professionals, 3 patients with breast cancer, and 2 patient advocates. The aim of the interviews was to collect input for the design of the CBM training, taking the values and preferences of the stakeholders into account, and to determine the timing and implementation of the training in the treatment course. Results: Overall, the interviews showed that the concept of CBM was accepted among all stakeholders. Important requirements were revealed such as the training needs to be simple and undemanding, yet engaging and persuasive. Based on the results, an eHealth app IVY (Implicit VitalitY) was created. The findings from the interviews suggested that IVY should be offered early in the breast cancer treatment course and should be carefully aligned with clinical treatment. Conclusions: The findings of this study show that using CBM as a preventive approach to target cancer-related fatigue is an innovative technique, and this approach was embraced by breast cancer stakeholders. Our study suggests that CBM training has several benefits such as being easy to use and potentially increasing perceived self-control in patients. %M 33688833 %R 10.2196/18325 %U https://formative.jmir.org/2021/3/e18325 %U https://doi.org/10.2196/18325 %U http://www.ncbi.nlm.nih.gov/pubmed/33688833 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e26702 %T Going Remote—Demonstration and Evaluation of Remote Technology Delivery and Usability Assessment With Older Adults: Survey Study %A Hill,Jordan R %A Harrington,Addison B %A Adeoye,Philip %A Campbell,Noll L %A Holden,Richard J %+ Department of Medicine, Indiana University School of Medicine, 1101 W 10th St, Indianapolis, IN, 46202, United States, 1 7655438559, jrh6@iu.edu %K COVID-19 %K mobile usability testing %K usability inspection %K methods %K aging %K agile %K mobile phone %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic necessitated “going remote” with the delivery, support, and assessment of a study intervention targeting older adults enrolled in a clinical trial. While remotely delivering and assessing technology is not new, there are few methods available in the literature that are proven to be effective with diverse populations, and none for older adults specifically. Older adults comprise a diverse population, including in terms of their experience with and access to technology, making this a challenging endeavor. Objective: Our objective was to remotely deliver and conduct usability testing for a mobile health (mHealth) technology intervention for older adult participants enrolled in a clinical trial of the technology. This paper describes the methodology used, its successes, and its limitations. Methods: We developed a conceptual model for remote operations, called the Framework for Agile and Remote Operations (FAR Ops), that combined the general requirements for spaceflight operations with Agile project management processes to quickly respond to this challenge. Using this framework, we iteratively created care packages that differed in their contents based on participant needs and were sent to study participants to deliver the study intervention—a medication management app—and assess its usability. Usability data were collected using the System Usability Scale (SUS) and a novel usability questionnaire developed to collect more in-depth data. Results: In the first 6 months of the project, we successfully delivered 21 care packages. We successfully designed and deployed a minimum viable product in less than 6 weeks, generally maintained a 2-week sprint cycle, and achieved a 40% to 50% return rate for both usability assessment instruments. We hypothesize that lack of engagement due to the pandemic and our use of asynchronous communication channels contributed to the return rate of usability assessments being lower than desired. We also provide general recommendations for performing remote usability testing with diverse populations based on the results of our work, including implementing screen sharing capabilities when possible, and determining participant preference for phone or email communications. Conclusions: The FAR Ops model allowed our team to adopt remote operations for our mHealth trial in response to interruptions from the COVID-19 pandemic. This approach can be useful for other research or practice-based projects under similar circumstances or to improve efficiency, cost, effectiveness, and participant diversity in general. In addition to offering a replicable approach, this paper tells the often-untold story of practical challenges faced by mHealth projects and practical strategies used to address them. Trial Registration: ClinicalTrials.gov NCT04121858; https://clinicaltrials.gov/ct2/show/NCT04121858 %M 33606655 %R 10.2196/26702 %U https://mhealth.jmir.org/2021/3/e26702 %U https://doi.org/10.2196/26702 %U http://www.ncbi.nlm.nih.gov/pubmed/33606655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18224 %T Perspectives From Underserved African Americans and Their Health Care Providers on the Development of a Diabetes Self-Management Smartphone App: Qualitative Exploratory Study %A Barber-Gumbs,Tai %A Trolle Lagerros,Ylva %A Sena,Laura M %A Gittelsohn,Joel %A Chang,Larry W %A Zachary,Wayne W %A Surkan,Pamela J %+ Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Room E5523, Baltimore, MD, 21205-2179, United States, 1 410 502 7396, psurkan@jhu.edu %K diabetes %K mHealth %K type 2 diabetes mellitus %K diabetes self-management %K mobile app %K mobile phone %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 2 diabetes mellitus (T2DM) affects approximately 10% of the US population, disproportionately afflicting African Americans. Smartphone apps have emerged as promising tools to improve diabetes self-management, yet little is known about the use of this approach in low-income minority communities. Objective: The goal of the study was to explore which features of an app were prioritized for people with T2DM in a low-income African American community. Methods: Between February 2016 and May 2018, we conducted formative qualitative research with 78 participants to explore how a smartphone app could be used to improve diabetes self-management. Information was gathered on desired features, and app mock-ups were presented to receive comments and suggestions of improvements from smartphone users with prediabetes and T2DM, their friends and family members, and health care providers; data were collected from six interactive forums, one focus group, and 15 in-depth interviews. We carried out thematic data analysis using an inductive approach. Results: All three types of participants reported that difficulty with accessing health care was a main problem and suggested that an app could help address this. Participants also indicated that an app could provide information for diabetes education and self-management. Other suggestions included that the app should allow people with T2DM to log and track diabetes care–related behaviors and receive feedback on their progress in a way that would increase engagement in self-management among persons with T2DM. Conclusions: We identified educational and tracking smartphone features that can guide development of diabetes self-management apps for a low-income African American population. Considering those features in combination gives rise to opportunities for more advanced support, such as determining self-management recommendations based on data in users’ logs. %M 33635279 %R 10.2196/18224 %U https://formative.jmir.org/2021/2/e18224 %U https://doi.org/10.2196/18224 %U http://www.ncbi.nlm.nih.gov/pubmed/33635279 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18172 %T Co-Designing a Mobile App to Improve Mental Health and Well-Being: Focus Group Study %A Alqahtani,Felwah %A Winn,Andrea %A Orji,Rita %+ Faculty of Computer Science, Dalhousie University, 6299 South St, Halifax, NS, B3H 4R2, Canada, 1 9027892230, Felwah.alqahtani@dal.ca %K mental health %K mobile app %K focus groups %K design recommendation %K mobile phone %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent advances in mobile technology have created opportunities to develop mobile apps to aid and assist people in achieving various health and wellness goals. Mental health apps hold significant potential to assist people affected by various mental health issues at any time they may need it, considering the ubiquitous nature of mobile phones. However, there is a need for research to explore and understand end users’ perceptions, needs, and concerns with respect to such technologies. Objective: The aim of this paper is to explore the opinions, perceptions, preferences, and experiences of people who have experienced some form of mental health issues based on self-diagnosis to inform the design of a next-generation mental health app that would be substantially more engaging and effective than the currently available apps to improve mental health and well-being. Methods: We conducted six focus group sessions with people who had experienced mental health issues based on self-diagnosis (average age 26.7 years, SD 23.63; 16/32, 50% male; 16/32, 50% female). We asked participants about their experiences with mental health issues and their viewpoints regarding two existing mental health apps (the Happify app and the Self-Help Anxiety Management app). Finally, participants were engaged in a design session where they each sketched a design for their ideal mental health and well-being mobile app. Results: Our findings revealed that participants used strategies to deal with their mental health issues: doing something to distract themselves from their current negative mood, using relaxation exercises and methods to relieve symptoms, interacting with others to share their issues, looking for an external source to solve their problems, and motivating themselves by repeating motivational sentences to support themselves or by following inspirational people. Moreover, regarding the design of mental health apps, participants identified that general design characteristics; personalization of the app, including tracking and feedback, live support, and social community; and providing motivational content and relaxation exercises are the most important features that users want in a mental health app. In contrast, games, relaxation audio, the Google map function, personal assistance to provide suggestions, goal setting, and privacy preservation were surprisingly the least requested features. Conclusions: Understanding end users’ needs and concerns about mental health apps will inform the future design of mental health apps that are useful to and used by many people. %M 33635281 %R 10.2196/18172 %U https://formative.jmir.org/2021/2/e18172 %U https://doi.org/10.2196/18172 %U http://www.ncbi.nlm.nih.gov/pubmed/33635281 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e22877 %T Smoking Cessation Using Wearable Sensors: Protocol for a Microrandomized Trial %A Hernandez,Laura M %A Wetter,David W %A Kumar,Santosh %A Sutton,Steven K %A Vinci,Christine %+ Moffitt Cancer Center, 4115 E. Fowler Avenue, Tampa, FL, 33617, United States, 1 813 745 5421, Christine.Vinci@moffitt.org %K mHealth %K microrandomized trial %K smoking cessation %K mindfulness %K tobacco %K mobile phone %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cigarette smoking has numerous health consequences and is the leading cause of morbidity and mortality in the United States. Mindfulness has the ability to enhance resilience to stressors and can strengthen an individual’s ability to deal with discomfort, which may be particularly useful when managing withdrawal and craving to smoke. Objective: This study aims to evaluate feasibility results from an intervention that provides real-time, real-world mindfulness strategies to a sample of racially and ethnically diverse smokers making a quit attempt. Methods: This study uses a microrandomized trial design to deliver mindfulness-based strategies in real time to individuals attempting to quit smoking. Data will be collected via wearable sensors, a study smartphone, and questionnaires filled out during the in-person study visits. Results: Recruitment is complete, and data management is ongoing. Conclusions: The data collected during this feasibility trial will provide preliminary findings about whether mindfulness strategies delivered in real time are a useful quit smoking aid that warrants additional investigation. Trial Registration: Clinicaltrials.gov NCT03404596; https://clinicaltrials.gov/ct2/show/NCT03404596 International Registered Report Identifier (IRRID): DERR1-10.2196/22877 %M 33625366 %R 10.2196/22877 %U https://www.researchprotocols.org/2021/2/e22877 %U https://doi.org/10.2196/22877 %U http://www.ncbi.nlm.nih.gov/pubmed/33625366 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e24561 %T A Mobile Health App to Support Patients Receiving Medication-Assisted Treatment for Opioid Use Disorder: Development and Feasibility Study %A Waselewski,Marika Elise %A Flickinger,Tabor Elisabeth %A Canan,Chelsea %A Harrington,William %A Franklin,Taylor %A Otero,Kori Nicole %A Huynh,Jacqueline %A Waldman,Ava Lena Davila %A Hilgart,Michelle %A Ingersoll,Karen %A Ait-Daoud Tiouririne,Nassima %A Dillingham,Rebecca Anne %+ Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St, Ann Arbor, MI, 48104, United States, 1 734 647 3305, marikag@med.umich.edu %K opioid use disorder %K mHealth %K retention in care %K self-management %K opioids %K public health %K mobile phone %D 2021 %7 23.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Opioid use disorder (OUD) is a public health crisis with more than 2 million people living with OUD in the United States. Medication-assisted treatment (MAT) is an evidence-based approach for the treatment of OUD that relies on a combination of behavioral therapy and medication. Less than half of those living with OUD are accessing this treatment. Mobile technology can enhance the treatment of chronic diseases in readily accessible and cost-effective ways through self-monitoring and support. Objective: The aim of this study is to describe the adaptation of a mobile platform for patients undergoing treatment for OUD and preliminary pilot testing results. Methods: Our study was conducted with patient and provider participants at the University of Virginia MAT clinic and was approved by the institutional review board. The formative phase included semistructured interviews to understand the needs of patients with OUD, providers’ perspectives, and opportunities for MAT support via a mobile app. A second round of formative interviews used mock-ups of app features to collect feedback on feature function and desirability. Formative participants’ input from 16 interviews then informed the development of a functional smartphone app. Patient participants (n=25) and provider participants (n=3) were enrolled in a 6-month pilot study of the completed platform. Patient app use and usability interviews, including a system usability score and open-ended questions, were completed 1 month into the pilot study. Open-ended responses were analyzed for prevalent themes. Results: Formative interviews resulted in the development of a mobile app, named HOPE, which includes both evidence-based and participant-suggested features. The features included daily prompts for monitoring mood, stress, treatment adherence, and substance use; patient tracking of goals, reminders, and triggering or encouraging experiences; informational resources; an anonymous community board to share support with other patients; and secure messaging for communication between patients and providers. All patient participants engaged with at least one app feature during their first month of pilot study participation, and the daily self-monitoring prompts were the most used. Patients and providers reported high levels of system usability (mean 86.9, SD 10.2 and mean 83.3, SD 12.8, respectively). Qualitative analysis of open-ended usability questions highlighted the value of self-monitoring, access to support through the app, and perceived improvement in connection to care and communication for both patient and provider participants. Conclusions: The use of the HOPE program by pilot participants, high usability scoring, and positive perceptions from 1-month interviews indicate successful program development. By engaging with end users and eliciting feedback throughout the development process, we were able to create an app and a web portal that was highly usable and acceptable to study participants. Further work is needed to understand the program’s effect on clinical outcomes, patient linkage, and engagement in care. %M 33620324 %R 10.2196/24561 %U https://formative.jmir.org/2021/2/e24561 %U https://doi.org/10.2196/24561 %U http://www.ncbi.nlm.nih.gov/pubmed/33620324 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24452 %T A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience %A Anyanwu,Emeka C %A Ward,R Parker %A Shah,Atman %A Arora,Vineet %A Umscheid,Craig A %+ Section of Cardiology, University of Chicago, 5841 S Maryland Avenue, Chicago, IL, 60637, United States, 1 (773) 834 0343, emeka@emeka.ca %K adoption %K communication %K COVID-19 %K hospital %K inpatient %K mHealth %K mobile app %K telemedicine %D 2021 %7 23.2.2021 %9 Short Paper %J JMIR Mhealth Uhealth %G English %X Background: COVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding. Objective: This study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19. Methods: We adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020. Results: On its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number–related suggestions through moblMD. Conclusions: We rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team’s familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care. %M 33513562 %R 10.2196/24452 %U https://mhealth.jmir.org/2021/2/e24452 %U https://doi.org/10.2196/24452 %U http://www.ncbi.nlm.nih.gov/pubmed/33513562 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e22572 %T A Theory-Based mHealth Intervention (Getting Off) for Methamphetamine-Using Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial %A Reback,Cathy J %A Fletcher,Jesse B %A Mata,Raymond P %+ Friends Research Institution, Inc, 6910 Santa Monica Blvd, Los Angeles, CA, 90038, United States, 1 323 463 1601, rmata@friendsresearch.org %K HIV %K AIDS %K methamphetamine %K mHealth %K mobile app %K ART %K mobile phone %D 2021 %7 22.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Methamphetamine (meth) use among men who have sex with men (MSM) is associated with increased HIV prevalence and transmission and substandard advancement along the HIV prevention and care continuum. Given the growth of mobile health (mHealth) technologies, it is no longer necessary to limit meth treatment options to physical, brick-and-mortar sites, and administration using generic, nontailored content. Objective: In a 2-arm randomized controlled trial (RCT; N=300), we aim to evaluate the use of an mHealth intervention (Getting Off) to assess the impact and noninferiority of a cross-platform app (developed from a manualized meth treatment intervention) to help MSM reduce meth use and HIV sexual risk behaviors and improve their advancement along the HIV prevention and care continuum (HIV testing, pre-exposure prophylaxis uptake and persistence, and antiretroviral therapy uptake and adherence). Methods: Participants will be randomized into 2 arms: arm A, with immediate access to the app (immediate delivery: n=150), or arm B, with delayed access to the app after a 30-day period (delayed delivery: n=150). Participants in both arms will use the same Getting Off app and will have 30 days to complete the 24 sessions. Participants will be assessed at the 1-, 2- (delayed delivery arm only), 3-, 6-, and 9-month timepoints to determine observed treatment effects and will be compared with a historical matched sample of participants (n=~600) who received the brick-and-mortar group-based Getting Off intervention. Results: Recruitment began in January 2019 for phase 1, the formative phase. In January and February 2019, 4 focus groups (N=36) were formed to provide input on the adaptation of the group-based manual intervention to a mobile app. Data collection for phase 2, the RCT, is expected to be completed in January 2023. The final results are anticipated in April 2023. Conclusions: By creating a culturally responsive mobile app, Getting Off aims to reduce meth use and improve sexual health outcomes among meth-using MSM. The Getting Off app could have significant public health impact by greatly expanding access to effective, affordable, private, culturally competent, and highly scalable meth treatment for MSM. Trial Registration: Clinicaltrials.gov NCT03884946; https://clinicaltrials.gov/ct2/show/NCT03884946 International Registered Report Identifier (IRRID): DERR1-10.2196/22572 %M 33616547 %R 10.2196/22572 %U https://www.researchprotocols.org/2021/2/e22572 %U https://doi.org/10.2196/22572 %U http://www.ncbi.nlm.nih.gov/pubmed/33616547 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24607 %T Framework for the Design Engineering and Clinical Implementation and Evaluation of mHealth Apps for Sleep Disturbance: Systematic Review %A Aji,Melissa %A Gordon,Christopher %A Stratton,Elizabeth %A Calvo,Rafael A %A Bartlett,Delwyn %A Grunstein,Ronald %A Glozier,Nick %+ Brain and Mind Center, The University of Sydney, Level 5, Professor Marie Bashir Centre, Missenden Road, Camperdown, 2050, Australia, 61 29515 1596, nick.glozier@sydney.edu.au %K mobile applications %K sleep %K insomnia %K internet-based intervention %K mHealth %K mobile health %K systematic review %D 2021 %7 17.2.2021 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. Objective: The aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. Methods: A systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). Results: A total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. Conclusions: This is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation. %M 33595441 %R 10.2196/24607 %U http://www.jmir.org/2021/2/e24607/ %U https://doi.org/10.2196/24607 %U http://www.ncbi.nlm.nih.gov/pubmed/33595441 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e14760 %T A Novel Food Record App for Dietary Assessments Among Older Adults With Type 2 Diabetes: Development and Usability Study %A Jung,Hyunggu %A Demiris,George %A Tarczy-Hornoch,Peter %A Zachry,Mark %+ Department of Computer Science and Engineering, University of Seoul, Information and Technology Building, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul, 02504, Republic of Korea, 82 2 6490 2455, hjung@uos.ac.kr %K mobile health %K older adults %K diabetes %K dietary assessment %K smartphone app %K usability test %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: More than 1 in 4 people in the United States aged 65 years and older have type 2 diabetes. For diabetes care, medical nutrition therapy is recommended as a clinically effective intervention. Previous researchers have developed and validated dietary assessment methods using images of food items to improve the accuracy of self-reporting over traditional methods. Nevertheless, little is known about the usability of image-assisted dietary assessment methods for older adults with diabetes. Objective: The aims of this study were (1) to create a food record app for dietary assessments (FRADA) that would support image-assisted dietary assessments, and (2) to evaluate the usability of FRADA for older adults with diabetes. Methods: For the development of FRADA, we identified design principles that address the needs of older adults and implemented three fundamental tasks required for image-assisted dietary assessments: capturing, viewing, and transmitting images of food based on the design principles. For the usability assessment of FRADA, older adults aged 65 to 80 years (11 females and 3 males) were assigned to interact with FRADA in a lab-based setting. Participants’ opinions of FRADA and its usability were determined by a follow-up survey and interview. As an evaluation indicator of usability, the responses to the survey, including an after-scenario questionnaire, were analyzed. Qualitative data from the interviews confirmed the responses to the survey. Results: We developed a smartphone app that enables older adults with diabetes to capture, view, and transmit images of food items they consumed. The findings of this study showed that FRADA and its instructions for capturing, viewing, and transmitting images of food items were usable for older adults with diabetes. The survey showed that participants found FRADA easy to use and would consider using FRADA daily. The analysis of the qualitative data from interviews revealed multiple categories, such as the usability of FRADA, potential benefits of using FRADA, potential features to be added to FRADA, and concerns of older adults with diabetes regarding interactions with FRADA. Conclusions: This study demonstrates in a lab-based setting not only the usability of FRADA by older adults with diabetes but also potential opportunities using FRADA in real-world settings. The findings suggest implications for creating a smartphone app for an image-assisted dietary assessment. Future work still remains to evaluate the feasibility and validity of FRADA with multiple stakeholders, including older adults with diabetes and dietitians. %M 33493129 %R 10.2196/14760 %U http://formative.jmir.org/2021/2/e14760/ %U https://doi.org/10.2196/14760 %U http://www.ncbi.nlm.nih.gov/pubmed/33493129 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e23921 %T Tablet-Based Apps for Phonics and Phonological Awareness: Protocol for Evidence-Based Appraisal of Content, Quality, and Usability %A Furlong,Lisa %A Serry,Tanya %A Erickson,Shane %A Morris,Meg E %+ School of Education, College of Arts, Social Sciences and Commerce, La Trobe University, Plenty Road and Kingsbury Drive, Bundoora, Melbourne, 3086, Australia, 61 457645539, l.furlong@latrobe.edu.au %K app %K appraisal %K characteristics %K COVID-19 %K health management %K mHealth %K mobile apps %K phonics %K phonological awareness %K quality %K reading %K usability %D 2021 %7 11.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of mobile apps to manage and promote health is becoming increasingly popular. Mobile apps are gaining popularity particularly in educational and interventional settings owing to their perceived advantages including support for and engagement of individuals with reading difficulties. In the context of COVID-19, the need for technology-based tools has increased. For practitioners and educators who wish to use apps in their practice or recommend apps to individuals with reading difficulties, it is challenging to identify high-quality apps in app stores. Objective: This protocol describes a systematic search, selection, and appraisal process for tablet apps targeting phonics knowledge and phonological awareness skills. This protocol aimed to (1) provide a systematic method for identifying tablet apps targeting phonics knowledge and phonological awareness skills in the Google Play Store and Apple’s App Store and (2) describe an evidence-based approach for quality appraisal of these apps by using structured tools. Methods: This protocol describes an evidence-based method guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework to systematically search, select, and appraise apps targeting phonics knowledge and phonological awareness skills, present in Google Play and the App Store. We intend to perform a systematic and comprehensive search and a 2-step process for screening: (1) broad screening (app titles) and (2) narrow screening (marketing descriptions). Quality appraisal of the included apps will involve two structured appraisal tools: (1) the Mobile Application Rating Scale and (2) the Appraising Apps for Reading Checklist. Results: This method will help determine the number of apps targeting phonics knowledge and phonological awareness, present on the Android and iOS platforms. The content, quality, and usability of these apps will be determined using structured appraisal tools. We have planned to conduct searches on Google Play and the App Store in January-March 2021; broad and focused screening, from April 2021; and data extraction and quality appraisal in October 2021. Conclusions: This protocol provides a basis for locating and evaluating apps targeting phonics knowledge and phonological awareness skills. This protocol will support practitioners, educators, and families to make informed decisions when purchasing apps for instructional use. International Registered Report Identifier (IRRID): PRR1-10.2196/23921 %M 33523827 %R 10.2196/23921 %U http://www.researchprotocols.org/2021/2/e23921/ %U https://doi.org/10.2196/23921 %U http://www.ncbi.nlm.nih.gov/pubmed/33523827 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e20630 %T Five Lessons Learned From Randomized Controlled Trials on Mobile Health Interventions: Consensus Procedure on Practical Recommendations for Sustainable Research %A Pach,Daniel %A Rogge,Alizé A %A Wang,Jiani %A Witt,Claudia M %+ Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstraße 57, Berlin, 10117, Germany, daniel.pach@charite.de %K mHealth %K mobile apps %K pain %K behavior change techniques (BCTs) %K recommendations %D 2021 %7 8.2.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Background: Clinical research on mobile health (mHealth) interventions is too slow in comparison to the rapid speed of technological advances, thereby impeding sustainable research and evidence-based implementation of mHealth interventions. Objective: We aimed to establish practical lessons from the experience of our working group, which might accelerate the development of future mHealth interventions and their evaluation by randomized controlled trials (RCTs). Methods: This paper is based on group and expert discussions, and focuses on the researchers’ perspectives after four RCTs on mHealth interventions for chronic pain. Results: The following five lessons are presented, which are based on practical application, increase of speed, and sustainability: (1) explore stakeholder opinions, (2) develop the mHealth app and trial simultaneously, (3) minimize complexity, (4) manage necessary resources, and (5) apply behavior change techniques. Conclusions: The five lessons developed may lead toward an agile research environment. Agility might be the key factor in the development and research process of a potentially sustainable and evidence-based mHealth intervention. %M 33555263 %R 10.2196/20630 %U https://mhealth.jmir.org/2021/2/e20630 %U https://doi.org/10.2196/20630 %U http://www.ncbi.nlm.nih.gov/pubmed/33555263 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e24382 %T Using Information Technology to Assess Patient Risk Factors in Primary Care Clinics: Pragmatic Evaluation %A Kosowan,Leanne %A Katz,Alan %A Halas,Gayle %A LaBine,Lisa %A Singer,Alexander %+ Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada, 1 204 789 3442, Alan.katz@umanitoba.ca %K risk factors %K information technology %K primary health care %K primary prevention %D 2021 %7 2.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco use, physical inactivity, and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice, and support by a primary care provider lead to behavior change attempts among patients. However, although physicians consider preventative health important, there is often a larger focus on symptom presentation, acute care, and medication review. Objective: This study evaluated the feasibility, adoption, and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics. Methods: This is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. The RFIT was implemented in 2 primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation. Results: Clinicians reported a smooth and fast transfer of RFIT responses to an electronic medical record encounter note. The RFIT was used by 207 patients, with a completion rate of 86%. Clinic staff reported that approximately 3%-5% of patients declined the use of the RFIT or required assistance to use the tablet. Among the 207 patients that used the RFIT, 22 (12.1%) smoked, 39 (21.2%) felt their diet could be improved, 20 (12.0%) reported high alcohol consumption, 103 (56.9%) reported less than 150 minutes of physical activity a week, and 6 (8.2%) patients lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups. Conclusions: Clinicians and clinic staff positively reviewed the use of information technology in primary care. Algorithmic information technology can collect, organize, and synthesize individual health information to inform and tailor primary care counseling to the patients’ context and readiness to change. The RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, the RFIT can inform brief interventions within primary care. %M 33528376 %R 10.2196/24382 %U https://formative.jmir.org/2021/2/e24382 %U https://doi.org/10.2196/24382 %U http://www.ncbi.nlm.nih.gov/pubmed/33528376 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e20213 %T Blending Cognitive Analytic Therapy With a Digital Support Tool: Mixed Methods Study Involving a User-Centered Design of a Prototype App %A Easton,Katherine %A Kellett,Stephen %A Cooper,Martin %A Millings,Abigail %A Varela,Jo %A Parry,Glenys %+ School of Education, University of Sheffield, 241 Glossop Rd, Sheffield, S10 2GW, United Kingdom, 44 114 222 817, k.a.easton@sheffield.ac.uk %K cognitive analytic therapy %K digital app %K relational awareness %K user-centered design %K acceptability %K user testing %D 2021 %7 1.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Patients can struggle to make good use of psychotherapy owing to deficits in awareness, and digital technologies that support awareness are at a premium. Currently, when patients participate in cognitive analytic therapy (CAT), the technology supporting relational awareness work involves completion of paper-based worksheets as between-session tasks. Objective: We aimed to design, with therapists and patients, a prototype digital mobile app. This was to help patients better engage in the “recognition” phase of the CAT treatment model by providing an unobtrusive means for practicing relational awareness with dynamic feedback on progress. Methods: A national online survey was conducted with CAT therapists (n=50) to determine readiness for adoption of a mobile app in clinical practice and to identify core content, functionality, and potential barriers to adoption. A prototype mobile app based on data and existing paper-based worksheets was built. Initial face-to-face user testing of the prototype system was completed with three therapists and three CAT expatients. Results: Among the therapists surveyed, 72% (36/50) reported not currently using any digital tools during CAT. However, the potential value of a mobile app to support patient awareness was widely endorsed. Areas of therapist concern were data security, data governance, and equality of access. These concerns were mirrored during subsequent user testing by CAT therapists. Expatients generated additional user specifications on the design, functionality, and usability of the app. Results from both streams were integrated to produce five key changes for the reiteration of the app. Conclusions: The user-centered design process has enabled a prototype CAT-App to be developed to enhance the relational awareness work of CAT. This means that patients can now practice relational awareness in a much more unobtrusive manner and with ongoing dynamic feedback of progress. Testing the acceptability and feasibility of this technological innovation in clinical practice is the next stage in the research process, which has since been conducted and has been submitted. The important challenges of data protection and governance must be navigated in order to ensure implementation and adoption if the CAT-App is found to be acceptable and clinically effective. %M 33522979 %R 10.2196/20213 %U https://mental.jmir.org/2021/2/e20213 %U https://doi.org/10.2196/20213 %U http://www.ncbi.nlm.nih.gov/pubmed/33522979 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e22723 %T Smartphone-Detected Ambient Speech and Self-Reported Measures of Anxiety and Depression: Exploratory Observational Study %A Di Matteo,Daniel %A Wang,Wendy %A Fotinos,Kathryn %A Lokuge,Sachinthya %A Yu,Julia %A Sternat,Tia %A Katzman,Martin A %A Rose,Jonathan %+ The Centre for Automation of Medicine, The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, DL Pratt Building, 6 King's College Road, Toronto, ON, M5S 3H5, Canada, 1 416 978 6992, dandm@ece.utoronto.ca %K mobile sensing %K passive sensing %K psychiatric assessment %K mood and anxiety disorders %K mobile apps %K linguistics %K speech recognition %K speech content %K lexical choice %D 2021 %7 29.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The ability to objectively measure the severity of depression and anxiety disorders in a passive manner could have a profound impact on the way in which these disorders are diagnosed, assessed, and treated. Existing studies have demonstrated links between both depression and anxiety and the linguistic properties of words that people use to communicate. Smartphones offer the ability to passively and continuously detect spoken words to monitor and analyze the linguistic properties of speech produced by the speaker and other sources of ambient speech in their environment. The linguistic properties of automatically detected and recognized speech may be used to build objective severity measures of depression and anxiety. Objective: The aim of this study was to determine if the linguistic properties of words passively detected from environmental audio recorded using a participant’s smartphone can be used to find correlates of symptom severity of social anxiety disorder, generalized anxiety disorder, depression, and general impairment. Methods: An Android app was designed to collect periodic audiorecordings of participants’ environments and to detect English words using automatic speech recognition. Participants were recruited into a 2-week observational study. The app was installed on the participants’ personal smartphones to record and analyze audio. The participants also completed self-report severity measures of social anxiety disorder, generalized anxiety disorder, depression, and functional impairment. Words detected from audiorecordings were categorized, and correlations were measured between words counts in each category and the 4 self-report measures to determine if any categories could serve as correlates of social anxiety disorder, generalized anxiety disorder, depression, or general impairment. Results: The participants were 112 adults who resided in Canada from a nonclinical population; 86 participants yielded sufficient data for analysis. Correlations between word counts in 67 word categories and each of the 4 self-report measures revealed a strong relationship between the usage rates of death-related words and depressive symptoms (r=0.41, P<.001). There were also interesting correlations between rates of word usage in the categories of reward-related words with depression (r=–0.22, P=.04) and generalized anxiety (r=–0.29, P=.007), and vision-related words with social anxiety (r=0.31, P=.003). Conclusions: In this study, words automatically recognized from environmental audio were shown to contain a number of potential associations with severity of depression and anxiety. This work suggests that sparsely sampled audio could provide relevant insight into individuals’ mental health. %M 33512325 %R 10.2196/22723 %U http://formative.jmir.org/2021/1/e22723/ %U https://doi.org/10.2196/22723 %U http://www.ncbi.nlm.nih.gov/pubmed/33512325 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e14326 %T Developing the Accuracy of Vital Sign Measurements Using the Lifelight Software Application in Comparison to Standard of Care Methods: Observational Study Protocol %A Jones,Thomas L %A Heiden,Emily %A Mitchell,Felicity %A Fogg,Carole %A McCready,Sharon %A Pearce,Laurence %A Kapoor,Melissa %A Bassett,Paul %A Chauhan,Anoop J %+ Portsmouth Hospitals NHS Trust, Southwick Hill Road, Portsmouth, United Kingdom, 1 02392286236 ext 77006236, anoop.chauhan@porthosp.nhs.uk %K health technology %K remote monitoring %K vital signs %K patient deterioration %D 2021 %7 28.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Vital sign measurements are an integral component of clinical care, but current challenges with the accuracy and timeliness of patient observations can impact appropriate clinical decision making. Advanced technologies using techniques such as photoplethysmography have the potential to automate noncontact physiological monitoring and recording, improving the quality and accessibility of this essential clinical information. Objective: In this study, we aim to develop the algorithm used in the Lifelight software application and improve the accuracy of its estimated heart rate, respiratory rate, oxygen saturation, and blood pressure measurements. Methods: This preliminary study will compare measurements predicted by the Lifelight software with standard of care measurements for an estimated population sample of 2000 inpatients, outpatients, and healthy people attending a large acute hospital. Both training datasets and validation datasets will be analyzed to assess the degree of correspondence between the vital sign measurements predicted by the Lifelight software and the direct physiological measurements taken using standard of care methods. Subgroup analyses will explore how the performance of the algorithm varies with particular patient characteristics, including age, sex, health condition, and medication. Results: Recruitment of participants to this study began in July 2018, and data collection will continue for a planned study period of 12 months. Conclusions: Digital health technology is a rapidly evolving area for health and social care. Following this initial exploratory study to develop and refine the Lifelight software application, subsequent work will evaluate its performance across a range of health characteristics, and extended validation trials will support its pathway to registration as a medical device. Innovations in health technology such as this may provide valuable opportunities for increasing the efficiency and accessibility of vital sign measurements and improve health care services on a large scale across multiple health and care settings. International Registered Report Identifier (IRRID): DERR1-10.2196/14326 %M 33507157 %R 10.2196/14326 %U http://www.researchprotocols.org/2021/1/e14326/ %U https://doi.org/10.2196/14326 %U http://www.ncbi.nlm.nih.gov/pubmed/33507157 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e19346 %T Utilization of Smartphone Depth Mapping Cameras for App-Based Grading of Facial Movement Disorders: Development and Feasibility Study %A Taeger,Johannes %A Bischoff,Stefanie %A Hagen,Rudolf %A Rak,Kristen %+ Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Straße 11, Würzburg, 97080, Germany, 49 931 201 21489, taeger_j@ukw.de %K facial nerve %K facial palsy %K app development %K medical informatics %K eHealth %K mHealth %K Stennert’s index %K depth mapping camera %K smartphone sensors %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: For the classification of facial paresis, various systems of description and evaluation in the form of clinician-graded or software-based scoring systems are available. They serve the purpose of scientific and clinical assessment of the spontaneous course of the disease or monitoring therapeutic interventions. Nevertheless, none have been able to achieve universal acceptance in everyday clinical practice. Hence, a quick and precise tool for assessing the functional status of the facial nerve would be desirable. In this context, the possibilities that the TrueDepth camera of recent iPhone models offer have sparked our interest. Objective: This paper describes the utilization of the iPhone’s TrueDepth camera via a specially developed app prototype for quick, objective, and reproducible quantification of facial asymmetries. Methods: After conceptual and user interface design, a native app prototype for iOS was programmed that accesses and processes the data of the TrueDepth camera. Using a special algorithm, a new index for the grading of unilateral facial paresis ranging from 0% to 100% was developed. The algorithm was adapted to the well-established Stennert index by weighting the individual facial regions based on functional and cosmetic aspects. Test measurements with healthy subjects using the app were performed in order to prove the reliability of the system. Results: After the development process, the app prototype had no runtime or buildtime errors and also worked under suboptimal conditions such as different measurement angles, so it met our criteria for a safe and reliable app. The newly defined index expresses the result of the measurements as a generally understandable percentage value for each half of the face. The measurements that correctly rated the facial expressions of healthy individuals as symmetrical in all cases were reproducible and showed no statistically significant intertest variability. Conclusions: Based on the experience with the app prototype assessing healthy subjects, the use of the TrueDepth camera should have considerable potential for app-based grading of facial movement disorders. The app and its algorithm, which is based on theoretical considerations, should be evaluated in a prospective clinical study and correlated with common facial scores. %M 33496670 %R 10.2196/19346 %U http://mhealth.jmir.org/2021/1/e19346/ %U https://doi.org/10.2196/19346 %U http://www.ncbi.nlm.nih.gov/pubmed/33496670 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e19465 %T Habits Heart App for Patient Engagement in Heart Failure Management: Pilot Feasibility Randomized Trial %A Wei,Kevin S %A Ibrahim,Nasrien E %A Kumar,Ashok A %A Jena,Sidhant %A Chew,Veronica %A Depa,Michal %A Mayanil,Namrata %A Kvedar,Joseph C %A Gaggin,Hanna K %+ Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, United States, 1 617 726 2709, HGAGGIN@mgh.harvard.edu %K heart failure %K smartphone application %K heart failure management %D 2021 %7 20.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Due to the complexity and chronicity of heart failure, engaging yet simple patient self-management tools are needed. Objective: This study aimed to assess the feasibility and patient engagement with a smartphone app designed for heart failure. Methods: Patients with heart failure were randomized to intervention (smartphone with the Habits Heart App installed and Bluetooth-linked scale) or control (paper education material) groups. All intervention group patients were interviewed and monitored closely for app feasibility while receiving standard of care heart failure management by cardiologists. The Atlanta Heart Failure Knowledge Test, a quality of life survey (Kansas City Cardiomyopathy Questionnaire), and weight were assessed at baseline and final visits. Results: Patients (N=28 patients; intervention: n=15; control: n=13) with heart failure (with reduced ejection fraction: 15/28, 54%; male: 20/28, 71%, female: 8/28, 29%; median age 63 years) were enrolled, and 82% of patients (N=23; intervention: 12/15, 80%; control: 11/13, 85%) completed both baseline and final visits (median follow up 60 days). In the intervention group, 2 out of the 12 patients who completed the study did not use the app after study onboarding due to illnesses and hospitalizations. Of the remaining 10 patients who used the app, 5 patients logged ≥1 interaction with the app per day on average, and 2 patients logged an interaction with the app every other day on average. The intervention group averaged 403 screen views (per patient) in 56 distinct sessions, 5-minute session durations, and 22 weight entries per patient. There was a direct correlation between duration of app use and improvement in heart failure knowledge (Atlanta Heart Failure Knowledge Test score; ρ=0.59, P=.04) and quality of life (Kansas City Cardiomyopathy Questionnaire score; ρ=0.63, P=.03). The correlation between app use and weight change was ρ=–0.40 (P=.19). Only 1 out of 11 patients in the control group retained education material by the follow-up visit. Conclusions: The Habits Heart App with a Bluetooth-linked scale is a feasible way to engage patients in heart failure management, and barriers to app engagement were identified. A larger multicenter study may be warranted to evaluate the effectiveness of the app. Trial Registration: ClinicalTrials.gov NCT03238729; http://clinicaltrials.gov/ct2/show/NCT03238729 %M 33470941 %R 10.2196/19465 %U http://mhealth.jmir.org/2021/1/e19465/ %U https://doi.org/10.2196/19465 %U http://www.ncbi.nlm.nih.gov/pubmed/33470941 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e19073 %T Mobile Health Intervention in the Maternal Care Pathway: Protocol for the Impact Evaluation of hAPPyMamma %A Bonciani,Manila %A De Rosis,Sabina %A Vainieri,Milena %+ Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Sant’Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, Pisa, 56127, Italy, 39 3462405234, m.bonciani@santannapisa.it %K mHealth %K maternal care pathway %K impact evaluation %K quasiexperimental study %D 2021 %7 19.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile health (mHealth) has great potential to both improve the quality and efficiency of care and increase health literacy and empowerment of patient users. There are several studies related to the introduction of mHealth tools for supporting pregnancy and the postnatal period, with promising but not yet rigorously evaluated impacts. This article presents the protocol for evaluating an mHealth intervention (hAPPyMamma) applied in the maternal and child care pathway of a high-income country (in a pilot area of Tuscany Region, Italy). Objective: The protocol describes hAPPyMamma and the methods for evaluating its impact, including the points of view of women and practitioners. The research hypothesis is that the use of hAPPyMamma will facilitate a more appropriate use of available services, a better care experience for women, and an improvement in the maternal competencies of the women using the app compared to the control group. The protocol also includes analysis of the organizational impact of the introduction of hAPPyMamma in the maternal pathway. Methods: A pre-post quasiexperimental design with a control group is used to undertake difference-in-differences analysis for assessing the impact of the mHealth intervention from the mothers’ points of view. The outcome measures are improvement of maternal health literacy and empowerment as well as experience in the maternal care pathway of the control and intervention groups of sampled mothers. The organizational impact is evaluated through a quantitative and qualitative survey addressing professionals and managers of the maternal care pathway involved in the intervention. Results: Following study recruitment, 177 women were enrolled in the control group and 150 in the intervention group, with a participation rate of 97%-98%. The response rate was higher in the control group than in the intervention group (96% vs 67%), though the intervention group had less respondent loss at the postintervention survey (10% compared to 33% of the control group). Data collection from the women was completed in April 2018, while that from professionals and managers is underway. Conclusions: The study helps consolidate evidence of the utility of mHealth interventions for maternal and child care in developed countries. This paper presents a protocol for analyzing the potential role of hAPPyMamma as an effective mHealth tool for improving the maternal care pathway at individual and organizational levels and consequently helps to understand whether and how to scale up this intervention, with local, national, and international scopes of application. International Registered Report Identifier (IRRID): DERR1-10.2196/19073 %M 33464218 %R 10.2196/19073 %U http://www.researchprotocols.org/2021/1/e19073/ %U https://doi.org/10.2196/19073 %U http://www.ncbi.nlm.nih.gov/pubmed/33464218 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e24424 %T Developing an Adaptive Mobile Intervention to Address Risky Substance Use Among Adolescents and Emerging Adults: Usability Study %A Coughlin,Lara N %A Nahum-Shani,Inbal %A Philyaw-Kotov,Meredith L %A Bonar,Erin E %A Rabbi,Mashfiqui %A Klasnja,Predrag %A Murphy,Susan %A Walton,Maureen A %+ Department of Psychiatry, Addiction Center, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 734 615 4774, laraco@med.umich.edu %K mHealth %K adolescents %K young adults %K just-in-time adaptive intervention %K alcohol misuse %K cannabis %K mobile phone %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Substance use among adolescents and emerging adults continues to be an important public health problem associated with morbidity and mortality. Mobile health (mHealth) provides a promising approach to deliver just-in-time adaptive interventions (JITAIs) to prevent escalation of use and substance use–related consequences. Objective: This pilot study aims to describe the iterative development and initial feasibility and acceptability testing of an mHealth smartphone app, called MiSARA, designed to reduce escalation in substance use. Methods: We used social media advertisements to recruit youth (n=39; aged 16-24 years, who screened positive for past-month binge drinking or recreational cannabis use) with a waiver of parental consent. Participants used the MiSARA app for 30 days, with feasibility and acceptability data reported at a 1-month follow-up. We present descriptive data regarding behavior changes over time. Results: The results show that most participants (31/39, 79%) somewhat liked the app at least, with most (29/39, 74%) rating MiSARA as 3 or more stars (out of 5). Almost all participants were comfortable with self-reporting sensitive information within the app (36/39, 92%); however, most participants also desired more interactivity (27/39, 69%). In addition, participants’ substance use declined over time, and those reporting using the app more often reported less substance use at the 1-month follow-up than those who reported using the app less often. Conclusions: The findings suggest that the MiSARA app is a promising platform for JITAI delivery, with future trials needed to optimize the timing and dose of messages and determine efficacy. %M 33448931 %R 10.2196/24424 %U http://mhealth.jmir.org/2021/1/e24424/ %U https://doi.org/10.2196/24424 %U http://www.ncbi.nlm.nih.gov/pubmed/33448931 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e21094 %T Feasibility, Usability, and Enjoyment of a Home-Based Exercise Program Delivered via an Exercise App for Musculoskeletal Health in Community-Dwelling Older Adults: Short-term Prospective Pilot Study %A Daly,Robin M %A Gianoudis,Jenny %A Hall,Travis %A Mundell,Niamh L %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, 3125, Australia, 61 392446040, rmdaly@deakin.edu.au %K home exercise %K multicomponent exercise %K mobile health %K musculoskeletal %K adherence %K usability %K older adults %K physical activity enjoyment %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many older adults choose and prefer to exercise at home, but to attain the greatest benefits, the correct type and dose of exercise should be prescribed and adherence maintained. Advances in digital health technologies now provide the opportunity for exercise professionals to deliver and monitor personalized, evidence-based exercise programs to anyone at any time. Objective: The aim of this study was to evaluate the feasibility, usability, and enjoyment of a web-based exercise prescription app as a platform for exercise professionals to remotely deliver and monitor an individually tailored, home-based multicomponent exercise program (delivered through tablet computers) to older adults living independently in the community. Methods: This was an 8-week, prospective single-arm pilot study in 20 adults aged ≥65 years living independently in the community: 10 owned a tablet computer (tablet owners) and 10 did not own tablets (tablet nonowners). All participants were prescribed a home-based, muscle strengthening, weight-bearing impact and challenging balance/mobility program (3 days/week) using a commercial exercise prescription app on a tablet computer. Study endpoints were feasibility (retention, adherence, adverse events), usability (System Usability Scale), physical activity enjoyment (Physical Activity Enjoyment Scale), changes in lower extremity function (Short Physical Performance Battery [SPPB]), and level of physical activity (questionnaire). Process measures related to the participants' experiences and perceptions of the exercise program and web-based app were also included. Results: A total of 19 participants (mean age, 70 years) completed the study (19/20, 95%), and mean adherence to the exercise program was 84% (95% CI 70%-97%). There were 2 minor adverse events in 2 participants from 401 completed sessions. Mean weekly walking time increased by 78 minutes (95% CI 0-156, P=.049) and moderate-to-vigorous physical activity time by 41 minutes (95% CI –8 to 90, P=.09). For SPPB scores, there was a 0.3 point (95% CI –0.1 to 0.7, P=.17) modest sized (effect size, d=0.42) improvement after 8 weeks. Mean (SD) system usability was high (86 [10] with 100 best imaginable). There was no change in the overall physical activity enjoyment scores after 8 weeks, but participants reported that they enjoyed using the web-based exercise app and the exercise program (median score 4 on a 5-point Likert scale). For all measures, there were no differences between previous tablet owners and nonowners. Conclusions: This pilot feasibility study indicates that it is safe and feasible for community-dwelling older adults to participate in a home-based, multicomponent exercise program targeting musculoskeletal health and function that was delivered and monitored remotely by exercise professionals using a tablet-based exercise prescription app. %M 33439147 %R 10.2196/21094 %U http://mhealth.jmir.org/2021/1/e21094/ %U https://doi.org/10.2196/21094 %U http://www.ncbi.nlm.nih.gov/pubmed/33439147 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e20636 %T Cancer Patients’ Perceived Value of a Smartphone App to Enhance the Safety of Home-Based Chemotherapy: Feasibility Study %A Kongshaug,Nina %A Skolbekken,John-Arne %A Faxvaag,Arild %A Hofsli,Eva %+ Cancer Clinic, St. Olav's University Hospital, Postbox 8905, Trondheim, 7491, Norway, 47 99703704, nina.kongshaug@stolav.no %K mhealth %K mobile app %K smartphone app %K oral chemotherapy %K patient safety %K home-based cancer treatment %D 2021 %7 6.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Oral anticancer therapies can be self-administered by patients outside the hospital setting, which poses challenges of adherence to a drug plan and monitoring of side effects. Modern information technology may be developed and implemented to address these pertinent issues. Objective: The aim of this study was to explore how a smartphone app developed through a stepwise, iterative process can help patients using oral chemotherapy to take their drug, and to report adherence and side effects in a reliable and verifiable manner. Methods: Fourteen patients starting capecitabine treatment were included in this study and used the smartphone app in addition to regular follow up of capecitabine treatment. Nine of these patients fulfilled the treatment plan and were interviewed based on a semistructured interview guide and the System Usability Scale (SUS). In addition, two focus groups were completed with 7 oncologists and 7 oncology nurses, respectively. Interview data were analyzed in accordance with the principles of systematic text condensation. Features of the app were also assessed. Results: The smartphone app provided the patients with a feeling of reassurance regarding correct adherence of their oral chemotherapy treatment. They used the app as a memory tool about their treatment and possible serious side effects, as well as for treatment education. Patients expressed concerns about using the app to report side effects that were not considered to be obviously serious, fearing overreporting. The health personnel expressed an overall positive attitude to integrate this new tool in their everyday work. Conclusions: Patients on oral chemotherapy treatment at home felt safe and found the app to be helpful. The app promoted learning about their treatment and made the patients more independent of the cancer clinic, reducing the need for the clinic’s limited resources for follow up of patients on oral anticancer medications. %M 33404505 %R 10.2196/20636 %U https://formative.jmir.org/2021/1/e20636 %U https://doi.org/10.2196/20636 %U http://www.ncbi.nlm.nih.gov/pubmed/33404505 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e16114 %T Mobile App Support for Cardiopulmonary Resuscitation: Development and Usability Study %A Müller,Sune Dueholm %A Lauridsen,Kasper Glerup %A Palic,Amra Hadrovic %A Frederiksen,Lotte Nygaard %A Mathiasen,Morten %A Løfgren,Bo %+ Department of Management, Aarhus University, Fuglesangs Allé 4, Aarhus, 8210, Denmark, 45 87165023, sdm@mgmt.au.dk %K the Kano model %K cardiopulmonary resuscitation %K healthcare %K smartphone apps %K public health %K ALS CPR algorithm %K app evaluation %K mobile phone %D 2021 %7 5.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The user requirements for in-hospital cardiopulmonary resuscitation (CPR) support apps are understudied. To study usability, functionality, and design based on user requirements, we applied a mixed methods research design using interviews, observations, and a Kano questionnaire to survey perspectives of both physicians and nurses. Objective: This study aims to identify what an in-hospital CPR support app should include to meet the requirements and expectations of health care professionals by evaluating the CprPrototype app. Methods: We used a mixed methods research design. The qualitative methods consisted of semistructured interviews and observations from an advanced life support (ALS) course; both provided input to the subsequent questionnaire development. The quantitative method is a questionnaire based on the Kano model classifying user requirements as must-be, one-dimensional (attributes causing satisfaction when present and dissatisfaction when absent), attractive, indifferent, and reverse (attributes causing dissatisfaction when present and satisfaction when absent). The questionnaire was supplemented with comment fields. All respondents were physicians and nurses providing ALS at hospitals in the Central Denmark Region. Results: A total of 83 physicians and nurses responded to the questionnaire, 15 physicians and nurses were observed during ALS training, and 5 physicians were interviewed. On the basis of the Kano questionnaire, 53% (9/17) of requirements were classified as indifferent, 29% (5/17) as attractive, and 18% (3/17) as one-dimensional. The comments revealed 7 different categories of user requirements with noticeable differences between those of physicians and nurses: technological challenges, keep track of time, documentation and history, disturbing element, improvement areas: functions, improvement areas: design, and better guidance. Conclusions: The study provides recommendations to developers on the user requirements that need to be addressed when developing CPR support apps. Three features (one-dimensional attributes) must be incorporated in an in-hospital CPR support app: reminder of rhythm check, reminder of resuscitation drugs, and differentiate between adults and children. In addition, 5 features (attractive attributes) would result in higher user satisfaction: all functions on one side, access to the patient journal in the app, automatic time recording when cardiac arrest is called, sound to guide the chest compression rate (metronome), and send CPR history to the DANARREST(Danish in-hospital cardiac arrest registry) database. %M 33399539 %R 10.2196/16114 %U https://mhealth.jmir.org/2021/1/e16114 %U https://doi.org/10.2196/16114 %U http://www.ncbi.nlm.nih.gov/pubmed/33399539 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e21643 %T Augmented Reality for Smoking Cessation: Development and Usability Study %A Vinci,Christine %A Brandon,Karen O %A Kleinjan,Marloes %A Hernandez,Laura M %A Sawyer,Leslie E %A Haneke,Jody %A Sutton,Steven K %A Brandon,Thomas H %+ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tobacco Research and Intervention Program, 4115 East Fowler Avenue, Tampa, FL, 33617, United States, 1 1 813 745 5421, Christine.Vinci@moffitt.org %K augmented reality %K smoking cessation %K cue exposure therapy %K cue reactivity %K behavior change %K smoking %K smartphone app %K mobile phone %D 2020 %7 31.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The recent widespread availability of augmented reality via smartphone offers an opportunity to translate cue exposure therapy for smoking cessation from the laboratory to the real world. Despite significant reductions in the smoking rates in the last decade, approximately 13.7% of the adults in the United States continue to smoke. Smoking-related cue exposure has demonstrated promise as an adjuvant therapy in the laboratory, but practical limitations have prevented its success in the real world. Augmented reality technology presents an innovative approach to overcome these limitations. Objective: The aim of this study was to develop a smartphone app that presents smoking-related augmented reality images for cue exposure. Smokers provided feedback on the images and reported on the perceived urge to smoke, qualities of reality/coexistence, and general feedback about quality and functioning. The feedback was used to refine the augmented reality images within the app. Methods: In collaboration with an augmented reality design company, we developed 6 smoking-related images (cigarette, lighter, ashtray, lit cigarette in ashtray, etc) and 6 neutral images similar in size or complexity for comparison (pen, eraser, notebook, soda bottle with droplets, etc). Ten smokers completed a survey of demographic characteristics, smoking history and behavior, dependence on nicotine, motivation to quit smoking, and familiarity with augmented reality technology. Then, participants viewed each augmented reality image and provided ratings on 10-point Likert scales for urge to smoke and reality/coexistence of the image into the scene. Participants were also queried with open-ended questions regarding the features of the images. Results: Of the 10 participants, 5 (50%) had experienced augmented reality prior to the laboratory visit, but only 4 of those 5 participants used augmented reality at least weekly. Although the sample was small (N=10), smokers reported significantly higher urge to smoke after viewing the smoking-related augmented reality images (median 4.58, SD 3.49) versus the neutral images (median 1.42, SD 3.01) (Z=–2.14, P=.03; d=0.70). The average reality and coexistence ratings of the images did not differ between smoking-related and neutral images (all P>.29). Augmented reality images were found on average to be realistic (mean [SD] score 6.49 [3.11]) and have good environmental coexistence (mean [SD] score 6.93 [3.04]) and user coexistence (mean [SD] score 6.38 [3.27]) on the 10-point scale. Participant interviews revealed some areas of excellence (eg, details of the lit cigarette) and areas for improvement (eg, stability of images, lighting). Conclusions: All images were generally perceived as being realistic and well-integrated into the environment. However, the smoking augmented reality images produced higher urge to smoke than the neutral augmented reality images. In total, our findings support the potential utility of augmented reality for cue exposure therapy. Future directions and next steps are discussed. %M 33382377 %R 10.2196/21643 %U http://mhealth.jmir.org/2020/12/e21643/ %U https://doi.org/10.2196/21643 %U http://www.ncbi.nlm.nih.gov/pubmed/33382377 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e19677 %T Development and Feasibility of an App to Decrease Risk Factors for Type 2 Diabetes in Hispanic Women With Recent Gestational Diabetes (Hola Bebé, Adiós Diabetes): Pilot Pre-Post Study %A Seely,Ellen W %A Weitzman,Patricia Flynn %A Cortes,Dharma %A Romero Vicente,Sara %A Levkoff,Sue E %+ Endocrinology, Diabetes and Hypertension Division, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, United States, 1 6177325012, eseely@bwh.harvard.edu %K gestational diabetes mellitus %K diabetes prevention %K Hispanic %K Latina %K intervention %K mobile apps %K mHealth %D 2020 %7 31.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Hispanic women have increased risk of gestational diabetes mellitus (GDM), which carries an increased risk for future type 2 diabetes, compared to non-Hispanic women. In addition, Hispanic women are less likely to engage in healthy eating and physical activity, which are both risk factors for type 2 diabetes. Supporting patients to engage in healthy lifestyle behaviors through mobile health (mHealth) interventions is increasingly recognized as a viable, underused tool for disease prevention, as they reduce barriers to access frequently experienced in face-to-face interventions. Despite the high percentage of smartphone ownership among Hispanics, mHealth programs to reduce risk factors for type 2 diabetes in Hispanic women with prior GDM are lacking. Objective: This study aimed to (1) develop a mobile app (¡Hola Bebé, Adiós Diabetes!) to pilot test a culturally tailored, bilingual (Spanish/English) lifestyle program to reduce risk factors for type 2 diabetes in Hispanic women with GDM in the prior 5 years; (2) examine the acceptability and usability of the app; and (3) assess the short-term effectiveness of the app in increasing self-efficacy for both healthy eating and physical activity, and in decreasing weight. Methods: Social cognitive theory provided the framework for the study. A prototype app was developed based on prior research and cultural tailoring of content. Features included educational audiovisual modules on healthy eating and physical activity; personal action plans; motivational text messages; weight tracking; user-friendly, easy-to-follow recipes; directions on building a balanced plate; and tiered badges to reward achievements. Perceptions of the app’s acceptability and usability were explored through four focus groups. Short-term effectiveness of the app was tested in an 8-week single group pilot study. Results: In total, 11 Hispanic women, receiving care at a federally qualified community health center, aged 18-45 years, and with GDM in the last 5 years, participated in four focus groups to evaluate the app’s acceptability and usability. Participants found the following sections most useful: audiovisual modules, badges for completion of activities, weight-tracking graphics, and recipes. Suggested modifications included adjustments in phrasing, graphics, and a tiering system of badges. After app modifications, we conducted usability testing with 4 Hispanic women, with the key result being the suggestion for a “how-to tutorial.” To assess short-term effectiveness, 21 Hispanic women with prior GDM participated in the pilot. There was a statistically significant improvement in both self-efficacy for physical activity (P=.003) and self-efficacy for healthy eating (P=.007). Weight decreased but not significantly. Backend process data revealed a high level of user engagement. Conclusions: These data support the app’s acceptability, usability, and short-term effectiveness, suggesting that this mHealth program has the potential to fill the gap in care experienced by Hispanic women with prior GDM following pregnancy. Future studies are needed to determine the effectiveness of an enhanced app in a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04149054; https://clinicaltrials.gov/ct2/show/NCT04149054 %M 33382039 %R 10.2196/19677 %U http://formative.jmir.org/2020/12/e19677/ %U https://doi.org/10.2196/19677 %U http://www.ncbi.nlm.nih.gov/pubmed/33382039 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e17542 %T A Smartphone App for Patients With Acute Coronary Syndrome (MoTER-ACS): User-Centered Design Approach %A Bashi,Nazli %A Varnfield,Marlien %A Karunanithi,Mohanraj %+ Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 5 - UQ Health Sciences, Building 901/16, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia, 61 732533611, ghafouryan@hotmail.com %K mobile health %K mHealth %K mobile health apps %K smartphone %K mobile phone %K self-management %K patient education %K cardiovascular disease %K acute coronary syndrome %D 2020 %7 18.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Postdischarge interventions are limited for patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and the need to travel from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions. Objective: The aim of this study was to develop a smartphone-based intervention for providing postdischarge support to patients with ACS. Methods: The content of Mobile Technology–Enabled Rehabilitation for Patients with ACS (MoTER-ACS) was derived from a series of small studies, termed prestudy surveys, conducted in 2017. The prestudy surveys were conducted in Prince Charles Hospital, Queensland, Australia, and consisted of questionnaires among a convenience sample of patients with ACS (n=30), a focus group discussion with health care professionals (n=10), and an online survey among cardiologists (n=15). Responses from the patient survey identified educational topics of MoTER-ACS. The focus group with health care professionals assisted with identifying educational materials, health monitoring, and self-management interventions. Based on the results of the cardiologists’ survey, monitoring of symptoms related to heart failure exacerbation was considered as a weekly diary. Results: The MoTER-ACS app covers multimedia educational materials to adopt a healthy lifestyle and includes user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain, assisting patients in self-managing their condition. A web portal that is linked to the data from the smartphone app is available to clinicians to regularly access patients’ data and provide support. Conclusions: The MoTER-ACS platform extends the capabilities of previous mobile health platforms by providing a home-based educational and self-management intervention for patients with ACS following discharge from the hospital. The MoTER-ACS intervention narrows the gap between existing hospital-based programs and home-based interventions by complementing the postdischarge program for patients with ACS. %M 33337339 %R 10.2196/17542 %U http://formative.jmir.org/2020/12/e17542/ %U https://doi.org/10.2196/17542 %U http://www.ncbi.nlm.nih.gov/pubmed/33337339 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e20525 %T ColistinDose, a Mobile App for Determining Intravenous Dosage Regimens of Colistimethate in Critically Ill Adult Patients: Clinician-Centered Design and Development Study %A Hua,Xueliang %A Li,Chen %A Pogue,Jason M %A Sharma,Varun S %A Karaiskos,Ilias %A Kaye,Keith S %A Tsuji,Brian T %A Bergen,Phillip J %A Zhu,Yan %A Song,Jiangning %A Li,Jian %+ Department of Microbiology, Monash University, 19 Innovation Walk, Monash University, Melbourne, VIC 3800, Australia, 61 3 9903 9702, jian.li@monash.edu %K ColistinDose %K colistimethate %K colistin methanesulfonate %K colistin %K polymyxins %K mobile app %K renal function %K renal replacement therapy %K intermittent hemodialysis %K sustained low-efficiency dialysis %K continuous renal replacement therapy %D 2020 %7 16.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Determining a suitable dose of intravenous colistimethate is challenging because of complicated pharmacokinetics, confusing terminology, and the potential for renal toxicity. Only recently have reliable pharmacokinetic/pharmacodynamic data and dosing recommendations for intravenous colistimethate become available. Objective: The aim of this work was to develop a clinician-friendly, easy-to-use mobile app incorporating up-to-date dosing recommendations for intravenous colistimethate in critically ill adult patients. Methods: Swift programming language and common libraries were used for the development of an app, ColistinDose, on the iPhone operating system (iOS; Apple Inc). The compatibility among different iOS versions and mobile devices was validated. Dosing calculations were based on equations developed in our recent population pharmacokinetic study. Recommended doses generated by the app were validated by comparison against doses calculated manually using the appropriate equations. Results: ColistinDose provides 3 major functionalities, namely (1) calculation of a loading dose, (2) calculation of a daily dose based on the renal function of the patient (including differing types of renal replacement therapies), and (3) retrieval of historical calculation results. It is freely available at the Apple App Store for iOS (version 9 and above). Calculated doses accurately reflected doses recommended in patients with varying degrees of renal function based on the published equations. ColistinDose performs calculations on a local mobile device (iPhone or iPad) without the need for an internet connection. Conclusions: With its user-friendly interface, ColistinDose provides an accurate and easy-to-use tool for clinicians to calculate dosage regimens of intravenous colistimethate in critically ill patients with varying degrees of renal function. It has significant potential to avoid the prescribing errors and patient safety issues that currently confound the clinical use of colistimethate, thereby optimizing patient treatment. %M 33325835 %R 10.2196/20525 %U http://mhealth.jmir.org/2020/12/e20525/ %U https://doi.org/10.2196/20525 %U http://www.ncbi.nlm.nih.gov/pubmed/33325835 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e20360 %T Mobile App (UPrEPU) to Monitor Adherence to Pre-exposure Prophylaxis in Men Who Have Sex With Men: Protocol for a User-Centered Approach to Mobile App Design and Development %A Strong,Carol %A Wu,Huei-Jiuan %A Tseng,Yuan-Chi %A Yuan,Chien-Wen %A Yu,Yi-Fang %A Liao,Jay Chiehen %A Chen,Yi-Wen %A Hung,Yi-Chen %A Li,Chia-Wen %A Huang,Po-Hsien %A Ko,Nai-Ying %A Ku,Stephane Wen-Wei %+ Department of Public Health, College of Medicine, National Cheng Kung University Hospital, 8F-8068, No 138, ShengLi Rd, North District, Tainan City, 704, Taiwan, 886 6 2353535 ext 5963, carol.chiajung@gmail.com %K mobile apps %K pre-exposure prophylaxis %K event-driven %K sexual behavior %K men who have sex with men %K user-centered design approach %D 2020 %7 1.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Daily and on-demand pre-exposure prophylaxis (PrEP) has been well demonstrated to effectively prevent HIV acquisition for men who have sex with men (MSM). More than half of the MSM PrEP users in Taiwan prefer on-demand PrEP; however, on-demand PrEP involves a complicated dosing regimen because it requires precoital and postcoital dosing and sex events are hard to anticipate. Although there are a growing number of mobile apps designed to improve access to HIV prevention services and HIV medication adherence, few mobile apps focus on adherence to PrEP or are designed to accommodate a complicated, on-demand PrEP dosing schedule. Objective: The aim of this project is to evaluate the usability of a newly developed mobile app (UPrEPU) to assist MSM PrEP users to self-monitor their adherence to either daily or on-demand PrEP using a user-centered scheme. Methods: This research will be conducted in 2 phases: app development and usability study. In the app development phase, we will first conduct formative research with end users and stakeholders through in-depth interviews; the results will provide PrEP users’ and PrEP navigators’ personas as material used in the app conceptualization stage. PrEP navigators are individuals in the health care system that help HIV-negative individuals who need assistance in accessing PrEP care. A low-fidelity prototype of the app feature will be formatted by applying a participatory design approach to engage PrEP users, designers, and app developers in the design process of the app. Then, a high-fidelity prototype of the app will be developed for the usability study and refined iteratively by the multidisciplinary team and new internal testers. Internal testers include the research team consisting of experts in public health, infectious disease, and industrial design and a close network of the research team that is taking PrEP. In the usability study phase, we will enroll 70 MSM PrEP users and follow them up for 4 months. Usability, feasibility, and effectiveness of adherence monitoring will be evaluated. Results: Refinement of the UPrEPU app is currently ongoing. The usability study commenced in May 2020. Conclusions: The UPrEPU app is one of the first apps designed to help MSM PrEP users to self-manage their PrEP schedule better regardless of dosing modes. With a design-thinking approach and adapting to the cultural context in Taiwan’s MSM population, this novel app will have substantial potential to be acceptable and feasible and contribute to the reduction of new HIV infections. Trial Registration: ClinicalTrials.gov NCT04248790; https://clinicaltrials.gov/ct2/show/NCT04248790 International Registered Report Identifier (IRRID): PRR1-10.2196/20360 %M 33258793 %R 10.2196/20360 %U https://www.researchprotocols.org/2020/12/e20360 %U https://doi.org/10.2196/20360 %U http://www.ncbi.nlm.nih.gov/pubmed/33258793 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e15833 %T Usability of eHealth and Mobile Health Interventions by Young People Living With Juvenile Idiopathic Arthritis: Systematic Review %A Butler,Sonia %A Sculley,Dean %A Santos,Derek Santos %A Fellas,Antoni %A Gironès,Xavier %A Singh-Grewal,Davinder %A Coda,Andrea %+ School of Bioscience and Pharmacy, University of Newcastle, 10 Chittaway Rd, Ourimbah, New South Wales, 2258, Australia, 61 421945914, sonia.butler@newcastle.edu.au %K juvenile idiopathic arthritis %K child %K adolescence %K eHealth %K mHealth %K systematic review %K mobile phone %K pain %K physical activity %K self-management %K quality of life %D 2020 %7 1.12.2020 %9 Review %J JMIR Pediatr Parent %G English %X Background: Considering the changing landscape of internet use and rising ownership of digital technology by young people, new methods could be considered to improve the current model of juvenile idiopathic arthritis (JIA) management. Objective: This systematic review aims to evaluate the usability of eHealth and mobile health (mHealth) interventions currently available for young people living with JIA. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to oversee this review. We systematically searched 15 databases for 252 potential studies; 2 authors independently screened all quantitative studies reporting the use of eHealth and mHealth interventions for young people (aged 1-18 years) diagnosed with JIA. Studies were excluded if they did not report outcome measures or were reviews, commentaries, or qualitative studies. Study methodological quality was scored using the Down and Black (modified) checklist. A narrative descriptive methodology was used to quantify the data because of heterogeneity across the studies. Results: A total of 11 studies were included in this review, reporting 7 eHealth and mHealth interventions for young people (aged 4-18 years) living with JIA, targeting health issues such as pain, health-related quality of life, physical activity, and chronic disease self-management. The usability of the interventions was facilitated through training and ongoing support. The engagement was promoted by a combination of persuasive influences, and barriers preventing adherence were removed through personal reminders and flexible program schedules to cater to JIA and non-JIA illnesses or other commonly seen activities in childhood. The feedback obtained was that most young people and their parents liked the interventions. Conclusions: The results of this review need to be considered cautiously because of the lack of rigorous testing and heterogeneity, which limits the detailed descriptions of data synthesis. Further research is needed to consider gender differences, associated costs, and the effectiveness of the interventions on health outcomes to better support young people living with JIA. %M 33258786 %R 10.2196/15833 %U http://pediatrics.jmir.org/2020/2/e15833/ %U https://doi.org/10.2196/15833 %U http://www.ncbi.nlm.nih.gov/pubmed/33258786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18982 %T Adaptation and Evaluation of a Symptom-Monitoring Digital Health Intervention for Patients With Relapsed and Refractory Multiple Myeloma: Pilot Mixed-Methods Implementation Study %A Biran,Noa %A Anthony Kouyaté,Robin %A Yucel,Emre %A McGovern,Gillian E %A Schoenthaler,Antoinette M %A Durling,Olivia G %A Unawane,Rashmi %A Schutt,Andrew %A Panjabi,Sumeet %+ Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, 92 Second Street, Hackensack, NJ, 07601, United States, 1 551 996 8704, Noa.Biran@hackensackmeridian.org %K mHealth %K digital health %K electronic patient-reported outcome %K ePRO %K patient-reported outcome %K PRO %K mobile %K app %K implementation science %K multiple myeloma %K relapsed refractory multiple myeloma %D 2020 %7 17.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Relapsed and refractory multiple myeloma (RRMM) is a bone marrow cancer that requires systemic treatment, which often results in severe symptom burden. Recent studies have found that electronic patient-reported outcome (ePRO) interventions implemented in the clinic setting have had positive outcomes for other oncology populations. Evidence of the efficacy of a similar approach is lacking for patients with RRMM. Objective: Recent recommendations for digital health interventions call for the publication of descriptions of iterative development processes in order to improve reproducibility and comparability. This study is an implementation pilot aiming to evaluate the acceptability and appropriateness of an ePRO intervention for patients with RRMM and to explore its impact on clinic workflow. Methods: A total of 11 patients with RRMM were recruited from the John Theurer Cancer Center in Hackensack, New Jersey. Patients used a mobile app to report on 17 symptoms at 4 sessions, each a week apart. Patients could also report symptoms ad hoc. When reports met predefined thresholds, the clinic was alerted and patients received automated guidance. Study end points were assessed using qualitative and quantitative methods. Results: A total of 9 patients (mean age 69.7 years) completed the study. Overall, 83% (30/36) of weekly sessions were completed. Patients found the frequency and time required to complete reporting acceptable. All patients agreed that the app was easy to use and understand. Providers felt the alerts they received required refinement. Patients and providers agreed it would be beneficial for patients to report for longer than 4 weeks. Patients felt that the training they received was adequate but contained too much information for a single session. All patients found the symptoms tracked to be appropriate; providers suggested shortening the list. All patients understood how to use the app for weekly reporting but had confusion about using it ad hoc. Providers felt the ad hoc feature could be removed. Neither patients nor providers viewed the in-app data reports but agreed on their potential value. Patients reported benefitting from symptom reporting through increased awareness of their symptoms. Clinic staff reported that app alerts were too numerous and redundant. They had difficulty responding to alerts within their existing workflow, partially because the data were not integrated into the electronic medical record system. Conclusions: Overall, the intervention was found to be acceptable and appropriate for patients with RRMM. Points of friction integrating the intervention into the clinic workflow were identified. Clinic staff provided recommendations for addressing these issues. Once such modifications are implemented, ePRO data from patients with RRMM could be used to inform and improve clinical research and care. This study underlines the importance of an iterative approach to implementation that includes all stakeholders in order to ensure successful adoption. %M 33200997 %R 10.2196/18982 %U http://formative.jmir.org/2020/11/e18982/ %U https://doi.org/10.2196/18982 %U http://www.ncbi.nlm.nih.gov/pubmed/33200997 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e20460 %T Engagement Features in Physical Activity Smartphone Apps: Focus Group Study With Sedentary People %A D'Addario,Marco %A Baretta,Dario %A Zanatta,Francesco %A Greco,Andrea %A Steca,Patrizia %+ Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, Milan, 20126, Italy, 39 3920317007, francesco.zanatta@unimib.it %K physical activity %K smartphone app %K engagement %K co-design %K thematic analysis %K mobile phone %D 2020 %7 16.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Engagement with physical activity mobile apps has been reported to be a core precondition for their effectiveness in digital behavior change interventions. However, to date, little attention has been paid to understanding the perspectives, needs, expectations, and experiences of potential users with physical activity mobile apps. Objective: The aim of this study was to investigate the features that are judged to be important for engagement with a physical activity mobile app and the reasons for their importance. Methods: A qualitative focus-group methodology with elements of co-design was adopted in this study. Participants reporting sedentary lifestyles and willingness to improve their physical activity behavior through mobile technology were recruited. The focus group sessions consisted of 13 participants (8 men and 5 women, mean [SD] age 41.9 [7.1] years). Two researchers conducted the data analysis independently by using the inductive thematic approach. Results: Four main themes emerged in relation to the research question and were named as follows: “physical activity participation motives,” “autonomy and self-regulation,” “need for relatedness,” and “smart.” Additionally, 2 subthemes originated from “physical activity participation motives” (ie, “medical guidance” and “weight loss and fitness for health”) and “smart” (ie, “action planning” and “adaptable and tailored”). Conclusions: Features enhancing autonomy and self-regulation and positively affecting health and physical well-being as well as the need for relatedness, adaptability, and flexibility should be considered as core elements in the engagement of potential users with physical activity mobile apps. The emerged findings may orient future research and interventions aiming to foster engagement of potential users with physical activity apps. %M 33196450 %R 10.2196/20460 %U http://mhealth.jmir.org/2020/11/e20460/ %U https://doi.org/10.2196/20460 %U http://www.ncbi.nlm.nih.gov/pubmed/33196450 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e18156 %T Patients and Medical Staff Attitudes Toward the Future Inclusion of eHealth in Tuberculosis Management: Perspectives From Six Countries Evaluated using a Qualitative Framework %A Margineanu,Ioana %A Louka,Christina %A Vincenti-Gonzalez,Maria %A Saktiawati,Antonia Morita Iswari %A Schierle,Johannes %A Abass,Kabiru Mohammed %A Akkerman,Onno %A Alffenaar,Jan-Willem %A Ranchor,Adelita V %A Stienstra,Ymkje %+ Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, University of Groningen, Hanzeplein 1, Groningen, Netherlands, 1 61 496 3518, ismargineanu@gmail.com %K eHealth %K tuberculosis %K policy %K clinical %K patient %K perspective %D 2020 %7 2.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digitally delivering healthcare services is very attractive for tuberculosis (TB) management as this disease has a complex diagnosis and lengthy management and involves multiple medical and nonmedical specialists. Especially in low- and middle-income countries, eHealth could potentially offer cost-effective solutions to bridge financial, social, time, and distance challenges. Objective: The goal of the research is to understand what would make eHealth globally applicable and gain insight into different TB situations, opportunities, and challenges. Methods: We performed focus group interviews with TB experts and patients from 6 different countries on 4 different continents. The focus group interviews followed the theory of planned behavior framework to offer structured recommendations for a versatile eHealth solution. The focus group interviews were preceded by a general demographic and technology use questionnaire. Questionnaire results were analyzed using basic statistics in Excel (Microsoft Corporation). Focus group interview data were analyzed using ATLAS.ti 8 (ATLAS.ti Scientific Software Development GmbH) by assigning codes to quotations and grouping codes into the 5 domains within the framework. Results: A total of 29 patients and 32 medical staff members were included in our study. All medical staff had used the internet, whereas 31% (9/61) of patients had never been online. The codes with the most quotations were information in relation to eHealth (144 quotations) and communication (67 quotations). The consensus among all participants from all countries is that there are important communication and information gaps that could be bridged by an eHealth app. Participants from different countries also highlighted different challenges, such as a majority of asylum-seeker patients or lack of infrastructure that could be addressed with an eHealth app. Conclusions: Within the 6 countries interviewed, there is high enthusiasm toward eHealth in TB. A potential app could first target information and communication gaps in TB, with additional modules aimed at setting-specific challenges. %M 33136052 %R 10.2196/18156 %U https://mhealth.jmir.org/2020/11/e18156 %U https://doi.org/10.2196/18156 %U http://www.ncbi.nlm.nih.gov/pubmed/33136052 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17999 %T Development of an Intervention Targeting Multiple Health Behaviors Among High School Students: Participatory Design Study Using Heuristic Evaluation and Usability Testing %A Müssener,Ulrika %A Thomas,Kristin %A Linderoth,Catharina %A Löf,Marie %A Åsberg,Katarina %A Henriksson,Pontus %A Bendtsen,Marcus %+ Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 1, Linköping, 58183, Sweden, 46 732702426, ulrika.mussener@liu.se %K mHealth intervention %K health behavior %K high school students %K participatory design %K heuristic evaluation %K usability testing %K mobile phone %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile electronic platforms provide exciting possibilities for health behavior promotion. For instance, they can promote smoking cessation, moderate alcohol consumption, healthy eating, and physical activity. Young adults in Sweden are proficient in the use of technology, having been exposed to computers, smartphones, and the internet from an early age. However, with the high availability of mobile health (mHealth) interventions of varying quality, it is critical to optimize the usability of mHealth interventions to ensure long-term use of these health promotion interventions. Objective: This study aims to investigate the usability of an mHealth intervention (LIFE4YOUth) targeting health behaviors among high school students through heuristic evaluation and usability testing. Methods: A preliminary version of the LIFE4YOUth mHealth intervention, which was aimed at promoting healthy eating, physical activity, smoking cessation, and nonrisky drinking among high school students, was developed in early 2019. We completed a total of 15 heuristic evaluations and 5 usability tests to evaluate the usability of the mHealth intervention prototype to improve its functioning, content, and design. Results: Heuristic evaluation from a total of 15 experts (10 employees and 5 university students, both women and men, aged 18-25 years) revealed that the major usability problems and the worst ratings, a total of 17 problems termed usability catastrophes, concerned shortcomings in displaying easy-to-understand information to the users or technical errors. The results of the usability testing including 5 high school students (both girls and boys, aged 15-18 years) showed that the design, quality, and quantity of content in the intervention may impact the users’ level of engagement. Poor functionality was considered a major barrier to usability. Of the 5 participants, one rated the LIFE4YOUth intervention as poor, 2 rated as average, and 2 assessed it as good, according to the System Usability Scale. Conclusions: High school students have high expectations of digital products. If an mHealth intervention does not offer optimal functions, they may cease to use it. Optimizing the usability of mHealth interventions is a critical step in the development process. Heuristic evaluation and usability testing in this study provided valuable knowledge about the prototype from a user’s perspective. The findings may lead to the development of similar interventions targeting the high school population. %M 33118942 %R 10.2196/17999 %U http://mhealth.jmir.org/2020/10/e17999/ %U https://doi.org/10.2196/17999 %U http://www.ncbi.nlm.nih.gov/pubmed/33118942 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e16898 %T Creating a Smartphone App for Caregivers of Children With Atopic Dermatitis With Caregivers, Health Care Professionals, and Digital Health Experts: Participatory Co-Design %A Xu,Xiaomeng %A Griva,Konstadina %A Koh,Mark %A Lum,Elaine %A Tan,Woan Shin %A Thng,Steven %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore, 65 81616659, xxu020@e.ntu.edu.sg %K atopic dermatitis %K eczema %K mobile phone %K telehealth %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps could support patients and caregivers in disease self-management. However, as patients’ experiences and needs might not always align with clinical judgments, the eliciting and engaging of perspectives of all stakeholders in the smartphone app design process is of paramount importance. Objective: The aims of this study are to better understand the needs of and challenges facing caregivers and health care professionals (HCPs) who care for children with atopic dermatitis (AD) and to explore the desirable features and content of a smartphone app that would support AD self-management. Methods: This study adopted a qualitative participatory co-design methodology involving 3 focus group discussions: workshop one focused on caregivers; workshop two engaged with HCPs; and in the last workshop, caregivers and digital health experts were asked to design the wireframe prototype. The participants completed a sociodemographic questionnaire, a technology acceptance questionnaire, and a workshop evaluation form. Results: Twelve caregivers participated in the first workshop, and 10 HCPs participated in the second workshop. Eight caregivers and 4 digital health experts attended the third workshop. Three superordinate themes that reflected caregivers’ and HCPs’ challenges and needs were identified: empowerment by education, confusion over treatment, and emotional impact. Workshop participants also raised a series of suggestions on the features and contents of the AD self-management app, which informed the last co-design workshop, and described their needs and challenges. In the last workshop, the participants developed a wireframe prototype of the app following the identified requirements and recommendations. Conclusions: The co-design approach was found to be a successful way of engaging with the participants, as it allowed them to express their creativity and helped us to articulate the root of the clinical problems. The co-design workshop was successful in creating and generating new ideas and solutions for smartphone app development. %M 33118949 %R 10.2196/16898 %U http://mhealth.jmir.org/2020/10/e16898/ %U https://doi.org/10.2196/16898 %U http://www.ncbi.nlm.nih.gov/pubmed/33118949 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20353 %T New Checklist for the Heuristic Evaluation of mHealth Apps (HE4EH): Development and Usability Study %A Khowaja,Kamran %A Al-Thani,Dena %+ Information & Computing Technology, College of Science & Engineering, Hamad Bin Khalifa University, LAS Building, Education City, Doha, , Qatar, 974 66314481, kamran.khowaja@gmail.com %K mHealth %K eHealth %K heuristic evaluation %K expert evaluation %K self-monitoring %K behavior change %K design guidelines %K framework %D 2020 %7 28.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Diabetes is one of the leading causes of death in developing countries. Existing mobile health (mHealth) app design guidelines lack a description of the support of continuous self-monitoring of health status, behavior change to improve and adopt a healthy lifestyle, and communication with health educators and health care professionals in case of any need. Objective: This paper presents the development of a specialized set of heuristics called heuristic evaluation for mHealth apps (HE4EH) as an all-in-one tool and its applicability by performing a heuristic evaluation of an mHealth app. Methods: An extensive review of heuristics and checklists was used to develop the HE4EH. The HE4EH was evaluated by domain experts for heuristics, checklist items, severity ratings, and overall satisfaction. The OneTouch app, which helps individuals with diabetes manage their blood glucose levels, was evaluated using HE4EH to identify usability problems that need to be fixed in the app. Results: The expert evaluation of HE4EH revealed that the heuristics were important, relevant, and clear. The checklist items across the heuristics were clear, relevant, and acceptably grouped. In terms of evaluating the OneTouch app using the HE4EH, the most frequently violated heuristics included Content, Visibility, Match, and Self-monitoring. Most of the usability problems found were minor. The system usability scale score indicated that the OneTouch app is marginally acceptable. Conclusions: This heuristic evaluation using the OneTouch app shows that the HE4EH can play a vital role for designers, researchers, and practitioners to use HE4EH heuristics and checklist items as a tool to design a new or evaluate and improve an existing mHealth app. %M 33112252 %R 10.2196/20353 %U http://mhealth.jmir.org/2020/10/e20353/ %U https://doi.org/10.2196/20353 %U http://www.ncbi.nlm.nih.gov/pubmed/33112252 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21454 %T African American Emerging Adult Perspectives on Unintended Pregnancy and Meeting Their Needs With Mobile Technology: Mixed Methods Qualitative Study %A Ingram,Lucy Annang %A Stafford,Crystal %A McCollum,Quentin %A Isreal,McKenzie %+ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 503G, Columbia, SC, 29202, United States, 1 803 777 4389, lannang@sc.edu %K unintended pregnancy %K emerging adult %K African American %K mobile technology %K pregnancy %K teenage years %K health promotion %K mobile %K sexual health %D 2020 %7 21.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the United States, a disproportionate number of unintended pregnancies occur among African Americans, particularly those in their later teenage years and early 20s. Mobile technology is becoming more ubiquitous as a method for health promotion; however, relatively little research has been done with this population to determine their perspectives about unintended pregnancy, the potential of successfully using mobile technology to prevent unintended pregnancy, and the content of such programs. Objective: The purpose of this study was to obtain the perspectives of African American emerging adults about unintended pregnancy and the use of mobile technology to reduce unintended pregnancy rates. Methods: Focus groups and interviews were conducted with 83 African Americans, aged 18-21 years. Data were analyzed using an open coding process. Emergent codes were then added as needed, and themes and subthemes were identified. Results: Participants cited the social environment and lack of education as primary reasons for disproportionate rates of unintended pregnancy. They noted that unintended pregnancy is an important issue and that they desire more sexual health information. They enthusiastically supported mobile technology as a means to communicate unintended pregnancy prevention programming and offered many suggestions for program content, look, and feel. Conclusions: Young and emerging adult African Americans want and need sexual health resources, and a mobile-based platform could be widely accepted and address needs to lower disproportionate rates of unintended pregnancy. An essential next step is to use these findings to inform the development of a mobile-based unintended pregnancy prevention and sexual health program prototype to determine feasibility. %M 33084591 %R 10.2196/21454 %U http://mhealth.jmir.org/2020/10/e21454/ %U https://doi.org/10.2196/21454 %U http://www.ncbi.nlm.nih.gov/pubmed/33084591 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17881 %T Light-Induced Fluorescence-Based Device and Hybrid Mobile App for Oral Hygiene Management at Home: Development and Usability Study %A Kim,Jun-Min %A Lee,Woo Ram %A Kim,Jun-Ho %A Seo,Jong-Mo %A Im,Changkyun %+ Dental Life Science Research Institute, Seoul National University Dental Hospital, 601 Seoul National University Dental Hospital, 1 Gwanak-ro, Gwanak-Gu, Seoul, , Republic of Korea, 82 2 6747 6587, changkyun@snu.ac.kr %K dental plaque %K oral hygiene %K red fluorescence %K mobile health %K deep learning %K object detection %K instance segmentation %D 2020 %7 16.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dental diseases can be prevented through the management of dental plaques. Dental plaque can be identified using the light-induced fluorescence (LIF) technique that emits light at 405 nm. The LIF technique is more convenient than the commercial technique using a disclosing agent, but the result may vary for each individual as it still requires visual identification. Objective: The objective of this study is to introduce and validate a deep learning–based oral hygiene monitoring system that makes it easy to identify dental plaques at home. Methods: We developed a LIF-based system consisting of a device that can visually identify dental plaques and a mobile app that displays the location and area of dental plaques on oral images. The mobile app is programmed to automatically determine the location and distribution of dental plaques using a deep learning–based algorithm and present the results to the user as time series data. The mobile app is also built with convergence of naive and web applications so that the algorithm is executed on a cloud server to efficiently distribute computing resources. Results: The location and distribution of users’ dental plaques could be identified via the hand-held LIF device or mobile app. The color correction filter in the device was developed using a color mixing technique. The mobile app was built as a hybrid app combining the functionalities of a native application and a web application. Through the scrollable WebView on the mobile app, changes in the time series of dental plaque could be confirmed. The algorithm for dental plaque detection was implemented to run on Amazon Web Services for object detection by single shot multibox detector and instance segmentation by Mask region-based convolutional neural network. Conclusions: This paper shows that the system can be used as a home oral care product for timely identification and management of dental plaques. In the future, it is expected that these products will significantly reduce the social costs associated with dental diseases. %M 33064097 %R 10.2196/17881 %U https://mhealth.jmir.org/2020/10/e17881 %U https://doi.org/10.2196/17881 %U http://www.ncbi.nlm.nih.gov/pubmed/33064097 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18545 %T App-Based Delivery of Clinical Emotional Freedom Techniques: Cross-Sectional Study of App User Self-Ratings %A Church,Dawson %A Stapleton,Peta %A Sabot,Debbie %+ School of Psychology, Faculty of Society & Design, Bond University, 14 University Drive, Robina, 4226, Australia, 61 755952515, dsabot@bond.edu.au %K anxiety %K stress %K meditation %K mobile health %K Emotional Freedom Techniques (EFT) %K mobile phone %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The burgeoning area of mobile health (mHealth) has experienced rapid growth in mobile apps designed to address mental health issues. Although abundant apps offer strategies for managing symptoms of anxiety and stress, information regarding their efficacy is scarce. Objective: This study aimed to assess the effect of an mHealth app on user self-ratings of psychological distress in a sample of 270,461 app users. The Tapping Solution App guides users through the therapeutic protocols of Clinical Emotional Freedom Techniques (EFT), an evidence-based psychophysiological intervention that combines acupressure with elements of cognitive and exposure therapies. Methods: App users provided self-ratings of emotional intensity before and after app sessions (termed “tapping meditations”) using an 11-point Subjective Units of Distress scale. App user data for 23 tapping meditations, which addressed psychological symptoms of anxiety and stress, were gathered between October 2018 and October 2019, totaling 380,034 completed app sessions. Results: Across 12 anxiety-tapping meditations, the difference in emotional intensity ratings from presession (mean 6.66, SD 0.25) to postsession (mean 3.75, SD 0.30) was statistically significant (P<.001; 95% CI −2.92 to −2.91). Across 11 stress-tapping meditations, a statistically significant difference was also found from presession (mean 6.91, SD 0.48) to postsession (mean 3.83, SD 0.54; P<.001; 95% CI −3.08 to −3.07). The results are consistent with the literature on the efficacy of Clinical EFT for anxiety and stress when offered in conventional therapeutic formats. Conclusions: The findings provide preliminary support for the effectiveness of the mHealth app in the immediate reduction of self-rated psychological distress. As an adjunct to professional mental health care, the app promises accessible and convenient therapeutic benefits. %M 32862128 %R 10.2196/18545 %U http://mhealth.jmir.org/2020/10/e18545/ %U https://doi.org/10.2196/18545 %U http://www.ncbi.nlm.nih.gov/pubmed/32862128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e17895 %T Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Development and Usability Study %A Green,Eric P %A Lai,Yihuan %A Pearson,Nicholas %A Rajasekharan,Sathyanath %A Rauws,Michiel %A Joerin,Angela %A Kwobah,Edith %A Musyimi,Christine %A Jones,Rachel M %A Bhat,Chaya %A Mulinge,Antonia %A Puffer,Eve S %+ Duke Global Health Institute, Box 90519, Durham, NC, 27708, United States, 1 9196817289, eric.green@duke.edu %K telemedicine %K mental health %K depression %K artificial intelligence %K Kenya %K text messaging %K mobile phone %D 2020 %7 5.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression during pregnancy and in the postpartum period is associated with poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings; however, there are significant barriers to scale-up. We address this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. Objective: This prepilot study aims to gather preliminary data on the Healthy Moms perinatal depression intervention to learn how to build and test a more robust service. Methods: We conducted a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. We invited these women to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants were randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. We prompted participants to rate their mood via SMS text messaging every 3 days during the baseline and intervention periods, and we used these preliminary repeated measures data to fit a linear mixed-effects model of response to treatment. We also reviewed system logs and conducted in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. Results: We invited 647 women to learn more about Zuri: 86 completed our automated SMS screening and 41 enrolled in the study. Most of the enrolled women submitted at least 3 mood ratings (31/41, 76%) and sent at least 1 message to Zuri (27/41, 66%). A third of the sample engaged beyond registration (14/41, 34%). On average, women who engaged post registration started 3.4 (SD 3.2) Healthy Moms sessions and completed 3.1 (SD 2.9) of the sessions they started. Most interviewees who tried Zuri reported having a positive attitude toward the service and expressed trust in Zuri. They also attributed positive life changes to the intervention. We estimated that using this alpha version of Zuri may have led to a 7% improvement in mood. Conclusions: Zuri is feasible to deliver via SMS and was acceptable to this sample of pregnant women and new mothers. The results of this prepilot study will serve as a baseline for future studies in terms of recruitment, data collection, and outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/11800 %M 33016883 %R 10.2196/17895 %U https://formative.jmir.org/2020/10/e17895 %U https://doi.org/10.2196/17895 %U http://www.ncbi.nlm.nih.gov/pubmed/33016883 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21676 %T Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: Ecological Momentary Assessment Study %A Papp,Lauren M %A Barringer,Alexandra %A Blumenstock,Shari M %A Gu,Pamela %A Blaydes,Madison %A Lam,Jaime %A Kouros,Chrystyna D %+ Department of Human Development and Family Studies, University of Wisconsin-Madison, 1300 Linden Drive, Madison, WI, 53706, United States, 1 608 262 8611, papp@wisc.edu %K compliance %K ecological momentary assessment %K prescription drug misuse %K young adult %D 2020 %7 1.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prescription drug misuse and abuse is an established public health challenge, and young adults are particularly affected. There is a striking lack of real-time, naturalistic data collection assessing intentions to misuse and other precipitating factors at the time of actual misuse, leaving the conditions under which individuals are most likely to misuse prescription medications unknown. Ecological momentary assessment (EMA) apps and protocols designed to capture this information would accelerate and expand the knowledge base and could directly contribute to prevention and treatment efforts. Objective: The objectives of this study are to describe the development and administration of a mobile app and the EMA protocol designed to collect real-time factors associated with college students’ prescription drug misuse intentions and behaviors in daily life; present completion rates, compliance, acceptability, and reactivity associated with the EMA protocol for participants who endorsed recent prescription drug misuse at screening (ie, risk group; n=300) and those who did not (ie, nonrisk group; n=55); and establish initial construct validity by linking the reports of misuse behaviors in daily life collected via the EMA app to prescription drug misuse reported on a standard survey. Methods: An EMA data collection app and protocol were designed specifically to capture hypothesized contextual factors along with prescription drug misuse intentions and behaviors in daily life. Using this protocol, young adult college students (N=352) completed signal- and event-contingent reports over a 28-day period. When the intention to misuse a prescription drug was endorsed, a brief follow-up prompt was sent 15 min later to collect participants’ indications of whether or not misuse had occurred. Results: Risk-group participants were significantly more likely than nonrisk counterparts to endorse any prescription drug misuse intentions in daily life (P<.001), to complete one or more follow-up reports (P<.001), and to endorse any prescription drug misuse behavior in daily life on the follow-ups (P<.001). Overall, participants demonstrated consistent engagement with the EMA procedures and returned an average of 74.5 (SD 23.82; range 10-122) reports. Participants in the risk and nonrisk groups did not differ in the number of reports they completed (P=.12), the number of their reporting days (P=.32), or their average completion rates (P=.14). The results indicated some evidence of reactivity to the momentary reporting procedure. Participants reported uniformly positive experiences and remained highly engaged throughout the reporting protocol and broader study. Conclusions: The novel EMA app and protocol provide an effective way to assess real-time factors associated with prescription drug misuse intentions and behaviors in daily life. The resulting investigations offer the potential to provide highly translatable information for research and prevention efforts. %M 32877351 %R 10.2196/21676 %U https://mhealth.jmir.org/2020/10/e21676 %U https://doi.org/10.2196/21676 %U http://www.ncbi.nlm.nih.gov/pubmed/32877351 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19070 %T Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study %A Corazza,Francesco %A Snijders,Deborah %A Arpone,Marta %A Stritoni,Valentina %A Martinolli,Francesco %A Daverio,Marco %A Losi,Maria Giulia %A Soldi,Luca %A Tesauri,Francesco %A Da Dalt,Liviana %A Bressan,Silvia %+ Division of Pediatric Emergency Medicine, Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy, 39 0498218015, francesco.corazza@unipd.it %K cardiac arrest %K resuscitation %K mobile app %K high-fidelity simulation training %K cognitive aid %K pediatrics %K emergency medicine %D 2020 %7 1.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pediatric cardiac arrest (PCA), although rare, is associated with high mortality. Deviations from international management guidelines are frequent and associated with poorer outcomes. Different strategies/devices have been developed to improve the management of cardiac arrest, including cognitive aids. However, there is very limited experience on the usefulness of interactive cognitive aids in the format of an app in PCA. No app has so far been tested for its usability and effectiveness in guiding the management of PCA. Objective: To develop a new audiovisual interactive app for tablets, named PediAppRREST, to support the management of PCA and to test its usability in a high-fidelity simulation-based setting. Methods: A research team at the University of Padova (Italy) and human–machine interface designers, as well as app developers, from an Italian company (RE:Lab S.r.l.) developed the app between March and October 2019, by applying an iterative design approach (ie, design–prototyping–evaluation iterative loops). In October–November 2019, a single-center nonrandomized controlled simulation–based pilot study was conducted including 48 pediatric residents divided into teams of 3. The same nonshockable PCA scenario was managed by 11 teams with and 5 without the app. The app user’s experience and interaction patterns were documented through video recording of scenarios, debriefing sessions, and questionnaires. App usability was evaluated with the User Experience Questionnaire (UEQ) (scores range from –3 to +3 for each scale) and open-ended questions, whereas participants’ workload was measured using the NASA Raw-Task Load Index (NASA RTLX). Results: Users’ difficulties in interacting with the app during the simulations were identified using a structured framework. The app usability, in terms of mean UEQ scores, was as follows: attractiveness 1.71 (SD 1.43), perspicuity 1.75 (SD 0.88), efficiency 1.93 (SD 0.93), dependability 1.57 (SD 1.10), stimulation 1.60 (SD 1.33), and novelty 2.21 (SD 0.74). Team leaders’ perceived workload was comparable (P=.57) between the 2 groups; median NASA RTLX score was 67.5 (interquartile range [IQR] 65.0-81.7) for the control group and 66.7 (IQR 54.2-76.7) for the intervention group. A preliminary evaluation of the effectiveness of the app in reducing deviations from guidelines showed that median time to epinephrine administration was significantly longer in the group that used the app compared with the control group (254 seconds versus 165 seconds; P=.015). Conclusions: The PediAppRREST app received a good usability evaluation and did not appear to increase team leaders’ workload. Based on the feedback collected from the participants and the preliminary results of the evaluation of its effects on the management of the simulated scenario, the app has been further refined. The effectiveness of the new version of the app in reducing deviations from guidelines recommendations in the management of PCA and its impact on time to critical actions will be evaluated in an upcoming multicenter simulation-based randomized controlled trial. %M 32788142 %R 10.2196/19070 %U https://mhealth.jmir.org/2020/10/e19070 %U https://doi.org/10.2196/19070 %U http://www.ncbi.nlm.nih.gov/pubmed/32788142 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e19880 %T A Novel Auditory-Cognitive Training App for Delaying or Preventing the Onset of Dementia: Participatory Design With Stakeholders %A Frost,Emily %A Porat,Talya %A Malhotra,Paresh %A Picinali,Lorenzo %+ Dyson School of Design Engineering, Imperial College London, Dyson Building, Imperial College Road, London, SW7 2DB, United Kingdom, 44 2075948158, e.frost@imperial.ac.uk %K cognitive decline %K mobile phone %K hearing loss %D 2020 %7 30.9.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Multiple gaming apps exist under the dementia umbrella for skills such as navigation; however, an app to specifically investigate the role of hearing loss in the process of cognitive decline is yet to be designed. There is a demonstrable gap in the utilization of games to further the knowledge of the potential relationship between hearing loss and dementia. Objective: This study aims to identify the needs, facilitators, and barriers in designing a novel auditory-cognitive training gaming app. Methods: A participatory design approach was used to engage key stakeholders across audiology and cognitive disorder specialties. Two rounds, including paired semistructured interviews and focus groups, were completed and thematically analyzed. Results: A total of 18 stakeholders participated, and 6 themes were identified to inform the next stage of app development. These included congruence with hobbies, life getting in the way, motivational challenge, accessibility, addictive competition, and realism. Conclusions: The findings can now be implemented in the development of the app. The app will be evaluated against outcome measures of speech listening in noise, cognitive and attentional tasks, quality of life, and usability. %M 32996884 %R 10.2196/19880 %U http://humanfactors.jmir.org/2020/3/e19880/ %U https://doi.org/10.2196/19880 %U http://www.ncbi.nlm.nih.gov/pubmed/32996884 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e15460 %T Smartphone Apps to Support Falls Rehabilitation Exercise: App Development and Usability and Acceptability Study %A Hawley-Hague,Helen %A Tacconi,Carlo %A Mellone,Sabato %A Martinez,Ellen %A Ford,Claire %A Chiari,Lorenzo %A Helbostad,Jorunn %A Todd,Chris %+ University of Manchester, Division of Nursing, Midwifery and Social Work., Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 7810358568, Helen.Hawley-Hague@manchester.ac.uk %K aged %K postural balance %K telerehabilitation %K patient compliance %K accidental falls %D 2020 %7 28.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Falls have implications for older adults’ health and well-being. Strength and balance interventions significantly reduce the risk of falls. However, patients do not always perform the unsupervised home exercise needed for fall reduction. Objective: This study aims to develop motivational smartphone apps co-designed with health professionals and older adults to support patients to perform exercise proven to aid fall reduction and to explore the apps’ usability and acceptability with both health professionals and patients. Methods: There were 3 phases of app development that included analysis, design, and implementation. For analysis, we examined the literature to establish key app components and had a consultation with 12 older adults attending a strength and balance class, exercise instructors, and 3 fall services. For design, we created prototype apps and conducted 2 patient and public involvement workshops, one with 5 health professionals and the second with 8 older adults from an exercise group. The apps were revised based on the feedback. For implementation, we tested them with one fall service and their patients for 3 weeks. Participatory evaluation was used through testing, semistructured interviews, and focus groups to explore acceptability and usability. Focus groups were conducted with the service that tested the apps and two other services. Qualitative data were analyzed using the framework approach. Results: On the basis of findings from the literature and consultations in the analysis phase, we selected Behavior Change Techniques, such as goal setting, action planning, and feedback on behavior, to be key parts of the app. We developed goals using familiar icons for patients to select and add while self-reporting exercise and decided to develop 2 apps, one for patients (My Activity Programme) and one for health professionals (Motivate Me). This enabled health professionals to guide patients through the goal-setting process, making it more accessible to nontechnology users. Storyboards were created during the design phase, leading to prototypes of “Motivate Me” and “My Activity Programme.” Key changes from the workshops included being able to add more details about the patients’ exercise program and a wider selection of goals within “Motivate Me.” The overall app design was acceptable to health professionals and older adults. In total, 7 patients and 3 health professionals participated in testing in the implementation phase, with interviews conducted with 6 patients and focus groups, with 3 teams (11 health professionals). Barriers, facilitators, and further functionality were identified for both apps, with 2 cross-cutting themes around phone usability and confidence. Conclusions: The motivational apps were found to be acceptable for older adults taking part in the design stage and patients and health professionals testing the apps in a clinical setting. User-led design is important to ensure that the apps are usable and acceptable. %M 32985992 %R 10.2196/15460 %U http://mhealth.jmir.org/2020/9/e15460/ %U https://doi.org/10.2196/15460 %U http://www.ncbi.nlm.nih.gov/pubmed/32985992 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e20317 %T Design and Usability Evaluation of Mobile Voice-Added Food Reporting for Elderly People: Randomized Controlled Trial %A Liu,Ying-Chieh %A Chen,Chien-Hung %A Lin,Yu-Sheng %A Chen,Hsin-Yun %A Irianti,Denisa %A Jen,Ting-Ni %A Yeh,Jou-Yin %A Chiu,Sherry Yueh-Hsia %+ Department of Health Care Management and Healthy Aging Research Center, College of Management, Chang Gung University, No. 259, Wen-Hwa 1st Road, 333 Kwei-Shan, Taoyuan, Taiwan, 886 3 2118800 ext 5250, sherrychiu@mail.cgu.edu.tw %K voice-added design %K food report %K elderly %K usability evaluation %K automatic speech recognition %K mHealth %K randomized trial %D 2020 %7 28.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in voice technology have raised new possibilities for apps related to daily health maintenance. However, the usability of such technologies for older users remains unclear and requires further investigation. Objective: We designed and evaluated two innovative mobile voice-added apps for food intake reporting, namely voice-only reporting (VOR) and voice-button reporting (VBR). Each app features a unique interactive procedure for reporting food intake. With VOR, users verbally report the main contents of each dish, while VBR provides both voice and existing touch screen inputs for food intake reporting. The relative usability of the two apps was assessed through the metrics of accuracy, efficiency, and user perception. Methods: The two mobile apps were compared in a head-to-head parallel randomized trial evaluation. A group of 57 adults aged 60-90 years (12 male and 45 female participants) was recruited from a retirement community and randomized into two experimental groups, that is, VOR (n=30) and VBR (n=27) groups. Both groups were tested using the same set of 17 food items including dishes and beverages selected and allocated to present distinct breakfast, lunch, and dinner meals. All participants used a 7-inch tablet computer for the test. The resulting data were analyzed to evaluate reporting accuracy and time efficiency, and the system usability scale (SUS) was used to measure user perception. Results: For eight error types identified in the experiment, the VBR group participants were significantly (P<.001) more error prone owing to the required use of button-tapping actions. The highest error rates in the VOR group were related to incomprehensible reporting speech (28/420, 6.7%), while the highest error rates in the VBR group were related to failure to make required button taps (39/378, 10.3%). The VOR group required significantly (P<.001) less time to complete food reporting. The overall subjective reactions of the two groups based on the SUS surpassed the benchmark and were not significantly different (P=.20). Conclusions: Experimental results showed that VOR outperformed VBR, suggesting that voice-only food input reporting is preferable for elderly users. Voice-added apps offer a potential mechanism for the self-management of dietary intake by elderly users. Our study contributes an evidence-based evaluation of prototype design and selection under a user-centered design model. The results provide a useful reference for selecting optimal user interaction design. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN17335889; http://www.isrctn.com/ISRCTN17335889. %M 32985999 %R 10.2196/20317 %U http://mhealth.jmir.org/2020/9/e20317/ %U https://doi.org/10.2196/20317 %U http://www.ncbi.nlm.nih.gov/pubmed/32985999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e17947 %T Giving Children With Osteogenesis Imperfecta a Voice: Participatory Approach for the Development of the Interactive Assessment and Communication Tool Sisom OI %A Siedlikowski,Maia %A Rauch,Frank %A Tsimicalis,Argerie %+ Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Suite 1800 Room 1835, 680 Sherbrooke Street West, Montreal, QC, , Canada, 1 5147706069, argerie.tsimicalis@mcgill.ca %K child health %K symptom assessment, communication, mobile apps, software %D 2020 %7 22.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Children with osteogenesis imperfecta (OI) experience acute and chronic symptoms that expose them to physical, mental, and social challenges. Empowering these children by involving them in their care can help them to cope with OI. Sisom is an interactive assessment and communication tool designed to help children aged 6-12 years with chronic illnesses express their symptoms. This tool has not yet been adapted to the unique needs of OI. Objective: The aim of this study was to develop a Sisom OI paper prototype by seeking the perspectives of end users. Methods: A participatory approach was adopted to develop the prototype overseen by an expert panel of 9 clinicians at a university-affiliated pediatric hospital. Purposive sampling was used to recruit 12 children with OI who were aged 6-12 years. The study was carried out over the course of 3 feedback cycles. Data were deductively interpreted using content analysis techniques. Results: Overall, 64% (57/89) of the Sisom symptoms were deemed relevant for inclusion in Sisom OI, with 42% (37/89) directly incorporated and 22% (20/89) incorporated with changes. In total, 114 symptoms were used to create the prototype, of which 57 were newly generated. The relevant symptoms addressed children’s thoughts and feelings about hospitalization and their wishes for participation in their own care. The new symptoms addressed fractures, body image, and social isolation related to difficulties with accessibility and intimidation. Conclusions: Once developed, Sisom OI will offer clinicians an innovative and child-centered approach to capture children’s perspectives on their condition. %M 32960176 %R 10.2196/17947 %U http://www.jmir.org/2020/9/e17947/ %U https://doi.org/10.2196/17947 %U http://www.ncbi.nlm.nih.gov/pubmed/32960176 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 5 %N 1 %P e20730 %T Ease of Use of the Electroconvulsive Therapy App by Its Users: Cross-Sectional Questionnaire Study %A Khan,Kinza %A Basavarajappa,Chethan %A Kunigiri,Girish %+ Bradgate Mental Health Unit, Leicester, Leicester, LE3 9EJ, United Kingdom, 44 1530 453827, Girish.Kunigiri@leicspart.nhs.uk %K mHealth %K depression %K apps %K electroconvulsive therapy %K smartphone %K mobile phone %K surveys %K psychiatry %D 2020 %7 22.9.2020 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Electroconvulsive therapy (ECT) is one of the oldest, most effective, and potentially life-saving noninvasive brain stimulation treatments for psychiatric illnesses such as severe depression, mania, and catatonia. The decision-making process to use ECT involves well-informed discussion between the clinician and the client. A platform, like an app, which provides this information in an easy-to-understand format may be of benefit to various stakeholders in making an informed decision. Apps developed by clinicians/hospitals taking into consideration user perspectives will filter and provide trustworthy information to the users. In this regard, the ECT app, an app which is freely available for download at the Apple Store, was developed by the Leicestershire Partnership National Health Service (NHS) Trust and Leicestershire Health Informatics Service (LHIS). Objective: The objective of this study is to evaluate and demonstrate the accessibility of the ECT app to the chosen audiences it was created for, via a paper and electronic questionnaire. Methods: A survey was conducted between January 2017 and March 2019. A survey questionnaire designed for the study was sent to mental health professionals, medical students, patients, carers, and members of the public via post, email, and SurveyMonkey or informed via posts shared in Psychiatry online groups and face-to-face contact. All participants who were willing to participate in the study were included. Results: Results were collected via paper forms, email responses, and SurveyMonkey and all were inputted into SurveyMonkey to facilitate analysis. A total of 20 responses were received during the study period (January 2017 to March 2019). The participants of the survey, which included a mixed group of professionals (12/20, 60%), patients (3/20, 15%), and carers (1/20, 5%), opined that the app was easy to download (14/20, 70%) and use (9/20, 45%); contained adequate information (19/20, 95%); they felt more informed after having used the app (9/20, 45%); and they would recommend it to others (19/20, 95%). The participants of the survey also provided suggestions on the app (10/20, 50%). Conclusions: The ECT app can be beneficial in sharing appropriate information to professionals and the public alike and help in gathering unbiased and nonjudgmental information on the current use of ECT as a treatment option. %R 10.2196/20730 %U http://biomedeng.jmir.org/2020/1/e20730/ %U https://doi.org/10.2196/20730 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e20165 %T Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies %A Seppen,Bart F %A Wiegel,Jimmy %A L'ami,Merel J %A Duarte dos Santos Rico,Sharon %A Catarinella,Fabio S %A Turkstra,Franktien %A Boers,Maarten %A Bos,Wouter H %+ Amsterdam Rheumatology and Immunology Center, Reade, Dr Jan van Breemenstraat 2, Amsterdam , Netherlands, 31 616796208, b.seppen@reade.nl %K mHealth %K eHealth %K patient-reported outcome, smartphone app %K rheumatoid arthritis %K self-monitoring %K telemonitoring %K mobile phone %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Several mobile apps that monitor symptoms of rheumatoid arthritis (RA) exist, but a recent systematic review indicated that high-quality apps are lacking. When patients self-monitor their own disease with patient-reported outcomes (PROs) and self-initiate care at the right moment, it may be possible to reduce the frequency of their clinic visits, which would reduce health care burden and costs. We developed an app, that is, the MijnReuma Reade app, for this purpose and performed 2 pilot tests with weekly self-monitoring. Objective: The primary objective of this study was to design, develop, and evaluate the usability, satisfaction, and usage of the MijnReuma Reade app—an app that allows patients with RA to monitor their own disease. The secondary objective was to review the patients’ perspectives on app usage and its intended purpose. Methods: This app was designed in collaboration with patients with RA, rheumatologists, and information technology experts. Two 1-month pilot studies were performed, after which satisfaction (0-10 scale), usability (system usability scale, 0-100), and usage (proportion of completed questionnaires) of this app were assessed. After the second pilot study, semistructured interviews were performed to determine patients’ perspectives and the promoters and barriers of app usage. Results: In the first and second pilot study, 42 and 27 patients were included, respectively. Overall, the patients were satisfied (medians, 8 and 7) and found the app usable (mean system usability scores, 76 and 71) in pilot studies 1 and 2, respectively. App usage declined over time in both the pilot studies; 61% (17/28) and 37% (10/27) of the patients who disclosed their usage statistics completed the final weekly questionnaire in pilot study 1 and pilot study 2, respectively. Approximately 81% (25/31) of the patients indicated they would like to skip hospital visits if the self-monitored disease activity is low. In the semistructured interviews, technical problems, internal resistance (respondent fatigue, the app reminded them of their disease), and a lack of symptoms were identified as barriers for usage. Patients reported that “experiencing more grip on their disease” and “improved communication with their physician” were promoters for usage. Patients reported that pain positively mediated usage, that is, more pain promoted and less pain discouraged app usage. Conclusions: This study illustrates the feasibility of the MijnReuma Reade app that enables self-monitoring of the disease activity in patients with RA with the overarching aim to allocate clinical consultations according to need. Satisfaction with the app and usability of the app were found to be high; however, app usage declined over time. Patients acknowledged the potential of the app to self-monitor their own disease and would like to be able to skip clinic visits if the monitored disease activity is low. To evaluate this strategy, a randomized controlled trial is underway. %M 32955447 %R 10.2196/20165 %U http://formative.jmir.org/2020/9/e20165/ %U https://doi.org/10.2196/20165 %U http://www.ncbi.nlm.nih.gov/pubmed/32955447 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e17416 %T Embedding the Pillars of Quality in Health Information Technology Solutions Using “Integrated Patient Journey Mapping” (IPJM): Case Study %A McCarthy,Stephen %A O'Raghallaigh,Paidi %A Woodworth,Simon %A Lim,Yoke Yin %A Kenny,Louise C %A Adam,Frédéric %+ Department of Business Information Systems, Cork University Business School, University College Cork, Western Road, Cork, T12 K8AF, Ireland, 353 21 490 ext 3214, stephen.mccarthy@ucc.ie %K health information technology %K health care quality %K data analytics %K multidisciplinary research %K mobile phone %D 2020 %7 17.9.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health information technology (HIT) and associated data analytics offer significant opportunities for tackling some of the more complex challenges currently facing the health care sector. However, to deliver robust health care service improvements, it is essential that HIT solutions be designed by parallelly considering the 3 core pillars of health care quality: clinical effectiveness, patient safety, and patient experience. This requires multidisciplinary teams to design interventions that both adhere to medical protocols and achieve the tripartite goals of effectiveness, safety, and experience. Objective: In this paper, we present a design tool called Integrated Patient Journey Mapping (IPJM) that was developed to assist multidisciplinary teams in designing effective HIT solutions to address the 3 core pillars of health care quality. IPJM is intended to support the analysis of requirements as well as to promote empathy and the emergence of shared commitment and understanding among multidisciplinary teams. Methods: A 6-month, in-depth case study was conducted to derive findings on the use of IPJM during Learning to Evaluate Blood Pressure at Home (LEANBH), a connected health project that developed an HIT solution for the perinatal health context. Data were collected from over 700 hours of participant observations and 10 semistructured interviews. Results: The findings indicate that IPJM offered a constructive tool for multidisciplinary teams to work together in designing an HIT solution, through mapping the physical and emotional journey of patients for both the current service and the proposed connected health service. This allowed team members to consider the goals, tasks, constraints, and actors involved in the delivery of this journey and to capture requirements for the digital touchpoints of the connected health service. Conclusions: Overall, IPJM facilitates the design and implementation of complex HITs that require multidisciplinary participation. %M 32940610 %R 10.2196/17416 %U http://humanfactors.jmir.org/2020/3/e17416/ %U https://doi.org/10.2196/17416 %U http://www.ncbi.nlm.nih.gov/pubmed/32940610 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17919 %T Design and Development of a Digital Weight Management Intervention (ToDAy): Qualitative Study %A Shoneye,Charlene L %A Mullan,Barbara %A Begley,Andrea %A Pollard,Christina M %A Jancey,Jonine %A Kerr,Deborah A %+ School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 61 61892664122, D.Kerr@curtin.edu.au %K obesity %K diet %K physical activity %K sedentary behavior %K digital behavioral interventions %K health behavior %K wearable activity monitor %K health %K mobile food record %K clinical trial %K focus group %K qualitative research %K mobile phone %D 2020 %7 9.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support. Objective: The ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors. Methods: This qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis. Results: Qualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence. Conclusions: This study explores users’ capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback. International Registered Report Identifier (IRRID): RR2-10.2196/12782 %M 32641284 %R 10.2196/17919 %U https://mhealth.jmir.org/2020/9/e17919 %U https://doi.org/10.2196/17919 %U http://www.ncbi.nlm.nih.gov/pubmed/32641284 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 9 %P e17770 %T A Smartphone App to Manage Cirrhotic Ascites Among Outpatients: Feasibility Study %A Bloom,Patricia %A Wang,Thomas %A Marx,Madeline %A Tagerman,Michelle %A Green,Bradley %A Arvind,Ashwini %A Ha,Jasmine %A Bloom,Judith %A Richter,James M %+ Department of Gastroenterology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States, 1 844 233 0433, ppbloom@med.umich.edu %K health care innovation %K ascites %K telemedicine %K health care delivery %K technology %K mobile phone %D 2020 %7 2.9.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Ascites is a common, painful, and serious complication of cirrhosis. Body weight is a reliable proxy for ascites volume; therefore, daily weight monitoring is recommended to optimize ascites management. Objective: This study aims to evaluate the feasibility of a smartphone app in facilitating outpatient ascites management. Methods: In this feasibility study, patients with cirrhotic ascites requiring active management were identified in both inpatient and outpatient settings. Patients were provided with a Bluetooth-connected scale, which transmitted weight data to a smartphone app and then via the internet to an electronic medical record (EMR). Weights were monitored every weekday. In the event of a weight change of ≥5 lbs in 1 week, patients were called and administered a short symptom questionnaire, and providers received an email alert. The primary outcomes of this study were the percentage of enrolled days during which weight data were successfully transmitted to an EMR and the percentage of weight alerts that prompted responses by the provider. Results: In this study, 25 patients were enrolled: 12 (48%) were male, and the mean age was 58 (SD 13; range 35-81) years. A total of 18 (72%) inpatients were enrolled. Weight data were successfully transmitted to an EMR during 71.2% (697/979) of the study enrollment days, with technology issues reported on 16.5% (162/979) of the days. Of a total of 79 weight change alerts fired, 41 (52%) were triggered by weight loss and 38 (48%) were by weight gain. Providers responded in some fashion to 66 (84%) of the weight alerts and intervened in response to 45 (57%) of the alerts, for example, by contacting the patient, scheduling clinic or paracentesis appointments, modifying the diuretic dose, or requesting a laboratory workup. Providers responded equally to weight increase and decrease alerts (P=.87). The staff called patients a mean of 3.7 (SD 3.5) times per patient, and the number of phone calls correlated with technology issues (r=0.60; P=.002). A total of 60% (15/25) of the patients chose to extend their participation beyond 30 days. A total of 17 patient readmissions occurred during the study period, with only 4 (24%) related to ascites. Conclusions: We demonstrated the feasibility of a smartphone app to facilitate the management of ascites and reported excellent rates of patient and provider engagement. This innovation could enable early therapeutic intervention, thereby decreasing the burden of morbidity and mortality among patients with cirrhosis. %M 32876581 %R 10.2196/17770 %U https://medinform.jmir.org/2020/9/e17770 %U https://doi.org/10.2196/17770 %U http://www.ncbi.nlm.nih.gov/pubmed/32876581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e17126 %T Lifestyle Interventions for Polycystic Ovary Syndrome: Cross-Sectional Survey to Assess Women's Treatment and Outcome Preferences %A Saslow,Laura R %A Aikens,James E %+ Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Room 2178, 400 N Ingalls Street, Ann Arbor, MI, 48109, United States, 1 734 764 7836, saslowl@umich.edu %K polycystic ovary syndrome %K lifestyle intervention %K online and mobile %K health psychology %K nutrition %D 2020 %7 2.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Diet and lifestyle programs improve health, but women’s preferences for these programs have not been formally explored. Objective: The aim of our study was to examine diet and lifestyle program preferences among women with PCOS. Methods: We conducted a cross-sectional online survey of women with PCOS. Results: At least half of the 197 respondents expressed strong interest in programs addressing energy level, anxiety, depression, weight, diabetes prevention, menstrual period regulation, and hirsutism. Similarly, at least half reported willingness to modify their sleep, stress, and physical activity; and slightly less than half reported willingness to adopt a very low-carbohydrate, paleo, or low–glycemic index diet. At least half reported interest in online or mobile programs and email-based mentoring. Younger age was associated with interest in help with acne and fertility; higher body mass index was associated with wanting help with weight loss, energy, and anxiety; and greater stress eating was associated with wanting help with depression, anxiety, and menstrual period regulation. Conclusions: To our knowledge, this is the first study to examine attitudes and preferences of women with PCOS toward such programs. Future online and mobile diet and lifestyle programs may be able to capitalize on this information to better target this population’s expressed preferences. %M 32876573 %R 10.2196/17126 %U https://formative.jmir.org/2020/9/e17126 %U https://doi.org/10.2196/17126 %U http://www.ncbi.nlm.nih.gov/pubmed/32876573 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e21784 %T Development of a Mobile Health Intervention with Personal Experiments for Smokers Who Are Ambivalent About Quitting: Formative Design and Testing %A Heffner,Jaimee L %A Catz,Sheryl L %A Klasnja,Predrag %A Tiffany,Brooks %A McClure,Jennifer B %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2737, Jennifer.B.McClure@kp.org %K tobacco %K nicotine %K smoking %K cessation %K smartphone %K motivation %K mHealth %K intervention %K formative %K development %D 2020 %7 27.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of cigarette smokers want to quit someday but are not ready to commit to long-term abstinence. However, available smoking cessation treatments are not well-suited to meet the needs of these ambivalent smokers. Low-cost, high-reach mobile health (mHealth) interventions may be a cost-efficient means of offering assistance to ambivalent smokers, yet there are currently no evidence-based options available for this group. Objective: The aim of this study was to develop and preliminarily evaluate the core content for an mHealth program targeting adult smokers who are ambivalent about quitting. The core content consisted of a series of “personal experiments” similar to those tested as part of a counseling intervention in prior work, including brief cognitive or behavioral tasks designed to boost readiness for changing smoking behavior. Methods: We conducted individual user interviews (N=3) to refine program content, and then conducted a one-arm pilot study (N=25) to assess user receptivity and the potential impact of the experiments on motivation and self-efficacy to quit or reduce smoking. Results: In user interviews, participants liked the concept of the personal experiments. Participants in the pilot study found a medium-fidelity prototype to be highly acceptable. After watching a brief orientation video that explained how the program works, most participants (80%, 20/25) indicated that it sounded interesting, primarily because it did not require any commitment to quit. All participants (100%, 25/25) completed all 7 experiments, including a 24-hour quit attempt, although not all were able to refrain from smoking for a full day based on qualitative feedback on the experiment. The mean rating of usefulness of the overall program was 4.12 (SD 1.09) out of 5, and the average rating of the difficulty of the experiments was 2.16 (SD 1.18) out of 5. At the last assessment point, 92% (23/25) of the participants indicated that they were more interested in either quitting or cutting back than when they began the program, and 72% (18/25) said that if the program had included a free trial of nicotine replacement therapy, they would have used it to try to quit smoking. Conclusions: This formative work confirmed that ambivalent smokers are willing to use and will remain engaged with an mHealth intervention that employs the novel concept of personal experiments to enhance their motivation for and ability to quit smoking. The addition of action-oriented treatment (self-help and free nicotine replacement therapy, quitline referral) could further support users’ efforts to stop smoking and remain quit. %M 32852278 %R 10.2196/21784 %U http://formative.jmir.org/2020/8/e21784/ %U https://doi.org/10.2196/21784 %U http://www.ncbi.nlm.nih.gov/pubmed/32852278 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e18506 %T Beneficial Features of a mHealth Asthma App for Children and Caregivers: Qualitative Study %A Iio,Misa %A Miyaji,Yumiko %A Yamamoto-Hanada,Kiwako %A Narita,Masami %A Nagata,Mayumi %A Ohya,Yukihiro %+ College of Nursing, Kanto Gakuin University, 1-50-1 Mutsuurahigashi, Kanazawa-ku, Yokohama, 236-8503, Japan, 81 45 786 5641, misaiio@kanto-gakuin.ac.jp %K children %K caregivers %K asthma %K mobile app %K proposed beneficial features %D 2020 %7 24.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: mHealth and uHealth apps are available for children with asthma and their caregivers. However, previous studies on mHealth apps for children older than 7 years old with asthma are limited, and most studies on asthma apps do not consider interactions involving communication between children and caregivers. Therefore, a prototype mHealth child asthma app was developed for children and their caregivers, with features of tailored feedback messages in continuing self-management and interactions between children and caregivers. Objective: The aim of this study was to identify the beneficial features of a prototype mHealth app developed for children with asthma and their caregivers. Methods: Children diagnosed with persistent asthma by allergy specialists at the National Center for Child Health and Development were recruited. The features of a prototype mHealth app for children with asthma and their caregivers were investigated using semistructured interviews after they tried the app. Data were analyzed using thematic analysis. Content-characteristic words were named and grouped together as categories to explore themes. Results: We recruited 27 children with asthma aged 2 to 12 years and 26 their caregivers. Findings on the good aspects of the app for children older than 7 years old and caregivers suggested 4 themes (confirmation of asthma knowledge, child-caregiver interaction, design of the app, and child’s interest), and 6 categories were identified. Findings on the good aspects of app for children 7 to 12 years old and caregivers suggested 5 themes (new knowledge, manga as a Japanese-style comic, child’s interest, trigger of self-management, and design and operability), and 11 categories were identified. Findings on the beneficial features of app suggested 6 themes (asthma knowledge, elements for continuous, universal design, notification, monitoring, and functions), and 12 categories were identified. Conclusions: Children with asthma and their caregivers perceived that the good aspects of the app were learning asthma knowledge with fun, including manga; interaction between child and caregiver; and easy-to-read design, such as colors. They wanted not only the asthma knowledge but also the universal design and enhanced elements, monitoring, and notification functions of the app. %M 32831181 %R 10.2196/18506 %U http://mhealth.jmir.org/2020/8/e18506/ %U https://doi.org/10.2196/18506 %U http://www.ncbi.nlm.nih.gov/pubmed/32831181 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e15866 %T Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study %A Patel,Devika %A Sarlati,Siavash %A Martin-Tuite,Patrick %A Feler,Joshua %A Chehab,Lara %A Texada,Michael %A Marquez,Ruben %A Orellana,F Julia %A Henderson,Terrell L %A Nwabuo,Adaobi %A Plevin,Rebecca %A Dicker,Rochelle Ami %A Juillard,Catherine %A Sammann,Amanda %+ Department of Surgery, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 (628) 206 3764, devika.patel@ucsf.edu %K human-centered design %K violence intervention %K information and communications technology %D 2020 %7 24.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Violence is a public health problem. Hospital-based violence intervention programs such as the San Francisco Wraparound Project (WAP) have been shown to reduce future violent injury. The WAP model employs culturally competent case managers who recruit and enroll violently injured patients as clients. Client acceptance of the WAP intervention is variable, and program success depends on streamlined, timely communication and access to resources. High rates of smartphone usage in populations who are at risk for violent reinjury create an opportunity to design a tailored information and communications technology (ICT) tool to support hospital-based violence intervention programs. Objective: Current evidence shows that ICT tools developed in the health care space may not be successful in engaging vulnerable populations. The goal of this study was to use human-centered design methodology to identify the unique communication needs of the clients and case managers at WAP to design a mobile ICT. Methods: We conducted 15 semi-structured interviews with users: clients, their friends and families, case managers, and other stakeholders in violence intervention and prevention. We used a human-centered design and general inductive approach to thematic analysis to identify themes in the qualitative data, which were extrapolated to insight statements and then reframed into design opportunities. Wireframes of potential mobile ICT app screens were developed to depict these opportunities. Results: Thematic analysis revealed four main insights that were characterized by the opposing needs of our users. (1) A successful relationship is both professional and personal. Clients need this around the clock, but case managers can only support this while on the clock. (2) Communications need to feel personal, but they do not always need to be personalized. (3) Healing is a journey of skill development and lifestyle changes that must be acknowledged, monitored, and rewarded. (4) Social networks need to provide peer support for healing rather than peer pressure to propagate violence. These insights resulted in the following associated design opportunities: (1) Maximize personal connection while controlling access, (2) allow case managers to personalize automated client interactions, (3) hold clients accountable to progress and reward achievements, and (4) build a connected, yet confidential community. Conclusions: Human-centered design enabled us to identify unique insights and design opportunities that may inform the design of a novel and tailored mobile ICT tool for the WAP community. %M 32831179 %R 10.2196/15866 %U http://mhealth.jmir.org/2020/8/e15866/ %U https://doi.org/10.2196/15866 %U http://www.ncbi.nlm.nih.gov/pubmed/32831179 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e20312 %T Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic %A Casilang,Clarisse G %A Stonbraker,Samantha %A Japa,Ingrid %A Halpern,Mina %A Messina,Luz %A Steenhoff,Andrew P %A Lowenthal,Elizabeth D %A Fleisher,Linda %+ Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, United States, 1 267 426 6298, casilangc@email.chop.edu %K global health %K breast feeding %K mHealth %K mobile phone %D 2020 %7 21.8.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide. Objective: This study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ≤5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs. Methods: Participants were recruited from 3 outpatient sites: the Niños Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes. Results: All participants (N=35) reported having a mobile phone, and 29 (83%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding. Conclusions: There is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding. %M 32821063 %R 10.2196/20312 %U http://pediatrics.jmir.org/2020/2/e20312/ %U https://doi.org/10.2196/20312 %U http://www.ncbi.nlm.nih.gov/pubmed/32821063 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e20679 %T A Digital Health Intervention for Weight Management for Latino Families Living in Rural Communities: Perspectives and Lessons Learned During Development %A Yin,Zenong %A Errisuriz,Vanessa L %A Evans,Martin %A Inupakutika,Devasena %A Kaghyan,Sahak %A Li,Shiyu %A Esparza,Laura %A Akopian,David %A Parra-Medina,Deborah %+ Latino Research Institute, The University of Texas at Austin, 210 W 24th St, Mailcode F9200, Austin, TX, 78712, United States, 1 512 471 4557, parramedina@austin.utexas.edu %K mhealth %K digital intervention %K Latino families %K rural population %K weight %K self-management %K diet %K lifestyle %K chronic disease %D 2020 %7 20.8.2020 %9 Viewpoint %J JMIR Form Res %G English %X Rural residents face numerous challenges in accessing quality health care for management of chronic diseases (eg, obesity, diabetes), including scarcity of health care services and insufficient public transport. Digital health interventions, which include modalities such as internet, smartphones, and monitoring sensors, may help increase rural residents’ access to health care. While digital health interventions have become an increasingly popular intervention strategy to address obesity, research examining the use of technological tools for obesity management among rural Latino populations is limited. In this paper, we share our experience developing a culturally tailored, interactive health intervention using digital technologies for a family-oriented, weight management program in a rural, primarily Latino community. We describe the formative research that guided the development of the intervention, discuss the process of developing the intervention technologies including issues of privacy and data security, examine the results of a pilot study, and share lessons learned. Our experience can help others design user-centered digital health interventions to engage underserved populations in the uptake of healthy lifestyle and disease management skills. %M 32726748 %R 10.2196/20679 %U http://formative.jmir.org/2020/8/e20679/ %U https://doi.org/10.2196/20679 %U http://www.ncbi.nlm.nih.gov/pubmed/32726748 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e18999 %T Developing a Heart Transplantation Self-Management Support Mobile Health App in Taiwan: Qualitative Study %A Chen,Yi-Wen %A Wei,Jeng %A Chen,Hwei-Ling %A Cheng,Ching-Hui %A Hou,I-Ching %+ School of Nursing, National Yang-Ming University, Nursing Building Room 407, Number 155, Section 2, Linong Street, Beitou District, Taipei, Taiwan, 886 28267000 ext 7315, evita@ym.edu.tw %K heart transplantation %K mobile health app %K self-management %D 2020 %7 19.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heart transplantation (HTx) is the most effective treatment for end-stage heart failure patients. After transplantation, patients face physiological, psychological, social, and other health care problems. Mobile health (mHealth) apps can change the delivery of conventional health care to ubiquitous care and improve health care quality. However, a dearth of mHealth apps exists for patients with HTx worldwide, including in Taiwan. Objective: The aim of this study was to investigate the information needed and to develop a preliminary framework for an mHealth app for post-HTx patients. Methods: A qualitative approach with individual in-depth interviews was conducted at a heart center in the regional hospital of northern Taiwan from June to November 2017. Patients that had undergone HTx and their health professionals were recruited for purposeful sampling. A semistructured interview guideline was used for individual interviews and transcribed. Thematic analysis was used for data analysis. Results: A total of 21 subjects, including 17 patients and 4 health professionals, were recruited for the study. The following five major themes were identified: reminding, querying, experience sharing, diet, and expert consulting. Minor themes included a desire to use the app with artificial intelligence and integration with professional management. Conclusions: An intelligent mHealth app that addresses the five main themes and integrates the processes of using a mobile app could facilitate HTx self-management for Taiwanese patients. %M 32812883 %R 10.2196/18999 %U http://mhealth.jmir.org/2020/8/e18999/ %U https://doi.org/10.2196/18999 %U http://www.ncbi.nlm.nih.gov/pubmed/32812883 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19433 %T Developing a Mobile App (iGAM) to Promote Gingival Health by Professional Monitoring of Dental Selfies: User-Centered Design Approach %A Tobias,Guy %A Spanier,Assaf B %+ Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University - Hadassah School of Dental Medicine, Ein Kerem, Jerusalem, 91120, Israel, 972 527052333, guy.tobias@mail.huji.ac.il %K mHealth %K telemedicine %K public health %K oral health promotion %K gum health %K flow of information %K COVID-19 %D 2020 %7 14.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dental visits are unpleasant; sometimes, patients only seek treatment when they are in intolerable pain. Recently, the novel coronavirus (COVID-19) pandemic has highlighted the need for remote communication when patients and dentists cannot meet in person. Gingivitis is very common and characterized by red, swollen, bleeding gums. Gingivitis heals within 10 days of professional care and with daily, thorough oral hygiene practices. If left untreated, however, its progress may lead to teeth becoming mobile or lost. Of the many medical apps currently available, none monitor gingivitis. Objective: This study aimed to present a characterization and development model of a mobile health (mHealth) app called iGAM, which focuses on periodontal health and improves the information flow between dentists and patients. Methods: A focus group discussed the potential of an app to monitor gingivitis, and 3 semistructured in-depth interviews were conducted on the use of apps for monitoring gum infections. We used a qualitative design process based on the Agile approach, which incorporated the following 5 steps: (1) user story, (2) use cases, (3) functional requirements, (4) nonfunctional requirements, and (5) Agile software development cycles. In a pilot study with 18 participants aged 18-45 years and with different levels of health literacy, participants were given a toothbrush, toothpaste, mouthwash, toothpicks, and dental floss. After installing iGAM, they were asked to photograph their gums weekly for 4 weeks. Results: All participants in the focus group believed in the potential of a mobile app to monitor gingivitis and reduce its severity. Concerns about security and privacy issues were discussed. From the interviews, 2 themes were derived: (1) “what's in it for me?” and (2) the need for a take-home message. The 5 cycles of development highlighted the importance of communication between dentists, app developers, and the pilot group. Qualitative analysis of the data from the pilot study showed difficulty with: (1) the camera, which was alleviated with the provision of mouth openers, and (2) the operation of the phone, which was alleviated by changing the app to be fully automated, with a weekly reminder and an instructions document. Final interviews showed satisfaction. Conclusions: iGAM is the first mHealth app for monitoring gingivitis using self-photography. iGAM facilitates the information flow between dentists and patients between checkups and may be useful when face-to-face consultations are not possible (such as during the COVID-19 pandemic). %M 32795985 %R 10.2196/19433 %U http://mhealth.jmir.org/2020/8/e19433/ %U https://doi.org/10.2196/19433 %U http://www.ncbi.nlm.nih.gov/pubmed/32795985 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e16862 %T Using Natural Language Processing and Sentiment Analysis to Augment Traditional User-Centered Design: Development and Usability Study %A Petersen,Curtis Lee %A Halter,Ryan %A Kotz,David %A Loeb,Lorie %A Cook,Summer %A Pidgeon,Dawna %A Christensen,Brock C %A Batsis,John A %+ The Dartmouth Institute for Health Policy, Dartmouth, 1 Medical Drive, Williamson Translational Research Building, Level 5, Lebanon, NH, 03756, United States, 1 603 653 9500, john.batsis@gmail.com %K aged adults %K sarcopenia %K remote sensing technology %K telemedicine %K mobile phone %D 2020 %7 7.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sarcopenia, defined as the age-associated loss of muscle mass and strength, can be effectively mitigated through resistance-based physical activity. With compliance at approximately 40% for home-based exercise prescriptions, implementing a remote sensing system would help patients and clinicians to better understand treatment progress and increase compliance. The inclusion of end users in the development of mobile apps for remote-sensing systems can ensure that they are both user friendly and facilitate compliance. With advancements in natural language processing (NLP), there is potential for these methods to be used with data collected through the user-centered design process. Objective: This study aims to develop a mobile app for a novel device through a user-centered design process with both older adults and clinicians while exploring whether data collected through this process can be used in NLP and sentiment analysis Methods: Through a user-centered design process, we conducted semistructured interviews during the development of a geriatric-friendly Bluetooth-connected resistance exercise band app. We interviewed patients and clinicians at weeks 0, 5, and 10 of the app development. Each semistructured interview consisted of heuristic evaluations, cognitive walkthroughs, and observations. We used the Bing sentiment library for a sentiment analysis of interview transcripts and then applied NLP-based latent Dirichlet allocation (LDA) topic modeling to identify differences and similarities in patient and clinician participant interviews. Sentiment was defined as the sum of positive and negative words (each word with a +1 or −1 value). To assess utility, we used quantitative assessment questionnaires—System Usability Scale (SUS) and Usefulness, Satisfaction, and Ease of use (USE). Finally, we used multivariate linear models—adjusting for age, sex, subject group (clinician vs patient), and development—to explore the association between sentiment analysis and SUS and USE outcomes. Results: The mean age of the 22 participants was 68 (SD 14) years, and 17 (77%) were female. The overall mean SUS and USE scores were 66.4 (SD 13.6) and 41.3 (SD 15.2), respectively. Both patients and clinicians provided valuable insights into the needs of older adults when designing and building an app. The mean positive-negative sentiment per sentence was 0.19 (SD 0.21) and 0.47 (SD 0.21) for patient and clinician interviews, respectively. We found a positive association with positive sentiment in an interview and SUS score (ß=1.38; 95% CI 0.37 to 2.39; P=.01). There was no significant association between sentiment and the USE score. The LDA analysis found no overlap between patients and clinicians in the 8 identified topics. Conclusions: Involving patients and clinicians allowed us to design and build an app that is user friendly for older adults while supporting compliance. This is the first analysis using NLP and usability questionnaires in the quantification of user-centered design of technology for older adults. %M 32540843 %R 10.2196/16862 %U https://mhealth.jmir.org/2020/8/e16862 %U https://doi.org/10.2196/16862 %U http://www.ncbi.nlm.nih.gov/pubmed/32540843 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e16180 %T Characteristics of Neuropsychiatric Mobile Health Trials: Cross-Sectional Analysis of Studies Registered on ClinicalTrials.gov %A Minen,Mia Tova %A Reichel,Julia Frederica %A Pemmireddy,Pallavi %A Loder,Elizabeth %A Torous,John %+ NYU Langone Health, 222 E 41st Street,, New York, NY, 10017, United States, 1 2122637744, minenmd@gmail.com %K smartphones %K mobile phones %K apps %K mental health %K regulation %K stroke %K migraine %K major depressive disorder %K Alzheimer disease %K anxiety disorders %K alcohol use disorders %K opioid use disorders %K epilepsy %K schizophrenia %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The development of mobile health (mHealth) technologies is progressing at a faster pace than that of the science to evaluate their validity and efficacy. Under the International Committee of Journal Medical Editors (ICMJE) guidelines, clinical trials that prospectively assign people to interventions should be registered with a database before the initiation of the study. Objective: The aim of this study was to better understand the smartphone mHealth trials for high-burden neuropsychiatric conditions registered on ClinicalTrials.gov through November 2018, including the number, types, and characteristics of the studies being conducted; the frequency and timing of any outcome changes; and the reporting of results. Methods: We conducted a systematic search of ClinicalTrials.gov for the top 10 most disabling neuropsychiatric conditions and prespecified terms related to mHealth. According to the 2016 World Health Organization Global Burden of Disease Study, the top 10 most disabling neuropsychiatric conditions are (1) stroke, (2) migraine, (3) major depressive disorder, (4) Alzheimer disease and other dementias, (5) anxiety disorders, (6) alcohol use disorders, (7) opioid use disorders, (8) epilepsy, (9) schizophrenia, and (10) other mental and substance use disorders. There were no date, location, or status restrictions. Results: Our search identified 135 studies. A total of 28.9% (39/135) of studies evaluated interventions for major depressive disorder, 14.1% (19/135) of studies evaluated interventions for alcohol use disorders, 12.6% (17/135) of studies evaluated interventions for stroke, 11.1% (15/135) of studies evaluated interventions for schizophrenia, 8.1% (11/135) of studies evaluated interventions for anxiety disorders, 8.1% (11/135) of studies evaluated interventions for other mental and substance use disorders, 7.4% (10/135) of studies evaluated interventions for opioid use disorders, 3.7% (5/135) of studies evaluated interventions for Alzheimer disease or other dementias, 3.0% (4/135) of studies evaluated interventions for epilepsy, and 3.0% (4/135) of studies evaluated interventions for migraine. The studies were first registered in 2008; more than half of the studies were registered from 2016 to 2018. A total of 18.5% (25/135) of trials had results reported in some publicly accessible location. Across all the studies, the mean estimated enrollment (reported by the study) was 1078, although the median was only 100. In addition, across all the studies, the actual reported enrollment was lower, with a mean of 249 and a median of 80. Only about a quarter of the studies (35/135, 25.9%) were funded by the National Institutes of Health. Conclusions: Despite the increasing use of health-based technologies, this analysis of ClinicalTrials.gov suggests that only a few apps for high-burden neuropsychiatric conditions are being clinically evaluated in trials. %M 32749230 %R 10.2196/16180 %U https://mhealth.jmir.org/2020/8/e16180 %U https://doi.org/10.2196/16180 %U http://www.ncbi.nlm.nih.gov/pubmed/32749230 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e15669 %T Needs and Requirements in the Designing of Mobile Interventions for Patients With Peripheral Arterial Disease: Questionnaire Study %A Lortz,Julia %A Simanovski,Jan %A Kuether,Tabea %A Kreitschmann-Andermahr,Ilonka %A Ullrich,Greta %A Steinmetz,Martin %A Rammos,Christos %A Jánosi,Rolf Alexander %A Moebus,Susanne %A Rassaf,Tienush %A Paldán,Katrin %+ Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, Essen, 45147, Germany, 49 201 723 4801, julia.lortz@uk-essen.de %K peripheral arterial disease %K mHealth %K digital intervention %K supervised exercise therapy %K smartphone usage %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of mobile interventions for noncommunicable diseases has increased in recent years. However, there is a dearth of apps for patients with peripheral arterial disease (PAD), who frequently have an impaired ability to walk. Objective: Using a patient-centered approach for the development of mobile interventions, we aim to describe the needs and requirements of patients with PAD regarding the overall care situation and the use of mobile interventions to perform supervised exercise therapy (SET). Methods: A questionnaire survey was conducted in addition to a clinical examination at the vascular outpatient clinic of the West-German Heart and Vascular Center of the University Clinic Essen in Germany. Patients with diagnosed PAD were asked to answer questions on sociodemographic characteristics, PAD-related need for support, satisfaction with their health care situation, smartphone and app use, and requirements for the design of mobile interventions to support SET. Results: Overall, a need for better support of patients with diagnosed PAD was identified. In total, 59.2% (n=180) expressed their desire for more support for their disease. Patients (n=304) had a mean age of 67 years and half of them (n=157, 51.6%) were smartphone users. We noted an interest in smartphone-supported SET, even for people who did not currently use a smartphone. “Information,” “feedback,” “choosing goals,” and “interaction with physicians and therapists” were rated the most relevant components of a potential app. Conclusions: A need for the support of patients with PAD was determined. This was particularly evident with regard to disease literacy and the performance of SET. Based on a detailed description of patient characteristics, proposals for the design of mobile interventions adapted to the needs and requirements of patients can be derived. %M 32663154 %R 10.2196/15669 %U https://formative.jmir.org/2020/8/e15669 %U https://doi.org/10.2196/15669 %U http://www.ncbi.nlm.nih.gov/pubmed/32663154 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17760 %T The Mobile App Development and Assessment Guide (MAG): Delphi-Based Validity Study %A Llorens-Vernet,Pere %A Miró,Jordi %+ Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment, Universitat Rovira i Virgili, Carretera de Valls, s/n, Tarragona, 43007, Spain, 34 +34649298921, jordi.miro@urv.cat %K assessment %K Delphi method %K MAG %K mobile apps %K mobile health %K validity %K guide %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In recent years, there has been an exponential growth of mobile health (mHealth)–related apps. This has occurred in a somewhat unsupervised manner. Therefore, having a set of criteria that could be used by all stakeholders to guide the development process and the assessment of the quality of the apps is of most importance. Objective: The aim of this paper is to study the validity of the Mobile App Development and Assessment Guide (MAG), a guide recently created to help stakeholders develop and assess mobile health apps. Methods: To conduct a validation process of the MAG, we used the Delphi method to reach a consensus among participating stakeholders. We identified 158 potential participants: 45 patients as potential end users, 41 health care professionals, and 72 developers. We sent participants an online survey and asked them to rate how important they considered each item in the guide to be on a scale from 0 to 10. Two rounds were enough to reach consensus. Results: In the first round, almost one-third (n=42) of those invited participated, and half of those (n=24) also participated in the second round. Most items in the guide were found to be important to a quality mHealth-related app; a total of 48 criteria were established as important. “Privacy,” “security,” and “usability” were the categories that included most of the important criteria. Conclusions: The data supports the validity of the MAG. In addition, the findings identified the criteria that stakeholders consider to be most important. The MAG will help advance the field by providing developers, health care professionals, and end users with a valid guide so that they can develop and identify mHealth-related apps that are of quality. %M 32735226 %R 10.2196/17760 %U http://mhealth.jmir.org/2020/7/e17760/ %U https://doi.org/10.2196/17760 %U http://www.ncbi.nlm.nih.gov/pubmed/32735226 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17481 %T A Mobile Health Approach for Improving Outcomes in Suicide Prevention (SafePlan) %A O'Grady,Conor %A Melia,Ruth %A Bogue,John %A O'Sullivan,Mary %A Young,Karen %A Duggan,Jim %+ School of Computer Science, National University of Ireland Galway, University Road, Galway, H91 TK33, Ireland, 353 91493336, james.duggan@nuigalway.ie %K mobile apps %K suicide %K mHealth %D 2020 %7 30.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a prominent cause of death worldwide, particularly among young people. It was the second leading cause of death among those aged 15-29 years globally in 2016. Treatment for patients with suicidal thoughts or behaviors often includes face-to-face psychological therapy with a mental health professional. These forms of interventions may involve maintaining and updating paper-based reports or worksheets in between sessions. Mobile technology can offer a way to support the implementation of evidence-based psychological techniques and the acquisition of protective coping skills. Objective: This study aims to develop a mobile app to facilitate service users’ access to mental health support and safety planning. This process involved eliciting expert input from clinicians who are actively engaged in the provision of mental health care. Methods: A survey was distributed to targeted health care professionals to determine what features should be prioritized in a new mobile app relating to suicide prevention. On the basis of the survey results, a clinical design group, comprising 6 members with experience in fields such as mobile health (mHealth), clinical psychology, and suicide prevention, was established. This group was supplemented with further input from additional clinicians who provided feedback over three focus group sessions. The sessions were centered on refining existing app components and evaluating new feature requests. This process was iterated through regular feedback until agreement was reached on the overall app design and functionality. Results: A fully functional mobile app, known as the SafePlan app, was developed and tested with the input of clinicians through an iterative design process. The app’s core function is to provide an interactive safety plan to support users with suicidal thoughts or behaviors as an adjunct to face-to-face therapy. A diary component that facilitates the generalization of skills learned through dialectical behavior therapy was also implemented. Usability testing was carried out on the final prototype by students from a local secondary school, who are representative of the target user population in both age and technology experience. The students were asked to complete a system usability survey (SUS) at the end of this session. The mean overall SUS rating was 71.85 (SD 1.38). Conclusions: The participatory process involving key stakeholders (clinicians, psychologists, and information technology specialists) has resulted in the creation of an mHealth intervention technology that has the potential to increase accessibility to this type of mental health service for the target population. The app has gone through the initial testing phase, and the relevant recommendations have been implemented, and it is now ready for trialing with both clinicians and their patients. %M 32729845 %R 10.2196/17481 %U http://www.jmir.org/2020/7/e17481/ %U https://doi.org/10.2196/17481 %U http://www.ncbi.nlm.nih.gov/pubmed/32729845 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e19585 %T User-Dependent Usability and Feasibility of a Swallowing Training mHealth App for Older Adults: Mixed Methods Pilot Study %A Kim,HyangHee %A Lee,Sang-Ho %A Cho,Nam-Bin %A You,Heecheon %A Choi,Teukgyu %A Kim,Jinwon %+ Graduate Program in Speech-Language Pathology, Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 11-12 Yondaedongmun-gil, Seodaemun-gu, Seoul, 03721, Republic of Korea, 82 2 2228 3900, h.kim@yonsei.ac.kr %K older adults %K dysphagia %K swallowing %K mHealth %K thematic analysis %K usability %K apps %K education %K experience %K sociodemographic %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits. Objective: The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults’ self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties. Methods: A total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews). Results: The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=–2.023, P=.04). Additionally, the usability scores in the low-potential group were within the “marginal acceptability” range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience. Conclusions: To the best of the authors’ knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program. %M 32663161 %R 10.2196/19585 %U http://mhealth.jmir.org/2020/7/e19585/ %U https://doi.org/10.2196/19585 %U http://www.ncbi.nlm.nih.gov/pubmed/32663161 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18437 %T A Community-Engaged Approach to Creating a Mobile HIV Prevention App for Black Women: Focus Group Study to Determine Preferences via Prototype Demos %A Chandler,Rasheeta %A Hernandez,Natalie %A Guillaume,Dominique %A Grandoit,Shanaika %A Branch-Ellis,Desiré %A Lightfoot,Marguerita %+ Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 727 8164, r.d.chandler@emory.edu %K mHealth app %K mobile technology %K Black women %K HIV prevention %K reproductive health %K women’s health %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Black women are an important but relatively overlooked at-risk group in HIV prevention efforts. Although there is an aggregate decline of HIV diagnoses among women in the United States, there are persistent disparate rates of new HIV infections among Black women compared to any other cisgender female subgroup. Strategies to end the HIV epidemic—as outlined in the Ending the HIV Epidemic initiative—for all communities must consider HIV prevention messaging and message delivery mediums that are created with community input. Although mobile health (mHealth) is a popular platform for delivering HIV interventions, there are currently no mobile apps that consider cisgender Black women with the goal of promoting a comprehensive women’s reproductive health and HIV prevention lifestyle. Previous research recommends inclusion of the target population from project inception and iteratively throughout development, to promote use of the intervention. Objective: The purpose of this study is to understand cisgender Black women’s preferences for functionality, format, and design of a mobile HIV prevention app and to examine their willingness to use an app for HIV prevention. Methods: We conducted a series of four focus groups with 23 Black cisgender women. Focus groups included discussion and demonstration elements to address cisgender women’s general preference for apps, HIV prevention content that would be useful in an app, and preferred app features that would promote use of an HIV-centric app. During focus group discussions, participants were shown narrated, custom wireframes of HIV prevention app prototypes to demonstrate potential app function. Results: Findings indicated the presence of eight subthemes within the coding structure of three overall themes: (1) health content within the mobile app, (2) mobile app functionality, format, and design, and (3) other suggested features. Specifically, participants detailed preferred educational content, content distribution, app aesthetics, privacy considerations, and marketing of the app. Conclusions: Findings suggest that Black cisgender women preferred an app that integrated HIV prevention and optimal sexual health promotion. Participants provided a range of preferences for content integration and facilitators of app engagement with an HIV prevention app. Preferences centered on gender and cultural congruency of information and content, evidenced by visuals, language, and resources. Black cisgender women are viable consumers for a mobile app–based HIV prevention intervention. %M 32706723 %R 10.2196/18437 %U http://mhealth.jmir.org/2020/7/e18437/ %U https://doi.org/10.2196/18437 %U http://www.ncbi.nlm.nih.gov/pubmed/32706723 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e18049 %T MyStrengths, a Strengths-Focused Mobile Health Tool: Participatory Design and Development %A Jessen,Stian %A Mirkovic,Jelena %A Nes,Lise Solberg %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Trondhjemsveien 235, Oslo, 0586, Norway, 47 98049759, stian.jessen@rr-research.no %K mHealth %K participatory design %K personal strengths %K gameful design %K gamification %K iterative development %K positive approach %K co-design %K user engagement %K mobile phone %K chronic care %K self-management %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with chronic illnesses are an increasingly large group. Research indicates that care and self-management should not only focus on the illness and problem-oriented aspects of these individuals’ lives but also support them in recognizing and leveraging their personal strengths in daily life. Objective: This paper presents the design and developmental process of MyStrengths, a mobile health (mHealth) app designed to help its users (people with chronic conditions) both find and make use of their personal strengths in their daily lives. Through 4 consecutive phases, this paper presents participant- and researcher-driven activities, discussions regarding design, and development of both the MyStrengths app and its content. Methods: During the 4 phases, we used a range of methods and activities, including (1) an idea-generating workshop aimed at creating ideas for strengths-supporting features with different stakeholders, including patients, caregivers, relatives, and designers (N=35); (2) research seminars with an international group of experts (N=6), in which the concept, theoretical background, and design ideas for the app were discussed; (3) a series of co-design workshops with people in the user group (N=22) aiming to create ideas for how to, in an engaging manner, design the app; and (4) in 4 developmental iterations, the app was evaluated by people in the user group (N=13). Content and strengths exercises were worked on and honed by the research team, the expert groups, and our internal editorial team during the entire developmental process. Results: The first phase found a wide range of stakeholder requirements to, and ideas for, strengths-focused mHealth apps. From reviewing literature during the second phase, we found a dearth of research on personal strengths with respect to people living with chronic illnesses. Activities during the third phase creatively provided numerous ideas and suggestions for engaging and gameful ways to develop and design the MyStrengths app. The final phase saw the output from all the earlier phases come together. Through multiple increasingly complete iterations of user evaluations testing and developing, the final prototype of the MyStrengths app was created. Conclusions: Although research supports the use of strengths-focused mHealth tools to support people living with chronic illnesses, there is little guidance as to how these tools and their content should be designed. Through all activities, we found great support among participating users for strengths-focused apps, and we can consider such apps to be both appropriate and valuable. This paper illustrates how combining a range of user-, researcher-, literature-, and designer-based methods can contribute to creating mHealth tools to support people with chronic illnesses to find and use more of their own personal strengths. %M 32706651 %R 10.2196/18049 %U http://formative.jmir.org/2020/7/e18049/ %U https://doi.org/10.2196/18049 %U http://www.ncbi.nlm.nih.gov/pubmed/32706651 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17409 %T Perceptions of Patients Regarding Mobile Health Interventions for the Management of Chronic Obstructive Pulmonary Disease: Mixed Methods Study %A Alwashmi,Meshari F %A Fitzpatrick,Beverly %A Farrell,Jamie %A Gamble,John-Michael %A Davis,Erin %A Nguyen,Hai Van %A Farrell,Gerard %A Hawboldt,John %+ Memorial University of Newfoundland and Labrador, 230 Elizabeth Avenue, St. John’s, NL, A1C 5S7, Canada, 1 7096910728, mfa720@mun.ca %K mhealth %K COPD %K health technology %K smartphone %K mobile phone %D 2020 %7 23.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Using a mobile health (mHealth) intervention consisting of a smartphone and compatible medical device has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes while mitigating health care costs. Objective: This study aims to describe the demographics, use, and access to smartphones of patients with COPD. It also aims to explore and develop an understanding of potential facilitators and barriers that might influence patients using mHealth interventions for COPD management. Methods: This was an explanatory, sequential mixed methods study. Patients who attended respirology clinics completed a questionnaire on technology access and use. We conducted semistructured individual interviews with the patients. Interview topics included the following: demographics, mHealth use, perceptions toward challenges of mHealth adoption, factors facilitating mHealth adoption, and preferences regarding features of mHealth interventions for COPD management. Results: A total of 100 adults completed the survey but 22 participants were excluded because they were not diagnosed with COPD. Of these, 10 patients with COPD participated in the interview. The quantitative component revealed that many patients with COPD owned a mobile phone, but only about one-fourth of the participants (18/77, 23%) owned a smartphone. The likelihood of owning a smartphone was not associated with age, sex, marital status, or geographical location, but patients with high educational status were more likely to own a smartphone. The qualitative component found that patients with COPD, in general, had a positive attitude toward mHealth adoption for COPD management, but several facilitators and barriers were identified. The main facilitators of mHealth adoption are possible health benefits for patients, ease of use, educating patients, and credibility. Alternatively, the barriers to adoption are technical issues, lack of awareness, potential limited uptake from older adults, privacy and confidentiality issues, finances, and lack of interest in mHealth Conclusions: It is important to understand the perceptions of patients with COPD regarding the adoption of innovative mHealth interventions for COPD management. This study identifies some potential facilitators and barriers that may inform the successful development and implementation of mHealth interventions for COPD management. %M 32706697 %R 10.2196/17409 %U http://mhealth.jmir.org/2020/7/e17409/ %U https://doi.org/10.2196/17409 %U http://www.ncbi.nlm.nih.gov/pubmed/32706697 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16971 %T A Mobile App to Rapidly Appraise the In-Store Food Environment: Reliability, Utility, and Construct Validity Study %A McMahon,Emma Joy %A Jaenke,Rachael %A Brimblecombe,Julie %+ Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Building Red 9, Casuarina campus, Ellengowan Drive, Darwin, 0810, Australia, 61 731694202, e.j.mcmahon@outlook.com %K mobile apps %K reliability and validity %K food %K diet %K environment and public health %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Consumer food environments are increasingly being recognized as influential determinants of food purchasing and subsequent intake and health. We developed a tool to enable efficient, but relatively comprehensive, appraisal of the in-store food environment. The Store Scout mobile app facilitates the evaluation of product (availability and range), placement (visibility, accessibility, proximity to high-traffic areas, and location relative to other products), price (price promotion), and promotion (displays and advertising) across 7 categories of food products, with appraisal given immediately as scores (0-100, where a higher score is more in line with best practice). Primary end users are public health nutritionists and nutritionists employed by store organizations; however, store managers and staff are also potential end users. Objective: This study aims to evaluate the reliability (interrater reliability and internal consistency), utility (distribution of scores), and construct validity (score by store type) of measurements using the Store Scout mobile app. Methods: The Store Scout mobile app was used independently by 2 surveyors to evaluate the store environment in 54 stores: 34 metropolitan stores (9 small and 11 large supermarkets, 10 convenience stores, and 4 petrol stations) in Brisbane, Australia, and 20 remote stores (19 small supermarkets and 1 petrol station) in Indigenous Australian communities in Northern Australia. The agreement between surveyors in the overall and category scores was evaluated using intraclass correlation coefficients (ICCs). Interrater reliability of measurement items was assessed using percentage agreement and the Gwet agreement coefficient (AC). Internal consistency was assessed by comparing the responses of items measuring similar aspects of the store environment. We examined the distribution of score values using boxplots and differences by store type using the Kruskal-Wallis test. Results: The median difference in the overall score between surveyors was 4.4 (range 0.0-11.1), with an ICC of 0.954 (95% CI 0.914-0.975). Most measurement items had very good (n=74/196, 37.8%) or good (n=81/196, 41.3%) interrater reliability using the Gwet AC. A minimal inconsistency of measurement was found. Overall scores ranged from 19.2 to 81.6. There was a significant difference in score by store type (P<.001). Large Brisbane supermarkets scored highest (median 77.4, range 53.2-81.6), whereas small Brisbane supermarkets (median 63.9, range 41.0-71.3) and small remote supermarkets (median 63.8, range 56.5-74.9) scored significantly higher than Brisbane petrol stations (median 33.1, range 19.2-37.8) and convenience stores (median 39.0, range 22.4-63.8). Conclusions: These findings suggest good reliability and internal consistency of food environment measurements using the Store Scout mobile app. We identified specific aspects that can be improved to further increase the reliability of this tool. We found a good distribution of score values and evidence that scoring could capture differences by store type in line with previous evidence, which gives an indication of construct validity. The Store Scout mobile app shows promise in its capability to measure and track the health-enabling characteristics of store environments. %M 32706683 %R 10.2196/16971 %U https://mhealth.jmir.org/2020/7/e16971 %U https://doi.org/10.2196/16971 %U http://www.ncbi.nlm.nih.gov/pubmed/32706683 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17703 %T Untold Stories in User-Centered Design of Mobile Health: Practical Challenges and Strategies Learned From the Design and Evaluation of an App for Older Adults With Heart Failure %A Cornet,Victor Philip %A Toscos,Tammy %A Bolchini,Davide %A Rohani Ghahari,Romisa %A Ahmed,Ryan %A Daley,Carly %A Mirro,Michael J %A Holden,Richard J %+ Regenstrief Institute, 1101 W 10th St #421, Indianapolis, IN, 46202, United States, 1 317 278 5323, rjholden@iu.edu %K user-centered design %K research methods %K mobile health %K digital health %K mobile apps %K usability %K technology %K evaluation %K human-computer interaction %K mobile phone %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. Objective: This study aims to characterize the practical challenges encountered and propose strategies when implementing UCD for mHealth. Methods: Our multidisciplinary team implemented a UCD process to design and evaluate a mobile app for older adults with heart failure. During and after this process, we documented the challenges the team encountered and the strategies they used or considered using to address those challenges. Results: We identified 12 challenges, 3 about UCD as a whole and 9 across the UCD stages of formative research, design, and evaluation. Challenges included the timing of stakeholder involvement, overcoming designers’ assumptions, adapting methods to end users, and managing heterogeneity among stakeholders. To address these challenges, practical recommendations are provided to UCD researchers and practitioners. Conclusions: UCD is a gold standard approach that is increasingly adopted for mHealth projects. Although UCD methods are well-described and easily accessible, practical challenges and strategies for implementing them are underreported. To improve the implementation of UCD for mHealth, we must tell and learn from these traditionally untold stories. %M 32706745 %R 10.2196/17703 %U http://mhealth.jmir.org/2020/7/e17703/ %U https://doi.org/10.2196/17703 %U http://www.ncbi.nlm.nih.gov/pubmed/32706745 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e14778 %T Formative Evaluation of a Smartphone App for Monitoring Daily Meal Distribution and Food Selection in Adolescents: Acceptability and Usability Study %A Langlet,Billy %A Maramis,Christos %A Diou,Christos %A Maglaveras,Nikolaos %A Fagerberg,Petter %A Heimeier,Rachel %A Lekka,Irini %A Delopoulos,Anastasios %A Ioakimidis,Ioannis %+ The Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, Blickagången 16, Huddinge, , Sweden, 46 08 524 810 95, billy.langlet@ki.se %K mHealth %K eHealth %K dietary behavior %K lifestyle behavioral monitoring %K lifestyle interventions %K obesity %K mobile phone %K smartphone %K weight management %K overweight %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity interventions face the problem of weight regain after treatment as a result of low compliance. Mobile health (mHealth) technologies could potentially increase compliance and aid both health care providers and patients. Objective: This study aimed to evaluate the acceptability and usability and define system constraints of an mHealth system used to monitor dietary habits of adolescents in real life, as a first step in the development of a self-monitoring and lifestyle management system against adolescent obesity. Methods: We recruited 26 students from a high school in Stockholm, Sweden. After a 30-minute information meeting and 5-minute individual instruction on how to use an mHealth system (smartphone with app and two external sensors), participants used it for 2-3 weeks to objectively collect dietary habits. The app and sensors were used by the participants, without supervision, to record as many main meals and snacks as possible in real life. Feasibility was assessed following the “mHealth evidence reporting and assessment checklist,” and usability was assessed by questionnaires. Compliance was estimated based on system use, where a registration frequency of 3 main meals (breakfast, lunch, and dinner) per day for the period of the experiment, constituted 100% compliance. Results: Participants included in the analysis had a mean age of 16.8 years (SD 0.7 years) and BMI of 21.9 kg/m2 (SD 4.1 kg/m2). Due to deviations from study instructions, 2 participants were excluded from the analysis. During the study, 6 participants required additional information on system use. The system received a ‘Good’ grade (77.1 of 100 points) on the System Usability Scale, with most participants reporting that they were comfortable using the smartphone app. Participants expressed a willingness to use the app mostly at home, but also at school; most of their improvement suggestions concerned design choices for the app. Of all main meals, the registration frequency increased from 70% the first week to 76% the second week. Participants reported that 40% of the registered meals were home-prepared, while 34% of the reported drinks contained sugar. On average, breakfasts took place at 8:30 AM (from 5:00 AM to 2:00 PM), lunches took place at 12:15 PM (from 10:15 AM to 6:15 PM), and dinners took place at 7:30 PM (from 3:00 PM to 11:45 PM). When comparing meal occurrence during weekdays vs weekends, breakfasts and lunches were eaten 3 hours later during weekends, while dinner timing was unaffected. Conclusions: From an infrastructural and functional perspective, system use was feasible in the current context. The smartphone app appears to have high acceptability and usability in high school students, which are the intended end-users. The system appears promising as a relatively low-effort method to provide real-life dietary habit measurements associated with overweight and obesity risk. %M 32706684 %R 10.2196/14778 %U http://mhealth.jmir.org/2020/7/e14778/ %U https://doi.org/10.2196/14778 %U http://www.ncbi.nlm.nih.gov/pubmed/32706684 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e17044 %T High School Students’ Preferences and Design Recommendations for a Mobile Phone–Based Intervention to Improve Psychological Well-Being: Mixed Methods Study %A Müssener,Ulrika %A Thomas,Kristin %A Bendtsen,Preben %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Sandbäcksgatan 1, Linköping, 58183, Sweden, 46 732702426, ulrika.mussener@liu.se %K mental health %K stress %K high school students %K intervention %K mHealth %D 2020 %7 9.7.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Young adults’ mental health is characterized by relatively high rates of stress and anxiety and low levels of help-seeking behavior. Mobile health (mHealth) interventions could offer a cost-effective and readily available avenue to provide personalized support to young adults. More research needs to be directed at the development of mHealth interventions targeting youths specifically, as well as at determining how to reach young people and how to effectively intervene to improve psychological well-being. Objective: The objective was to gather perceptions from high school students to inform the development of a prototype mHealth intervention aiming to promote psychological well-being. Methods: A mixed methods design was used to (1) investigate high school students’ perceptions about stress and its consequences in daily life, as well as their ability to cope with stress, and (2) explore their preferences and design recommendations for an mHealth intervention to improve psychological well-being. Students from two high schools in the southeast of Sweden were invited to take part in the study. Recruitment of high school students was completed over a 6-week period, between October 25 and December 7, 2018. Recruitment entailed inviting students to complete a stress test (ie, screening and feedback) on their mobile phones. After completing the stress test, all participants were invited to complete a follow-up questionnaire and take part in telephone interviews. Results: A total of 149 high school students completed the stress test, of which 68 completed the questionnaire. There were 67 free-text comments distributed across the items. The majority of participants (55/68, 81%) stated that they coped with stress better or in the same way after engaging in the stress test, due to time management, dialogue with others, and self-refection. A total of 4 out of 68 participants (6%)—3 female students (75%) and 1 male student (25%)—took part in telephone interviews. Three main themes were identified from the interview data: perceptions about stress, design features, and intervention features. Conclusions: Stress was described by the students as a condition caused by high demands set by oneself and the social environment that impacted their physical health, personal relationships, school performance, and emotional well-being. Participants claimed that mHealth interventions need to be clearly tailored to a young age group, be evidence based, and offer varied types of support, such as information about stress, exercises to help organize tasks, self-assessment, coping tools, and recommendations of other useful websites, literature, blogs, self-help books, or role models. Mobile phones seemed to be a feasible and acceptable platform for the delivery of an intervention. %M 32673268 %R 10.2196/17044 %U https://pediatrics.jmir.org/2020/2/e17044 %U https://doi.org/10.2196/17044 %U http://www.ncbi.nlm.nih.gov/pubmed/32673268 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17347 %T A Scalable System for Passively Monitoring Oral Health Behaviors Using Electronic Toothbrushes in the Home Setting: Development and Feasibility Study %A Shetty,Vivek %A Morrison,Douglas %A Belin,Thomas %A Hnat,Timothy %A Kumar,Santosh %+ Section of Oral & Maxillofacial Surgery, Department of Biomedical Engineering, University of California, Los Angeles, Los Angeles, CA, United States, 1 3108255170, vshetty@ucla.edu %K health behaviors %K oral self-care %K digital tools %K remote monitoring %K passive measurement %D 2020 %7 24.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dental disease (including dental caries and periodontal disease) is largely preventable and closely linked to inadequate oral health behaviors. Digital health technologies have great potential for unobtrusively monitoring brushing behaviors in home settings and promoting optimal oral self-care routines at scale. Objective: The aim of this study is to leverage the ubiquity of electronic toothbrushes and smartphones with the development of a Remote Oral Behaviors Assessment System (ROBAS) and evaluate its feasibility for passively tracking brushing behaviors in real-world settings. Methods: We developed ROBAS by linking inertial sensors contained within consumer electronic toothbrushes to a scalable software platform comprised of a smartphone app linked to a cloud platform. First, the criterion validity of ROBAS for accurately capturing brushing details was established in a laboratory setting. Next, real-world performance and usability were evaluated in a stratified community sample of 32 participants who used ROBAS daily for 1 month and maintained a diary of their brushing episodes. Semistructured interviews at baseline and exit captured the user experience. We used regression models and Bland-Altman analyses to assess the criterion validity, functionality, accuracy, and consistency of ROBAS. Results: Using a stopwatch as the criterion reference, ROBAS showed a mean absolute percent error (MAPE) of 1.8%, an estimated bias of 0.64 seconds that was not statistically distinguishable from zero (95% CI –0.93 to 2.22 seconds, SE 0.79), and a connection failure rate of 6.7% (95% CI 0.8%-22.1%, SE 4.6%). In real-world testing, ROBAS showed close agreement with the daily diary recordings of brushing episodes; estimated average discrepancies between the diary and ROBAS were 0.13 sessions per day (95% CI 0.01-0.26, SE 0.06), 8.0 seconds per brushing session (95% CI 1.4-14.7, SE 3.3), and 30 seconds of brushing per day (95% CI 9.3-50.1, SE 10.0). Retrospective self-reports produced substantially higher estimates of brushing frequency and duration compared to ROBAS measurements. Participants reported ROBAS was easy to use and expressed an interest in receiving ROBAS-delivered feedback on their brushing behaviors. Most participants were bothered by the use of an additional study phone, and some reported connectivity-related issues. Conclusions: ROBAS has a high criterion validity for measuring oral health behaviors. It can accurately and reliably monitor brushing patterns in home settings for extended periods. Unobtrusive data collection through ROBAS sets the stage for automated coaching and optimization of oral self-care practices at the individual and population level. %M 32579118 %R 10.2196/17347 %U http://mhealth.jmir.org/2020/6/e17347/ %U https://doi.org/10.2196/17347 %U http://www.ncbi.nlm.nih.gov/pubmed/32579118 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16072 %T Low-Burden Mobile Monitoring, Intervention, and Real-Time Analysis Using the Wear-IT Framework: Example and Usability Study %A Brick,Timothy R %A Mundie,James %A Weaver,Jonathan %A Fraleigh,Robert %A Oravecz,Zita %+ Department of Human Development and Family Studies, Real-Time Science Laboratory, The Pennsylvania State University, 115 HHD Building, University Park, PA, , United States, 1 8148654868, tbrick@psu.edu %K smartphone apps %K ecological momentary assessment %K real-time analysis %K behavior change %D 2020 %7 17.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) methods often rely on active input from participants, for example, in the form of self-report questionnaires delivered via web or smartphone, to measure health and behavioral indicators and deliver interventions in everyday life settings. For short-term studies or interventions, these techniques are deployed intensively, causing nontrivial participant burden. For cases where the goal is long-term maintenance, limited infrastructure exists to balance information needs with participant constraints. Yet, the increasing precision of passive sensors such as wearable physiology monitors, smartphone-based location history, and internet-of-things devices, in combination with statistical feature selection and adaptive interventions, have begun to make such things possible. Objective: In this paper, we introduced Wear-IT, a smartphone app and cloud framework intended to begin addressing current limitations by allowing researchers to leverage commodity electronics and real-time decision making to optimize the amount of useful data collected while minimizing participant burden. Methods: The Wear-IT framework uses real-time decision making to find more optimal tradeoffs between the utility of data collected and the burden placed on participants. Wear-IT integrates a variety of consumer-grade sensors and provides adaptive, personalized, and low-burden monitoring and intervention. Proof of concept examples are illustrated using artificial data. The results of qualitative interviews with users are provided. Results: Participants provided positive feedback about the ease of use of studies conducted using the Wear-IT framework. Users expressed positivity about their overall experience with the framework and its utility for balancing burden and excitement about future studies that real-time processing will enable. Conclusions: The Wear-IT framework uses a combination of passive monitoring, real-time processing, and adaptive assessment and intervention to provide a balance between high-quality data collection and low participant burden. The framework presents an opportunity to deploy adaptive assessment and intervention designs that use real-time processing and provides a platform to study and overcome the challenges of long-term mHealth intervention. %M 32554373 %R 10.2196/16072 %U https://formative.jmir.org/2020/6/e16072 %U https://doi.org/10.2196/16072 %U http://www.ncbi.nlm.nih.gov/pubmed/32554373 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15449 %T User-Centered Design of a Mobile Health Intervention to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease (Copilot): Mixed Methods Study %A Korpershoek,Yvonne J G %A Hermsen,Sander %A Schoonhoven,Lisette %A Schuurmans,Marieke J %A Trappenburg,Jaap C A %+ Research Group Chronic Illnesses, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, Netherlands, 31 6 38763949, yvonne.korpershoek@hu.nl %K mobile health %K mHealth %K user-centered design %K behavior change %K COPD %K exacerbation %K self-management %K self-care %K mobile phone %D 2020 %7 15.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease (COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was developed to enhance exacerbation-related self-management in patients with COPD. Objective: This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD. Methods: The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers, COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention. Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative research methods were used throughout the design and development process. Results: The background analysis and design conceptualization phase resulted in final guiding principles for the intervention, a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth intervention—Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan. Conclusions: By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation impact. This extensive report of the intervention development process contributes to more transparency in the development of complex interventions in health care and can be used by researchers and designers as guidance for the development of future mHealth interventions. %M 32538793 %R 10.2196/15449 %U https://www.jmir.org/2020/6/e15449 %U https://doi.org/10.2196/15449 %U http://www.ncbi.nlm.nih.gov/pubmed/32538793 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16720 %T A Mobile App Adopting an Identity Focus to Promote Physical Activity (MoveDaily): Iterative Design Study %A Hooglugt,Floris %A Ludden,Geke D S %+ Department of Design, Production and Management, University of Twente, Drienerlolaan 5, Enschede, 7522NB, Netherlands, 31 534892920, g.d.s.ludden@utwente.nl %K research through design %K physical activity %K habits %K identity %K behavior change %K mHealth %K design %D 2020 %7 15.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Web-based and mobile interventions to influence physical activity behavior have had limited effects on sustained behavior change. One reason may be that the interventions aim to change largely habitual behavior. Following an identity-oriented approach could be a successful strategy to behavior change because people are committed to behave in line with their self-perception of identity. Objective: In this paper, we take a closer look at the role of motivation in long-term adherence to lifestyle interventions. The paper outlines a method for web-based or mobile intervention development that allows exploration of integrating behavior change theory into the design process. We will describe the development of a mobile app that allows people to be self-determined and to value and self-regulate physical activity by adopting an identity-oriented approach. Methods: This paper describes a Research through Design (RtD) process in which design activities are carried out as part of the knowledge-generating process. Two RtD phases were completed, followed by a conceptual design phase. In the first RtD phase, 8 participants used diary cards to study initial attitudes toward starting with small changes in physical activity. In the second RtD phase, 26 participants used a web-based app to study changes in physical activity. We used an adapted version of the Self-Report Habit Index (SRHI) to evaluate individuals’ perceptions of a particular behavior with respect to the three facets of a habit. The conceptual design phase consolidated the results from first two RtD phases into a design of a mobile app that combines an identity approach with gamification principles. The conceptual design was evaluated in a user-experience study with 4 participants. Results: In the first RtD phase, we found that interacting daily with diary cards and reflecting on physical activity patterns is a promising strategy but works better through a digital medium. In the second RtD phase, SHRI ratings from all participants generally increased each week. In the conceptual design phase, we found that the concept of the mobile app was positively evaluated by participants. However, participants mentioned that terms such as “identity” do not resonate with them and that scenarios could be simpler. Conclusions: This paper provides deeper insights into designing for electronic health (eHealth) interventions and services and suggests a new way that motivation can be shaped by the design of an intervention and adherence to physical activity. To the best of our knowledge, this was the first iterative design study in which the effects of adopting an identity approach to both motivation and physical activity were included and observed. Initial promising results were found for using a web-based intervention where habits and identification with the personal importance of a behavior were repetitively triggered. %M 32538795 %R 10.2196/16720 %U http://mhealth.jmir.org/2020/6/e16720/ %U https://doi.org/10.2196/16720 %U http://www.ncbi.nlm.nih.gov/pubmed/32538795 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17114 %T User Experiences and Preferences Regarding an App for the Treatment of Urinary Incontinence in Adult Women: Qualitative Study %A Wessels,Nienke J %A Hulshof,Lisa %A Loohuis,Anne M M %A van Gemert-Pijnen,Lisette %A Jellema,Petra %A van der Worp,Henk %A Blanker,Marco H %+ Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Postbus 196, Huispostcode FA21, Groningen, 9700 AD, Netherlands, 31 503616746, n.j.wessels@umcg.nl %K ehealth %K mobile applications %K self-management %K qualitative research %D 2020 %7 12.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although several apps are available to support the treatment of urinary incontinence (UI), little has been reported about the experiences and preferences of their users. Objective: The objective of this study was to explore the experiences and preferences of women using a mobile app for the treatment of UI and to identify potential improvements to the app. We developed this app for three types of UI: stress UI, urgency UI, and mixed UI. Methods: The participants in this qualitative study were women with self-reported stress UI, urgency UI, or mixed UI who used an app-based treatment to manage their condition for at least six weeks. Following the intervention, semistructured interviews were conducted to explore the participants’ experiences and preferences regarding the app. All interviews were audio-recorded, transcribed verbatim, and analyzed separately by two researchers. Results: Data saturation was reached after interviewing 9 women (aged 32-68 years) with stress UI (n=1, 11%), urgency UI (n=3, 33%), or mixed UI (n=5, 56%). Accessibility, awareness, usability, and adherence emerged as the main themes. On the one hand, participants appreciated that the app increased their accessibility to care, preserved their privacy, increased their awareness of therapeutic options, was easy to use and useful, and supported treatment adherence. On the other hand, some participants reported that they wanted more contact with a care provider, and others reported that using the app increased their awareness of symptoms. Conclusions: This qualitative study indicates that women appreciate app-based treatment for UI because it can lower barriers to treatment and increase both awareness and adherence to treatment. However, the app does not offer the ability of face-to-face contact and can lead to a greater focus on symptoms. %M 32530431 %R 10.2196/17114 %U http://mhealth.jmir.org/2020/6/e17114/ %U https://doi.org/10.2196/17114 %U http://www.ncbi.nlm.nih.gov/pubmed/32530431 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16165 %T Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study %A Giorgi Rossi,Paolo %A Ferrari,Francesca %A Amarri,Sergio %A Bassi,Andrea %A Bonvicini,Laura %A Dall'Aglio,Luca %A Della Giustina,Claudia %A Fabbri,Alessandra %A Ferrari,Anna Maria %A Ferrari,Elena %A Fontana,Marta %A Foracchia,Marco %A Gallelli,Teresa %A Ganugi,Giulia %A Ilari,Barbara %A Lo Scocco,Sara %A Maestri,Gianluca %A Moretti,Veronica %A Panza,Costantino %A Pinotti,Mirco %A Prandini,Riccardo %A Storani,Simone %A Street,Maria Elisabeth %A Tamelli,Marco %A Trowbridge,Hayley %A Venturelli,Francesco %A Volta,Alessandro %A Davoli,Anna Maria %A , %+ Servizio Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, Reggio Emilia, Italy, 39 0522 335470, francy.ferr80@gmail.com %K childhood obesity %K health promotion %K mHealth %K cocreation %K mobile app %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Childhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies. Objective: The goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents’ phones aimed at promoting child health and preventing obesity. Methods: After stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app. Results: Three key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children’s need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet. Conclusions: The pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project. %M 32357123 %R 10.2196/16165 %U https://mhealth.jmir.org/2020/6/e16165 %U https://doi.org/10.2196/16165 %U http://www.ncbi.nlm.nih.gov/pubmed/32357123 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15096 %T A Mobile Phone–Based Sexual and Reproductive Health Intervention for Female Sex Workers in Kenya: Development and Qualitative Study %A Ampt,Frances H %A L'Engle,Kelly %A Lim,Megan S C %A Plourde,Kate F %A Mangone,Emily %A Mukanya,Collins Mudogo %A Gichangi,Peter %A Manguro,Griffins %A Hellard,Margaret %A Stoové,Mark %A Chersich,Matthew F %A Jaoko,Walter %A Agius,Paul A %A Temmerman,Marleen %A Wangari,Winnie %A Luchters,Stanley %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 2 9282 2111, frances.ampt@burnet.edu.au %K sex work %K mobile health (mHealth) %K unintended pregnancy %K qualitative research %D 2020 %7 29.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women’s Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. Objective: This paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants’ responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability. Methods: The research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach. Results: The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information. Conclusions: Our results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs’ lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change. %M 32469326 %R 10.2196/15096 %U https://mhealth.jmir.org/2020/5/e15096 %U https://doi.org/10.2196/15096 %U http://www.ncbi.nlm.nih.gov/pubmed/32469326 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 1 %P e15859 %T Assessing Breast Cancer Survivors’ Perceptions of Using Voice-Activated Technology to Address Insomnia: Feasibility Study Featuring Focus Groups and In-Depth Interviews %A Arem,Hannah %A Scott,Remle %A Greenberg,Daniel %A Kaltman,Rebecca %A Lieberman,Daniel %A Lewin,Daniel %+ Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Rm 514, Washington, DC, 20052, United States, 1 2029944676, hannaharem@gwu.edu %K artificial intelligence %K breast neoplasms %K survivors %K insomnia %K cognitive behavioral therapy %K mobile phones %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer survivors (BCSs) are a growing population with a higher prevalence of insomnia than women of the same age without a history of cancer. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be effective in this population, but it is not widely available to those who need it. Objective: This study aimed to better understand BCSs’ experiences with insomnia and to explore the feasibility and acceptability of delivering CBT-I using a virtual assistant (Amazon Alexa). Methods: We first conducted a formative phase with 2 focus groups and 3 in-depth interviews to understand BCSs’ perceptions of insomnia as well as their interest in and comfort with using a virtual assistant to learn about CBT-I. We then developed a prototype incorporating participant preferences and CBT-I components and demonstrated it in group and individual settings to BCSs to evaluate acceptability, interest, perceived feasibility, educational potential, and usability of the prototype. We also collected open-ended feedback on the content and used frequencies to describe the quantitative data. Results: We recruited 11 BCSs with insomnia in the formative phase and 14 BCSs in the prototype demonstration. In formative work, anxiety, fear, and hot flashes were identified as causes of insomnia. After prototype demonstration, nearly 79% (11/14) of participants reported an interest in and perceived feasibility of using the virtual assistant to record sleep patterns. Approximately two-thirds of the participants thought lifestyle modification (9/14, 64%) and sleep restriction (9/14, 64%) would be feasible and were interested in this feature of the program (10/14, 71% and 9/14, 64%, respectively). Relaxation exercises were rated as interesting and feasible using the virtual assistant by 71% (10/14) of the participants. Usability was rated as better than average, and all women reported that they would recommend the program to friends and family. Conclusions: This virtual assistant prototype delivering CBT-I components by using a smart speaker was rated as feasible and acceptable, suggesting that this prototype should be fully developed and tested for efficacy in the BCS population. If efficacy is shown in this population, the prototype should also be adapted for other high-risk populations. %M 32348274 %R 10.2196/15859 %U http://cancer.jmir.org/2020/1/e15859/ %U https://doi.org/10.2196/15859 %U http://www.ncbi.nlm.nih.gov/pubmed/32348274 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16747 %T An App for Detecting Bullying of Nurses Using Convolutional Neural Networks and Web-Based Computerized Adaptive Testing: Development and Usability Study %A Ma,Shu-Ching %A Chou,Willy %A Chien,Tsair-Wei %A Chow,Julie Chi %A Yeh,Yu-Tsen %A Chou,Po-Hsin %A Lee,Huan-Fang %+ Department of Nursing, College of Medicine, National Cheng Kung University, No 988, Chung Hwa Road, Yung Kung District, Tainan 710, Taiwan, Tainan, 710, Taiwan, 886 +8862812811, Eamonn0330@gmail.com %K nurse bullying %K NAQ-R assessment %K receiver operating characteristic curve %K convolutional neural network %K computerized adaptive testing %D 2020 %7 20.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Workplace bullying has been measured in many studies to investigate its effects on mental health issues. However, none have used web-based computerized adaptive testing (CAT) with bully classifications and convolutional neural networks (CNN) for reporting the extent of individual bullying in the workplace. Objective: This study aims to build a model using CNN to develop an app for automatic detection and classification of nurse bullying-levels, incorporated with online Rasch computerized adaptive testing, to help assess nurse bullying at an earlier stage. Methods: We recruited 960 nurses working in a Taiwan Ch-Mei hospital group to fill out the 22-item Negative Acts Questionnaire-Revised (NAQ-R) in August 2012. The k-mean and the CNN were used as unsupervised and supervised learnings, respectively, for: (1) dividing nurses into three classes (n=918, 29, and 13 with suspicious mild, moderate, and severe extent of being bullied, respectively); and (2) building a bully prediction model to estimate 69 different parameters. Finally, data were separated into training and testing sets in a proportion of 70:30, where the former was used to predict the latter. We calculated the sensitivity, specificity, and receiver operating characteristic curve (area under the curve [AUC]), along with the accuracy across studies for comparison. An app predicting the respondent bullying-level was developed, involving the model’s 69 estimated parameters and the online Rasch CAT module as a website assessment. Results: We observed that: (1) the 22-item model yields higher accuracy rates for three categories, with an accuracy of 94% for the total 960 cases, and accuracies of 99% (AUC 0.99; 95% CI 0.99-1.00) and 83% (AUC 0.94; 95% CI 0.82-0.99) for the lower and upper groups (cutoff points at 49 and 66 points) based on the 947 cases and 42 cases, respectively; and (2) the 700-case training set, with 95% accuracy, predicts the 260-case testing set reaching an accuracy of 97. Thus, a NAQ-R app for nurses that predicts bullying-level was successfully developed and demonstrated in this study. Conclusions: The 22-item CNN model, combined with the Rasch online CAT, is recommended for improving the accuracy of the nurse NAQ-R assessment. An app developed for helping nurses self-assess workplace bullying at an early stage is required for application in the future. %M 32432557 %R 10.2196/16747 %U https://mhealth.jmir.org/2020/5/e16747 %U https://doi.org/10.2196/16747 %U http://www.ncbi.nlm.nih.gov/pubmed/32432557 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e15895 %T The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach %A Ector,Geneviève ICG %A Westerweel,Peter E %A Hermens,Rosella PMG %A Braspenning,Karin AE %A Heeren,Barend CM %A Vinck,Oscar MF %A de Jong,Jan JM %A Janssen,Jeroen JWM %A Blijlevens,Nicole MA %+ Department of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 8, Nijmegen, 6500 Hb, Netherlands, 31 243618810, genevieve.ector@radboudumc.nl %K eHealth %K chronic myeloid leukemia %K patient participation %K mobile apps %D 2020 %7 15.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: With the global rise in chronic health conditions, health care is transforming, and patient empowerment is being emphasized to improve treatment outcomes and reduce health care costs. Patient-centered innovations are needed. We focused on patients with chronic myeloid leukemia (CML), a chronic disease with a generally good long-term prognosis because of the advent of tyrosine kinase inhibitors. However, both medication adherence by patients and guideline adherence by physicians are suboptimal, unnecessarily jeopardizing treatment outcomes. Objective: The aim of this study was to develop a patient-centered innovation for patients with CML using a design thinking methodology. Methods: The 5 phases of design thinking (ie, empathize, define, ideate, prototype, and test) were completed, and each phase started with the patient. Stakeholders and end users were identified and interviewed, and observations in the care system were made. Using tools in human-centered design, problems were defined and various prototypes of solutions were generated. These were evaluated by patients and stakeholders and then further refined. Results: The patients desired (1) insights into their own disease; (2) insights into the symptoms experienced, both in terms of knowledge and comprehension; and (3) improvements in the organization of care delivery. A web-based platform, CMyLife, was developed and pilot-tested. It has multiple features, all targeting parts of the bigger solution, including a website with reliable information and a forum, a guideline app, personal medical records with logs of symptoms and laboratory results (including a molecular marker and linked to the guideline app), tailored feedback based on the patients’ symptoms and/or results, screen-to-screen consulting, delivery of medication, and the collection of blood samples at home. Conclusions: The multifeatured innovation, CMyLife, was developed in a multidisciplinary way and with active patient participation. The aim of developing CMyLife was to give patients the tools to monitor their results, interpret these results, and act on them. With this tool, they are provided with the know-how to consider their results in relation to their personal care process. Whether CMyLife achieves its goal and the evaluation of the added value will be the focus of future studies. CML could become the first malignancy for which patients are able to monitor and manage their disease by themselves. %M 32412424 %R 10.2196/15895 %U https://www.jmir.org/2020/5/e15895 %U https://doi.org/10.2196/15895 %U http://www.ncbi.nlm.nih.gov/pubmed/32412424 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e16289 %T Recommendations for Developing Support Tools With People Suffering From Chronic Obstructive Pulmonary Disease: Co-Design and Pilot Testing of a Mobile Health Prototype %A Davies,Alan %A Mueller,Julia %A Hennings,Jean %A Caress,Ann-Louise %A Jay,Caroline %+ School of Health Sciences, University of Manchester, Room 1002, Vaughan House, Portsmouth St, Manchester, M13 9GB, United Kingdom, 44 7843112378, alan.davies-2@manchester.ac.uk %K chronic obstructive pulmonary disease %K app design %K mHealth %K ecological momentary assessment %K mobile phone %D 2020 %7 15.5.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Gaps exist between developers, commissioners, and end users in terms of the perceived desirability of different features and functionalities of mobile apps. Objective: The objective of this study was to co-design a prototype mobile app for people with chronic obstructive pulmonary disease (COPD). We present lessons learned and recommendations from working on a large project with various stakeholders to develop a mobile app for patients with COPD. Methods: We adopted a user-centered, participatory approach to app development. Following a series of focus groups and interviews to capture requirements, we developed a prototype app designed to enable daily symptom recording (experience sampling). The prototype was tested in a usability study applying the think aloud protocol with people with COPD. It was then released via the Android app store, and experience sampling data and event data were captured to gather further usability data. Results: A total of 5 people with COPD participated in the pilot study. Identified themes include familiarity with technology, appropriate levels for feeding back information, and usability issues such as manual dexterity. Moreover, 37 participants used the app over a 4-month period (median age 47 years). The symptoms most correlated to perceived well-being were tiredness (r=0.61; P<.001) and breathlessness (r=0.59; P<.001). Conclusions: Design implications for COPD apps include the need for clearly labeled features (rather than relying on colors or symbols that require experience using smartphones), providing weather information, and using the same terminology as health care professionals (rather than simply lay terms). Target users, researchers, and developers should be involved at every stage of app development, using an iterative approach to build a prototype app, which should then be tested in controlled settings as well as in the wild (ie, when deployed and used in real-world settings) over longer periods. %M 32410730 %R 10.2196/16289 %U http://humanfactors.jmir.org/2020/2/e16289/ %U https://doi.org/10.2196/16289 %U http://www.ncbi.nlm.nih.gov/pubmed/32410730 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15888 %T A Sexual Health Promotion App for Transgender Women (Trans Women Connected): Development and Usability Study %A Sun,Christina J %A Anderson,Kirsten M %A Kuhn,Tamara %A Mayer,Liat %A Klein,Charles H %+ School of Public Health, Oregon Health & Science University-Portland State University, 506 SW Mill St., Suite 450, SCH, Portland, OR, 97201, United States, 1 503 725 8858, chrsun@pdx.edu %K transgender persons %K HIV %K sexual health %K minority health %K health care disparities %K health status disparities %D 2020 %7 12.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women. Objective: This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app. Methods: We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions. Results: Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer–friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively. Conclusions: This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway. %M 32396131 %R 10.2196/15888 %U https://mhealth.jmir.org/2020/5/e15888 %U https://doi.org/10.2196/15888 %U http://www.ncbi.nlm.nih.gov/pubmed/32396131 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e16605 %T A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile–Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation %A Stevens,Timothy %A McGinnis,Ryan S %A Hewgill,Blake %A Choquette,Rebecca H %A Tourville,Timothy W %A Harvey,Jean %A Lachapelle,Richard %A Beynnon,Bruce D %A Toth,Michael J %A Skalka,Christian %+ Department of Medicine, University of Vermont, Health Science Research Facility Rm 126B, 149 Beaumont Ave, Burlington, VT, 05405, United States, 1 (802) 656 7989, michael.toth@med.uvm.edu %K device use tracking %K internet of things %K neuromuscular electrical stimulation %K exercise %K smart devices %K mHealth %K rehabilitation %K mobile health %K digital health %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions. Objective: This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time. Methods: The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System–based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity. Results: Compared with the NMES device software–tracked device use, the RehabTracker system recorded 83% (40/48) of the rehabilitation sessions, with 100% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed. Conclusions: RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing. %M 32384052 %R 10.2196/16605 %U http://humanfactors.jmir.org/2020/2/e16605/ %U https://doi.org/10.2196/16605 %U http://www.ncbi.nlm.nih.gov/pubmed/32384052 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e18400 %T Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development %A Fedele,David A %A Cushing,Christopher C %A Koskela-Staples,Natalie %A Patton,Susana R %A McQuaid,Elizabeth L %A Smyth,Joshua M %A Prabhakaran,Sreekala %A Gierer,Selina %A Nezu,Arthur M %+ Department of Clinical & Health Psychology, University of Florida, 101 S Newell Dr, Rm 3151, PO Box 100165, Gainesville, FL, 32610, United States, 1 3522945765, dfedele@phhp.ufl.edu %K asthma %K mobile health %K adherence %K adolescence %K self-regulation %K problem-solving %K adolescent %K youth %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents’ difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents’ objectively measured ICS adherence data indicate suboptimal rates of medication use. Objective: The current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content. Methods: We developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17–year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development. Results: Consistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow). Conclusions: ReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT’s emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process. %M 32374273 %R 10.2196/18400 %U https://mhealth.jmir.org/2020/5/e18400 %U https://doi.org/10.2196/18400 %U http://www.ncbi.nlm.nih.gov/pubmed/32374273 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15502 %T Preparing African American Men to Make Informed Prostate Cancer Screening Decisions: Development and Pilot Testing of an Interactive Online Decision Aid %A Allen,Jennifer Dacey %A Reich,Amanda %A Cuevas,Adolfo G %A Ladin,Keren %+ Department of Community Health, Tufts University, 574 Boston Ave, Suite 208, Medford, MA, 02421, United States, 1 617 627 3233, jennifer.allen@tufts.edu %K decision support techniques %K prostate neoplasms %K early detection of cancer %K decision making (shared) %K men’s health %K minority health %D 2020 %7 5.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: African American men are at a higher risk of developing and dying from prostate cancer compared to white men. The serum prostate-specific antigen (PSA) screening test has a high risk of false-positive results and overdiagnosis; therefore, it is not routinely recommended. Rather, men are encouraged to make individualized decisions with their medical providers, after being fully informed about its potential benefits, limitations, and risks. Objective: This study aimed to describe the development and pilot testing of an interactive Web-based decision aid (DA; Prostate Cancer Screening Preparation [PCSPrep]) for African American men, designed to promote informed decision making for prostate cancer screening. Methods: Four focus groups (n=33) were conducted to assess men’s reactions to DAs developed in prior studies and gather information to modify the content and format. The pilot test employed a pre-posttest evaluation design. A convenience sample of 41 men aged 45-70 years with no history of prostate cancer was recruited from community settings. Participants completed online surveys before and after using PCSPrep that assessed prostate cancer screening knowledge, decision self-efficacy, decisional conflict, and preparation for decision making. Results: Use of PCSPrep was associated with a significant increase in prostate cancer knowledge (49% vs 62% correct responses; P<.001), and men also experienced less decisional conflict (24 vs 15 on a scale of 0-100; P=.008). No changes in self-efficacy about decision making or screening preferences were observed. Most men (81%) reported that using PCSPrep prepared them to make informed decisions in partnership with their provider. Conclusions: PCSPrep was an acceptable DA that improved men’s knowledge, reduced decisional conflict, and promoted the perception of being prepared for shared decision making. Further research is needed to test the DA in a larger randomized trial. %M 32369032 %R 10.2196/15502 %U https://mhealth.jmir.org/2020/5/e15502 %U https://doi.org/10.2196/15502 %U http://www.ncbi.nlm.nih.gov/pubmed/32369032 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15780 %T The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach %A Hou,I-Ching %A Lan,Min-Fang %A Shen,Shan-Hsiang %A Tsai,Pei Yu %A Chang,King Jen %A Tai,Hao-Chih %A Tsai,Ay-Jen %A Chang,Polun %A Wang,Tze-Fang %A Sheu,Shuh-Jen %A Dykes,Patricia C %+ School of Nursing, National Yang-Ming University, No 155, Sec 2, Li-Nong Street, Beitou, Taipei, 11221, Taiwan, 886 28267000 ext 7315, evita@ym.edu.tw %K breast cancer %K mobile health application %K self-management %K design thinking %D 2020 %7 30.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient’s perspective. Objective: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. Methods: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. Results: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. Conclusions: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer. %M 32352390 %R 10.2196/15780 %U http://mhealth.jmir.org/2020/4/e15780/ %U https://doi.org/10.2196/15780 %U http://www.ncbi.nlm.nih.gov/pubmed/32352390 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14376 %T Proposal for the User-Centered Design Approach for Health Apps Based on Successful Experiences: Integrative Review %A Molina-Recio,Guillermo %A Molina-Luque,Rafael %A Jiménez-García,Ana M. %A Ventura-Puertos,Pedro E %A Hernández-Reyes,Alberto %A Romero-Saldaña,Manuel %+ Department of Nursing, University of Córdoba, Av. Menéndez Pidal 7, Córdoba, Spain, 34 957 218 101, rafael.moluq@gmail.com %K mHealth %K user-centered development %K focus groups %K discussion groups %K interdisciplinarity %D 2020 %7 22.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Different strategies encompassed within mHealth have shown themselves to be effective for maintaining good health or controlling certain diseases. However, there is usually a very high rate of abandonment of health apps. Therefore, it would seem obvious that there is a need for involving the end users (whether they are health professionals, patients, or both) in the design process from the early stages in order to enable their needs and characteristics to be identified. In this sense, it is common knowledge that focusing on the user permits the consideration of valuable details aimed at making the correct adjustment between the patient, the technology, and the organization of attention. Objective: The goal of the research was to propose a methodology based on the review of previous successful user experiences in setting up health apps by using qualitative techniques (focus groups and discussion groups) that includes the participation of information technology and health professionals and the patients themselves. Methods: An integrative review was made of studies in which a qualitative methodology was employed mainly through focus and/or discussion groups for the design and development of health apps, consulting diverse databases (PubMed, Scopus, and Proquest) with the following search strategy: “mHealth AND apps AND focus group OR discussion group.” A total of 69 papers were included in the review. Results: A proposal structured in 4 sessions of variable duration was made in which information technology and health professionals and patients take part: composing, preparing, and organizing contents (session 1); testing structure and usability (session 2); does the app fit the needs of end users? (session 3); and last testing—keep on improving (session 4). Throughout the sessions, we propose studying aspects like previous user experiences in mHealth, barriers to the adoption of mHealth, interface contents, management and browsability, usability, perceived quality, security and privacy, capacity to self-manage disease with the app, ergonomics, and glanceability, etc. Specific tools that have proved useful in previous research for measuring these aspects are presented. Conclusions: These work sessions would be based on predominantly qualitative methodologies although, as they evolve, validated questionnaires permitting the assessment of the objectivity of certain technical aspects could be incorporated. With this proposal, a project centered on end users could be effected, responding to their needs. However, this requires validation that will be made via implementation in the development of health apps, with the subsequent measurement of results in terms of adherence and improvement in the clinical variables of the end users. %M 32319965 %R 10.2196/14376 %U http://mhealth.jmir.org/2020/4/e14376/ %U https://doi.org/10.2196/14376 %U http://www.ncbi.nlm.nih.gov/pubmed/32319965 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e16151 %T Development and Modification of a Mobile Health Program to Promote Postpartum Weight Loss in Women at Elevated Risk for Cardiometabolic Disease: Single-Arm Pilot Study %A Nicklas,Jacinda M %A Leiferman,Jenn A %A Lockhart,Steven %A Daly,Kristen M %A Bull,Sheana S %A Barbour,Linda A %+ Division of General Internal Medicine, University of Colorado School of Medicine, 12348 E Montview Blvd, Aurora, CO, 80045, United States, 1 3037249028, Jacinda.Nicklas@cuanschutz.edu %K mobile health %K postpartum %K chronic disease %K prevention %K weight loss %D 2020 %7 9.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnancy complications in combination with postpartum weight retention lead to significant risks of cardiometabolic disease and obesity. The majority of traditional face-to-face interventions have not been effective in postpartum women. Mobile technology enables the active engagement of postpartum women to promote lifestyle changes to prevent chronic diseases. Objective: We sought to employ an interactive, user-centered, and participatory method of development, evaluation, and iteration to design and optimize the mobile health (mHealth) Fit After Baby program. Methods: For the initial development, a multidisciplinary team integrated evidence-based approaches for health behavior, diet and physical activity, and user-centered design and engagement. We implemented an iterative feedback and design process via 3 month-long beta pilots in which postpartum women with cardiometabolic risk factors participated in the program and provided weekly and ongoing feedback. We also conducted two group interviews using a structured interview guide to gather additional feedback. Qualitative data were recorded, transcribed, and analyzed using established qualitative methods. Modifications based on feedback were integrated into successive versions of the app. Results: We conducted three pilot testing rounds with a total of 26 women. Feedback from each pilot cohort informed changes to the functionality and content of the app, and then a subsequent pilot group participated in the program. We optimized the program in response to feedback through three iterations leading to a final version. Conclusions: This study demonstrates the feasibility of using an interactive, user-centered, participatory method of rapid, iterative design and evaluation to develop and optimize a mHealth intervention program for postpartum women. Trial Registration: ClinicalTrials.gov NCT02384226; https://www.clinicaltrials.gov/ct2/show/NCT02384226 %M 32271149 %R 10.2196/16151 %U https://formative.jmir.org/2020/4/e16151 %U https://doi.org/10.2196/16151 %U http://www.ncbi.nlm.nih.gov/pubmed/32271149 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14721 %T A Mobile Health Intervention for Fetal Alcohol Spectrum Disorders (Families Moving Forward Connect): Development and Qualitative Evaluation of Design and Functionalities %A Petrenko,Christie LM %A Parr,Jennifer %A Kautz,Carson %A Tapparello,Cristiano %A Olson,Heather Carmichael %+ Mt Hope Family Center, University of Rochester, 187 Edinburgh St, Rochester, NY, 14608, United States, 1 585 275 2991, christie.petrenko@rochester.edu %K fetal alcohol spectrum disorders %K fetal alcohol syndrome %K parenting %K children %K mobile health %K mHealth %K treatment %D 2020 %7 6.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Fetal alcohol spectrum disorders (FASD) affect approximately 2% to 5% of the US population. However, most families are unable to access FASD-informed interventions. Barriers to care include the lack of a knowledgeable and skilled workforce and family-level barriers such as limited financial resources, inability to access childcare, and stigma. As a result, families often try peer-to-peer and self-help support strategies. However, they often take these strategies from disparate sources, which have quite variable intervention quality and empirical support. Objective: This study aimed to initiate systematic development and evaluation of a mobile health intervention (app) for caregivers raising children with FASD. Focus groups were conducted to elicit participant perspectives on app design and functionalities to inform further app development. Methods: The app, called FMF Connect, was derived from the scientifically validated Families Moving Forward (FMF) Program, a clinician-delivered behavioral consultation intervention. FMF Connect was intended for caregiver self-delivery and included five main components: (1) Learning Modules, (2) Family Forum, (3) Library, (4) Notebook, and (5) Dashboard. Focus group methods were used to solicit perspectives from diverse families during the early stages of app development. Questions were asked about interface design, relevance of components and content, and perceived barriers and facilitators of use. A total of 25 caregivers participated in 7 focus groups across 5 US cities. Data were analyzed thematically. Results: Focus group participants were generally enthusiastic about the app interface design and components. Four global positive impression themes emerged, including (1) ease of access, (2) how the app guides and organizes information, (3) connection to other users and information, and (4) ability to share some content with others. Themes arose not only in discussions relating to positive app features but also when participants were asked about motivators for app use. Participants related how these positive global themes could address some system-level barriers, such as limited access to services, feeling isolated, and increased advocacy needs related to the societal lack of FASD knowledge. Participants identified many positive features about individual app components and functionalities. They also communicated potential barriers to use and raised important concerns and considerations relating to several app components. These included recognizability of the app based on the logo, and the balance of following the planned intervention sequence versus obtaining immediate answers. Also mentioned were privacy and dynamics within the Family Forum. Conclusions: FMF Connect is a promising novel intervention with potential to reach many families in need and reduce significant barriers to care, resulting in a broader public health impact. Study findings will guide further app development both in terms of content and technological advances to optimize intervention effects. FMF Connect app development provides useful directions for other apps aimed at changing parenting practices. %M 32250274 %R 10.2196/14721 %U https://mhealth.jmir.org/2020/4/e14721 %U https://doi.org/10.2196/14721 %U http://www.ncbi.nlm.nih.gov/pubmed/32250274 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e16336 %T Love My Body: Pilot Study to Understand Reproductive Health Vulnerabilities in Adolescent Girls %A Tzilos Wernette,Golfo %A Countryman,Kristina %A Khatibi,Kristie %A Riley,Erin %A Stephenson,Rob %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 (734) 998 7120, gtzilos@med.umich.edu %K adolescent %K alcohol %K sexually transmitted infections %K risky sex %K pregnancy %D 2020 %7 30.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexually transmitted infections (STIs) are on the rise in the United States, and adolescent girls (15-19 years old) are more susceptible to acquiring STIs than their male peers. The co-occurrence of alcohol use and sexual risk taking contribute significantly to STI acquisition. Mobile health (mHealth) interventions are ideally suited for our target population and have demonstrated increases in STI testing in young people, as well as reductions in alcohol use. Objective: This pilot study used both qualitative and quantitative methods to explore the views of adolescent girls (age range 15-19 years old; 74.6%, 279/374 white) on the desired qualities and content of an mHealth app for sexual health. Methods: We conducted nine 60-min in-depth interviews (IDIs) to gather information and identify themes of sexual health and alcohol use, and we tested the feasibility of using a two-week social media campaign to collect survey information regarding sexual health risk in adolescent girls. Results: We iteratively coded IDIs and identified major themes around pressure of alcohol use, lack of STI knowledge, male pressure to not use condoms, and pregnancy as a worse outcome than STIs. Results from the web-based survey on risky health behaviors, which was completed by 367 participants, support the use of a sexual health app designed for girls. Conclusions: Future work will integrate these themes to inform the development of a culturally sensitive mHealth app to prevent STIs among adolescent girls. %M 32224484 %R 10.2196/16336 %U http://www.jmir.org/2020/3/e16336/ %U https://doi.org/10.2196/16336 %U http://www.ncbi.nlm.nih.gov/pubmed/32224484 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e17004 %T Hackathons as Stepping Stones in Health Care Innovation: Case Study With Systematic Recommendations %A Poncette,Akira-Sebastian %A Rojas,Pablo-David %A Hofferbert,Joscha %A Valera Sosa,Alvaro %A Balzer,Felix %A Braune,Katarina %+ Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Charitéplatz 1, Berlin, 10117, Germany, 49 30450 ext 50, Akira-sebastian.poncette@charite.de %K digital health %K transdisciplinary research %K hackathon %K technological innovation %K patient-centered care %K social media %D 2020 %7 24.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Until recently, developing health technologies was time-consuming and expensive, and often involved patients, doctors, and other health care professionals only as passive recipients of the end product. So far, users have been minimally involved in the ideation and creation stages of digital health technologies. In order to best address users’ unmet needs, a transdisciplinary and user-led approach, involving cocreation and direct user feedback, is required. In this context, hackathon events have become increasingly popular in generating enthusiasm for user-centered innovation. Objective: This case study describes preparatory steps and the performance of a health hackathon directly involving patients and health care professionals at all stages. Feasibility and outcomes were assessed, leading to the development of systematic recommendations for future hackathons as a vehicle for bottom-up innovation in health care. Methods: A 2-day hackathon was conducted in February 2017 in Berlin, Germany. Data were collected through a field study. Collected field notes were subsequently discussed in 15 informal meetings among the research team. Experiences of conducting two further hackathons in December 2017 and November 2018 were included. Results: In total, 30 participants took part, with 63% (19/30) of participants between 25 and 34 years of age, 30% (9/30) between 35 and 44 years of age, and 7% (2/30) younger than 25 years of age. A total of 43% (13/30) of the participants were female. The participation rate of medical experts, including patients and health care professionals, was 30% (9/30). Five multidisciplinary teams were formed and each tackled a specific health care problem. All presented projects were apps: a chatbot for skin cancer recognition, an augmented reality exposure-based therapy (eg, for arachnophobia), an app for medical neighborhood connectivity, a doctor appointment platform, and a self-care app for people suffering from depression. Patients and health care professionals initiated all of the projects. Conducting the hackathon resulted in significant growth of the digital health community of Berlin and was followed up by larger hackathons. Systematic recommendations for conducting cost-efficient hackathons (n≤30) were developed, including aspects of community building, stakeholder engagement, mentoring, themes, announcements, follow-up, and timing for each step. Conclusions: This study shows that hackathons are effective in bringing innovation to health care and are more cost- and time-efficient and potentially more sustainable than traditional medical device and digital product development. Our systematic recommendations can be useful to other individuals and organizations that want to establish user-led innovation in academic hospitals by conducting transdisciplinary hackathons. %M 32207691 %R 10.2196/17004 %U http://www.jmir.org/2020/3/e17004/ %U https://doi.org/10.2196/17004 %U http://www.ncbi.nlm.nih.gov/pubmed/32207691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e16831 %T Mobile App to Help People With Chronic Illness Reflect on Their Strengths: Formative Evaluation and Usability Testing %A Kristjansdottir,Olöf Birna %A Børøsund,Elin %A Westeng,Marianne %A Ruland,Cornelia %A Stenberg,Una %A Zangi,Heidi A %A Stange,Kurt %A Mirkovic,Jelena %+ Department for Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4959 Nydalen, Oslo, 0424, Norway, 47 92433964, olof@mestring.no %K mobile app %K self-management %K strengths %K chronic illness %K rheumatology %K usability %K formative evaluation %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Supporting patient engagement and empowerment is increasingly seen as essential in providing person-centered health care to people with chronic illness. Mobile apps helping patients reflect on their concerns as preparation for consultations with their health care providers can have beneficial effects on the consultation quality. However, apps focusing on empowerment and personal strengths are still scarce. Objective: This study aimed to (1) develop a mobile app to support patients with rheumatic diseases in reflecting on their strengths in preparation for consultations with health care providers and (2) explore patients’ perceived usability of the app in a nonclinical test setting. Methods: A prototype app was developed based on input from patients and health care providers, as reported in previous studies. The app was designed for use in self-management support settings aiming to promote awareness of strengths and to focus attention on strengths in the patient-health care provider dialogue. The features included in the prototype were as follows: (1) introduction to the topic of strengths, (2) list of examples of strengths to promote reflection and registration of own strengths, (3) summary of registered strengths, (4) value-based goal setting, (5) linking of strengths to goals, (6) summary of all registrations, and (7) options to share summary digitally or as a print version. In this study, the app was refined through a formative evaluation with patients and health care providers recruited from a specialized rheumatology hospital unit. Patients’ perceptions of the app’s usability were explored in a test setting with self-report measurements and semistructured interviews. The interviews were audiotaped, transcribed, and analyzed with directed content analysis. Data from questionnaires were analyzed with descriptive statistics. Results: Developmental and formative evaluation included 18 patients and 7 health care providers. The evaluation resulted in minor adjustments to the prototype but no major changes in features. The usability testing included 12 patients. All participants found the usability acceptable; the median score on the System Usability Scale was 86.3 (range 70-100). All reported that it was meaningful and relevant to use the app. Out of 12 participants, 9 (75%) reported becoming more aware of their own strengths by using the app; 1 (8%) disagreed and 2 (17%) provided a neutral response. The results on the goal-related feature were mixed, with half of the patients finding it useful to link strengths to concrete goals. A statistically significant positive change from pre- to postintervention was identified on measures of self-efficacy and negative emotions. Conclusions: In this formative evaluation of a mobile app to promote patients’ reflections on their strengths, patients perceived the app as meaningful and supporting awareness. The results suggest the usefulness of building in functionality to support use of strengths and goal attainment. Further studies on efficacy and usability in a clinical setting, including health care providers, are needed. %M 32130126 %R 10.2196/16831 %U https://formative.jmir.org/2020/3/e16831 %U https://doi.org/10.2196/16831 %U http://www.ncbi.nlm.nih.gov/pubmed/32130126 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e14118 %T A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study %A Martin,Anne %A Caon,Maurizio %A Adorni,Fulvio %A Andreoni,Giuseppe %A Ascolese,Antonio %A Atkinson,Sarah %A Bul,Kim %A Carrion,Carme %A Castell,Conxa %A Ciociola,Valentina %A Condon,Laura %A Espallargues,Mireia %A Hanley,Janet %A Jesuthasan,Nithiya %A Lafortuna,Claudio L %A Lang,Alexandra %A Prinelli,Federica %A Puidomenech Puig,Elisa %A Tabozzi,Sarah A %A McKinstry,Brian %+ UK Medical Research Council / Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, United Kingdom, 44 141353 ext 7603, Anne.Martin@glasgow.ac.uk %K health behavior %K obesity %K co-design %K mHealth %K mobile app %K mobile phone %K adolescents %K youth %K focus groups %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology. Objective: This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds. Methods: A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight–promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants’ user experience feedback and development ideas were collected through focus groups and completion of questionnaires. Results: For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology. Conclusions: Incorporating adolescents’ preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial. %M 32130179 %R 10.2196/14118 %U https://mhealth.jmir.org/2020/3/e14118 %U https://doi.org/10.2196/14118 %U http://www.ncbi.nlm.nih.gov/pubmed/32130179 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15346 %T A Culturally Relevant Smartphone-Delivered Physical Activity Intervention for African American Women: Development and Initial Usability Tests of Smart Walk %A Joseph,Rodney P %A Keller,Colleen %A Vega-López,Sonia %A Adams,Marc A %A English,Rebekah %A Hollingshead,Kevin %A Hooker,Steven P %A Todd,Michael %A Gaesser,Glenn A %A Ainsworth,Barbara E %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, United States, 1 6024960772, rodney.joseph@asu.edu %K eHealth %K mHealth %K exercise %K minority health %K primary prevention %K heart diseases %K African-American %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smart Walk is a culturally relevant, social cognitive theory–based, smartphone-delivered intervention designed to increase physical activity (PA) and reduce cardiometabolic disease risk among African American (AA) women. Objective: This study aimed to describe the development and initial usability testing results of Smart Walk. Methods: Smart Walk was developed in 5 phases. Phases 1 to 3 focused on initial intervention development, phase 4 involved usability testing, and phase 5 included intervention refinement based on usability testing results. In phase 1, a series of 9 focus groups with 25 AA women (mean age 38.5 years, SD 7.8; mean BMI 39.4 kg/m2, SD 7.3) was used to identify cultural factors associated with PA and ascertain how constructs of social cognitive theory can be leveraged in the design of a PA intervention. Phase 2 included the analysis of phase 1 qualitative data and development of the structured PA intervention. Phase 3 focused on the technical development of the smartphone app used to deliver the intervention. Phase 4 consisted of a 1-month usability trial of Smart Walk (n=12 women; mean age 35.0 years, SD 8.5; mean BMI 40 kg/m2, SD 5.0). Phase 5 included refinement of the intervention based on the usability trial results. Results: The 5-phase process resulted in the development of the Smart Walk smartphone-delivered PA intervention. This PA intervention was designed to target social cognitive theory constructs of behavioral capability, outcome expectations, social support, self-efficacy, and self-regulation and address deep structure sociocultural characteristics of collectivism, racial pride, and body appearance preferences of AA women. Key features of the smartphone app included (1) personal profile pages, (2) multimedia PA promotion modules (ie, electronic text and videos), (3) discussion boards, and (4) a PA self-monitoring tool. Participants also received 3 PA promotion text messages each week. Conclusions: The development process of Smart Walk was designed to maximize the usability, cultural relevance, and impact of the smartphone-delivered PA intervention. %M 32130198 %R 10.2196/15346 %U https://mhealth.jmir.org/2020/3/e15346 %U https://doi.org/10.2196/15346 %U http://www.ncbi.nlm.nih.gov/pubmed/32130198 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16030 %T A Men Who Have Sex With Men–Friendly Doctor Finder Hackathon in Guangzhou, China: Development of a Mobile Health Intervention to Enhance Health Care Utilization %A Li,Chunyan %A Xiong,Yuan %A Sit,Hao Fong %A Tang,Weiming %A Hall,Brian J %A Muessig,Kathryn E %A Wei,Chongyi %A Bao,Huanyu %A Wei,Shufang %A Zhang,Dapeng %A Mi,Guodong %A Yu,Fei %A Tucker,Joseph D %+ Social Entrepreneurship to Spur Health Global, University of North Carolina Chapel Hill Project-China, No 2 Lujing Road, Guangzhou, 510095, China, 86 13302391532, jdtucker@med.unc.edu %K mobile health %K hackathon %K crowdsourcing %K men who have sex with men %K MSM-friendly %K health care utilization %D 2020 %7 27.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHeath)–based HIV and sexual health promotion among men who have sex with men (MSM) is feasible in low- and middle-income settings. However, many currently available mHealth tools on the market were developed by the private sector for profit and have limited input from MSM communities. Objective: A health hackathon is an intensive contest that brings together participants from multidisciplinary backgrounds to develop a proposed solution for a specific health issue within a short period. The purpose of this paper was to describe a hackathon event that aimed to develop an mHealth tool to enhance health care (specifically HIV prevention) utilization among Chinese MSM, summarize characteristics of the final prototypes, and discuss implications for future mHealth intervention development. Methods: The hackathon took place in Guangzhou, China. An open call for hackathon participants was advertised on 3 Chinese social media platforms, including Blued, a popular social networking app among MSM. All applicants completed a Web-based survey and were then scored. The top scoring applicants were grouped into teams based on their skills and content area expertise. Each team was allowed 1 month to prepare for the hackathon. The teams then came together in person with on-site expert mentorship for a 72-hour hackathon contest to develop and present mHealth prototype solutions. The judging panel included experts in psychology, public health, computer science, social media, clinical medicine, and MSM advocacy. The final prototypes were evaluated based on innovation, usability, and feasibility. Results: We received 92 applicants, and 38 of them were selected to attend the April 2019 hackathon. A total of 8 teams were formed, including expertise in computer science, user interface design, business or marketing, clinical medicine, and public health. Moreover, 24 participants self-identified as gay, and 3 participants self-identified as bisexual. All teams successfully developed a prototype tool. A total of 4 prototypes were designed as a mini program that could be embedded within a popular Chinese social networking app, and 3 prototypes were designed as stand-alone apps. Common prototype functions included Web-based physician searching based on one’s location (8 prototypes), health education (4 prototypes), Web-based health counseling with providers or lay health volunteers (6 prototypes), appointment scheduling (8 prototypes), and between-user communication (2 prototypes). All prototypes included strategies to ensure privacy protection for MSM users, and some prototypes offered strategies to ensure privacy of physicians. The selected prototypes are undergoing pilot testing. Conclusions: This study demonstrated the feasibility and acceptability of using a hackathon to create mHealth intervention tools. This suggests a different pathway to developing mHealth interventions and could be relevant in other settings. %M 32130189 %R 10.2196/16030 %U http://mhealth.jmir.org/2020/2/e16030/ %U https://doi.org/10.2196/16030 %U http://www.ncbi.nlm.nih.gov/pubmed/32130189 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16403 %T A Possible Mobile Health Solution in Orthopedics and Trauma Surgery: Development Protocol and User Evaluation of the Ankle Joint App %A Dittrich,Florian %A Back,David Alexander %A Harren,Anna Katharina %A Jäger,Marcus %A Landgraeber,Stefan %A Reinecke,Felix %A Beck,Sascha %+ Department for Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstr. 100, Building 37-38, Homburg, Germany, 49 68411624520, florian.dittrich@uks.eu %K smartphone %K ankle sprain %K rehabilitation %K self-care %K mHealth %K mobile phone %D 2020 %7 26.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients’ young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis. Objective: In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile health (mHealth)–based rehabilitation programs after ankle sprains are rare. The aim of this study was to expose any issues present in the development process of a medical app as well as associated risks and chances. Methods: The development process of the Ankle Joint App was defined in chronological order using a protocol. The app’s quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n=20) and voluntary athletes (n=20). Results: A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app’s content provides actual medical literature, training videos, and a log function. Excellent interrater reliability (interrater reliability=0.92; 95% CI 0.86-0.96) was obtained. The mean overall score for the Ankle Joint App was 4.4 (SD 0.5). The mean subjective quality scores were 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had mean scores of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6). Conclusions: The data obtained demonstrate that mHealth-based rehabilitation programs might be a useful tool for patient education and collection of personal data. The achieved (user) MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to obtain funded evidence for the ankle joints app’s effects on economical and medical aspects in comparison with established nondigital therapy paths. %M 32130171 %R 10.2196/16403 %U http://mhealth.jmir.org/2020/2/e16403/ %U https://doi.org/10.2196/16403 %U http://www.ncbi.nlm.nih.gov/pubmed/32130171 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16063 %T Automatic Work-Hours Recorder for Medical Staff (Staff Hours): Mobile App Development %A Chiang,Ting-Wei %A Chen,Si-Yu %A Pan,Yuan-Chien %A Lin,Yu-Hsuan %+ Institute of Population Health Sciences, National Health Research Institutes, Room A3234, No 35 Keyan Road, Zhunan Town, Miaoli County, 35053, Taiwan, 886 37206166 ext 36383, yuhsuanlin@nhri.edu.tw %K smartphone %K mobile apps %K medical staff %K global positioning system %K shift work schedule %D 2020 %7 25.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are numerous mobile apps for tracking work hours, but only a few of them record work hours automatically instead of relying on manual logging. No apps have been customized for medical staff, whose work schedules are highly complicated as they have both regular hours and on-call duties. Objective: The specific aims of this study were to (1) identify the Staff Hours app users’ GPS-defined work hours, (2) examine the overtime work hours from the app-recorded total work hours and the participants’ self-reported scheduled work hours, and (3) compare these app-recorded total work hours among different occupations. Methods: We developed an app, Staff Hours, to automatically calculate a user’s work hours via GPS background data. Users can enter their scheduled hours, including regular hours and on-call duties. The app automatically generates overtime reports by comparing the app-recorded total work hours with the user-defined scheduled hours. A total of 183 volunteers (60 females and 123 males; mean age 32.98 years, SD 6.74) were included in this study. Most of the participants (162/183, 88.5%) were medical staff, and their positions were resident physicians (n=89), visiting staff (n=38), medical students (n=10), registered nurses (n=25), and non–health care professionals (non-HCPs; n=21). Results: The total work hours (mean 55.69 hours, SD 21.34) of the 183 participants were significantly higher than their scheduled work hours (mean 50.67 hours, SD 21.44; P=.01). Medical staff had significantly longer total work hours (mean 57.01 hours, SD 21.20) than non-HCPs (mean 45.48 hours, SD 20.08; P=.02). Residents (mean 60.38 hours, SD 18.67) had significantly longer work hours than visiting staff (mean 51.42 hours, SD 20.33; P=.03) and non-HCPs (mean 45.48 hours, SD 20.08; P=.004). Conclusions: Staff Hours is the first automatic GPS location–based app designed for medical staff to track work hours and calculate overtime. For medical staff, this app could keep complete and accurate records of work hours in real time, reduce bias, and allow for better complying with labor regulations. %M 32130165 %R 10.2196/16063 %U http://mhealth.jmir.org/2020/2/e16063/ %U https://doi.org/10.2196/16063 %U http://www.ncbi.nlm.nih.gov/pubmed/32130165 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e14466 %T Using Goal-Directed Design to Create a Mobile Health App to Improve Patient Compliance With Hypertension Self-Management: Development and Deployment %A Duan,Huilong %A Wang,Zheyu %A Ji,Yumeng %A Ma,Li %A Liu,Fang %A Chi,Mingwei %A Deng,Ning %A An,Jiye %+ College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, 38 Zheda Rd, Zhouyiqing Bldg 512, Yuquan Campus, Hangzhou, China, 86 571 2295 2693, zju.dengning@gmail.com %K goal-directed design %K smartphone %K mobile health %K patients %K hypertension self-management %K mobile phone %D 2020 %7 25.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hypertension is a lifestyle-induced chronic disease that threatens the lives of patients. Control of hypertension requires patients to follow self-management regimes; unfortunately, however, patient compliance with hypertension self-management is low, especially in developing countries. Improvement of patient compliance is premised on meeting patient needs. Mobile health apps are becoming increasingly popular for self-management of chronic diseases. However, few mobile apps have been designed to meet patient needs for hypertension self-management. Objective: The goal of this study was to develop a mobile health app to improve patient compliance with hypertension self-management and evaluate the effectiveness of the app in terms of patient compliance. Methods: The goal-directed design method was applied to guide study design. We divided the study into 4 stages. Stages 1 to 3 comprised the development process. To improve the applicability of the goal-directed design method to chronic disease management, we extracted elements of user models concerned with patient compliance and defined a concrete process for user modeling. In stage 1, personas of hypertensive patients were built using qualitative and quantitative methods. Clustering methods based on questionnaire responses were used to group patients. Qualitative interviews were conducted to identify the needs of different groups. In stage 2, several functional modules were designed to meet the needs of different groups based on the results from stage 1. In stage 3, prototypes of functional modules were designed and implemented as a real app. Stage 4 was the deployment process, in which we conducted a pilot study to investigate patient compliance after using the app. Patient compliance was calculated through the frequency with which they took blood pressure measurements. In addition, qualitative interviews were conducted to learn the underlying reasons for the compliance results. Results: In stage 1, patients were divided into 3 groups based on 82 valid questionnaire responses. Eighteen patients from the different groups (7, 5, and 6 patients) were interviewed, and the needs of the groups were summarized as follows: improve self-management ability, enhance self-management motivation, and receive self-management support. In stages 2 and 3, 6 functional modules were designed and implemented based on specified needs, and the usability of the app was improved through usability tests. In stage 4, 143 patients were recruited to use different versions of the app for 2 months. Results show that patient compliance improved as functional modules were added (P<.001) and was maintained at a high level (rate of 0.73). Interview results from 32 patients show that the design of the app met different needs; thus, patients were more compliant with it. Conclusions: This study developed a mobile health app for hypertension self-management using the goal-directed design method. The app proved to be effective for improving patient compliance with hypertension self-management. %M 32130161 %R 10.2196/14466 %U http://mhealth.jmir.org/2020/2/e14466/ %U https://doi.org/10.2196/14466 %U http://www.ncbi.nlm.nih.gov/pubmed/32130161 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e16090 %T Development and Field Evaluation of the INTER-ACT App, a Pregnancy and Interpregnancy Coaching App to Reduce Maternal Overweight and Obesity: Mixed Methods Design %A Bogaerts,Annick %A Bijlholt,Margriet %A Mertens,Lotte %A Braeken,Marijke %A Jacobs,Bart %A Vandenberghe,Bert %A Ameye,Lieveke %A Devlieger,Roland %+ Department of Development and Regeneration, University of Leuven, O&N IV Herestraat 49 - bus 805, Leuven, 3000, Belgium, 32 16 19 31 27, annick.bogaerts@kuleuven.be %K pregnancy %K postpartum %K coaching %K lifestyle %K mobile app %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The interpregnancy and pregnancy periods are important windows of opportunity to prevent excessive gestational weight retention. Despite an overwhelming number of existing health apps, validated apps to support a healthy lifestyle between and during pregnancies are lacking. Objective: To describe the development and evaluation of the INTER-ACT app, which is part of an interpregnancy and pregnancy lifestyle coaching module, to prevent excessive weight gain in pregnancy and enhance optimal weight and a healthy lifestyle in the interpregnancy period. Methods: A mixed methods design was used to identify the needs of health care providers and end users, according to 15 semistructured interviews, two focus groups, and two surveys. The user interface was evaluated in a pilot study (N=9). Results: Health care providers indicated that a mobile app can enhance a healthy lifestyle in pregnant and postpartum women. Pregnant women preferred graphic displays in the app, weekly notifications, and support messages according to their own goals. Both mothers and health care providers reported increased awareness and valued the combination of the app with face-to-face coaching. Conclusions: The INTER-ACT app was valued by its end users because it was offered in combination with face-to-face contact with a caregiver. %M 32130109 %R 10.2196/16090 %U http://formative.jmir.org/2020/2/e16090/ %U https://doi.org/10.2196/16090 %U http://www.ncbi.nlm.nih.gov/pubmed/32130109 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16062 %T From “Step Away” to “Stand Down”: Tailoring a Smartphone App for Self-Management of Hazardous Drinking for Veterans %A Blonigen,Daniel %A Harris-Olenak,Brooke %A Kuhn,Eric %A Humphreys,Keith %A Timko,Christine %A Dulin,Patrick %+ Department of Veterans Affairs Palo Alto Health Care System, 795 Willow Road, MPD-152, Menlo Park, CA, 94025, United States, 1 6504935000 ext 27828, daniel.blonigen@va.gov %K veterans %K hazardous drinking %K Step Away %K Stand Down %K peer support %D 2020 %7 13.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: US military veterans who screen positive for hazardous drinking during primary care visits may benefit from a mobile app. Step Away is an evidence-based mobile intervention system for the self-management of hazardous drinking. However, Step Away was not designed for veterans, and differences between veterans and civilians could limit the reach and effectiveness of the app with this population. Objective: The primary objective of this study was to repurpose Step Away to address the needs and preferences of the veteran primary care population. The Method for Program Adaptation through Community Engagement (M-PACE) model was used to guide the adaptation process. This model can serve as a generalizable approach that other researchers and intervention developers can follow to systematically tailor mobile health tools for a new population. Methods: Veteran patients who screened positive for hazardous drinking during a primary care visit (n=12) and peer providers employed by the US Veterans Health Administration (n=11) were recruited to systematically review Step Away and provide feedback on its content and presentation via Web-based surveys and a semistructured interview. Participant feedback was reviewed through an iterative process by key stakeholders who adjudicated which suggested modifications to the app could enhance engagement and effectiveness with veterans while maintaining program integrity. Results: Usability ratings of the individual modules of Step Away were uniformly positive across patients and peers, as was the perceived utility of the app overall. Personalized feedback on the health consequences and costs of drinking, options for customization, and the measurement-based care capabilities of the app were viewed as facilitators of engagement. Conversely, lengthy text, small font, and a lack of interactive features were viewed as potential barriers with the older primary care population. Modifications to create a veteran version of the app (Stand Down: Think Before You Drink) included altering the appearance of the app to incorporate more veteran-centric content, adding links and options for resources and activities for veterans, and reducing the amount of text and adding veteran-specific references and common concerns and triggers for drinking in this population. Conclusions: The M-PACE model provided a systematic approach to repurpose Step Away to fit the needs and preferences of veteran primary care patients who engage in hazardous drinking. Stand Down may serve as an innovative, low-cost means of expanding access to care for veterans who engage in hazardous drinking. %M 32053118 %R 10.2196/16062 %U http://mhealth.jmir.org/2020/2/e16062/ %U https://doi.org/10.2196/16062 %U http://www.ncbi.nlm.nih.gov/pubmed/32053118 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e14661 %T International ResearchKit App for Women with Menstrual Pain: Development, Access, and Engagement %A Wang,Jiani %A Rogge,Alizé A %A Armour,Mike %A Smith,Caroline A %A D’Adamo,Christopher R %A Pischke,Claudia R %A Yen,Hung-Rong %A Wu,Mei-Yao %A Moré,Ari Ojeda Ocampo %A Witt,Claudia M %A Pach,Daniel %+ Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstraße 57, Berlin, 10117, Germany, 49 30450529011, daniel.pach@charite.de %K dysmenorrhea %K mHealth %K mobile applications %K acupressure %K pain %K behavior change techniques (BCTs) %K ResearchKit %K recruitment %D 2020 %7 11.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Primary dysmenorrhea is a common condition in women of reproductive age. A previous app-based study undertaken by our group demonstrated that a smartphone app supporting self-acupressure introduced by a health care professional can reduce menstrual pain. Objective: This study aims to evaluate whether a specific smartphone app is effective in reducing menstrual pain in 18- to 34-year-old women with primary dysmenorrhea in a self-care setting. One group of women has access to the full-featured study app and will be compared with 2 control groups who have access to fewer app features. Here, we report the trial design, app development, user access, and engagement. Methods: On the basis of the practical implications of the previous app-based study, we revised and reengineered the study app and included the ResearchKit (Apple Inc) framework. Behavior change techniques (BCTs) were implemented in the app and validated by expert ratings. User access was estimated by assessing recruitment progress over time. User evolution and baseline survey respondent rate were assessed to evaluate user engagement. Results: The development of the study app for a 3-armed randomized controlled trial required a multidisciplinary team. The app is accessible for the target population free of charge via the Apple App Store. In Germany, within 9 months, the app was downloaded 1458 times and 328 study participants were recruited using it without external advertising. A total of 98.27% (5157/5248) of the app-based baseline questions were answered. The correct classification of BCTs used in the app required psychological expertise. Conclusions: Conducting an innovative app study requires multidisciplinary effort. Easy access and engagement with such an app can be achieved by recruitment via the App Store. Future research is needed to investigate the determinants of user engagement, optimal BCT application, and potential clinical and self-care scenarios for app use. Trial Registration: ClinicalTrials.gov NCT03432611; https://clinicaltrials.gov/ct2/show/NCT03432611 (Archived by WebCite at http://www.webcitation.org/75LLAcnCQ). %M 32058976 %R 10.2196/14661 %U https://mhealth.jmir.org/2020/2/e14661 %U https://doi.org/10.2196/14661 %U http://www.ncbi.nlm.nih.gov/pubmed/32058976 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 1 %P e16254 %T Engaging African American Youth in the Development of a Serious Mobile Game for Sexual Health Education: Mixed Methods Study %A Patchen,Loral %A Ellis,Lindsey %A Ma,Tony Xuyen %A Ott,Corilyn %A Chang,Katie H K %A Araya,Brook %A Atreyapurapu,Sravanthi %A Alyusuf,Amal %A Gaines Lanzi,Robin %+ MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, United States, 1 2028777128, loral.patchen@medstar.net %K sexual health %K sex education %K African Americans %K youth %K adolescents %K video games %K games, experimental %K community-based participatory research %K user-centered design %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Although teen pregnancy rates decreased dramatically in the United States over the past decade, the rates of sexually transmitted infections (STIs) among adolescents and young adults increased. STI rates disproportionately affect African American youth and young adults. Innovative, accessible, and culturally relevant sexual health interventions are urgently needed. Objective: This study aimed to identify the optimal modality for a game-based sexual health intervention; develop the educational, entertainment, and technological aspects of the serious game; and demonstrate its usability and acceptance by the target population. Methods: This project was grounded in formative data collection with community-based participatory research principles and practices combined with a user-centered design and development approach. Sexually Active Adolescent–Focused Education (SAAFE) was developed using input and feedback from African American youths aged 15 to 21 years who participated in a youth advisory board and focus group discussions to inform the co-design and cocreation of the serious game. The process was highly iterative with multiple sessions for user input following design changes. It proceeded in 3 stages. Social cognitive theory and problem-solving theory were leveraged to provide evidence-based, trauma-informed education through a serious game. Usability testing assessed the quality of user experience with the prototype. Results: Across all 3 stages, a total of 86 self-identified African American males and females aged 15 to 21 years from the District of Columbia and Birmingham, Alabama, participated. Participants requested a dating simulation game. They wanted SAAFE to be customizable, realistic, entertaining, educational, modern, and experiential, linking consequences to their gameplay decisions. Usability testing resulted in an initial System Usability Survey score of 77.7, placing the game in the 82nd percentile and above average for usability. Conclusions: Initial results suggest that the SAAFE prototype is a promising intervention to engage African American youth in sexual health education using a role-playing game. If proven efficacious, the game has the potential to meet the need for sex education, counterbalance unhealthy portrayals of sex in popular media, and respond to the disparities in the STI epidemic. %M 32012041 %R 10.2196/16254 %U http://games.jmir.org/2020/1/e16254/ %U https://doi.org/10.2196/16254 %U http://www.ncbi.nlm.nih.gov/pubmed/32012041 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13495 %T “Positive Peers”: Function and Content Development of a Mobile App for Engaging and Retaining Young Adults in HIV Care %A Step,Mary M %A McMillen Smith,Jennifer %A Kratz,Joshua %A Briggs,Julia %A Avery,Ann %+ College of Public Health, Kent State University, 321 Lowry Hall, 750 Hilltop Dr, Kent, OH, 44242-0001, United States, 1 2164036048, MSTEP@KENT.EDU %K HIV %K young adults %K mobile applications %K self-management %D 2020 %7 30.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Although treatment for HIV infection is widely available and well tolerated, less than 30% of adolescents and young adults living with HIV infection achieve stable viral suppression. Mobile technology affords increased opportunities for young people living with HIV to engage with information, health management tools, and social connections that can support adherence to treatment recommendations and medication. Although mobile apps are increasingly prevalent, few are informed by the target population. Objective: The objective of this study was to describe the “Positive Peers” app, a mobile app currently being evaluated in a public hospital in the Midwestern United States. Formative development, key development strategies, user recruitment, and lessons learned are discussed in this paper. Methods: “Positive Peers” was developed in collaboration with a community advisory board (CAB) comprising in-care young adults living with HIV and a multidisciplinary project team. Mobile app functions and features were developed over iterative collaborative sessions that were tailored to the CAB members. In turn, the CAB built rapport with the project team and revealed unique information that was used in app development. Results: The study was funded on September 1, 2015; approved by the MetroHealth Institutional Review Board on August 31, 2016; and implemented from October 11, 2016, to May 31, 2019. The “Positive Peers” mobile app study has enrolled 128 users who reflect priority disparity population subgroups. The app administrator had frequent contact with users across app administration and study-related activities. Key lessons learned from the study include changing privacy concerns, data tracking reliability, and user barriers. Intermediate and outcome variable evaluation is expected in October 2019. Conclusions: Successful development of the “Positive Peers” mobile app was supported by multidisciplinary expertise, an enthusiastic CAB, and a multifaceted, proactive administrator. %M 32012035 %R 10.2196/13495 %U http://formative.jmir.org/2020/1/e13495/ %U https://doi.org/10.2196/13495 %U http://www.ncbi.nlm.nih.gov/pubmed/32012035 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e12618 %T Designing a Mobile App to Enhance Parenting Skills of Latinx Parents: A Community-Based Participatory Approach %A Doty,Jennifer L %A Brady,Sonya S %A Monardez Popelka,Javiera %A Rietveld,Laura %A Garcia-Huidobro,Diego %A Doty,Matthew J %A Linares,Roxana %A Svetaz,Maria Veronica %A Allen,Michele L %+ Department of Family, Youth and Community Sciences, University of Florida, 3038D McCarty Hall D, PO Box, Gainesville, FL, 32611-0001, United States, 1 3522733543, jennifer.doty@ufl.edu %K mobile application %K eHealth %K community-based participatory research %K Hispanic Americans, family %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Latinx families are among the highest users of smartphones, yet few health-focused Web programs have been developed for this audience. Parent-based smartphone apps designed for Latinx families may help increase access to evidence-informed parenting programming and ultimately reduce health disparities among children and adolescents. To maximize uptake of such apps, the Center for eHealth Research and Disease Management (CeHRes) Roadmap for electronic health (eHealth) development recommends 5 phases of development: (1) contextual inquiry, (2) value specification, (3) design, (4) operationalization, and (5) evaluation. Objective: Guided by the CeHRes Roadmap, our objective was to apply a community-based participatory research (CBPR) approach to mobile app development. We present a formative evaluation to inform the design of an eHealth mobile app for Latinx parents of adolescents based on a face-to-face parenting program, Padres Informados/Jovenes Preparados (PIJP). Methods: Community participants in the process included Latinx parents and stakeholders. We conducted a parent survey (N=115) and interviews (N=20) to understand the context and obtain feedback on a mockup and prototype of the app, facilitator workshops to streamline content, and stakeholder interviews (N=4) to discuss values and app requirements. Results: We report results from the first 3 phases of the CeHRes Roadmap. In the survey, 96.5% (111/115) of parents reported they had access to a cell phone, 85.6% (89/104) reported they would use a parenting app in the next month if they had access, and 80.2% (89/111) reported intentions to use a stress reduction app. Parents reported that setting goals about parenting and tracking those goals were important potential features of an app. In logistic regression analyses, technology attitudes and barriers were not related to parent’s intentions to use a parenting mobile app (95% CI 0.51-1.17 and 95% CI 0.28-2.12, respectively). Qualitative interviews confirmed Latinx parents’ technology engagement and desire for education and child development information online. Stakeholder interviews identified 3 community values: familism, the promotion of adolescent health, and delivery of economic value. Community stakeholders participated in defining the mobile app requirements. On the basis of community and parent input, the mobile app prototype was designed with 3 sections: (1) 8 modules of video-based parenting skills instruction with content from the face-to-face PIJP program, (2) breath rate information from a wearable device to support awareness of stress levels that could affect parenting, and (3) goal setting and tracking capacities. Conclusions: The findings of this study highlight the utility of an iterative, participatory design process. The CBPR approach and community collaboration enhanced the CeHRes Roadmap by promoting power sharing, facilitating recruitment, and building trust among community members. Experiences applying community research to the initial 3 phases of the CeHRes Roadmap in a Latinx community are discussed, along with plans for the 2 final phases. %M 32012034 %R 10.2196/12618 %U https://formative.jmir.org/2020/1/e12618 %U https://doi.org/10.2196/12618 %U http://www.ncbi.nlm.nih.gov/pubmed/32012034 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12424 %T Considerations for Improved Mobile Health Evaluation: Retrospective Qualitative Investigation %A Dick,Samantha %A O'Connor,Yvonne %A Thompson,Matthew J %A O'Donoghue,John %A Hardy,Victoria %A Wu,Tsung-Shu Joseph %A O'Sullivan,Timothy %A Chirambo,Griphin Baxter %A Heavin,Ciara %+ Health Information Systems Research Centre, Cork University Business School, University College Cork, Cork, Ireland, 353 21 420 5576, samantha.dick@ucc.ie %K telemedicine %K mHealth %K research design %K developing countries %D 2020 %7 22.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone use and, consequently, mobile health (mHealth) interventions have seen an exponential increase in the last decade. There is an excess of 318,000 health-related apps available free of cost for consumers to download. However, many of these interventions are not evaluated and are lacking appropriate regulations. Randomized controlled trials are often considered the gold standard study design in determining the effectiveness of interventions, but recent literature has identified limitations in the methodology when used to evaluate mHealth. Objective: The objective of this study was to investigate the system developers’ experiences of evaluating mHealth interventions in the context of a developing country. Methods: We employed a qualitative exploratory approach, conducting semistructured interviews with multidisciplinary members of an mHealth project consortium. A conventional content analysis approach was used to allow codes and themes to be identified directly from the data. Results: The findings from this study identified the system developers’ perceptions of mHealth evaluation, providing an insight into the requirements of an effective mHealth evaluation. This study identified social and technical factors which should be taken into account when evaluating an mHealth intervention. Conclusions: Contextual issues represented one of the most recurrent challenges of mHealth evaluation in the context of a developing country, highlighting the importance of a mixed method evaluation. There is a myriad of social, technical, and regulatory variables, which may impact the effectiveness of an mHealth intervention. Failure to account for these variables in an evaluation may limit the ability of the intervention to achieve long-term implementation and scale. %M 32012085 %R 10.2196/12424 %U https://mhealth.jmir.org/2020/1/e12424 %U https://doi.org/10.2196/12424 %U http://www.ncbi.nlm.nih.gov/pubmed/32012085 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e12538 %T The Use and Effects of an App-Based Physical Activity Intervention “Active2Gether” in Young Adults: Quasi-Experimental Trial %A Middelweerd,Anouk %A Mollee,Julia %A Klein,Michel MCA %A Manzoor,Adnan %A Brug,Johannes %A te Velde,Saskia J %+ Research Center for Healthy and Sustainable Living, Hogeschool Utrecht University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, Netherlands, 31 614752495, saskia.tevelde@hu.nl %K physical activity %K smartphone %K mobile app %D 2020 %7 21.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Insufficient physical activity (PA) is highly prevalent and associated with adverse health conditions and the risk of noncommunicable diseases. To increase levels of PA, effective interventions to promote PA are needed. Present-day technologies such as smartphones, smartphone apps, and activity trackers offer several possibilities in health promotion. Objective: This study aimed to explore the use and short-term effects of an app-based intervention (Active2Gether) to increase the levels of PA in young adults. Methods: Young adults aged 18-30 years were recruited (N=104) using diverse recruitment strategies. The participants were allocated to the Active2Gether-Full condition (tailored coaching messages, self-monitoring, and social comparison), Active2Gether-Light condition (self-monitoring and social comparison), and the Fitbit-only control condition (self-monitoring). All participants received a Fitbit One activity tracker, which could be synchronized with the intervention apps, to monitor PA behavior. A 12-week quasi-experimental trial was conducted to explore the intervention effects on weekly moderate-to-vigorous PA (MVPA) and relevant behavioral determinants (ie, self-efficacy, outcome expectations, social norm, intentions, satisfaction, perceived barriers, and long-term goals). The ActiGraph wGT3XBT and GT3X+ were used to assess baseline and postintervention follow-up PA. Results: Compared with the Fitbit condition, the Active2Gether-Light condition showed larger effect sizes for minutes of MVPA per day (regression coefficient B=3.1; 95% CI −6.7 to 12.9), and comparatively smaller effect sizes were seen for the Active2Gether-Full condition (B=1.2; 95% CI −8.7 to 11.1). Linear and logistic regression analyses for the intervention effects on the behavioral determinants at postintervention follow-up showed no significant intervention effects of the Active2Gether-Full and Active2Gether-Light conditions. The overall engagement with the Fitbit activity tracker was high (median 88% (74/84) of the days), but lower in the Fitbit condition. Participants in the Active2Gether conditions reported more technical problems than those in the Fitbit condition. Conclusions: This study showed no statistically significant differences in MVPA or determinants of MVPA after exposure to the Active2Gether-Full condition compared with the Active2Gether-Light or Fitbit condition. This might partly be explained by the small sample size and the low rates of satisfaction in the participants in the two Active2Gether conditions that might be because of the high rates of technical problems. %M 31961330 %R 10.2196/12538 %U http://formative.jmir.org/2020/1/e12538/ %U https://doi.org/10.2196/12538 %U http://www.ncbi.nlm.nih.gov/pubmed/31961330 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14939 %T A Mobile App for Longterm Monitoring of Narcolepsy Symptoms: Design, Development, and Evaluation %A Quaedackers,Laury %A De Wit,Jan %A Pillen,Sigrid %A Van Gilst,Merel %A Batalas,Nikolaos %A Lammers,Gert Jan %A Markopoulos,Panos %A Overeem,Sebastiaan %+ Center for Sleep Medicine, Kempenhaeghe, Sterkselseweg 65, Heeze, 5591 VE, Netherlands, 31 40 2279490, quaedackersl@kempenhaeghe.nl %K outcome measure %K hypersomnia %K patient-related outcome measure %K PROM %K mHealth %K symptom monitoring %D 2020 %7 7.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Narcolepsy is a chronic sleep disorder with a broad variety of symptoms. Although narcolepsy is primarily characterized by excessive daytime sleepiness and cataplexy (loss of muscle control triggered by emotions), patients may suffer from hypnagogic hallucinations, sleep paralysis, and fragmented night sleep. However, the spectrum of narcolepsy also includes symptoms not related to sleep, such as cognitive or psychiatric problems. Symptoms vary greatly among patients and day-to-day variance can be considerable. Available narcolepsy questionnaires do not cover the whole symptom spectrum and may not capture symptom variability. Therefore, there is a clinical need for tools to monitor narcolepsy symptoms over time to evaluate their burden and the effect of treatment. Objective: This study aimed to describe the design, development, implementation, and evaluation of the Narcolepsy Monitor, a companion app for long-term symptom monitoring in narcolepsy patients. Methods: After several iterations during which content, interaction design, data management, and security were critically evaluated, a complete version of the app was built. The Narcolepsy Monitor allows patients to report a broad spectrum of experienced symptoms and rate their severity based on the level of burden that each symptom imposes. The app emphasizes the reporting of changes in relative severity of the symptoms. A total of 7 patients with narcolepsy were recruited and asked to use the app for 30 days. Evaluation was done by using in-depth interviews and user experience questionnaire. Results: We designed and developed a final version of the Narcolepsy Monitor after which user evaluation took place. Patients used the app on an average of 45.3 (SD 19.2) days. The app was opened on 35% of those days. Daytime sleepiness was the most dynamic symptom, with a mean number of changes of 5.5 (SD 3.7) per month, in contrast to feelings of anxiety or panic, which was only moved 0.3 (SD 0.7) times per month. Mean symptom scores were highest for daytime sleepiness (1.8 [SD 1.0]), followed by lack of energy (1.6 [SD 1.4]) and often awake at night (1.5 [SD 1.0]). The personal in-depth interviews revealed 3 major themes: (1) reasons to use, (2) usability, and (3) features. Overall, patients appreciated the concept of ranking symptoms on subjective burden and found the app easy to use. Conclusions: The Narcolepsy Monitor appears to be a helpful tool to gain more insight into the individual burden of narcolepsy symptoms over time and may serve as a patient-reported outcome measure for this debilitating disorder. %M 31909723 %R 10.2196/14939 %U https://mhealth.jmir.org/2020/1/e14939 %U https://doi.org/10.2196/14939 %U http://www.ncbi.nlm.nih.gov/pubmed/31909723 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13728 %T A Behavioral Activation Mobile Health App for Smokers With Depression: Development and Pilot Evaluation in a Single-Arm Trial %A Heffner,Jaimee L %A Watson,Noreen L %A Serfozo,Edit %A Mull,Kristin E %A MacPherson,Laura %A Gasser,Melissa %A Bricker,Jonathan B %+ Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, PO Box 19024, Seattle, WA, , United States, 1 206 667 7314, jheffner@fredhutch.org %K tobacco %K nicotine %K smoking cessation %K depression %K smartphone %D 2019 %7 27.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of Behavioral Activation Treatment for Depression (BAT-D) into smoking cessation interventions is a promising approach to address depression as a barrier to quitting. However, this approach has only been tested as a face-to-face intervention, which has low reach. Objective: The aims of the study were to develop a BAT-D mobile health app with high potential reach and determine its feasibility, acceptability, and preliminary effects on theory-based behavioral processes of behavioral activation, reduced depressive symptoms, and smoking cessation. Methods: Following a user-centered design process consisting of competitive analysis, focus groups, and prototype testing, we conducted a single-arm pilot trial of Actify!, a BAT-D app for depressed smokers. Participants used SmokefreeTXT along with Actify! to provide cessation content that had not yet been built into the app for this initial phase of pilot testing. Participants in the trial were current, daily smokers with mild to moderate depressive symptoms. We examined use outcomes for all enrolled participants and process and cessation outcomes at 6 weeks postenrollment for study completers (16/17, 94% retention). Results: Regarding acceptability, average number of log-ins per participant was 16.6 (SD 13.7), and 63% (10/16) reported being satisfied overall with the app. Posttreatment interviews identified some usability challenges (eg, high perceived burden of planning and scheduling values-based activities). There was a significant decrease in depressive symptoms from baseline to follow-up (mean change in Patient Health Questionnaire–9 scores was –4.5, 95% CI –7.7 to –1.3; P=.01). Additionally, carbon monoxide (CO)-confirmed, 7-day point prevalence abstinence (PPA) at 6-week follow-up was 31% (5/16), and the 30-day PPA was 19% (3/16). Conclusions: Results demonstrate promising engagement with Actify! and potential for impact on theory-based change processes and cessation outcomes. Preliminary quit rates compare favorably to previous trials of smoking cessation apps for the general population (ie, short-term, self-reported 30-day quit rates in the 8% to 18% range) and a previous trial of face-to-face BAT-D for depressed smokers (ie, CO-confirmed, 7-day PPA rate of 17% at end of treatment). %M 31774405 %R 10.2196/13728 %U http://formative.jmir.org/2019/4/e13728/ %U https://doi.org/10.2196/13728 %U http://www.ncbi.nlm.nih.gov/pubmed/31774405 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14380 %T An Interactive Mobile Phone App (SMART 5-A-DAY) for Increasing Knowledge of and Adherence to Fruit and Vegetable Recommendations: Development and Pilot Randomized Controlled Trial %A Appleton,Katherine Marie %A Passmore,David %A Burn,Isobel %A Pidgeon,Hanna %A Nation,Philippa %A Boobyer,Charlotte %A Jiang,Nan %+ Bournemouth University, Poole House, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 01202965985, k.appleton@bournemouth.ac.uk %K fruit %K vegetables %K diet therapy %K knowledge %K questionnaires %K portion sizes %D 2019 %7 20.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Fruit and vegetable consumption is important for health, but many individuals fail to consume adequate amounts for health benefits. Although many individuals are aware of current fruit and vegetable consumption recommendations, research suggests that adherence to these is hampered by low knowledge of the details of these recommendations. Objective: This paper reports the development and details of a pilot randomized controlled test of a novel interactive mobile phone app for addressing low knowledge of the UK 5-a-day fruit and vegetable recommendations. Methods: Requirements for the app were first defined by researchers and potential end users and prioritized using the MoSCoW (Must have, Should have, Could have, Won’t have) method. Second, a prototype mobile phone app was developed using an agile approach. Third, the prototype app was tested in a randomized controlled pilot trial for impacts on knowledge and intake of fruit and vegetables. Volunteers were randomized to either receive (n=50) or not receive the app (n=44) for 2 or 4 weeks, and fruit and vegetable knowledge, intake, and behavior were assessed at the beginning of the study and after 1 and 2 weeks or after 2 and 4 weeks, respectively. App usage and qualitative feedback were also investigated. All findings then informed the development of a final app. Results: Low knowledge of consumption recommendations centered around portion sizes and the need for variety, and an interactive mobile phone app was considered a suitable tool for improving this knowledge in a practical manner that would be available both at time of consumption and outside of these times. The pilot test revealed improved behavior after 2 weeks compared with baseline in volunteers who received the app, but improvements in knowledge on fruit and vegetable recommendations were found in both groups, and no improvements in fruit and vegetable intakes were found in formal measures. Patterns of app usage and qualitative feedback also suggested a number of modifications. The resultant final app incorporates several behavior change techniques (goal-setting, self-monitoring, and personalized feedback) as well as aiming to improve knowledge. Conclusions: A novel interactive mobile phone app was successfully developed based on requirements, and when tested in a pilot randomized controlled trial, this app was found to have some impacts on fruit and vegetable outcomes. Although benefits from the app were small, impacts will likely increase as a result of recent modifications. The final SMART 5-A-DAY app is available in the Google Play Store and now needs testing in the target population. Trial Registration: ClinicalTrials.gov NCT02779491; https://www.clinicaltrials.gov/ct2/show/NCT02779491 %M 31746766 %R 10.2196/14380 %U http://mhealth.jmir.org/2019/11/e14380/ %U https://doi.org/10.2196/14380 %U http://www.ncbi.nlm.nih.gov/pubmed/31746766 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e12966 %T A Mobile Phone App for the Provision of Personalized Food-Based Information in an Eating-Out Situation: Development and Initial Evaluation %A Appleton,Katherine Marie %A Bray,Jeff %A Price,Sarah %A Liebchen,Gernot %A Jiang,Nan %A Mavridis,Ioannis %A Saulais,Laure %A Giboreau,Agnès %A Perez-Cueto,Federico J A %A Coolen,Rebecca %A Ronge,Manfred %A Hartwell,Heather %+ Research Centre for Behaviour Change, Department of Psychology, Faculty of Science and Technology, Bournemouth University, Poole House, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202 965985, k.appleton@bournemouth.ac.uk %K eating %K eating behavior %K food %K diet %K mhealth %K mobile app %K digitalhealth %K smartphone %D 2019 %7 4.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing pressure from governments, public health bodies, and consumers is driving a need for increased food-based information provision in eating-out situations. Meals eaten outside the home are known to be less healthy than meals eaten at home, and consumers can complain of poor information on the health impact and allergen content of meals eaten out. Objective: This paper aimed to describe the development and early assessment of a mobile phone app that allows the provision of accurate personalized food-based information while considering individual characteristics (allergies, diet type, and preferences) to enable informed consumer choice when eating out. Methods: An app was designed and developed to address these requirements using an agile approach. The developed app was then evaluated at 8 public engagement events using the System Usability Scale (SUS) questionnaire and qualitative feedback. Results: Consideration of the literature and consultation with consumers revealed a need for information provision for consumers in the eating-out situation, including the ability to limit the information provided to that which was personally relevant or interesting. The app was designed to provide information to consumers on the dishes available in a workplace canteen and to allow consumers the freedom to personalize the app and choose the information that they received. Evaluation using the SUS questionnaire revealed positive responses to the app from a range of potential users, and qualitative comments demonstrated broad interest in its use. Conclusions: This paper details the successful development and early assessment of a novel mobile phone app designed to provide food-based information in an eating-out situation in a personalized manner. %M 31682575 %R 10.2196/12966 %U http://formative.jmir.org/2019/4/e12966/ %U https://doi.org/10.2196/12966 %U http://www.ncbi.nlm.nih.gov/pubmed/31682575 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e13691 %T End User–Informed Mobile Health Intervention Development for Adolescent Cannabis Use Disorder: Qualitative Study %A Bagot,Kara %A Hodgdon,Elizabeth %A Sidhu,Natasha %A Patrick,Kevin %A Kelly,Mikaela %A Lu,Yang %A Bath,Eraka %+ University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, MC 0405, La Jolla, CA, 92093, United States, 1 8582462553, kbagot@ucsd.edu %K adolescent %K cannabis %K mobile health %K treatment %K smartphone %D 2019 %7 4.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The rates of cannabis use continue to increase among adolescents and the current interventions have modest effects and high rates of relapse following treatment. There is increasing evidence for the efficacy of mobile technology–based interventions for adults with substance use disorders, but there is limited study of this technology in adolescents who use cannabis. Objective: The goal of our study was to elucidate elements of an app-based adjunctive intervention for cannabis cessation that resonate with adolescents who use cannabis. Methods: Adolescents, aged between 14 and 17 years, who used cannabis were recruited from San Diego County high schools. Semistructured focus groups (6 total; N=37) were conducted to examine the ways in which participants used smartphones, including the use of any health behavior change apps, as well as to elicit opinions about elements that would promote engagement with an app-based intervention for adolescent cannabis cessation. An iterative coding structure was used with first cycle structural coding, followed by pattern coding. Results: Themes that emerged from the analysis included (1) youth valued rewards to incentivize the progressive reduction of cannabis use, which included both nontangible rewards that mimic those obtained on social media platforms and prosocial activity-related rewards, (2) having the ability to self-monitor progression, (3) peer social support, (4) privacy and confidentiality discrete logo and name and usernames within the app, and (5) individualizing frequency and content of notifications and reminders. Conclusions: Integrating content, language, interfaces, delivery systems, and rewards with which adolescents who use cannabis are familiar, engage with on a day-to-day basis, and identify as relevant, may increase treatment engagement and retention for adolescents in substance use treatment. We may increase treatment effectiveness by adapting and individualizing current evidence-based interventions, so that they target the needs of adolescents and are more easily incorporated into their everyday routines. %M 31588909 %R 10.2196/13691 %U https://mhealth.jmir.org/2019/10/e13691 %U https://doi.org/10.2196/13691 %U http://www.ncbi.nlm.nih.gov/pubmed/31588909 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e12200 %T Design and Development of Smoking Cessation Apps Based on Smokers’ and Providers’ Perspectives in China: Survey Study %A Xu,Junfang %A Bricker,Jonathan %A Fu,Xiaoxing %A Su,Chunyan %A Wang,Peicheng %A Qi,Tengfei %A Cheng,Feng %+ Research Center for Public Health, School of Medicine, Tsinghua University, 30 Shuangqing Rd, Beijing, 100084, China, 86 010 6278 4700, fcheng@mail.tsinghua.edu.cn %K smoking cessation apps %K mHealth %K design %K smartphones %K China %D 2019 %7 4.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although there are more than 60 smartphone apps for smoking cessation in China, many of them do not include the content and features that health care professionals and smokers prefer—which may make them impractical, unengaging, and ineffective. Therefore, we investigated both health care providers’ and smokers’ preferences for features of future smoking cessation apps. Objective: This study aimed to investigate Chinese health care providers’ and smokers’ desired features of a smoking cessation app, with the goal of providing design recommendations for app designers and researchers. Methods: Both Chinese smokers who own smartphones (n=357) and Chinese health care providers (n=224) responded to a survey collecting data on their sociodemographic characteristics and opinions on the importance of 20 smoking cessation app design features studied in previous US research. Results: Chinese health care providers expressed strong support of smoking cessation apps on a number of attitude indicators (range 153/224, 68.3% to 204/224, 91.1%). They rated nearly all (18/20) features as very or extremely important (range 52.2%-83.4%) and rated nearly all features (17/20) as more important than the smokers did. More than 60% of smokers rated the following 4 features as very or extremely important: allow sharing the process of smoking cessation with family members and friends (216/319, 67.7%), helping smokers track their progress (such as the amount of smoking per day; 213/319, 66.8%), helping with the side effects of medications and nicotine withdrawal symptoms (201/319, 63.0%), and adapting to ongoing needs and interests of smokers (194/319, 60.8%). Contrary to a similar study of US smokers and health care providers, Chinese smokers and providers rated reputation and ability to communicate with family members and friends as important features, whereas Chinese smokers rated privacy and security as less important. Conclusions: The design of future smoking cessation and health behavior change apps should consider perspectives of both providers and smokers as well as the role of culture. %M 31588914 %R 10.2196/12200 %U https://mhealth.jmir.org/2019/10/e12200 %U https://doi.org/10.2196/12200 %U http://www.ncbi.nlm.nih.gov/pubmed/31588914 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e13829 %T Health-Related Quality of Life Before and After Use of a Smartphone App for Adolescents and Young Adults With Cancer: Pre-Post Interventional Study %A Pappot,Helle %A Assam Taarnhøj,Gry %A Elsbernd,Abbey %A Hjerming,Maiken %A Hanghøj,Signe %A Jensen,Marc %A Boisen,Kirsten Arntz %+ Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 51943003, gry.assam.taarnhoej@regionh.dk %K adolescent %K young adult %K cancer %K mHealth %K smartphone %K survivorship %K quality of life %D 2019 %7 3.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescent and young adult (AYA) patients with cancer are a group with underexplored needs throughout treatment and in survivorship. This missing knowledge can influence their quality of life (QoL). Given this fact, we have developed a smartphone app based on a cocreation process and have an investigation of QoL among users planned as part of pilot testing this app. Future research is warranted to determine the effect of mobile health (mHealth) tools such as smartphone apps among the AYA cancer population. Objective: The aim of this study was to investigate the feasibility of a smartphone app among AYA patients with cancer in active treatment and posttreatment, in a pilot test by measuring health-related QoL before and after the use of the app. Methods: Participants were recruited via the youth support initiative and social organization for AYAs with cancer, Kræftværket, based at Rigshospitalet, University Hospital of Copenhagen, Denmark. Participants were evenly distributed in active treatment and posttreatment groups. After written informed consent, all participants were asked to use the app Kræftværket as they deemed appropriate over a 6-week period. The participants were asked to complete the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire before and after the 6-week period. The collected QoL data were analyzed with t tests to determine differences between groups and from baseline. Results: In total, we enrolled 20 participants, 10 in active treatment and 10 posttreatment (median time after treatment was 4 months) group. Median age of the participants was 25 years. No differences in QoL were seen at baseline (P=.65). The posttreatment group experienced a significant increase in overall QoL after the 6-week period (global QoL: baseline 62.5, SD 22.3; after 6 weeks 80.8, SD 9.7; P=.04). For the group in active treatment, the QoL remained stable throughout the 6 weeks. Conclusions: This study shows the feasibility and possible effect on QoL associated with the use of an mHealth tool in AYA patients. mHealth support tools are warranted for this population. %M 31584008 %R 10.2196/13829 %U https://mhealth.jmir.org/2019/10/e13829 %U https://doi.org/10.2196/13829 %U http://www.ncbi.nlm.nih.gov/pubmed/31584008 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e13703 %T A Biofeedback App to Instruct Abdominal Breathing (Breathing-Mentor): Pilot Experiment %A Faust-Christmann,Corinna Anna %A Taetz,Bertram %A Zolynski,Gregor %A Zimmermann,Tobias %A Bleser,Gabriele %+ wearHEALTH, Department of Computer Science, Technische Universität Kaiserslautern, Gottlieb-Daimler-Str Gebäude 48, Kaiserslautern, 67663, Germany, 49 631 205 3456, christmann@cs.uni-kl.de %K mobile health %K relaxation %K pain management %K biofeedback %K respiration %K breathing exercises %K feasibility study %D 2019 %7 30.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Deep and slow abdominal breathing is an important skill for the management of stress and pain. However, despite multiple proofs on the effectiveness of biofeedback, most breathing apps remain limited to pacing specific breathing patterns, without sensor feedback on the actual breathing behavior. Objective: To fill this gap, an app named Breathing-Mentor was developed. This app combines effective visualization of the instruction with biofeedback on deep abdominal breathing, based on the mobile phone’s accelerometers. The aim of this pilot study was to investigate users’ feedback and breathing behavior during initial contact with the app. Methods: To reveal the possible effects of biofeedback, two versions of the mobile app were developed. Both contained the same visual instruction, but only the full version included additional biofeedback. In total, 40 untrained participants were randomly assigned to one of the two versions of the app. They had to follow the app’s instructions as closely as possible for 5 min. Results: The group with additional biofeedback showed an increased signal-to-noise ratio for instructed breathing frequency (0.1 Hz) compared with those using visual instruction without biofeedback (F1,37=4.18; P<.048). During this initial contact with the full version, self-reported relaxation effectivity was, however, lower than the group using visual instruction without biofeedback (t37=−2.36; P=.02), probably owing to increased cognitive workload to follow the instruction. Conclusions: This study supports the feasibility and usefulness of incorporating biofeedback in the Breathing-Mentor app to train abdominal breathing. Immediate effects on relaxation levels should, however, not be expected for untrained users. %M 31573919 %R 10.2196/13703 %U http://mhealth.jmir.org/2005/9/e13703/ %U https://doi.org/10.2196/13703 %U http://www.ncbi.nlm.nih.gov/pubmed/31573919 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 6 %N 2 %P e13511 %T A Collaboration Between Game Developers and Rehabilitation Researchers to Develop a Web-Based App for Persons With Physical Disabilities: Case Study %A Terrill,Alexandra L %A MacKenzie,Justin J %A Reblin,Maija %A Einerson,Jackie %A Ferraro,Jesse %A Altizer,Roger %+ Department of Occupational & Recreational Therapies, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, United States, 1 801 581 5951, alex.terrill@hsc.utah.edu %K spinal cord injury %K software design %K interdisciplinary health team %K rehabilitation %K internet %D 2019 %7 6.9.2019 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Individuals with a disability and their partners, who often provide care, are both at risk for depression and lower quality of life. Mobile health (mHealth) interventions are promising to address barriers to mental health care. Rehabilitation researchers and software development researchers must collaborate effectively with each other and with clinical and patient stakeholders to ensure successful mHealth development. Objective: This study aimed to aid researchers interested in mHealth software development by describing the collaborative process between a team of rehabilitation researchers, software development researchers, and stakeholders. Thus, we provide a framework (conceptual model) for other teams to replicate to build a Web-based mHealth app for individuals with physical disability. Methods: Rehabilitation researchers, software development researchers, and stakeholders (people with physical disabilities and clinicians) are involved in an iterative software development process. The overall process of developing an mHealth intervention includes initial development meetings and a co-design method called design box, in which the needs and key elements of the app are discussed. On the basis of the objectives outlined, a prototype is developed and goes through scoping iterations with feedback from stakeholders and end users. The prototype is then tested by users to identify technical errors and gather feedback on usability and accessibility. Results: Illustrating the overall development process, we present a case study based on our experience developing an app (SupportGroove) for couples coping with spinal cord injury. Examples of how we addressed specific challenges are also included. For example, feedback from stakeholders resulted in development of app features for individuals with limited functional ability. Initial designs lacked accessibility design principles made visible by end users. Solutions included large text, single click, and minimal scrolling to facilitate menu navigation for individuals using eye gaze technology. Prototype testing allowed further refinement and demonstrated high usability and engagement with activities in the app. Qualitative feedback indicated high levels of satisfaction, accessibility, and confidence in potential utility. We also present key lessons learned about working in a collaborative interdisciplinary team. Conclusions: mHealth promises to help overcome barriers to mental health intervention access. However, the development of these interventions can be challenging because of the disparate and often siloed expertise required. By describing the mHealth software development process and illustrating it with a successful case study of rehabilitation researchers, software development researchers, and stakeholders collaborating effectively, our goal is to help other teams avoid challenges we faced and benefit from our lessons learned. Ultimately, good interdisciplinary collaboration will benefit individuals with disabilities and their families. %M 31573927 %R 10.2196/13511 %U http://rehab.jmir.org/2019/2/e13511/ %U https://doi.org/10.2196/13511 %U http://www.ncbi.nlm.nih.gov/pubmed/31573927 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 2 %N 1 %P e14633 %T Design of a Consumer Mobile Health App for Heart Failure: Findings From the Nurse-Led Co-Design of Care4myHeart %A Woods,Leanna %A Duff,Jed %A Roehrer,Erin %A Walker,Kim %A Cummings,Elizabeth %+ School of Nursing, University of Tasmania, 1 Leichhardt St, Darlinghurst, Australia, 61 0285727930, leannaj@utas.edu.au %K heart failure %K mobile health (mHealth) %K mobile apps %K self-management %K mobile phone %K patient involvement %D 2019 %7 23.9.2019 %9 Original Paper %J JMIR Nursing %G English %X Background: Consumer health care technology shows potential to improve outcomes for community-dwelling persons with chronic conditions, yet health app quality varies considerably. In partnership with patients and family caregivers, hospital clinicians developed Care4myHeart, a mobile health (mHealth) app for heart failure (HF) self-management. Objective: The aim of this paper was to report the outcomes of the nurse-led design process in the form of the features and functions of the developed app, Care4myHeart. Methods: Seven patients, four family caregivers, and seven multidisciplinary hospital clinicians collaborated in a design thinking process of innovation. The co-design process, involving interviews, design workshops, and prototype feedback sessions, incorporated the lived experience of stakeholders and evidence-based literature in a design that would be relevant and developed with rigor. Results: The home screen displays the priority HF self-management components with a reminder summary, general information on the condition, and a settings tab. The health management section allows patients to list health care team member’s contact details, schedule medical appointments, and store documents. The My Plan section contains nine important self-management components with a combination of information and advice pages, graphical representation of patient data, feedback, and more. The greatest strength of the co-design process to achieve the design outcomes was the involvement of local patients, family caregivers, and clinicians. Moreover, incorporating the literature, guidelines, and current practices into the design strengthened the relevance of the app to the health care context. However, the strength of context specificity is also a limitation to portability, and the final design is limited to the stakeholders involved in its development. Conclusions: We recommend health app development teams strategically incorporate relevant stakeholders and literature to design mHealth solutions that are rigorously designed from a solid evidence base and are relevant to those who will use or recommend their use. %M 34345774 %R 10.2196/14633 %U https://nursing.jmir.org/2019/1/e14633 %U https://doi.org/10.2196/14633 %U http://www.ncbi.nlm.nih.gov/pubmed/34345774 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 4 %N 3 %P e12600 %T Acceptability of Mobile Health Interventions to Increase Diabetic Risk Factor Awareness Among the Commuter Population in Johannesburg: Descriptive Cross-Sectional Study %A Fischer,Alex %A Chadyiwa,Martha %A Tshuma,Ndumiso %A Nkosi,Vusumuzi %+ Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, John Orr Building, Doornfontein Campus, Doornfontein, Johannesburg, 2094, South Africa, 27 0737762705, afischer@wrhi.ac.za %K mHealth %K diabetes mellitus %K noncommunicable disease %K South Africa %D 2019 %7 20.09.2019 %9 Original Paper %J JMIR Diabetes %G English %X Background: Developing countries are experiencing a shift from infectious diseases such as HIV and tuberculosis to noncommunicable diseases (NCDs) such as diabetes. Diabetes accounts for more disability-adjusted life years than any other NCD in South Africa, and research has identified a number of preventable risk factors; however, there is not enough evidence from lower resource settings as to how best to disseminate this information to the population. Today, 90% of the world’s population lives in mobile phone coverage areas, and this provides a unique opportunity to reach large populations with health information. Objective: This study aimed to investigate how potential mobile health (mHealth) platforms should be paired with diabetes risk factor education so that at-risk communities are empowered with information to prevent and manage diabetes. Methods: A Likert-style survey was distributed to commuters in the City of Johannesburg in July 2018 that explored participants’ background characteristics as well as their knowledge and awareness surrounding diabetic risk factors (such as exercise, smoking, and hypertension) and their comfort level with various information delivery methods (such as WhatsApp, short message service, and email). The grouped variables from diabetic risk factors and information delivery methods were described with mean Likert scores and then investigated for relationships with Spearman Rho correlation coefficients. Results: Background characteristics revealed that the self-reported prevalence of diabetes was twice as high in this studied commuter population than the national average. WhatsApp was the most favorable mHealth information delivery method and had a moderate correlation coefficient with diet and nutrition (0.338; P<.001) as well as a weaker correlation with physical activity (0.243; P<.001). Although not as robust as the WhatsApp correlations, each of the other information delivery methods also showed weaker, yet statistically significant, relationships with one or more of the risk factors. Conclusions: The elevated self-reported diabetes prevalence reinforces the need for diabetes risk factor education in the studied commuter population of Johannesburg. The most feasible mHealth intervention for diabetic risk factor education should focus on WhatsApp messaging while also offering content across other mHealth and traditional platforms to remove barriers to access and enhance the user experience. The content should emphasize diet and nutrition as well as physical activity while also incorporating information on secondary risk factors. %M 31586363 %R 10.2196/12600 %U http://diabetes.jmir.org/2019/3/e12600/ %U https://doi.org/10.2196/12600 %U http://www.ncbi.nlm.nih.gov/pubmed/31586363 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 3 %P e14023 %T Tailoring of a Smartphone Smoking Cessation App (Kick.it) for Serious Mental Illness Populations: Qualitative Study %A Klein,Pauline %A Lawn,Sharon %A Tsourtos,George %A van Agteren,Joep %+ College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, 5001, Australia, 61 427 370 673, klei0081@flinders.edu.au %K mental health %K mHealth %K tobacco %K smoking cessation %K public health %K technology %D 2019 %7 03.09.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Smoking rates of Australians with severe mental illness (SMI) are disproportionately higher than the general population. Despite the rapid growth in mobile health (mHealth) apps, limited evidence exists to inform their design for SMI populations. Objective: This study aimed to explore the feasibility, acceptability, and utility of adapting a novel smoking cessation app (Kick.it) to assist smokers with SMI to prevent smoking relapse and quit. Methods: Using co-design, two in-depth interviews with 12 adult smokers and ex-smokers with SMI were conducted in this qualitative study. Stage 1 interviews explored participants’ smoking-related experiences and perceptions of social support for smoking cessation, informed the development of the stage 2 interview schedule, and provided context for participants’ responses to the second interview. Stage 2 interviews explored participants’ perceptions of the feasibility, utility, and acceptability of the app features for SMI populations. Results: People with SMI perceived mHealth interventions to support their quit smoking attempts as feasible, acceptable, and useful. Key emerging themes included personalization of the app to users’ psychosocial needs, a caring app to mediate self-esteem and self-efficacy, an app that normalizes smoking relapse and multiple quit attempts, a strong focus on user experience to improve usability, and a social network to enhance social support for smoking cessation. Conclusions: This study gained an in-depth understanding of the lived experiences of smoking and quitting among people with SMI and their perception of the Kick.it app features to help inform the tailoring of the app. Specific program tailoring is required to assist them in navigating the complex interactions between mental illness and smoking in relation to their psychosocial well-being and capacity to quit. This study describes the adaptations required for the Kick.it app to meet the specific needs and preferences of people with SMI. Results of this study will guide the tailoring of the Kick.it app for SMI populations. The study findings can also inform a co-design process for the future development and design of smoking cessation apps for SMI populations. %M 31482850 %R 10.2196/14023 %U https://humanfactors.jmir.org/2019/3/e14023 %U https://doi.org/10.2196/14023 %U http://www.ncbi.nlm.nih.gov/pubmed/31482850 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13194 %T Applying a User-Centered Approach to Building a Mobile Personal Health Record App: Development and Usability Study %A Zhou,Leming %A DeAlmeida,Dilhari %A Parmanto,Bambang %+ Department of Health Information Management, University of Pittsburgh, 6021 Forbes Tower, 3600 Forbes Avenue at Meyran Avenue, Pittsburgh, PA, 15260, United States, 1 412 383 6653, lmzhou@gmail.com %K mobile app %K personal health record %K needs assessment %D 2019 %7 05.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A personal health record (PHR) system encourages patients to engage with their own health care by giving them the ability to manage and keep track of their own health data. Of the numerous PHR systems available in the market, many are Web-based patient portals and a few are mobile apps. They have mainly been created by hospitals and electronic health record (EHR) vendors. One major limitation of these hospital-created PHR systems is that patients can only view specific health data extracted from their EHR. Patients do not have the freedom to add important personal health data they collect in their daily lives into their PHR. Therefore, there is an information gap between clinical visits. Objective: The aim of this study was to develop and evaluate a new mobile PHR app that can be easily used to manage various types of personal health data to fill the information gap. Methods: A user-centered approach was used to guide the development and evaluation of the new mobile PHR app. There were three steps in this study: needs assessment, app design and development, and conducting a usability study. First, a large-scale questionnaire study was conducted with the general population to gain an understanding of their needs and expectations with regard to a mobile PHR app. A mobile PHR app for personal medical data tracking and management was then created based on the results of the questionnaire study. End users were actively involved in all stages of the app development. Finally, a usability study was performed with participants to evaluate the usability of the mobile PHR app, which involved asking participants to finish a set of tasks and to respond to a usability questionnaire. Results: In the questionnaire study for needs assessment, there were 609 participants in total. The answers from these participants revealed that they wanted to manage various types of personal health data in a mobile PHR app. Participants also reported some features they desired to have in the app. On the basis of the needs assessment findings, a new mobile PHR app (PittPHR) was created with 6 major modules: health records, history, trackers, contacts, appointments, and resources. This app allows users to customize the trackers according to their needs. In the usability study, there were 15 participants. The usability study participants expressed satisfaction with the app and provided comments and suggestions for further development. Conclusions: This new mobile PHR app provides options for users to manage a wide range of personal health data conveniently in one place. The app fills the information gap between clinical visits. The study results indicated that this new mobile PHR app meets the need of users and that users welcome this app. %M 31278732 %R 10.2196/13194 %U https://mhealth.jmir.org/2019/7/e13194/ %U https://doi.org/10.2196/13194 %U http://www.ncbi.nlm.nih.gov/pubmed/31278732 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 3 %P e13847 %T Health Care Professionals’ Clinical Perspectives and Acceptance of a Blood Glucose Meter and Mobile App Featuring a Dynamic Color Range Indicator and Blood Sugar Mentor: Online Evaluation in Seven Countries %A Grady,Mike %A Venugopal,Usha %A Robert,Katia %A Hurrell,Graham %A Schnell,Oliver %+ LifeScan Scotland, Beechwood Park North, Inverness, IV2 3ED, United Kingdom, 44 1463 721000 ext 721889, mgrady@lifescan.com %K ColorSure Dynamic Range Indicator %K Blood Sugar Mentor %K mobile app %K blood glucose meter %K self-monitoring of blood glucose %K health care professionals %D 2019 %7 03.07.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite many new therapies and technologies becoming available in the last decade, people with diabetes continue to struggle to achieve good glycemic control. Innovative and affordable solutions are needed to support health care professionals (HCPs) to improve patient outcomes. Objective: To gather current self-management perceptions of HCPs in seven countries and investigate HCP satisfaction with a new glucose meter and mobile app featuring a dynamic color range indicator and a blood sugar mentor. Methods: A total of 355 HCPs, including 142 endocrinologists (40.0%), 108 primary care physicians (30.4%), and 105 diabetes nurses (29.6%), were recruited from the United Kingdom (n=50), France (n=50), Germany (n=50), India (n=54), Algeria (50), Canada (n=51), and the United States (n=50). HCPs experienced the OneTouch Verio Reflect glucose meter and the OneTouch Reveal mobile app online from their own office computers using interactive demonstrations via webpages and multiple animations. After providing demographic and clinical practice insights, HCPs responded to statements about the utility of the system. Results: Concerning current practice, 83.1% (295/355) of HCPs agreed that poor numeracy or health literacy was a barrier for their patients. A total of 85.9% (305/355) and 92.1% (327/355) of HCPs responded that type 2 diabetes (T2D) and type 1 diabetes (T1D) patients were aware of what represented a low, in-range, or high blood glucose result. Only 62.0% (220/355) felt current glucose meters made it easy for patients to understand if results were in range. A total of 50.1% (178/355) and 78.0% (277/355) of HCPs were confident that T1D and T2D patients took action for low or high results. A total of 87.0% (309/355) agreed that the ColorSure Dynamic Range Indicator could help them teach patients how to interpret results and 88.7% (315/355) agreed it made them more aware of hyper- and hypoglycemic results so they could take action. A total of 83.7% (297/355) of HCPs agreed that the Blood Sugar Mentor feature gave personalized guidance, insight, and encouragement so patients could take action. A total of 82.8% (294/355) of HCPs also agreed that the Blood Sugar Mentor provided real-time guidance to reinforce the goals HCPs had set so patients could take steps to manage their diabetes between office visits. After experiencing the full system, 85.9% (305/355) of HCPs agreed it was beneficial for patients with lower numeracy or health literacy; 96.1% (341/355) agreed that it helped patients understand when results were low, in range, or high; and 91.0% (323/355) agreed that the way it displayed diabetes information would make patients more inclined to act upon results. A total of 89.0% (316/355) of HCPs agreed that it would be helpful for agreeing upon appropriate in-range goals for their patients for their next clinic visit. Conclusions: This multi-country online study provides evidence that HCPs were highly satisfied with the OneTouch Verio Reflect meter and the OneTouch Reveal mobile app. Each of these use color-coded information and the Blood Sugar Mentor feature to assist patients with interpreting, analyzing, and acting upon their blood glucose results, which is particularly beneficial to keep patients on track between scheduled office visits. %M 31271146 %R 10.2196/13847 %U https://humanfactors.jmir.org/2019/3/e13847/ %U https://doi.org/10.2196/13847 %U http://www.ncbi.nlm.nih.gov/pubmed/31271146 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12242 %T What Patients Want in a Smartphone App That Supports Colonoscopy Preparation: Qualitative Study to Inform a User-Centered Smartphone App %A Sewitch,Maida J %A Fallone,Carlo A %A Ghali,Peter %A Lee,Ga Eun %+ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve West, Montreal, QC, H4A 3S5, Canada, 1 514 934 1934 ext 44736, maida.sewitch@mcgill.ca %K colonoscopy %K early detection of cancer %K mobile health technology %K qualitative research %K smartphone %K user-centered %D 2019 %7 02.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The preparation for colonoscopy is elaborate and complex. In the context of colorectal cancer screening, up to 11% of patients do not keep their colonoscopy appointments and up to 33% of those attending their appointments have inadequately cleansed bowels that can delay cancer diagnosis and treatment. A smartphone app may be an acceptable and wide-reaching tool to improve patient adherence to colonoscopy. Objective: The aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments. Methods: We conducted 2 focus group discussions (FGDs) with gastroenterology patients treated at the McGill University Health Centre in Montreal, Canada. Patients were aged 50 to 75 years, were English- or French-speaking, and had undergone outpatient colonoscopy in the previous 3 months; they did not have inflammatory bowel disease or colorectal cancer. FGDs were 75 to 90 min, conducted by a trained facilitator, and audiotaped. Participants discussed the electronic health support tools they might use to help them prepare for the colonoscopy, the content needed for colonoscopy preparation, and the features that would make the smartphone app useful. Recordings of FGDs were transcribed and analyzed using thematic analysis to identify key user-defined content and features to inform the design of colonAPPscopy. Results: A total of 9 patients (7 male and 2 female) participated in one of 2 FGDs. Main content areas focused on bowel preparation instructions, medication restrictions, appointment logistics, communication, and postcolonoscopy expectations. Design features to make the app useful and engaging included minimization of data input, reminders and alerts for up to 7 days precolonoscopy, and visual aids. Participants wanted a smartphone app that comes from a trusted source, sends timely and tailored messages, provides reassurance, provides clear instructions, and is simple to use. Conclusions: Participants identified the need for postcolonoscopy information as well as reminders and alerts in the week before colonoscopy, novel content, and features that had not been included in previous smartphone-based strategies for colonoscopy preparation. The ability to tailor instructions made the smartphone app preferable to other modes of delivery. Study findings recognize the importance of including potential users in the development phase of building a smartphone app. %M 31125310 %R 10.2196/12242 %U https://mhealth.jmir.org/2019/7/e12242/ %U https://doi.org/10.2196/12242 %U http://www.ncbi.nlm.nih.gov/pubmed/31125310 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e14592 %T Development and Testing of a Mobile Phone App for Risk Estimation of Gas Volume Expansion and Intraocular Pressure Elevation in Patients With Intravitreous Gas or Air Tamponade: Interobserver Assessment Study %A Zhang,Zhaotian %A Li,Fei %A Zhang,Haochuan %A Miao,Zhipeng %A Wei,Yantao %A Wang,Li %A Zhang,Shaochong %+ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54S Xianlie Road, Guangzhou, 510060, China, 86 2087330415, zhangshaochong@gzzoc.com %K intraocular pressure %K mobile phone %K vitrectomy %K air %D 2019 %7 26.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pars plana vitrectomy (PPV) with intravitreous tamponade of gas or air has been widely used for a series of vitreoretinal diseases. It is estimated that 100,000 patients per year undergo PPV globally, and half of them were subsequently tamponaded with gas or air. According to Boyle’s law (P1V1=P2V2), patients with an intravitreous remnant of gas or air will be under high risk of intraocular pressure (IOP) elevation and subsequent vision loss owing to the expanded intravitreous gas or air when traveling post operation to a place with a significantly higher altitude. We always explain to patients why postoperative travel is potentially risky. Emergency cases of elevated IOP caused by postoperative traveling would sometimes come to surgeons. However, there have been few disease education or reference tools for both the surgeons and patients to have better communication. Objective: The aim of this study was to introduce and evaluate a mobile phone app developed by surgeons (the authors) for preliminary risk estimation of volume expansion and IOP elevation in patients with intravitreous gas or air when traveling to a place of higher altitude. Methods: The app was developed on the iOS and Android operating systems. Boyle’s law (P1V1=P2V2) was the theoretical basis of the app. Intravitreous gas or air volume and altitude values were independent factors to deduce the risk report. Consecutive patients underwent vitrectomy, and those with an intravitreous remnant of gas or air were recruited. The surgeons judged the vertical height of the fluid/gas interface through the dilated pupil; the patients were instructed to judge it according to their visual field when looking straight ahead and line it out on a chart included in the app. Finally, all the patients were required to fill a Likert scale–based questionnaire with 2 main items to evaluate the participants’ user experience and attitudes toward the app. Results: A total of 50 patients were included (30 males and 20 females). All patients could independently operate the app to complete the test. The median heights of the fluid/gas interface independently judged by the surgeon and patients were 40% (range: 10%-75%) and 41% (range: 9%-78%), respectively (P=.63). The median altitude of the participants’ destinations was 150.0 m (range: 0-3490 m). The Bland-Altman analysis revealed a good agreement between the surgeons’ and patients’ judgments (bias of −0.3%), with 95% limits of agreement of −5.8% to 5.3%. Overall, the Likert scale revealed a positive attitude from the patients toward the app. Conclusions: The app is reliable for patients to have preliminary risk estimation of intravitreous gas or air volume expansion and IOP elevation if travel to a place of higher altitude is planned. The surgeons could also use it as a platform for better disease communication. %M 31244482 %R 10.2196/14592 %U http://mhealth.jmir.org/2019/6/e14592/ %U https://doi.org/10.2196/14592 %U http://www.ncbi.nlm.nih.gov/pubmed/31244482 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e8130 %T A Medication Adherence App for Children With Sickle Cell Disease: Qualitative Study %A Curtis,Kristina %A Lebedev,Anastasiya %A Aguirre,Elisa %A Lobitz,Stephan %+ Health Behaviour and Interventions Research, Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, 4th Floor, Coventry, CV1 5FB, United Kingdom, 44 07916142132, kristina.curtis@coventry.ac.uk %K children %K adolescents %K sickle cell disease %K medication adherence %K models, theoretical %K mHealth %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young people with sickle cell disease (SCD) often demonstrate low medication adherence and low motivation for effectively self-managing their condition. The growing sophistication of mobile phones and their popularity among young people render them a promising platform for increasing medication adherence. However, so far, few apps targeting SCD have been developed from research with the target population and underpinned with theory and evidence. Objective: The aim of this study was to develop a theory-and-evidence-based medication adherence app to support children and adolescents with SCD. Methods: The Behavior Change Wheel (BCW), a theoretically based intervention development framework, along with a review of the literature, 10 interviews with children and adolescents with SCD aged between 12 and 18 years, and consultation with experts informed app development. Thematic analysis of interviews provided relevant theoretical and evidence-based components to underpin the design and development of the app. Results: Findings suggested that some patients had lapses in memory for taking their medication (capability); variation in beliefs toward the effectiveness of medication and confidence in self-managing their condition (motivation); a limited time to take medication; and barriers and enablers within the changing context of social support during the transition into adulthood (opportunity). Steps were taken to select the appropriate behavioral change components (involving behavior change techniques [BCTs] such as information on antecedents, prompts/cues; self-monitoring of the behavior; and social support) and translate them into app features designed to overcome these barriers to medication adherence. Conclusions: Patients with SCD have complex barriers to medication adherence necessitating the need for comprehensive models of behavior change to analyze the problem. Children and adolescents require an app that goes beyond simple medication reminders and takes into account the patient’s beliefs, emotions, and environmental barriers to medication adherence. %M 31215518 %R 10.2196/mhealth.8130 %U http://mhealth.jmir.org/2019/6/e8130/ %U https://doi.org/10.2196/mhealth.8130 %U http://www.ncbi.nlm.nih.gov/pubmed/31215518 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13256 %T Development of a Mobile Health Intervention to Promote Papanicolaou Tests and Human Papillomavirus Vaccination in an Underserved Immigrant Population: A Culturally Targeted and Individually Tailored Text Messaging Approach %A Lee,Hee Yun %A Lee,Mi Hwa %A Sharratt,Monica %A Lee,Sohye %A Blaes,Anne %+ School of Social Work, The University of Alabama, 1022 Little Hall Box 870314, Tuscaloosa, AL, 35401, United States, 1 205 348 6553, hlee94@ua.edu %K uterine cervical cancer %K papanicolaou test %K papillomavirus infections %K papillomavirus vaccines %K text messaging %K Asian American %K immigrants %D 2019 %7 6.6.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Disparities in cervical cancer incidence and mortality signify the need for intervention efforts targeting Korean American immigrant women. Objective: The purpose of this study was to demonstrate how a culturally targeted and tailored mobile text messaging intervention, mobile screening (mScreening), was developed to promote the uptake of Papanicolaou tests and human papillomavirus vaccine among young Korean American immigrant women. Methods: Guided by the Fogg behavior model, the mScreening intervention was developed through a series of focus groups. Braun and Clarke’s thematic analysis was used to identify core themes. Results: Overall, 4 themes were identified: (1) tailored message content (ie, basic knowledge about cervical cancer), (2) an interactive and visual message format (ie, age-appropriate and friendly messages using emoticons), (3) brief message delivery formats to promote participant engagement, and (4) use of an incentive to motivate participation (ie, gift cards). Conclusions: This study demonstrated the processes of gathering culturally relevant information to develop a mobile phone text messaging intervention and incorporating the target population’s perspectives into the development of the intervention. The findings of the study could help guide future intervention development targeting different types of cancer screening in other underserved racial or ethnic groups. %M 31199340 %R 10.2196/13256 %U https://mhealth.jmir.org/2019/6/e13256/ %U https://doi.org/10.2196/13256 %U http://www.ncbi.nlm.nih.gov/pubmed/31199340 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e10465 %T User Preferences and Persona Design for an mHealth Intervention to Support Adherence to Cardiovascular Disease Medication in Singapore: A Multi-Method Study %A Haldane,Victoria %A Koh,Joel Jun Kai %A Srivastava,Aastha %A Teo,Krichelle Wei Qi %A Tan,Yao Guo %A Cheng,Rui Xiang %A Yap,Yi Cheng %A Ong,Pei-Shi %A Van Dam,Rob M %A Foo,Jie Min %A Müller-Riemenschneider,Falk %A Koh,Gerald Choon-Huat %A Foong,Pin Sym %A Perel,Pablo %A Legido-Quigley,Helena %+ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, ON,, Canada, 1 416 978 4326, v.haldane@mail.utoronto.ca %K personas %K biopsychosocial personas %K qualitative %K ASCVD %K adherence %K patient perspectives %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile health (mHealth) has gained popularity globally, including for its use in a variety of health interventions, particularly through short message service (SMS) text messaging. However, there are challenges to the use of mHealth, particularly among older users who have a large heterogeneity in usability and accessibility barriers when using technology. Objective: In order to better understand and conceptualize the diversity of users and give insight into their particular needs, we turned to persona creation. Personas are user archetypes created through data generated from multi-method inquiry with actual target users. Personas are an appropriate yet largely underutilized component of current mHealth research. Methods: Leveraging data from a multi-method study conducted in Singapore with an ethnically diverse population including Chinese, Malay, and Indian participants, we used a proforma to analyze data from the qualitative component (ie, 20 in-depth interviews) and quantitative component (ie, 100 interviewer-guided surveys). We then identified key characteristics, including technology use and preferences as well as adherence factors, to synthesize five personas reflective of persons over the age of 40 years in Singapore with atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk factors, such as hypertension. Results: We present five personas typologized as (1) The Quiet Analog, (2) The Busy Grandparent, (3) The Socializer, (4) The Newly Diagnosed, and (5) The Hard-to-Reach. We report on four key characteristics: health care access, medication adherence, mobile phone technology usage (ie, ownership, access, and utilization), and interest in mHealth. Finally, we provide insights into how these personas may be used in the design and implementation of an mHealth intervention. Our work demonstrates how multi-method data can create biopsychosocial personas that can be used to explore and address the diversity in behaviors, preferences, and needs in user groups. Conclusions: With wider adoption of mHealth, it is important that we consider user-centered design techniques and design thinking in order to create meaningful, patient-centered interventions for adherence to medications. Future research in this area should include greater exploration of how these five personas can be used to better understand how and when is best to deliver mHealth interventions in Singapore and beyond. %M 31140445 %R 10.2196/10465 %U http://mhealth.jmir.org/2019/5/e10465/ %U https://doi.org/10.2196/10465 %U http://www.ncbi.nlm.nih.gov/pubmed/31140445 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e14124 %T Technical Guidance for Clinicians Interested in Partnering With Engineers in Mobile Health Development and Evaluation %A Shah,Lochan M %A Yang,William E %A Demo,Ryan C %A Lee,Matthias A %A Weng,Daniel %A Shan,Rongzi %A Wongvibulsin,Shannon %A Spaulding,Erin M %A Marvel,Francoise A %A Martin,Seth S %+ Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21231, United States, 1 410 550 3350, lochanshah2019@gmail.com %K mHealth %K cardiology %K myocardial infarction %K personalized medicine %D 2019 %7 15.05.2019 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The explosion of mobile health (mHealth) interventions has prompted significant investment and exploration that has extended past industry into academia. Although research in this space is emerging, it focuses on the clinical and population level impact across different populations. To realize the full potential of mHealth, an intimate understanding of how mHealth is being used by patients and potential differences in usage between various demographic groups must also be prioritized. In this viewpoint, we use our experiences in building an mHealth intervention that incorporates an iOS app, Bluetooth-enabled blood pressure cuff, and Apple Watch to share knowledge on (1) how user interaction data can be tracked in the context of health care privacy laws, (2) what is required for effective, nuanced communication between clinicians and engineers to design mHealth interventions that are patient-centered and have high clinical impact, and (3) how to handle and set up a process to handle user interaction data efficiently. %M 31094337 %R 10.2196/14124 %U http://mhealth.jmir.org/2019/5/e14124/ %U https://doi.org/10.2196/14124 %U http://www.ncbi.nlm.nih.gov/pubmed/31094337 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 1 %P e12317 %T Designing and Testing Apps to Support Patients With Cancer: Looking to Behavioral Science to Lead the Way %A Hamel,Lauren M %A Thompson,Hayley S %A Albrecht,Terrance L %A Harper,Felicity WK %+ Population Studies and Disparities Research Program, Department of Oncology, Wayne State University, 4100 John R St, Detroit, MI, 48201, United States, 1 5868633884, hamell@karmanos.org %K behavioral science %K cancer %K mobile apps %K evidence-based practice %K smartphone %K mHealth %D 2019 %7 22.4.2019 %9 Viewpoint %J JMIR Cancer %G English %X Background: Behavioral science has a long and strong tradition of rigorous experimental and applied methodologies, which have produced several influential and far-reaching theoretical frameworks and have guided countless inquiries of human behavior in various contexts. In cancer care, behavioral scientists have established a firm foundation of research focused on understanding the experience of cancer and using that understanding to design and implement theory- and evidenced-based interventions to help patients cope with the cancer experience. Given the rich behavioral research base in oncology, behavioral scientists are ideally positioned to lead the integration of evidence-based science on behavior and behavior change into the development of smartphone apps supporting patients with cancer. Smartphone apps are being disseminated to patients with cancer with claims of being able to help them negotiate areas of vulnerability in their cancer experience. However, the vast majority of these apps are developed without the rigor and expertise of behavioral scientists. Objective: In this article, we have illustrated the importance of behavioral science leading the development and evaluation of apps to support patients with cancer by providing an illustrative scientific process that our team of behavioral scientists, patient stakeholders, medical oncologists, and software developers used to empirically design and evaluate 2 patient-focused apps: the Discussion of Cost App (DISCO App) and MyPatientPal. Methods: Using a focused literature review and a descriptive roadmap of our team’s process for designing and evaluating patient-focused behavioral apps for patients with cancer, we have demonstrated how behavioral scientists are integral to the development of empirically sound apps to help support patients with cancer. Specifically, we have illustrated the process by which our multidisciplinary team combined the established user-centered design principles and behavioral science theory and scientific rigor to design and evaluate 2 patient-focused apps. Results: On the basis of initial acceptability and feasibility testing among patients and providers, our team has demonstrated how critical behavioral science is for designing and evaluating app-based interventions for patients with cancer. Conclusions: Behavioral science can and should be coupled with user-centered design principles to provide theoretical guidance and the rigor of the scientific method, thereby adding the much-needed and critical evidence for these types of app-based interventions for patients with cancer. %M 31066691 %R 10.2196/12317 %U http://cancer.jmir.org/2019/1/e12317/ %U https://doi.org/10.2196/12317 %U http://www.ncbi.nlm.nih.gov/pubmed/31066691 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e11833 %T A Two-Way Interactive Text Messaging Application for Low-Income Patients with Chronic Medical Conditions: Design-Thinking Development Approach %A Marko-Holguin,Monika %A Cordel,Stephanie Luz %A Van Voorhees,Benjamin William %A Fogel,Joshua %A Sykes,Emily %A Fitzgibbon,Marian %A Glassgow,Anne Elizabeth %+ Department of Pediatrics, College of Medicine, University of Illinois at Chicago, 840 S Wood Street, Chicago, IL, 60612, United States, 1 3124131165, mmarko@uic.edu %K mobile applications %K telemedicine %K patient participation %K patient acceptance of health care %K delivery of health care %K family health %K community health services %K healthcare disparities %K information technology %K cell phone use %D 2019 %7 01.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Two-way interactive text messaging between patient and community health workers (CHWs) through mobile phone SMS (short message service) text messaging is a form of digital health that can potentially enhance patient engagement in young adults and families that have a child with chronic medical conditions such as diabetes mellitus, sickle cell disease, and asthma. These patients have complex needs, and a user-centered way can be useful for designing a tool to address their needs. Objective: The aim of this study was to utilize the user-centered approach of design thinking to develop a two-way interactive communication SMS text messaging tool for communication between patients or caregivers and CHWs. Methods: We applied a design thinking methodology for development of the SMS text messaging tool. We collected qualitative data from 127 patients/caregivers and 13 CHWs, health care professionals, and experts. In total, 4 iterative phases were used to design the final prototype. Results: The design thinking process led to the final SMS text messaging tool that was transformed from a one-dimensional, template-driven prototype (phases 1 and 2) into a dynamic, interactive, and individually tailored tool (phases 3 and 4). The individualized components consider social factors that influence patients’ ability to engage such as transportation issues and appointment reminders. SMS text messaging components also include operational factors to support staff such as patient contact lists, SMS text messaging templates, and technology chat support. Conclusions: Design thinking can develop a tool to meet the engagement needs of patients with complex health care needs and be user-friendly for health care staff. %M 31042152 %R 10.2196/11833 %U https://mhealth.jmir.org/2019/5/e11833/ %U https://doi.org/10.2196/11833 %U http://www.ncbi.nlm.nih.gov/pubmed/31042152 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e13226 %T A Digital Cognitive Aid for Anesthesia to Support Intraoperative Crisis Management: Results of the User-Centered Design Process %A Schild,Stefanie %A Sedlmayr,Brita %A Schumacher,Ann-Kathrin %A Sedlmayr,Martin %A Prokosch,Hans-Ulrich %A St.Pierre,Michael %A , %+ Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, 91058, Germany, 49 9131 85 26785, stefanie.schild@fau.de %K anesthesiology %K checklist %K crew resource management, healthcare %K emergency treatment %K ergonomics %K human factors %K practice guideline %K reference books, medical %K resuscitation %K user-computer interface %D 2019 %7 29.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stressful situations during intraoperative emergencies have negative impact on human cognitive functions. Consequently, task performance may decrease and patient safety may be compromised. Cognitive aids can counteract these effects and support anesthesiologists in their crisis management. The Professional Association of German Anesthesiologists set up a project to develop a comprehensive set of digital cognitive aids for intraoperative emergencies. A parallel development for several software platforms and stationary and mobile devices will accommodate the inhomogeneity of the information technology infrastructure within German anesthesia departments. Objective: This paper aimed to provide a detailed overview of how the task of developing a digital cognitive aid for intraoperative crisis management in anesthesia was addressed that meets user requirements and is highly user-friendly. Methods: A user-centered design (UCD) process was conducted to identify, specify, and supplement the requirements for a digital cognitive aid. The study covered 4 aspects: analysis of the context of use, specification of user requirements, development of design solutions, and evaluation of design solutions. Three prototypes were developed and evaluated by end users of the application. Following each evaluation, the new requirements were prioritized and used for redesign. For the first and third prototype, the System Usability Scale (SUS) score was determined. The second prototype was evaluated with an extensive Web-based questionnaire. The evaluation of the third prototype included a think-aloud protocol. Results: The chosen methods enabled a comprehensive collection of requirements and helped to improve the design of the application. The first prototype achieved an average SUS score of 74 (SD 12), indicating good usability. The second prototype included the following main revisions: 2-column layout, initial selection of patient type (infant, adult, or parturient), 4 offered search options, and the option to check off completed action steps. Its evaluation identified the following major revision points: add quick selection for resuscitation checklists, design the top bar and tabs slightly larger, and add more pictograms to the text. The third prototype achieved an average SUS score of 77 (SD 15). The evaluation of the think-aloud protocol revealed a good intuitiveness of the application and identified a missing home button as the main issue. Conclusions: Anesthesiology—as an acute medical field—is particularly characterized by its high demands on decision making and action in dynamic, or time-critical situations. The integration of usability aspects is essential for everyday and emergency suitability. The UCD process allowed us to develop a prototypical digital cognitive aid, exhibiting high usability and user satisfaction in the demanding environment of anesthesiological emergencies. Both aspects are essential to increase the acceptance of the application in later stages. The study approach, combining different methods for determining user requirements, may be useful for other implementation projects in a highly demanding environment. %M 31033445 %R 10.2196/13226 %U http://mhealth.jmir.org/2019/4/e13226/ %U https://doi.org/10.2196/13226 %U http://www.ncbi.nlm.nih.gov/pubmed/31033445 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12134 %T Reading Level and Suitability of Congestive Heart Failure (CHF) Education in a Mobile App (CHF Info App): Descriptive Design Study %A Athilingam,Ponrathi %A Jenkins,Bradlee %A Redding,Barbara A %+ College of Nursing, University of South Florida, 12901 Bruce B Downs Blvd, MDC 22, Tampa, FL, 33612, United States, 1 8139747526, pathilin@health.usf.edu %K health literacy %K reading level %K patient education %K heart failure %K mobile app %D 2019 %7 25.04.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Education at the time of diagnosis or at discharge after an index illness is a vital component of improving outcomes in congestive heart failure (CHF). About 90 million Americans have limited health literacy and have a readability level at or below a 5th-grade level, which could affect their understanding of education provided at the time of diagnosis or discharge from hospital. Objective: The aim of this paper was to assess the suitability and readability level of a mobile phone app, the CHF Info App. Methods: A descriptive design was used to assess the reading level and suitability of patient educational materials included in the CHF Info App. The suitability assessment of patient educational materials included in the CHF Info App was independently assessed by two of the authors using the 26-item Suitability Assessment of Materials (SAM) tool. The reading grade level for each of the 10 CHF educational modules included in the CHF Info App was assessed using the comprehensive online Text Readability Consensus Calculator based on the seven most-common readability formulas: the Flesch Reading Ease Formula, the Gunning Fog Index, the Flesch-Kincaid Grade Level Formula, the Coleman-Liau Index, the Simplified Measure of Gobbledygook Index, the Automated Readability Index, and the Linsear Write Formula. The reading level included the text-scale score, the ease-of-reading score, and the corresponding grade level. Results: The educational materials included in the CHF Info App ranged from a 5th-grade to an 8th-grade reading level, with a mean of a 6th-grade level, which is recommended by the American Medical Association. The SAM tool result demonstrated adequate-to-superior levels in all four components assessed, including content, appearance, visuals, and layout and design, with a total score of 77%, indicating superior suitability. Conclusions: The authors conclude that the CHF Info App will be suitable and meet the recommended health literacy level for American adult learners. Further testing of the CHF Info App in a longitudinal study is warranted to determine improvement in CHF knowledge. %M 31518265 %R 10.2196/12134 %U http://aging.jmir.org/2019/1/e12134/ %U https://doi.org/10.2196/12134 %U http://www.ncbi.nlm.nih.gov/pubmed/31518265 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e13362 %T The Potential of Self-Management mHealth for Pediatric Cystic Fibrosis: Mixed-Methods Study for Health Care and App Assessment %A Martinez-Millana,Antonio %A Zettl,Annabel %A Floch,Jacqueline %A Calvo-Lerma,Joaquim %A Sevillano,Jose Luis %A Ribes-Koninckx,Carmen %A Traver,Vicente %+ Instituto ITACA, Universitat Politècnica de València, Camino de vera sn, Valencia,, Spain, 34 963 877 606, anmarmil@itaca.upv.es %K mHealth %K cystic fibrosis %K health care systems %K user requirements %K apps %K market analysis %D 2019 %7 18.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Remote care services and patient empowerment have boosted mobile health (mHealth). A study of user needs related to mHealth for pediatric cystic fibrosis (PCF) identified the set of preferred features mobile apps should support; however, the potential use of PCF apps and their suitability to fit into PCF clinical management remains unexplored. Objective: We examine whether PCF holds potential for the implementation of mHealth care. Methods: The study is based on a literature review and qualitative analysis of content and was conducted in two parts: (1) we reviewed scientific and gray literature to explore how European countries manage PCF and conducted a qualitative study of 6 PCF units and (2) we performed a systematic review of apps available in the myhealthapps.net repository searching for cystic fibrosis (CF) management and nutrition apps, which we analyzed for characteristics, business models, number of downloads, and usability. Results: European CF routine care guidelines are acknowledged in most European countries, and treatments are fully covered in almost all countries. The majority of teams in CF units are interdisciplinary. With respect to the systematic review of apps, we reviewed 12 apps for CF management and 9 for general nutrition management in the myhealthapps.net directory. All analyzed apps provided functionalities for recording aspects related to the disease and nutrition such as medication, meals, measurements, reminders, and educational material. None of the apps reviewed in this study supported pancreatic enzyme replacement therapy. CF apps proved to be less appealing and usable than nutrition apps (2.66 [SD 1.15] vs 4.01 [SD 0.90]; P<.001, z-value: –2.6). User needs detected in previous research are partially matched by current apps for CF management. Conclusions: The health care context for PCF is a unique opportunity for the adoption of mHealth. Well-established clinical guidelines, heterogeneous clinical teams, and coverage by national health care systems provide a suitable scenario for the use of mHealth solutions. However, available apps for CF self-management do not cover essential aspects such as nutrition and education. To increase the adoption of mHealth for CF self-management, new apps should include these features. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-014931 %M 30998222 %R 10.2196/13362 %U http://mhealth.jmir.org/2019/4/e13362/ %U https://doi.org/10.2196/13362 %U http://www.ncbi.nlm.nih.gov/pubmed/30998222 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e12103 %T Usable Mobile App for Community Education on Colorectal Cancer: Development Process and Usability Study %A Mohamad Marzuki,Muhamad Fadhil %A Yaacob,Nor Azwany %A bin Yaacob,Najib Majdi %A Abu Hassan,Muhammad Radzi %A Ahmad,Shahrul Bariyah %+ Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, 16150, Malaysia, 60 194743054, fadhilmarzuki@gmail.com %K colorectal cancer %K mobile app %K development %K mHealth %D 2019 %7 16.04.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Participation in colorectal cancer screening is still low among Malaysians despite the increasing trend of incidence, with more than half of the new cases being detected in the advanced stages. Knowledge improvement might increase screening participation and thus improve the chances of disease detection. With the advancement of communication technology, people nowadays prefer to read from their mobile phone using a Web browser or mobile apps compared with the traditional printed material. Therefore, health education and promotion should adapt this behavior change in educating the community. Objective: This study aimed to document the process of designing and developing a mobile app for community education on colorectal cancer and assess the usability of the prototype. Methods: The nominal group technique (NGT) was used for the content development of the mobile app. NGT involving community educationists and clinicians combined with community representatives as the target users identified relevant health information and communication strategies including features for a user-friendly mobile app. The prototype was developed using framework Ionic 1, based on the Apache Cordova and Angular JS (Google). It was published in the Google Play store. In total, 50 mobile phone users aged 50 years and above and who had never been diagnosed with any type of cancer were invited to download and use the app. They were asked to assess the usability of the app using the validated Malay version of System Usability Scale Questionnaire for the Assessment of Mobile Apps questionnaire. The One-sample t test was used to assess the usability score with a cut-off value of 68 for the usable mobile app. Results: The Colorectal Cancer Awareness Application (ColorApp) was successfully developed in the local Malay language. The NGT discussion had suggested 6 main menus in the ColorApp prototype, which are Introduction, Sign and Symptoms, Risk Factors, Preventive Measures, Colorectal Cancer Screening Program, and immunochemical fecal occult blood test kit. A total of 2 additional artificial intelligence properties menus were added to allow user-ColorApp interaction: Analyze Your Status and ColorApp Calculator. The prototype has been published in the Google Play store. The mean usability score was 72 (SD 11.52), which indicates that ColorApp is a usable mobile app, and it can be used as a tool for community education on colorectal cancer. Conclusions: ColorApp mobile app can be used as a user-friendly tool for community education on colorectal cancer. %M 30990454 %R 10.2196/12103 %U http://humanfactors.jmir.org/2019/2/e12103/ %U https://doi.org/10.2196/12103 %U http://www.ncbi.nlm.nih.gov/pubmed/30990454 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 4 %P e11965 %T User Involvement in Developing the MYPLAN Mobile Phone Safety Plan App for People in Suicidal Crisis: Case Study %A Buus,Niels %A Juel,Anette %A Haskelberg,Hila %A Frandsen,Hanne %A Larsen,Jette Louise Skovgaard %A River,Jo %A Andreasson,Kate %A Nordentoft,Merete %A Davenport,Tracey %A Erlangsen,Annette %+ Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, 88, Mallett St, Camperdown, 2050, Australia, 61 0429835019, niels.buus@sydney.edu.au %K mobile apps %K patient participation %K primary prevention %K self-injurious behavior %K suicide, attempted %D 2019 %7 16.04.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: The effect of safety planning for people in suicidal crisis is not yet determined, but using safety plans to mitigate acute psychological crisis is regarded as best practice. Between 2016 and 2017, Australian and Danish stakeholders were involved in revising and updating the Danish MYPLAN mobile phone safety plan and translating the app into a culturally appropriate version for Australia. Objective: The objective of this study was to examine the negotiation of stakeholders’ suggestions and contributions to the design, function, and content of the MYPLAN app and to characterize significant developments in the emerging user-involving processes. Methods: We utilized a case study design where 4 focus groups and 5 user-involving workshops in Denmark and Australia were subjected to thematic analysis. Results: The analyses identified 3 consecutive phases in the extensive development of the app: from phase 1, Suggesting core functions, through phase 2, Refining functions, to phase 3, Negotiating the finish. The user-involving processes continued to prevent closure and challenged researchers and software developers to repeatedly reconsider the app’s basic user interface and functionality. It was a limitation that the analysis did not include potentially determinative backstage dimensions of the decision-making process. Conclusions: The extended user involvement prolonged the development process, but it also allowed for an extensive exploration of different user perspectives and needs. %M 30990456 %R 10.2196/11965 %U http://mental.jmir.org/2019/4/e11965/ %U https://doi.org/10.2196/11965 %U http://www.ncbi.nlm.nih.gov/pubmed/30990456 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12551 %T A Mobile Phone App for Bedside Nursing Care: Design and Development Using an Adapted Software Development Life Cycle Model %A Ehrler,Frederic %A Lovis,Christian %A Blondon,Katherine %+ Division of Medical Information Sciences, University Hospitals of Geneva, 4, Gabrielle-Perret-Gentil, Geneva, 1205, Switzerland, 41 223728697, frederic.ehrler@hcuge.ch %K mHealth %K nursing %K hospital information systems %D 2019 %7 11.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nurses are increasingly spending time on computers, and providing them with a tailored tool to access clinical information and perform documentation at the bedside could help to improve their efficiency. Designing an app to support nurses’ work at the bedside is a challenging task, given the complexity of the care process. Objective: This study aimed to present the design, development, and testing of a smartphone app for nurses guided by an adapted software development life cycle model that takes into consideration the complexity and constraints of a health care setting. Methods: The model drives us through an iterative development process intersected by 3 stages of formative evaluation of growing ecological validity. Results: The initial requirements identification stage included 11 participants who helped us select the most important functionalities to integrate into the tool. Starting with a usability evaluation allowed for the identification of design issues that could have caused misuse. Then, making on-site evaluations under the supervision of an investigator helped to understand the adequacy of the tool with limited risks. Finally, the on-site evaluation allowed us to validate the acceptance of the app by caregivers. Conclusions: The interpretation of the collected evaluation confirms the necessary involvement of end users early in the process to help address the heterogeneity of the nursing workflow processes in the different wards. We also highlight the delicate balance between high-security measures to protect access to patient data and maintaining ease of access for efficiency and usability. Although a close collaboration with clinicians throughout the entire project facilitated the development of a tailored solution, it was also important to involve all stakeholders, in particular, the information technology (IT) security officers. %M 30973339 %R 10.2196/12551 %U http://mhealth.jmir.org/2019/4/e12551/ %U https://doi.org/10.2196/12551 %U http://www.ncbi.nlm.nih.gov/pubmed/30973339 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e10990 %T Development of a Smartphone App for Informal Carers of People With Cancer: Processes and Learnings %A Heynsbergh,Natalie %A Heckel,Leila %A Botti,Mari %A O,Seung Chul %A Livingston,Patricia M %+ School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong,, Australia, 61 392446333, n.heynsbergh@deakin.edu.au %K cancer %K carer %K smartphone %K mobile applications %K technology %D 2019 %7 11.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There are few support systems available to informal carers who provide care to cancer patients. Smartphone apps have the capacity to reach large audiences and can provide information and support at a time convenient to carers. Objective: The aim of this study was to design a smartphone app prototype for carers of adults with cancer. Methods: A multiple-method design was used to develop a smartphone app. Current and past carers of people with any type of cancer were recruited from a public hospital, a private hospital, and a carer organization, who participated in either a focus group or phone interview. Carers answered questions about items to include in an app to address supportive care needs identified. Using carers’ feedback, a smartphone app was designed and tested. Beta testing was conducted using a convenience sample of participants who completed scenarios to inform the app’s design, functionality, and usability. Scenarios were timed and marked as complete or incomplete. Participants completed a questionnaire about the usability of the app. Beta testing occurred in 2 stages—a paper-based version of the app and an app-based test using the participants’ preferred device. Alpha testing was completed internally to ensure the functionality of the app. Data were collected between May 2016 and August 2017. Results: A total of 33 carers participated in phone interviews and 12 in focus groups; their average age was 55 (SD 14) years, and 60% (27/45) were female. The majority of carers (76%, 25/33) had a positive attitude toward using smartphone apps. Carers noted that smartphone technology might improve their ability to seek information and support in managing their own health as well as the care needs of the person with cancer. Carers requested a variety of information and resources to be included in the app. Paper-based testing included the following: participants (N=10) were aged above 30 years (30%, 3/10), 30 to 49 years (30%, 3/10), and 50 years or above (40%, 4/10), and 60% (6/10) were male. Participants found the app user-friendly and pleasing in appearance. App-based testing included the following: participants (N=10) were aged above 30 years (20%, 2/10), 30 to 49 years (30%, 3/10), and 50 years or above (50%, 5/10), and 50% (5/10) were male. Participants reported the app to be user-friendly and easy to navigate. The majority (60%, 6/10) of participants were unable to create a shortcut icon to add the app to the home screen of their phone. Conclusions: Carers highlighted the needed information and support to assist them during the caring period; they also reported having a positive attitude toward smartphone apps. The Carer Guide App is currently undergoing a pilot study to further test usability among carers of people with 1 cancer type. %M 30973346 %R 10.2196/10990 %U http://formative.jmir.org/2019/2/e10990/ %U https://doi.org/10.2196/10990 %U http://www.ncbi.nlm.nih.gov/pubmed/30973346 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12457 %T Translating/Creating a Culturally Responsive Spanish-Language Mobile App for Visit Preparation: Case Study of “Trans-Creation” %A Ruvalcaba,Denise %A Nagao Peck,Hidemi %A Lyles,Courtney %A Uratsu,Connie S %A Escobar,Patricia R %A Grant,Richard W %+ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, United States, 1 510 891 5960, Richard.W.Grant@kp.org %K IT tool development %K transcreation %K doctor-patient communication %K primary care %D 2019 %7 05.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health information technology (IT) tools are increasingly used to improve patient care. However, implementation of English-only health IT tools could potentially worsen health disparities for non-English speakers. Objective: We aim to describe the “trans-creation” process of developing linguistically and culturally appropriate health IT tools through a detailed case analysis of a waiting room health mobile app designed to help Spanish-speaking Latino people prepare for primary care visits. Methods: We adapted the English-language Visit Planner mobile app for Spanish-speaking Latino patients. We applied culturally defined themes derived from prior published research and input by both skilled linguists and potential end users. Initial changes were iteratively reviewed and edited by a team of writers, health care educators, subject matter experts, patients, and providers. Results: The trans-creation process resulted in the following key culturally mediated changes to the tool: replacing the “provider” actors with “patient” actors; changing the choice of “Stress at Home or Work” (represented by an icon of a house) to “Mi Familia” (translation: my family; icon is an outline of family members holding hands); replacing the English terms “anxiety” and “depression” with “Me siento desanimado”(translation: I am feeling down) to avoid mental health stigma; and using more concise text translation to ensure the wording fit the available on-screen space. Conclusions: The trans-creation process of cultural and linguistic adaptation led to several design changes that would not have been implemented if we had simply translated the words from English to Spanish. %M 30950803 %R 10.2196/12457 %U https://mhealth.jmir.org/2019/4/e12457/ %U https://doi.org/10.2196/12457 %U http://www.ncbi.nlm.nih.gov/pubmed/30950803 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10904 %T Text Messaging to Enhance Behavioral Health Treatment Engagement Among Justice-Involved Youth: Qualitative and User Testing Study %A Tolou-Shams,Marina %A Yonek,Juliet %A Galbraith,Katharine %A Bath,Eraka %+ Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA,, United States, 1 415 206 2212, marina.tolou-shams@ucsf.edu %K juvenile delinquency %K treatment adherence and compliance %K mental health %K short message service text messaging %D 2019 %7 05.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health and substance use disorders are highly prevalent in justice-involved youth, yet only 8% of court-involved, nonincarcerated (CINI) youth in need of treatment receive it. Dual diagnosis (co-occurring psychiatric and substance use disorders) in justice-involved youth is highly predictive of recidivism. Identifying novel approaches, such as the use of mobile health (mHealth) technologies, to close this gap between need and receipt of behavioral health treatment for the CINI population could potentially offset rates of reoffending into adulthood. Text-messaging (short message service, SMS) interventions have demonstrated efficacy in improving treatment adherence and other associated outcomes in other vulnerable youth populations, but development and testing of mHealth interventions to improve behavioral health treatment rates and outcomes for CINI youth are lacking. Objective: This study aimed to collect qualitative data from key stakeholders to inform the development of a theoretically grounded, family-based text-messaging (SMS) intervention targeting CINI youth’s behavioral health treatment engagement; additionally, the aim was to conduct end-user testing over 6 months with CINI youth and caregivers to determine intervention feasibility and acceptability. Methods: CINI youth and caregivers were referred from a California-based Juvenile Probation Department and community-based provider organizations providing services for justice-involved youth. Eligibility criteria included the following: being a justice-involved youth or a caregiver of a justice-involved youth, English speaking, youth aged 13 to 17 years old and either referred to or currently attending mental health or substance use treatment, and youth and caregiver have access to a cell phone with text-messaging capability. Results: Overall, 28 individuals participated in focus groups and interviews—8 youth, 5 caregivers, and 15 juvenile justice (JJ) personnel. Three major themes emerged: (1) texting among JJ personnel and CINI youth and caregivers in their caseload is common but not systematic, (2) stigma and privacy are perceived as barriers to texting youth about behavioral health treatment appointments, and (3) messages should be short, simple, relatable, positive, and personalized. In total, 9 participants (7 youth and 2 caregivers) participated in end-user testing and rated the intervention as useful, helpful, and supportive. Conclusions: Text messaging (SMS) is an acceptable and feasible means of reminding CINI youth to attend behavioral health treatment appointments. Future implementation challenges include making text messaging (SMS) personalized and tailored but not resource intensive (eg, requiring one-to-one, 24/7 human contact) and identifying which systems will deliver and sustain the intervention. Text messaging (SMS) among justice personnel, youth, and their caregivers is already widespread, but lack of clear guidelines about privacy, confidentiality, and information sharing poses ethical conundrums. Future hybrid-type research designs that explore the efficacy of the intervention while also studying ethical, system, and policy-level factors associated with using digital health interventions to improve CINI youth outcomes is a key next step. %M 30950808 %R 10.2196/10904 %U https://mhealth.jmir.org/2019/4/e10904/ %U https://doi.org/10.2196/10904 %U http://www.ncbi.nlm.nih.gov/pubmed/30950808 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12191 %T Examining Development Processes for Text Messaging Interventions to Prevent Cardiovascular Disease: Systematic Literature Review %A Ricci-Cabello,Ignacio %A Bobrow,Kirsten %A Islam,Sheikh Mohammed Shariful %A Chow,Clara K %A Maddison,Ralph %A Whittaker,Robyn %A Farmer,Andrew J %+ Balearic Islands Health Research Institute, Carretera de Valldemossa, 79, Hospital Universitari Son Espases, Edifici S., Palma de Mallorca, 07120, Spain, 34 697750971, nacho.ricci.cabello@gmail.com %K systematic review %K cardiovascular disease %K telemedicine %K text messaging %K methods %D 2019 %7 29.03.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Interventions delivered by mobile phones have the potential to prevent cardiovascular disease (CVD) by supporting behavior change toward healthier lifestyles and treatment adherence. To allow replication and adaptation of these interventions across settings, it is important to fully understand how they have been developed. However, the development processes of these interventions have not previously been systematically examined. Objective: This study aimed to systematically describe and compare the development process of text messaging interventions identified in the Text2PreventCVD systematic review. Methods: We extracted data about the development process of the 9 interventions identified in the Text2PreventCVD systematic review. Data extraction, which was guided by frameworks for the development of complex interventions, considered the following development stages: intervention planning, design, development, and pretesting. Following data extraction, we invited the developers of the interventions to contribute to our study by reviewing the accuracy of the extracted data and providing additional data not reported in the available publications. Results: A comprehensive description of the development process was available for 5 interventions. Multiple methodologies were used for the development of each intervention. Intervention planning involved gathering information from stakeholder consultations, literature reviews, examination of relevant theory, and preliminary qualitative research. Intervention design involved the use of behavior change theories and behavior change techniques. Intervention development involved (1) generating message content based on clinical guidelines and expert opinions; (2) conducting literature reviews and primary qualitative research to inform decisions about message frequency, timing, and level of tailoring; and (3) gathering end-user feedback concerning message readability, intervention acceptability, and perceived utility. Intervention pretesting involved pilot studies with samples of 10 to 30 participants receiving messages for a period ranging from 1 to 4 weeks. Conclusions: The development process of the text messaging interventions examined was complex and comprehensive, involving multiple studies to guide decisions about the scope, content, and structure of the interventions. Additional research is needed to establish whether effective messaging systems can be adapted from work already done or whether this level of development is needed for application in other conditions and settings. %M 30924790 %R 10.2196/12191 %U http://mhealth.jmir.org/2019/3/e12191/ %U https://doi.org/10.2196/12191 %U http://www.ncbi.nlm.nih.gov/pubmed/30924790 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11300 %T Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care %A Doarn,Charles R %A Vonder Meulen,Mary Beth %A Pallerla,Harini %A Acquavita,Shauna P %A Regan,Saundra %A Elder,Nancy %A Tubb,Matthew R %+ Department of Family and Community Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0582, Cincinnati, OH, 45267, United States, 1 5135586148, charles.doarn@uc.edu %K mobile health %K smoking cessation %K primary care %K decision aid %D 2019 %7 29.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. Objective: The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. Methods: A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. Results: Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. Conclusions: Subject matter experts, although generally amenable to one another’s disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building. %M 30924783 %R 10.2196/11300 %U https://formative.jmir.org/2019/1/e11300/ %U https://doi.org/10.2196/11300 %U http://www.ncbi.nlm.nih.gov/pubmed/30924783 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12207 %T An Argument Against Cross-Platform Development: Lessons From an Augmented Reality App Prototype for Rural Emergency Responders %A Weichelt,Bryan %A Heimonen,Tomi %A Pilz,Matthew %A Yoder,Aaron %A Bendixsen,Casper %+ Marshfield Clinic Research Institute, National Farm Medicine Center, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 7152217276, weichelt.bryan@marshfieldresearch.org %K rural health %K mhealth %K telemedicine %K emergency medical services %D 2019 %7 28.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile augmented reality (MAR) apps offer potential support for emergency responders in rural areas. Objective: In this report, we described lessons learned from the development process of augmented reality (AR) Farm Mapping to Assist, Protect and Prepare Emergency Responders (MAPPER), a MAR app that provides emergency responders onsite information about the agricultural operation they enter. Methods: Cross-platform frameworks were used to create AR MAPPER to accommodate budget constraints and overcome issues with markerless MAR technologies. Although the single codebase and Web technologies streamlined development, cross-device hardware limitations impacted location accuracy, lengthened the development cycle, and required regular updates to third-party libraries. Results: A hybrid development approach of using Web-based technologies with native tie-ins for specialized components and enhanced performance cut time and costs. This also led to consistency across multiple platforms and ensured that there is only a single set of source files to modify for Android and iPhone operating systems. Meanwhile, active development was delayed by some major hurdles. Apple and Google both released new versions of their operating systems, and the Wikitude framework issued four major updates, each of which brought with it some important enhancements and also led to some new issues. Conclusions: Developers should consider single platform native development to benefit from platform-specific MAR implementations and to avoid development, testing, and maintenance costs associated with cross-platform implementation. Emergency response organizations may be more likely to utilize a single platform across the devices used by their command staff. This also reduces the benefits of cross-platform development. Furthermore, providing map-based, non-AR cross-platform apps for landowners, farmers, and ranchers would help improve and maintain data quality, which is crucial for the utility and user experience of MAR apps. %M 30920380 %R 10.2196/12207 %U http://mhealth.jmir.org/2019/3/e12207/ %U https://doi.org/10.2196/12207 %U http://www.ncbi.nlm.nih.gov/pubmed/30920380 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 3 %P e12378 %T Cocreative Development of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems %A Buitenweg,David C %A Bongers,Ilja L %A van de Mheen,Dike %A van Oers,Hans AM %A van Nieuwenhuizen,Chijs %+ Scientific Center for Care and Wellbeing (Tranzo), Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037 DB, Netherlands, 31 13 4668338, d.c.buitenweg@tilburguniversity.edu %K mobile app %K quality of life %K mental health %K homeless persons %K medical informatics %D 2019 %7 28.03.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Quality of life (QoL) is a prominent outcome measure in mental health. However, conventional methods for QoL assessment rely heavily on language‐based communication and therefore may not be optimal for all individuals with severe mental health problems. In addition, QoL assessment is usually based on a fixed number of life domains. This approach conflicts with the notion that QoL is influenced by individual values and preferences. A digital assessment app facilitates both the accessibility and personalization of QoL assessment and may, therefore, help to further advance QoL assessment among individuals with severe mental health problems. Objective: This study focused on the development of an innovative, visual, and personalized QoL assessment app for people with severe mental health problems: the QoL-ME. Methods: This study targeted 3 groups of individuals with severe mental health problems: (1) people with psychiatric problems, (2) people treated in forensic psychiatry, and (3) people who are homeless. A group of 59 participants contributed to the 6 iterations of the cocreative development of the QoL-ME. In the brainstorming stage, consisting of the first iteration, participants’ previous experiences with questionnaires and mobile apps were explored. Participants gave their feedback on initial designs and wireframes in the second to fourth iterations that made up the design stage. In the usability stage that comprised the final 2 iterations, the usability of the QoL-ME was evaluated. Results: In the brainstorming stage, participants stressed the importance of privacy and data security and of receiving feedback when answering questionnaires. Participants in the design stage indicated a preference for paging over scrolling, linear navigation, a clean and minimalist layout, the use of touchscreen functionality in various modes of interaction, and the use of visual analog scales. The usability evaluation in the usability stage revealed good to excellent usability. Conclusions: The cocreative development of the QoL-ME resulted in an app that corresponds to the preferences of participants and has strong usability. Further research is needed to evaluate the psychometric quality of the QoL-ME and to investigate its usefulness in practice. %M 30920381 %R 10.2196/12378 %U http://mental.jmir.org/2019/3/e12378/ %U https://doi.org/10.2196/12378 %U http://www.ncbi.nlm.nih.gov/pubmed/30920381 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11374 %T Pregnant Users’ Perceptions of the Birth Plan Interface in the “My Prenatal Care” App: Observational Validation Study %A Moraes Carrilho,Juliana %A Oliveira,Isaias José Ramos %A Santos,Dimitri %A Osanan,Gabriel Costa %A Cruz-Correia,Ricardo João %A Reis,Zilma Silveira Nogueira %+ Informatics Center in Health, Universidade Federal de Minas Gerais, Faculty of Medicine, Av Professor Alfredo Balena, 190, Funcionários, Belo Horizonte, 30140070, Brazil, 55 31985177473, zilma.medicina@gmail.com %K birth plan %K perinatal care %K usability, mobile health %K mobile app %K pregnancy %K prenatal care %K mobile phone %D 2019 %7 28.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Birth plans are meant to be a declaration of the expectations and preferences of pregnant woman regarding childbirth. The My Prenatal Care app engages pregnant women in an educational intervention for a healthy pregnancy. We hypothesized that users’ positive perception of an in-app birth plan is a relevant step for establishing direct communication between pregnant women and the health care team, based on an online report available on the app. Objective: This study aimed to evaluate pregnant women’s perception about the communicability of birth-plan preparation using a mobile app. Methods: This was an observational, exploratory, descriptive study. The methodology was user centered, and both qualitative and quantitative approaches were employed. The tools of the communicability evaluation method were applied. Overall, 11 pregnant women evaluated their experience of using a birth-plan prototype interface. The evaluation was performed in a controlled environment, with authorized video recording. There were 8 task-oriented interactions proposed to evaluate interface communicability with users when using the Birth Plan menu. For evaluating perceptions and experiences, a survey with structured and open-ended questions in addition to the free expression of participants was conducted. The primary outcomes assessed were interface communicability and user’s perception of the Birth Plan prototype interface in the My Prenatal Care mobile app. Secondarily, we involved users in the prototyping phase of the interface to identify bottlenecks for making improvements in the app. Results: Regarding users’ performance in accomplishing previously prepared tasks, we found that 10 of 11 (91%) women were capable of completing at least 6 of 8 (75%) tasks. A positive relationship was found between the number of communicability problems and the success of completing the tasks. An analysis of the records revealed three communicability breakdowns related to the data entry, save, and scrollbar functions. The participants freely expressed suggestions for improvements such as for the save function and the process of sharing the birth-plan form upon completion. Conclusions: Users had a positive perception of the Birth Plan menu of the My Prenatal Care app. This user-centered validation enabled the identification of solutions for problems, resulting in improvements in the app. %M 30920372 %R 10.2196/11374 %U http://formative.jmir.org/2019/1/e11374/ %U https://doi.org/10.2196/11374 %U http://www.ncbi.nlm.nih.gov/pubmed/30920372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10731 %T The Development of VegEze: Smartphone App to Increase Vegetable Consumption in Australian Adults %A Hendrie,Gilly A %A James-Martin,Genevieve %A Williams,Gemma %A Brindal,Emily %A Whyte,Ben %A Crook,Anna %+ Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, PO Box 10041, Adelaide, 5000, Australia, 61 88305 ext 0662, gilly.hendrie@csiro.au %K mHealth %K mobile applications %K vegetables %K adult %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor-quality dietary patterns are often characterized by inadequate consumption of fruits and vegetables. Changing dietary behavior is difficult, and although it is often clear what needs to change, how to enact change is more difficult. Smartphones have characteristics that may support the complexity of changing dietary behavior. Objective: This paper describes the iterative process of developing a theory-based smartphone app called VegEze that aimed to increase vegetable consumption. Methods: To upscale, reach target users, and create a user-friendly end product, a collaborative research-industry partnership was formed to build the app over a 20-week period. The Integrate, Design, Assess, and Share framework was used as a scientific basis to guide the development. The behavior change wheel was also used as a theoretical grounding in combination with other theory-based strategies, such as self-monitoring, social comparison, and gamification—which have all been shown to be successful in dietary change or digital health interventions. We conducted 1 consumer survey (N=1068), 1 usability testing session (N=11), and a pilot effectiveness and usability trial (N=283) to inform the design of the app. Results: The target behavior for the app was defined as having 3 different types of vegetables at dinner. The perceived achievability of this target behavior was high; 93% of respondents (993/1068 users) felt they were likely or very likely to be able to regularly achieve the behavior. App features that users wanted included the following: recipes and meal ideas (876/1068, 82% of users), functionality to track their intake (662/1068, 62%), and information on how to prepare vegetables (545/1068, 51%). On the basis of importance of self-monitoring as a behavior change technique (BCT) and its rating by users, the vegetable tracker was a core feature of the app and was designed to be quick and simple to use. Daily feedback messages for logging intake and communicating progress were designed to be engaging and fun, using friendly, positive language and emoji icons. Daily and weekly feedback on vegetable consumption was designed to be simple, informative, and reinforce monitoring. A creative team was engaged to assist in the branding of the app to ensure it had an identity that reflected the fun and simple nature of the underlying behavior. The app included 16 BCTs, most of which were from the goals and planning subsection of the BCT taxonomy. Conclusions: Combining a theoretical framework with an industry perspective and input resulted in an app that was developed in a timely manner while retaining its evidence-base. VegEze is an iOS app currently available in the App Store, and the overall impact of the VegEze app will be evaluated in an uncontrolled, quantitative study. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000481279; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12618000481279 (Archived by WebCite: at http://www.webcitation.org/769oG9EaA) %M 30916653 %R 10.2196/10731 %U http://formative.jmir.org/2019/1/e10731/ %U https://doi.org/10.2196/10731 %U http://www.ncbi.nlm.nih.gov/pubmed/30916653 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11498 %T Combining Real-Time Ratings With Qualitative Interviews to Develop a Smoking Cessation Text Messaging Program for Primary Care Patients %A Kruse,Gina %A Park,Elyse R %A Shahid,Naysha N %A Abroms,Lorien %A Haberer,Jessica E %A Rigotti,Nancy A %+ Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street 16th Fl, Boston, MA, 02114, United States, 1 617 724 3157, gkruse@mgh.harvard.edu %K text messaging %K smoking cessation %K primary care %D 2019 %7 26.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text messaging (short message service, SMS) interventions show promise as a way to help cigarette smokers quit. Few studies have examined the effectiveness of text messaging (SMS) programs targeting smokers associated with primary care or hospital settings. Objective: This study aimed to develop a text messaging (SMS) program targeting primary care smokers. Methods: Adult smokers in primary care were recruited from February 2017 to April 2017. We sent patients 10 to 11 draft text messages (SMS) over 2 days and asked them to rate each message in real time. Patients were interviewed daily by telephone to discuss ratings, message preferences, and previous experiences with nicotine replacement therapy (NRT). Content analysis of interviews was directed by a step-wise text messaging (SMS) intervention development process and the Information-Motivation-Behavioral Skills model of medication adherence. Results: We sent 149 text messages (SMS) to 15 patients. They replied with ratings for 93% (139/149) of the messages: 134 (96%, 134/139) were rated as clear or useful and 5 (4%, 5/139) as unclear or not useful. Patients’ preferences included the addition of graphics, electronic cigarette (e-cigarette) content, and use of first names. Regarding NRT, patients identified informational gaps around safety and effectiveness, preferred positively framed motivational messages, and needed behavioral skills to dose and dispose of NRT. Conclusions: Patients recommended text message (SMS) personalization, inclusion of e-cigarette information and graphics, and identified barriers to NRT use. Combining real-time ratings with telephone interviews is a feasible method for incorporating primary care patients’ preferences into a behavioral text messaging (SMS) program. %M 30912755 %R 10.2196/11498 %U http://mhealth.jmir.org/2019/3/e11498/ %U https://doi.org/10.2196/11498 %U http://www.ncbi.nlm.nih.gov/pubmed/30912755 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12535 %T Mobile Health Features Supporting Self-Management Behavior in Patients With Chronic Arthritis: Mixed-Methods Approach on Patient Preferences %A Geuens,Jonas %A Geurts,Luc %A Swinnen,Thijs W %A Westhovens,Rene %A Vanden Abeele,Vero %+ e-Media Research Lab, Katholieke Universiteit Leuven, A Vesaliusstraat 13, Leuven, 3000, Belgium, 32 16301111, jonas.geuens@kuleuven.be %K mobile applications %K arthritis %K self-management %D 2019 %7 25.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients with chronic arthritis (CA) ideally apply self-management behaviors between consultations. This enduring, tedious task of keeping track of disease-related parameters, adhering to medication schemes, and engaging in physical therapy may be supported by using a mobile health (mHealth) app. However, further research is needed to determine which self-management features are valued most by adult patients with CA patients. Objective: The aim of this study was to determine the preference of features for an mHealth app to support self-management behavior in patients with CA. In addition, we aimed to explore the motives behind these ratings. Methods: A mixed-methods approach was used to gather information from 31 adult patients (14 females), aged 23 to 71 years (mean 51 [SD 12.16]), with CA. Structured interviews were conducted to gather data pertaining to preferences of app features. Interviews were analyzed qualitatively, whereas ratings for each of the 28 features studied were analyzed quantitatively. Results: In general, patients with CA favored the use of features pertaining to supporting active and direct disease management, (eg, medication intake and detecting and alarming of bad posture), helping them to keep a close watch on their disease status and inform their health care professional (eg, providing a means to log and report disease-related data) and receiving personalized information (eg, offering tailored information based on the patient’s health data). Patients strongly disliked features that provide a means of social interaction or provide incentivization for disease-related actions (eg, being able to compare yourself with other patients, cooperating toward a common goal, and receiving encouragement from friends and/or family). Driving these evaluations is the finding that every patient with CA hurts in his/her own way, the way the disease unfolds over time and manifests itself in the patient and social environment is different for every patient, and patients with CA are well aware of this. Conclusions: We have offered an insight into how patients with CA favor mHealth features for self-management apps. The results of this research can inform the design and development of prospective self-management apps for patients with CA. %M 30907737 %R 10.2196/12535 %U http://mhealth.jmir.org/2019/3/e12535/ %U https://doi.org/10.2196/12535 %U http://www.ncbi.nlm.nih.gov/pubmed/30907737 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11157 %T A Smartphone App to Assess Alcohol Consumption Behavior: Development, Compliance, and Reactivity %A Poulton,Antoinette %A Pan,Jason %A Bruns Jr,Loren Richard %A Sinnott,Richard O %A Hester,Robert %+ Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville, 3010, Australia, 61 83446377, antoinette.poulton@unimelb.edu.au %K alcohol drinking %K smartphone apps %K smartphone %K mobile phone %K research app development %K compliance %K reactivity %D 2019 %7 25.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are disadvantages—largely related to cost, participant burden, and missing data—associated with traditional electronic methods of assessing drinking behavior in real time. This potentially diminishes some of the advantages—namely, enhanced sample size and diversity—typically attributed to these methods. Download of smartphone apps to participants’ own phones might preserve these advantages. However, to date, few researchers have detailed the process involved in developing custom-built apps for use in the experimental arena or explored methodological concerns regarding compliance and reactivity. Objective: The aim of this study was to describe the process used to guide the development of a custom-built smartphone app designed to capture alcohol intake behavior in the healthy population. Methodological issues related to compliance with and reactivity to app study protocols were examined. Specifically, we sought to investigate whether hazard and nonhazard drinkers would be equally compliant. We also explored whether reactivity in the form of a decrease in drinking or reduced responding (“yes”) to drinking behavior would emerge as a function of hazard or nonhazard group status. Methods: An iterative development process that included elements typical of agile software design guided the creation of the CNLab-A app. Healthy individuals used the app to record alcohol consumption behavior each day for 21 days. Submissions were either event- or notification-contingent. We considered the size and diversity of the sample, and assessed the data for evidence of app protocol compliance and reactivity as a function of hazard and nonhazard drinker status. Results: CNLab-A yielded a large and diverse sample (N=671, mean age 23.12). On average, participants submitted data on 20.27 (SD 1.88) out of 21 days (96.5%, 20.27/21). Both hazard and nonhazard drinkers were highly compliant with app protocols. There were no differences between groups in terms of number of days of app use (P=.49) or average number of app responses (P=.54). Linear growth analyses revealed hazardous drinkers decreased their alcohol intake by 0.80 standard drinks over the 21-day experimental period. There was no change to the drinking of nonhazard individuals. Both hazard and nonhazard drinkers showed a slight decrease in responding (“yes”) to drinking behavior over the same period. Conclusions: Smartphone apps participants download to their own phones are effective and methodologically sound means of obtaining alcohol consumption information for research purposes. Although further investigation is required, such apps might, in future, allow for a more thorough examination of the antecedents and consequences of drinking behavior. %M 30907738 %R 10.2196/11157 %U https://mhealth.jmir.org/2019/3/e11157/ %U https://doi.org/10.2196/11157 %U http://www.ncbi.nlm.nih.gov/pubmed/30907738 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 1 %P e11852 %T High-Fidelity Prototyping for Mobile Electronic Data Collection Forms Through Design and User Evaluation %A Mugisha,Alice %A Babic,Ankica %A Wakholi,Peter %A Tylleskär,Thorkild %+ Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 21 Overlege Danielssens building, Bergen, 5020, Norway, 47 99884851, mugishaalice@gmail.com %K high-fidelity prototype %K group user testing %K mobile electronic data collection forms %K usability evaluation %D 2019 %7 22.03.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile data collection systems are often difficult to use for nontechnical or novice users. This can be attributed to the fact that developers of such tools do not adequately involve end users in the design and development of product features and functions, which often creates interaction challenges. Objective: The main objective of this study was to assess the guidelines for form design using high-fidelity prototypes developed based on end-user preferences. We also sought to investigate the association between the results from the System Usability Scale (SUS) and those from the Study Tailored Evaluation Questionnaire (STEQ) after the evaluation. In addition, we sought to recommend some practical guidelines for the implementation of the group testing approach particularly in low-resource settings during mobile form design. Methods: We developed a Web-based high-fidelity prototype using Axure RP 8. A total of 30 research assistants (RAs) evaluated this prototype in March 2018 by completing the given tasks during 1 common session. An STEQ comprising 13 affirmative statements and the commonly used and validated SUS were administered to evaluate the usability and user experience after interaction with the prototype. The STEQ evaluation was summarized using frequencies in an Excel sheet while the SUS scores were calculated based on whether the statement was positive (user selection minus 1) or negative (5 minus user selection). These were summed up and the score contributions multiplied by 2.5 to give the overall form usability from each participant. Results: Of the RAs, 80% (24/30) appreciated the form progress indication, found the form navigation easy, and were satisfied with the error messages. The results gave a SUS average score of 70.4 (SD 11.7), which is above the recommended average SUS score of 68, meaning that the usability of the prototype was above average. The scores from the STEQ, on the other hand, indicated a 70% (21/30) level of agreement with the affirmative evaluation statements. The results from the 2 instruments indicated a fair level of user satisfaction and a strong positive association as shown by the Pearson correlation value of .623 (P<.01). Conclusions: A high-fidelity prototype was used to give the users experience with a product they would likely use in their work. Group testing was done because of scarcity of resources such as costs and time involved especially in low-income countries. If embraced, this approach could help assess user needs of the diverse user groups. With proper preparation and the right infrastructure at an affordable cost, usability testing could lead to the development of highly usable forms. The study thus makes recommendations on the practical guidelines for the implementation of the group testing approach particularly in low-resource settings during mobile form design. %M 30900995 %R 10.2196/11852 %U http://humanfactors.jmir.org/2019/1/e11852/ %U https://doi.org/10.2196/11852 %U http://www.ncbi.nlm.nih.gov/pubmed/30900995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11578 %T Development of PositiveLinks: A Mobile Phone App to Promote Linkage and Retention in Care for People With HIV %A Laurence,Colleen %A Wispelwey,Erin %A Flickinger,Tabor E %A Grabowski,Marika %A Waldman,Ava Lena %A Plews-Ogan,Erin %A Debolt,Claire %A Reynolds,George %A Cohn,Wendy %A Ingersoll,Karen %A Dillingham,Rebecca %+ Department of Medicine, University of Virginia School of Medicine, PO Box 801379, Charlottesville, VA, 22908, United States, 1 434 982 0103, Rd8v@hscmail.mcc.virginia.edu %K mHealth %K HIV %K treatment adherence and compliance %K retention in care %D 2019 %7 20.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Linkage to and retention in HIV care are challenging, especially in the Southeastern United States. The rise in mobile phone app use and the potential for an app to deliver just in time messaging provides a new opportunity to improve linkage and retention among people living with HIV (PLWH). Objective: This study aimed to develop an app to engage, link, and retain people in care. We evaluated the acceptability, feasibility, and impact of the app among users. Methods: App development was informed by principles of chronic disease self-management and formative interviews with PLWH. Once developed, the app was distributed among participants, and usability feedback was incorporated in subsequent iterations. We interviewed app users after 3 weeks to identify usability issues, need for training on the phone or app, and to assess acceptability. We tracked and analyzed usage of app features for the cohort over 2 years. Results: A total of 77 participants used the app during the pilot study. The query response rate for the first 2 years was 47.7%. Query response declined at a rate of 0.67% per month. The community message board was the most popular feature, and 77.9% (60/77) of users posted on the board at least once during the 2 years. Conclusions: The PositiveLinks app was feasible and acceptable among nonurban PLWH. High participation on the community message board suggests that social support from peers is important for people recently diagnosed with or returning to care for HIV. %M 30892269 %R 10.2196/11578 %U http://formative.jmir.org/2019/1/e11578/ %U https://doi.org/10.2196/11578 %U http://www.ncbi.nlm.nih.gov/pubmed/30892269 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12489 %T An mHealth Assistive System “MyLung” to Empower Patients with Chronic Obstructive Pulmonary Disease: Design Science Research %A Alharbey,Riad %A Chatterjee,Samir %+ Information Systems and Technology, College of Computer Science and Engineering, University of Jeddah, Asfan 21959, Jeddah,, Saudi Arabia, 966 545593498, ralharbi@uj.edu.sa %K assistive technology %K patient empowerment %K chronic obstructive pulmonary disease %K design science research %D 2019 %7 19.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) comprises a group of progressive diseases that deteriorate lung functions. When patients cannot breathe, nothing else in their lives matter. Breathlessness has negative implications on patients’ lives, which leads to physical and psychological limitations. Moreover, the lack of relevant and updated information about the causes and consequences of the disease can exacerbate the problems of health literacy, information accessibility, and medical adherence. Objective: The objective of this study is to design an innovative mobile health (mHealth) app system called “MyLung” that provides complete solutions in order to increase self-awareness and promote better self-care management. This system, an information technology artifact, includes three novel integrative modules: education, risk reduction, and monitoring. Methods: The utility and effectiveness of the assistive mobile-based technology were evaluated using a mixed-methods approach. The study combined quantitative and qualitative research methods to thoroughly understand how the assistive mobile-based technology can influence patients’ behavioral intention to change their lifestyle. Thirty patients were categorized into two groups (intervention group and control group). Results: The results from the quantitative analysis led to four follow-up interviews in the qualitative study. The results of the quantitative study provided significant evidence to show that the design of MyLung leads to a change in the awareness level, self-efficacy, and behavioral intention for patients with COPD. The t tests revealed a significant difference before and after using the mobile-based app with regard to the awareness level (mean 3.28 vs 4.56; t10=6.062; P<.001), self-efficacy (mean 3.11 vs 5.56; t10=2.96; P=.01), and behavioral intention (mean 2.91 vs 4.55; t10=3.212; P=.009). Independent sample t tests revealed significant differences between the intervention group and the control group in terms of the awareness level (mean 4.56 vs 3.31; t19=4.80; P<.001) and self-efficacy (mean 5.56 vs 3.66; t19=2.8; P<.01). Integration of findings from quantitative and qualitative studies reveled the impact of the design in a comprehensive manner. These inferences are referred to as “meta-inferences” in this study. Conclusions: We designed an innovative assistive mobile-based technology to empower patients with COPD, which helped increase awareness and engage patients in self-care management activities. The assistive technology aims to inform patients about the risk factors of COPD and to improve access to relevant information. Meta-inferences that emerge from the research outputs contribute to research into chronic management information systems by helping us gain a more complete understanding of the potential impacts of this proposed mobile-based design on patients with chronic disease. %M 30888329 %R 10.2196/12489 %U http://formative.jmir.org/2019/1/e12489/ %U https://doi.org/10.2196/12489 %U http://www.ncbi.nlm.nih.gov/pubmed/30888329 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e10921 %T A Mobile-Based Mindfulness and Social Support Program for Adolescents and Young Adults With Sarcoma: Development and Pilot Testing %A Donovan,Elizabeth %A Martin,Sarah R %A Seidman,Laura C %A Zeltzer,Lonnie K %A Cousineau,Tara M %A Payne,Laura A %A Trant,Meredith %A Weiman,Marjorie %A Knoll,Marla %A Federman,Noah C %+ Department of Psychology, College of Natural, Behavioral, and Health Sciences, Simmons University, 300 Fenway, Boston, MA, 02115, United States, 1 617 521 2604, elizabeth.donovan3@simmons.edu %K cancer %K mindfulness %K social support %K mobile app %K adolescents %K young adults %D 2019 %7 18.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approximately 70,000 adolescents and young adults (AYA) are diagnosed with cancer each year in the United States. Sarcomas carry a particularly high symptom burden and are some of the most common cancers among AYA. Recent work has documented significant levels of unmet needs among AYA with cancer, particularly the need for psychosocial support. Mobile technology may be a cost-effective and efficient way to deliver a psychosocial intervention to AYA with cancer and cancer survivors. Objective: The two aims of this study were to (1) develop a pilot version of a mobile-based mindfulness and social support program and (2) evaluate program usage and acceptability. An exploratory aim was to examine change in psychosocial outcomes. Methods: Thirty-seven AYA with sarcoma or sarcoma survivors, parents, and health care providers participated in the study. Semistructured interviews were conducted with 10 AYA, parents of five of the adolescents, and six health care providers. Themes from the interviews helped to inform the development of a mobile-based mindfulness pilot program and a companion Facebook-based social support group. Twenty AYA consented to participate in a single-arm pre-post evaluation of the program; 17 downloaded the app and joined the Facebook group. Seven of these participants had participated in the semistructured interviews. Six additional health care providers consented to participate in the evaluation stage. Results: On average, participants completed 16.9 of the 28 unique sessions and used the mindfulness app for a mean 10.2 (SD 8.2) days during the 28-day evaluation period. The majority of participants (16/17) engaged in the social group and posted at least one reply to the moderator’s prompts. The mean number of responses per person to the moderator of the social group was 15.2 of 31 (49%, range 0%-97%). Both AYA and health care providers responded positively to the Mindfulness for Resilience in Illness program and offered useful recommendations for improvements. Exploratory psychosocial analyses indicated there were no significant differences from pretest to posttest on measures of perceived social support, mindfulness, body image, or psychological functioning. Conclusions: This study offers preliminary support for the feasibility and acceptability of a mobile-based mindfulness and Facebook-based social support program for AYA with sarcoma. The feedback from AYA and health care providers will assist in creating a fully developed intervention. Trial Registration: ClinicalTrials.gov NCT03130751; https://clinicaltrials.gov/ct2/show/NCT03130751 %M 30882352 %R 10.2196/10921 %U http://mhealth.jmir.org/2019/3/e10921/ %U https://doi.org/10.2196/10921 %U http://www.ncbi.nlm.nih.gov/pubmed/30882352 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11108 %T Perspectives on Acceptance and Use of a Mobile Health Intervention for the Prevention of Atherosclerotic Cardiovascular Disease in Singapore: Mixed-Methods Study %A Haldane,Victoria %A Tan,Yao Guo %A Teo,Krichelle Wei Qi %A Koh,Joel Jun Kai %A Srivastava,Aastha %A Cheng,Rui Xiang %A Yap,Yi Cheng %A Ong,Pei-Shi %A van Dam,Rob M %A Foo,Jie Min %A Müller-Riemenschneider,Falk %A Koh,Gerald Choon-Huat %A Perel,Pablo %A Legido-Quigley,Helena %+ Institute of Health Policy, Management & Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 416 978 4326, v.haldane@mail.utoronto.ca %K atherosclerosis %K mHealth %K eHealth %K patient-centered care %K patient acceptance of health care %K medication adherence %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cardiovascular disease, including atherosclerotic cardiovascular disease (ASCVD), is a growing public health threat globally and many individuals remain undiagnosed, untreated, and uncontrolled. Simultaneously, mobile health (mHealth) interventions using short messaging service (SMS) have gained popularity globally. There is an opportunity for innovative approaches such as mHealth to encourage and enable adherence to medications for ASCVD and its risk factors. Objective: This study aimed to understand mobile technology acceptance, use, and facilitating conditions among the study population ahead of the design of an mHealth intervention. Methods: Using data from a mixed-methods study conducted in Singapore, we conducted a cross-sectional survey with 100 participants and in-depth, semistructured interviews with 20 patients. All participants were over the age of 40 years with ASCVD or its risk factors. Interviews were conducted in English and Mandarin and if needed translated to English. Nvivo 11 (QSR International) was used for analyses. Results: Participants reported their perspectives on technology use and preferences, including low or sporadic mobile phone use and usability concerns including small screen and text size, among others; the benefit of previous mHealth use in creating a favorable opinion of SMS for health information; trust in both the source of mHealth SMS, as well as in treatment; the formation of habits; and fear of sequelae or death for facilitating intention to use an mHealth intervention and adhere to medication. We also highlighted a case that underscored the importance of the period after diagnosis in habit forming as an opportunity for an mHealth intervention. Conclusions: We explored both technology- and adherence-related factors that influence a patient’s intention to use an mHealth intervention for adherence to ASCVD medication in Singapore. We highlighted the importance of identifying the right opportunity to engage with patients and promote an mHealth intervention for adherence, such as immediately following diagnosis when patients are establishing medication-taking habits. %M 30869651 %R 10.2196/11108 %U http://mhealth.jmir.org/2019/3/e11108/ %U https://doi.org/10.2196/11108 %U http://www.ncbi.nlm.nih.gov/pubmed/30869651 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11785 %T The Development of an Arabic Weight-Loss App Akser Waznk: Qualitative Results %A Alturki,Ryan %A Gay,Valerie %+ School of Electrical and Data Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, 81 Broadway, Ultimo, Sydney, 2007, Australia, 61 410583330, ryan.m.alturki@student.uts.edu.au %K weight loss %K mobile app %K obesity %K physical activity %K smartphone %K mHealth %K motivation %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity and its related illnesses are a major health problem around the world. Saudi Arabia has one of the highest national obesity rates globally; however, it is not easy to intervene to prevent obesity and becoming overweight owing to Saudi Arabia’s cultural and social norms, and linguistic barriers. In recent years, there has been an exponential growth in the usage of smartphones and apps in Saudi Arabia. These could be used as a cost-effective tool to facilitate the delivery of behavior-modification interventions for obese and overweight people. There are a variety of health and fitness apps that claim to offer lifestyle-modification tools. However, these do not identify the motivational features required to overcome obesity, consider the evidence-based practices for weight management, or enhance the usability of apps by considering usability attributes. Objective: This study aimed to explore the opportunity and the need to develop an Arabic weight-loss app that provides localized content and addresses the issues with existing apps identified here. This study has explained the steps taken to design an Arabic weight-loss app that was developed to facilitate the adjustment of key nutritional and physical activities and behaviors, which considers the social and cultural norms of Saudi Arabia. Methods: Qualitative studies were conducted with 26 obese Saudi Arabians, who tested the level of usability of 2 weight-loss apps and then provided feedback and recommendations. The app Akser Waznk is an interactive, user-friendly app designed primarily for iPhones. It has several features intended to assist users to monitor and track their food consumption and physical activities. The app provides personalized diet and weight loss advice. Unique features such as Let’s Walk are designed to motivate users to walk more. An augmented reality function is implemented to provide information regarding fitness equipment, fruits, and vegetables. The app uses behavior-change techniques to increase activities and healthy behaviors and evidence-informed practices for weight-loss management. The Akser Waznk app considers user privacy and data security by applying a number of guidelines and procedures. Results: The development of the app took 26 months. In all, 7 experts (5 dietitians, and 2 physical activity professionals) evaluated the app’s contents. Moreover, 10 potential users (5 men and 5 women) tested the app’s level of usability, its features, and performance during a pilot study. They reported that the app’s design is interactive, and the motivational features are user-friendly. Conclusions: Mobile technology, such as mobile apps, has the potential to be an effective tool that facilitates the changing of unhealthy lifestyle behaviors within the Saudi community. To be successful, the target group, the usability, motivational features, and social and cultural norms must be considered. %M 30869639 %R 10.2196/11785 %U http://formative.jmir.org/2019/1/e11785/ %U https://doi.org/10.2196/11785 %U http://www.ncbi.nlm.nih.gov/pubmed/30869639 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11111 %T Co-Design of a Consultation Audio-Recording Mobile App for People With Cancer: The SecondEars App %A Lipson-Smith,Ruby %A White,Fiona %A White,Alan %A Serong,Lesley %A Cooper,Guy %A Price-Bell,Georgia %A Hyatt,Amelia %+ Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia, 61 3 8559 7837, amelia.hyatt@petermac.org %K referral and consultation %K adult %K humans %K cancer %K audiovisual aids %K mobile apps %K community-based participatory research %K health behavior %K psychological theory %D 2019 %7 12.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Many patients choose to audio-record their medical consultations so that they can relisten to them at home and share them with family. Consultation audio-recordings can improve patients’ recall and understanding of medical information and increase their involvement in decision making. A hospital-endorsed consultation audio-recording mobile app would provide patients with the permission and means to audio-record their consultations. The Theory of Planned Behavior provides a framework for understanding how patients can be encouraged to appropriately audio-record consultations. Objective: The aim of this study was to use a co-design process to develop a consultation audio-recording mobile app called SecondEars. Methods: App development began with stakeholder engagement, followed by a series of 6 co-design workshops and then user acceptance testing. Stakeholder engagement included advice from legal, information technology (IT), clinical and allied health leads; digital strategy; and medical records. he co-design workshops were attended by: patient consumers, members of the research team, IT staff, the app designers, clinicians, and staff from medical records. During workshops 1 to 4, the purpose and scope of the app were refined, possible pitfalls were addressed, and design features were discussed. The app designers then incorporated the results from these workshops to produce a wireframe mock-up of the proposed SecondEars app, which was presented for feedback at workshops 5 and 6. Results: The stakeholders identified 6 requirements for the app, including that it be patient driven, secure, clear in terms of legal responsibilities, linked to the patient’s medical record, and that it should require minimal upfront and ongoing resources. These requirements informed the scope of the co-design workshops. The workshops were attended by between 4 and 13 people. The workshop attendees developed a list of required features and suggestions for user interface design. The app developers used these requirements and recommendations to develop a prototype of the SecondEars app in iOS, which was then refined through user acceptance testing. Conclusions: The SecondEars app allows patients to have control and autonomy over audio-recording and sharing their consultations while maintaining privacy and safety for medical information and legal protection for clinicians. The app has been designed to have low upkeep and minimal impact on clinical processes. The SecondEars prototype is currently being tested with patients in a clinical setting. %M 30860487 %R 10.2196/11111 %U http://formative.jmir.org/2019/1/e11111/ %U https://doi.org/10.2196/11111 %U http://www.ncbi.nlm.nih.gov/pubmed/30860487 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e10750 %T Comparison of Developers’ and End-Users’ Perspectives About Smoking Cessation Support Through the Crush the Crave App %A Struik,Laura Louise %A Bottorff,Joan L %A Baskerville,N Bruce %A Oliffe,John %A Crichton,Susan %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4520, laurastruik134@hotmail.com %K mobile app %K smoking cessation %K tobacco control %K young adult %K qualitative research %D 2019 %7 07.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: High smoking rates among end-users, combined with their high rates of app use, render this age group as a particularly captive audience for quit smoking apps. There is emerging evidence that apps are an effective way to support smoking cessation among end-users. How the expectations behind the design of apps align with the needs and preferences of end-users, and if this differs by gender, is poorly understood, limiting the ability to evaluate and scale these interventions. Objective: The objective of this qualitative case study was to detail how the overall design approach of Crush the Crave (CTC), a quit smoking app that targets end-users, compares with young adult women’s and men’s perspectives and experiences, with consideration for the influence of gender. Methods: Semistructured interviews were conducted with 15 developers involved in the development of CTC and 31 young adult CTC users. Data were analyzed inductively to derive thematic findings of the perceived pros and cons of CTC by both developers and end-users. Findings were grouped under 4 categories (1) technology and platforms utilized for the app, (2) foundation of app content, (3) underlying focus of the app, and (4) look, feel and functionality of the app. Results: Under the category, technology and platforms utilized for the app, it was found that both developers and end-users agreed that apps aligned with the needs and preferences of young adult smokers. Major limitations with the technology identified by end-users were the frequent “glitches” and requirement for internet or data. For the category, foundation of app content,developers agreed that the strength of CTC was in its strong evidence-base. What mattered to end-users, however, was that the content was packaged positively, focusing on the benefits of quitting versus the consequences of smoking. It was found under the category, underlying focus of the app, that the individually-led focus of the app resonated with both developers and end-users, especially young men. Under the final category, look, feel and functionality of the app, it was found that developers were very positive about the app's aesthetics but end-users thought that the aesthetics incited a negative effect. Also, while end-users found it easy to use, they did not find the app intuitive. Finally, end-users thought that, because the app functions were largely based on a user’s quit date versus their ongoing efforts, this often lent to unmeaningful data. Conclusions: The current study findings highlight the importance of understanding multiple perspectives of stakeholders involved in a mobile-based intervention. By gathering the viewpoints of developers and end-users, both problematic and effective approaches that underlie development goals were revealed as a means of informing the development, implementation, and evaluation of future electronic health (eHealth) interventions. %M 30843864 %R 10.2196/10750 %U https://mhealth.jmir.org/2019/3/e10750/ %U https://doi.org/10.2196/10750 %U http://www.ncbi.nlm.nih.gov/pubmed/30843864 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11371 %T Design and Development of a Person-Centered Patient Portal Using Participatory Stakeholder Co-Design %A Kildea,John %A Battista,John %A Cabral,Briana %A Hendren,Laurie %A Herrera,David %A Hijal,Tarek %A Joseph,Ackeem %+ Gerald Bronfman Department of Oncology, McGill University, Suite 720, 5100 de Maisonneuve Boulevard West, Montreal, QC,, Canada, 1 5149341934 ext 44154, john.kildea@mcgill.ca %K patient portals %K patient participation %K telemedicine %K software design %D 2019 %7 11.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient portals are increasingly accepted as part of standard medical care. However, to date, most patient portals provide just passive access to medical data. The use of modern technology such as smartphones and data personalization algorithms offers the potential to make patient portals more person-centered and enabling. Objective: The aim of this study is to share our experience in designing and developing a person-centered patient portal following a participatory stakeholder co-design approach. Methods: Our stakeholder co-design approach comprised 6 core elements: (1) equal coleadership, including a cancer patient on treatment; (2) patient preference determination; (3) security, governance, and legal input; (4) continuous user evaluation and feedback; (5) continuous staff input; and (6) end-user testing. We incorporated person-centeredness by recognizing that patients should decide for themselves their level of medical data access, all medical data should be contextualized with explanatory content, and patient educational material should be personalized and timely. Results: Using stakeholder co-design, we built, and are currently pilot-testing, a person-centered patient portal smartphone app called Opal. Conclusions: Inclusion of all stakeholders in the design and development of patient-facing software can help ensure that the necessary elements of person-centeredness, clinician acceptability, and informatics feasibility are achieved. %M 30741643 %R 10.2196/11371 %U http://www.jmir.org/2019/2/e11371/ %U https://doi.org/10.2196/11371 %U http://www.ncbi.nlm.nih.gov/pubmed/30741643 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10978 %T Design, Development, and Evaluation of an Injury Surveillance App for Cricket: Protocol and Qualitative Study %A Soomro,Najeebullah %A Chhaya,Meraj %A Soomro,Mariam %A Asif,Naukhez %A Saurman,Emily %A Lyle,David %A Sanders,Ross %+ Broken Hill University Department of Rural Health, University of Sydney, Corrindah Court, Broken Hill, 2880, Australia, 61 880801282, naj.soomro@sydney.edu.au %K cricket %K injury surveillance %K mobile app %K mobile phone %K TeamDoc %K mHealth %D 2019 %7 22.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Injury surveillance and workload monitoring are important aspects of professional sports, including cricket. However, at the community level, there is a dearth of accessible and intelligent surveillance tools. Mobile apps are an accessible tool for monitoring cricket-related injuries at all levels. Objective: The objective of this paper is to share the novel methods associated with the development of the free TeamDoc app and provide evidence from an evaluation of the user experience and perception of the app regarding its functionality, utility, and design. Methods: TeamDoc mobile app for Android and Apple smartphones was developed using 3 languages: C++, Qt Modeling Language, and JavaScript. For the server-side connectivity, Hypertext Preprocessor (PHP) was used as it is a commonly used cross-platform language. PHP includes components that interact with popular database management systems, allowing for secure interaction with databases on a server level. The app was evaluated by administrating a modified user version of the Mobile App Rating Scale (uMARS; maximum score: 5). Results: TeamDoc is the first complementary, standalone mobile app that records cricket injuries through a smartphone. It can also record cricketing workloads, which is a known risk factor for injury. The app can be used without the need for supplementary computer devices for synchronization. The uMARS scores showed user satisfaction (overall mean score 3.6 [SD 0.5]), which demonstrates its acceptability by cricketers. Conclusions: Electronic injury surveillance systems have been shown to improve data collection during competitive sports. Therefore, TeamDoc may assist in improving injury reporting and may also act as a monitoring system for coaching staff to adjust individual training workloads. The methods described in this paper provide a template for researchers to develop similar apps for other sports. %M 30668516 %R 10.2196/10978 %U http://mhealth.jmir.org/2019/1/e10978/ %U https://doi.org/10.2196/10978 %U http://www.ncbi.nlm.nih.gov/pubmed/30668516 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11246 %T Text Messaging to Enhance Mindfulness-Based Smoking Cessation Treatment: Program Development Through Qualitative Research %A Spears,Claire A %A Bell,Sharrill A %A Scarlett,Charlayne A %A Anderson,Natalie K %A Cottrell-Daniels,Cherell %A Lotfalian,Sadaf %A Bandlamudi,Maitreyi %A Grant,Amanda %A Sigurdardottir,Anna %A Carter,Brittani P %A Abroms,Lorien C %A Wetter,David W %+ Division of Health Promotion and Behavior, Georgia State University School of Public Health, 140 Decatur Street SE, Suite 612, Atlanta, GA, United States, 1 404 413 9335, cspears@gsu.edu %K mobile phone %K low socioeconomic status %K qualitative %K short message service text messaging %K smoking cessation %D 2019 %7 07.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness-based programs show promise for promoting smoking cessation in diverse populations. Mobile health strategies could increase treatment engagement and in-the-moment support, thus enhancing the effects of mindfulness-based smoking cessation interventions. However, most mobile health programs have been developed without sufficient input from the target population. Objective: By eliciting input from the target population, predominantly low socioeconomic status (SES) African American adult smokers, throughout the development of an SMS (short message service) text messaging program that teaches mindfulness for smoking cessation, we aimed for the resulting program to be optimally effective and consistent with participants’ needs and preferences. Methods: Two qualitative studies (N=25) were conducted with predominantly low SES, African American adult smokers. In Study 1 (initial qualitative input; n=15), participants engaged in focus groups to provide suggestions for program development. In Study 2 (abbreviated trial; n=10), participants received a 1-week version of the SMS text messaging program and provided feedback through in-depth interviews. Results: In Study 1, participants suggested that the SMS text messaging program should be personalized and interactive (ie, involve two-way messaging); provide strategies for coping with cravings and recovering from smoking lapses; involve relatively short, to-the-point messages; and include pictures. In Study 2, participants were highly engaged with the texts, indicated that the program was useful, and provided additional suggestions for improvement. Conclusions: Eliciting feedback from the target population throughout the intervention development process allowed for iterative revisions to increase feasibility, acceptability, and effectiveness. Overall, SMS text messaging appears to be a feasible, appealing way to provide in-the-moment personalized support and encourage mindfulness among low-income African American smokers. %M 30617043 %R 10.2196/11246 %U https://mhealth.jmir.org/2019/1/e11246/ %U https://doi.org/10.2196/11246 %U http://www.ncbi.nlm.nih.gov/pubmed/30617043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10944 %T Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study %A Ceasar,Joniqua Nashae %A Claudel,Sophie Elizabeth %A Andrews,Marcus R %A Tamura,Kosuke %A Mitchell,Valerie %A Brooks,Alyssa T %A Dodge,Tonya %A El-Toukhy,Sherine %A Farmer,Nicole %A Middleton,Kimberly %A Sabado-Liwag,Melanie %A Troncoso,Melissa %A Wallen,Gwenyth R %A Powell-Wiley,Tiffany M %+ National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, MSC 1454, 10 Center Drive, Bethesda, MD, 20892, United States, 1 301 594 3735, tiffany.powell-wiley@nih.gov %K cardiovascular health %K community-based participatory research %K health behaviors %K mHealth %K mobile phone %K physical activity %K qualitative data %D 2019 %7 04.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. Objective: This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. Methods: We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants’ experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. Results: In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). Conclusions: Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population. %M 30684422 %R 10.2196/10944 %U https://formative.jmir.org/2019/1/e10944/ %U https://doi.org/10.2196/10944 %U http://www.ncbi.nlm.nih.gov/pubmed/30684422 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e185 %T App-Based Intervention Combining Evidence-Based Behavior Change Techniques With a Model-Based Reasoning System to Promote Physical Activity Among Young Adults (Active2Gether): Descriptive Study of the Development and Content %A Middelweerd,Anouk %A te Velde,Saskia J %A Mollee,Julia S %A Klein,Michel CA %A Brug,Johannes %+ VU Medical Center Amsterdam, Department of Epidemiology & Biostatistics, De Boelelaan 1089a, Amsterdam, 1081 HV, Netherlands, 31 31614752495, saskia@tevelderesearch.com %K physical activity %K mHealth %K moderate-vigorous physical activity %K mobile phones %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The Active2Gether intervention is an app-based intervention designed to help and encourage young adults to become and remain physically active by means of personalized, real-time activity tracking and context-specific feedback. Objective: The objective of our study was to describe the development and content of the Active2Gether intervention for physical activity promotion. Methods: A systematic and stepwise approach was used to develop the Active2Gether intervention. This included formulating objectives and a theoretical framework, selecting behavior change techniques, specifying the tailoring, pilot testing, and describing an evaluation protocol. Results: The development of the Active2Gether intervention comprised seven steps: analyzing the (health) problem, developing a program framework, writing (tailored) messages, developing tailoring assessments, developing the Active2Gether intervention, pilot testing, and testing and evaluating the intervention. The primary objective of the intervention was to increase the total time spent in moderate-vigorous physical activity for those who do not meet the Dutch guideline, maintain physical activity levels of those who meet the guideline, or further increase physical activity levels if they so indicated. The theoretical framework is informed by the social cognitive theory, and insights from other theories and evidence were added for specific topics. Development of the intervention content and communication channel resulted in the development of an app that provides highly tailored coaching messages that are framed in an autonomy-supportive style. These coaching messages include behavior change techniques aiming to address relevant behavioral determinants (eg, self-efficacy and outcome expectations) and are partly context specific. A model-based reasoning engine has been developed to tailor the intervention with respect to the type of support provided by the app, send relevant and context-specific messages to the user, and tailor the graphs displayed in the app. For the input of the tailoring, different instruments and sensors are used, such as an activity monitor (Fitbit One), Web-based and mobile questionnaires, and the location services on the user’s mobile phone. Conclusions: The systematic and stepwise approach resulted in an intervention that is based on theory and input from end users. The use of a model-based reasoning system to provide context-specific coaching messages goes beyond many existing eHealth and mHealth interventions. %M 30578198 %R 10.2196/resprot.7169 %U https://www.researchprotocols.org/2018/12/e185/ %U https://doi.org/10.2196/resprot.7169 %U http://www.ncbi.nlm.nih.gov/pubmed/30578198 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e192 %T Parents’ Perspectives on the Theoretical Domains Framework Elements Needed in a Pediatric Health Behavior App: A Crowdsourced Social Validity Study %A Cushing,Christopher C %A Fedele,David A %A Brannon,Erin E %A Kichline,Tiffany %+ Clinical Child Psychology Program, University of Kansas, Dole Human Development Center, 1000 Sunnyside Avenue, Room 2011, Lawrence, KS, 66049, United States, 1 7858640713, christopher.cushing@ku.edu %K mHealth %K adolescent %K children %K parent %K stakeholder %K consumer preference %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most pediatric studies do not include parent stakeholders in the design of the intervention itself and many pediatric mobile health (mHealth) interventions are not meaningfully disseminated after the trial period ends. Consequently, the consumer desire for mobile apps targeting pediatric health behavior is likely to be met by commercial products that are not based in theory or evidence and may not take stakeholder preferences into account. Objective: The aim was to assess parent preference for mobile app features that map onto specific Theoretical Domains Framework (TDF) elements. Methods: This study was a crowdsourced social validity study of 183 parents who were asked to rate their preferences for mobile app features that correspond to elements of the TDF. The TDF organizes a large number of theoretical models and constructs into three components: (1) capability, (2) motivation, and (3) opportunity. Parents of children were recruited through Amazon Mechanical Turk. Results: The majority of participants were Caucasian and mean age was 36.9 (SD 8.0) years. Results revealed broad acceptability of communication, motivation, and opportunity domains. However, the degree to which each domain was valued varied within behavioral category. Parents demonstrated a preference for increasing procedural knowledge for physical activity and diet behaviors over sleep (F2,545=5.18, P=.006). Similarly, parents valued self-monitoring as more important for physical activity than sleep (F2,546=4.04, P=.02). When asked about the value of features to help children develop skills, parents preferred those features for dietary behavior over sleep (F2,546=3.57, P=.03). Parents perceived that goal-setting features would be most useful for physical activity over sleep and diet (F2,545=5.30, P=.005). Incentive features within the app were seen as most useful for physical activity over sleep (F2,546=4.34, P=.01). Conclusions: This study presents a low-cost strategy for involving a large number of stakeholders in the discussion of how health behavior theory should be applied in a mHealth intervention. Our approach is innovative in that it took a scientific framework (ie, TDF) and made it digestible to parents so that they could then provide their opinions about features that might appear in a future app. Our survey items discriminated between various health behaviors allowing stakeholders to communicate the different health behaviors that they would like a TDF feature to change. Moreover, we were able to develop a set of consumer opinions about features that were directly linked to elements of the TDF. %M 30578173 %R 10.2196/mhealth.9808 %U https://mhealth.jmir.org/2018/12/e192/ %U https://doi.org/10.2196/mhealth.9808 %U http://www.ncbi.nlm.nih.gov/pubmed/30578173 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11107 %T A Mobile App to Provide Evidence-Based Information About Crystal Methamphetamine (Ice) to the Community (Cracks in the Ice): Co-Design and Beta Testing %A Birrell,Louise %A Deen,Hannah %A Champion,Katrina Elizabeth %A Newton,Nicola C %A Stapinski,Lexine A %A Kay-Lambkin,Frances %A Teesson,Maree %A Chapman,Cath %+ National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, 22 – 32 King Street, Randwick, Sydney, 2031, Australia, 61 2 8936 1217, h.deen@unsw.edu.au %K internet %K methamphetamine %K mobile apps %K mobile phone %K substance-related disorder %D 2018 %7 20.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite evidence of increasing harms and community concern related to the drug crystal methamphetamine (“ice”), there is a lack of easily accessible, evidence-based information for community members affected by its use, and to date, no evidence-based mobile apps have specifically focused on crystal methamphetamine. Objective: This study aims to describe the co-design and beta testing of a mobile app to provide evidence-based, up-to-date information about crystal methamphetamine to the general community. Methods: A mobile app about crystal methamphetamine was developed in 2017. The development process involved multiple stakeholders (n=12), including technology and drug and alcohol experts, researchers, app developers, a consumer expert with lived experience, and community members. Beta testing was conducted with Australian general community members (n=34), largely recruited by the Web through Facebook advertising. Participants were invited to use a beta version of the app and provide feedback about the content, visual appeal, usability, engagement, features, and functions. In addition, participants were asked about their perceptions of the app’s influence on awareness, understanding, and help-seeking behavior related to crystal methamphetamine, and about their knowledge about crystal methamphetamine before and after using the app. Results: The vast majority of participants reported the app was likely to increase awareness and understanding and encourage help-seeking. The app received positive ratings overall and was well received. Specifically, participants responded positively to the high-quality information provided, usability, and visual appeal. Areas suggested for improvement included reducing the amount of text, increasing engagement, removing a profile picture, and improving navigation through the addition of a “back” button. Suggested improvements were incorporated prior to the app’s public release. App use was associated with an increase in perceived knowledge about crystal methamphetamine; however, this result was not statistically significant. Conclusions: The Cracks in the Ice mobile app provides evidence-based information about the drug crystal methamphetamine for the general community. The app is regularly updated, available via the Web and offline, and was developed in collaboration with experts and end users. Initial results indicate that it is easy to use and acceptable to the target group. %M 30573443 %R 10.2196/11107 %U https://mhealth.jmir.org/2018/12/e11107/ %U https://doi.org/10.2196/11107 %U http://www.ncbi.nlm.nih.gov/pubmed/30573443 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11579 %T Creating Gameful Design in mHealth: A Participatory Co-Design Approach %A Jessen,Stian %A Mirkovic,Jelena %A Ruland,Cornelia M %+ Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Box 4950 Nydalen, Oslo, 0424, Norway, 47 980 49 759, stian.jessen@rr-research.no %K gamification %K gameful design %K participatory design %K co-design %K mHealth %K eHealth %K self-management %K chronic disease %K patient requirements %K patient participation %K patient personal strengths %D 2018 %7 14.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gameful designs (gamification), using design pieces and concepts typically found in the world of games, is a promising approach to increase users’ engagement with, and adherence to, electronic health and mobile health (mHealth) tools. Even though both identifying and addressing users’ requirements and needs are important steps of designing information technology tools, little is known about the users’ requirements and preferences for gameful designs in the context of self-management of chronic conditions. Objective: This study aimed to present findings as well as the applied methods and design activities from a series of participatory design workshops with patients with chronic conditions, organized to generate and explore user needs, preferences, and ideas to the implementation of gameful designs in an mHealth self-management app. Methods: We conducted three sets of two consecutive co-design workshops with a total of 22 participants with chronic conditions. In the workshops, we applied participatory design methods to engage users in different activities such as design games, scenario making, prototyping, and sticky notes exercises. The workshops were filmed, and the participants’ interactions, written products, ideas, and suggestions were analyzed thematically. Results: During the workshops, the participants identified a wide range of requirements, concerns, and ideas for using the gameful elements in the design of an mHealth self-management app. Overall inputs on the design of the app concerned aspects such as providing a positive user experience by promoting collaboration and not visibly losing to someone or by designing all feedback in the app to be uplifting and positive. The participants provided both general inputs (regarding the degree of competitiveness, use of rewards, or possibilities for customization) and specific inputs (such as being able to customize the look of their avatars or by having rewards that can be exchanged for real-world goods in a gift shop). However, inputs also highlighted the importance of making tools that provide features that are meaningful and motivating on their own and do not only have to rely on gameful design features to make people use them. Conclusions: The main contribution in this study was users’ contextualized and richly described needs and requirements for gamefully designed mHealth tools for supporting chronic patients in self-management as well as the methods and techniques used to facilitate and support both the participant’s creativity and communication of ideas and inputs. The range, variety, and depth of the inputs from our participants also showed the appropriateness of our design approach and activities. These findings may be combined with literature and relevant theories to further inform in the selection and application of gameful designs in mHealth apps, or they can be used as a starting point for conducting more participatory workshops focused on co-designing gameful health apps. %M 30552080 %R 10.2196/11579 %U http://mhealth.jmir.org/2018/12/e11579/ %U https://doi.org/10.2196/11579 %U http://www.ncbi.nlm.nih.gov/pubmed/30552080 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e11473 %T A Web-Based Intervention for Relatives of People Experiencing Psychosis or Bipolar Disorder: Design Study Using a User-Centered Approach %A Honary,Mahsa %A Fisher,Naomi Ruth %A McNaney,Roisin %A Lobban,Fiona %+ School of Computing and Communications, Lancaster University, Room C51, InfoLab21, South Drive, Lancaster, LA1 4WA, United Kingdom, 44 1524 593222, m.honary@lancaster.ac.uk %K mental health %K Web-based intervention %K user-centered design %K caregivers %K bipolar disorder %K psychosis %D 2018 %7 07.12.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Relatives of people experiencing bipolar mood episodes or psychosis face a multitude of challenges (eg, social isolation, limited coping strategies, and issues with maintaining relationships). Despite this, there is limited informational and emotional support for people who find themselves in supporting or caring roles. Digital technologies provide us with an opportunity to offer accessible tools, which can be used flexibly to provide evidence-based information and support, allowing relatives to build their understanding of mental health problems and learn from others who have similar experiences. However, to design tools that are useful to relatives, we first need to understand their needs. Objective: The aim of this study was to use a user-centered design approach to develop an accessible Web-based intervention, based on the Relatives Education And Coping Toolkit (REACT) booklet, to support the informational and emotional needs of relatives of people experiencing psychosis or bipolar disorder. Methods: We engaged relatives of people with experiences of bipolar disorder or psychosis in workshops to identify their needs and design requirements for developing a Web-based version of a paper-based toolkit. We used a 2-phase qualitative approach to explore relatives’ views on content, design, and functionalities, which are considered to be engaging and useful in a Web-based intervention. In phase 1, we consulted 24 relatives in 2 workshops to better understand their existing support infrastructure, their barriers for accessing support, unmet needs, and relatives’ views on online support. On the basis of the results of these workshops, we developed a set of design considerations to be explored in a smaller workshop. Workshop 3 then involved working with 2 digitally literate relatives to design a usable and acceptable interface for our Web-based toolkit. Finally, in phase 2, we conducted a heuristic evaluation to assess the usability of the toolkit. Results: Our findings indicated that relatives require technologies that (1) they can place their trust in, particularly when discussing a highly sensitive topic, (2) enable learning from the lived experiences of others while retaining confidentiality, and (3) they can work through at their own pace in a personalized manner. Conclusions: Our study highlights the need for providing a trustworthy, supportive tool where relatives can engage with people who have similar experiences to their own. Our heuristic evaluation showed promise in terms of perceived usability of the REACT Web-based intervention. Through this work, we emphasize the need to involve stakeholders with various characteristics, including users with limited computer literacy or experience in online support. %M 30530457 %R 10.2196/11473 %U http://mental.jmir.org/2018/4/e11473/ %U https://doi.org/10.2196/11473 %U http://www.ncbi.nlm.nih.gov/pubmed/30530457 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e11222 %T How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo %A Hardy,Amy %A Wojdecka,Anna %A West,Jonathan %A Matthews,Ed %A Golby,Christopher %A Ward,Thomas %A Lopez,Natalie D %A Freeman,Daniel %A Waller,Helen %A Kuipers,Elizabeth %A Bebbington,Paul %A Fowler,David %A Emsley,Richard %A Dunn,Graham %A Garety,Philippa %+ Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, United Kingdom, 44 2078485178, amy.hardy@kcl.ac.uk %K inclusive design %K user-centered design %K participatory design %K design thinking %K mHealth %K eHealth %K digital therapy %K schizophrenia %K paranoia %K psychosis %D 2018 %7 05.12.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Real-world implementation of psychological interventions for psychosis is poor. Barriers include therapy being insufficiently usable and useful for a diverse range of people. User-centered, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence, and effectiveness. Objective: This study aimed to optimize the usability of an existing psychological intervention, Thinking Well, which targets reasoning processes in paranoia using a basic digital interface. Methods: We conducted inclusive, user-centered design research characterized by purposive sampling of extreme users from the margins of groups, ethnographic investigation of the problem context, and iterative prototyping of solutions. The UK Design Council’s double diamond method was used. This consisted of 4 phases: discover, including a case series of Thinking Well, stakeholder interviews, desk research, user profiling, system mapping, and a mood board; define, consisting of workshops to synthesize findings and generate the design brief; develop, involving concept workshops and prototype testing; and deliver, in which the final minimal viable product was storyboarded and iteratively coded. Results: Consistent with our previous work, the Thinking Well case series showed medium to large effects on paranoia and well-being and small effects on reasoning. These were maintained at follow-up despite some participants reporting difficulties with the therapy interface. Insights from the discover phase confirmed that usability was challenged by information complexity and poor accessibility. Participants were generally positive about the potential of technology to be enjoyable, help manage paranoia, and provide tailored interpersonal support from therapists and peers, although they reported privacy and security concerns. The define phase highlighted that the therapy redesign should support monitoring, simplify information processing, enhance enjoyment and trust, promote personalization and normalization, and offer flexible interpersonal support. During the develop phase over 60 concepts were created, with 2 key concepts of thoughts visualized as bubbles and therapy as a journey selected for storyboarding. The output of the deliver phase was a minimal viable product of an innovative digital therapy, SlowMo. SlowMo works by helping people to notice their worries and fast thinking habits, and encourages them to slow down for a moment to find ways of feeling safer. A Web app supports the delivery of 8 face-to-face sessions, which are synchronized to a native mobile app. Conclusions: SlowMo makes use of personalization, ambient information, and visual metaphors to tailor the appeal, engagement, and memorability of therapy to a diversity of needs. Feasibility testing has been promising, and the efficacy of SlowMo therapy is now being tested in a multicentered randomized controlled trial. The study demonstrates that developments in psychological theory and techniques can be enhanced by improving the usability of the therapy interface to optimize its impact in daily life. %M 30518514 %R 10.2196/11222 %U http://mental.jmir.org/2018/4/e11222/ %U https://doi.org/10.2196/11222 %U http://www.ncbi.nlm.nih.gov/pubmed/30518514 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11661 %T Preliminary Effectiveness of a Smartphone App to Reduce Depressive Symptoms in the Workplace: Feasibility and Acceptability Study %A Deady,Mark %A Johnston,David %A Milne,David %A Glozier,Nick %A Peters,Dorian %A Calvo,Rafael %A Harvey,Samuel %+ Black Dog Institute, Faculty of Medicine, University of New South Wales, Hospital Road, Randwick, Sydney,, Australia, 61 293824517, m.deady@unsw.edu.au %K depression %K workplace %K mHealth %K smartphone %K eHealth %K pilot %D 2018 %7 04.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The workplace represents a unique setting for mental health interventions. Due to range of job-related factors, employees in male-dominated industries are at an elevated risk. However, these at-risk groups are often overlooked. HeadGear is a smartphone app–based intervention designed to reduce depressive symptoms and increase well-being in these populations. Objective: This paper presents the development and pilot testing of the app’s usability, acceptability, feasibility, and preliminary effectiveness. Methods: The development process took place from January 2016 to August 2017. Participants for prototype testing (n=21; stage 1) were recruited from industry partner organizations to assess acceptability and utility. A 5-week effectiveness and feasibility pilot study (n=84; stage 2) was then undertaken, utilizing social media recruitment. Demographic data, acceptability and utility questionnaires, depression (Patient Health Questionnaire-9), and other mental health measures were collected. Results: The majority of respondents felt HeadGear was easy to use (92%), easily understood (92%), were satisfied with the app (67%), and would recommend it to a friend (75%; stage 1). Stage 2 found that compared with baseline, depression and anxiety symptoms were significantly lower at follow-up (t30=2.53; P=.02 and t30=2.18; P=.04, respectively), days of sick leave in past month (t28=2.38; P=.02), and higher self-reported job performance (t28=−2.09; P=.046; stage 2). Over 90% of respondents claimed it helped improve their mental fitness, and user feedback was again positive. Attrition was high across the stages. Conclusions: Overall, HeadGear was well received, and preliminary findings indicate it may provide an innovative new platform for improving mental health outcomes. Unfortunately, attrition was a significant issue, and findings should be interpreted with caution. The next stage of evaluation will be a randomized controlled trial. If found to be efficacious, the app has the potential to reduce disease burden and improve health in this at-risk group. %M 30514694 %R 10.2196/11661 %U https://mhealth.jmir.org/2018/12/e11661/ %U https://doi.org/10.2196/11661 %U http://www.ncbi.nlm.nih.gov/pubmed/30514694 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e10007 %T A Mobile App for the Self-Report of Psychological Well-Being During Pregnancy (BrightSelf): Qualitative Design Study %A Doherty,Kevin %A Barry,Marguerite %A Marcano-Belisario,José %A Arnaud,Bérenger %A Morrison,Cecily %A Car,Josip %A Doherty,Gavin %+ School of Computer Science and Statistics, Trinity College Dublin, College Green, Dublin,, Ireland, 353 1 8963858, Gavin.Doherty@tcd.ie %K engagement %K mental health %K mHealth %K midwifery %K perinatal depression %K pregnancy %K self-report %K well-being %K mobile phone %D 2018 %7 27.11.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Maternal mental health impacts both parental well-being and childhood development. In the United Kingdom, 15% of women are affected by depression during pregnancy or within 1 year of giving birth. Suicide is a leading cause of perinatal maternal mortality, and it is estimated that >50% of perinatal depression cases go undiagnosed. Mobile technologies are potentially valuable tools for the early recognition of depressive symptoms, but complex design challenges must be addressed to enable their use in public health screening. Objective: The aim of this study was to explore the issues and challenges surrounding the use of mobile phones for the self-report of psychological well-being during pregnancy. Methods: This paper presents design research carried out as part of the development of BrightSelf, a mobile app for the self-report of psychological well-being during pregnancy. Design sessions were carried out with 38 participants, including pregnant women, mothers, midwives, and other health professionals. Overall, 19 hours of audio were fully transcribed and used as the basis of thematic analysis. Results: The study highlighted anxieties concerning the pregnancy journey, challenges surrounding current approaches to the appraisal of well-being in perinatal care, and the midwife-patient relationship. Designers should consider the framing of perinatal mental health technologies, the experience of self-report, supporting self-awareness and disclosure, providing value to users through both self-report and supplementary features, and designing for longitudinal engagement. Conclusions: This study highlights the needs, motivations, and anxieties of women with respect to technology use in pregnancy and implications for the design of mobile health technologies. %M 30482742 %R 10.2196/10007 %U http://mental.jmir.org/2018/4/e10007/ %U https://doi.org/10.2196/10007 %U http://www.ncbi.nlm.nih.gov/pubmed/30482742 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e25 %T Behavior Change for Youth Drivers: Design and Development of a Smartphone-Based App (BackPocketDriver) %A Warren,Ian %A Meads,Andrew %A Whittaker,Robyn %A Dobson,Rosie %A Ameratunga,Shanthi %+ Department of Computer Science, University of Auckland, Science Centre Building, 38 Princess Street, Auckland, 1010, New Zealand, 64 9 373 7599 ext 88784, ian-w@cs.auckland.ac.nz %K smartphone %K public health %K telemedicine %K telemetry %D 2018 %7 26.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The over-representation of youth in road crash injury and fatality rates is a major public health issue globally. In New Zealand, youth drivers are most vulnerable in the restricted license period when they can drive without the requirement for supervision by an experienced adult. Behavioral change interventions delivered using mobile phone technology to young drivers could serve as a useful mechanism to develop safe driving skills, but this potential remains to be fully explored. Objective: This study aimed to apply behavioral change principles to design and develop a smartphone-based intervention with the aim of helping youth drivers to develop and hone safe driving skills. Methods: An iterative process was used to support development of the smartphone intervention. We reviewed behavioral change literature, identifying fundamental principles and exploring use of behavior change techniques (BCTs) in other areas of public health. We engaged with key stakeholders, including young drivers, government agencies, and relevant organizations. We also took into account technology adoption considerations when designing the app. Results: We developed BackPocketDriver (BPD), an Android smartphone app that uses in-built sensors to monitor and infer driver behavior. The app implements features that were identified during the design process and are traceable to BCTs and theory. A key feature is messaging, which is used to instruct, motivate, educate, and relay feedback to participants. In addition, messaging addresses attitudes and beliefs. Other features include journey feedback summaries, goal setting, achievements, and leaderboards. Conclusions: BPD’s design rests on a sound foundation of theory and evidence. With explicit links between theory and features, the app aims to be an effective intervention to change and improve youth driver behavior. The next phase of this study is to run a small pilot study to assess BPD’s effectiveness. %M 30684435 %R 10.2196/formative.9660 %U http://formative.jmir.org/2018/2/e25/ %U https://doi.org/10.2196/formative.9660 %U http://www.ncbi.nlm.nih.gov/pubmed/30684435 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11131 %T Simulated Clinical Encounters Using Patient-Operated mHealth: Experimental Study to Investigate Patient-Provider Communication %A Tunnell,Harry %A Faiola,Anthony %A Bolchini,Davide %A Bartlett Ellis,Rebecca %+ School of Informatics and Computing, Department of Human-Centered Computing, Indiana University, 535 West Michigan Street, IT 475, Indianapolis, IN, 46202, United States, 1 317 278 4636, hadtunne@iupui.edu %K medical informatics %K personal health record %K medication reconciliation %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: This study investigates patient-centered mobile health (mHealth) technology in terms of the secondary user experience (UX). Specifically, it examines how personal mobile technology, under patient control, can be used to improve patient-provider communication about the patient’s health care during their first visit to a provider. Common ground, a theory about language use, is used as the theoretical basis to examine interactions. A novel concept of this study is that it is one of the first empirical studies to explore the relative meaningfulness of a secondary UX for specific health care tasks. Objective: The objective of this study was to investigate the extent that patient-operated mHealth technology can be designed to improve the communication between the patient and provider during an initial face-to-face encounter. Methods: The experimental study was conducted in 2 large Midwestern cities from February 2016 to May 2016. A custom-designed smartphone app prototype was used as the study treatment. The experimental design was posttest-only control group and included video-recorded simulated face-to-face clinical encounters in which an actor role-played a patient. Experienced clinicians consisting of doctors (n=4) and nurses (n=8) were the study participants. A thematic analysis of qualitative data was performed. Quantitative data collected from time on task measurements were analyzed using descriptive statistics. Results: Three themes that represent how grounding manifested during the encounter, what it meant for communication during the encounter, and how it influenced the provider’s perception of the patient emerged from the qualitative analysis. The descriptive statistics were important for inferring evidence of efficiency and effectiveness of communication for providers. Overall, encounter and task times averaged slightly faster in almost every instance for the treatment group than that in the control group. Common ground clearly was better in the treatment group, indicating that the idea of designing for the secondary UX to improve provider outcomes has merit. Conclusions: Combining the notions of common ground, human-computer interaction design, and smartphone technology resulted in a prototype that improved the efficiency and effectiveness of face-to-face collaboration for secondary users. The experimental study is one of the first studies to demonstrate that an investment in the secondary UX for high payoff tasks has value but that not all secondary UXs are meaningful for design. This observation is useful for prioritizing how resources should be applied when considering the secondary UX. %M 30389652 %R 10.2196/11131 %U https://mhealth.jmir.org/2018/11/e11131/ %U https://doi.org/10.2196/11131 %U http://www.ncbi.nlm.nih.gov/pubmed/30389652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e23 %T Using Cocreation in the Process of Designing a Smartphone App for Adolescents and Young Adults With Cancer: Prototype Development Study %A Elsbernd,Abbey %A Hjerming,Maiken %A Visler,Camilla %A Hjalgrim,Lisa Lyngsie %A Niemann,Carsten Utoft %A Boisen,Kirsten Arntz %A Jakobsen,Jens %A Pappot,Helle %+ Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 3545 8403, helle.pappot@regionh.dk %K adolescent and young adult %K cancer %K cocreation %K mHealth %K oncology %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Adolescent and young adult (AYA) oncology and hematology is a developing field of medicine, focusing on a population that faces many challenges throughout medical treatment and beyond. Mobile health (mHealth) interventions provide exciting new opportunities for improvement of health-related quality of life (HRQoL) in AYAs with cancer. Many smartphone apps are currently available for AYAs with cancer; however, for AYAs with cancer, very few apps have been designed with direct input from AYAs themselves or have demonstrated their effectiveness and benefit. Objective: The objective of this project was to develop the prototype of a smartphone app for AYAs with cancer through the process of cocreation, with the active input of AYAs who have received treatment for cancer directly impacting content and design. Methods: Patients were recruited from a population of Danish AYAs who had received treatment for cancer between the ages of 15 and 29 years. The cocreation process was completed over the course of 3 workshops and intermittent ad hoc meetings, where the recruited AYAs worked in coordination with 1 nurse, 1 doctor, and 2 representatives from a digital agency and app developer. During each workshop, participants prioritized their goals for the app. After new app content was developed, feedback was requested from the participants, and changes were made accordingly. This iterative process continued until consensus on final product features and design were achieved. Health care professionals provided minimal input and primarily performed observational roles in the workshops, with direct interaction limited to introducing the project and explaining measurement features of the app in development. Results: Three key features to be included in the prototype app were identified from the cocreation workshops: (1) a community forum; (2) an information library; and (3) a symptom and side-effect tracking tool. Bright, warm colors were selected for the app by the participating AYAs. The final prototype will be launched for pilot testing and implementation testing in February of 2018. Conclusions: The process of cocreation is a user-involved process that can create an end product that is useful and customized for the target population. This process, as such, is a beneficial process to utilize when addressing the specific needs of AYAs with cancer. The results of the here described app prototype will be evaluated in more detail in the near future. However, this description of the cocreation process in app development can be utilized for the creation of other mHealth interventions. %M 30684439 %R 10.2196/formative.9842 %U http://formative.jmir.org/2018/2/e23/ %U https://doi.org/10.2196/formative.9842 %U http://www.ncbi.nlm.nih.gov/pubmed/30684439 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e184 %T Development of an mHealth platform for HIV Care: Gathering User Perspectives Through Co-Design Workshops and Interviews %A Marent,Benjamin %A Henwood,Flis %A Darking,Mary %A , %+ School of Applied Social Science, University of Brighton, Watson Building, Falmer, BN1 9PH, United Kingdom, 44 1273643914, b.marent@brighton.ac.uk %K mHealth %K mobile applications %K telemedicine %K information technology %K sexual health %K HIV %K self-management %K patient participation %K sociology, medical %K community-based participatory research %K health services %D 2018 %7 19.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite advances in testing and treatment, HIV incidence rates within European countries are at best stable or else increasing. mHealth technology has been advocated to increase quality and cost-effectiveness of health services while dealing with growing patient numbers. However, studies suggested that mHealth apps are rarely adopted and often considered to be of low quality by users. Only a few studies (conducted in the United States) have involved people living with HIV (PLWH) in the design of mHealth. Objective: The goal of this study was to facilitate a co-design process among PLWH and clinicians across 5 clinical sites in the European Union to inform the development of an mHealth platform to be integrated into clinical care pathways. We aimed to (1) elicit experiences of living with HIV and of working in HIV care, (2) identify mHealth functionalities that are considered useful for HIV care, and (3) identify potential benefits as well as concerns about mHealth. Methods: Between January and June 2016, 14 co-design workshops and 22 semistructured interviews were conducted, involving 97 PLWH and 63 clinicians. Data were analyzed thematically and iteratively, drawing on grounded theory techniques. Results: Findings were established into 3 thematic clusters: (1) approaching the mHealth platform, (2) imagining the mHealth platform, and (3) anticipating the mHealth platform’s implications. Co-design participants approached the mHealth platform with pre-existing concerns arising from their experiences of receiving or providing care. PLWH particularly addressed issues of stigma and questioned how mHealth could enable them to manage their HIV. Clinicians problematized the compatibility of mHealth with existing information technology systems and questioned which patients should be targeted by mHealth. Imagining the potential of mHealth for HIV care, co-design participants suggested medical functionalities (accessing test results, managing medicines and appointments, and digital communication channels), social functionalities (peer support network, international travel, etc), and general features (security and privacy, credibility, language, etc). Co-design participants also anticipated potential implications of mHealth for self-management and the provision of care. Conclusions: Our approach to co-design enabled us to facilitate early engagement in the mHealth platform, enabling patient and clinician feedback to become embedded in the development process at a preprototype phase. Although the technologies in question were not yet present, understanding how users approach, imagine, and anticipate technology formed an important source of knowledge and proved highly significant within the technology design and development process. %M 30339132 %R 10.2196/mhealth.9856 %U http://mhealth.jmir.org/2018/10/e184/ %U https://doi.org/10.2196/mhealth.9856 %U http://www.ncbi.nlm.nih.gov/pubmed/30339132 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 4 %P e11826 %T Data Visualizations to Support Health Practitioners’ Provision of Personalized Care for Patients With Cancer and Multiple Chronic Conditions: User-Centered Design Study %A Backonja,Uba %A Haynes,Sarah C %A Kim,Katherine K %+ Betty Irene Moore School of Nursing, University of California Davis, 2450 48th Street, Suite 2600, Sacramento, CA, 95817, United States, 1 510 761 5461, kathykim@ucdavis.edu %K cancer care facilities %K informatics %K patient-centered care %K patient-generated health data %K precision medicine %K visualization %D 2018 %7 16.10.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: There exists a challenge of understanding and integrating various types of data collected to support the health of individuals with multiple chronic conditions engaging in cancer care. Data visualization has the potential to address this challenge and support personalized cancer care. Objective: The aim of the study was to assess the health care practitioners’ perceptions of and feedback regarding visualizations developed to support the care of individuals with multiple chronic conditions engaging in cancer care. Methods: Medical doctors (n=4) and registered nurses (n=4) providing cancer care at an academic medical center in the western United States provided feedback on visualization mock-ups. Mock-up designs were guided by current health informatics and visualization literature and the Munzner Nested Model for Visualization Design. User-centered design methods, a mock patient persona, and a scenario were used to elicit insights from participants. Directed content analysis was used to identify themes from session transcripts. Means and SDs were calculated for health care practitioners’ rankings of overview visualizations. Results: Themes identified were data elements, supportive elements, confusing elements, interpretation, and use of visualization. Overall, participants found the visualizations useful and with the potential to provide personalized care. Use of color, reference lines, and familiar visual presentations (calendars, line graphs) were noted as helpful in interpreting data. Conclusions: Visualizations guided by a framework and literature can support health care practitioners’ understanding of data for individuals with multiple chronic conditions engaged in cancer care. This understanding has the potential to support the provision of personalized care. %M 30327290 %R 10.2196/11826 %U http://humanfactors.jmir.org/2018/4/e11826/ %U https://doi.org/10.2196/11826 %U http://www.ncbi.nlm.nih.gov/pubmed/30327290 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e182 %T mHealth App Patient Testing and Review of Educational Materials Designed for Self-Management of Gout Patients: Descriptive Qualitative Studies %A Nguyen,Amy D %A Frensham,Lauren J %A Wong,Michael XC %A Meslin,Sylvain MM %A Martin,Paige %A Lau,Annie YS %A Baysari,Melissa T %A Day,Richard O %+ Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, 2109, Australia, 61 2 9850 2412, amy.nguyen@mq.edu.au %K mobile apps %K gout %K self-management %K chronic disease %K uric acid %D 2018 %7 15.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gout is a form of chronic arthritis caused by elevated serum uric acid (SUA) and culminates in painful gout attacks. Although effective uric acid-lowering therapies exist, adherence is low. This is partly due to the lack of support for patients to self-manage their disease. Mobile health apps have been used in the self-management of chronic conditions. However, not all are developed with patients, limiting their effectiveness. Objective: The objective of our study was to collect feedback from gout patients to design an effective gout self-management app. Methods: Two descriptive qualitative studies were conducted. In Study 1, researchers developed a short educational video and written materials about gout management, designed to be embedded into an app; 6 interviews and 1 focus group were held with gout patients to gather feedback on these materials. Usability testing in Study 2 involved additional gout patients using a pilot version of Healthy.me Gout, a gout self-management app, for 2 weeks. Following the trial, patients participated in an interview about their experiences using the app. Results: Patients viewed the gout educational material positively, appreciating the combined use of video, text, and images. Patients were receptive to using a mobile app to self-manage their gout. Feedback about Healthy.me Gout was generally positive with patients reporting that the tracking and diary features were most useful. Patients also provided suggestions for improving the app and educational materials. Conclusions: These studies involved patients in the development of a gout self-management app. Patients provided insight to improve the app’s presentation and usability and general lessons on useful features for chronic disease apps. Gout patients enjoyed tracking their SUA concentrations and gout attack triggers. These capabilities can be translated into self-management apps for chronic diseases that require monitoring of pathological values, medication adherence, or symptoms. Future health app design should integrate patient input and be developed iteratively to address concerns identified by patients. %M 30322835 %R 10.2196/mhealth.9811 %U http://mhealth.jmir.org/2018/10/e182/ %U https://doi.org/10.2196/mhealth.9811 %U http://www.ncbi.nlm.nih.gov/pubmed/30322835 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 3 %N 4 %P e10105 %T Promoting Self-Care of Diabetic Foot Ulcers Through a Mobile Phone App: User-Centered Design and Evaluation %A Ploderer,Bernd %A Brown,Ross %A Seng,Leonard Si Da %A Lazzarini,Peter A %A van Netten,Jaap J %+ School of Electrical Engineering and Computer Science, Queensland University of Technology, Gardens Point 2 George Street, Brisbane, QLD, 4001, Australia, 61 73138 ext 4927, b.ploderer@qut.edu.au %K mobile apps %K foot ulcer, diabetic %K self-care (rehabilitation) %K therapeutic adherence and compliance %K patient engagement %K podiatry %D 2018 %7 10.10.2018 %9 Original Paper %J JMIR Diabetes %G English %X Background: Without effective self-care, people with diabetic foot ulcers (DFUs) are at risk of prolonged healing times, hospitalization, amputation, and reduced quality of life. Despite these consequences, adherence to DFU self-care remains low. New strategies are needed to engage people in the self-care of their DFUs. Objective: This study aimed to evaluate the usability and potential usefulness of a new mobile phone app to engage people with DFUs in self-care. Methods: We developed a new mobile phone app, MyFootCare, to engage people with DFUs through goals, progress monitoring, and reminders in self-care. Key features included novel visual analytics that automatically extract and monitor DFU size information from mobile phone photos of the foot. A functional prototype of MyFootCare was created and evaluated through a user-centered design process with 11 participants with DFUs. Data were collected through semistructured interviews discussing existing self-care practices and observations of MyFootCare with participants. Data were analyzed qualitatively through thematic analysis. Results: Key themes were as follows: (1) participants already used mobile phone photos to monitor their DFU progress; (2) participants had limited experience with using mobile phone apps; (3) participants desired the objective DFU size data provided by the tracking feature of MyFootCare to monitor their DFU progress; (4) participants were ambivalent about the MyFootCare goal image and diary features, commenting that these features were useful but also that it was unlikely that they would use them; and (5) participants desired to share their MyFootCare data with their clinicians to demonstrate engagement in self-care and to reflect on their progress. Conclusions: MyFootCare shows promising features to engage people in DFU self-care. Most notably, ulcer size data are useful to monitor progress and engage people. However, more work is needed to improve the usability and accuracy of MyFootCare, that is, by refining the process of taking and analyzing photos of DFUs and removing unnecessary features. These findings open the door for further work to develop a system that is easy to use and functions in everyday life conditions and to test it with people with DFUs and their carers. %M 30305266 %R 10.2196/10105 %U https://diabetes.jmir.org/2018/4/e10105/ %U https://doi.org/10.2196/10105 %U http://www.ncbi.nlm.nih.gov/pubmed/30305266 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 9 %P e11031 %T Development of a Path to Home Mobile App for the Geriatric Rehabilitation Program at Bruyère Continuing Care: Protocol for User-Centered Design and Feasibility Testing Studies %A Backman,Chantal %A Harley,Anne %A Peyton,Liam %A Kuziemsky,Craig %A Mercer,Jay %A Monahan,Mary Anne %A Schmidt,Sandra %A Singh,Harvinder %A Gravelle,Deborah %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, Roger Guindon, RGN 3239, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada, 1 613 562 5800 ext 8418, chantal.backman@uottawa.ca %K patient discharge %K care transition %K user-centered design %K geriatric rehabilitation %K mHealth %K transitional care %K rehabilitation %K health services for the aged %K telemedicine %D 2018 %7 24.9.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: As the population ages, the need for appropriate geriatric rehabilitation services will also increase. Pressures faced by hospitals to reduce length of stay and reduce costs have driven the need for more complex care being delivered in the home or community setting. As a result, a multifaceted approach that can provide geriatric rehabilitation patients with safe and effective person- and family-centered care during transitions from hospital to home is required. We hypothesize that a technology-supported person- and family-centered care transition could empower geriatric rehabilitation patients, engage them in shared decision making, and ultimately help them to safely manage their personalized needs during care transitions from hospital to home. Objective: The purpose of this study is to design and test the feasibility of a novel Path to Home mobile app to manage the personalized needs of geriatric rehabilitation patients during their transitions from hospital to home. Methods: This study will consist of (1) codesigning a patient- and provider-tailored mobile app, and (2) feasibility pilot testing of the mobile app to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we will follow a user-centered design process integrated with a modern agile software development methodology to iteratively codesign the personalized care transition Path to Home mobile app. In phase 2, we will conduct a single-arm feasibility pilot test with geriatric rehabilitation patients using the personalized care transition Path to Home mobile app to manage their needs during the transition from hospital to home. Results: The project was funded in May 2018, and enrollment and data analysis are underway. First results are expected to be submitted for publication in 2019. Conclusions: Our findings will help validate the use of this technology for geriatric rehabilitation patients discharged from the hospital to home. Future research will more rigorously evaluate the health and economic benefits to inform wide-scale adoption of the technology. Registered Report Identifier: RR1-10.2196/11031 %M 30249591 %R 10.2196/11031 %U http://www.researchprotocols.org/2018/9/e11031/ %U https://doi.org/10.2196/11031 %U http://www.ncbi.nlm.nih.gov/pubmed/30249591 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e11400 %T Exploration of Users’ Perspectives and Needs and Design of a Type 1 Diabetes Management Mobile App: Mixed-Methods Study %A Zhang,Yiyu %A Li,Xia %A Luo,Shuoming %A Liu,Chaoyuan %A Liu,Fang %A Zhou,Zhiguang %+ Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, No 139, Renmin Road, Changsha, 410011, China, 86 073185292154, zhouzhiguang@csu.edu.cn %K diabetes mellitus, type 1 %K mobile applications %K qualitative research %K surveys and questionnaires %D 2018 %7 21.9.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the popularity of mobile phones, mobile apps have great potential for the management of diabetes, but the effectiveness of current diabetes apps for type 1 diabetes mellitus (T1DM) is poor. No study has explored the reasons for this deficiency from the users’ perspective. Objective: The aims of this study were to explore the perspectives and needs of T1DM patients and diabetes experts concerning a diabetes app and to design a new T1DM management mobile app. Methods: A mixed-methods design combining quantitative surveys and qualitative interviews was used to explore users’ needs and perspectives. Experts were surveyed at 2 diabetes conferences using paper questionnaires. T1DM patients were surveyed using Sojump (Changsha ran Xing InfoTech Ltd) on a network. We conducted semistructured, in-depth interviews with adult T1DM patients or parents of child patients who had ever used diabetes apps. The interviews were audio-recorded, transcribed, and coded for theme identification. Results: The expert response rate was 63.5% (127/200). The respondents thought that the reasons for app invalidity were that patients did not continue using the app (76.4%, 97/127), little guidance was received from health care professionals (HCPs; 73.2%, 93/127), diabetes education knowledge was unsystematic (52.8%, 67/127), and the app functions were incomplete (44.1%, 56/127). A total of 245 T1DM patient questionnaires were collected, of which 21.2% (52/245) of the respondents had used diabetes apps. The reasons for their reluctance to use an app were limited time (39%, 20/52), complicated operations (25%, 13/52), uselessness (25%, 13/52), and cost (25%, 13/52). Both the experts and patients thought that the most important functions of the app were patient-doctor communication and the availability of a diabetes diary. Two themes that were useful for app design were identified from the interviews: (1) problems with patients’ diabetes self-management and (2) problems with current apps. In addition, needs and suggestions for a diabetes app were obtained. Patient-doctor communication, diabetes diary, diabetes education, and peer support were all considered important by the patients, which informed the development of a prototype multifunctional app. Conclusions: Patient-doctor communication is the most important function of a diabetes app. Apps should be integrated with HCPs rather than stand-alone. We advocate that doctors follow up with their patients using a diabetes app. Our user-centered method explored comprehensively and deeply why the effectiveness of current diabetes apps for T1DM was poor and what T1DM patients needed for a diabetes app and provided meaningful guidance for app design. %M 30249580 %R 10.2196/11400 %U http://mhealth.jmir.org/2018/9/e11400/ %U https://doi.org/10.2196/11400 %U http://www.ncbi.nlm.nih.gov/pubmed/30249580 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e16 %T Improving Transitions of Care for Young Adults With Congenital Heart Disease: Mobile App Development Using Formative Research %A Lopez,Keila N %A O'Connor,Michael %A King,Jason %A Alexander,James %A Challman,Melissa %A Lovick,Donna K %A Goodly,Nicole %A Smith,Amelia %A Fawcett,Elliott %A Mulligan,Courtney %A Thompson,Debbe %A Fordis,Michael %+ Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin Street, MC 19-345, Houston, TX, 77030, United States, 1 832 826 5600, knlopez@bcm.edu %K adolescent health %K chronic disease %K transitions of care %K health disparities %K mobile health %K mHealth %K patient empowerment %K patient involvement %K self-efficacy %K user-centered design %D 2018 %7 11.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Congenital heart diseases (CHDs) are the most common type of birth defects. Improvements in CHD care have led to approximately 1.4 million survivors reaching adulthood. Successful transition and transfer from pediatric to adult care is crucial. Unfortunately, less than 30% of adolescents with CHD successfully transition to adult care; this number is lower for minority and lower socioeconomic status populations. Few CHD programs exist to facilitate successful transition. Objective: The goal of our study was to describe the formative research used to develop a prototype mobile app to facilitate transition to adult care for adolescents with CHD. Methods: A literature search about best practices in transition medicine for CHD was conducted to inform app development. Formative research with a diverse group of CHD adolescents and their parents was conducted to determine gaps and needs for CHD transition to adult care. As part of the interview, surveys assessing transition readiness and CHD knowledge were completed. Two adolescent CHD expert panels were convened to inform educational content and app design. Results: The literature review revealed 113 articles, of which 38 were studies on transition programs and attitudes and 3 identified best practices in transition specific to CHD. A total of 402 adolescents aged 15 to 22 years (median 16 years) participated in semistructured interviews. The group was racially and ethnically diverse (12.6% [51/402] African American and 37.8% [152/402] Latino) and 42.0% (169/402) female; 36.3% (146/402) received public insurance. Most adolescents (313/402, 76.7%) had moderate or severe CHD complexity and reported minimal CHD understanding (79.0% [275/348] of those aged 15 to 17 years and 61.1% [33/54] of those aged 18 to 22 years). Average initial transition readiness score was 50.9/100, meaning that transition readiness training was recommended. When participants with moderate to severe CHD (313/402, 77.9%) were asked about technology use, 94.2% (295/313) reported having access to a mobile phone. Interviews with parents revealed limited interactions with the pediatric cardiologist about transition-related topics: 79.4% (331/417) reported no discussions regarding future family planning, and 55.2% (230/417) reported the adolescent had not been screened for mental health concerns (depression, anxiety). Further, 66.4% (277/417) reported not understanding how health care changes as adolescents become adults. Adolescents in the expert panels (2 groups of 3 adolescents each) expressed interest in a CHD-specific tailored app consisting of quick access to specific educational questions (eg, “Can I exercise?”), a CHD story-blog forum, a mentorship platform, a question and answer space, and a checklist to facilitate transition. They expressed interest in using the app to schedule CHD clinic appointments and receive medication reminders. Based on this data, a prototype mobile app was created to assist in adolescent CHD transition. Conclusions: Formative research revealed that most adolescents with CHD had access to mobile phones, were not prepared for transition to adult care, and were interested in an app to facilitate transition to adult CHD care. Understanding adolescent and parent needs, interests, and concerns helped in the development of a mobile app with a broader, tailored approach for adolescents with CHD. %R 10.2196/formative.9963 %U http://formative.jmir.org/2018/2/e16/ %U https://doi.org/10.2196/formative.9963 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e11450 %T A Mobile Health Intervention for HIV Prevention Among Racially and Ethnically Diverse Young Men: Usability Evaluation %A Cho,Hwayoung %A Powell,Dakota %A Pichon,Adrienne %A Thai,Jennie %A Bruce,Josh %A Kuhns,Lisa M %A Garofalo,Robert %A Schnall,Rebecca %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123056201, hc2787@columbia.edu %K mobile apps %K mobile health %K information technology %K health information technology %K usability evaluation %K adolescents %K HIV prevention %K men who have sex with men %D 2018 %7 07.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps have the potential to be a useful mode of delivering HIV prevention information, particularly for young men (13-24 years) who account for 21% of new HIV diagnoses in the United States. We translated an existing evidence-based, face-to-face HIV prevention curriculum into a portable platform and developed a mobile Web app: MyPEEPS Mobile. Objective: The purpose of this study was to assess the usability of MyPEEPS Mobile from both expert and end user perspectives. Methods: We conducted a heuristic evaluation with five experts in informatics to identify violations of usability principles and end user usability testing with 20 young men aged 15 to 18 years in New York, NY, Birmingham, AL, and Chicago, IL to identify potential obstacles to their use of the app. Results: Mean scores of the overall severity of the identified heuristic violations rated by experts ranged from 0.4 and 2.6 (0=no usability problem to 4=usability catastrophe). Overall, our end users successfully completed the tasks associated with use case scenarios and provided comments/recommendations on improving usability of MyPEEPS Mobile. The mean of the overall Post-Study System Usability Questionnaire scores rated by the end users was 1.63 (SD 0.65), reflecting strong user acceptance of the app. Conclusions: The comments made by experts and end users will be used to refine MyPEEPS Mobile prior to a pilot study assessing the acceptability of the app across diverse sexual minority young men in their everyday lives. %M 30194060 %R 10.2196/11450 %U http://mhealth.jmir.org/2018/9/e11450/ %U https://doi.org/10.2196/11450 %U http://www.ncbi.nlm.nih.gov/pubmed/30194060 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e19 %T A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing %A Børøsund,Elin %A Mirkovic,Jelena %A Clark,Matthew M %A Ehlers,Shawna L %A Andrykowski,Michael A %A Bergland,Anne %A Westeng,Marianne %A Solberg Nes,Lise %+ Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway, 47 92667262, elin.borosund@rr-research.no %K stress management %K mindfulness %K cancer %K eHealth %K mHealth %K mobile apps %K development %K usability %K user-centered design %K mobile phones %D 2018 %7 06.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions. Objective: The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations. Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout. Results: The design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization. Conclusions: Interventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors. Trial Registration: ClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB) %M 30684438 %R 10.2196/formative.9954 %U http://formative.jmir.org/2018/2/e19/ %U https://doi.org/10.2196/formative.9954 %U http://www.ncbi.nlm.nih.gov/pubmed/30684438 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e173 %T Assessing the Cross-Cultural Adaptation and Translation of a Text-Based Mobile Smoking Cessation Program in Samoa (TXTTaofiTapaa): Pilot Study %A McCool,Judith %A Tanielu,Helen %A Umali,Elaine %A Whittaker,Robyn %+ Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1141, New Zealand, 64 09 373 7599 ext 82372, j.mccool@auckland.ac.nz %K mHealth %K mobile phone %K Pacific %K Samoa %K tobacco cessation %K text messages %D 2018 %7 31.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Samoa faces a persistently high prevalence of adult tobacco use and few existing cessation support services. Mobile phones are ubiquitous and generally affordable. Objective: This study aimed to adopt a text message (short message service, SMS) smoking cessation program designed in New Zealand (stop smoking with mobile phones, STOMP) for use in Samoa to assist national objectives in reducing the tobacco use. Methods: Using focus groups with smokers and ex-smokers, we explored the context for tobacco use and preferences for SMS text messages. Postintervention focus groups were held after participants received SMS text messages for 1 week. Frequent face-to-face meetings with the primary partner (Ministry of Health Samoa) and key stakeholders contributed to the adaptation process. Participatory feedback and collaboration from stakeholders became an integral part of the cultural adaptation and translation of the program. Furthermore, detailed document analyses were included as part of the formal evaluation of the initiative to explore the core determinants of success in adapting the program to the Samoan cultural context. Results: The SMS text messages evolved remarkably following an iterative process of consultation, in situ testing, revision, and retesting to arrive at an acceptable country-specific version of the mobile smoking cessation program. The SMS text messages retained in the final set were consistent with the theory of behavioral change but reflected both linguistic and cultural nuances appropriate for Samoa. Adapting messages required simultaneous multilevel processes, including complex high-level engagement, between the team and the stakeholders, along with crafting the precise content for (character limited) messages. Conclusions: Receiving cessation support messages through a mobile phone is promising and appears to be an acceptable and accessible mode of delivery for tobacco cessation, particularly in the absence of alternative support. Adapting a text-based program in Samoa requires fastidious attention to the nuances of culture, language, and sociopolitical structures in the country. %M 30170994 %R 10.2196/mhealth.9033 %U http://mhealth.jmir.org/2018/8/e173/ %U https://doi.org/10.2196/mhealth.9033 %U http://www.ncbi.nlm.nih.gov/pubmed/30170994 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e54 %T A Mobile App–Based Intervention for Depression: End-User and Expert Usability Testing Study %A Fuller-Tyszkiewicz,Matthew %A Richardson,Ben %A Klein,Britt %A Skouteris,Helen %A Christensen,Helen %A Austin,David %A Castle,David %A Mihalopoulos,Cathrine %A O'Donnell,Renee %A Arulkadacham,Lilani %A Shatte,Adrian %A Ware,Anna %+ School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 392517344, matthewf@deakin.edu.au %K depression %K eHealth %K mHealth %K young adult %D 2018 %7 23.08.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the growing number of mental health apps available for smartphones, the perceived usability of these apps from the perspectives of end users or health care experts has rarely been reported. This information is vital, particularly for self-guided mHealth interventions, as perceptions of navigability and quality of content are likely to impact participant engagement and treatment compliance. Objective: The aim of this study was to conduct a usability evaluation of a personalized, self-guided, app-based intervention for depression. Methods: Participants were administered the System Usability Scale and open-ended questions as part of a semistructured interview. There were 15 participants equally divided into 3 groups: (1) individuals with clinical depression who were the target audience for the app, (2) mental health professionals, and (3) researchers who specialize in the area of eHealth interventions and/or depression research. Results: The end-user group rated the app highly, both in quantitative and qualitative assessments. The 2 expert groups highlighted the self-monitoring features and range of established psychological treatment options (such as behavioral activation and cognitive restructuring) but had concerns that the amount and layout of content may be difficult for end users to navigate in a self-directed fashion. The end-user data did not confirm these concerns. Conclusions: Encouraging participant engagement via self-monitoring and feedback, as well as personalized messaging, may be a viable way to maintain participation in self-guided interventions. Further evaluation is necessary to determine whether levels of engagement with these features enhance treatment effects. %M 30139722 %R 10.2196/mental.9445 %U http://mental.jmir.org/2018/3/e54/ %U https://doi.org/10.2196/mental.9445 %U http://www.ncbi.nlm.nih.gov/pubmed/30139722 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10125 %T Game Plan: Development of a Web App Designed to Help Men Who Have Sex With Men Reduce Their HIV Risk and Alcohol Use %A Wray,Tyler %A Kahler,Christopher W %A Simpanen,Erik M %A Operario,Don %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI,, United States, 1 401 863 6659, tyler_wray@brown.edu %K alcohol %K HIV risk %K internet %K intervention %D 2018 %7 23.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Men who have sex with men (MSM) are at high risk for HIV, and alcohol use is a major risk factor for HIV infection. Internet-facilitated brief interventions have been shown to reduce alcohol use and HIV-risk behavior in other at-risk populations, but have so far incorporated limited content and have not been tested among MSM. Objective: This manuscript describes Game Plan, an interactive, tablet-optimized web application designed to help heavy drinking, high-risk MSM consider reducing their alcohol use and sexual risk behavior. In this paper, we discuss the rationale, goals, and flow for each of Game Plan’s components, which were modelled after common in-person and web-based brief motivational interventions for these behaviors. Methods: The development of Game Plan was informed by a thorough user-focused design research process that included (1) audits of existing interventions, (2) focus groups with stakeholders and (3) intended users (high-risk, heavy drinking MSM), and (4) usability testing. The aesthetic, features, and content of the app were designed iteratively throughout this process Results: The fully-functional Game Plan app provides (1) specific and personal feedback to users about their level of risk, (2) exercises to help prompt users to reflect on whether their current behavior aligns with other important life goals and values, and for those open to change, (3) exercises to help users understand factors that contribute to risk, and (4) a change planning module. In general, this flow was constructed to roughly align with the two phases described in early accounts of motivational interviewing (MI): (1) Content intended to elicit intrinsic motivation for change, and when/if sufficient motivation is present, (2) content intended to translate that motivation into specific goals and plans for change. This sequence first focuses on the user’s HIV risk behavior, followed by their alcohol use and the connection between the two. The app’s overall aesthetic (eg, branding, color palettes, icons/graphics) and its onboarding sequence was also designed to align with the “spirit” of MI by conveying respect for autonomy, open-mindedness (ie, avoiding judgment), and empathy. Conclusions: Should future research support its efficacy in facilitating behavior change, Game Plan could represent a wide-reaching and scalable tool that is well-suited for use in settings where delivering evidence-based, in-person interventions would be difficult or cost-prohibitive. %M 30684415 %R 10.2196/10125 %U http://formative.jmir.org/2018/2/e10125/ %U https://doi.org/10.2196/10125 %U http://www.ncbi.nlm.nih.gov/pubmed/30684415 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e172 %T A Mobile App (iBeni) With a Neuropsychological Basis for Cognitive Stimulation for Elderly Adults: Pilot and Validation Study %A Martínez-Alcalá,Claudia I %A Rosales-Lagarde,Alejandra %A Hernández-Alonso,Esmeralda %A Melchor-Agustin,Roberto %A Rodriguez-Torres,Erika E %A Itzá-Ortiz,Benjamín A %+ Consejo Nacional de Ciencia y Tecnología, Av Insurgentes Sur 1582, Col Crédito Constructor, Del Benito Juárez, Ciudad de México, 03940, Mexico, 52 (771) 71 72 000 ext 4332, c_isabel_alcala@hotmail.com %K mobile application %K cognitive stimulation %K cognitive impairment %K older adults %K neuropsychological evaluation. %D 2018 %7 21.08.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cognitive impairment is considered one of the most feared chronic conditions among the older adult population since its incidence is approximately twice more frequent than that of dementia. In Mexico, no studies or reports of older adults using technology for cognitive interventions have been published, given that institutions usually frame cognitive stimulation tasks in paper and pencil (ie, in the traditional manner). Objective: The objective of this study was to create and analyze the effect, viability, and impact of a mobile app for cognitive stimulation implemented among a group of elderly adults (over 60 years of age) from the state of Hidalgo in Mexico. Methods: This study was a nonprobabilistic pilot trial using convenience sampling. An intervention was implemented among a group of 22 older adults between 60 and 80 years of age over 12 weeks. Half of the older adults were stimulated with the mobile app (experimental group) and the other half followed the traditional paper and pencil training (control group). Assessments with the Mini-Mental State Examination (MMSE) and the Neuropsi, a neuropsychological test validated in Mexico, were done before and after both cognitive stimulations. Results: According to the analyzed data, 6/11 (55%) participants from the experimental group obtained better results in their cognitive skills, and 5 (45%) of the adults maintained their score, given that the participants were able to execute the exercises repetitively. Meanwhile, for the control group, only 3/11 (27%) participants obtained better results in the postevaluation. Significant values for results of the MMSE were obtained in the postevaluation for the experimental group compared to the control group, while results did not show significant differences in the Neuropsi. Regarding the validation of the app, all the participants evaluated its pertinence positively. Conclusions: The intervention data show that the experimental group obtained better results in the postevaluation given that the participants were able to execute the exercises repetitively. The control group could not accomplish this since they had to respond on the manual and no further attempts were provided. However, both groups increased their score in the neuropsychological evaluations. This suggests that a longer and more frequent intervention is required. Registered Report Identifier: RR1-10.2196/9603 %M 30131319 %R 10.2196/resprot.9603 %U http://www.researchprotocols.org/2018/8/e172/ %U https://doi.org/10.2196/resprot.9603 %U http://www.ncbi.nlm.nih.gov/pubmed/30131319 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e10211 %T A Realistic Talking Human Embodied Agent Mobile Phone Intervention to Promote HIV Medication Adherence and Retention in Care in Young HIV-Positive African American Men Who Have Sex With Men: Qualitative Study %A Dworkin,Mark %A Chakraborty,Apurba %A Lee,Sangyoon %A Monahan,Colleen %A Hightow-Weidman,Lisa %A Garofalo,Robert %A Qato,Dima %A Jimenez,Antonio %+ Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W Taylor Street, Chicago, IL, 60612, United States, 1 312 413 0348, mdworkin@uic.edu %K adherence %K mHealth %K HIV %K African American %K men who have sex with men %K avatar, embodied agent %D 2018 %7 31.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Avatars and embodied agents are a promising innovation for human health intervention because they may serve as a relational agent that might augment user engagement in a behavioral change intervention and motivate behavioral change such as antiretroviral adherence and retention in care. Objective: This study aimed to develop a theory-driven talking avatar-like embodied agent mobile phone intervention guided by the information-motivation-behavioral skills model to promote HIV medication adherence and retention in care in young African American men who have sex with men (MSM). Methods: We performed 5 iterative focus groups in Chicago with HIV-positive African American MSM aged 18-34 years to inform the ongoing development of a mobile phone app. Participants for the focus groups were recruited from 4 University of Illinois at Chicago Community Outreach Intervention Project sites located in different high HIV incidence areas of the city and the University of Illinois at Chicago HIV clinic using fliers and word of mouth. The focus group data analysis included developing an ongoing list of priorities for app changes and discussion between two of the investigators based on the project timeline, resources, and to what extent they served the app’s objectives. Results: In this study, 16 men participated, including 3 who participated in two groups. The acceptability for an embodied agent app was universal in all 5 focus groups. The app included the embodied agent response to questions and antiretroviral regimen information, adherence tracking, CD4 count and viral load tracking, motivational spoken messages, and customizability. Concerns that were identified and responded to in the development process included privacy, stigma, avoiding the harsh or commanding tone of voice, avoiding negative motivational statements, and making reminder functions for a variety of health care interactions. Conclusions: An avatar-like embodied agent mHealth approach was acceptable to young HIV-positive African American MSM. Its relational nature may make it an effective method of informing, motivating, and promoting health behavioral skills. Furthermore, the app’s ease of access, stigma-free environment, and audiovisual format may help overcome some adherence barriers reported in this population. %M 30064971 %R 10.2196/10211 %U http://mhealth.jmir.org/2018/7/e10211/ %U https://doi.org/10.2196/10211 %U http://www.ncbi.nlm.nih.gov/pubmed/30064971 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 1 %P e6 %T Maternal and Child Acceptability of a Proposed Guided Imagery Therapy Mobile App Designed to Treat Functional Abdominal Pain Disorders in Children: Mixed-Methods Predevelopment Formative Research %A Hollier,John M %A Vaughan,Adetola O %A Liu,Yan %A van Tilburg,Miranda AL %A Shulman,Robert J %A Thompson,Debbe I %+ Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, Suite 1010, Houston, TX, 77030, United States, 1 8328243814, jmhollie@bcm.edu %K functional abdominal pain disorders %K guided imagery therapy %K mixed methods %K mobile applications %K pediatrics %K parents %K Technology Acceptance Model %K imagery (psychotherapy) %D 2018 %7 29.06.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Functional abdominal pain disorders are chronic abdominal pain conditions, which affect up to 20% of children worldwide. Of the various functional abdominal pain disorder treatment modalities, psychological therapies such as guided imagery therapy appear most effective. However, there are significant barriers to receiving psychological therapies, including access to trained therapists. Alternatively, remotely delivered psychological therapies for functional abdominal pain disorders have been efficacious. Objective: The objective of our study was to assess acceptability of a proposed guided imagery therapy app designed to treat functional abdominal pain disorders through remote delivery of prerecorded audio sessions and to evaluate user preferences for using such an app. Methods: Using a mixed-methods approach, we conducted a predevelopment formative study among children aged 7 to 12 years with a functional abdominal pain disorder and their parents. The parents completed our modified Technology Acceptance Model (TAM) questionnaire, which quantified behavioral intention and related factors for using a guided imagery therapy app. Dyads participated in separate in-person semistructured interviews to assess their attitudes toward and preferences for a guided imagery therapy app. Questionnaire and interview findings were collected concurrently, analyzed separately, and then integrated through methods triangulation. Results: Among the 15 participating parent-child dyads, 5 (33%) children were Hispanic and 11 (73%) had irritable bowel syndrome. They had diverse socioeconomic status. All parent participants were mothers. The TAM questionnaire indicated that mothers scored favorably on behavioral intention to use a guided imagery therapy app (mean score 12.0, SD 2.6, possible range 3-15). Scores for the TAM factors perceived usefulness, perceived ease of use, hedonic motivation, compatibility, and habit also were favorable. Maternal interviews confirmed positive attitudes toward the proposed app. They advocated a visual component to hold their child’s attention during the guided imagery therapy sessions; recommended incorporating background sounds into the sessions; favored session reminder notifications from the app; and thought the best time for their child to listen to the sessions would be in the evening or before bed. The child interviews also confirmed positive attitudes toward the proposed app. They suggested guided imagery therapy session topics such as sports and adventures; listening to sessions in their bedroom; and the need for parental supervision to install the app on their mobile device. Integration of the quantitative and qualitative methods findings complimented one another on acceptability. The favorable behavioral intention TAM score aligned well with expressed positive maternal and child attitudes toward the app and can be explained by the desire to avoid medications. The questionnaire and interviews also confirmed therapeutic benefit as an intrinsic motivator to promote routine use. Conclusions: A guided imagery therapy app designed to treat pediatric patients with functional abdominal pain disorders appears to be acceptable to both mothers and children. Incorporating parent and child preferences into a guided imagery therapy app could promote therapeutic compliance and increase access to optimal care. %M 31518303 %R 10.2196/pediatrics.8535 %U http://pediatrics.jmir.org/2018/1/e6/ %U https://doi.org/10.2196/pediatrics.8535 %U http://www.ncbi.nlm.nih.gov/pubmed/31518303 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e214 %T Tutorial for Using Control Systems Engineering to Optimize Adaptive Mobile Health Interventions %A Hekler,Eric B %A Rivera,Daniel E %A Martin,Cesar A %A Phatak,Sayali S %A Freigoun,Mohammad T %A Korinek,Elizabeth %A Klasnja,Predrag %A Adams,Marc A %A Buman,Matthew P %+ Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, Atkinson Hall (Mail Code 0811, Office 6113), La Jolla, CA, 92093-0811, United States, 1 858 822 7482, ehekler@ucsd.edu %K adaptive interventions %K mHealth %K eHealth %K digital health %K control systems engineering %K behavior change %K optimization %K multiphase optimization strategy %K physical activity %K behavioral maintenance %D 2018 %7 28.06.2018 %9 Tutorial %J J Med Internet Res %G English %X Background: Adaptive behavioral interventions are individualized interventions that vary support based on a person's evolving needs. Digital technologies enable these adaptive interventions to function at scale. Adaptive interventions show great promise for producing better results compared with static interventions related to health outcomes. Our central thesis is that adaptive interventions are more likely to succeed at helping individuals meet and maintain behavioral targets if its elements can be iteratively improved via data-driven testing (ie, optimization). Control systems engineering is a discipline focused on decision making in systems that change over time and has a wealth of methods that could be useful for optimizing adaptive interventions. Objective: The purpose of this paper was to provide an introductory tutorial on when and what to do when using control systems engineering for designing and optimizing adaptive mobile health (mHealth) behavioral interventions. Overview: We start with a review of the need for optimization, building on the multiphase optimization strategy (MOST). We then provide an overview of control systems engineering, followed by attributes of problems that are well matched to control engineering. Key steps in the development and optimization of an adaptive intervention from a control engineering perspective are then summarized, with a focus on why, what, and when to do subtasks in each step. Implications: Control engineering offers exciting opportunities for optimizing individualization and adaptation elements of adaptive interventions. Arguably, the time is now for control systems engineers and behavioral and health scientists to partner to advance interventions that can be individualized, adaptive, and scalable. This tutorial should aid in creating the bridge between these communities. %M 29954725 %R 10.2196/jmir.8622 %U http://www.jmir.org/2018/6/e214/ %U https://doi.org/10.2196/jmir.8622 %U http://www.ncbi.nlm.nih.gov/pubmed/29954725 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 6 %P e153 %T Mobile Phone Cognitive Bias Modification Research Platform for Substance Use Disorders: Protocol for a Feasibility Study %A Zhang,Melvyn %A Ying,JiangBo %A Song,Guo %A Fung,Daniel SS %A Smith,Helen %+ National Addictions Management Service, Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 63892000, melvynzhangweibin@gmail.com %K attention bias modification %K eHealth %K mHealth %K development %D 2018 %7 12.06.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive biases refer to automatic attentional and interpretational tendencies, which could be retained by cognitive bias modification interventions. Cristea et al and Jones et al have published reviews (in 2016 and 2017 respectively) on the effectiveness of such interventions. The advancement of technologies such as electronic health (eHealth) and mobile health (mHealth) has led to them being harnessed for the delivery of cognitive bias modification. To date, at least eight studies have demonstrated the feasibility of mobile technologies for the delivery of cognitive bias modification. Most of the studies are limited to a description of the conventional cognitive bias modification methodology that has been adopted. None of the studies shared the developmental process for the methodology involved, such that future studies could adopt it in the cost-effective replication of such interventions. Objective: It is important to have a common platform that could facilitate the design and customization of cognitive bias modification interventions for a variety of psychiatric and addictive disorders. It is the aim of the current research protocol to describe the design of a research platform that allows for customization of cognitive bias modification interventions for addictive disorders. Methods: A multidisciplinary team of 2 addiction psychiatrists, a psychologist with expertise in cognitive bias modification, and a computer engineer, were involved in the development of the intervention. The proposed platform would comprise of a mobile phone version of the cognitive bias task which is controlled by a server that could customize the algorithm for the tasks and collate the reaction-time data in realtime. The server would also allow the researcher to program the specific set of images that will be present in the task. The mobile phone app would synchronize with the backend server in real-time. An open-sourced cross-platform gaming software from React Native was used in the current development. Results: Multimedia Appendix 1 contains a video demonstrating the operation of the app, as well as a sample dataset of the reaction times (used for the computation of attentional biases) captured by the app. Conclusions: The current design can be utilized for cognitive bias modification across a spectrum of disorders and is not limited to one disorder. It will be of value for future research to utilize the above platform and compare the efficacy of mHealth approaches, such as the one described in this study, with conventional Web-based approaches in the delivery of attentional bias modification interventions. Registered Report Identifier: RR1-10.2196/9740 %M 29895513 %R 10.2196/resprot.9740 %U http://www.researchprotocols.org/2018/6/e153/ %U https://doi.org/10.2196/resprot.9740 %U http://www.ncbi.nlm.nih.gov/pubmed/29895513 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e10181 %T TEAMS (Tele-Exercise and Multiple Sclerosis), a Tailored Telerehabilitation mHealth App: Participant-Centered Development and Usability Study %A Thirumalai,Mohanraj %A Rimmer,James H %A Johnson,George %A Wilroy,Jereme %A Young,Hui-Ju %A Mehta,Tapan %A Lai,Byron %+ Department of Health Services Administration, University of Alabama at Birmingham, SHPB #590E, 1716 9th Avenue South, Birmingham, AL, 35233, United States, 1 2059347189, mohanraj@uab.edu %K multiple sclerosis %K exercise %K therapy %K mHealth %K user-centered design %D 2018 %7 24.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People with multiple sclerosis face varying levels of disability and symptoms, thus requiring highly trained therapists and/or exercise trainers to design personalized exercise programs. However, for people living in geographically isolated communities, access to such trained professionals can be challenging due to a number of barriers associated with cost, access to transportation, and travel distance. Generic mobile health exercise apps often fall short of what people with multiple sclerosis need to become physically active (ie, exercise content that has been adapted to accommodate a wide range of functional limitations). Objective: This usability study describes the development process of the TEAMS (Tele-Exercise and Multiple Sclerosis) app, which is being used by people with multiple sclerosis in a large randomized controlled trial to engage in home-based telerehabilitation. Methods: Twenty-one participants with disabilities (10 people with multiple sclerosis) were involved in the double iterative design, which included the simultaneous development of the app features and exercise content (exercise videos and articles). Framed within a user-centered design approach, the development process included 2 stages: ground-level creation (focus group followed by early stage evaluations and developments), and proof of concept through 2 usability tests. Usability (effectiveness, usefulness, and satisfaction) was evaluated using a mixed-methods approach. Results: During testing of the app’s effectiveness, the second usability test resulted in an average of 1 problem per participant, a decrease of 53% compared to the initial usability test. Five themes were constructed from the qualitative data that related to app usefulness and satisfaction, namely: high perceived confidence for app usability, positive perceptions of exercise videos, viable exercise option at home, orientation and familiarity required for successful participation, and app issues. Participants acknowledged that the final app was ready to be delivered to the public after minor revisions. After including these revisions, the project team released the final app that is being used in the randomized controlled trial. Conclusions: A multi-level user-centered development process resulted in the development of an inclusive exercise program for people with multiple sclerosis operated through an easy-to-use app. The promotion of exercise through self-regulated mHealth programs requires a stakeholder-driven approach to app development. This ensures that app and content match the preferences and functional abilities of the end user (ie, people with varying levels of multiple sclerosis). %M 29798832 %R 10.2196/10181 %U http://mhealth.jmir.org/2018/5/e10181/ %U https://doi.org/10.2196/10181 %U http://www.ncbi.nlm.nih.gov/pubmed/29798832 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e119 %T Multistakeholder Perspectives on Maternal Text Messaging Intervention in Uganda: Qualitative Study %A Ilozumba,Onaedo %A Dieleman,Marjolein %A Van Belle,Sara %A Mukuru,Moses %A Bardají,Azucena %A Broerse,Jacqueline EW %+ Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, Netherlands, 31 205983143, ona.ilozumba@vu.nl %K maternal health %K telemedicine %K community health workers %K Uganda %K evaluation studies %D 2018 %7 10.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite continued interest in the use of mobile health for improving maternal health outcomes, there have been limited attempts to identify relevant program theories. Objectives: This study had two aims: first, to explicate the assumptions of program designers, which we call the program theory and second, to contrast this program theory with empirical data to gain a better understanding of mechanisms, facilitators, and barriers related to the program outcomes. Methods: To achieve the aforementioned objectives, we conducted a retrospective qualitative study of a text messaging (short message service) platform geared at improving individual maternal health outcomes in Uganda. Through interviews with program designers (n=3), we elicited 3 main designers’ assumptions and explored these against data from qualitative interviews with primary beneficiaries (n=26; 15 women and 11 men) and health service providers (n=6), as well as 6 focus group discussions with village health team members (n=50) who were all involved in the program. Results: Our study results highlighted that while the program designers’ assumptions were appropriate, additional mechanisms and contextual factors, such as the importance of incentives for village health team members, mobile phone ownership, and health system factors should have been considered. Conclusions: Our results indicate that text messages could be an effective part of a more comprehensive maternal health program when context and system barriers are identified and addressed in the program theories. %M 29748159 %R 10.2196/mhealth.9565 %U http://mhealth.jmir.org/2018/5/e119/ %U https://doi.org/10.2196/mhealth.9565 %U http://www.ncbi.nlm.nih.gov/pubmed/29748159 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e113 %T User Needs in the Development of a Health App Ecosystem for Self-Management of Cystic Fibrosis: User-Centered Development Approach %A Floch,Jacqueline %A Zettl,Annabel %A Fricke,Lena %A Weisser,Tina %A Grut,Lisbet %A Vilarinho,Thomas %A Stav,Erlend %A Ascolese,Antonio %A Schauber,Cornelia %+ SINTEF, Strindveien 4, Trondheim, 7465, Norway, 47 93008536, jacqueline.floch@sintef.no %K self-management %K cystic fibrosis %K mobile health %K user centered design %D 2018 %7 08.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital self-management in cystic fibrosis (CF) is foreseen as a means toward better understanding of the disease and its treatment and better adherence to the treatment. Mobile apps hold the potential to provide access to information, motivate, and strengthen compliance. However, to deliver high-quality apps, the development should be based on thorough knowledge about user needs. Empirical research on the user-centered development of mobile apps for health care is, however, still limited. Objective: The aim of this research is to develop and evaluate an app ecosystem for self-management in CF. It targets not only those directly affected by CF but also parents and health care professionals involved in the treatment. This paper covers the first step of the design process that aims to analyze the context and the user requirements. The primary research question is as follows: what digital support has the potential to usefully support persons with CF and their caregivers in the CF care? To answer this question, we address two preliminary questions: what important factors in everyday life affect the care of persons with CF? and how is the CF care delivered today and what are the limitations of CF care services? Methods: The overall research adopts a user-centered design approach in which future users are involved in the development process from the very beginning to ensure that the apps developed best suit the potential users. The research presented in the paper follows an interpretative case study research strategy seeking to understand the concerns and needs of persons with CF and their caregivers. Data were collected through semistructured qualitative interviews involving 74 participants in seven European countries and from internet forums. Results: The results of the analysis phase show a strong need for individuality of the digital support, as well as for its adaptability to different contexts. The paper presents the concerns and needs of the participants in the study and extracts a set of relevant features for a self-management app ecosystem. Education, enzyme dosage calculation, nutrition management, treatment organization, health diary, treatment follow-up, practical guidelines for treatment, communication with doctors, and communication with peers are foreseen as useful features. Conclusions: The results indicate the readiness for self-management in the CF care even in countries that provide well-functioning health care services for CF care. The large diversity of user requirements identified reflects the crucial role user integration plays in developing apps for a chronic condition such as CF. The need for personalization stemming from the individuality of the patients and the need for communication with health care professionals support the idea of an app ecosystem for the self-management of CF. %M 29739742 %R 10.2196/mhealth.8236 %U http://mhealth.jmir.org/2018/5/e113/ %U https://doi.org/10.2196/mhealth.8236 %U http://www.ncbi.nlm.nih.gov/pubmed/29739742 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e46 %T Recommendations for the Development of a Mobile HIV Prevention Intervention for Men Who Have Sex With Men and Hijras in Mumbai: Qualitative Study %A Rawat,Shruta %A Wilkerson,J Michael %A Lawler,Sylvia M %A Patankar,Pallav %A Rosser,BR Simon %A Shukla,Kanjani %A Butame,Seyram %A Ekstrand,Maria L %+ School of Public Health, University of Texas Health Science Center at Houston, 7000 Fannin St, Ste 2620, Houston, TX,, United States, 1 713 500 9974, Johnny.M.Wilkerson@uth.tmc.edu %K health promotion %K health seeking %K gays and lesbians %K Internet %K HIV/AIDS %D 2018 %7 03.05.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As Internet and mobile phone use expands in India, there is an opportunity to develop mobile health (mHealth) interventions for marginalized populations, including men who have sex with men (MSM) and hijras (transgender women), hesitant to access traditional health care systems. Objective: The purpose of this study was to determine if an mHealth intervention was acceptable to MSM and hijras living in Mumbai, and if so, what features would be useful in targeting the prevention of HIV acquisition and to increase the quality of life among persons living with HIV/AIDS. Methods: Data from 4 focus groups with MSM and interviews with 4 hijras, 10 health service providers, and 8 mHealth developers were thematically analyzed. Results: Once the need for an mHealth intervention was confirmed, comments about features were organized into 3 themes: content, interface, and retention. Content subthemes included providing sex education for younger community members, providing information about STIs, and providing information and social support for persons living with HIV. Interface subthemes included presenting content using pictures; using videos to present stories of role models; using push notifications for testing, appointment, and medication reminders; using geolocation to link to just-in-time services; and using telemedicine to increase access to health service providers and community services. The 5 retention subthemes included keeping it fun, using gaming mechanics, developing content in regional languages, protecting confidentiality, and linking to social networking apps. Conclusions: These findings may help inform mHealth development in India. %M 29724705 %R 10.2196/publichealth.9088 %U http://publichealth.jmir.org/2018/2/e46/ %U https://doi.org/10.2196/publichealth.9088 %U http://www.ncbi.nlm.nih.gov/pubmed/29724705 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e30 %T Worker Preferences for a Mental Health App Within Male-Dominated Industries: Participatory Study %A Peters,Dorian %A Deady,Mark %A Glozier,Nick %A Harvey,Samuel %A Calvo,Rafael A %+ Wellbeing Technology Lab, Faculty of Engineering and IT, University of Sydney, Bldg J03, Electrical Engineering, Sydney, 2006, Australia, 61 0289015604, dorian.peters@sydney.edu.au %K mental health %K mhealth %K mobile apps %K workplace %K men %K participatory design %D 2018 %7 25.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Men are less likely to seek help for mental health problems, possibly because of stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces such as the emergency services or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of mental health technologies men would be willing to engage with, and no app can be effective if the intended users do not engage with it. Objective: The goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. Methods: Workers from male-dominated workplaces in rural, suburban, and urban locations took part in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. Results: A total of 60 workers aged between 26 and 65 years, 92% (55/60) male, from male-dominated workplaces in rural (16/60, 27%), suburban (14/60, 23%), and urban (30/60, 50%) locations participated in one of the 6 workshops, resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term “mental health” was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment, and mood-fix tool were highly valued, and app characteristics such as brevity of interactions, minimal on-screen text, and a solutions-oriented approach were considered essential by participants. Some implementation strategies based on these findings are included in the discussion. Conclusions: Future mental health mobile phone apps targeting workers in male-dominated workplaces need to consider language use and preferred features, as well as balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights for mental health technologies, for men in general, and for others in high-stigma environments. %M 29695371 %R 10.2196/mental.8999 %U http://mental.jmir.org/2018/2/e30/ %U https://doi.org/10.2196/mental.8999 %U http://www.ncbi.nlm.nih.gov/pubmed/29695371 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e45 %T Developing Sustainable and Impactful Mobile Phone HIV Testing Interventions for Spanish-Speaking Men Who Have Sex With Men in the United States: Lessons Learned From Informative Interviews %A Mitchell,Jason %A Torres,Maria Beatriz %A Asmar,Lucy %A Danh,Thu %A Horvath,Keith J %+ Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Biomed T110, Honolulu, HI, 96822, United States, 1 808 956 3342, jasonmit@hawaii.edu %K smartphone %K HIV testing %K HIV prevention %K men who have sex with men %K Spanish %D 2018 %7 24.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although many men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic or Latino MSM, is needed. Many mHealth interventions in development, including the ones on HIV testing, have primarily focused on English-speaking white, black, and MSM of other races. To date, no studies have assessed app use, attitudes, and motivations for downloading and sustaining use of mobile apps and preferences with respect to HIV prevention among Spanish-speaking, Hispanic MSM in the United States. Objective: The primary aims of this study were to determine what features and functions of smartphone apps do Hispanic, Spanish-speaking MSM believe are associated with downloading apps to their smartphones, (2) what features and functions of smartphone apps are most likely to influence men’s sustained use of apps over time, and (3) what features and functions do men prefer in a smartphone app aimed to promote regular testing for HIV. Methods: Interviews (N=15) were conducted with a racially diverse group of sexually active, HIV-negative, Spanish-speaking, Hispanic MSM in Miami, Florida. Interviews were digitally recorded, transcribed verbatim, translated back to English, and de-identified for analysis. A constant-comparison method (ie, grounded theory coding) was employed to examine themes that emerged from the interviews. Results: Personal interest was the primary reason associated with whether men downloaded an app. Keeping personal information secure, cost, influence by peers and posted reviews, ease of use, and functionality affected whether they downloaded and used the app over time. Men also reported that entertainment value and frequency of updates influenced whether they kept and continued to use an app over time. There were 4 reasons why participants chose to delete an app—dislike, lack of use, cost, and lack of memory or space. Participants also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors. Conclusions: The features and functions of mobile apps that Spanish-speaking MSM in this study believed were associated with downloading and/or sustained engagement of an app generally reflected the priorities mentioned in an earlier study with English-speaking MSM. Unlike the earlier study, Spanish-speaking MSM prioritized personal interest in a mobile app and de-emphasized the efficiency of an app to make their lives easier in their decision to download an app to their mobile device. Tailoring mobile apps to the language and needs of Spanish-speaking MSM is critical to help increase their willingness to download a mobile app. Despite the growing number of HIV-prevention apps in development, few are tailored to Spanish-speaking MSM, representing an important gap that should be addressed in future research. %M 29691205 %R 10.2196/publichealth.8992 %U http://publichealth.jmir.org/2018/2/e45/ %U https://doi.org/10.2196/publichealth.8992 %U http://www.ncbi.nlm.nih.gov/pubmed/29691205 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e91 %T Development of a Healthy Lifestyle Mobile App for Overweight Pregnant Women: Qualitative Study %A Lau,Ying %A Cheng,Ling Jie %A Chi,Claudia %A Tsai,Cammy %A Ong,Kai Wen %A Ho-Lim,Sarah Su Tin %A Wang,Wei %A Tan,Kian-Lee %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011603, nurly@nus.edu.sg %K mobile apps %K overweight %K obesity %D 2018 %7 23.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are becoming an increasingly ubiquitous platform for delivery of health behavior interventions among overweight and obese perinatal women. However, only a few methodological guidelines on integrating theory, evidence, and qualitative research for their designs are available. Objective: The aim of this study was to develop a theory-based, evidence-driven, and user-centered healthy lifestyle app targeting overweight and obese multiethnic pregnant women. Methods: This paper illustrates how intervention development may be enriched with theoretical basis, systematic review, and qualitative study. An individual face-to-face interview was performed to incorporate the user’s involvement in the design. These interviews were audiotaped and transcribed. Thematic analysis technique was used for emerging themes. Results: Integrated concepts of social cognitive theory of self-regulation, self-regulation model, and strength model of self-control were selected as bases of the intervention. Evidence from our systematic review and meta-analysis provided the strongest evidence for the development of intervention. We invited 16 obese or overweight pregnant women to participate in a semistructured interview . The following key themes emerged: content, platform, interactivity, format, and functionality. Apps are a favorable technology platform for healthy diet advice, appropriate physical exercise, and weight management because they are user-friendly and convenient. The app used in this study contains culture-specific, pregnancy-related, and credible contents, including educational, professional and peer support, and self-monitoring domains. The design should include aesthetic appeal, visualized features, and interactive multimedia. Conclusions: A 3-step process integrating theoretical basis, evidence from systematic review, and research findings from target users can be considered a guide for future app development. %M 29685868 %R 10.2196/mhealth.9718 %U http://mhealth.jmir.org/2018/4/e91/ %U https://doi.org/10.2196/mhealth.9718 %U http://www.ncbi.nlm.nih.gov/pubmed/29685868 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e90 %T The Interactive Child Distress Screener: Development and Preliminary Feasibility Testing %A March,Sonja %A Day,Jamin %A Zieschank,Kirsty %A Ireland,Michael %+ Institute for Resilient Regions, University of Southern Queensland, Sinnathamby Blvd, Springfield Central, 4300, Australia, 61 34704434, sonja.march@usq.edu.au %K child %K preschool %K mental health %K symptom assessment %K self-assessment (psychology) %D 2018 %7 19.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Early identification of child emotional and behavioral concerns is essential for the prevention of mental health problems; however, few suitable child-reported screening measures are available. Digital tools offer an exciting opportunity for obtaining clinical information from the child’s perspective. Objective: The aim of this study was to describe the initial development and pilot testing of the Interactive Child Distress Screener (ICDS). The ICDS is a Web-based screening instrument for the early identification of emotional and behavioral problems in children aged between 5 and 12 years. Methods: This paper utilized a mixed-methods approach to (1) develop and refine item content using an expert review process (study 1) and (2) develop and refine prototype animations and an app interface using codesign with child users (study 2). Study 1 involved an iterative process that comprised the following four steps: (1) the initial development of target constructs, (2) preliminary content validation (face validity, item importance, and suitability for animation) from an expert panel of researchers and psychologists (N=9), (3) item refinement, and (4) a follow-up validation with the same expert panel. Study 2 also comprised four steps, which are as follows: (1) the development of prototype animations, (2) the development of the app interface and a response format, (3) child interviews to determine feasibility and obtain feedback, and (4) refinement of animations and interface. Cognitive interviews were conducted with 18 children aged between 4 and 12 years who tested 3 prototype animated items. Children were asked to describe the target behavior, how well the animations captured the intended behavior, and provide suggestions for improvement. Their ability to understand the wording of instructions was also assessed, as well as the general acceptability of character and sound design. Results: In study 1, a revised list of 15 constructs was generated from the first and second round of expert feedback. These were rated highly in terms of importance (mean 6.32, SD 0.42) and perceived compatibility of items (mean 6.41, SD 0.45) on a 7-point scale. In study 2, overall feedback regarding the character design and sounds was positive. Children’s ability to understand intended behaviors varied according to target items, and feedback highlighted key objectives for improvements such as adding contextual cues or improving character detail. These design changes were incorporated through an iterative process, with examples presented. Conclusions: The ICDS has potential to obtain clinical information from the child’s perspective that may otherwise be overlooked. If effective, the ICDS will provide a quick, engaging, and easy-to-use screener that can be utilized in routine care settings. This project highlights the importance of involving an expert review and user codesign in the development of digital assessment tools for children. %M 29674310 %R 10.2196/mhealth.9456 %U http://mhealth.jmir.org/2018/4/e90/ %U https://doi.org/10.2196/mhealth.9456 %U http://www.ncbi.nlm.nih.gov/pubmed/29674310 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e61 %T Social Interaction Needs and Entertainment Approaches to Pregnancy Well-Being in mHealth Technology Design for Low-Income Transmigrant Women: Qualitative Codesign Study %A AlJaberi,Hana %+ Purdue Polytechnic Institute, Department of Computer Graphics Technology, Purdue University, 401 N Grant St, West Lafayette, IN, 47907, United States, 1 7654947505, aljaberi.hana@gmail.com %K mHealth %K mobile health %K participatory design %K pregnancy %K Caribbean %K immigrant women %D 2018 %7 13.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low-income Caribbean transmigrant women face unique health challenges during pregnancy that set forth multidimensional implications for the design of mobile health (mHealth). Acknowledgment of the unique health needs of low-income Caribbean immigrant women in the United States and what that entails regarding technology design remains rarely examined in the literature of mHealth technologies. Objective: The goal of this study was to reveal the needs and gaps in mHealth interventions for pregnant immigrant women not yet realized in this field. These understandings reveal design opportunities for mHealth. Methods: The use of the qualitative participatory action research approach of codesign workshops in this study resulted in design solutions by the participants after reflecting on their earlier focus group discussions. The highlights are not the resulting designs per se but rather the inferences derived from the researcher reflecting on these designs. Results: The designs exposed two themes relevant to this paper. First, the participants desired the inclusion and rebuilding of social and organizational relationships in mHealth. The resulting designs formulate an understanding of the women’s health-related social support needs and how technology can facilitate them. Second, the participants wanted entertainment with an element of social participation incorporated in mHealth pregnancy management interventions. This brings attention to the role entertainment can add to the impact mHealth can deliver for pregnancy well-being. Conclusions: The study concluded with an examination of social and entertainment design implications that reveal pregnant immigrant women’s virtual health-related sharing habits, choice of sharing interaction scenarios during pregnancy (eg, local, long distance, one-way, two-way, and many-many), and choice of sharing media (eg, text, voice, and video). Additionally, the study revealed exclusions to social sharing capabilities in health technologies for these women. %M 29653919 %R 10.2196/mhealth.7708 %U http://mhealth.jmir.org/2018/4/e61/ %U https://doi.org/10.2196/mhealth.7708 %U http://www.ncbi.nlm.nih.gov/pubmed/29653919 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e76 %T Women’s Perceptions of Using Mobile Phones for Maternal and Child Health Support in Afghanistan: Cross-Sectional Survey %A Yamin,Fazal %A Kaewkungwal,Jaranit %A Singhasivanon,Pratap %A Lawpoolsri,Saranath %+ Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithee Road, Ratchathewi, Bangkok,, Thailand, 66 2 306 9188, saranath.law@mahidol.ac.th %K Afghanistan %K mobile health %K maternal health, child health %K perception %K mobile phone %D 2018 %7 10.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Growing rates of global mobile subscriptions pave the way for implementation of mobile health (mHealth) initiatives, especially among hard-to-reach populations. Objective: This study aimed to determine the perceptions of Afghan women regarding the use of mobile phones for maternal and child health services. Methods: A cross-sectional survey was conducted in both rural and urban districts of Nangarhar Province, Afghanistan. The interviewer-administered questionnaire was used to assess participants’ demographic profile, mobile phone usage, and perception of respondents toward different aspects of health care delivery via mobile phones. Results: Of the 240 participants, 142 (59.2%) owned mobile phones and 220 (91.7%) routinely used mobile phones. Approximately 209 (87.1%) of participants were willing to receive health messages via a mobile phone. Automated voice call was the most preferred method for sending health messages. More than 90% of the women reported that they would like to receive reminders for their children’s vaccinations and antenatal care visits. Conclusions: Users’ perception was associated with mobile phone ownership, literacy level, and experience using mobile phones. In the study area, where the literacy rate is low, mHealth was well perceived. %M 29636317 %R 10.2196/mhealth.9504 %U http://mhealth.jmir.org/2018/4/e76/ %U https://doi.org/10.2196/mhealth.9504 %U http://www.ncbi.nlm.nih.gov/pubmed/29636317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e7 %T User-Centered Design of a Mobile App for Weight and Health Management in Adolescents With Complex Health Needs: Qualitative Study %A Rivera,Jordan %A McPherson,Amy C %A Hamilton,Jill %A Birken,Catherine %A Coons,Michael %A Peters,Michelle %A Iyer,Sindoora %A George,Tessy %A Nguyen,Cynthia %A Stinson,Jennifer %+ The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G0A4, Canada, 1 416 813 7654 ext 304514, jennifer.stinson@sickkids.ca %K obesity %K weight loss %K adolescent %K mobile apps %D 2018 %7 04.04.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted toward the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level health care. Objective: The aim of this study was to conduct a user-centered needs assessment of adolescents interested in weight management with complex health needs requiring specialized health care services, their parents, and health care providers (HCPs) to inform the design and development of a mobile app for weight and health management. Methods: A qualitative study design was employed. Participants were recruited from two tertiary health care centers. Separate audiotaped focus group interviews were conducted with adolescents aged 12 to 18 years, parents, and HCPs. Interviews were transcribed, and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVivo (QSR International) 10.0. Results: A total of 19 adolescents, 16 parents, and 21 HCPs were interviewed. Qualitative analysis revealed seven major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with HCPs, supporting mental health, gamification and incentives, and user interface (UI) design. Adolescents provided several ideas related to each feature, whereas parents’ views focused on assistance with meal planning and greater access to HCPs. HCPs viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with an HCP. Conclusions: This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized health care services toward the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to HCPs, features to support mental health, and an attractive and engaging UI. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs. %M 30684409 %R 10.2196/formative.8248 %U http://formative.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/formative.8248 %U http://www.ncbi.nlm.nih.gov/pubmed/30684409 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e72 %T Evaluating an mHealth App for Health and Well-Being at Work: Mixed-Method Qualitative Study %A de Korte,Elsbeth Marieke %A Wiezer,Noortje %A Janssen,Joris H %A Vink,Peter %A Kraaij,Wessel %+ Netherlands Organisation for Applied Scientific Research, Schipholweg 77-89, Leiden, 2316 ZL, Netherlands, 31 6 211 34434, elsbeth.dekorte@tno.nl %K mHealth %K work %K qualitative research methods %K interview %K focus group %K technology acceptance %K user satisfaction %K usability %K well-being %K prevention %D 2018 %7 28.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To improve workers’ health and well-being, workplace interventions have been developed, but utilization and reach are unsatisfactory, and effects are small. In recent years, new approaches such as mobile health (mHealth) apps are being developed, but the evidence base is poor. Research is needed to examine its potential and to assess when, where, and for whom mHealth is efficacious in the occupational setting. To develop interventions for workers that actually will be adopted, insight into user satisfaction and technology acceptance is necessary. For this purpose, various qualitative evaluation methods are available. Objective: The objectives of this study were to gain insight into (1) the opinions and experiences of employees and experts on drivers and barriers using an mHealth app in the working context and (2) the added value of three different qualitative methods that are available to evaluate mHealth apps in a working context: interviews with employees, focus groups with employees, and a focus group with experts. Methods: Employees of a high-tech company and experts were asked to use an mHealth app for at least 3 weeks before participating in a qualitative evaluation. Twenty-two employees participated in interviews, 15 employees participated in three focus groups, and 6 experts participated in one focus group. Two researchers independently coded, categorized, and analyzed all quotes yielded from these evaluation methods with a codebook using constructs from user satisfaction and technology acceptance theories. Results: Interviewing employees yielded 785 quotes, focus groups with employees yielded 266 quotes, and the focus group with experts yielded 132 quotes. Overall, participants muted enthusiasm about the app. Combined results from the three evaluation methods showed drivers and barriers for technology, user characteristics, context, privacy, and autonomy. A comparison between the three qualitative methods showed that issues revealed by experts only slightly overlapped with those expressed by employees. In addition, it was seen that the type of evaluation yielded different results. Conclusions: Findings from this study provide the following recommendations for organizations that are planning to provide mHealth apps to their workers and for developers of mHealth apps: (1) system performance influences adoption and adherence, (2) relevancy and benefits of the mHealth app should be clear to the user and should address users’ characteristics, (3) app should take into account the work context, and (4) employees should be alerted to their right to privacy and use of personal data. Furthermore, a qualitative evaluation of mHealth apps in a work setting might benefit from combining more than one method. Factors to consider when selecting a qualitative research method are the design, development stage, and implementation of the app; the working context in which it is being used; employees’ mental models; practicability; resources; and skills required of experts and users. %M 29592846 %R 10.2196/mhealth.6335 %U http://mhealth.jmir.org/2018/3/e72/ %U https://doi.org/10.2196/mhealth.6335 %U http://www.ncbi.nlm.nih.gov/pubmed/29592846 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e75 %T Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users’ Willingness to Pay: Web-Based Survey Among Older Adults %A Rasche,Peter %A Mertens,Alexander %A Brandl,Christopher %A Liu,Shan %A Buecking,Benjamin %A Bliemel,Christopher %A Horst,Klemens %A Weber,Christian David %A Lichte,Philipp %A Knobe,Matthias %+ Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Bergdriesch 27, Aachen, 52062, Germany, 49 0241 80 99 ext 477, p.rasche@iaw.rwth-aachen.de %K prevention %K cell phone %K accidents %D 2018 %7 27.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults’ fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. Objective: The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users’ satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. Methods: A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users’ expectations of a product and how their satisfaction is influenced by the availability of individual product features. Results: Five product features were identified to increase users’ acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants’ WTP was assessed after all 17 product features were rated and revealed a median monthly payment WTP rate of €5.00 (interquartile range 10.00). Conclusions: The results show various motivating product features that should be incorporated into a fall prevention smartphone app. Results reveal aspects that fall prevention and intervention designers should keep in mind to encourage individuals to start joining their program and facilitate long-term user engagement, resulting in a greater interest in fall risk prevention. %M 29588268 %R 10.2196/mhealth.9467 %U http://mhealth.jmir.org/2018/3/e75/ %U https://doi.org/10.2196/mhealth.9467 %U http://www.ncbi.nlm.nih.gov/pubmed/29588268 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e66 %T An mHealth Pain Coping Skills Training Intervention for Hematopoietic Stem Cell Transplantation Patients: Development and Pilot Randomized Controlled Trial %A Somers,Tamara J %A Kelleher,Sarah A %A Dorfman,Caroline S %A Shelby,Rebecca A %A Fisher,Hannah M %A Rowe Nichols,Krista %A Sullivan,Keith M %A Chao,Nelson J %A Samsa,Gregory P %A Abernethy,Amy P %A Keefe,Francis J %+ Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W Main St, Ste 340, Durham, NC, 27705, United States, 1 919 416 3408, tamara.somers@duke.edu %K stem cell transplantation %K hematopoietic stem cell %K cancer-related pain %K coping skills %D 2018 %7 19.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pain is a challenge for patients following hematopoietic stem cell transplantation (HCT). Objective: This study aimed to develop and test the feasibility, acceptability, and initial efficacy of a Web-based mobile pain coping skills training (mPCST) protocol designed to address the needs of HCT patients. Methods: Participants had undergone HCT and reported pain following transplant (N=68). To guide intervention development, qualitative data were collected from focus group participants (n=25) and participants who completed user testing (n=7). After their input was integrated into the mPCST intervention, a pilot randomized controlled trial (RCT, n=36) was conducted to examine the feasibility, acceptability, and initial efficacy of the intervention. Measures of acceptability, pain severity, pain disability, pain self-efficacy, fatigue, and physical disability (self-report and 2-min walk test [2MWT]) were collected. Results: Participants in the focus groups and user testing provided qualitative data that were used to iteratively refine the mPCST protocol. Focus group qualitative data included participants’ experiences with pain following transplant, perspectives on ways to cope with pain, and suggestions for pain management for other HCT patients. User testing participants provided feedback on the HCT protocol and information on the use of videoconferencing. The final version of the mPCST intervention was designed to bridge the intensive outpatient (1 in-person session) and home settings (5 videoconferencing sessions). A key component of the intervention was a website that provided personalized messages based on daily assessments of pain and activity. The website also provided intervention materials (ie, electronic handouts, short videos, and audio files). The intervention content included pain coping advice from other transplant patients and instructions on how to apply pain coping skills while engaging in meaningful and leisure activities. In the RCT phase of this research, HCT patients (n=36) were randomized to receive the mPCST intervention or to proceed with the treatment as usual. Results revealed that the mPCST participants completed an average of 5 out of 6 sessions. The participants reported that the intervention was highly acceptable (mean 3/4), and they found the sessions to be helpful (mean 8/10) and easy to understand (mean 7/7). The mPCST participants demonstrated significant improvements in pre- to post-treatment pain, self-efficacy (P=.03, d=0.61), and on the 2MWT (P=.03, d=0.66), whereas the patients in the treatment-as-usual group did not report any such improvements. Significant changes in pain disability and fatigue were found in both groups (multiple P<.02); the magnitudes of the effect sizes were larger for the mPCST group than for the control group (pain disability: d=0.79 vs 0.69; fatigue: d=0.94 vs 0.81). There were no significant changes in pain severity in either group. Conclusions: Using focus groups and user testing, we developed an mPCST protocol that was feasible, acceptable, and beneficial for HCT patients with pain. Trial Registration: ClinicalTrials.gov NCT01984671; https://clinicaltrials.gov/ct2/show/NCT01984671 (Archived by WebCite at http://www.webcitation.org/6xbpx3clZ) %M 29555620 %R 10.2196/mhealth.8565 %U http://mhealth.jmir.org/2018/3/e66/ %U https://doi.org/10.2196/mhealth.8565 %U http://www.ncbi.nlm.nih.gov/pubmed/29555620 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e51 %T More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design %A Giunti,Guido %A Mylonopoulou,Vasiliki %A Rivera Romero,Octavio %+ Salumedia Tecnologias, Avda. Republica Argentina nº 24, Edificio Torre de los Remedios 5ª planta modulo A, Sevilla, 41011, Spain, 34 717702622, drguidogiunti@gmail.com %K multiple sclerosis %K telemedicine %K fatigue %K mobile applications %K video games %K qualitative research %K exercise %K chronic disease %K user-computer interface %K software design %D 2018 %7 02.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end users’ needs and characteristics in the center of design and development, involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS, which presents an interesting area to explore. Objective: The purpose of this study was to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using UCD. Methods: Building on previous work of our team where we identified needs, barriers, and facilitators for mHealth apps for persons with MS, we followed UCD to design and evaluate a mobile app prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models (BCM). Usability was assessed through inspection methods using Nielsen’s heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day-to-day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth app such as the importance of metaphors in concept design, negotiate requirements with the BCM constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an app targeted for helping persons with MS in their fatigue management needs. We illustrate how UCD can help in designing mHealth apps and the benefits and challenges that designers might face when using this approach. This paper provides insight into the design process of gamified behavioral change mHealth apps and the negotiation process implied in it. %M 29500159 %R 10.2196/mhealth.9437 %U http://mhealth.jmir.org/2018/3/e51/ %U https://doi.org/10.2196/mhealth.9437 %U http://www.ncbi.nlm.nih.gov/pubmed/29500159 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e52 %T Crush the Crave: Development and Formative Evaluation of a Smartphone App for Smoking Cessation %A Baskerville,Neill B %A Struik,Laura L %A Dash,Darly %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2M 3G1, Canada, 1 519 888 4567 ext 35236, nbbaskerville@uwaterloo.ca %K mobile app %K smoking cessation %K young adult %K software design %K formative feedback %D 2018 %7 02.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Emerging evidence supports the use of smartphone apps for smoking cessation, especially in young adults given their high smoking rates and high smartphone ownership rates. Although evaluative evidence is encouraging for supporting smoking cessation, there remains a paucity of research describing the design and development processes of mobile health (mHealth) interventions. Objective: The aim of this paper was to describe the process of developing Crush the Crave (CTC), an evidence-informed app to support smoking cessation in young adults, and the results of a formative evaluation of app usage behavior, as part of a broader program of research that seeks to establish the effectiveness of the CTC app. Methods: The Spiral Technology Action Research (STAR) 5-cycle model (listen, plan, do, act, and study) was employed to guide the development, implementation, and dissemination of CTC. The approach to development and formative evaluation included focus groups with young adult smokers (n=78) across 2 phases, analysis of the content of existing apps, 2 sessions with content experts, and Google Analytics to assess user behavior during a 12-month pilot. Results: LISTEN—focus groups revealed young adult smoker preferences of (1) positive reinforcement, (2) personalization, (3) social support, (4) quit support, (5) tracking the behavior, and (6) tracking quit benefits. PLAN—informed by evidence for smoking cessation, young adult preferences and an assessment of popular cessation apps, content experts produced a mind map and a storyboard describing app content and structure. DO—focus groups with young adult smokers provided feedback on the first version of the app with opinions on content and suggestions for improvement such as providing alerts and distractions from craving. ACT—refinements were made, and app content was organized using the 4 key design components informed by principles of persuasive technology for behavior change: credibility, task support, dialogue support, and social support. CTC was launched in April 2013 and piloted from the period July 2013 to June 2014 where 1987 Android users had 18,567 sessions, resulting in 59,384 page views and 89.58% (1780/1987) of users returning within the same day to use CTC. STUDY—a pragmatic randomized controlled trial of CTC was launched in August 2014 to demonstrate that including mHealth technology as a population-based intervention can help young adult smokers to quit. The results of this phase will be presented in a subsequent publication. Conclusions: CTC is one of the first smoking cessation apps designed to meet the needs of young adult smokers. The development was informed by the inclusion of young adults in the design and the systematic application of multiple stakeholder input, scientific evidence, and theory. The STAR model approach was followed from the beginning of intervention development, which should facilitate optimization of mHealth interventions in the future. Trial Registration: ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i) %M 29500157 %R 10.2196/mhealth.9011 %U http://mhealth.jmir.org/2018/3/e52/ %U https://doi.org/10.2196/mhealth.9011 %U http://www.ncbi.nlm.nih.gov/pubmed/29500157 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 1 %N 1 %P e1 %T Acceptability and Feasibility of a Trial Testing Allocation to Sunscreen and a Smartphone App for Sun Protection: Discontinued Randomized Controlled Trial %A Rodrigues,Angela M %A Sniehotta,Falko F %A Birch-Machin,Mark A %A Olivier,Patrick %A Araújo-Soares,Vera %+ Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle, NE2 4AX, United Kingdom, 44 191 208 8974, angela.rodrigues@newcastle.ac.uk %K sunscreening agents %K sun protection factor %K smartphone %K mobile applications %K feasibility studies %K randomized controlled trial %K skin neoplasms %K melanoma %K skin aging %K holidays %K health promotion %K health behavior %D 2018 %7 27.02.2018 %9 Original Paper %J JMIR Dermatol %G English %X Background: Recreational sun exposure has been associated with melanoma prevalence, and tourism settings are of particular interest for skin cancer prevention. Effective, affordable, and geographically flexible interventions to promote sun protection are needed. Objective: The aim of this study was to describe the protocol for a definitive randomized controlled trial (RCT) evaluating a smartphone mobile intervention (mISkin app) promoting sun protection in holidaymakers and to assess the acceptability and feasibility of the mISkin app and associated trial procedures in an internal pilot study. Methods: Participants were recruited from the general community. Holidaymakers traveling abroad and owning a smartphone were enrolled in the internal pilot of a 2 (mISkin vs control) x 2 (sun protection factor [SPF] 15 vs SPF 30) RCT with a postholiday follow-up. The smartphone app is fully automated and entails a behavioral intervention to promote sun protection. It consisted of five components: skin assessment, educational videos, ultraviolet (UV) photos, gamification, and prompts for sun protection. Participants were also randomly allocated to receive sunscreen SPF 15 or SPF 30. Primary outcomes for the internal pilot study were acceptability and feasibility of trial procedures and intervention features. Secondary outcomes were collected at baseline and after holidays through face-to-face-assessments and included skin sun damage, sunscreen use (residual weight and application events), and sun protection practices (Web-based questionnaire). Results: From 142 registers of interest, 42 participants were randomized (76% [32/42] female; mean age 35.5 years). Outcome assessments were completed by all participants. Random allocation to SPF 15 versus SPF 30 was found not to be feasible in a definitive trial protocol. Of the 21 people allocated to the mISkin intervention, 19 (91%) installed the mISkin on their phones, and 18 (86%) used it at least once. Participants were satisfied with the mISkin app and made suggestions for further improvements. Due to difficulties with the random allocation to SPF and slow uptake, the trial was discontinued. Conclusions: The internal pilot study concluded that randomization to SPF was not feasible and that recruitment rate was slower than expected because of difficulties with gatekeeper engagement. Possible solutions to the problems identified are discussed. Further refinements to the mISkin app are needed before a definitive trial. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN63943558; http://www.isrctn.com/ISRCTN63943558 (Archived by WebCite at http://www.webcitation.org/6xOLvbab8) %R 10.2196/derma.8608 %U https://derma.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/derma.8608 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e45 %T Mobile App Delivery of the EORTC QLQ-C30 Questionnaire to Assess Health-Related Quality of Life in Oncological Patients: Usability Study %A Kessel,Kerstin A %A Vogel,Marco ME %A Alles,Anna %A Dobiasch,Sophie %A Fischer,Hanna %A Combs,Stephanie E %+ Department of Radiation Oncology, Technical University of Munich, Ismaninger Straße 22, Munich, 81675, Germany, 49 0894140 ext 4502, kerstin.kessel@tum.de %K radiation oncology %K healthcare surveys %K mobile applications %K mobile apps %K telemedicine %K health-related quality of life %K questionnaires %K oncology  %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are evolving in the medical field. However, ongoing discussions have questioned whether such apps are really valuable and whether patients will accept their use in day-to-day clinical life. Therefore, we initiated a usability study in our department. Objective: We present our results of the first app prototype and patient testing of health-related quality of life (HRQoL) assessment in oncological patients. Methods: We developed an app prototype for the iOS operating system within eight months in three phases: conception, initial development, and pilot testing. For the HRQoL assessment, we chose to implement only the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30; German version 3). Usability testing was conducted for three months. Participation was voluntary and pseudonymized. After completion of the QLQ-C30 questionnaire using iPads provided by our department, we performed a short survey with 10 questions. This survey inquired about patients’ opinions regarding general aspects, including technical advances in medicine, mobile and app assistance during cancer treatment, and the app-specific functions (eg, interface and navigation). Results: After logging into the app, the user can choose between starting a questionnaire, reviewing answers (administrators only), and logging out. The questionnaire is displayed with the same information, questions, and answers as on the original QLQ-C30 sheet. No alterations in wording were made. Usability was tested with 81 patients; median age was 55 years. The median time for completing the HRQoL questionnaire on the iPad was 4.0 minutes. Of all participants, 84% (68/81) owned a mobile device. Similarly, 84% (68/81) of participants would prefer a mobile version of the HRQoL questionnaire instead of a paper-based version. Using the app in daily life during and after cancer treatment would be supported by 83% (67/81) of participants. In the prototype version of the app, data were stored on the device; in the future, 79% (64/81) of the patients would agree to transfer data via the Internet. Conclusions: Our usability test showed good results regarding attractiveness, operability, and understandability. Moreover, our results demonstrate a high overall acceptance of mobile apps and telemedicine in oncology. The HRQoL assessment via the app was accepted thoroughly by patients, and individuals are keen to use it in clinical routines, while data privacy and security must be ensured. %M 29463489 %R 10.2196/mhealth.9486 %U http://mhealth.jmir.org/2018/2/e45/ %U https://doi.org/10.2196/mhealth.9486 %U http://www.ncbi.nlm.nih.gov/pubmed/29463489 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e44 %T A Smartphone App to Promote an Active Lifestyle in Lower-Educated Working Young Adults: Development, Usability, Acceptability, and Feasibility Study %A Simons,Dorien %A De Bourdeaudhuij,Ilse %A Clarys,Peter %A De Cocker,Katrien %A Vandelanotte,Corneel %A Deforche,Benedicte %+ Health Promotion and Education Unit, Department of Public Health, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium, 32 498457442, dorien.simons@ugent.be %K mHealth %K young adult %K mobile applications %K physical activity %K active transport %K health promotion %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) levels are problematic in lower-educated working young adults (18-26 years). To promote PA, smartphone apps have great potential, but there is no evidence for their effectiveness in this population. To increase the likelihood that a newly developed app will be effective, formative research and user testing are required. Objective: The aim of this study was to describe the development, usability, acceptability, and feasibility of a new theory- and evidence-based smartphone app to promote an active lifestyle in lower-educated working young adults. Methods: The new app was developed by applying 4 steps. First, determinants important to promote an active lifestyle in this population were selected. Second, evidence-based behavior change techniques were selected to convert the determinants into practical applications. Third, a new smartphone app was developed. Fourth, volunteers (n=11, both lower and higher educated) tested the app on usability, and lower-educated working young adults (n=16) tested its acceptability and feasibility via (think aloud) interviews, a questionnaire, and Google Analytics. The app was accordingly adapted for the final version. Results: A new Android app, Active Coach, was developed that focused on knowledge, attitude, social support, and self-efficacy (based on outcomes from step 1), and that applied self-regulation techniques (based on outcomes from step 2). The app consists of a 9-week program with personal goals, practical tips, and scientific facts to encourage an active lifestyle. To ensure all-day and automatic self-monitoring of the activity behavior, the Active Coach app works in combination with a wearable activity tracker, the Fitbit Charge. Issues detected by the usability test (eg, text errors, wrong messages) were all fixed. The acceptability and feasibility test showed that participants found the app clear, understandable, and motivating, although some aspects needed to be more personal. Conclusions: By applying a stepwise, user-centered approach that regularly consulted the target group, the new app is adapted to their specific needs and preferences. The Active Coach app was overall positively evaluated by the lower-educated working young adults at the end of the development process. %M 29463491 %R 10.2196/mhealth.8287 %U http://mhealth.jmir.org/2018/2/e44/ %U https://doi.org/10.2196/mhealth.8287 %U http://www.ncbi.nlm.nih.gov/pubmed/29463491 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e38 %T Digital Peer-Support Platform (7Cups) as an Adjunct Treatment for Women With Postpartum Depression: Feasibility, Acceptability, and Preliminary Efficacy Study %A Baumel,Amit %A Tinkelman,Amanda %A Mathur,Nandita %A Kane,John M %+ Department of Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa,, Israel, 972 482 4011, abaumel@univ.haifa.ac.il %K mhealth %K postpartum depression %K perinatal mood disorder %K peer support %K online %K self-help %D 2018 %7 13.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Peer support is considered to be an important framework of support for mothers experiencing postpartum depression (PPD); however, some barriers exist that may limit its use including peer availability and mothers’ lack of time due to child care. Objective: This non-randomized study was designed to examine the feasibility, acceptance, and preliminary clinical outcomes of using 7 Cups of Tea (7Cups), a digital platform that delivers self-help tools and 24/7 emotional support delivered by trained volunteers, as an adjunct treatment for mothers diagnosed with PPD. Methods: Mothers with PPD were referred during intake to the study coach who provided guidance about 7Cups. 7Cups features included self-help tools and chats with trained volunteers who had experienced a perinatal mood disorder in their past. Acceptability was measured by examining self-reports and user engagement with the program. The primary outcome was the Edinburgh Postnatal Depression Scale (EPDS) change score between pre- and postintervention at 2 months, as collected in usual care by clinicians blinded to the study questions. Using a propensity score matching to control for potential confounders, we compared women receiving 7Cups to women receiving treatment as usual (TAU). Results: Participants (n=19) proactively logged into 7Cups for a median of 12 times and 175 minutes. Program use was mostly through the mobile app (median of mobile use 94%) and between 18:00 and 08:00 when clinicians are unavailable (68% of total program use time). Participants chatted with volunteers for a total of 3064 minutes and have indicated in their responses 0 instances in which they felt unsafe. Intent-to-treat analysis revealed that 7Cups recipients experienced significant decreases in EPDS scores (P<.001, Cohen d=1.17). No significant difference in EPDS decrease over time was found between 7Cups and TAU, yet the effect size was medium favoring 7Cups (P=.05, Cohen d=0.58). Conclusions: This study supports using a computerized method to train lay people, without any in-person guidance or screening, and engage them with patients diagnosed with mental illness as part of usual care. The medium effect size (d=0.58) favoring the 7Cups group relative to TAU suggests that 7Cups might enhance treatment outcomes. A fully powered trial has to be conducted to examine this effect. %M 29439944 %R 10.2196/mhealth.9482 %U http://mhealth.jmir.org/2018/2/e38/ %U https://doi.org/10.2196/mhealth.9482 %U http://www.ncbi.nlm.nih.gov/pubmed/29439944 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e33 %T A Wearable Sensor-Based Exercise Biofeedback System: Mixed Methods Evaluation of Formulift %A O'Reilly,Martin Aidan %A Slevin,Patrick %A Ward,Tomas %A Caulfield,Brian %+ Insight Centre for Data Analytics, University College Dublin, O'Brien Centre for Science, 3rd Fl, Belfield, Dublin, D4, Ireland, 353 871245972, martin.oreilly@insight-centre.org %K mHealth %K feedback %K posture %K exercise therapy %K biomedical technology %K lower extremity %K physical therapy specialty %D 2018 %7 31.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Formulift is a newly developed mobile health (mHealth) app that connects to a single inertial measurement unit (IMU) worn on the left thigh. The IMU captures users’ movements as they exercise, and the app analyzes the data to count repetitions in real time and classify users’ exercise technique. The app also offers feedback and guidance to users on exercising safely and effectively. Objective: The aim of this study was to assess the Formulift system with three different and realistic types of potential users (beginner gym-goers, experienced gym-goers, and qualified strength and conditioning [S&C] coaches) under a number of categories: (1) usability, (2) functionality, (3) the perceived impact of the system, and (4) the subjective quality of the system. It was also desired to discover suggestions for future improvements to the system. Methods: A total of 15 healthy volunteers participated (12 males; 3 females; age: 23.8 years [SD 1.80]; height: 1.79 m [SD 0.07], body mass: 78.4 kg [SD 9.6]). Five participants were beginner gym-goers, 5 were experienced gym-goers, and 5 were qualified and practicing S&C coaches. IMU data were first collected from each participant to create individualized exercise classifiers for them. They then completed a number of nonexercise-related tasks with the app. Following this, a workout was completed using the system, involving squats, deadlifts, lunges, and single-leg squats. Participants were then interviewed about their user experience and completed the System Usability Scale (SUS) and the user version of the Mobile Application Rating Scale (uMARS). Thematic analysis was completed on all interview transcripts, and survey results were analyzed. Results: Qualitative and quantitative analysis found the system has “good” to “excellent” usability. The system achieved a mean (SD) SUS usability score of 79.2 (8.8). Functionality was also deemed to be good, with many users reporting positively on the systems repetition counting, technique classification, and feedback. A number of bugs were found, and other suggested changes to the system were also made. The overall subjective quality of the app was good, with a median star rating of 4 out of 5 (interquartile range, IQR: 3-5). Participants also reported that the system would aid their technique, provide motivation, reassure them, and help them avoid injury. Conclusions: This study demonstrated an overall positive evaluation of Formulift in the categories of usability, functionality, perceived impact, and subjective quality. Users also suggested a number of changes for future iterations of the system. These findings are the first of their kind and show great promise for wearable sensor-based exercise biofeedback systems. %M 29386171 %R 10.2196/mhealth.8115 %U http://mhealth.jmir.org/2018/1/e33/ %U https://doi.org/10.2196/mhealth.8115 %U http://www.ncbi.nlm.nih.gov/pubmed/29386171 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e25 %T Young People’s, Parents’, and Professionals’ Views on Required Components of Mobile Apps to Support Self-Management of Juvenile Arthritis: Qualitative Study %A Waite-Jones,Jennifer M %A Majeed-Ariss,Rabiya %A Smith,Joanna %A Stones,Simon R %A Van Rooyen,Vanessa %A Swallow,Veronica %+ Faculty of Science, Charles Sturt University, Building 1293 Room 2, Bathurst,, Australia, 61 0419 490 431, v.m.swallow@leeds.ac.uk %K Adolescent %K young people %K juvenile arthritis %K mobile apps %K self-management %K qualitative research %D 2018 %7 19.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is growing evidence that supporting self-management of Juvenile Arthritis can benefit both patients and professionals. Young people with Juvenile Arthritis and their healthy peers increasingly use mobile technologies to access information and support in day-to-day life. Therefore, a user-led, rigorously developed and evaluated mobile app could be valuable for facilitating young people’s self-management of Juvenile Arthritis. Objective: The objective of this study was to seek the views of young people with Juvenile Arthritis, their parents or carers, and health care professionals (HCPs) as to what should be included in a mobile app to facilitate young people’s self-management of chronic Juvenile Arthritis. Methods: A qualitative approach was adopted with a purposeful sample of 9 young people aged 10-18 years with Juvenile Arthritis, 8 parents or carers, and 8 HCPs involved in their care. Data were gathered through semi-structured focus group and individual interviews with young people and their parents or carers and HCPs. Interview discussion was facilitated through demonstration of four existing health apps to explore participants’ views on strengths and limitations of these, barriers and facilitators to mobile app use, preferred designs, functionality, levels of interaction, and data sharing arrangements. Data were analyzed using the framework approach. Results: Analysis revealed three interlinked, overarching themes: (1) purpose, (2) components and content, and (3) social support. Despite some differences in emphasis on essential content, general agreement was found between young people with Juvenile Arthritis their parents or carers, and professionals that a mobile app to aid self-management would be useful. Underpinning the themes was a prerequisite that young people are enabled to feel a sense of ownership and control of the app, and that it be an interactive, engaging resource that offers developmentally appropriate information and reminders, as well as enabling them to monitor their symptoms and access social support. Conclusions: Findings justify and pave the way for a future feasibility study into the production and preliminary testing of such an app. This would consider issues such as compatibility with existing technologies, costs, age, and cross-gender appeal as well as resource implications. %M 29351898 %R 10.2196/mhealth.9179 %U http://mhealth.jmir.org/2018/1/e25/ %U https://doi.org/10.2196/mhealth.9179 %U http://www.ncbi.nlm.nih.gov/pubmed/29351898 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e2 %T Digital Health Innovation: A Toolkit to Navigate From Concept to Clinical Testing %A Marvel,Francoise Adeline %A Wang,Jane %A Martin,Seth Shay %+ Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 7th Floor, Baltimore, MD, 21287, United States, 1 4105020469, fmarvel1@jhmi.edu %K digital health innovation models %K mHealth %K innovation framework %K development of smartphone applications %K wearable technology %K healthcare transformation %D 2018 %7 18.01.2018 %9 Viewpoint %J JMIR Cardio %G English %X Digital health technologies such as smartphone apps, Web-based platforms, and wearable devices are rapidly emerging as promising interventions for acute and chronic disease management, particularly in the field of cardiovascular medicine. However, there is limited guidance on how to effectively develop and rigorously test digital health interventions (DHIs). Through our experience with innovating Corrie, a smartphone-based app paired with a smartwatch and blood pressure monitor for myocardial infarction recovery in the acute setting, we aim to provide a toolkit for navigating the digital health technology development and clinical testing processes. The toolkit consists of 6 steps: step one emphasizes concept generation by defining a specific clinical problem and the existing solutions aimed to address it; step two aims to recruit a multidisciplinary team within an academic institution; step three leverages technology accelerators and industry partnerships; step four develops the digital health technology with continuous feedback from patient and family end-users; step five solicits feedback from a diverse array of stakeholders; and step six performs a clinical study at a single site that, if successful, rapidly scales to multiple sites. DHI development is often a complex and vastly uncharted territory. By exploring the steps we took from concept to clinical testing with the first cardiology CareKit app, we hope to provide useful insights to teams that are starting out on their path to digital health innovation. We emphasize the central importance of embracing transdisciplinary work to move from silos to synergy. %M 31758761 %R 10.2196/cardio.7586 %U http://cardio.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/cardio.7586 %U http://www.ncbi.nlm.nih.gov/pubmed/31758761 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 1 %P e2 %T User-Centered Design of Learn to Quit, a Smoking Cessation Smartphone App for People With Serious Mental Illness %A Vilardaga,Roger %A Rizo,Javier %A Zeng,Emily %A Kientz,Julie A %A Ries,Richard %A Otis,Chad %A Hernandez,Kayla %+ Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, 2812 Erwin Road, Suite 403 Box 13, Durham, NC, 27705, United States, 1 9196813441, roger.vilardaga@duke.edu %K smoking cessation %K mHealth %K serious mental illness %K user-centered design %K gamification %K acceptance and commitment therapy %D 2018 %7 16.01.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Smoking rates in the United States have been reduced in the past decades to 15% of the general population. However, up to 88% of people with psychiatric symptoms still smoke, leading to high rates of disease and mortality. Therefore, there is a great need to develop smoking cessation interventions that have adequate levels of usability and can reach this population. Objective: The objective of this study was to report the rationale, ideation, design, user research, and final specifications of a novel smoking cessation app for people with serious mental illness (SMI) that will be tested in a feasibility trial. Methods: We used a variety of user-centered design methods and materials to develop the tailored smoking cessation app. This included expert panel guidance, a set of design principles and theory-based smoking cessation content, development of personas and paper prototyping, usability testing of the app prototype, establishment of app’s core vision and design specification, and collaboration with a software development company. Results: We developed Learn to Quit, a smoking cessation app designed and tailored to individuals with SMI that incorporates the following: (1) evidence-based smoking cessation content from Acceptance and Commitment Therapy and US Clinical Practice Guidelines for smoking cessation aimed at providing skills for quitting while addressing mental health symptoms, (2) a set of behavioral principles to increase retention and comprehension of smoking cessation content, (3) a gamification component to encourage and sustain app engagement during a 14-day period, (4) an app structure and layout designed to minimize usability errors in people with SMI, and (5) a set of stories and visuals that communicate smoking cessation concepts and skills in simple terms. Conclusions: Despite its increasing importance, the design and development of mHealth technology is typically underreported, hampering scientific innovation. This report describes the systematic development of the first smoking cessation app tailored to people with SMI, a population with very high rates of nicotine addiction, and offers new design strategies to engage this population. mHealth developers in smoking cessation and related fields could benefit from a design strategy that capitalizes on the role visual engagement, storytelling, and the systematic application of behavior analytic principles to deliver evidence-based content. %M 29339346 %R 10.2196/games.8881 %U http://games.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/games.8881 %U http://www.ncbi.nlm.nih.gov/pubmed/29339346 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e1 %T Internet-Based Group Intervention for Ovarian Cancer Survivors: Feasibility and Preliminary Results %A Kinner,Ellen M %A Armer,Jessica S %A McGregor,Bonnie A %A Duffecy,Jennifer %A Leighton,Susan %A Corden,Marya E %A Gauthier Mullady,Janine %A Penedo,Frank J %A Lutgendorf,Susan K %+ Department of Psychological & Brain Sciences, University of Iowa, W322 Seashore Hall, Iowa City, IA, 52242, United States, 1 319 335 2432, susan-lutgendorf@uiowa.edu %K ovarian cancer %K quality of life %K feasibility studies %K eHealth %K psychological stress %D 2018 %7 15.01.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Development of psychosocial group interventions for ovarian cancer survivors has been limited. Drawing from elements of cognitive-behavioral stress management (CBSM), mindfulness-based stress reduction (MBSR), and acceptance and commitment therapy (ACT), we developed and conducted preliminary testing of an Internet-based group intervention tailored specifically to meet the needs of ovarian cancer survivors. The Internet-based platform facilitated home delivery of the psychosocial intervention to a group of cancer survivors for whom attending face-to-face programs could be difficult given their physical limitations and the small number of ovarian cancer survivors at any one treatment site. Objective: The aim of this study was to develop, optimize, and assess the usability, acceptability, feasibility, and preliminary intended effects of an Internet-based group stress management intervention for ovarian cancer survivors delivered via a tablet or laptop. Methods: In total, 9 ovarian cancer survivors provided feedback during usability testing. Subsequently, 19 survivors participated in 5 waves of field testing of the 10-week group intervention led by 2 psychologists. The group met weekly for 2 hours via an Internet-based videoconference platform. Structured interviews and weekly evaluations were used to elicit feedback on the website and intervention content. Before and after the intervention, measures of mood, quality of life (QOL), perceived stress, sleep, and social support were administered. Paired t tests were used to examine changes in psychosocial measures over time. Results: Usability results indicated that participants (n=9) performed basic tablet functions quickly with no errors and performed website functions easily with a low frequency of errors. In the field trial (n=19), across 5 groups, the 10-week intervention was well attended. Perceived stress (P=.03) and ovarian cancer-specific QOL (P=.01) both improved significantly during the course of the intervention. Trends toward decreased distress (P=.18) and greater physical (P=.05) and functional well-being (P=.06) were also observed. Qualitative interviews revealed that the most common obstacles participants experienced were technical issues and the time commitment for practicing the techniques taught in the program. Participants reported that the intervention helped them to overcome a sense of isolation and that they appreciated the ability to participate at home. Conclusions: An Internet-based group intervention tailored specifically for ovarian cancer survivors is highly usable and acceptable with moderate levels of feasibility. Preliminary psychosocial outcomes indicate decreases in perceived stress and improvements in ovarian cancer-specific QOL following the intervention. A randomized clinical trial is needed to demonstrate the efficacy of this promising intervention for ovarian cancer survivors. %M 29335233 %R 10.2196/cancer.8430 %U http://cancer.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/cancer.8430 %U http://www.ncbi.nlm.nih.gov/pubmed/29335233 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e6 %T Development of a Maternal, Newborn and Child mHealth Intervention in Thai Nguyen Province, Vietnam: Protocol for the mMom Project %A McBride,Bronwyn %A Nguyen,Liem Thanh %A Wiljer,David %A Vu,Nguyen C %A Nguyen,Cuong K %A O'Neil,John %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada, 1 778 782 5361, joneil@sfu.ca %K mobile health %K Vietnam %K maternal health %K reproductive health %K health equity %D 2018 %7 11.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Ethnic minority women (EMW) living in mountainous areas of northern Vietnam have disproportionately high infant and maternal mortality rates as a result of low maternal health knowledge, poverty, and remoteness from low-capacity health centers. Objective: The objective of this study was to describe the protocol for the development and evaluation of the mMom intervention, which is an integrated mobile health (mHealth) system designed to improve maternal and infant health knowledge, and behavior among women in remote areas of Thai Nguyen, Vietnam. Methods: This project featured the following four phases: (1) development of an mHealth platform integrated into the existing health management information system in partnership with the provincial health department; (2) ethnographic fieldwork and intervention content development; (3) intervention piloting and implementation; and (4) evaluation of the intervention’s impact on participants’ maternal health knowledge, behavior, and interactions with the health system. Results: The mMom project development process resulted in the following: (1) the successful development of the mMom system, including the mHealth platform hardware and integration, the intervention plan and content, and the monitoring and evaluation framework; (2) the piloting and implementation of the intervention as planned; and (3) the implementation of the monitoring and evaluation framework components. Conclusions: This protocol outlines the development of the mMom intervention and describes critical next steps in understanding the impact of the intervention on participants and the wider health system in Thai Nguyen province, Vietnam. %M 29326095 %R 10.2196/resprot.7912 %U http://www.researchprotocols.org/2018/1/e6/ %U https://doi.org/10.2196/resprot.7912 %U http://www.ncbi.nlm.nih.gov/pubmed/29326095 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e11 %T Usage of an Exercise App in the Care for People With Osteoarthritis: User-Driven Exploratory Study %A Danbjørg,Dorthe Boe %A Villadsen,Allan %A Gill,Ester %A Rothmann,Mette Juel %A Clemensen,Jane %+ Centre for Innovative Medical Technology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Sdr Boulevard 29, Odense, 5000, Denmark, 45 26202186, dortheboe@gmail.com %K arthritis %K rehabilitation %K telemedicine %D 2018 %7 11.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Exercise has proven to reduce pain and increase quality of life among people living with osteoarthritis (OA). However, one major challenge is adherence to exercise once supervision ends. Objective: This study aimed to identify mental and physical barriers and motivational and social aspects of training at home, and to test or further develop an exercise app. Methods: The study was inspired from participatory design, engaging users in the research process. Data were collected through focus groups and workshops, and analyzed by systematic text condensation. Results: Three main themes were found: competition as motivation, training together, and barriers. The results revealed that the participants wanted to do their training and had knowledge on exercise and pain but found it hard to motivate themselves. They missed the observation, comments, and encouragement by the supervising physiotherapist as well as their peers. Ways to optimize the training app were identified during the workshops as participants shared their experience. Conclusions: This study concludes that the long-term continuation of exercising for patients with OA could be improved with the use of a technology tailored to users’ needs, including motivational and other behavioral factors. %M 29326092 %R 10.2196/mhealth.7734 %U https://mhealth.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/mhealth.7734 %U http://www.ncbi.nlm.nih.gov/pubmed/29326092 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e6 %T Development and Evaluation of a Mobile Personalized Blood Glucose Prediction System for Patients With Gestational Diabetes Mellitus %A Pustozerov,Evgenii %A Popova,Polina %A Tkachuk,Aleksandra %A Bolotko,Yana %A Yuldashev,Zafar %A Grineva,Elena %+ Department of Biomedical Engineering, Saint Petersburg State Electrotechnical University, Professora Popova, 5, Saint Petersburg, 197376, Russian Federation, 7 812 234 01 33, pustozerov.e@gmail.com %K blood glucose prediction %K mHealth %K gestational diabetes mellitus %K recommender system %K personalized medicine %K mobile app %D 2018 %7 09.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personalized blood glucose (BG) prediction for diabetes patients is an important goal that is pursued by many researchers worldwide. Despite many proposals, only a few projects are dedicated to the development of complete recommender system infrastructures that incorporate BG prediction algorithms for diabetes patients. The development and implementation of such a system aided by mobile technology is of particular interest to patients with gestational diabetes mellitus (GDM), especially considering the significant importance of quickly achieving adequate BG control for these patients in a short period (ie, during pregnancy) and a typically higher acceptance rate for mobile health (mHealth) solutions for short- to midterm usage. Objective: This study was conducted with the objective of developing infrastructure comprising data processing algorithms, BG prediction models, and an appropriate mobile app for patients’ electronic record management to guide BG prediction-based personalized recommendations for patients with GDM. Methods: A mobile app for electronic diary management was developed along with data exchange and continuous BG signal processing software. Both components were coupled to obtain the necessary data for use in the personalized BG prediction system. Necessary data on meals, BG measurements, and other events were collected via the implemented mobile app and continuous glucose monitoring (CGM) system processing software. These data were used to tune and evaluate the BG prediction model, which included an algorithm for dynamic coefficients tuning. In the clinical study, 62 participants (GDM: n=49; control: n=13) took part in a 1-week monitoring trial during which they used the mobile app to track their meals and self-measurements of BG and CGM system for continuous BG monitoring. The data on 909 food intakes and corresponding postprandial BG curves as well as the set of patients’ characteristics (eg, glycated hemoglobin, body mass index [BMI], age, and lifestyle parameters) were selected as inputs for the BG prediction models. Results: The prediction results by the models for BG levels 1 hour after food intake were root mean square error=0.87 mmol/L, mean absolute error=0.69 mmol/L, and mean absolute percentage error=12.8%, which correspond to an adequate prediction accuracy for BG control decisions. Conclusions: The mobile app for the collection and processing of relevant data, appropriate software for CGM system signals processing, and BG prediction models were developed for a recommender system. The developed system may help improve BG control in patients with GDM; this will be the subject of evaluation in a subsequent study. %M 29317385 %R 10.2196/mhealth.9236 %U http://mhealth.jmir.org/2018/1/e6/ %U https://doi.org/10.2196/mhealth.9236 %U http://www.ncbi.nlm.nih.gov/pubmed/29317385 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e203 %T Insights From Google Play Store User Reviews for the Development of Weight Loss Apps: Mixed-Method Analysis %A Frie,Kerstin %A Hartmann-Boyce,Jamie %A Jebb,Susan %A Albury,Charlotte %A Nourse,Rebecca %A Aveyard,Paul %+ Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865289317, kerstin.frie@phc.ox.ac.uk %K weight loss %K mobile applications %K telemedicine %K consumer behavior %D 2017 %7 22.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Significant weight loss takes several months to achieve, and behavioral support can enhance weight loss success. Weight loss apps could provide ongoing support and deliver innovative interventions, but to do so, developers must ensure user satisfaction. Objective: The aim of this study was to conduct a review of Google Play Store apps to explore what users like and dislike about weight loss and weight-tracking apps and to examine qualitative feedback through analysis of user reviews. Methods: The Google Play Store was searched and screened for weight loss apps using the search terms weight loss and weight track*, resulting in 179 mobile apps. A content analysis was conducted based on the Oxford Food and Activity Behaviors taxonomy. Correlational analyses were used to assess the association between complexity of mobile health (mHealth) apps and popularity indicators. The sample was then screened for popular apps that primarily focus on weight-tracking. For the resulting subset of 15 weight-tracking apps, 569 user reviews were sampled from the Google Play Store. Framework and thematic analysis of user reviews was conducted to assess which features users valued and how design influenced users’ responses. Results: The complexity (number of components) of weight loss apps was significantly positively correlated with the rating (r=.25; P=.001), number of reviews (r=.28; P<.001), and number of downloads (r=.48; P<.001) of the app. In contrast, in the qualitative analysis of weight-tracking apps, users expressed preference for simplicity and ease of use. In addition, we found that positive reinforcement through detailed feedback fostered users’ motivation for further weight loss. Smooth functioning and reliable data storage emerged as critical prerequisites for long-term app usage. Conclusions: Users of weight-tracking apps valued simplicity, whereas users of comprehensive weight loss apps appreciated availability of more features, indicating that complexity demands are specific to different target populations. The provision of feedback on progress can motivate users to continue their weight loss attempts. Users value seamless functioning and reliable data storage. %M 29273575 %R 10.2196/mhealth.8791 %U http://mhealth.jmir.org/2017/12/e203/ %U https://doi.org/10.2196/mhealth.8791 %U http://www.ncbi.nlm.nih.gov/pubmed/29273575 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e7 %T Identifying Asbestos-Containing Materials in Homes: Design and Development of the ACM Check Mobile Phone App %A Govorko,Matthew Hayden %A Fritschi,Lin %A White,James %A Reid,Alison %+ School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, 6845, Australia, 61 8 9266 1361, alison.reid@curtin.edu.au %K application development %K asbestos %K asbestos-containing materials %K mobile phones %K smartphone %K residential environment %K mobile applications %K environment and public health %D 2017 %7 14.12.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Asbestos-containing materials (ACMs) can still be found in many homes in Australia and other countries. ACMs present a health risk when they are damaged or disturbed, such as during do-it-yourself home renovations. However, community members lack knowledge and awareness about asbestos identification and its safe management in residential settings. Objective: The objective of our study was to describe the process of developing a mobile phone app, ACM Check, that incorporates a questionnaire designed to identify and assess ACMs located in residential settings. Methods: A multidisciplinary team was involved in the formative development and creation of the mobile phone app. The formative development process comprised 6 steps: defining the scope of the app; conducting a comprehensive desktop review by searching online literature databases, as well as a wider online search for gray literature; drafting and revising the content, questionnaire, conditional branching rules, and scoring algorithms; obtaining expert input; manually pretesting the questionnaire; and formulating a final content document to be provided to the software development company. We then constructed ACM Check on the iOS platform for use in a validation study, and then updated the app, replicated it on Android, and released it to the public. Results: The ACM Check app identifies potential ACMs, prioritizes the materials based on their condition and likelihood of disturbance, and generates a summary report for each house assessed. Conclusions: ACM Check is an initiative to raise community members’ awareness of asbestos in the residential environment and also serves as a data collection tool for epidemiologic research. It can potentially be modified for implementation in other countries or used as the basis for the assessment of other occupational or environmental hazards. %M 30684427 %R 10.2196/formative.8370 %U http://formative.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/formative.8370 %U http://www.ncbi.nlm.nih.gov/pubmed/30684427 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e174 %T Developing mHealth Messages to Promote Postmenstrual Regulation Contraceptive Use in Bangladesh: Participatory Interview Study %A Eckersberger,Elisabeth %A Pearson,Erin %A Andersen,Kathryn %A Hossain,Altaf %A Footman,Katharine %A Biswas,Kamal Kanti %A Nuremowla,Sadid %A Reiss,Kate %+ Ipas, PO Box 9990, Chapel Hill, NC, 27515, United States, 1 9199677052, eckersbergere@ipas.org %K abortion %K reproductive health services %K contraception %K family planning %K mHealth %K Bangladesh %D 2017 %7 14.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Abortions are restricted in Bangladesh, but menstrual regulation is an approved alternative, defined as a procedure of regulating the menstrual cycle when menstruation is absent for a short duration. Use of contraception after menstrual regulation can reduce subsequent unintended pregnancy, but in Bangladesh, the contraceptive method mix is dominated by short-term methods, which have higher discontinuation and failure rates. Mobile phones are a channel via which menstrual regulation clients could be offered contraceptive support after leaving the clinic. Objective: This study aimed to support the development of a mobile phone intervention to support postmenstrual regulation family planning use in Bangladesh. It explored what family planning information women want to receive after having a menstrual regulation procedure, whether they would like to receive this information via their mobile phone, and if so, what their preferences are for the way in which it is delivered. Methods: We conducted participatory interviews with 24 menstrual regulation clients in Dhaka and Sylhet divisions in Bangladesh. Women were recruited from facilities in urban and peri-urban areas, which included public sector clinics supported by Ipas, an international nongovernmental organization (NGO), and NGO clinics run by Marie Stopes. Main themes covered in the interviews were factors affecting the use of contraception, what information and support women want after their menstrual regulation procedure, how respondents would prefer to receive information about contraception, and other key issues for mobile health (mHealth) interventions, such as language and privacy. As part of the in-depth interviews, women were shown and played 6 different messages about contraception on the research assistant’s phone, which they were given to operate, and were then asked to give feedback. Results: Women were open to both receiving messages about family planning methods on their mobile phones and talking to a counselor about family planning methods over the phone after their menstrual regulation. Women most commonly wanted information about the contraceptive method they were currently using and wanted this information to be tailored to their particular needs. Women preferred voice messages to text and liked the interactive voice message format. When asked to repeat and identify the main points of the messages, women demonstrated good understanding of the content. Women did not seem too concerned with privacy or with others reading the messages and welcomed including their husbands in speaking to a counselor. Conclusions: This study found that menstrual regulation clients are very interested in receiving information on their phones to support family planning use and wanted more information about the method of contraception they were using. Participatory voicemail was the preferred modality. %M 29242175 %R 10.2196/mhealth.6969 %U http://mhealth.jmir.org/2017/12/e174/ %U https://doi.org/10.2196/mhealth.6969 %U http://www.ncbi.nlm.nih.gov/pubmed/29242175 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e56 %T A Mobile Text Message Intervention to Reduce Repeat Suicidal Episodes: Design and Development of Reconnecting After a Suicide Attempt (RAFT) %A Larsen,Mark Erik %A Shand,Fiona %A Morley,Kirsten %A Batterham,Philip J %A Petrie,Katherine %A Reda,Bill %A Berrouiguet,Sofian %A Haber,Paul S %A Carter,Gregory %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 293828508, mark.larsen@blackdog.org.au %K suicide, attempted %K emergency service, hospital %K continuity of patient care %K text messaging %K Internet %D 2017 %7 13.12.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is a leading cause of death, particularly among young people. Continuity of care following discharge from hospital is critical, yet this is a time when individuals often lose contact with health care services. Offline brief contact interventions following a suicide attempt can reduce the number of repeat attempts, and text message (short message service, SMS) interventions are currently being evaluated. Objective: The aim of this study was to extend postattempt caring contacts by designing a brief Web-based intervention targeting proximal risk factors and the needs of this population during the postattempt period. This paper details the development process and describes the realized system. Methods: To inform the design of the intervention, a lived experience design group was established. Participants were asked about their experiences of support following their suicide attempt, their needs during this time, and how these could be addressed in a brief contact eHealth intervention. The intervention design was also informed by consultation with lived experience panels external to the project and a clinical design group. Results: Prompt outreach following discharge, initial distraction activities with low cognitive demands, and ongoing support over an extended period were identified as structural requirements of the intervention. Key content areas identified included coping with distressing feelings, safety planning, emotional regulation and acceptance, coping with suicidal thoughts, connecting with others and interpersonal relationships, and managing alcohol consumption. Conclusions: The RAFT (Reconnecting AFTer a suicide attempt) text message brief contact intervention combines SMS contacts with additional Web-based brief therapeutic content targeting key risk factors. It has the potential to reduce the number of repeat suicidal episodes and to provide accessible, acceptable, and cost-effective support for individuals who may not otherwise seek face-to-face treatment. A pilot study to test the feasibility and acceptability of the RAFT intervention is underway. %M 29237584 %R 10.2196/mental.7500 %U http://mental.jmir.org/2017/4/e56/ %U https://doi.org/10.2196/mental.7500 %U http://www.ncbi.nlm.nih.gov/pubmed/29237584 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e4 %T Using mHealth to Support Postabortion Contraceptive Use: Results From a Feasibility Study in Urban Bangladesh %A Biswas,Kamal Kanti %A Hossain,Altaf %A Chowdhury,Rezwana %A Andersen,Kathryn %A Sultana,Sharmin %A Shahidullah,S M %A Pearson,Erin %+ Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, United States, 919 967 7052, andersenk@Ipas.org %K mHealth %K Bangladesh %K contraceptive usage %K postabortion contraception %D 2017 %7 27.10.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: As access to mobile technology improves in low- and middle-income countries, it becomes easier to provide information about sensitive issues, such as contraception and abortion. In Bangladesh, 97% of the population has access to a mobile signal, and the equity gap is closing in mobile phone ownership. Bangladesh has a high pregnancy termination rate and improving effective use of contraception after abortion is essential to reducing subsequent unwanted pregnancies. Objective: This study examines the feasibility and acceptability of implementing a short message service (SMS) text message-based mHealth intervention to support postabortion contraceptive use among abortion clients in Bangladesh, including women’s interest in the intervention, intervention preferences, and privacy concerns. Methods: This feasibility study was conducted in four urban, high abortion caseload facilities. Women enrolled in the study were randomized into an intervention (n=60) or control group (n=60) using block randomization. Women completed a baseline interview on the day of their abortion procedure and a follow-up interview 4 months later (retention rate: 89.1%, 107/120). Women in the intervention group received text message reminders to use their selected postabortion contraceptive methods and reminders to contact the facility if they had problems or concerns with their method. Women who did not select a method received weekly messages that they could visit the clinic if they would like to start a method. Women in the control group did not receive any messages. Results: Almost all women in the feasibility study reported using their mobile phones at least once per day (98.3%, 118/120) and 77.5% (93/120) used their phones for text messaging. In the intervention group, 87% (48/55) of women were using modern contraception at the 4-month follow-up, whereas 90% (47/52) were using contraception in the control group (P=.61). The intervention was not effective in increasing modern contraceptive use at follow-up, but 93% (51/55) of women reported at follow-up that the text reminders helped them use their method correctly and 76% (42/55) said they would sign up for this service again. Approximately half of the participants (53%, 29/55) said that someone they did not want to know about the text message reminders found out, mostly their husbands or children. Conclusions: In this small-scale feasibility study, text reminders did not increase postabortion contraceptive use. Despite the ineffectiveness of the text reminder intervention, implementation of a mHealth intervention among abortion clients in urban Bangladesh was feasible in that women were interested in receiving follow-up messages after their abortion and mobile phone use was common. Text messages may not be the best modality for a mHealth intervention due to relatively low baseline SMS text message use and privacy concerns. %M 30684398 %R 10.2196/formative.5151 %U http://formative.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/formative.5151 %U http://www.ncbi.nlm.nih.gov/pubmed/30684398 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e124 %T Designing a Self-Management App for Young People With Type 1 Diabetes: Methodological Challenges, Experiences, and Recommendations %A Castensøe-Seidenfaden,Pernille %A Reventlov Husted,Gitte %A Teilmann,Grete %A Hommel,Eva %A Olsen,Birthe Susanne %A Kensing,Finn %+ Pediatric and Adolescent Department, Nordsjællands Hospital, Hillerød, University of Copenhagen, Dyrehavevej 29, 1521, Hillerød, 3400, Denmark, 45 29824322, pernille.castensoee-seidenfaden@regionh.dk %K adolescents %K mHealth %K diabetes %K chronic condition %K self-management %K transition %K participatory design %K usability %K feasibility %K methodological recommendations %D 2017 %7 23.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young people with type 1 diabetes often struggle to self-manage their disease. Mobile health (mHealth) apps show promise in supporting self-management of chronic conditions such as type 1 diabetes. Many health care providers become involved in app development. Unfortunately, limited information is available to guide their selection of appropriate methods, techniques, and tools for a participatory design (PD) project in health care. Objective: The aim of our study was to develop an mHealth app to support young people in self-managing type 1 diabetes. This paper presents our methodological recommendations based on experiences and reflections from a 2-year research study. Methods: A mixed methods design was used to identify user needs before designing the app and testing it in a randomized controlled trial. App design was based on qualitative, explorative, interventional, and experimental activities within an overall iterative PD approach. Several techniques and tools were used, including workshops, a mail panel, think-aloud tests, and a feasibility study. Results: The final mHealth solution was “Young with Diabetes” (YWD). The iterative PD approach supported researchers and designers in understanding the needs of end users (ie, young people, parents, and health care providers) and their assessment of YWD, as well as how to improve app usability and feasibility. It is critical to include all end user groups during all phases of a PD project and to establish a multidisciplinary team to provide the wide range of expertise required to build a usable and useful mHealth app. Conclusions: Future research is needed to develop and evaluate more efficient PD techniques. Health care providers need guidance on what tools and techniques to choose for which subgroups of users and guidance on how to introduce an app to colleagues to successfully implement an mHealth app in health care organizations. These steps are important for anyone who wants to design an mHealth app for any illness. %M 29061552 %R 10.2196/mhealth.8137 %U http://mhealth.jmir.org/2017/10/e124/ %U https://doi.org/10.2196/mhealth.8137 %U http://www.ncbi.nlm.nih.gov/pubmed/29061552 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 4 %P e40 %T Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention %A Johnson,Sara S %A Levesque,Deborah A %A Broderick,Lynne E %A Bailey,Dustin G %A Kerns,Robert D %+ Pro-Change Behavior Systems, Inc, 1174 Kingstown Road, Suite 101, South Kingstown, RI, 02879, United States, 1 2032080481, sjohnson@prochange.com %K pain management %K self-management %K mobile health %K mhealth %D 2017 %7 17.10.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. Objective: The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans’ stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Methods: Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Results: Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Conclusions: Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program’s long-term effects on pain and pain self-management. %M 29042341 %R 10.2196/medinform.7117 %U http://medinform.jmir.org/2017/4/e40/ %U https://doi.org/10.2196/medinform.7117 %U http://www.ncbi.nlm.nih.gov/pubmed/29042341 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e153 %T Willingness to Use Mobile Phone Apps for HIV Prevention Among Men Who Have Sex with Men in London: Web-Based Survey %A Goedel,William C %A Mitchell,Jason W %A Krebs,Paul %A Duncan,Dustin T %+ Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY,, United States, 1 6465012715, wcg219@nyu.edu %K mobile phone apps %K mHealth %K men who have sex with men (MSM) %K HIV %D 2017 %7 11.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many men who have sex with men (MSM) use apps to connect with and meet other MSM. Given that these apps are often used to arrange sexual encounters, it is possible that apps may be suitable venues for messages and initiatives related to HIV prevention such as those to increase HIV testing rates among this population. Objective: The purpose of this study was to assess willingness to use a new app for reminders of when to be tested for HIV infection among a sample of MSM in London who use apps to arrange sexual encounters. Methods: Broadcast advertisements targeted users of a popular social-networking app for MSM in London. Advertisements directed users to a Web-based survey of sexual behaviors and sexual health needs. Willingness to use apps for reminders of when to be tested for HIV was assessed. In addition, participants responded to items assessing recent sexual behaviors, substance use, and demographic characteristics. Exploratory analyses were undertaken to examine differences in willingness to use an app by demographic and behavioral characteristics. Results: Broadcast advertisements yielded a sample of 169 HIV-negative MSM. Overall, two-thirds (108/169, 63.9%) reported willingness to use an app to remind them when to be tested for HIV. There were no significant differences in willingness to use these apps based on demographic characteristics, but MSM who reported recent binge drinking and recent club drug use more frequently reported willingness to use this app compared to their nonusing counterparts. Conclusions: MSM in this sample are willing to use a new app for HIV testing reminders. Given the high levels of willingness to use them, these types of apps should be developed, evaluated, and made available for this population. %M 29021132 %R 10.2196/mhealth.8143 %U http://mhealth.jmir.org/2017/10/e153/ %U https://doi.org/10.2196/mhealth.8143 %U http://www.ncbi.nlm.nih.gov/pubmed/29021132 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 2 %P e14 %T A Mobile Breast Cancer Survivorship Care App: Pilot Study %A Baseman,Janet %A Revere,Debra %A Baldwin,Laura-Mae %+ Department of Epidemiology, University of Washington, 1105 NE 45th Street Suite 400, Seattle, WA, 98105, United States, 1 206 616 1495, jbaseman@uw.edu %K breast neoplasms %K data collection %K feasibility studies %K mobile apps %K survivors %K telemedicine %D 2017 %7 26.09.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer survivors living in rural areas experience unique challenges due to additional burdens, such as travel and limited access to specialists. Rural survivors of breast cancer have reported poorer outcomes, poorer mental health and physical functioning, and lower-than-average quality of life compared to urban survivors. Objective: To explore the feasibility and acceptability of developing a mobile health survivorship care app to facilitate care coordination; support medical, psychosocial, and practical needs; and improve survivors' long-term health outcomes. Methods: An interactive prototype app, SmartSurvivor, was developed that included recommended survivorship care plan components. The prototype's feasibility and acceptability were tested by a sample of breast cancer survivors (n=6), primary care providers (n=4), and an oncologist (n=1). Results: Overall, both survivors and providers felt that SmartSurvivor was a potentially valuable tool to support long-term survivorship care plan objectives. Portability, accessibility, and having one place for all contact, treatment, symptom tracking, and medication summaries was highly valued. Conclusions: Our pilot study indicates that SmartSurvivor is a feasible and acceptable approach to meeting survivorship care objectives and the needs of both breast cancer survivors and their health care providers. Exploration of mobile health options for supporting survivorship care plan needs is a promising area of research. %M 28951383 %R 10.2196/cancer.8192 %U http://cancer.jmir.org/2017/2/e14/ %U https://doi.org/10.2196/cancer.8192 %U http://www.ncbi.nlm.nih.gov/pubmed/28951383 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 9 %P e141 %T A User-Centered Approach: Understanding Client and Caregiver Needs and Preferences in the Development of mHealth Apps for Self-Management %A Bendixen,Roxanna M %A Fairman,Andrea D %A Karavolis,Meredith %A Sullivan,Carly %A Parmanto,Bambang %+ School of Health and Rehabilitation Sciences, Department of Occupational Therapy, University of Pittsburgh, 5020 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6603, bendixen@pitt.edu %K mobile health %K telemedicine %K self-care %K adolescence %K spina bifida %K cerebral palsy %K spinal cord injury %D 2017 %7 26.09.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many adolescents and young adults with chronic illness or disability often fail to develop the self-management skills necessary to independently handle medical and self-management routines. In light of these needs, we are developing iMHere 2.0 (Interactive Mobile Health and Rehabilitation), a mobile health (mHealth) system to support a self-management program. Objective: Our objective was to gather data from persons with brain and spinal cord anomalies (BSA) and their caregivers to better understand how mHealth would be most helpful in supporting them to proactively manage daily self-care routines and to access medical care as needed. The specific purpose was not only to gather feedback and to gain increased insight into the design of the new version of iMHere, but also to gather perspectives of new groups, namely adolescents as young as 12 years and their parents and/or caregivers. Methods: Our project employed focus group sessions and surveys to collect data from participants with BSA, as well as their caregivers. A total of six focus group sessions were conducted on four separate occasions until the data gathered reached saturation. The objectives of our focus group sessions were to better understand ways to develop mHealth systems to support self-management, to promote independence, to motivate long-term system use, and to prevent medical problems that lead to hospitalizations and emergency room visits for youth and young adults with BSA. Results: A total of 16 youth and young adults with BSA and 11 caregivers participated in the sessions. Within and among our groups, the following five overarching themes emerged from the data: (1) make it easy, (2) engage, (3) educate and prepare, (4) motivate and support, and (5) personalize. Participants shared their perspectives and detailed information about mHealth apps that would be important for independence in self-care and self-management. Conclusions: Our findings suggest that most individuals keep their mobile phones with them at all times and typically use a mobile phone for social media, music, photos, and texting. Our qualitative analysis indicates that youth and young adults with BSA, as well as their caregivers, acknowledge the importance of being actively engaged in developing and using mHealth apps that monitor and manage their health care needs. Information gleaned from these focus group sessions and surveys have provided data to refine the iMHere 2.0 mHealth prototype platform that we have developed. %M 28951378 %R 10.2196/mhealth.7136 %U http://mhealth.jmir.org/2017/9/e141/ %U https://doi.org/10.2196/mhealth.7136 %U http://www.ncbi.nlm.nih.gov/pubmed/28951378 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 9 %P e138 %T A Smartphone App for Improvement of Colonoscopy Preparation (ColoprAPP): Development and Feasibility Study %A Walter,Benjamin %A Schmid,Roland %A von Delius,Stefan %+ Universitätsklinik Ulm, Medizinische Klinik I, Universität Ulm, Albert-Einstein-Allee 23, Ulm,, Germany, 49 731 500 44818, Benjamin.Walter@uniklinik-ulm.de %K bowel preparation %K smartphone app %K intestinal cleansing %K patient education %K colonoscopy %K colonoscopy preparation %D 2017 %7 20.09.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Optimal bowel preparation is one of the major cornerstones for quality of colonoscopy. But poor bowel preparation still occurs in 10% to 25% of all patients. To optimize patient guidance, we developed a new smartphone app (ColoprAPP) for Android smartphones which guides and accompanies the patient starting 4 days before colonoscopy throughout the whole colonoscopy preparation procedure. Objective: The objective of this study was to assess the function of a newly developed smartphone app for supporting colonoscopy preparation. Methods: We carried out a prospective feasibility study including 25 patients undergoing outpatient colonoscopy at our hospital. As a control, we retrieved the data of 25 patients undergoing outpatient colonoscopy matching in age, sex, and indication for colonoscopy from our colonoscopy database. Patients were asked to download the smartphone app, ColoprAPP, in addition to being given the regular colonoscopy preparation leaflet. All colonoscopies were performed in the morning after using a split-dose preparation containing a polyethlene glycol–based purgative. The study was designed to test feasibility of the prototype, evaluate grade of bowel cleanliness (Boston bowel preparation scale [BBPS]), and assess patient satisfaction with the app. Results: The smartphone app use was feasible in all patients. BBPS count as a marker for grade of bowel preparation was significantly higher in the smartphone app–supported group (mean 8.1 [SD 0.3] vs 7.1 [SD 0.4], P=.02). Left (mean 2.8 [SD 0.1] vs 2.4 [SD 0.11], P=.02) and transverse colon (mean 2.8 [SD 0.07] vs 2.4 [SD 0.11], P<.001) revealed significantly higher BBPS counts in the smartphone app–supported group than in controls. Patient satisfaction with a smartphone app–supported colonoscopy preparation was high with an average numeric rating scale score for usefulness of 8.2 (visual analog scale 1-10). Conclusions: A novel developed smartphone app for reinforced education of bowel cleansing was feasible and led to high BBPS scores and patient satisfaction. Trial registration: ClinicalTrials.gov NCT02512328; https://clinicaltrials.gov/ct2/show/NCT02512328 (Archived by WebCite at http://www.webcitation.org/6sz3Kk26z) %M 28931498 %R 10.2196/mhealth.7703 %U http://mhealth.jmir.org/2017/9/e138/ %U https://doi.org/10.2196/mhealth.7703 %U http://www.ncbi.nlm.nih.gov/pubmed/28931498 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e123 %T Opportunities of mHealth in Preconception Care: Preferences and Experiences of Patients and Health Care Providers and Other Involved Professionals %A Van Dijk,Matthijs R %A Koster,Maria PH %A Rosman,Ageeth N %A Steegers-Theunissen,Regine PM %+ Erasmus MC, Obstetrics and Gynecology, Dr Molewaterplein 50, Rotterdam, PO Box 2040, Netherlands, 31 107038254, r.steegers@erasmusmc.nl %K Focus group %K Lifestyle %K mHealth %K Nutrition %K Personalized medicine %K Preconception care %D 2017 %7 17.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The importance of the preconception period and preconception care (PCC) are broadly acknowledged and the potential benefits regarding health promotion have been studied extensively. PCC provides the opportunity to identify, prevent, and treat modifiable and nonmodifiable risk factors to optimize the health of couples trying to become pregnant. The prevalence of modifiable and nonmodifiable risk factors in these couples is high, but the uptake of PCC remains low. Objective: The aim of this study is to identify the preferences and experiences of women and men (patients) trying to become pregnant and of health care providers and other involved professionals regarding mobile health (mHealth), in particular the coaching platform Smarter Pregnancy, and its potential role in PCC. Methods: Patients who participated in the Smarter Pregnancy randomized controlled trial (RCT) and health care providers and professionals also involved in PCC were invited to participate in a qualitative study. The barriers, benefits, and opportunities of big data collection by mHealth were discussed in focus group sessions, prompted with statements regarding PCC. Results: We composed five focus groups, consisting of 27 patients in total (23 women and 4 men), who participated in the RCT, and nine health care providers and other professionals. Of the patients, 67% (18/27) were familiar with the concept of PCC, but only 15% (4/27) received any form of PCC. A majority of 56% (combined percentages of statements 1 [n=18], 2 [n=11], and 3 [n=16]) of the patients believed in the benefit of receiving PCC, and all agreed that men should be involved in PCC as well. Patients did not have a problem using anonymized data obtained from mHealth tools for scientific purposes. Patients and health care providers and other professionals both acknowledged the lack of awareness regarding the importance of PCC and stated that mHealth provides several opportunities to support clinical PCC. Conclusions: Our findings substantiate previous studies addressing the low uptake of PCC due to unawareness or lack of perception of its relevance by couples who are trying to become pregnant. The positive judgment and experiences with mHealth, in particular Smarter Pregnancy, will stimulate future research and further development of effective and cost-effective personalized mHealth apps for patients, health care providers, and other professionals as an add-on to clinical PCC. %M 28818820 %R 10.2196/mhealth.7834 %U http://mhealth.jmir.org/2017/8/e123/ %U https://doi.org/10.2196/mhealth.7834 %U http://www.ncbi.nlm.nih.gov/pubmed/28818820 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e121 %T Developing and Evaluating JIApp: Acceptability and Usability of a Smartphone App System to Improve Self-Management in Young People With Juvenile Idiopathic Arthritis %A Cai,Ran A %A Beste,Dominik %A Chaplin,Hema %A Varakliotis,Socrates %A Suffield,Linda %A Josephs,Francesca %A Sen,Debajit %A Wedderburn,Lucy R %A Ioannou,Yiannakis %A Hailes,Stephen %A Eleftheriou,Despina %+ Arthritis Research UK Centre for Adolescent Rheumatology, University College London, UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH, United Kingdom, 44 0203 108 2420, a.cai@ucl.ac.uk %K juvenile idiopathic arthritis %K self-management %K adolescent %K young adult %K mobile applications %K qualitative research %K smartphone %D 2017 %7 15.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Flare-ups in juvenile idiopathic arthritis (JIA) are characterized by joint pain and swelling and often accompanied with fatigue, negative emotions, and reduced participation in activities. To minimize the impact of JIA on the physical and psychosocial development and well-being of young people (YP), it is essential to regularly monitor disease activity and side effects, as well as to support self-management such as adherence to treatment plans and engagement in general health-promoting behaviors. Smartphone technology has the potential to engage YP with their health care through convenient self-monitoring and easy access to information. In addition, having a more accurate summary of self-reported fluctuations in symptoms, behaviors, and psychosocial problems can help both YP and health care professionals (HCPs) better understand the patient’s condition, identify barriers to self-management, and assess treatment effectiveness and additional health care needs. No comprehensive smartphone app has yet been developed in collaboration with YP with JIA, their parents, and HCPs involved in their care. Objectives: The objective of this study was to design, develop, and evaluate the acceptability and usability of JIApp, a self-management smartphone app system for YP with JIA and HCPs. Methods: We used a qualitative, user-centered design approach involving YP, parents, and HCPs from the rheumatology team. The study was conducted in three phases: (1) phase I focused on developing consensus on the features, content, and design of the app; (2) phase II was used for further refining and evaluating the app prototype; and (3) phase III focused on usability testing of the app. The interview transcripts were analyzed using qualitative content analysis. Results: A total of 29 YP (aged 10-23, median age 17) with JIA, 7 parents, and 21 HCPs were interviewed. Major themes identified as the ones that helped inform app development in phase I were: (1) remote monitoring of symptoms, well-being, and activities; (2) treatment adherence; and (3) education and support. During phase II, three more themes emerged that informed further refinement of the app prototype. These included (4) adapting a reward system to motivate end users for using the app; (5) design of the app interface; and (6) clinical practice integration. The usability testing during phase III demonstrated high rates of overall satisfaction and further affirmed the content validity of the app. Conclusions: We present the development and evaluation of a smartphone app to encourage self-management and engagement with health care for YP with JIA. The app was found to have high levels of acceptability and usability among YP and HCPs and has the potential to improve health care and outcomes for this age group. Future feasibility testing in a prospective study will firmly establish the reliability, efficacy, and cost-effectiveness of such an app intervention for patients with arthritis. %M 28811270 %R 10.2196/mhealth.7229 %U http://mhealth.jmir.org/2017/8/e121/ %U https://doi.org/10.2196/mhealth.7229 %U http://www.ncbi.nlm.nih.gov/pubmed/28811270 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e117 %T Analysis of Requirements for Developing an mHealth-Based Health Management Platform %A Zhang,Hehua %A Zhang,Han %A Wang,Xiaoning %A Yang,Zuosen %A Zhao,Yuhong %+ Shengjing Hospital of China Medical University, China Medical University, Heping District, Sanhao, Street No. 36, Liaoning, Shenyang,, China, 86 18900910777, zhaoyh@sj-hospital.org %K online information-seeking %K health management %K mHealth %D 2017 %7 03.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Studies have consistently shown that mobile and Web-based apps have positive impacts on people’s daily lifestyles, health management, and disease treatment. As the development of medical and health informatization in China has evolved, different kinds of mobile-based apps for individuals and hospitals have been developed by software vendors. However, doubts and challenges posed by the media have prevented these apps from having a stable and substantial user base. Analyses of user requirements have not typically been performed prior to the design of such mobile apps. The health information government authority in Liaoning Province, China, was planning to establish a mobile health (mHealth)-based health management platform, aiming to alleviate the difficulties citizens have in seeking hospital services. Objective: The goal of this study was to determine the actual health and medical needs of citizens that may be addressed by medical information technologies. The results may contribute to the functional design and development of health management and appointed treatment-oriented mobile apps. Methods: In this study, a semi-structured questionnaire on mHealth requirements was designed and tested, and 240 questionnaires were given to the outpatients of the First Hospital of the China Medical University in Shenyang, Liaoning Province, China; of these, 228 valid responses were collected, for a response rate of 95%. We discussed the current development of mHealth with 50 related experts and engineers from health authorities and a medical information company. SPSS 13.0 was used for statistical analyses. Results: After detailed analyses of the questionnaire data, several findings were evident: first, most citizens and patients were unclear about their health conditions (64.5%, 147/228) and were interested in receiving a mobile app as a tool to manage their health and medical needs (71.1%, 162/228). Patients in different outpatient departments had different opinions regarding online registration. Conversely, the main problems for outpatients were long waiting times (66.4%, 148/223) and difficulties in making appointments (46.5%, 106/228), and they also worried about payments and Internet problems when using a mobile app for appointment reservations. Furthermore, as the main service target of mHealth is the health management of the general population, we first need to solve the associated interoperability and data security problems associated with such apps. Conclusions: This study provides insight into the health and medical requirements of smartphone apps, and draws attention to some of the challenges and opportunities of mHealth. We suggest several value-added features and characteristics that app developers should take into consideration when developing health and medical-related apps. The findings also highlight some major challenges that require further consideration and research to ensure that these apps meet the core needs of patients and aid the development of the health information system in Liaoning Province, China. %M 28778840 %R 10.2196/mhealth.5890 %U http://mhealth.jmir.org/2017/8/e117/ %U https://doi.org/10.2196/mhealth.5890 %U http://www.ncbi.nlm.nih.gov/pubmed/28778840 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e102 %T A Smartphone App for Families With Preschool-Aged Children in a Public Nutrition Program: Prototype Development and Beta-Testing %A Hull,Pamela %A Emerson,Janice S %A Quirk,Meghan E %A Canedo,Juan R %A Jones,Jessica L %A Vylegzhanina,Violetta %A Schmidt,Douglas C %A Mulvaney,Shelagh A %A Beech,Bettina M %A Briley,Chiquita %A Harris,Calvin %A Husaini,Baqar A %+ Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN,, United States, 1 615 936 3241, pam.hull@vanderbilt.edu %K pediatric obesity %K health education %K public health informatics %K mobile apps %D 2017 %7 02.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the United States provides free supplemental food and nutrition education to low-income mothers and children under age 5 years. Childhood obesity prevalence is higher among preschool children in the WIC program compared to other children, and WIC improves dietary quality among low-income children. The Children Eating Well (CHEW) smartphone app was developed in English and Spanish for WIC-participating families with preschool-aged children as a home-based intervention to reinforce WIC nutrition education and help prevent childhood obesity. Objective: This paper describes the development and beta-testing of the CHEW smartphone app. The objective of beta-testing was to test the CHEW app prototype with target users, focusing on usage, usability, and perceived barriers and benefits of the app. Methods: The goals of the CHEW app were to make the WIC shopping experience easier, maximize WIC benefit redemption, and improve parent snack feeding practices. The CHEW app prototype consisted of WIC Shopping Tools, including a barcode scanner and calculator tools for the cash value voucher for purchasing fruits and vegetables, and nutrition education focused on healthy snacks and beverages, including a Yummy Snack Gallery and Healthy Snacking Tips. Mothers of 63 black and Hispanic WIC-participating children ages 2 to 4 years tested the CHEW app prototype for 3 months and completed follow-up interviews. Results: Study participants testing the app for 3 months used the app on average once a week for approximately 4 and a half minutes per session, although substantial variation was observed. Usage of specific features averaged at 1 to 2 times per month for shopping-related activities and 2 to 4 times per month for the snack gallery. Mothers classified as users rated the app’s WIC Shopping Tools relatively high on usability and benefits, although variation in scores and qualitative feedback highlighted several barriers that need to be addressed. The Yummy Snack Gallery and Healthy Snacking Tips scored higher on usability than benefits, suggesting that the nutrition education components may have been appealing but too limited in scope and exposure. Qualitative feedback from mothers classified as non-users pointed to several important barriers that could preclude some WIC participants from using the app at all. Conclusions: The prototype study successfully demonstrated the feasibility of using the CHEW app prototype with mothers of WIC-enrolled black and Hispanic preschool-aged children, with moderate levels of app usage and moderate to high usability and benefits. Future versions with enhanced shopping tools and expanded nutrition content should be implemented in WIC clinics to evaluate adoption and behavioral outcomes. This study adds to the growing body of research focused on the application of technology-based interventions in the WIC program to promote program retention and childhood obesity prevention. %M 28768611 %R 10.2196/mhealth.7477 %U http://mhealth.jmir.org/2017/8/e102/ %U https://doi.org/10.2196/mhealth.7477 %U http://www.ncbi.nlm.nih.gov/pubmed/28768611 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 3 %P e28 %T A Smartphone App for Adolescents With Sleep Disturbance: Development of the Sleep Ninja %A Werner-Seidler,Aliza %A O'Dea,Bridianne %A Shand,Fiona %A Johnston,Lara %A Frayne,Anna %A Fogarty,Andrea S %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 293823769, a.werner-seidler@blackdog.org.au %K insomnia %K sleep %K adolescence %K depression %K cognitive behavioral therapy %K smartphone %D 2017 %7 28.07.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Sleep disturbances are common in young people and have consequences for academic, social, emotional, and behavioral development. The most effective treatment is cognitive behavioral therapy for insomnia (CBT-I), with evidence suggesting that it is efficacious even when delivered digitally. Objective: There are no commercially available digitally delivered CBT-I programs for use by young people. The aim of this project was to develop a smartphone app that delivers CBT-I to young people to improve sleep. Methods: To inform the development of the app, young people (N=21) aged between 12 and 16 years attended one of the 3 focus groups (each with 4-10 participants). These focus groups were conducted at different stages of the development process such that the process could be iterative. Participants were asked the reasons why they might use an app to help them sleep, the kinds of features or functions that they would like to see in such an app, and any concerns they may have in using the app. Data were analyzed using a thematic analysis approach. Of the issues discussed by the participants, the researchers selected themes associated with content, functionality, and accessibility and user experience to examine, as these were most informative for the app design process. Results: In terms of content, young people were interested in receiving information about recommended sleep guidelines and personalized information for their age group. They reported that keeping a sleep diary was acceptable, but they should be able to complete it flexibly, in their own time. They reported mixed views about the use of the phone’s accelerometer. Young people felt that the functionality of the app should include elements of game playing if they were to remain engaged with the app. Flexibility of use and personalized features were also desirable, and there were mixed views about the schedule of notifications and reminders. Participants reported that for the app to be accessible and usable, it should be from a trusted developer, have engaging aesthetics, have a layout that is easy to navigate, not rely on Internet coverage, and preferably be free. Participants felt that being able to conceal the purpose of the app from peers was an advantage and were willing to provide personal information to use the app if the purpose and use of that information was made clear. Overall, participants endorsed the use of the app for sleep problems among their age group and reported motivation to use it. Conclusions: The Sleep Ninja is a fully-automated app that delivers CBT-I to young people, incorporating the features and information that young people reported they would expect from this app. A pilot study testing the feasibility, acceptability, and efficacy of the Sleep Ninja is now underway. %M 28754651 %R 10.2196/mental.7614 %U http://mental.jmir.org/2017/3/e28/ %U https://doi.org/10.2196/mental.7614 %U http://www.ncbi.nlm.nih.gov/pubmed/28754651 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 7 %P e133 %T Apps for Health-Related Education in Pharmacy Practice: Needs Assessment Survey Among Patients Within a Large Metropolitan Area %A Mirk,Sean M %A Wegrzyn,Nicole Marie %+ Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, 555 31st Street, Downers Grove, IL, 60515, United States, 1 630 515 7330, smirk@midwestern.edu %K patient education %K mHealth %K health information management %K user-centered design %D 2017 %7 19.07.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Patient education resources are crucial to the effectiveness of prescribed pharmacotherapy. However, user interest and patient preference for these materials is lacking. Regardless of the field, nearly every article on designing mHealth apps references the lack of end-user involvement as a key flaw to sustainable design. The traditional paper-based methods of patient education are difficult to tailor to a patient’s specific needs and learning styles, but a customizable app might be beneficial. Objective: Regarding a mobile app for patient education, the objectives of the study were to (1) quantify patient interest, (2) determine desirable features, and (3) determine if a relationship exists between patient variables and interest in an iPad app for patient education. Methods: A paper-based questionnaire was developed and administered to consenting patients receiving care within three sites: two suburban outpatient sites where ambulatory care services are provided and one urban hospital site where ambulatory care transition services are provided. Results: A total of 121 surveys were completed. Most respondents were female (64/120, 53.3%), between 50 and 70 years of age, white/Caucasian (94/120, 78.3%), owned at least one technology device, and knew what an iPad was. Diabetes was the most common disease state (43/120, 35.8%), followed by heart failure (27/120, 22.5%), history of venous thromboembolism (VTE) (21/120, 17.5%), and asthma/chronic obstructive pulmonary disease (17/120, 14.2%). Overall interest in a mobile health app for patient education was 63.7% (72/113). Interest increased to 68.4% (78/114) if a health care provider recommended it. Respondents with one chronic health condition were more likely to be interested in an app compared to those with two or more. Respondents with a history of VTE were mostly likely to be interested in using an app on their own accord, while respondents with diabetes were mostly likely to be interested if their health care provider recommended it. Conclusions: This preliminary needs assessment identified that patients are interested in using mHealth apps for health-related education in pharmacy practice, particularly if their health care provider recommends it. %M 28724511 %R 10.2196/resprot.5886 %U http://www.researchprotocols.org/2017/7/e133/ %U https://doi.org/10.2196/resprot.5886 %U http://www.ncbi.nlm.nih.gov/pubmed/28724511 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e98 %T The Health Buddies App as a Novel Tool to Improve Adherence and Knowledge in Atrial Fibrillation Patients: A Pilot Study %A Desteghe,Lien %A Kluts,Kiki %A Vijgen,Johan %A Koopman,Pieter %A Dilling-Boer,Dagmara %A Schurmans,Joris %A Dendale,Paul %A Heidbuchel,Hein %+ Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt, 3500, Belgium, 32 11 30 82 26, lien.desteghe@uhasselt.be %K mHealth %K anticoagulants %K medication adherence %K education %K atrial fibrillation %D 2017 %7 19.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Atrial fibrillation (AF) constitutes an important risk for stroke, especially in an ageing population. A new app (Health Buddies) was developed as a tool to improve adherence to non-vitamin K antagonist oral anticoagulants (NOACs) in an elderly AF population by providing a virtual contract with their grandchildren, spelling out daily challenges for both. Objective: The aim of this pilot study was to assess the feasibility and usability of the Health Buddies app in AF patients. Methods: Two workshops were conducted to steer app development and to test a first prototype. The feasibility of the finalized app was investigated by assessing the number of eligible AF patients (based on current prescription of NOACs, the presence of grandchildren between 5 and 15 years old, availability of a mobile phone, computer, or tablet), and the proportion of those who were willing to participate. Participants had to use the app for 3 months. The motivation of the patients to use the app was assessed based on the number of logins to the app. Their perception of its usefulness was examined by specific questionnaires. Additionally, the effects on knowledge level about AF and its treatment, and adherence to NOAC intake were investigated. Results: Out of 830 screened AF patients, 410 were taking NOACs and 114 were eligible for inclusion. However, only 3.7% (15/410) of the total NOAC population or 13.2% of the eligible patients (15/114) were willing to participate. The main reasons for not participating were no interest to participate in general or in the concept in particular (29/99, 29%), not feeling comfortable using technology (22/99, 22%), no interest by the grandchildren or their parents (20/99, 20%), or too busy a lifestyle (12/99, 12%). App use significantly decreased towards the end of the study period in both patients (P=.009) and grandchildren (P<.001). NOAC adherence showed a taking adherence and regimen adherence of 88.6% (SD 15.4) and 81.8% (SD 18.7), respectively. Knowledge level increased from 64.6% (SD 14.7) to 70.4% (SD 10.4) after 3 months (P=.09). The app scored positively on clarity, novelty, stimulation, and attractiveness as measured with the user experience questionnaire. Patients evaluated the educational aspect of this app as a capital gain. Conclusions: Only a small proportion of the current AF population seems eligible for the innovative Health Buddies app in its current form. Although the app was positively rated by its users, a large subset of patients was not willing to participate in this study or to use the app. Efforts have to be made to expand the target group in the future. %M 28724512 %R 10.2196/mhealth.7420 %U http://mhealth.jmir.org/2017/7/e98/ %U https://doi.org/10.2196/mhealth.7420 %U http://www.ncbi.nlm.nih.gov/pubmed/28724512 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e45 %T Informing the Development of a Mobile Phone HIV Testing Intervention: Intentions to Use Specific HIV Testing Approaches Among Young Black Transgender Women and Men Who Have Sex With Men %A Koblin,Beryl A %A Nandi,Vijay %A Hirshfield,Sabina %A Chiasson,Mary Ann %A Hoover,Donald R %A Wilton,Leo %A Usher,DaShawn %A Frye,Victoria %+ Laboratory of Infectious Disease Prevention, New York Blood Center, 310 E.67th Street, New York, NY,, United States, 1 212 570 3105, bkoblin@nybc.org %K HIV infections %K African American %K homosexuality, male %K transgender persons %K cell phones %D 2017 %7 07.07.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Regular human immunodeficiency virus (HIV) testing of persons at risk is critical to HIV prevention. Infrequent HIV testing and late diagnosis of HIV infection have been observed among young black men who have sex with men (MSM) and transwomen (transgender women)—two groups overrepresented in the HIV epidemic. Objective: The objective of this study was to inform the development of a brief mobile phone intervention to increase HIV testing among young black MSM and transwomen by providing a tailored recommendation of an optimal HIV testing approach. We identified demographic, behavioral, psychosocial, and sociostructural factors associated with intentions to use three specific HIV testing approaches: self-testing, testing at a clinic or other provider, and couples HIV testing and counseling (CHTC). Methods: Individuals were eligible for a Web-based survey if they were male at birth; were between the ages of 16 and 29 years; self-identified as black, African American, Caribbean black, African black, or multiethnic black; were not known to be HIV-infected; and reported insertive or receptive anal intercourse with a man or transwoman in the last 12 months. Recruitment occurred via banner advertisements placed on a range of social and sexual networking websites and apps in New York City and nationally, and via events attended by young black MSM and transwomen in New York City. Intention to test by each testing method was analyzed using logistic regression with best subset models and stepwise variable selection. Results: Among 169 participants, intention to use a self-test was positively associated with comfort in testing by a friend or a partner at home (Adjusted odds ratio, AOR, 2.40; 95% CI 1.09-5.30), and stigma or fear as a reason not to test (AOR 8.61; 95% CI 2.50-29.68) and negatively associated with higher social support (AOR 0.48; 95% CI 0.33-0.72) and having health insurance (AOR 0.21; 95% CI 0.09-0.54). Intention to test at a clinic or other provider was positively associated with self-efficacy for HIV testing (AOR 2.87; 95% CI 1.48-5.59) and social support (AOR 1.98; 95% CI 1.34-2.92), and negatively associated with a lifetime history of incarceration (AOR 0.37; 95% CI 0.16-0.89). Intention to test by CHTC was negatively associated with higher educational level (Some college or Associate’s degree vs high school graduate or less [AOR 0.81; 95% CI 0.39-1.70]; Bachelor’s degree or more vs high school graduate or less [AOR 0.28; 95% CI 0.11-0.70]). Conclusions: Unique factors were associated with intention to test using specific testing approaches. These data will be critical for the development of a tailored intervention that shows promise to increase comfort and experiences with a variety of testing approaches among young black MSM and transwomen. %M 28687531 %R 10.2196/publichealth.7397 %U http://publichealth.jmir.org/2017/3/e45/ %U https://doi.org/10.2196/publichealth.7397 %U http://www.ncbi.nlm.nih.gov/pubmed/28687531 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e122 %T Reducing Parental Uncertainty Around Childhood Cancer: Implementation Decisions and Design Trade-Offs in Developing an Electronic Health Record-Linked Mobile App %A Marsolo,Keith %A Shuman,William %A Nix,Jeremy %A Morrison,Caroline F %A Mullins,Larry L %A Pai,Ahna LH %+ Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7024, Cincinnati, OH, 45229, United States, 1 5138030333, keith.marsolo@cchmc.org %K electronic health records %K mobile apps %K uncertainty %K ethnographic design %D 2017 %7 26.06.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Parents of children newly diagnosed with cancer are confronted with multiple stressors that place them at risk for significant psychological distress. One strategy that has been shown to help reduce uncertainty is the provision of basic information; however, families of newly diagnosed cancer patients are often bombarded with educational material. Technology has the potential to help families manage their informational needs and move towards normalization. Objective: The aim of this study was to create a mobile app that pulls together data from both the electronic health record (EHR) and vetted external information resources to provide tailored information to parents of newly diagnosed children as one method to reduce the uncertainty around their child’s illness. This app was developed to be used by families in a National Institutes of Health (NIH)-funded randomized controlled trial (RCT) aimed at decreasing uncertainty and the subsequent psychological distress. Methods: A 2-phase qualitative study was conducted to elicit the features and content of the mobile app based on the needs and experience of parents of children newly diagnosed with cancer and their providers. Example functions include the ability to view laboratory results, look up appointments, and to access educational material. Educational material was obtained from databases maintained by the National Cancer Institute (NCI) as well as from groups like the Children’s Oncology Group (COG) and care teams within Cincinnati Children’s Hospital Medical Center (CCHMC). The use of EHR-based Web services was explored to allow data like laboratory results to be retrieved in real-time. Results: The ethnographic design process resulted in a framework that divided the content of the mobile app into the following 4 sections: (1) information about the patient’s current treatment and other data from the EHR; (2) educational background material; (3) a calendar to view upcoming appointments at their medical center; and (4) a section where participants in the RCT document the study data. Integration with the NCI databases was straightforward; however, accessing the EHR Web services posed a challenge, though the roadblocks were not technical in nature. The lack of a formal, end-to-end institutional process for requesting Web service access and a mechanism to shepherd the request through all stages of implementation proved to be the biggest barrier. Conclusions: We successfully deployed a mobile app with a custom user interface that can integrate with the EHR to retrieve laboratory results and appointment information using vendor-provided Web services. Developers should expect to face hurdles when integrating with the EHR, but many of them can be addressed with frequent communication and thorough documentation. Executive sponsorship is also a key factor for success. Trial Registration: ClinicalTrials.gov NCT02505165; https://clinicaltrials.gov/ct2/show/NCT02505165 (Archived by WebCite at http://www.Webcitation.org/6r9ZSUgoT) %M 28652227 %R 10.2196/resprot.7523 %U http://www.researchprotocols.org/2017/6/e122/ %U https://doi.org/10.2196/resprot.7523 %U http://www.ncbi.nlm.nih.gov/pubmed/28652227 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e124 %T An Interactive, Mobile-Based Tool for Personal Social Network Data Collection and Visualization Among a Geographically Isolated and Socioeconomically Disadvantaged Population: Early-Stage Feasibility Study With Qualitative User Feedback %A Eddens,Katherine S %A Fagan,Jesse M %A Collins,Tom %+ Department of Health, Behavior & Society, College of Public Health, University of Kentucky, #352 Bowman Hall, 151 Washington Avenue, Lexington, KY, 40506, United States, 1 859 218 0111, kate.eddens@uky.edu %K social networks %K social network analysis %K personal networks %K mobile surveys %K survey development %K survey implementation %K low literacy %K health disparities %K rural health %K Appalachia %K cancer screening %K diffusion of innovations %D 2017 %7 22.06.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Personal social networks have a profound impact on our health, yet collecting personal network data for use in health communication, behavior change, or translation and dissemination interventions has proved challenging. Recent advances in social network data collection software have reduced the burden of network studies on researchers and respondents alike, yet little testing has occurred to discover whether these methods are: (1) acceptable to a variety of target populations, including those who may have limited experience with technology or limited literacy; and (2) practical in the field, specifically in areas that are geographically and technologically disconnected, such as rural Appalachian Kentucky. Objective: We explored the early-stage feasibility (Acceptability, Demand, Implementation, and Practicality) of using innovative, interactive, tablet-based network data collection and visualization software (OpenEddi) in field collection of personal network data in Appalachian Kentucky. Methods: A total of 168 rural Appalachian women who had previously participated in a study on the use of a self-collected vaginal swab (SCVS) for human papillomavirus testing were recruited by community-based nurse interviewers between September 2013 and August 2014. Participants completed egocentric network surveys via OpenEddi, which captured social and communication network influences on participation in, and recruitment to, the SCVS study. After study completion, we conducted a qualitative group interview with four nurse interviewers and two participants in the network study. Using this qualitative data, and quantitative data from the network study, we applied guidelines from Bowen et al to assess feasibility in four areas of early-stage development of OpenEddi: Acceptability, Demand, Implementation, and Practicality. Basic descriptive network statistics (size, edges, density) were analyzed using RStudio. Results: OpenEddi was perceived as fun, novel, and superior to other data collection methods or tools. Respondents enjoyed the social network survey component, and visualizing social networks produced thoughtful responses from participants about leveraging or changing network content and structure for specific health-promoting purposes. Areas for improved literacy and functionality of the tool were identified. However, technical issues led to substantial (50%) data loss, limiting the success of its implementation from a researcher’s perspective, and hindering practicality in the field. Conclusions: OpenEddi is a promising data collection tool for use in geographically isolated and socioeconomically disadvantaged populations. Future development will mitigate technical problems, improve usability and literacy, and test new methods of data collection. These changes will support goals for use of this tool in the delivery of network-based health communication and social support interventions to socioeconomically disadvantaged populations. %M 28642217 %R 10.2196/resprot.6927 %U http://www.researchprotocols.org/2017/6/e124/ %U https://doi.org/10.2196/resprot.6927 %U http://www.ncbi.nlm.nih.gov/pubmed/28642217 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e120 %T Development of a Web-Based Intervention for Addressing Distress in Caregivers of Patients Receiving Stem Cell Transplants: Formative Evaluation With Qualitative Interviews and Focus Groups %A Pensak,Nicole Amoyal %A Joshi,Tanisha %A Simoneau,Teresa %A Kilbourn,Kristin %A Carr,Alaina %A Kutner,Jean %A Laudenslager,Mark L %+ Hackensack University Medical Center, Department of Research, Cancer Prevention and Control, John Theurer Cancer Center, 40 Prospect Avenue, Hackensack, NJ, 07601, United States, 1 5519964267, Nicole.Pensak@HackensackMeridian.org %K cancer %K caregivers %K distress %K anxiety %K depression %K stem cell transplant %D 2017 %7 22.06.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Caregivers of cancer patients experience significant burden and distress including depression and anxiety. We previously demonstrated the efficacy of an eight session, in-person, one-on-one stress management intervention to reduce distress in caregivers of patients receiving allogeneic hematopoietic stem cell transplants (allo-HSCT). Objective: The objective of this study was to adapt and enhance the in-person caregiver stress management intervention to a mobilized website (eg, tablet, smartphone, or computer-based) for self-delivery in order to enhance dissemination to caregiver populations most in need. Methods: We used an established approach for development of a mhealth intervention, completing the first two research and evaluation steps: Step One: Formative Research (eg, expert and stakeholder review from patients, caregivers, and palliative care experts) and Step Two: Pretesting (eg, Focus Groups and Individual Interviews with caregivers of patients with autologous HSCT (auto-HSCT). Step one included feedback elicited for a mock-up version of Pep-Pal session one from caregiver, patients and clinician stakeholders from a multidisciplinary palliative care team (N=9 caregivers and patient stakeholders and N=20 palliative care experts). Step two included two focus groups (N=6 caregivers) and individual interviews (N=9 caregivers) regarding Pep-Pal’s look and feel, content, acceptability, and potential usability/feasibility. Focus groups and individual interviews were audio-recorded. In addition, individual interviews were transcribed, and applied thematic analysis was conducted in order to gain an in-depth understanding to inform the development and refinement of the mobilized caregiver stress management intervention, Pep-Pal (PsychoEducation and skills for Patient caregivers). Results: Overall, results were favorable. Pep-Pal was deemed acceptable for caregivers of patients receiving an auto-HSCT. The refined Pep-Pal program consisted of 9 sessions (Introduction to Stress, Stress and the Mind Body Connection, How Thoughts Can Lead to Stress, Coping with Stress, Strategies for Maintaining Energy and Stamina, Coping with Uncertainty, Managing Changing Relationships and Communicating Needs, Getting the Support You Need, and Improving Intimacy) delivered via video instruction through a mobilized website. Conclusions: Feedback from stakeholder groups, focus groups, and individual interviews provided valuable feedback in key areas that was integrated into the development of Pep-Pal with the goal of enhancing dissemination, engagement, acceptability, and usability. %M 28642213 %R 10.2196/resprot.7075 %U http://www.researchprotocols.org/2017/6/e120/ %U https://doi.org/10.2196/resprot.7075 %U http://www.ncbi.nlm.nih.gov/pubmed/28642213 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e79 %T Beyond Basic Feedback in Mobile Brief Interventions: Designing SMS Message Content for Delivery to Young Adults During Risky Drinking Events %A Wright,Cassandra J C %A Dietze,Paul M %A Lim,Megan S C %+ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne,, Australia, 61 392822173, cassandra.wright@burnet.edu.au %K alcohol drinking %K young adult %K mHealth %K text messaging %K motivational interviewing %K community-based participatory research %D 2017 %7 20.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Brief interventions can reduce alcohol consumption in young people through screening and delivery of personally relevant feedback. Recently, Web and mobile platforms have been harnessed to increase the reach of brief interventions. Existing literature on mobile-based alcohol brief interventions indicates mixed use of theory in developing interventions. There is no research available to guide the development of SMS text messaging (short message service, SMS) interventions delivered during risky drinking events. Objective: The aim of this study was to develop and pilot an alcohol-related risk-reduction brief intervention delivered by SMS to Australian young adults during drinking events. This paper describes the development of intervention message content, with specific focus on the context of delivery during drinking events. Methods: A sample of 42 young adults attended 4 workshops; these comprised focus-group style discussion on drinking habits and motivations, discussion of intervention design, analysis of existing alcohol media campaigns, and participant development of message content. Data were analyzed thematically. Results: Participants described a focus on having fun and blocking out any incongruent negative influences during drinking episodes. For content to be acceptable, nonjudgmental and non-authoritative language was deemed essential. A preference for short, actionable messages was observed, including suggestions for reminders around drinking water, organizing transport home, checking on friends, and plans the next day. Participants were excited about the potential for messages to be tailored to individuals, as previous alcohol-related campaigns were deemed too generic and often irrelevant. Normative-based messages were also perceived as largely irrelevant as participants felt that they understood the drinking-related norms of their immediate peers already. Conclusions: Findings from this study offer insights into young adults’ drinking events and practical advice for designing alcohol-related brief interventions. During our formative development process, we demonstrated a neat correspondence between young people’s preferences for alcohol harm reduction interventions and the theoretical principles of brief interventions, including acceptable topics and message style. %M 28634153 %R 10.2196/mhealth.6497 %U http://mhealth.jmir.org/2017/6/e79/ %U https://doi.org/10.2196/mhealth.6497 %U http://www.ncbi.nlm.nih.gov/pubmed/28634153 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e81 %T Mobile Health in Oncology: A Patient Survey About App-Assisted Cancer Care %A Kessel,Kerstin Anne %A Vogel,Marco ME %A Kessel,Carmen %A Bier,Henning %A Biedermann,Tilo %A Friess,Helmut %A Herschbach,Peter %A von Eisenhart-Rothe,Rüdiger %A Meyer,Bernhard %A Kiechle,Marion %A Keller,Ulrich %A Peschel,Christian %A Schmid,Roland M %A Combs,Stephanie E %+ Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, 81675, Germany, 49 894140 ext 4501, kerstin.kessel@tum.de %K clinical oncology %K surveys and questionnaires %K mobile apps %K mHealth %K eHealth %D 2017 %7 14.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the last decade, the health care sector has been enriched by numerous innovations such as apps and connected devices that assist users in weight reduction and diabetes management. However, only a few native apps in the oncological context exist, which support patients during treatment and aftercare. Objective: The objective of this study was to analyze patients’ acceptance regarding app use and to investigate the functions of an oncological app that are most required, and the primary reasons for patients to refuse app-assisted cancer care. Methods: We designed and conducted a survey with 23 questions, inquiring patients about their technical knowledge and equipment, as well as the possible advantages and disadvantages, data transfer, and general functionality of an app. Results: A total of 375 patients participated; the participation rate was 60.7% (375/618). Gender distribution was about 3:4 (female:male) with a median age of 59 years (range 18-92 years). Whereas 69.6% (261/375) of patients used mobile devices, 16.3% (61/375) did not own one, and 9.1% (34/375) only used a personal computer (PC). About half of the patients rated their usability skills as very good and good (18.9% 71/375; 35.2% 132/375), 23.5% (88/375) described their skills as intermediate, and 14.4% (54/375) as bad. Of all patients, 182 (48.5%, 182/375) were willing to send data to their treating clinic via an app, that is, to a server (61.0% 111/182) or as email (33.5%, 61/182). About two-thirds (68.7%, 125/182) believed that additional and regularly sent data would be an ideal complement to the standard follow-up procedure. Additionally, 86.8% (158/182) wished to be contacted by a physician when entered data showed irregularities. Because of lack of skills (34.4%, 56/163), concerns about the use of data (35.0%, 57/163), lack of capable devices (25.8%, 42/163), and the wish for personal contact with the treating physician (47.2%, 77/163), a total of 163 (43.5%, 163/375) patients refused to use an app. Pearson correlation showed a significant but mild relationship between age and app use (P=.03, r=−.12), favoring younger age; male gender correlated as well (P=.04; r=−.11). Conclusions: The results show that the introduction of mobile apps needs to follow different strategies depending on the patients’ attitude. Age and gender seem to be the strongest predictive factors. For oncology patients, our survey showed that about half of the patients were willing to send data via an app supporting their treatment. In the future, clinical data such as quality of life and treatment satisfaction recorded by mobile health (mHealth) devices could be used to evaluate and improve therapy workflow. Furthermore, apps could support classical visits, document adverse effects, and remind patients of treatment dates or drug intake. %M 28615159 %R 10.2196/mhealth.7689 %U http://mhealth.jmir.org/2017/6/e81/ %U https://doi.org/10.2196/mhealth.7689 %U http://www.ncbi.nlm.nih.gov/pubmed/28615159 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e112 %T Systematic and Iterative Development of a Smartphone App to Promote Sun-Protection Among Holidaymakers: Design of a Prototype and Results of Usability and Acceptability Testing %A Rodrigues,Angela M %A Sniehotta,Falko F %A Birch-Machin,Mark A %A Olivier,Patrick %A Araújo-Soares,Vera %+ Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle, NE2 4AX, United Kingdom, 44 01912088974, angela.rodrigues@newcastle.ac.uk %K sun-protection %K sunburn %K sunscreening agents %K sunbathing %K health behavior %K health promotion %K formative research %K intervention %D 2017 %7 12.06.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Sunburn and intermittent exposure to ultraviolet rays are risk factors for melanoma. Sunburn is a common experience during holidays, making tourism settings of particular interest for skin cancer prevention. Holidaymakers are a volatile populations found at different locations, which may make them difficult to reach. Given the widespread use of smartphones, evidence suggests that this might be a novel, convenient, scalable, and feasible way of reaching the target population. Objective: The main objective of this study was to describe and appraise the process of systematically developing a smartphone intervention (mISkin app) to promote sun-protection during holidays. Methods: The iterative development process of the mISkin app was conducted over four sequential stages: (1) identify evidence on the most effective behavior change techniques (BCTs) used (active ingredients) as well as theoretical predictors and theories, (2) evidence-based intervention design, (3) co-design with users of the mISkin app prototype, and (4) refinement of the app. Each stage provided key findings that were subsequently used to inform the design of the mISkin app. Results: The sequential approach to development integrates different strands of evidence to inform the design of an evidence-based intervention. A systematic review on previously tested interventions to promote sun-protection provided cues and constraints for the design of this intervention. The development and design of the mISkin app also incorporated other sources of information, such as other literature reviews and experts’ consultations. The developed prototype of the mISkin app was evaluated by engaging potential holidaymakers in the refinement and further development of the mISkin app through usability (ease-of-use) and acceptability testing of the intervention prototype. All 17 participants were satisfied with the mISkin prototype and expressed willingness to use it. Feedback on the app was integrated in the optimization process of the mISkin app. Conclusions: The mISkin app was designed to promote sun-protection among holidaymakers and was based on current evidence, experts’ knowledge and experience, and user involvement. Based on user feedback, the app has been refined and a fully functional version is ready for formal testing in a feasibility pilot study. %M 28606892 %R 10.2196/resprot.7172 %U http://www.researchprotocols.org/2017/6/e112/ %U https://doi.org/10.2196/resprot.7172 %U http://www.ncbi.nlm.nih.gov/pubmed/28606892 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e78 %T Mobile App Design, Development, and Publication for Adverse Drug Reaction Assessments of Causality, Severity, and Preventability %A Ithnin,Muslimah %A Mohd Rani,Mohd Dzulkhairi %A Abd Latif,Zuraidah %A Kani,Paveethra %A Syaiful,Asmalita %A Nor Aripin,Khairun Nain %A Tengku Mohd,Tengku Amatullah Madeehah %+ Universiti Sains Islam Malaysia, Tingkat 13, Menara B, Persiaran MPAJ, Jalan Pandan Utama, Pandan Indah, Kuala Lumpur, 55100, Malaysia, 60 3 4289 2400, madeehah@usim.edu.my %K mobile applications %K computer-assisted decision making %K drug monitoring %K pharmacovigilance %K adverse drug reactions %D 2017 %7 30.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality. Improved assessment of ADRs to identify the causal relationship, the severity, and the preventability will aid ADRs prevention or reduce patient burden. Objective: The aim of this study was to develop mobile apps in assisting clinical decision in ADR assessments of causality, severity, and preventability using validated tools. The usability of the apps was assessed. Methods: We designed mobile apps using validated assessment tools for ADRs. They are the Liverpool ADRs Causality Assessment Tool, Hartwig’s Severity Assessment Scale, and the Modified Schumock and Thronton Preventability Scale. The apps were named “Adverse Drug ReactionCausality,” “Adverse Drug ReactionSeverity,” and “Adverse Drug RxnPreventability.” A survey was conducted using the System Usability Scale (SUS) to assess the usability of the developed apps among health care professionals. Results: These apps are available for download through Google Play Store for free since January 2015. From the survey, the mean SUS score was 70.9 based on 26 responses from the pediatric ward of Hospital Ampang, Malaysia. Conclusions: The developed apps received an overall acceptable usability among health care professionals. The usage of these apps will improve detection, assessment, and avoidance of future ADRs. They will also contribute to future research on ADRs, thus increasing drug safety. %M 28559222 %R 10.2196/mhealth.6261 %U http://mhealth.jmir.org/2017/5/e78/ %U https://doi.org/10.2196/mhealth.6261 %U http://www.ncbi.nlm.nih.gov/pubmed/28559222 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e99 %T Development of a Modular Research Platform to Create Medical Observational Studies for Mobile Devices %A Zens,Martin %A Grotejohann,Birgit %A Tassoni,Adrian %A Duttenhoefer,Fabian %A Südkamp,Norbert P %A Niemeyer,Philipp %+ Medical Center - University of Freiburg, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg, 79106, Germany, 49 1633374461, martin.zens@me.com %K mHealth %K telemedicine %K mobile health %K app-based study %K research platform %D 2017 %7 23.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Observational studies have proven to be a valuable resource in medical research, especially when performed on a large scale. Recently, mobile device-based observational studies have been discovered by an increasing number of researchers as a promising new source of information. However, the development and deployment of app-based studies is not trivial and requires profound programming skills. Objective: The aim of this project was to develop a modular online research platform that allows researchers to create medical studies for mobile devices without extensive programming skills. Methods: The platform approach for a modular research platform consists of three major components. A Web-based platform forms the researchers’ main workplace. This platform communicates via a shared database with a platform independent mobile app. Furthermore, a separate Web-based login platform for physicians and other health care professionals is outlined and completes the concept. Results: A prototype of the research platform has been developed and is currently in beta testing. Simple questionnaire studies can be created within minutes and published for testing purposes. Screenshots of an example study are provided, and the general working principle is displayed. Conclusions: In this project, we have created a basis for a novel research platform. The necessity and implications of a modular approach were displayed and an outline for future development given. International researchers are invited and encouraged to participate in this ongoing project %M 28536095 %R 10.2196/resprot.7705 %U http://www.researchprotocols.org/2017/5/e99/ %U https://doi.org/10.2196/resprot.7705 %U http://www.ncbi.nlm.nih.gov/pubmed/28536095 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e62 %T eTEST: Developing a Smart Home HIV Testing Kit that Enables Active, Real-Time Follow-Up and Referral After Testing %A Wray,Tyler %A Chan,Philip A %A Simpanen,Erik %A Operario,Don %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI, 02903, United States, 1 9134882714, tyler_wray@brown.edu %K HIV %K smartphone %K Internet %K counseling %K referral and consultation %K qualitative research %D 2017 %7 08.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Men who have sex with men (MSM) are the group at highest risk for contracting human immunodeficiency virus (HIV) in the United States, but many do not test as frequently as recommended. Home-based self-testing (HBST) for HIV holds promise for promoting regular testing among these individuals, but currently available HBSTs have limited follow-up options, providing only a 1-800 number that participants can call. Failure to actively conduct follow-up counseling and referrals after HBST use could result in delays in seeking confirmatory testing and care among users receiving reactive (preliminary positive) test results. HBST also fails to connect users who test negative with other prevention services that can reduce their future risk for HIV. Objective: The aim of our study was to use qualitative research methods with high-risk MSM to inform development of a “smart” HBST kit. The kit utilizes existing Internet-of-Things (IoT) technologies to monitor HBST use in real-time and enable delivery of timely, active follow-up counseling and referrals over the phone. Methods: In phase 1, individual interviews (n=10) explored how participants might use HBST and their views and preferences for conducting counseling and referral after HBST. Based on these perspectives, we developed a smartphone app (iOS, Android) that uses data from light sensors on Bluetooth low energy (BLE) beacons to monitor when HBST kits are opened, facilitating timely follow-up phone contact with users. In phase 2, a usability study conducted among high-risk MSM (n=10) examined the acceptability and feasibility of this system and provided user perspectives after using the system along with HBST. Results: Phase 1 themes suggested that MSM preferred HBST, that most thought active follow-up after HBST would be valuable, and that doing so over the phone within 24 h after testing was preferable. Phase 2 results showed that the eTEST system successfully detected HBST use in nearly all cases. Participant perspectives also suggested that the timing, method (ie, phone call), and duration of follow-up were appropriate and helpful. Conclusions: Using BLE beacons and a smartphone app to enable follow-up counseling and referral over the phone after HBST use is feasible and acceptable to high-risk MSM. Future research is needed to compare the effects of follow-up counseling on rates of repeat testing and receipt of referral services (eg, testing for sexually transmitted infections and initiation of preexposure prophylaxis) and to explore the acceptability of the eTEST system over longer periods of time. %M 28483744 %R 10.2196/mhealth.6491 %U http://mhealth.jmir.org/2017/5/e62/ %U https://doi.org/10.2196/mhealth.6491 %U http://www.ncbi.nlm.nih.gov/pubmed/28483744 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e67 %T Evaluation of a Mindfulness-Based Mobile App Aimed at Promoting Awareness of Weight-Related Behaviors in Adolescents: A Pilot Study %A Turner,Tami %A Hingle,Melanie %+ Department of Nutritional Sciences, The University of Arizona, 1177 E 4th St, Shantz Bldg, Room 328, Tucson, AZ,, United States, 1 520 626 7112, tamiturner@email.arizona.edu %K mindfulness %K adolescent %K mHealth %K diet %K physical activity %K app %D 2017 %7 26.04.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Mindfulness-based interventions are reported to be highly acceptable and have positive effects on youth, yet most are clinic- or school-based aimed at emotional regulation or academic performance. To provide flexible program delivery, we developed and tested a standalone mindfulness-based app aimed at improving weight-related behaviors (eg, diet, physical activity, sleep) in adolescents. Objective: Our objective was to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. Methods: In a single-arm pilot study, 15 adolescents (14-18 years) were prompted to access the app once a day, every day for 6 weeks. Outcomes were measured by in-app and poststudy surveys, and descriptive statistical analyses were performed. Time within a mindfulness state was self-reported during weekly timed practices. Results: The app was rated highly for content and encouraging the practice of activities to promote mindfulness states. Teens reported increased awareness of eating behaviors and high adherence, particularly during physically active practices. Average self-reported time spent in a mindfulness state increased 2.5 times by week 6 (78 [SD 17] seconds) compared to week 1 (31 [SD 21] seconds). Conclusions: The high acceptability and utility ratings of the app, increases in reported time in mindfulness states, and high frequency of participation, including mindful eating and physical activity, suggest the mindfulness-based mobile app has the potential to improve awareness of weight-related behaviors. %M 28446423 %R 10.2196/resprot.6695 %U http://www.researchprotocols.org/2017/4/e67/ %U https://doi.org/10.2196/resprot.6695 %U http://www.ncbi.nlm.nih.gov/pubmed/28446423 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e70 %T The Malaria System MicroApp: A New, Mobile Device-Based Tool for Malaria Diagnosis %A Oliveira,Allisson Dantas %A Prats,Clara %A Espasa,Mateu %A Zarzuela Serrat,Francesc %A Montañola Sales,Cristina %A Silgado,Aroa %A Codina,Daniel Lopez %A Arruda,Mercia Eliane %A i Prat,Jordi Gomez %A Albuquerque,Jones %+ Federal Rural University of Pernambuco, Department of Statistics and Informatics, Rua Dom Manoel de Medeiros, s/n, Dois Irmãos, Recife, 52171900, Brazil, 55 8133206491, allissondantas@gmail.com %K artificial intelligence %K applied computing %K automated diagnosis %K malaria %K mobile devices %D 2017 %7 25.04.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Malaria is a public health problem that affects remote areas worldwide. Climate change has contributed to the problem by allowing for the survival of Anopheles in previously uninhabited areas. As such, several groups have made developing news systems for the automated diagnosis of malaria a priority. Objective: The objective of this study was to develop a new, automated, mobile device-based diagnostic system for malaria. The system uses Giemsa-stained peripheral blood samples combined with light microscopy to identify the Plasmodium falciparum species in the ring stage of development. Methods: The system uses image processing and artificial intelligence techniques as well as a known face detection algorithm to identify Plasmodium parasites. The algorithm is based on integral image and haar-like features concepts, and makes use of weak classifiers with adaptive boosting learning. The search scope of the learning algorithm is reduced in the preprocessing step by removing the background around blood cells. Results: As a proof of concept experiment, the tool was used on 555 malaria-positive and 777 malaria-negative previously-made slides. The accuracy of the system was, on average, 91%, meaning that for every 100 parasite-infected samples, 91 were identified correctly. Conclusions: Accessibility barriers of low-resource countries can be addressed with low-cost diagnostic tools. Our system, developed for mobile devices (mobile phones and tablets), addresses this by enabling access to health centers in remote communities, and importantly, not depending on extensive malaria expertise or expensive diagnostic detection equipment. %M 28442456 %R 10.2196/resprot.6758 %U http://www.researchprotocols.org/2017/4/e70/ %U https://doi.org/10.2196/resprot.6758 %U http://www.ncbi.nlm.nih.gov/pubmed/28442456 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e49 %T Development of a Culturally Tailored Text Message Maternal Health Program: TextMATCH %A Dobson,Rosie %A Whittaker,Robyn %A Bartley,Hannah %A Connor,Augusta %A Chen,Ruyan %A Ross,Mairead %A McCool,Judith %+ National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 93737599 ext 88908, r.dobson@auckland.ac.nz %K mHealth %K short message service %K maternal health %K culture %K text messages %D 2017 %7 20.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phones are increasingly being used to deliver health information and health services globally. Mobile health (mHealth) interventions may be well-suited for minority groups with greater barriers to accessing traditional health services. However, little has been written about the process of culturally adapting interventions for multiple ethnic and cultural minorities within a population. Objective: This study describes the process of developing a culturally tailored text message-based maternal health program (TextMATCH: Text for MATernal and Child Health) for Māori, Pacific, Asian, and South Asian families living in New Zealand. We report on engagement and acceptability of the TextMATCH program. Methods: Program data was examined to describe engagement with the program 18 months after implementation. Telephone interviews were conducted with a sample of participants who consented to provide feedback on acceptability and relevance of the program. Results: A total of 1404 participants enrolled in TextMATCH over 18 months, with 18.52% (260) actively opting out at some point (after 0 to 17 months of messages). It was found that 356 (70.9%) of the 502 eligible participants actively switched from the initial pregnancy program to the baby program after delivery. Phone interviews were conducted with 29 participants including 6 who had withdrawn (duration of program from 3 to 16 months). Only 2 participants reported that the program was not useful, with the remainder rating the usefulness of messages positively (average 4.24 out of 5). All participants stated that the messages were relevant, culturally appropriate, and easy to understand. Most were happy with the specific advice and the language options provided. Conclusions: We have demonstrated the importance of an intensive approach to the development of a culturally adapted and tailored mHealth program for multiple different cultural minority groups within our population. %M 28428159 %R 10.2196/mhealth.7205 %U http://mhealth.jmir.org/2017/4/e49/ %U https://doi.org/10.2196/mhealth.7205 %U http://www.ncbi.nlm.nih.gov/pubmed/28428159 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e63 %T Testing the Feasibility and Usability of a Novel Smartphone-Based Self-Management Support System for Dialysis Patients: A Pilot Study %A Hayashi,Aki %A Yamaguchi,Satoko %A Waki,Kayo %A Fujiu,Katsuhito %A Hanafusa,Norio %A Nishi,Takahiro %A Tomita,Hyoe %A Kobayashi,Haruka %A Fujita,Hideo %A Kadowaki,Takashi %A Nangaku,Masaomi %A Ohe,Kazuhiko %+ Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo,, Japan, 81 3 3815 5411 ext 34462, kwaki-tky@umin.ac.jp %K telemedicine %K mobile phone app %K hemodialysis %K self-management %D 2017 %7 20.04.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Diet and fluid restrictions that need continuous self-management are among the most difficult aspects of dialysis treatment. Smartphone applications may be useful for supporting self-management. Objective: Our objective is to investigate the feasibility and usability of a novel smartphone-based self-management support system for dialysis patients. Methods: We developed the Self-Management and Recording System for Dialysis (SMART-D), which supports self-monitoring of three mortality-related factors that can be modified by lifestyle: interdialytic weight gain and predialysis serum potassium and phosphorus concentrations. Data is displayed graphically, with all data evaluated automatically to determine whether they achieve the values suggested by the Japanese Society for Dialysis Therapy guidelines. In a pilot study, 9 dialysis patients used SMART-D system for 2 weeks. A total of 7 of them completed questionnaires rating their assessment of SMART-D’s usability and their satisfaction with the system. In addition, the Kidney Disease Quality of Life scale was compared before and after the study period. Results: All 9 participants were able to use SMART-D with no major problems. Completion rates for body weight, pre- and postdialysis weight, and serum potassium and phosphorus concentrations were, respectively, 89% (SD 23), 95% (SD 7), and 78% (SD 44). Of the 7 participants who completed the usability survey, all were motivated by the sense of security derived from using the system, and 6 of the 7 (86%) reported that using SMART-D helped improve their lifestyle and self-management. Conclusions: Using SMART-D was feasible, and the system was well regarded by patients. Further study with larger scale cohorts and longer study and follow-up periods is needed to evaluate the effects of SMART-D on clinical outcomes and quality of life. %M 28428168 %R 10.2196/resprot.7105 %U http://www.researchprotocols.org/2017/4/e63/ %U https://doi.org/10.2196/resprot.7105 %U http://www.ncbi.nlm.nih.gov/pubmed/28428168 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e62 %T Mobile Application to Promote Adherence to Oral Chemotherapy and Symptom Management: A Protocol for Design and Development %A Fishbein,Joel Nathan %A Nisotel,Lauren Ellen %A MacDonald,James John %A Amoyal Pensak,Nicole %A Jacobs,Jamie Michele %A Flanagan,Clare %A Jethwani,Kamal %A Greer,Joseph Andrew %+ Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA,, United States, 1 617 643 2143, jgreer2@mgh.harvard.edu %K telemedicine %K neoplasms %K mobile apps %K medication adherence %K self-administration %K antineoplastic agents %K ambulatory monitoring %K mHealth %K software design %D 2017 %7 20.04.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Oral chemotherapy is increasingly used in place of traditional intravenous chemotherapy to treat patients with cancer. While oral chemotherapy includes benefits such as ease of administration, convenience, and minimization of invasive infusions, patients receive less oversight, support, and symptom monitoring from clinicians. Additionally, adherence is a well-documented challenge for patients with cancer prescribed oral chemotherapy regimens. With the ever-growing presence of smartphones and potential for efficacious behavioral intervention technology, we created a mobile health intervention for medication and symptom management. Objective: The objective of this study was to develop and evaluate the usability and acceptability of a smartphone app to support adherence to oral chemotherapy and symptom management in patients with cancer. Methods: We used a 5-step development model to create a comprehensive mobile app with theoretically informed content. The research and technical development team worked together to develop and iteratively test the app. In addition to the research team, key stakeholders including patients and family members, oncology clinicians, health care representatives, and practice administrators contributed to the content refinement of the intervention. Patient and family members also participated in alpha and beta testing of the final prototype to assess usability and acceptability before we began the randomized controlled trial. Results: We incorporated app components based on the stakeholder feedback we received in focus groups and alpha and beta testing. App components included medication reminders, self-reporting of medication adherence and symptoms, an education library including nutritional information, Fitbit integration, social networking resources, and individually tailored symptom management feedback. We are conducting a randomized controlled trial to determine the effectiveness of the app in improving adherence to oral chemotherapy, quality of life, and burden of symptoms and side effects. At every stage in this trial, we are engaging stakeholders to solicit feedback on our progress and next steps. Conclusions: To our knowledge, we are the first to describe the development of an app designed for people taking oral chemotherapy. The app addresses many concerns with oral chemotherapy, such as medication adherence and symptom management. Soliciting feedback from stakeholders with broad perspectives and expertise ensured that the app was acceptable and potentially beneficial for patients, caregivers, and clinicians. In our development process, we instantiated 7 of the 8 best practices proposed in a recent review of mobile health app development. Our process demonstrated the importance of effective communication between research groups and technical teams, as well as meticulous planning of technical specifications before development begins. Future efforts should consider incorporating other proven strategies in software, such as gamification, to bolster the impact of mobile health apps. Forthcoming results from our randomized controlled trial will provide key data on the effectiveness of this app in improving medication adherence and symptom management. Trial Registration: ClinicalTrials.gov NCT02157519; https://clinicaltrials.gov/ct2/show/NCT02157519 (Archived by WebCite at http://www.webcitation.org/6prj3xfKA) %M 28428158 %R 10.2196/resprot.6198 %U http://www.researchprotocols.org/2017/4/e62/ %U https://doi.org/10.2196/resprot.6198 %U http://www.ncbi.nlm.nih.gov/pubmed/28428158 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e124 %T Using Persuasive Technology to Increase Physical Activity in People With Chronic Obstructive Pulmonary Disease by Encouraging Regular Walking: A Mixed-Methods Study Exploring Opinions and Preferences %A Bartlett,Yvonne Kiera %A Webb,Thomas L %A Hawley,Mark S %+ Manchester Centre for Health Psychology, Manchester Academic Health Science Centre, The School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M139PL, United Kingdom, 44 161306436 ext 65436, kiera.bartlett@manchester.ac.uk %K persuasive technology %K chronic obstructive pulmonary disease %K physical activity %K walking %K mHealth %K mobile apps %D 2017 %7 20.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: People with chronic obstructive pulmonary disease (PwCOPD) often experience breathlessness and fatigue, making physical activity challenging. Although many persuasive technologies (such as mobile phone apps) have been designed to support physical activity among members of the general population, current technologies aimed at PwCOPD are underdeveloped and only use a limited range of persuasive technology design principles. Objective: The aim of this study was to explore how acceptable different persuasive technology design principles were considered to be in supporting and encouraging physical activity among PwCOPD. Methods: Three prototypes for mobile apps using different persuasive technology design principles as defined by the persuasive systems design (PSD) model—namely, dialogue support, primary task support, and social support—were developed. Opinions of these prototypes were explored through 28 interviews with PwCOPD, carers, and the health care professionals (HCPs) involved in their care and questionnaires completed by 87 PwCOPD. Participants also ranked how likely individual techniques (eg, competition) would be to convince them to use a technology designed to support physical activity. Data were analyzed using framework analysis, Friedman tests, and Wilcoxon signed rank tests and a convergent mixed methods design was used to integrate findings. Results: The prototypes for mobile apps were received positively by participants. The prototype that used a dialogue support approach was identified as the most likely to be used or recommended by those interviewed, and was perceived as more persuasive than both of the other prototypes (Z=−3.06, P=.002; Z=−5.50, P<.001) by those who completed the questionnaire. PwCOPD identified dialogue support and primary task support techniques as more likely to convince them to use a technology than social support techniques (Z=−5.00, P<.001; Z=−4.92, P<.001, respectively). Opinions of social support techniques such as competition and collaboration were divided. Conclusions: Dialogue support and primary task support approaches are considered to be both acceptable and likely to be persuasive by PwCOPD, carers, and HCPs. In the future, these approaches should be considered when designing apps to encourage physical activity by PwCOPD. %M 28428155 %R 10.2196/jmir.6616 %U http://www.jmir.org/2017/4/e124/ %U https://doi.org/10.2196/jmir.6616 %U http://www.ncbi.nlm.nih.gov/pubmed/28428155 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e53 %T Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents %A Holtz,Bree E %A Murray,Katharine M %A Hershey,Denise D %A Dunneback,Julie K %A Cotten,Shelia R %A Holmstrom,Amanda J %A Vyas,Arpita %A Kaiser,Molly K %A Wood,Michael A %+ Department of Advertising and Public Relations, Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, 48824, United States, 1 5178844537, bholtz@msu.edu %K mHealth %K qualitative research %K type 1 diabetes %K family %D 2017 %7 19.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Type 1 diabetes (T1D) afflicts approximately 154,000 people under 20 years of age. Three-quarters of adolescents are not achieving glycosylated hemoglobin (HbA1c) targets, which leads to negative health outcomes. Mobile health (mHealth), the use of technology in health, has been used successfully to improve health in many chronic conditions, including diabetes. Objective: The purpose of this study was to use patient-centered research methods to inform and improve the design and functionality of our T1D app, MyT1DHero, and to provide insight for others who are designing a health app for adolescents and parents. Methods: This study included data from focus groups with participants recruited from the Juvenile Diabetes Research Foundation (JDRF) southeast Michigan’s family network. All data collected during the sessions were audio-recorded, transcribed, and coded. Results: Four key themes were identified: (1) diabetes is unpredictable, (2) negative and frustrated communication, (3) motivations to use an app, and (4) feedback specific to our app. Conclusions: A patient-centered approach was used to assist in the development of an app for adolescents with T1D. Participants were satisfied with overall app design; customization, interactivity, and tangible rewards were identified as being necessary for continued use. Participants believed the app would help improve the communication between parents and adolescents. Many apps developed in the health context have not used a patient-centered design method or have seen vast improvements in health. This paper offers suggestions to others seeking to develop apps for adolescents and their parents. %M 28428167 %R 10.2196/mhealth.6654 %U http://mhealth.jmir.org/2017/4/e53/ %U https://doi.org/10.2196/mhealth.6654 %U http://www.ncbi.nlm.nih.gov/pubmed/28428167 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e48 %T Design of a Mobile App for Nutrition Education (TreC-LifeStyle) and Formative Evaluation With Families of Overweight Children %A Gabrielli,Silvia %A Dianti,Marco %A Maimone,Rosa %A Betta,Marta %A Filippi,Lorena %A Ghezzi,Monica %A Forti,Stefano %+ Fondazione Bruno Kessler, High Impact Initiative on Health & Wellbeing, Via Sommarive 18, Trento, 38123, Italy, 39 0461 312 477, sgabrielli@fbk.eu %K mHealth %K child %K overweight %K pediatrics %K health behavior %K evaluation studies %D 2017 %7 13.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nutrition and diet apps represent today a popular area of mobile health (mHealth), offering the possibility of delivering behavior change (BC) interventions for healthy eating and weight management in a scalable and cost-effective way. However, if commercial apps for pediatric weight management fail to retain users because of a lack of theoretical background and evidence-based content, mHealth apps that are more evidence-based are found less engaging and popular among consumers. Approaching the apps development process from a multidisciplinary and user-centered design (UCD) perspective is likely to help overcome these limitations, raising the chances for an easier adoption and integration of nutrition education apps within primary care interventions. Objective: The aim of this study was to describe the design and development of the TreC-LifeStyle nutrition education app and the results of a formative evaluation with families. Methods: The design of the nutrition education intervention was based on a multidisciplinary UCD approach, involving a team of BC experts, working with 2 nutritionists and 3 pediatricians from a primary care center. The app content was derived from evidence-based knowledge founded on the Food Pyramid and Mediterranean Diet guidelines used by pediatricians in primary care. A formative evaluation of the TreC-LifeStyle app involved 6 families of overweight children (aged 7-12 years) self-reporting daily food intake of children for 6 weeks and providing feedback on the user experience with the mHealth intervention. Analysis of the app’s usage patterns during the intervention and of participants’ feedback informed the refinement of the app design and a tuning of the nutrition education strategies to improve user engagement and compliance with the intervention. Results: Design sessions with the contribution of pediatricians and nutritionists helped define the nutrition education app and intervention, providing an effective human and virtual coaching approach to raise parents’ awareness about children’s eating behavior and lifestyle. The 6 families participating in the pilot study found the app usable and showed high compliance with the intervention over the 6 weeks, but analysis of their interaction and feedback showed the need for improving some of the app features related to the BC techniques “monitoring of the behavior” and “information provision.” Conclusions: The UCD and formative evaluation of TreC-LifeStyle show that nutrition education apps are feasible and acceptable solutions to support health promotion interventions in primary care. %M 28408361 %R 10.2196/mhealth.7080 %U http://mhealth.jmir.org/2017/4/e48/ %U https://doi.org/10.2196/mhealth.7080 %U http://www.ncbi.nlm.nih.gov/pubmed/28408361 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e113 %T Young People’s Preferences for an Asthma Self-Management App Highlight Psychological Needs: A Participatory Study %A Peters,Dorian %A Davis,Sharon %A Calvo,Rafael Alejandro %A Sawyer,Susan M %A Smith,Lorraine %A Foster,Juliet M %+ School of Electrical and Information Engineering, Faculty of Engineering, University of Sydney, Bldg J03, Electrical Engineering, Maze Crescent, Sydney, 2006, Australia, 61 0289015604, dorian.peters@sydney.edu.au %K asthma %K mobile applications %K quality of life %K mental health %K adolescents %K chronic disease %K mhealth %K participatory design %D 2017 %7 11.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Although the prevalence of mental illness among young people with asthma is known to be twice the rate of the wider population, none of the asthma apps reported have acknowledged or attempted to include psychological support features. This is perhaps because user involvement in the development of asthma apps has been scarce. User involvement, facilitated by participatory design methods, can begin to address these issues while contributing insights to our understanding of the psychological experience associated with asthma and how technology might improve quality of life. Objective: The goal of this participatory user research study was to explore the experience, needs, and ideas of young people with asthma while allowing them to define requirements for an asthma app that would be engaging and effective at improving their well-being. Methods: Young people aged 15-24 years with doctor-diagnosed asthma were invited to participate in a participatory workshop and to complete a workbook designed to elicit their thoughts and ideas about living with asthma, technology use, and the design of an app. Participants generated a number of artifacts (including collages, concept maps, and paper prototypes) designed to reify their ideas, tacit knowledge, and experience. Results: A total of 20 participants (mean age 17.8 years; 60%, 12/20 female) representing a range from inadequately to well-controlled asthma completed a workbook and 13 of these also took part in a workshop (four workshops were held in total), resulting in 102 participant-generated artifacts. Theoretical thematic analysis resulted in a set of personal needs, feature ideas, and app characteristics considered relevant by young people for an asthma support app. The data revealed that psychological factors such as anxiety, and impediments to autonomy, competence, and relatedness (as consistent with self-determination theory [SDT]), were considered major influences on quality of life by young people with asthma. Furthermore, the incorporation of features pertaining to psychological experience was particularly valued by participants. Conclusions: In addition to practical features for asthma management, an app for young people with asthma should include support for the mental health factors associated with lived experience (ie, anxiety, lack of autonomy, and social disconnectedness). We show how support for these factors can be translated into design features of an app for asthma. In addition to informing the development of asthma-support technologies for young people, these findings could have implications for technologies designed to support people with chronic illness more generally. %M 28400353 %R 10.2196/jmir.6994 %U http://www.jmir.org/2017/4/e113/ %U https://doi.org/10.2196/jmir.6994 %U http://www.ncbi.nlm.nih.gov/pubmed/28400353 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e40 %T Designing Health Apps to Support Dietetic Professional Practice and Their Patients: Qualitative Results From an International Survey %A Chen,Juliana %A Lieffers,Jessica %A Bauman,Adrian %A Hanning,Rhona %A Allman-Farinelli,Margaret %+ School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Level 4 East, Charles Perkins Centre (D17), John Hopkins Drive, Camperdown, 2006, Australia, 61 2 8627 0843, jche6526@uni.sydney.edu.au %K dietetics %K apps %K app design %K mHealth %K smartphone %D 2017 %7 31.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietitians are engaging with mobile health (mHealth) technologies, particularly with diet and nutrition apps in their patient care. Despite the plethora of apps available, the majority are not designed with a dietitian’s input. Objective: The aim of this study was to identify the user preferences of dietitians in relation to tools, resources, and design features for smartphone health apps that would support their dietetic professional practice and their patients. Methods: As part of a larger international Web-based survey of health-app use among dietitians, three open-ended responses were included for specific exploration of app design features and additional resources or tools that could guide the development of apps for use in dietetic practice and patient care. Inductive thematic analysis of responses was conducted using the qualitative data analysis program, NVivo version 11 (QSR International Pty Ltd), to understand the design preferences and features valued by dietitians. Results: The responses from 381 dietitian respondents were analyzed. Five key themes were identified. Dietitians wanted access to credible apps, suggesting that dietetic associations should have greater involvement in reviewing and endorsing evidence-based apps for use in dietary counseling. Improvements to the usability of apps, relating to their ease of use and design, were also raised, as self-monitoring of dietary behaviors using existing nutrition apps was deemed to be burdensome. Furthermore, apps providing dietitian-oriented support were favored, for example, those with the ability to streamline the dietary assessment process, so that dietitians could spend more time on dietary counseling and negotiating patient goals for dietary and lifestyle behavior change. Provision of patient-oriented support, such as functionality to tailor apps to patient-specific needs, was also considered important. Finally, respondents valued apps that could integrate into their work systems to enhance the quality of the dietitian-patient relationship. Conclusions: App developers should draw upon the features and characteristics valued by dietitians to guide their development of apps that support dietetic practice and enhance patient care. Moreover, to achieve better dietitian and patient-centered app design, it is imperative that app developers take a collaborative approach with dietitians, their professional associations, and their patients. %M 28363882 %R 10.2196/mhealth.6945 %U http://mhealth.jmir.org/2017/3/e40/ %U https://doi.org/10.2196/mhealth.6945 %U http://www.ncbi.nlm.nih.gov/pubmed/28363882 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 4 %N 1 %P e3 %T Designing a Mobile Health App for Patients With Dysphagia Following Head and Neck Cancer: A Qualitative Study %A Constantinescu,Gabriela %A Loewen,Irene %A King,Ben %A Brodt,Chris %A Hodgetts,William %A Rieger,Jana %+ Department of Communication Sciences and Disorders, University of Alberta, 2-70 Corbett Hall, University of Alberta, Edmonton, AB, T6R 3T5, Canada, 1 780 492 4992, jana.rieger@ualberta.ca %K app design %K dysphagia %K games for health %K gamification %K head and neck cancer %K mHealth %K mobile health %K patient adherence %K patient engagement %D 2017 %7 24.03.2017 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having difficulty adhering to prescribed regimens. Health apps with game elements have been used in other health domains to motivate and engage patients. Understanding the factors that impact adherence may allow for more effective gamified solutions. Objective: The aim of our study was to (1) identify self-reported factors that influence adherence to conventional home therapy without a mobile device in HNC patients and (2) identify appealing biofeedback designs that could be used in a health app. Methods: A total of 10 (4 females) HNC patients (mean=60.1 years) with experience completing home-based rehabilitation programs were recruited. Thematic analysis of semi-structured interviews was used to answer the first objective. Convergent interviews were used to obtain reactions to biofeedback designs. Results: Facilitators and barriers of adherence to home therapy were described through 6 themes: patient perceptions on outcomes and progress, clinical appointments, cancer treatment, rehabilitation program, personal factors, and connection. App visuals that provide feedback on performance during swallowing exercises should offer an immediate representation of effort relative to a goal. Simple, intuitive graphics were preferred over complex, abstract ones. Continued engagement with the app could be facilitated by tracking progress and by using visuals that build structures with each use. Conclusions: This is a detailed documentation of the initial steps in designing a health app for a specific patient group. Results revealed the importance of patient engagement in early stages of app development. %M 28582245 %R 10.2196/rehab.6319 %U http://rehab.jmir.org/2017/1/e3/ %U https://doi.org/10.2196/rehab.6319 %U http://www.ncbi.nlm.nih.gov/pubmed/28582245 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e31 %T Design Considerations for mHealth Programs Targeting Smokers Not Yet Ready to Quit: Results of a Sequential Mixed-Methods Study %A McClure,Jennifer B %A Heffner,Jaimee %A Hohl,Sarah %A Klasnja,Predrag %A Catz,Sheryl L %+ Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2737, McClure.J@ghc.org %K tobacco %K smoking cessation %K telemedicine %K mobile health %K smartphone %K motivation %D 2017 %7 10.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) smoking cessation programs are typically designed for smokers who are ready to quit smoking. In contrast, most smokers want to quit someday but are not yet ready to quit. If mHealth apps were designed for these smokers, they could potentially encourage and assist more people to quit smoking. No prior studies have specifically examined the design considerations of mHealth apps targeting smokers who are not yet ready to quit. Objective: To inform the user-centered design of mHealth apps for smokers who were not yet ready to quit by assessing (1) whether these smokers were interested in using mHealth tools to change their smoking behavior; (2) their preferred features, functionality, and content of mHealth programs addressing smoking; and (3) considerations for marketing or distributing these programs to promote their uptake. Methods: We conducted a sequential exploratory, mixed-methods study. Qualitative interviews (phase 1, n=15) were completed with a demographically diverse group of smokers who were smartphone owners and wanted to quit smoking someday, but not yet. Findings informed a Web-based survey of smokers from across the United States (phase 2, n=116). Data were collected from April to September, 2016. Results: Findings confirmed that although smokers not yet ready to quit are not actively seeking treatment or using cessation apps, most would be interested in using these programs to help them reduce or change their smoking behavior. Among phase 2 survey respondents, the app features, functions, and content rated most highly were (1) security of personal information; (2) the ability to track smoking, spending, and savings; (3) content that adaptively changes with one’s needs; (4) the ability to request support as needed; (5) the ability to earn and redeem awards for program use; (6) guidance on how to quit smoking; and (7) content specifically addressing management of nicotine withdrawal, stress, depression, and anxiety. Results generally did not vary by stage of change for quitting smoking (precontemplation vs contemplation). The least popular feature was the ability to share progress via social media. Relevant to future marketing or distribution considerations, smokers were price-sensitive and valued empirically validated programs. Program source, expert recommendations, and user ratings were also important considerations. Conclusions: Smokers who are not yet ready to quit represent an important target group for intervention. Study findings suggest that many of these individuals are receptive to using mHealth tools to reduce or quit smoking, despite not having made a commitment to quit yet. The preferences for specific mHealth intervention features, functionality, and content outlined in this paper can aid addiction treatment experts, design specialists, and software developers interested in creating engaging interventions for smokers who want to quit in the future but are not yet committed to this important health goal. %M 28283465 %R 10.2196/mhealth.6845 %U http://mhealth.jmir.org/2017/3/e31/ %U https://doi.org/10.2196/mhealth.6845 %U http://www.ncbi.nlm.nih.gov/pubmed/28283465 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e29 %T A Mobile Clinical Decision Support Tool for Pediatric Cardiovascular Risk-Reduction Clinical Practice Guidelines: Development and Description %A Furberg,Robert D %A Williams,Pamela %A Bagwell,Jacqueline %A LaBresh,Kenneth %+ Digital Health and Clinical Informatics, RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, United States, 1 919 316 3726, rfurberg@rti.org %K pediatrics %K cardiovascular risk reduction %K mHealth %K clinical decision support %K clinical practice guidelines %D 2017 %7 07.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Widespread application of research findings to improve patient outcomes remains inadequate, and failure to routinely translate research findings into daily clinical practice is a major barrier for the implementation of any evidence-based guideline. Strategies to increase guideline uptake in primary care pediatric practices and to facilitate adherence to recommendations are required. Objective: Our objective was to operationalize the US National Heart, Lung, and Blood Institute’s Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents into a mobile clinical decision support (CDS) system for healthcare providers, and to describe the process development and outcomes. Methods: To overcome the difficulty of translating clinical practice guidelines into a computable form that can be used by a CDS system, we used a multilayer framework to convert the evidence synthesis into executable knowledge. We used an iterative process of design, testing, and revision through each step in the translation of the guidelines for use in a CDS tool to support the development of 4 validated modules: an integrated risk assessment; a blood pressure calculator; a body mass index calculator; and a lipid management instrument. Results: The iterative revision process identified several opportunities to improve the CDS tool. Operationalizing the integrated guideline identified numerous areas in which the guideline was vague or incorrect and required more explicit operationalization. Iterative revisions led to workable solutions to problems and understanding of the limitations of the tool. Conclusions: The process and experiences described provide a model for other mobile CDS systems that translate written clinical practice guidelines into actionable, real-time clinical recommendations. %M 28270384 %R 10.2196/mhealth.6291 %U http://mhealth.jmir.org/2017/3/e29/ %U https://doi.org/10.2196/mhealth.6291 %U http://www.ncbi.nlm.nih.gov/pubmed/28270384 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e27 %T Development and Testing of a Mobile Phone App for Self-Monitoring of Calcium Intake in Young Women %A Tay,Ilona %A Garland,Suzanne %A Gorelik,Alexandra %A Wark,John Dennis %+ Royal Melbourne Hospital, Bone and Mineral Medicine, Royal Parade, Parkville, VIC, 3052, Australia, 61 3 83445201, jdwark@unimelb.edu.au %K behavior therapy %K cell phones %K health behavior %K primary prevention %K self care %K telemedicine %D 2017 %7 07.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Interventions to prevent osteoporosis by increasing dairy intake or physical activity in young women have been limited to increasing osteoporosis knowledge and awareness. However, findings have shown that this does not always lead to a change in behaviors. Self-monitoring using mobile devices in behavioral interventions has yielded significant and positive outcomes. Yet, to our knowledge, mobile self-monitoring has not been used as an intervention strategy to increase calcium intake, particularly in young women, for better bone health outcomes. Objective: As development and testing of mobile app–based interventions requires a sequence of steps, our study focused on testing the acceptability and usability of Calci-app, a dietary app to self-monitor calcium consumption, before it is used in a behavioral change intervention in young women aged 18-25 years. Methods: Calci-app development followed 4 steps: (1) conceptualization, (2) development and pretesting, (3) pilot testing, and (4) mixed methods evaluation. Results: We present the development process of Calci-app and evaluation of the acceptability and usability of the app in young women. Overall, 78% (31/40) of study participants completed the 5-day food record with high compliance levels (defined as more than 3 days of full or partial completion). There was a significant reduction in the proportion of participants completing all meal entries over the 5 days (P=.01). Participants generally found Calci-app easy and convenient to use, but it was time-consuming and they expressed a lack of motivation to use the app. Conclusions: We present a detailed description of the development process of Calci-app and an evaluation of its usability and acceptability to self-monitor dietary calcium intake. The findings from this preliminary study demonstrated acceptable use of Calci-app to self-monitor calcium consumption. However, for regular and long-term use the self-monitoring function in Calci-app could be expanded to allow participants to view their total daily calcium intake compared with the recommended daily intake. Additionally, to facilitate sustainable lifestyle behavior modifications, a combination of various behavior change techniques should be considered, such as education, goal setting, and advice to participants based on their stage of change. The feedback on barriers and facilitators from testing Calci-app will be used to design a bone health mHealth intervention to modify risky lifestyle behaviors in young women for better bone health outcomes. %M 28270379 %R 10.2196/mhealth.5717 %U http://mhealth.jmir.org/2017/3/e27/ %U https://doi.org/10.2196/mhealth.5717 %U http://www.ncbi.nlm.nih.gov/pubmed/28270379 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e6 %T Mobile Technology Use by People Experiencing Multiple Sclerosis Fatigue: Survey Methodology %A Van Kessel,Kirsten %A Babbage,Duncan R %A Reay,Nicholas %A Miner-Williams,Warren M %A Kersten,Paula %+ Department of Psychology, Faculty of Health and Enviromental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland,, New Zealand, 64 9 921 9999 ext 7691, kvankess@aut.ac.nz %K mobile phone technology %K multiple sclerosis %K app %K fatigue %K symptoms %K cognitive behavioral therapy %K intervention %D 2017 %7 28.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Fatigue is one of the most commonly reported symptoms of multiple sclerosis (MS). It has a profound impact on all spheres of life, for people with MS and their relatives. It is one of the key precipitants of early retirement. Individual, group, and Internet cognitive behavioral therapy–based approaches to supporting people with MS to manage their fatigue have been shown to be effective. Objective: The aim of this project was to (1) survey the types of mobile devices and level of Internet access people with MS use or would consider using for a health intervention and (2) characterize the levels of fatigue severity and their impact experienced by the people in our sample to provide an estimate of fatigue severity of people with MS in New Zealand. The ultimate goal of this work was to support the future development of a mobile intervention for the management of fatigue for people with MS. Methods: Survey methodology using an online questionnaire was used to assess people with MS. A total of 51 people with MS participated. The average age was 48.5 years, and the large majority of the sample (77%) was female. Results: Participants reported significant levels of fatigue as measured with the summary score of the Neurological Fatigue Index (mean 31.4 [SD 5.3]). Most (84%) respondents scored on average more than 3 on the fatigue severity questions, reflecting significant fatigue. Mobile phone usage was high with 86% of respondents reporting having a mobile phone; apps were used by 75% of respondents. Most participants (92%) accessed the Internet from home. Conclusions: New Zealand respondents with MS experienced high levels of both fatigue severity and fatigue impact. The majority of participants have a mobile device and access to the Internet. These findings, along with limited access to face-to-face cognitive behavioral therapy–based interventions, create an opportunity to develop a mobile technology platform for delivering a cognitive behavioral therapy–based intervention to decrease the severity and impact of fatigue in people with MS. %M 28246073 %R 10.2196/mhealth.6192 %U http://mhealth.jmir.org/2017/2/e6/ %U https://doi.org/10.2196/mhealth.6192 %U http://www.ncbi.nlm.nih.gov/pubmed/28246073 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e17 %T Features of a Mobile Support App for Patients With Chronic Obstructive Pulmonary Disease: Literature Review and Current Applications %A Sobnath,Drishty D %A Philip,Nada %A Kayyali,Reem %A Nabhani-Gebara,Shereen %A Pierscionek,Barbara %A Vaes,Anouk W %A Spruit,Martijn A %A Kaimakamis,Evangelos %+ Digital Media for Health, Medical Information and Network Technology, Faculty of Science, Engineering and Computing, Kingston University London, Penrhyn Road, Surrey, KT12EE, United Kingdom, 44 020 8417 9000, d.sobnath@kingston.ac.uk %K mHealth %K COPD app %K COPD support tool %K self-management application %K chronic diseases, application design %K WELCOME %D 2017 %7 20.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic obstructive pulmonary disease (COPD) is a serious long-term lung disease in which the airflow from the lungs is progressively reduced. By 2030, COPD will become the third cause of mortality and seventh cause of morbidity worldwide. With advances in technology and mobile communications, significant progress in the mobile health (mHealth) sector has been recently observed. Mobile phones with app capabilities (smartphones) are now considered as potential media for the self-management of certain types of diseases such as asthma, cancer, COPD, or cardiovascular diseases. While many mobile apps for patients with COPD are currently found on the market, there is little published material on the effectiveness of most of them, their features, and their adoption in health care settings. Objectives: The aim of this study was to search the literature for current systems related to COPD and identify any missing links and studies that were carried out to evaluate the effectiveness of COPD mobile apps. In addition, we reviewed existing mHealth apps from different stores in order to identify features that can be considered in the initial design of a COPD support tool to improve health care services and patient outcomes. Methods: In total, 206 articles related to COPD management systems were identified from different databases. Irrelevant materials and duplicates were excluded. Of those, 38 articles were reviewed to extract important features. We identified 214 apps from online stores. Following exclusion of irrelevant apps, 48 were selected and 20 of them were downloaded to review some of their common features. Results: Our review found that out of the 20 apps downloaded, 13 (65%, 13/20) had an education section, 5 (25%, 5/20) consisted of medication and guidelines, 6 (30%, 6/20) included a calendar or diary and other features such as reminders or symptom tracking. There was little published material on the effectiveness of the identified COPD apps. Features such as (1) a social networking tool; (2) personalized education; (3) feedback; (4) e-coaching; and (5) psychological motivation to enhance behavioral change were found to be missing in many of the downloaded apps. Conclusions: This paper summarizes the features of a COPD patient-support mobile app that can be taken into consideration for the initial design of an integrated care system to encourage the self-management of their condition at home. %M 28219878 %R 10.2196/mhealth.4951 %U http://mhealth.jmir.org/2017/2/e17/ %U https://doi.org/10.2196/mhealth.4951 %U http://www.ncbi.nlm.nih.gov/pubmed/28219878 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e11 %T Mixed-Methods Analysis of Factors Impacting Use of a Postoperative mHealth App %A Scott,Aaron R %A Alore,Elizabeth A %A Naik,Aanand D %A Berger,David H %A Suliburk,James W %+ Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, United States, 1 713 798 8070, suliburk@bcm.edu %K mHealth %K colorectal surgery %K smartphone apps %D 2017 %7 08.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Limited communication and care coordination following discharge from hospitals may contribute to surgical complications. Smartphone apps offer a novel mechanism for communication and care coordination. However, factors which may affect patient app use in a postoperative, at-home setting are poorly understood. Objective: The objectives of this study were to (1) gauge interest in smartphone app use among patients after colorectal surgery and (2) better understand factors affecting patient app use in a postoperative, at-home setting. Methods: A prospective feasibility study was performed at a hospital that principally serves low socioeconomic status patients. After colorectal surgery, patients were enrolled and given a smartphone app, which uses previously validated content to provide symptom-based recommendations. Patients were instructed to use the app daily for 14 days after discharge. Demographics and usability data were collected at enrollment. Usability was measured with the System Usability Scale (SUS). At follow-up, the SUS was repeated and patients underwent a structured interview covering ease of use, willingness to use, and utility of use. Two members of the research team independently reviewed the field notes from follow-up interviews and extracted the most consistent themes. Chart and app log reviews identified clinical endpoints. Results: We screened 115 patients, enrolled 20 patients (17.4%), and completed follow-up interviews with 17 patients (85%). Reasons for nonenrollment included: failure to meet inclusion criteria (47/115, 40.9%), declined to participate (26/115, 22.6%), and other reasons (22/115, 19.1%). There was no difference in patient ratings between usability at first-use and after extended use, with SUS scores greater than the 95th percentile at both time points. Despite high usability ratings, 6/20 (30%) of patients never used the app at home after hospital discharge and 2/20 (10%) only used the app once. Interviews revealed three themes related to app use: (1) patient-related barriers could prevent use even though the app had high usability scores; (2) patients viewed the app as a second opinion, rather than a primary source of information; and (3) many patients viewed the app as an external burden. Conclusions: Use patterns in this study, and response rates after prompts to contact the operative team, suggest that apps need to be highly engaging to be adopted by patients. The growing penetration of smartphones and the proliferation of app-based interventions are unlikely to improve care coordination and communication, unless apps address the barriers and patient perceptions identified in this study. This study shows that high usability alone is not sufficient to motivate patients to use smartphone apps in the postoperative period. %M 28179215 %R 10.2196/mhealth.6728 %U http://mhealth.jmir.org/2017/2/e11/ %U https://doi.org/10.2196/mhealth.6728 %U http://www.ncbi.nlm.nih.gov/pubmed/28179215 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 1 %P e7 %T SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women’s Perceptions %A Munro,Sarah %A Hui,Amber %A Salmons,Vanessa %A Solomon,Carolyn %A Gemmell,Emily %A Torabi,Nahal %A Janssen,Patricia A %+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 4026, patti.janssen@ubc.ca %K pregnancy %K text messaging %K prenatal education %K health behavior %D 2017 %7 07.02.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: We engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada. Objective: To explore women’s preferences for a prenatal education program by text messaging. Methods: We conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women’s perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings. Results: A total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98%), used text messages “all the time” (28/40, 70%), and surfed the Internet on their phone (37/40, 93%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol. Conclusions: This formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes. %M 28174149 %R 10.2196/publichealth.6949 %U http://publichealth.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/publichealth.6949 %U http://www.ncbi.nlm.nih.gov/pubmed/28174149 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e5 %T A Self-Regulation Theory–Based Asthma Management Mobile App for Adolescents: A Usability Assessment %A Sage,Adam %A Roberts,Courtney %A Geryk,Lorie %A Sleath,Betsy %A Tate,Deborah %A Carpenter,Delesha %+ Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 2213 Kerr Hall, Chapel Hill, NC,, United States, 1 330 388 3025, asage@email.unc.edu %K mHealth %K asthma %K mobile %K usability %D 2017 %7 01.02.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Self-regulation theory suggests people learn to influence their own behavior through self-monitoring, goal-setting, feedback, self-reward, and self-instruction, all of which smartphones are now capable of facilitating. Several mobile apps exist to manage asthma; however, little evidence exists about whether these apps employ user-centered design processes that adhere to government usability guidelines for mobile apps. Objective: Building upon a previous study that documented adolescent preferences for an asthma self-management app, we employed a user-centered approach to assess the usability of a high-fidelity wireframe for an asthma self-management app intended for use by adolescents with persistent asthma. Methods: Individual interviews were conducted with adolescents (ages 11-18 years) with persistent asthma who owned a smartphone (N=8). Adolescents were asked to evaluate a PDF app wireframe consisting of 76 screen shots displaying app features, including log in and home screen, profile setup, settings and info, self-management features, and graphical displays for charting asthma control and medication. Preferences, comments, and suggestions for each set of screen shots were assessed using the audio-recorded interviews. Two coders reached consensus on adolescent evaluations of the following aspects of app features: (1) usability, (2) behavioral intentions to use, (3) confusing aspects, and (4) suggestions for improvement. Results: The app wireframe was generally well received, and several suggestions for improvement were recorded. Suggestions included increased customization of charts and notifications, reminders, and alerts. Participants preferred longitudinal data about asthma control and medication use to be displayed using line graphs. All participants reported that they would find an asthma management app like the one depicted in the wireframe useful for managing their asthma. Conclusions: Early stage usability tests guided by government usability guidelines (usability.gov) revealed areas for improvement for an asthma self-management app for adolescents. Addressing these areas will be critical to developing an engaging and effective asthma self-management app that is capable of improving adolescent asthma outcomes. %M 28148471 %R 10.2196/humanfactors.7133 %U http://humanfactors.jmir.org/2017/1/e5/ %U https://doi.org/10.2196/humanfactors.7133 %U http://www.ncbi.nlm.nih.gov/pubmed/28148471 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 1 %P e1 %T Rotterdam Prostate Cancer Risk Calculator: Development and Usability Testing of the Mobile Phone App %A Pereira-Azevedo,Nuno %A Osório,Luís %A Fraga,Avelino %A Roobol,Monique J %+ Department of Urology, Erasmus University Medical Center, Room NA-1706, PO Box 2040, Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3000 CA Rotterdam, Netherlands, 31 107032240, nuno@pereira-azevedo.com %K mHealth %K prostate cancer %K nomogram %D 2017 %7 06.01.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: The use of prostate cancer screening tools that take into account relevant prebiopsy information (ie, risk calculators) is recommended as a way of determining the risk of cancer and the subsequent need for a prostate biopsy. This has the potential to limit prostate cancer overdiagnosis and subsequent overtreatment. mHealth apps are gaining traction in urological practice and are used by both practitioners and patients for a variety of purposes. Objective: The impetus of the study was to design, develop, and assess a smartphone app for prostate cancer screening, based on the Rotterdam Prostate Cancer Risk Calculator (RPCRC). Methods: The results of the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC) study were used to elaborate several algorithms that allowed the risk of prostate cancer to be estimated. A step-by-step workflow was established to ensure that depending on the available clinical information the most complete risk model of the RPCRC was used. The user interface was designed and then the app was developed as a native app for iOS. The usability of the app was assessed using the Post-Study System Usability Questionnaire (PSSUQ) developed by IBM, in a group of 92 participants comprising urologists, general practitioners, and medical students. Results: A total of 11 questions were built into the app, and, depending on the answers, one of the different algorithms of the RPCRC could be used to predict the risk of prostate cancer and of clinically significant prostate cancer (Gleason score ≥7 and clinical stage >T2b). The system usefulness, information quality, and interface quality scores were high—92% (27.7/30), 87% (26.2/30), and 89% (13.4/15), respectively. No usability problems were identified. Conclusions: The RPCRC app is helpful in predicting the risk of prostate cancer and, even more importantly, clinically significant prostate cancer. Its algorithms have been externally validated before and the usability score shows the app’s interface is well designed. Further usability testing is required in different populations to verify these results and ensure that it is easy to use, to warrant a broad appeal, and to provide better patient care. %M 28410180 %R 10.2196/cancer.6750 %U http://cancer.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/cancer.6750 %U http://www.ncbi.nlm.nih.gov/pubmed/28410180 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e137 %T Design and Feasibility of a Text Messaging Intervention to Prevent Indoor Tanning Among Young Adult Women: A Pilot Study %A Evans,William D %A Mays,Darren %+ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, United States, 1 202 994 3632, wdevans@gwu.edu %K indoor tanning %K risk perceptions %K text messaging %K feasibility testing %D 2016 %7 22.12.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although skin cancer is largely preventable, it affects nearly 1 of 5 US adults. There is a need for research on how to optimally design persuasive public health indoor tanning prevention messages. Objective: The objective of our study was to examine whether framed messages on indoor tanning behavioral intentions delivered through short message service (SMS) text messaging would produce (1) positive responses to the messages, including message receptivity and emotional response; (2) indoor tanning efficacy beliefs, including response efficacy and self-efficacy; and (3) indoor tanning risk beliefs. Methods: We conducted a pilot study of indoor tanning prevention messages delivered via mobile phone text messaging in a sample of 21 young adult women who indoor tan. Participants completed baseline measures, were randomly assigned to receive gain-, loss-, or balanced-framed text messages, and completed postexposure outcome measures on indoor tanning cognitions and behaviors. Participants received daily mobile phone indoor tanning prevention text messages for 1 week and completed the same postexposure measures as at baseline. Results: Over the 1-week period there were trends or significant changes after receipt of the text messages, including increased perceived susceptibility (P<.001), response efficacy beliefs (P<.001), and message receptivity (P=.03). Ordinary least squares stepwise linear regression models showed an effect of text message exposure on self-efficacy to quit indoor tanning (t6=–2.475, P<.02). Ordinary least squares linear regression including all measured scales showed a marginal effect of SMS texts on self-efficacy (t20=1.905, P=.08). Participants endorsed highly favorable views toward the text messaging protocol. Conclusions: This study supports this use of mobile text messaging as an indoor tanning prevention strategy. Given the nature of skin cancer risk perceptions, the addition of multimedia messaging service is another area of potential innovation for disseminating indoor tanning prevention messages. %M 28007691 %R 10.2196/mhealth.6493 %U http://mhealth.jmir.org/2016/4/e137/ %U https://doi.org/10.2196/mhealth.6493 %U http://www.ncbi.nlm.nih.gov/pubmed/28007691 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 1 %N 2 %P e5 %T DiaFit: The Development of a Smart App for Patients with Type 2 Diabetes and Obesity %A Modave,François %A Bian,Jiang %A Rosenberg,Eric %A Mendoza,Tonatiuh %A Liang,Zhan %A Bhosale,Ravi %A Maeztu,Carlos %A Rodriguez,Camila %A Cardel,Michelle I %+ Department of Health Outcomes and Policy, University of Florida, 2004 Mowry road, CTRB 3217, Gainesville, FL, 32610, United States, 1 3522945984, modavefp@ufl.edu %K mHealth %K diabetes %K obesity %K apps %D 2016 %7 13.12.2016 %9 Original Paper %J JMIR Diabetes %G English %X Background: Optimal management of chronic diseases, such as type 2 diabetes (T2D) and obesity, requires patient-provider communication and proactive self-management from the patient. Mobile apps could be an effective strategy for improving patient-provider communication and provide resources for self-management to patients themselves. Objective: The objective of this paper is to describe the development of a mobile tool for patients with T2D and obesity that utilizes an integrative approach to facilitate patient-centered app development, with patient and physician interfaces. Our implementation strategy focused on the building of a multidisciplinary team to create a user-friendly and evidence-based app, to be used by patients in a home setting or at the point-of-care. Methods: We present the iterative design, development, and testing of DiaFit, an app designed to improve the self-management of T2D and obesity, using an adapted Agile approach to software implementation. The production team consisted of experts in mobile health, nutrition sciences, and obesity; software engineers; and clinicians. Additionally, the team included citizen scientists and clinicians who acted as the de facto software clients for DiaFit and therefore interacted with the production team throughout the entire app creation, from design to testing. Results: DiaFit (version 1.0) is an open-source, inclusive iOS app that incorporates nutrition data, physical activity data, and medication and glucose values, as well as patient-reported outcomes. DiaFit supports the uploading of data from sensory devices via Bluetooth for physical activity (iOS step counts, FitBit, Apple watch) and glucose monitoring (iHealth glucose meter). The app provides summary statistics and graphics for step counts, dietary information, and glucose values that can be used by patients and their providers to make informed health decisions. The DiaFit iOS app was developed in Swift (version 2.2) with a Web back-end deployed on the Health Insurance Portability and Accountability Act compliant-ready Amazon Web Services cloud computing platform. DiaFit is publicly available on GitHub to the diabetes community at large, under the GNU General Public License agreement. Conclusions: Given the proliferation of health-related apps available to health consumers, it is essential to ensure that apps are evidence-based and user-oriented, with specific health conditions in mind. To this end, we have used a software development approach focusing on community and clinical engagement to create DiaFit, an app that assists patients with T2D and obesity to better manage their health through active communication with their providers and proactive self-management of their diseases. %M 29388609 %R 10.2196/diabetes.6662 %U http://diabetes.jmir.org/2016/2/e5/ %U https://doi.org/10.2196/diabetes.6662 %U http://www.ncbi.nlm.nih.gov/pubmed/29388609 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e131 %T Design and Testing of the Safety Agenda Mobile App for Managing Health Care Managers’ Patient Safety Responsibilities %A Mira,José Joaquín %A Carrillo,Irene %A Fernandez,Cesar %A Vicente,Maria Asuncion %A Guilabert,Mercedes %+ Alicante-Sant Joan Health District, Consellería Sanitat, Hospital-Plá Health Center c/ Hermanos López Osaba s/n, Alicante, 03013, Spain, 34 606433599, jose.mira@umh.es %K patient safety %K mobile apps %K administrators %K health service %D 2016 %7 08.12.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adverse events are a reality in clinical practice. Reducing the prevalence of preventable adverse events by stemming their causes requires health managers’ engagement. Objective: The objective of our study was to develop an app for mobile phones and tablets that would provide managers with an overview of their responsibilities in matters of patient safety and would help them manage interventions that are expected to be carried out throughout the year. Methods: The Safety Agenda Mobile App (SAMA) was designed based on standardized regulations and reviews of studies about health managers’ roles in patient safety. A total of 7 managers used a beta version of SAMA for 2 months and then they assessed and proposed improvements in its design. Their experience permitted redesigning SAMA, improving functions and navigation. A total of 74 Spanish health managers tried out the revised version of SAMA. After 4 months, their assessment was requested in a voluntary and anonymous manner. Results: SAMA is an iOS app that includes 37 predefined tasks that are the responsibility of health managers. Health managers can adapt these tasks to their schedule, add new ones, and share them with their team. SAMA menus are structured in 4 main areas: information, registry, task list, and settings. Of the 74 users who tested SAMA, 64 (86%) users provided a positive assessment of SAMA characteristics and utility. Over an 11-month period, 238 users downloaded SAMA. This mobile app has obtained the AppSaludable (HealthyApp) Quality Seal. Conclusions: SAMA includes a set of activities that are expected to be carried out by health managers in matters of patient safety and contributes toward improving the awareness of their responsibilities in matters of safety. %M 27932315 %R 10.2196/mhealth.5796 %U http://mhealth.jmir.org/2016/4/e131/ %U https://doi.org/10.2196/mhealth.5796 %U http://www.ncbi.nlm.nih.gov/pubmed/27932315 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e229 %T Parent and Clinician Preferences for an Asthma App to Promote Adolescent Self-Management: A Formative Study %A Geryk,Lorie L %A Roberts,Courtney A %A Sage,Adam J %A Coyne-Beasley,Tamera %A Sleath,Betsy L %A Carpenter,Delesha M %+ Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, 301 Pharmacy Lane, Chapel Hill, NC, 27599, United States, 1 9198432278, llgeryk@email.unc.edu %K asthma %K self-management %K social support %K mHealth %K mobile apps %K adolescents %K parents %K clinicians %D 2016 %7 06.12.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Most youth asthma apps are not designed with parent and clinician use in mind, and rarely is the app development process informed by parent or clinician input. Objective: This study was conducted to generate formative data on the use, attitudes, and preferences for asthma mHealth app features among parents and clinicians, the important stakeholders who support adolescents with asthma and promote adolescent self-management skills. Methods: We conducted a mixed-methods study from 2013 to 2014 employing a user-centered design philosophy to acquire feedback from a convenience sample of 20 parents and 6 clinicians. Participants were given an iPod Touch and asked to evaluate 10 features on 2 existing asthma apps. Participant experiences using the apps were collected from questionnaires and a thematic analysis of audio-recorded and transcribed (verbatim) interviews using MAXQDA. Descriptive statistics were calculated to characterize the study sample and app feature feedback. Independent samples t tests were performed to compare parent and clinician ratings of app feature usefulness (ratings: 1=not at all useful to 5=very useful). Results: All parents were female (n=20), 45% were black, 20% had an income ≥US $50,000, and 45% had a bachelor’s degree or higher education. The clinician sample included 2 nurses and 4 physicians with a mean practice time of 13 years. Three main themes provided an understanding of how participants perceived their roles and use of asthma app features to support adolescent asthma self-management: monitoring and supervision, education, and communication/information sharing. Parents rated the doctor report feature highest, and clinicians rated the doctor appointment reminder highest of all evaluated app features on usefulness. The peak flow monitoring feature was the lowest ranked feature by both parents and clinicians. Parents reported higher usefulness for the doctor report (t(10)=2.7, P<.02), diary (t(10)=2.7, P<.03), and self-check quiz (t(14)=2.5, P<.02) features than clinicians. Specific participant suggestions for app enhancements (eg, a tutorial showing correct inhaler use, refill reminders, pop-up messages tied to a medication log, evidence-based management steps) were also provided. Conclusions: Parent and clinician evaluations and recommendations can play an important role in the development of an asthma app designed to help support youth asthma management. Two-way asthma care communication between families and clinicians and components involving families and clinicians that support adolescent self-management should be incorporated into adolescent asthma apps. %M 27923777 %R 10.2196/resprot.5932 %U http://www.researchprotocols.org/2016/4/e229/ %U https://doi.org/10.2196/resprot.5932 %U http://www.ncbi.nlm.nih.gov/pubmed/27923777 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e100 %T “Please Don’t Send Us Spam!” A Participative, Theory-Based Methodology for Developing an mHealth Intervention %A Toefy,Yoesrie %A Skinner,Donald %A Thomsen,Sarah %+ Research on Community and Health, Department of Community Health Sciences, Faculty of Medicine, Stellenbosch University, Suite 4009, Teaching Block, Tygerberg Campus, Franscie van Zyl Drive, Cape Town, 8000, South Africa, 27 784510221, ytoefy@sun.ac.za %K mHealth %K male circumcision %K postoperative wound-healing period %K health promotion %K audio messaging %K behaviour change %D 2016 %7 17.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health solutions have the potential of reducing burdens on health systems and empowering patients with important information. However, there is a lack of theory-based mHealth interventions. Objective: The purpose of our study was to develop a participative, theory-based, mobile phone, audio messaging intervention attractive to recently circumcised men at voluntary medical male circumcision (VMMC) clinics in the Cape Town area in South Africa. We aimed to shift some of the tasks related to postoperative counselling on wound management and goal setting on safe sex. We place an emphasis on describing the full method of message generation to allow for replication. Methods: We developed an mHealth intervention using a staggered qualitative methodology: (1) focus group discussions with 52 recently circumcised men and their partners to develop initial voice messages they felt were relevant and appropriate, (2) thematic analysis and expert consultation to select the final messages for pilot testing, and (3) cognitive interviews with 12 recent VMMC patients to judge message comprehension and rank the messages. Message content and phasing were guided by the theory of planned behavior and the health action process approach. Results: Patients and their partners came up with 245 messages they thought would help men during the wound-healing period. Thematic analysis revealed 42 different themes. Expert review and cognitive interviews with more patients resulted in 42 messages with a clear division in terms of needs and expectations between the initial wound-healing recovery phase (weeks 1–3) and the adjustment phase (weeks 4–6). Discussions with patients also revealed potential barriers to voice messaging, such as lack of technical knowledge of mobile phones and concerns about the invasive nature of the intervention. Patients’ own suggested messages confirmed Ajzen’s theory of planned behavior that if a health promotion intervention can build trust and be relevant to the recipient’s needs in the first contacts, then the same recipients will perceive subsequent motivational messages more favorably. The health action process approach was also a useful tool for guiding the phasing of the messages. Participants were more positive and salutogenic than public health experts. Conclusions: The system showed how a process of consultation can work with a set of potential recipients of an mHealth service to ensure that their needs are included. Classic behavioral theories can and should be used to design modern mHealth interventions. We also believe that patients are the best source of messaging, ensuring that messages are culturally relevant and interesting to the recipient. %M 27535589 %R 10.2196/mhealth.6041 %U http://mhealth.jmir.org/2016/3/e100/ %U https://doi.org/10.2196/mhealth.6041 %U http://www.ncbi.nlm.nih.gov/pubmed/27535589 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e31 %T Development of an Ecological Momentary Assessment Mobile App for a Low-Literacy, Mexican American Population to Collect Disordered Eating Behaviors %A Connelly,Kay %A Stein,Karen F %A Chaudry,Beenish %A Trabold,Nicole %+ School of Informatics and Computing, Indiana University, 919 E 10th St, Bloomington, IN, 47408, United States, 1 812 855 0739, connelly@indiana.edu %K feeding and eating disorders %K health literacy %K socioeconomic status %K human-centered computing %K user-computer interface %K mobile apps %D 2016 %7 14.07.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Ecological momentary assessment (EMA) is a popular method for understanding population health in which participants report their experiences while in naturally occurring contexts in order to increase the reliability and ecological validity of the collected data (as compared to retrospective recall). EMA studies, however, have relied primarily on text-based questionnaires, effectively eliminating low-literacy populations from the samples. Objective: To provide a case study of design of an EMA mobile app for a low-literacy population. In particular, we present the design process and final design of an EMA mobile app for low literate, Mexican American women to record unhealthy eating and weight control behaviors (UEWCBs). Methods: An iterative, user-centered design process was employed to develop the mobile app. An existing EMA protocol to measure UEWCBs in college-enrolled Mexican American women was used as the starting point for the application. The app utilizes an icon interface, with optional audio prompts, that is culturally sensitive and usable by a low-literacy population. A total of 41 women participated over the course of 4 phases of the design process, which included 2 interview and task-based phases (n=8, n=11), focus groups (n=15), and a 5-day, in situ deployment (n=7). Results: Participants’ mental models of UEWCBs differed substantially from prevailing definitions found in the literature, prompting a major reorganization of the app interface. Differences in health literacy and numeracy were better identified with the Newest Vital Sign tool, as compared with the Short Assessment of Health Literacy tool. Participants had difficulty imagining scenarios in the interviews to practice recording a specific UEWCB; instead, usability was best tested in situ. Participants were able to use the EMA mobile app over the course of 5 days to record UEWCBs. Conclusions: Results suggest that the iterative, user-centered design process was essential for designing the app to be made usable by the target population. Simply taking the protocol designed for a higher-literacy population and replacing words with icons and/or audio would have been unsuccessful with this population. %M 27418020 %R 10.2196/publichealth.5511 %U http://publichealth.jmir.org/2016/2/e31/ %U https://doi.org/10.2196/publichealth.5511 %U http://www.ncbi.nlm.nih.gov/pubmed/27418020 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e82 %T YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth %A Sheoran,Bhupendra %A Silva,Cara Lynn %A Lykens,James Elliot %A Gamedze,Londiwe %A Williams,Samantha %A Ford,Jessie VanNess %A Habel,Melissa A %+ YTH, 409 13th St, 14th Floor, Oakland, CA, 94612, United States, 1 510 835 9400, sheoran@yth.org %K mHealth %K homelessness %K youth %K STD %K sexually transmitted diseases %K mobile app %D 2016 %7 14.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Homeless and unstably housed (H/UH) youth are disproportionately affected by sexual health issues, including human immunodeficiency virus/sexually transmitted diseases, teen pregnancy, and dating violence, and are at a higher risk for poor mental health and underutilization of services. Research suggests that linking health care to H/UH adolescents might help improve their continuity of care, with most preferring to access health care information via the Internet. YTH StreetConnect is a dual-purpose mobile app that helps H/UH youth access health and vital services in Santa Clara County, CA, USA. We developed YTH StreetConnect PRO in parallel with the youth app as a companion tablet app for providers who serve H/UH youth. Objective: The objective of our study was to develop a mobile app to support H/UH youth and their providers in accessing health and vital resources, and to conduct usability and feasibility testing of the app among H/UH youth and technical consultants with local expertise in serving H/UH youth. Methods: Formative research included a literature review on H/UH youths’ mobile phone and Internet usage. In January 2015, we conducted interviews with medical and service providers of H/UH youth. Usability and feasibility testing were done with target audiences. Additionally, we conducted focus groups with youth regarding the app’s youth friendliness, accessibility, and usefulness. Results: H/UH youth and their providers noted the app’s functionality, youth friendliness, and resources. Usability testing proposed improvements to the app, including visual updates to the user interface, map icons, new underrepresented resource categories, and the addition of a peer rating system. Limitations included a small sample size among H/UH youth and providers and a single site for the study (Santa Clara County, CA), making the findings ungeneralizable to the US population. Conclusions: YTH StreetConnect is a promising way to increase service utilization, provide referral access, and share resources among H/UH youth and providers. Input from H/UH youth and providers offers insights on how to improve future models of YTH StreetConnect and similar programs that assist H/UH youth. %M 27417882 %R 10.2196/mhealth.5168 %U http://mhealth.jmir.org/2016/3/e82/ %U https://doi.org/10.2196/mhealth.5168 %U http://www.ncbi.nlm.nih.gov/pubmed/27417882 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e83 %T An Evidence-Based Antimicrobial Stewardship Smartphone App for Hospital Outpatients: Survey-based Needs Assessment Among Patients %A Micallef,Christianne %A McLeod,Monsey %A Castro-Sánchez,Enrique %A Gharbi,Myriam %A Charani,Esmita %A Moore,Luke SP %A Gilchrist,Mark %A Husson,Fran %A Costelloe,Ceire %A Holmes,Alison H %+ National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College, Hammersmith Campus, London W12 0NN, United Kingdom, 44 0203 313 2732, c.micallef@imperial.ac.uk %K mobile electronic devices %K mHealth %K mobile health %K antimicrobial resistance %K patient involvement %D 2016 %7 06.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Current advances in modern technology have enabled the development and utilization of electronic medical software apps for both mobile and desktop computing devices. A range of apps on a large variety of clinical conditions for patients and the public are available, but very few target antimicrobials or infections. Objective: We sought to explore the use of different antimicrobial information resources with a focus on electronic platforms, including apps for portable devices, by outpatients at two large, geographically distinct National Health Service (NHS) teaching hospital trusts in England. We wanted to determine whether there is demand for an evidence-based app for patients, to garner their perceptions around infections/antimicrobial prescribing, and to describe patients’ experiences of their interactions with health care professionals in relation to this topic. Methods: A cross-sectional survey design was used to investigate aspects of antimicrobial prescribing and electronic devices experienced by patients at four hospitals in London and a teaching hospital in the East of England. Results: A total of 99 surveys were completed and analyzed. A total of 82% (80/98) of respondents had recently been prescribed antimicrobials; 87% (85/98) of respondents were prescribed an antimicrobial by a hospital doctor or through their general practitioner (GP) in primary care. Respondents wanted information on the etiology (42/65, 65%) and prevention and/or management (32/65, 49%) of their infections, with the infections reported being upper and lower respiratory tract, urinary tract, oral, and skin and soft tissue infections. All patients (92/92, 100%) desired specific information on the antimicrobial prescribed. Approximately half (52/95, 55%) stated it was “fine” for doctors to use a mobile phone/tablet computer during the consultation while 13% (12/95) did not support the idea of doctors accessing health care information in this way. Although only 30% (27/89) of respondents reported on the use of health care apps, 95% (81/85) offered information regarding aspects of antimicrobials or infections that could be provided through a tailored app for patients. Analysis of the comments revealed the following main global themes: knowledge, technology, and patient experience. Conclusions: The majority of respondents in our study wanted to have specific etiological and/or infection management advice. All required antimicrobial-related information. Also, most supported the use of electronic resources of information, including apps, by their doctors. While a minority of people currently use health apps, many feel that apps could be used to provide additional support/information related to infections and appropriate use of antimicrobials. In addition, we found that there is a need for health care professionals to engage with patients and help address common misconceptions around the generation of antimicrobial resistance. %M 27383743 %R 10.2196/mhealth.5243 %U http://mhealth.jmir.org/2016/3/e83/ %U https://doi.org/10.2196/mhealth.5243 %U http://www.ncbi.nlm.nih.gov/pubmed/27383743 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e79 %T Deriving Requirements for Pervasive Well-Being Technology From Work Stress and Intervention Theory: Framework and Case Study %A Koldijk,Saskia %A Kraaij,Wessel %A Neerincx,Mark A %+ Delft University of Technology, Interactive Intelligence, Mekelweg 4, Delft,, Netherlands, 31 888665875, M.A.Neerincx@tudelft.nl %K psychological stress %K professional burn-out %K behavioral symptoms %K self-management %K health technology %K early medical intervention %D 2016 %7 05.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stress in office environments is a big concern, often leading to burn-out. New technologies are emerging, such as easily available sensors, contextual reasoning, and electronic coaching (e-coaching) apps. In the Smart Reasoning for Well-being at Home and at Work (SWELL) project, we explore the potential of using such new pervasive technologies to provide support for the self-management of well-being, with a focus on individuals' stress-coping. Ideally, these new pervasive systems should be grounded in existing work stress and intervention theory. However, there is a large diversity of theories and they hardly provide explicit directions for technology design. Objective: The aim of this paper is to present a comprehensive and concise framework that can be used to design pervasive technologies that support knowledge workers to decrease stress. Methods: Based on a literature study we identify concepts relevant to well-being at work and select different work stress models to find causes of work stress that can be addressed. From a technical perspective, we then describe how sensors can be used to infer stress and the context in which it appears, and use intervention theory to further specify interventions that can be provided by means of pervasive technology. Results: The resulting general framework relates several relevant theories: we relate “engagement and burn-out” to “stress”, and describe how relevant aspects can be quantified by means of sensors. We also outline underlying causes of work stress and how these can be addressed with interventions, in particular utilizing new technologies integrating behavioral change theory. Based upon this framework we were able to derive requirements for our case study, the pervasive SWELL system, and we implemented two prototypes. Small-scale user studies proved the value of the derived technology-supported interventions. Conclusions: The presented framework can be used to systematically develop theory-based technology-supported interventions to address work stress. In the area of pervasive systems for well-being, we identified the following six key research challenges and opportunities: (1) performing multi-disciplinary research, (2) interpreting personal sensor data, (3) relating measurable aspects to burn-out, (4) combining strengths of human and technology, (5) privacy, and (6) ethics. %M 27380749 %R 10.2196/mhealth.5341 %U http://mhealth.jmir.org/2016/3/e79/ %U https://doi.org/10.2196/mhealth.5341 %U http://www.ncbi.nlm.nih.gov/pubmed/27380749 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e176 %T How a Fully Automated eHealth Program Simulates Three Therapeutic Processes: A Case Study %A Holter,Marianne T. S %A Johansen,Ayna %A Brendryen,Håvar %+ The Norwegian Centre for Addiction Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1039 Blindern, Oslo, 0315, Norway, 47 93 62 30 61, m.t.s.holter@medisin.uio.no %K Internet %K eHealth %K telemedicine %K behavior therapy %K motivational interviewing %K working alliance %K intervention mapping %K smoking cessation %K cell phones %K text messaging %D 2016 %7 28.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth programs may be better understood by breaking down the components of one particular program and discussing its potential for interactivity and tailoring in regard to concepts from face-to-face counseling. In the search for the efficacious elements within eHealth programs, it is important to understand how a program using lapse management may simultaneously support working alliance, internalization of motivation, and behavior maintenance. These processes have been applied to fully automated eHealth programs individually. However, given their significance in face-to-face counseling, it may be important to simulate the processes simultaneously in interactive, tailored programs. Objective: We propose a theoretical model for how fully automated behavior change eHealth programs may be more effective by simulating a therapist’s support of a working alliance, internalization of motivation, and managing lapses. Methods: We show how the model is derived from theory and its application to Endre, a fully automated smoking cessation program that engages the user in several “counseling sessions” about quitting. A descriptive case study based on tools from the intervention mapping protocol shows how each therapeutic process is simulated. Results: The program supports the user’s working alliance through alliance factors, the nonembodied relational agent Endre and computerized motivational interviewing. Computerized motivational interviewing also supports internalized motivation to quit, whereas a lapse management component responds to lapses. The description operationalizes working alliance, internalization of motivation, and managing lapses, in terms of eHealth support of smoking cessation. Conclusions: A program may simulate working alliance, internalization of motivation, and lapse management through interactivity and individual tailoring, potentially making fully automated eHealth behavior change programs more effective. %M 27354373 %R 10.2196/jmir.5415 %U http://www.jmir.org/2016/6/e176/ %U https://doi.org/10.2196/jmir.5415 %U http://www.ncbi.nlm.nih.gov/pubmed/27354373 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e81 %T Theory-Based Design and Development of a Socially Connected, Gamified Mobile App for Men About Breastfeeding (Milk Man) %A White,Becky K %A Martin,Annegret %A White,James A %A Burns,Sharyn K %A Maycock,Bruce R %A Giglia,Roslyn C %A Scott,Jane A %+ School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, 6845, Australia, 61 8 9266 9050, jane.scott@curtin.edu.au %K mHealth %K smartphone %K mobile phone %K app %K breastfeeding %K fathers %K gamification %K social connectivity %D 2016 %7 27.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite evidence of the benefits of breastfeeding, <15% of Australian babies are exclusively breastfed to the recommended 6 months. The support of the father is one of the most important factors in breastfeeding success, and targeting breastfeeding interventions to the father has been a successful strategy in previous research. Mobile technology offers unique opportunities to engage and reach populations to enhance health literacy and healthy behavior. Objective: The objective of our study was to use previous research, formative evaluation, and behavior change theory to develop the first evidence-based breastfeeding app targeted at men. We designed the app to provide men with social support and information aiming to increase the support men can offer their breastfeeding partners. Methods: We used social cognitive theory to design and develop the Milk Man app through stages of formative research, testing, and iteration. We held focus groups with new and expectant fathers (n=18), as well as health professionals (n=16), and used qualitative data to inform the design and development of the app. We tested a prototype with fathers (n=4) via a think-aloud study and the completion of the Mobile Application Rating Scale (MARS). Results: Fathers and health professionals provided input through the focus groups that informed the app development. The think-aloud walkthroughs identified 6 areas of functionality and usability to be addressed, including the addition of a tutorial, increased size of text and icons, and greater personalization. Testers rated the app highly, and the average MARS score for the app was 4.3 out of 5. Conclusions: To our knowledge, Milk Man is the first breastfeeding app targeted specifically at men. The development of Milk Man followed a best practice approach, including the involvement of a multidisciplinary team and grounding in behavior change theory. It tested well with end users during development. Milk Man is currently being trialed as part of the Parent Infant Feeding Initiative (ACTRN12614000605695). %M 27349756 %R 10.2196/mhealth.5652 %U http://mhealth.jmir.org/2016/2/e81/ %U https://doi.org/10.2196/mhealth.5652 %U http://www.ncbi.nlm.nih.gov/pubmed/27349756 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e57 %T Remotely Delivered Exercise-Based Cardiac Rehabilitation: Design and Content Development of a Novel mHealth Platform %A Rawstorn,Jonathan C %A Gant,Nicholas %A Meads,Andrew %A Warren,Ian %A Maddison,Ralph %+ National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 9 373 7599 ext 84498, j.rawstorn@auckland.ac.nz %K telemedicine %K telerehabilitation %K wireless technology %K remote sensing technology %K behavioral medicine %K myocardial ischemia %D 2016 %7 24.06.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Participation in traditional center-based cardiac rehabilitation exercise programs (exCR) is limited by accessibility barriers. Mobile health (mHealth) technologies can overcome these barriers while preserving critical attributes of center-based exCR monitoring and coaching, but these opportunities have not yet been capitalized on. Objective: We aimed to design and develop an evidence- and theory-based mHealth platform for remote delivery of exCR to any geographical location. Methods: An iterative process was used to design and develop an evidence- and theory-based mHealth platform (REMOTE-CR) that provides real-time remote exercise monitoring and coaching, behavior change education, and social support. Results: The REMOTE-CR platform comprises a commercially available smartphone and wearable sensor, custom smartphone and Web-based applications (apps), and a custom middleware. The platform allows exCR specialists to monitor patients’ exercise and provide individualized coaching in real-time, from almost any location, and provide behavior change education and social support. Intervention content incorporates Social Cognitive Theory, Self-determination Theory, and a taxonomy of behavior change techniques. Exercise components are based on guidelines for clinical exercise prescription. Conclusions: The REMOTE-CR platform extends the capabilities of previous telehealth exCR platforms and narrows the gap between existing center- and home-based exCR services. REMOTE-CR can complement center-based exCR by providing an alternative option for patients whose needs are not being met. Remotely monitored exCR may be more cost-effective than establishing additional center-based programs. The effectiveness and acceptability of REMOTE-CR are now being evaluated in a noninferiority randomized controlled trial. %M 27342791 %R 10.2196/mhealth.5501 %U http://mhealth.jmir.org/2016/2/e57/ %U https://doi.org/10.2196/mhealth.5501 %U http://www.ncbi.nlm.nih.gov/pubmed/27342791 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e76 %T Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer %A Arvidsson,Susann %A Gilljam,Britt-Mari %A Nygren,Jens %A Ruland,Cornelia Maria %A Nordby-Bøe,Trude %A Svedberg,Petra %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, SE-301 18, Sweden, 46 35 16 71 00, susann.arvidsson@hh.se %K cancer %K children %K communication %K mobile app %K participation %K validation %D 2016 %7 24.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Children with cancer undergo intensive and long treatment periods that expose them and their families to a number of difficult physical, mental, and social challenges. Empowering children by actively involving them in their care can help them to cope with these challenges. It can, however, be difficult for children to be involved and talk about their illness experiences in a “traditional” conversation with health care professionals, especially for younger children. Sisom (Norwegian acronym “Si det som det er” or “Tell it how it is”) is an interactive computer-based assessment and communication tool to give children (aged 6-12 years) with cancer a “voice” in their care. Because of technological advances and widespread use of mobile devices Sisom had to be redesigned to better meet the needs of children of today. Objective: To redesign Sisom for use on mobile devices and to validate and adapt it for use in a Swedish population of children with cancer. Methods: A user-experience design was used. Content adaptation included forward-backward translation by Swedish and Norwegian translators. Healthy children (n=5), children with experiences of cancer treatment (n=5) and their parents (n=5), and pediatric nurses (n=2) were then involved in culturally adapting Sisom to the Swedish context. The iterative low- and high-fidelity evaluation was supported by a think aloud method, semistructured interviews, and drawings to capture children’s views of Sisom. The redesign and evaluation continued until no further changes or improvements were identified by the participants or the researchers. Results: Children, parents, and pediatric nurses offered many suggestions for improvements to the original version in terms of content, aesthetics, and usability of Sisom. The most significant change that emerged through user input was a modification that entailed not using problem-focused statements in the assessment items. The parents and pediatric nurses considered the revised assessment items to be general and less diagnosis specific. The evaluation of aesthetics resulted in brighter colors and more positive and exciting details in the animations. The evaluation of usability included improvements of the verbal instructions on how to navigate in Sisom 2, and also that the answers to assessment items in Sisom 2 should be saved to provide the children with the option to pause and to continue answering the remaining assessment items at a later stage. Conclusions: Overall, this paper describes the process of using user-experience design with children in order to redesign and validate an interactive assessment and communication tool and how the outcomes of this process resulted in a new version, Sisom 2. All participants confirmed the usability and qualities of using the final version. Future research should be directed toward the implementation of Sisom 2 in clinical practice and to evaluate outcomes from individual and organizational levels. %M 27343004 %R 10.2196/mhealth.5715 %U http://mhealth.jmir.org/2016/2/e76/ %U https://doi.org/10.2196/mhealth.5715 %U http://www.ncbi.nlm.nih.gov/pubmed/27343004 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e58 %T The Electronic Patient Reported Outcome Tool: Testing Usability and Feasibility of a Mobile App and Portal to Support Care for Patients With Complex Chronic Disease and Disability in Primary Care Settings %A Steele Gray,Carolyn %A Gill,Ashlinder %A Khan,Anum Irfan %A Hans,Parminder Kaur %A Kuluski,Kerry %A Cott,Cheryl %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Suite 425, Toronto, ON, M5T 3M6, Canada, 1 4164618252 ext 2908, csteele@bridgepointhealth.ca %K eHealth %K mHealth %K multimorbidity %K primary care %K usability %K feasibility %K pilot %D 2016 %7 02.06.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: People experiencing complex chronic disease and disability (CCDD) face some of the greatest challenges of any patient population. Primary care providers find it difficult to manage multiple discordant conditions and symptoms and often complex social challenges experienced by these patients. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges by supporting goal-oriented primary care delivery. Using the tool, patients and providers collaboratively develop health care goals on a portal linked to a mobile device to help patients and providers track progress between visits. Objectives: This study tested the usability and feasibility of adopting the ePRO tool into a single interdisciplinary primary health care practice in Toronto, Canada. The Fit between Individuals, Fask, and Technology (FITT) framework was used to guide our assessment and explore whether the ePRO tool is: (1) feasible for adoption in interdisciplinary primary health care practices and (2) usable from both the patient and provider perspectives. This usability pilot is part of a broader user-centered design development strategy. Methods: A 4-week pilot study was conducted in which patients and providers used the ePRO tool to develop health-related goals, which patients then monitored using a mobile device. Patients and providers collaboratively set goals using the system during an initial visit and had at least 1 follow-up visit at the end of the pilot to discuss progress. Focus groups and interviews were conducted with patients and providers to capture usability and feasibility measures. Data from the ePRO system were extracted to provide information regarding tool usage. Results: Six providers and 11 patients participated in the study; 3 patients dropped out mainly owing to health issues. The remaining 8 patients completed 210 monitoring protocols, equal to over 1300 questions, with patients often answering questions daily. Providers and patients accessed the portal on an average of 10 and 1.5 times, respectively. Users found the system easy to use, some patients reporting that the tool helped in their ability to self-manage, catalyzed a sense of responsibility over their care, and improved patient-centered care delivery. Some providers found that the tool helped focus conversations on goal setting. However, the tool did not fit well with provider workflows, monitoring questions were not adequately tailored to individual patient needs, and daily reporting became tedious and time-consuming for patients. Conclusions: Although our study suggests relatively low usability and feasibility of the ePRO tool, we are encouraged by the early impact on patient outcomes and generally positive responses from both user groups regarding the potential of the tool to improve care for patients with CCDD. As is consistent with our user-centered design development approach, we have modified the tool based on user feedback, and are now testing the redeveloped tool through an exploratory trial. %M 27256035 %R 10.2196/mhealth.5331 %U http://mhealth.jmir.org/2016/2/e58/ %U https://doi.org/10.2196/mhealth.5331 %U http://www.ncbi.nlm.nih.gov/pubmed/27256035 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e24 %T Development of a Weight Loss Mobile App Linked With an Accelerometer for Use in the Clinic: Usability, Acceptability, and Early Testing of its Impact on the Patient-Doctor Relationship %A Choo,Seryung %A Kim,Ju Young %A Jung,Se Young %A Kim,Sarah %A Kim,Jeong Eun %A Han,Jong Soo %A Kim,Sohye %A Kim,Jeong Hyun %A Kim,Jeehye %A Kim,Yongseok %A Kim,Dongouk %A Steinhubl,Steve %+ Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic Of Korea, 82 31 787 7796, kkamduri@snubh.org %K mobile apps %K electronic health record %K weight reduction programs %K physician-patient relations %D 2016 %7 31.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Although complications of obesity are well acknowledged and managed by clinicians, management of obesity itself is often difficult, which leads to its underdiagnosis and undertreatment in hospital settings. However, tools that could improve the management of obesity, including self-monitoring, engagement with a social network, and open channels of communication between the patient and doctor, are limited in a clinic-based setting. Objective: The objective of our study was to evaluate the usability and acceptability of a newly developed mobile app linked with an accelerometer and its early effects on patient-doctor relationships. Methods: From September 2013 to February 2014, we developed a mobile app linked with an accelerometer as a supportive tool for a clinic-based weight loss program. The app used information from electronic health records and delivered tailored educational material. Personal goal setting, as well as monitoring of weight changes and physical activity combined with feedback, are key features of the app. We also incorporated an interactive message board for patients and doctors. During the period of March 2014 to May 2014, we tested our mobile app for 1 month in participants in a hospital clinic setting. We assessed the app’s usability and acceptability, as well as the patient-doctor relationship, via questionnaires and analysis of app usage data. Results: We recruited 30 individuals (18 male and 12 female) for the study. The median number of log-ins per day was 1.21, with the most frequently requested item being setting goals, followed by track physical activities and view personal health status. Scales of the depth of the patient-doctor relationship decreased from 27.6 (SD 4.8) to 25.1 (SD 4.5) by a Wilcoxon signed rank test (P=.02). Conclusions: A mobile phone app linked with an accelerometer for a clinic-based weight loss program is useful and acceptable for weight management but exhibited less favorable early effects on patient-doctor relationships. %M 27032541 %R 10.2196/mhealth.4546 %U http://mhealth.jmir.org/2016/1/e24/ %U https://doi.org/10.2196/mhealth.4546 %U http://www.ncbi.nlm.nih.gov/pubmed/27032541 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e25 %T Evidence-Based mHealth Chronic Disease Mobile App Intervention Design: Development of a Framework %A Wilhide III,Calvin C %A Peeples,Malinda M %A Anthony Kouyaté,Robin C %+ WellDoc Inc, 1501 St Paul Street, Baltimore, MD, 21202, United States, 1 443 797 2126, ccwilhide@verizon.net %K mHealth %K mobile applications %K mobile app design %K chronic disease %K diabetes %K mHealth framework %K behavioral intervention %K intervention design %K mHealth implementation %K telemedicine %D 2016 %7 16.02.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Mobile technology offers new capabilities that can help to drive important aspects of chronic disease management at both an individual and population level, including the ability to deliver real-time interventions that can be connected to a health care team. A framework that supports both development and evaluation is needed to understand the aspects of mHealth that work for specific diseases, populations, and in the achievement of specific outcomes in real-world settings. This framework should incorporate design structure and process, which are important to translate clinical and behavioral evidence, user interface, experience design and technical capabilities into scalable, replicable, and evidence-based mobile health (mHealth) solutions to drive outcomes. Objective: The purpose of this paper is to discuss the identification and development of an app intervention design framework, and its subsequent refinement through development of various types of mHealth apps for chronic disease. Methods: The process of developing the framework was conducted between June 2012 and June 2014. Informed by clinical guidelines, standards of care, clinical practice recommendations, evidence-based research, best practices, and translated by subject matter experts, a framework for mobile app design was developed and the refinement of the framework across seven chronic disease states and three different product types is described. Results: The result was the development of the Chronic Disease mHealth App Intervention Design Framework. This framework allowed for the integration of clinical and behavioral evidence for intervention and feature design. The application to different diseases and implementation models guided the design of mHealth solutions for varying levels of chronic disease management. Conclusions: The framework and its design elements enable replicable product development for mHealth apps and may provide a foundation for the digital health industry to systematically expand mobile health interventions and validate their effectiveness across multiple implementation settings and chronic diseases. %M 26883135 %R 10.2196/resprot.4838 %U http://www.researchprotocols.org/2016/1/e25/ %U https://doi.org/10.2196/resprot.4838 %U http://www.ncbi.nlm.nih.gov/pubmed/26883135 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e8 %T A Mixed-Methods Approach to the Development, Refinement, and Pilot Testing of Social Networks for Improving Healthy Behaviors %A Hales,Sarah %A Turner-McGrievy,Gabrielle %A Fahim,Arjang %A Freix,Andrew %A Wilcox,Sara %A Davis,Rachel E %A Huhns,Michael %A Valafar,Homayoun %+ Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Discovery I Building, 915 Greene St., Columbia, SC, , United States, 1 843 670 5317, bridges5@mailbox.sc.edu %K mHealth %K obesity %K weight loss %K social support %K social cognitive theory %D 2016 %7 12.02.2016 %9 Original Paper %J JMIR Human Factors %G English %X Background: Mobile health (mHealth) has shown promise as a way to deliver weight loss interventions, including connecting users for social support. Objective: To develop, refine, and pilot test the Social Pounds Off Digitally (POD) Android app for personalized health monitoring and interaction. Methods: Adults who were overweight and obese with Android smartphones (BMI 25-49.9 kg/m2; N=9) were recruited for a 2-month weight loss pilot intervention and iterative usability testing of the Social POD app. The app prompted participants via notification to track daily weight, diet, and physical activity behaviors. Participants received the content of the behavioral weight loss intervention via podcast. In order to re-engage infrequent users (did not use the app within the previous 48 hours), the app prompted frequent users to select 1 of 3 messages to send to infrequent users targeting the behavioral theory constructs social support, self-efficacy, or negative outcome expectations. Body weight, dietary intake (2 24-hr recalls), and reported calories expended during physical activity were assessed at baseline and 2 months. All participants attended 1 of 2 focus groups to provide feedback on use of the app. Results: Participants lost a mean of 0.94 kg (SD 2.22, P=.24) and consumed significantly fewer kcals postintervention (1570 kcal/day, SD 508) as compared to baseline (2384 kcal/day, SD 993, P=.01). Participants reported expending a mean of 171 kcal/day (SD 153) during intentional physical activity following the intervention as compared to 138 kcal/day (SD 139) at baseline, yet this was not a statistically significant difference (P=.57). There was not a statistically significant correlation found between total app entries and percent weight loss over the course of the intervention (r=.49, P=.19). Mean number of app entries was 77.2 (SD 73.8) per person with a range of 0 to 219. Messages targeting social support were selected most often (32/68, 47%), followed by self-efficacy (28/68, 41%), and negative outcome expectations (8/68, 12%). Themes from the focus groups included functionality issues, revisions to the messaging system, and the addition of a point system with rewards for achieving goals. Conclusions: The Social POD app provides an innovative way to re-engage infrequent users by encouraging frequent users to provide social support. Although more time is needed for development, this mHealth intervention can be disseminated broadly for many years and to many individuals without the need for additional intensive in-person hours. %M 27026535 %R 10.2196/humanfactors.4512 %U http://humanfactors.jmir.org/2016/1/e8/ %U https://doi.org/10.2196/humanfactors.4512 %U http://www.ncbi.nlm.nih.gov/pubmed/27026535 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e17 %T Design Considerations for Smoking Cessation Apps: Feedback From Nicotine Dependence Treatment Providers and Smokers %A McClure,Jennifer B %A Hartzler,Andrea L %A Catz,Sheryl L %+ Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, , United States, 1 206 287 2737, McClure.J@ghc.org %K tobacco use cessation %K smoking %K mobile health %K smartphone %D 2016 %7 12.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Hundreds of smoking cessation apps are commercially available, but most are not theory-based or designed to take advantage of mobile technology in ways that could make them more engaging and possibly more effective. Considering input from both clinical experts (who understand best practice nicotine dependence treatment requirements) to inform appropriate content and from smokers (the end users) to express their preferences is important in designing these programs in the future. Objective: To assess and compare the opinions of nicotine dependence treatment providers and smokers regarding the design of future smoking cessation apps. Methods: We surveyed providers (n=264) and smokers who own smartphones (n=40) to assess their opinions on the importance of 21 app design features. Features represented 5 domains: cost, reputation, privacy and security, content and user experience, and communication. Domains were chosen to reflect best practice treatment, leverage mobile technology to support smoking cessation, and elicit important user preferences. Data were collected between June and July 2015. Results: Most providers agreed that mHealth apps hold promise for helping people quit smoking (203/264, 76.9%) and would recommend them to their clients/patients (201/264, 76.1%), especially if the app were empirically validated (236/264, 89.4%). Few providers believe effective cessation apps currently exist (112/264, 42.4%). Few smokers (5/40, 13%) had ever downloaded a smoking cessation app; of the ones who had not, most said they would consider doing so (29/35, 83%). Both respondent groups indicated the following features were very to extremely important to include in cessation apps: free or low cost, keeps information private, matches individual needs and interests, adapts as one’s needs and interests change, helps to manage nicotine withdrawal symptoms and medication side effects, and allows users to track their progress. Providers and smokers also indicated gaming and social media connectivity were less important than other features. Despite these similarities, the groups had significantly different opinions about the relative importance of various features. In particular, providers rated privacy as the most important feature, whereas smokers rated low cost and the ability to adaptively tailor content as the most important features. Conclusions: Smoking cessation apps hold great promise as intervention tools but only if they engage users and appropriately treat nicotine dependence. Intervention development should take into consideration the perspectives of both treatment experts and smokers. This paper highlights important perspectives from each of these groups to be considered when designing future app-based smoking cessation programs. %M 26872940 %R 10.2196/mhealth.5181 %U http://mhealth.jmir.org/2016/1/e17/ %U https://doi.org/10.2196/mhealth.5181 %U http://www.ncbi.nlm.nih.gov/pubmed/26872940 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e14 %T Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion %A Heffernan,Kayla Joanne %A Chang,Shanton %A Maclean,Skye Tamara %A Callegari,Emma Teresa %A Garland,Suzanne Marie %A Reavley,Nicola Jane %A Varigos,George Andrew %A Wark,John Dennis %+ Department of Computing and Information Systems, Melbourne School of Engineering, The University of Melbourne, Doug McDonell Building, The University of Melbourne, Parkville, 3010, Australia, 61 383441500, shanton.chang@unimelb.edu.au %K mhealth %K complex messaging %K vitamin D %K eHealth smartphone apps %K interactive %D 2016 %7 09.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The now ubiquitous catchphrase, “There’s an app for that,” rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of “do no harm.” There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. Objective: This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. Methods: For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. Results: By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). Conclusions: This research has provided principles for developing interactive eHealth apps for complex messaging as guidelines by aggregating existing design concepts and expanding these concepts and new learnings from our development process. A set of guidelines to develop interactive eHealth apps generally, and specifically those for complex messaging, was previously missing from the literature; this research has contributed these principles. Safe-D delivers complex messaging simply, to aid education, and explicitly, considering user safety. %M 26860623 %R 10.2196/mhealth.4423 %U http://mhealth.jmir.org/2016/1/e14/ %U https://doi.org/10.2196/mhealth.4423 %U http://www.ncbi.nlm.nih.gov/pubmed/26860623 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 2 %P e15 %T Assessing the Usability of Six Data Entry Mobile Interfaces for Caregivers: A Randomized Trial %A Ehrler,Frederic %A Haller,Guy %A Sarrey,Evelyne %A Walesa,Magali %A Wipfli,Rolf %A Lovis,Christian %+ Division of Medical Information Sciences, Department of medical imaging and medical information sciences, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223728697, frederic.ehrler@hcuge.ch %K data collection %K mobile applications %K computers, handheld %K user-computer interface %K vital signs %K patient safety %D 2015 %7 15.12.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: There is an increased demand in hospitals for tools, such as dedicated mobile device apps, that enable the recording of clinical information in an electronic format at the patient’s bedside. Although the human-machine interface design on mobile devices strongly influences the accuracy and effectiveness of data recording, there is still a lack of evidence as to which interface design offers the best guarantee for ease of use and quality of recording. Therefore, interfaces need to be assessed both for usability and reliability because recording errors can seriously impact the overall level of quality of the data and affect the care provided. Objective: In this randomized crossover trial, we formally compared 6 handheld device interfaces for both speed of data entry and accuracy of recorded information. Three types of numerical data commonly recorded at the patient’s bedside were used to evaluate the interfaces. Methods: In total, 150 health care professionals from the University Hospitals of Geneva volunteered to record a series of randomly generated data on each of the 6 interfaces provided on a smartphone. The interfaces were presented in a randomized order as part of fully automated data entry scenarios. During the data entry process, accuracy and effectiveness were automatically recorded by the software. Results: Various types of errors occurred, which ranged from 0.7% for the most reliable design to 18.5% for the least reliable one. The length of time needed for data recording ranged from 2.81 sec to 14.68 sec, depending on the interface. The numeric keyboard interface delivered the best performance for pulse data entry with a mean time of 3.08 sec (SD 0.06) and an accuracy of 99.3%. Conclusions: Our study highlights the critical impact the choice of an interface can have on the quality of recorded data. Selecting an interface should be driven less by the needs of specific end-user groups or the necessity to facilitate the developer’s task (eg, by opting for default solutions provided by commercial platforms) than by the level of speed and accuracy an interface can provide for recording information. An important effort must be made to properly validate mobile device interfaces intended for use in the clinical setting. In this regard, our study identified the numeric keyboard, among the proposed designs, as the most accurate interface for entering specific numerical values. This is an important step toward providing clearer guidelines on which interface to choose for the appropriate use of handheld device interfaces in the health care setting. %M 27025648 %R 10.2196/humanfactors.4093 %U http://humanfactors.jmir.org/2015/2/e15/ %U https://doi.org/10.2196/humanfactors.4093 %U http://www.ncbi.nlm.nih.gov/pubmed/27025648 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e92 %T Mobile Phone App Aimed at Improving Iron Intake and Bioavailability in Premenopausal Women: A Qualitative Evaluation %A Mann,Davina %A Riddell,Lynn %A Lim,Karen %A Byrne,Linda K %A Nowson,Caryl %A Rigo,Manuela %A Szymlek-Gay,Ewa A %A Booth,Alison O %+ Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 0392517211, davinam@deakin.edu.au %K cell phones %K telemedicine %K mobile apps %K iron %K behavior therapy %K focus groups %K goals %D 2015 %7 28.09.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Low iron intake can lead to iron deficiency, which can result in impaired health and iron-deficiency anemia. A mobile phone app, combining successful dietary strategies to increase bioavailable iron with strategies for behavior change, such as goal setting, monitoring, feedback, and resources for knowledge acquisition, was developed with the aim to increase bioavailable iron intake in premenopausal women. Objective: To evaluate the content, usability, and acceptability of a mobile phone app designed to improve intake of bioavailable dietary iron. Methods: Women aged 18-50 years with an Android mobile phone were invited to participate. Over a 2-week period women were asked to interact with the app. Following this period, semistructured focus groups with participants were conducted. Focus groups were audio recorded and analyzed via an inductive open-coding method using the qualitative analysis software NVivo 10. Themes were identified and frequency of code occurrence was calculated. Results: Four focus groups (n=26) were conducted (age range 19-36 years, mean 24.7, SD 5.2). Two themes about the app’s functionality were identified (frequency of occurrence in brackets): interface and design (134) and usability (86). Four themes about the app’s components were identified: goal tracker (121), facts (78), photo diary (40), and games (46). A number of suggestions to improve the interface and design of the app were provided and will inform the ongoing development of the app. Conclusions: This research indicates that participants are interested in iron and their health and are willing to use an app utilizing behavior change strategies to increase intake of bioavailable iron. The inclusion of information about the link between diet and health, monitoring and tracking of the achievement of dietary goals, and weekly reviews of goals were also seen as valuable components of the app and should be considered in mobile health apps aimed at adult women. %M 26416479 %R 10.2196/mhealth.4300 %U http://mhealth.jmir.org/2015/3/e92/ %U https://doi.org/10.2196/mhealth.4300 %U http://www.ncbi.nlm.nih.gov/pubmed/26416479 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e91 %T Comparison of a User-Centered Design, Self-Management App to Existing mHealth Apps for Persons Living With HIV %A Schnall,Rebecca %A Mosley,Jocelyn Patterson %A Iribarren,Sarah J %A Bakken,Suzanne %A Carballo-Diéguez,Alex %A Brown III,William %+ Columbia University, School of Nursing, 617 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K mHealth %K HIV %K mobile apps %K user-centered design %D 2015 %7 18.09.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: There is preliminary evidence that mobile health (mHealth) apps are feasible, attractive, and an effective platform for the creation of self-management tools for persons living with HIV (PLWH). As a foundation for the current study, we conducted formative research using focus groups, participatory design sessions, and usability evaluation methods to inform the development of a health management app for PLWH. The formative research resulted in identification of the following functional requirements of a mHealth app for self-management: (1) communication between providers and peers, (2) medication reminders, (3) medication log, (4) lab reports, (5) pharmacy information, (6) nutrition and fitness, (7) resources (eg, social services, substance use, video testimonials), (8) settings, and (9) search function. Objective: The purpose of this study was to conduct an ecological review of the existing apps for PLWH and to compare the functionality of existing apps with the app specifications identified in our formative work. Methods: We searched two mobile app stores (Google Play and iTunes) and found a total of 5606 apps. We reviewed the apps, narrowed our search terms, and found a total of 112 apps. Of these, we excluded 97 (86.6%) apps that were either not in English (10/112, 8.9%), not HIV focused (32/112, 28.9%), or focused only on HIV prevention (2/112, 7.8%); targeted health care providers (26/112, 23.2%); provided information only on conference schedules and events (7/112, 6.3%), fundraisers (7/112, 6.3%), specific clinics (7/112, 6.3%), international or narrow local resources (3/112, 2.7%); or were identified in the first search but were no longer on the market at the next review (4/112, 3.6%). The 15 apps meeting inclusion criteria were then evaluated for inclusion of the nine functionalities identified in our earlier work. Results: Of the 15 apps that we included in our final review, none had all of the functionalities that were identified in our formative work. The apps that we identified included the following functionalities: communication with providers and/or peers (4/15, 27%), medication reminders (6/15, 40%), medication logs (7/15, 47%), lab reports (5/15, 33%), pharmacy information (4/15, 27%), resources (7/15, 47%), settings (11/15, 73%), and search function (6/15, 40%). No apps included nutrition or fitness information. Conclusions: Currently, there are only a small number of apps that have been designed for PLWH to manage their health. Of the apps that are currently available, none have all of the desired functionalities identified by PLWH and experts in our formative research. Findings from this work elucidate the need to develop and evaluate mobile apps that meet PLWH’s desired functional specifications. %M 26385783 %R 10.2196/mhealth.4882 %U http://mhealth.jmir.org/2015/3/e91/ %U https://doi.org/10.2196/mhealth.4882 %U http://www.ncbi.nlm.nih.gov/pubmed/26385783 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e85 %T A New App for At-Home Cognitive Training: Description and Pilot Testing on Patients with Multiple Sclerosis %A Tacchino,Andrea %A Pedullà,Ludovico %A Bonzano,Laura %A Vassallo,Claudio %A Battaglia,Mario Alberto %A Mancardi,Gianluigi %A Bove,Marco %A Brichetto,Giampaolo %+ Italian Multiple Sclerosis Foundation, Scientific Research Area, Via Operai 40, Genoa, 16100, Italy, 39 010 2712832, giampaolo.brichetto@aism.it %K tablet %K mobile phone %K mobile device %K cognitive rehabilitation %K cognitive impairment %K working memory %K self-management %K adaptive working load algorithms %K usability %D 2015 %7 31.08.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Cognitive impairment is common in people with neurological diseases and severely affects their social and professional life. It has been shown that intensive and personalized cognitive rehabilitation (CR), based on working memory exercises, leads to improved cognitive status of healthy and cognitive-impaired subjects. New technologies would help to promote accessible, at-home, and self-managed CR interventions. Objective: The aim of this paper is to describe the design of Cognitive Training Kit (COGNI-TRAcK), an app for mobile devices, to self-administer an at-home, intensive, and personalized CR intervention based on working memory exercises, and test its disposability-to-use (usability, motivation to use, compliance to treatment) on cognitive-impaired patients with multiple sclerosis (MS). Methods: COGNI-TRAcK includes user-friendly interfaces for personal data input and management and for CR intervention configurations. Inner routines automatically implement adaptive working load algorithms and allow data processing and analysis. A dedicated team developed COGNI-TRAcK with C# programming language, by using the platform Xamarin Studio 4.0.10 for Android (API level 15 and following). Three exercises based on working memory are now available. To assess the disposability-to-use of the system, patients with MS were selected as likely users due to the young age of disease onset. Cognitive-impaired patients with MS (N=16) with a mean age of 49.06 years (SD 9.10) and a mean score of 3.75 (SD 1.92) on the Expanded Disability Status Scale (EDSS) were submitted to an 8-week at-home intervention administered by the app. The intervention consisted of 5 daily scheduled 30-minute sessions per week. Disposability-to-use of COGNI-TRAcK was investigated by means of a questionnaire administered to patients at the end of the training. Results: The adherence to the treatment was 84% (33.4/40). Of the patients with MS, 94% (15/16) understood the instructions given, 100% (16/16) felt independent to use COGNI-TRAcK at home, 75% (12/16) found the exercises interesting, and 81% (13/16) found the exercises useful and were motivated to use the app again. Moreover, during the exercises, patients with MS were highly motivated to perform well (mean score 3.19/4, SE 0.16), experienced rather low levels of stress (mean score 2.19/4, SE 0.26), were not bored (mean score 1.81/4, SE 0.30), and felt amusement (mean score 2.25/4, SE 0.23). Conclusions: As COGNI-TRAcK is highly usable, motivating, and well-accepted by patients with MS, its effectiveness can now be investigated. To improve COGNI-TRAcK, new releases should contain more working memory exercises, have enhanced perceived amusement, and promote Internet communication procedures for data transfer and fostering remote control of the intervention. %M 26323749 %R 10.2196/mhealth.4269 %U http://mhealth.jmir.org/2015/3/e85/ %U https://doi.org/10.2196/mhealth.4269 %U http://www.ncbi.nlm.nih.gov/pubmed/26323749 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e73 %T Identification of Behavior Change Techniques and Engagement Strategies to Design a Smartphone App to Reduce Alcohol Consumption Using a Formal Consensus Method %A Garnett,Claire %A Crane,David %A West,Robert %A Brown,Jamie %A Michie,Susan %+ Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2076795682, c.garnett.12@ucl.ac.uk %K smartphone apps %K alcohol consumption %K consensus %K Delphi technique %K behavior change techniques %D 2015 %7 29.06.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Digital interventions to reduce excessive alcohol consumption have the potential to have a broader reach and be more cost-effective than traditional brief interventions. However, there is not yet strong evidence for their ability to engage users or their effectiveness. Objective: This study aimed to identify the behavior change techniques (BCTs) and engagement strategies most worthy of further study by inclusion in a smartphone app to reduce alcohol consumption, using formal expert consensus methods. Methods: The first phase of the study consisted of a Delphi exercise with three rounds. It was conducted with 7 international experts in the field of alcohol and/or behavior change. In the first round, experts identified BCTs most likely to be effective at reducing alcohol consumption and strategies most likely to engage users with an app; these were rated in the second round; and those rated as effective by at least four out of seven participants were ranked in the third round. The rankings were analyzed using Kendall’s W coefficient of concordance, which indicates consensus between participants. The second phase consisted of a new, independent group of experts (n=43) ranking the BCTs that were identified in the first phase. The correlation between the rankings of the two groups was assessed using Spearman’s rank correlation coefficient. Results: Twelve BCTs were identified as likely to be effective. There was moderate agreement among the experts over their ranking (W=.465, χ211=35.8, P<.001) and the BCTs receiving the highest mean rankings were self-monitoring, goal-setting, action planning, and feedback in relation to goals. There was a significant correlation between the ranking of the BCTs by the group of experts who identified them and a second independent group of experts (Spearman’s rho=.690, P=.01). Seventeen responses were generated for strategies likely to engage users. There was moderate agreement among experts on the ranking of these engagement strategies (W=.563, χ215=59.2, P<.001) and those with the highest mean rankings were ease of use, design – aesthetic, feedback, function, design – ability to change design to suit own preferences, tailored information, and unique smartphone features. Conclusions: The BCTs with greatest potential to include in a smartphone app to reduce alcohol consumption were judged by experts to be self-monitoring, goal-setting, action planning, and feedback in relation to goals. The strategies most likely to engage users were ease of use, design, tailoring of design and information, and unique smartphone features. %M 26123578 %R 10.2196/mhealth.3895 %U http://mhealth.jmir.org/2015/2/e73/ %U https://doi.org/10.2196/mhealth.3895 %U http://www.ncbi.nlm.nih.gov/pubmed/26123578 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e69 %T Targeting Parents for Childhood Weight Management: Development of a Theory-Driven and User-Centered Healthy Eating App %A Curtis,Kristina Elizabeth %A Lahiri,Sudakshina %A Brown,Katherine Elizabeth %+ The Institute of Digital Healthcare, Warwick Manufacturing Group, The University of Warwick, Coventry, Coventry, CV4 7AL, United Kingdom, 44 24 7615 1632, k.e.curtis@warwick.ac.uk %K child %K obesity %K health behaviour %K mHealth %K healthy eating %K evidenc-based %K theory %D 2015 %7 18.06.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The proliferation of health promotion apps along with mobile phones' array of features supporting health behavior change offers a new and innovative approach to childhood weight management. However, despite the critical role parents play in children’s weight related behaviors, few industry-led apps aimed at childhood weight management target parents. Furthermore, industry-led apps have been shown to lack a basis in behavior change theory and evidence. Equally important remains the issue of how to maximize users’ engagement with mobile health (mHealth) interventions where there is growing consensus that inputs from the commercial app industry and the target population should be an integral part of the development process. Objective: The aim of this study is to systematically design and develop a theory and evidence-driven, user-centered healthy eating app targeting parents for childhood weight management, and clearly document this for the research and app development community. Methods: The Behavior Change Wheel (BCW) framework, a theoretically-based approach for intervention development, along with a user-centered design (UCD) philosophy and collaboration with the commercial app industry, guided the development process. Current evidence, along with a series of 9 focus groups (total of 46 participants) comprised of family weight management case workers, parents with overweight and healthy weight children aged 5-11 years, and consultation with experts, provided data to inform the app development. Thematic analysis of focus groups helped to extract information related to relevant theoretical, user-centered, and technological components to underpin the design and development of the app. Results: Inputs from parents and experts working in the area of childhood weight management helped to identify the main target behavior: to help parents provide appropriate food portion sizes for their children. To achieve this target behavior, the behavioral diagnosis revealed the need for eliciting change in parents’ capability, motivation, and opportunity in 10-associated Theoretical Domains Framework (TDF) domains. Of the 9 possible intervention functions, 6 were selected to bring about this change which guided the selection of 21 behavior change techniques. Parents’ preferences for healthy eating app features revolved around four main themes (app features, time saving and convenience, aesthetics, and gamification) whereupon a criterion was applied to guide the selection on which preferences should be integrated into the design of the app. Collaboration with the app company helped to build on users’ preferences for elements of gamification such as points, quizzes, and levels to optimize user engagement. Feedback from parents on interactive mock-ups helped to inform the final development of the prototype app. Conclusions: Here, we fully explicate a systematic approach applied in the development of a family-oriented, healthy eating health promotion app grounded in theory and evidence, and balanced with users’ preferences to help maximize its engagement with the target population. %M 26088692 %R 10.2196/mhealth.3857 %U http://mhealth.jmir.org/2015/2/e69/ %U https://doi.org/10.2196/mhealth.3857 %U http://www.ncbi.nlm.nih.gov/pubmed/26088692 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e41 %T What Overweight Women Want From a Weight Loss App: A Qualitative Study on Arabic Women %A Alnasser,Aroub Abdulaziz %A Alkhalifa,Abdulrahman Saleh %A Sathiaseelan,Arjuna %A Marais,Debbi %+ King Saud University, Food Science and Nutrition, PO Box 86683, Riyadh, 11632, Saudi Arabia, 966 114556208, aroub@ksu.edu.sa %K weight loss %K focus groups %K smartphone %K mobile apps %K Arabic %K qualitative research %D 2015 %7 20.05.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Overweight and obesity are international public health issues. With mobile and app use growing globally, the development of weight loss apps are increasing along with evidence that interventions using technology have been effective in the treatment of obesity. Although studies have been conducted regarding what content health professionals would recommend within weight loss apps, there are limited studies that explore users’ viewpoints. There is specifically a paucity of research that takes the cultural background of the user into consideration, especially in Middle Eastern countries where the lives and weight loss intervention needs of women not only vary vastly from the West, but the obesity rate is also increasing exponentially. Objective: The current study sought to explore the proposed features of an Arabic weight loss app by seeking the experiences and opinions of overweight and obese Saudi Arabian users in order to design a mobile phone app to fit their needs. Methods: Focus group discussions were conducted with a purposive sample of volunteer overweight and obese Saudi women (BMI ≥ 25) who were older than 18 years and who owned a mobile phone. The most common Arabic and English weight loss mobile apps were downloaded to initiate dialogue about app usage and to get their opinions on what an ideal weight loss app would look like and the features it would include. All transcribed, translated discussions were thematically analyzed, categorized for each of the main topics of the discussion, and specific quotations were identified. Results: Four focus groups were conducted with a total of 39 participants. Most participants owned an Android mobile phone and only a few participants were aware of the availability of health-related apps. Barriers to weight loss were identified including: motivation, support (social and professional), boring diets, customs, and lifestyle. Diverse themes emerged as suggestions for an ideal weight loss app including: Arabic language and culturally sensitive; motivational support and social networking; dietary and physical activity tools; and a tailorable, user-friendly interface. Conclusions: This study identifies weight loss app features from the users’ perspective, which should be considered in the development of a weight loss app for this population. %M 25993907 %R 10.2196/mhealth.4409 %U http://mhealth.jmir.org/2015/2/e41/ %U https://doi.org/10.2196/mhealth.4409 %U http://www.ncbi.nlm.nih.gov/pubmed/25993907 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e11 %T Using a Collaborative Research Approach to Develop an Interdisciplinary Research Agenda for the Study of Mobile Health Interventions for Older Adults %A Mercer,Kathryn %A Baskerville,Neill %A Burns,Catherine M %A Chang,Feng %A Giangregorio,Lora %A Tomasson Goodwin,Jill %A Sadat Rezai,Leila %A Grindrod,Kelly %+ School of Pharmacy, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada, 1 888 4568 ext 21358, kgrindrod@uwaterloo.ca %K mHealth %K mobile health %K nominal group technique %K participatory research: collaborative research %K older adults %K research %K seniors %D 2015 %7 10.02.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Seniors with chronic diseases are often called on to self-manage their conditions. Mobile health (mHealth) tools may be a useful strategy to help seniors access health information at the point of decision-making, receive real-time feedback and coaching, and monitor health conditions. However, developing successful mHealth interventions for seniors presents many challenges. One of the key challenges is to ensure the scope of possible research questions includes the diverse views of seniors, experts and the stakeholder groups who support seniors as they manage chronic disease. Objective: Our primary objective was to present a case-study of a collaborative research approach to the development of an interdisciplinary research agenda. Our secondary objectives were to report on the results of a nominal group technique (NGT) approach used generate research questions and to assess the success of including non-academic researchers to enrich the scope, priority, and total number of possible research questions. Methods: We invited researchers and stakeholders to participate in a full day meeting that included rapid-style presentations by researchers, health care professionals, technology experts, patients and community groups followed by group discussions. An NGT was used to establish group consensus on the following question: In your opinion, what research needs to be done to better understand the effectiveness, usability and design of mobile health apps and devices for older adults? Results: Overall, the collaborative approach was a very successful strategy to bring together a diverse group of participants with the same end goal. The 32 participants generated 119 items in total. The top three research questions that emerged from the NGT were related to adoption, the need for high quality tools and the digital divide. Strong sub-themes included privacy and security, engagement and design. The NGT also helped us include the perspectives information from non-academic researchers that would not have been captured if the process had been limited to the research team. Conclusions: Developing ways for patients and other stakeholders to have a voice when it comes to developing patient awareness as related to mHealth may guide future research into engagement, ownership, usability and design. It is our intention that our paper be used and adapted by other researchers to engage small or vulnerable populations often excluded from mHealth research and design. %M 25669321 %R 10.2196/mhealth.3509 %U http://mhealth.jmir.org/2015/1/e11/ %U https://doi.org/10.2196/mhealth.3509 %U http://www.ncbi.nlm.nih.gov/pubmed/25669321 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e55 %T Application of Low-Cost Methodologies for Mobile Phone App Development %A Zhang,Melvyn %A Cheow,Enquan %A Ho,Cyrus SH %A Ng,Beng Yeong %A Ho,Roger %A Cheok,Christopher Cheng Soon %+ National HealthCare Group, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore, 539747, Singapore, 65 63892000, melvynzhangweibin@gmail.com %K education %K technology %K mobile phone apps %K cost-effectiveness %D 2014 %7 09.12.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The usage of mobile phones and mobile phone apps in the recent decade has indeed become more prevalent. Previous research has highlighted a method of using just the Internet browser and a text editor to create an app, but this does not eliminate the challenges faced by clinicians. More recently, two methodologies of app development have been shared, but there has not been any disclosures pertaining to the costs involved. In addition, limitations such as the distribution and dissemination of the apps have not been addressed. Objective: The aims of this research article are to: (1) highlight a low-cost methodology that clinicians without technical knowledge could use to develop educational apps; (2) clarify the respective costs involved in the process of development; (3) illustrate how limitations pertaining to dissemination could be addressed; and (4) to report initial utilization data of the apps and to share initial users’ self-rated perception of the apps. Methods: In this study, we will present two techniques of how to create a mobile app using two of the well-established online mobile app building websites. The costs of development are specified and the methodology of dissemination of the apps will be shared. The application of the low-cost methodologies in the creation of the “Mastering Psychiatry” app for undergraduates and “Déjà vu” app for postgraduates will be discussed. A questionnaire survey has been administered to undergraduate students collating their perceptions towards the app. Results: For the Mastering Psychiatry app, a cumulative total of 722 users have used the mobile app since inception, based on our analytics. For the Déjà vu app, there has been a cumulative total of 154 downloads since inception. The utilization data demonstrated the receptiveness towards these apps, and this is reinforced by the positive perceptions undergraduate students (n=185) had towards the low-cost self-developed apps. Conclusions: This is one of the few studies that have demonstrated the low-cost methodologies of app development; as well as student and trainee receptivity toward self-created Web-based mobile phone apps. The results obtained have demonstrated that these Web-based low-cost apps are applicable in the real life, and suggest that the methodologies shared in this research paper might be of benefit for other specialities and disciplines. %M 25491323 %R 10.2196/mhealth.3549 %U http://mhealth.jmir.org/2014/4/e55/ %U https://doi.org/10.2196/mhealth.3549 %U http://www.ncbi.nlm.nih.gov/pubmed/25491323 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e50 %T Development and Evaluation of an iPad App for Measuring the Cost of a Nutritious Diet %A Palermo,Claire %A Perera-Schulz,Dharani %A Kannan,Anitha %A Truby,Helen %A Shiell,Alan %A Emilda,Sindhu %A Quenette,Steve %+ Department of Nutrition and Dietetics, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, 3168, Australia, 61 3 99024270, claire.palermo@monash.edu %K portable digital device %K iPad %K healthy food %K food cost %D 2014 %7 04.12.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Monitoring food costs informs governments of the affordability of healthy diets. Many countries have adopted a standardized healthy food basket. The Victorian Healthy Food Basket contains 44 food items necessary to meet the nutritional requirements of four different Australian family types for a fortnight. Objective: The aim of this study was to describe the development of a new iPad app as core to the implementation of the Victorian Healthy Food Basket. The app significantly automates the data collection. We evaluate if the new technology enhanced the quality and efficacy of the research. Methods: Time taken for data collection and entry was recorded. Semi-structured evaluative interviews were conducted with five field workers during the pilot of the iPad app. Field workers were familiar with previous manual data collection methods. Qualitative process evaluation data was summarized against key evaluation questions. Results: Field workers reported that using the iPad for data collection resulted in increased data accuracy, time savings, and efficient data management, and was preferred over manual collection. Conclusions: Portable digital devices may be considered to improve and extend data collection in the field of food cost monitoring. %M 25486678 %R 10.2196/mhealth.3314 %U http://mhealth.jmir.org/2014/4/e50/ %U https://doi.org/10.2196/mhealth.3314 %U http://www.ncbi.nlm.nih.gov/pubmed/25486678 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e53 %T Enabling Psychiatrists to be Mobile Phone App Developers: Insights Into App Development Methodologies %A Zhang,Melvyn WB %A Tsang,Tammy %A Cheow,Enquan %A Ho,Cyrus SH %A Yeong,Ng Beng %A Ho,Roger CM %+ National Healthcare Group, 10 Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 63892000, melvynzhangweibin@gmail.com %K smartphone application %K mobile application %K creation %D 2014 %7 11.11.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The use of mobile phones, and specifically smartphones, in the last decade has become more and more prevalent. The latest mobile phones are equipped with comprehensive features that can be used in health care, such as providing rapid access to up-to-date evidence-based information, provision of instant communications, and improvements in organization. The estimated number of health care apps for mobile phones is increasing tremendously, but previous research has highlighted the lack of critical appraisal of new apps. This lack of appraisal of apps has largely been due to the lack of clinicians with technical knowledge of how to create an evidence-based app. Objective: We discuss two freely available methodologies for developing Web-based mobile phone apps: a website builder and an app builder. With these, users can program not just a Web-based app, but also integrate multimedia features within their app, without needing to know any programming language. Methods: We present techniques for creating a mobile Web-based app using two well-established online mobile app websites. We illustrate how to integrate text-based content within the app, as well as integration of interactive videos and rich site summary (RSS) feed information. We will also briefly discuss how to integrate a simple questionnaire survey into the mobile-based app. A questionnaire survey was administered to students to collate their perceptions towards the app. Results: These two methodologies for developing apps have been used to convert an online electronic psychiatry textbook into two Web-based mobile phone apps for medical students rotating through psychiatry in Singapore. Since the inception of our mobile Web-based app, a total of 21,991 unique users have used the mobile app and online portal provided by WordPress, and another 717 users have accessed the app via a Web-based link. The user perspective survey results (n=185) showed that a high proportion of students valued the textbook and objective structured clinical examination videos featured in the app. A high proportion of students concurred that a self-designed mobile phone app would be helpful for psychiatry education. Conclusions: These methodologies can enable busy clinicians to develop simple mobile Web-based apps for academic, educational, and research purposes, without any prior knowledge of programming. This will be beneficial for both clinicians and users at large, as there will then be more evidence-based mobile phone apps, or at least apps that have been appraised by a clinician. %M 25486985 %R 10.2196/mhealth.3425 %U http://mhealth.jmir.org/2014/4/e53/ %U https://doi.org/10.2196/mhealth.3425 %U http://www.ncbi.nlm.nih.gov/pubmed/25486985 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e47 %T Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men %A Goldenberg,Tamar %A McDougal,Sarah J %A Sullivan,Patrick S %A Stekler,Joanne D %A Stephenson,Rob %+ Rollins School of Public Health, Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 727 8799, tsgolde@emory.edu %K MSM %K HIV %K mobile phone app %K mHealth %K HIV prevention %D 2014 %7 29.10.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The Centers for Disease Control and Prevention recommends that sexually active men who have sex with men (MSM) in the United States test for human immunodeficiency virus (HIV) at least three times per year, but actual testing frequency is much less frequent. Though mHealth is a popular vehicle for delivering HIV interventions, there are currently no mobile phone apps that target MSM with the specific aim of building an HIV testing plan, and none that focuses on developing a comprehensive prevention plan and link MSM to additional HIV prevention and treatment resources. Previous research has suggested a need for more iterative feedback from the target population to ensure use of these interventions. Objective: The purpose of this study is to understand MSM’s preferences for functionality, format, and design of a mobile phone-based HIV prevention app and to examine MSM’s willingness to use an app for HIV prevention. Methods: We conducted focus group discussions with 38 gay and bisexual men, with two in-person groups in Atlanta, two in Seattle, and one online focus group discussion with gay and bisexual men in rural US regions. These discussions addressed MSM’s general preferences for apps, HIV testing barriers and facilitators for MSM, and ways that an HIV prevention app could address these barriers and facilitators to increase the frequency of HIV testing and prevention among MSM. During focus group discussions, participants were shown screenshots and provided feedback on potential app functions. Results: Participants provided preferences on functionality of the app, including the type and delivery of educational content, the value of interactive engagement, and the importance of social networking as an app component. Participants also discussed preferences on how the language should be framed for the delivery of information, identifying that an app needs to be simultaneously fun and professional. Privacy and altruistic motivation were considered to be important factors in men’s willingness to use a mobile HIV prevention app. Finally, men described the potential impact that a mobile HIV prevention app could have, identifying individual, interpersonal, and community-based benefits. Conclusions: In summary, participants described a comprehensive app that should incorporate innovative ideas to educate and engage men so that they would be motivated to use the app. In order for an app to be useful, it needs to feel safe and trustworthy, which is essential when considering the app’s language and privacy. Participants provided a range of preferences for using an HIV prevention app, including what they felt MSM need with regards to HIV prevention and what they want in order to engage with an app. Making an HIV prevention app enjoyable and usable for MSM is a difficult challenge. However, the usability of the app is vital because no matter how great the intervention, if MSM do not use the app, then it will not be useful. %M 25355249 %R 10.2196/mhealth.3745 %U http://mhealth.jmir.org/2014/4/e47/ %U https://doi.org/10.2196/mhealth.3745 %U http://www.ncbi.nlm.nih.gov/pubmed/25355249 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e41 %T Dietary Approaches to Stop Hypertension: Lessons Learned From a Case Study on the Development of an mHealth Behavior Change System %A Mann,Devin M %A Quintiliani,Lisa M %A Reddy,Shivani %A Kitos,Nicole R %A Weng,Michael %+ Boston University, Department of Medicine, 801 Massachusetts Ave, Suite 870, Boston, MA, 02118, United States, 1 617 638 8021, dmann@bu.edu %K mHealth %K chronic disease %K behavior change %D 2014 %7 23.10.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Evidence-based solutions for changing health behaviors exist but problems with feasibility, sustainability, and dissemination limit their impact on population-based behavior change and maintenance. Objective: Our goal was to overcome the limitations of an established behavior change program by using the inherent capabilities of smartphones and wireless sensors to develop a next generation mobile health (mHealth) intervention that has the potential to be more feasible. Methods: In response to the clinical need and the growing capabilities of smartphones, our study team decided to develop a behavioral hypertension reduction mHealth system inspired by Dietary Approaches to Stop Hypertension (DASH), a lifestyle modification program. We outline the key design and development decisions that molded the project including decisions about behavior change best practices, coaching features, platform, multimedia content, wireless devices, data security, integration of systems, rapid prototyping, usability, funding mechanisms, and how all of these issues intersect with clinical research and behavioral trials. Results: Over the 12 months, our study team faced many challenges to developing our prototype intervention. We describe 10 lessons learned that will ultimately stimulate more effective and sustainable approaches. Conclusions: The experiences presented in this case study can be used as a reference for others developing mHealth behavioral intervention development projects by highlighting the benefits and challenges facing mHealth research. %M 25340979 %R 10.2196/mhealth.3307 %U http://mhealth.jmir.org/2014/4/e41/ %U https://doi.org/10.2196/mhealth.3307 %U http://www.ncbi.nlm.nih.gov/pubmed/25340979 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e23 %T A Mobile App Offering Distractions and Tips to Cope With Cigarette Craving: A Qualitative Study %A Ploderer,Bernd %A Smith,Wally %A Pearce,Jon %A Borland,Ron %+ Department of Computing and Information Systems, The University of Melbourne, Doug McDonell Building (Building 168), Parkville, Victoria, 3010, Australia, 61 38344 ext 1511, ploderer@unimelb.edu.au %K smoking cessation %K relapse prevention %K quitting %K mobile phone %K distraction %D 2014 %7 07.05.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Despite considerable effort, most smokers relapse within a few months after quitting due to cigarette craving. The widespread adoption of mobile phones presents new opportunities to provide support during attempts to quit. Objective: To design and pilot a mobile app "DistractMe" to enable quitters to access and share distractions and tips to cope with cigarette cravings. Methods: A qualitative study with 14 smokers who used DistractMe on their mobiles during the first weeks of their quit attempt. Based on interviews, diaries, and log data, we examined how the app supported quitting strategies. Results: Three distinct techniques of coping when using DistractMe were identified: diversion, avoidance, and displacement. We further identified three forms of engagement with tips for coping: preparation, fortification, and confrontation. Overall, strategies to prevent cravings and their effects (avoidance, displacement, preparation, and fortification) were more common than immediate coping strategies (diversion and confrontation). Tips for coping were more commonly used than distractions to cope with cravings, because they helped to fortify the quit attempt and provided opportunities to connect with other users of the application. However, distractions were important to attract new users and to facilitate content sharing. Conclusions: Based on the qualitative results, we recommend that mobile phone-based interventions focus on tips shared by peers and frequent content updates. Apps also require testing with larger groups of users to assess whether they can be self-sustaining. %M 25099632 %R 10.2196/mhealth.3209 %U http://mhealth.jmir.org/2014/2/e23/ %U https://doi.org/10.2196/mhealth.3209 %U http://www.ncbi.nlm.nih.gov/pubmed/25099632 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e12 %T Ideas and Enhancements Related to Mobile Applications to Support Type 1 Diabetes %A Pulman,Andy %A Taylor,Jacqui %A Galvin,Kathleen %A Masding,Mike %+ The School of Health & Social Care, Bournemouth University, R109, Royal London House, Christchurch Road, Bournemouth, BH1 3LT, United Kingdom, 44 1202 962749, apulman@bournemouth.ac.uk %K patient education %K type 1 diabetes %K mobile %K apps %K sociotechnical design %K lifeworld %K humanising healthcare %K patient voice %K empathy %K ideas %K enhancements %D 2013 %7 25.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile devices have become increasingly important to young people who now use them to access a wide variety of health-related information. Research and policy related to the integration of health information and support with this technology do not effectively consider the viewpoint of a younger patient. Views of young people with type 1 diabetes are vital in developing quality services and improving their own health-related quality of life (HRQOL), yet research on their lifestyle and use of Web and mobile technology to support their condition and in non–health-related areas is sparse. Objective: To develop insight into young people with type 1 diabetes and their current use of Web and mobile technology and its potential impact on HRQOL. This can be achieved by constructing an in-depth picture of their day-to-day experiences from qualitative interviewing and exploring how they make use of technology in their lives and in relation to their condition and treatment. The goal was then to build something to help them, using the researcher’s technical expertise and seeking users’ opinions during the design and build, utilizing sociotechnical design principles. Methods: Data were collected by semistructured, in-depth qualitative interviews (N=9) of young people with type 1 diabetes aged 18-21. Interviews were transcribed and loaded onto NVivo for theme identification. Data analysis was undertaken during initial interviews (n=4) to locate potential ideas and enhancements for technical development. Latter interviews (n=5) assisted in the iterative sociotechnical design process of the development and provided additional developmental ideas. Results: Six themes were identified providing an understanding of how participants lived with and experienced their condition and how they used technology. Four technological suggestions for improvement were taken forward for prototyping. One prototype was developed as a clinically approved app. A number of ideas for new mobile apps and enhancements to currently existing apps that did not satisfactorily cater to this age group’s requirements for use in terms of design and functionality were suggested by interviewees but were not prototyped. Conclusions: This paper outlines the nonprototyped suggestions from interviewees and argues that young people with type 1 diabetes have a key role to play in the design and implementation of new technology to support them and improve HRQOL. It is vital to include and reflect on their suggestions as they have a radically different view of technology than either their parents or practitioners. We need to consider the relationship to technology that young people with type 1 diabetes have, and then reflect on how this might make a difference to them and when it might not be a suitable mechanism to use. %M 25100684 %R 10.2196/mhealth.2567 %U http://mhealth.jmir.org/2013/2/e12/ %U https://doi.org/10.2196/mhealth.2567 %U http://www.ncbi.nlm.nih.gov/pubmed/25100684 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e10 %T iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions %A Parmanto,Bambang %A Pramana,Gede %A Yu,Daihua Xie %A Fairman,Andrea D %A Dicianno,Brad E %A McCue,Michael P %+ Department of Health Information Management, School of Health & Rehabilitation Sciences, University of Pittsburgh, 6026 Forbes Tower, University of Pittsburgh, Pittsburgh, PA, PA 15243, United States, 1 412 383 6649, parmanto@pitt.edu %K mobile health %K mhealth %K self-care %K clinician-directed self-care %K self-management %K telehealth %K telemedicine %K smartphone %K chronic disease management %K spina bifida %K patient-clinician communications %D 2013 %7 11.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population. Objective: The project’s goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians. Methods: We developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two. The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery. Results: There were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient’s self-care tasks, send adherence data to the clinician portal, and receive personalized regimens from the portal. The Web-based portal was designed for clinicians to monitor patients’ conditions and to support self-care regimens. The two-way communication protocol was developed to facilitate secure and efficient data exchange between the apps and the portal. The 3 phases of usability study discovered usability issues in the areas of self-care workflow, navigation and interface, and communications between the apps and the portal. The system was used by 14 patients in the first 6 months of the clinical implementation, with 1 drop out due to having a poor wireless connection. The apps have been highly utilized consistently by patients, even those addressing complex issues such as medication and skincare. The patterns of utilization showed an increase in use in the first month, followed by a plateau. Conclusions: The system was capable of supporting self-care and adherence to regimen, monitoring adherence, supporting clinician engagement with patients, and has been highly utilized. %M 25100682 %R 10.2196/mhealth.2391 %U http://mhealth.jmir.org/2013/2/e10/ %U https://doi.org/10.2196/mhealth.2391 %U http://www.ncbi.nlm.nih.gov/pubmed/25100682 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e11 %T Mobile Mental Wellness Training for Stress Management: Feasibility and Design Implications Based on a One-Month Field Study %A Ahtinen,Aino %A Mattila,Elina %A Välkkynen,Pasi %A Kaipainen,Kirsikka %A Vanhala,Toni %A Ermes,Miikka %A Sairanen,Essi %A Myllymäki,Tero %A Lappalainen,Raimo %+ VTT Technical Research Centre of Finland, Sinitaival 6, Tampere, 33720, Finland, 358 207223384, elina.m.mattila@vtt.fi %K stress %K mental health %K mobile phone %K acceptance and commitment therapy %K field studies %K user experience %K design %D 2013 %7 10.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens. Objective: The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management. Methods: Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week’s and one month’s use. In-depth user experience interviews were conducted after one month’s use to study the acceptance and user experiences of Oiva. Results: Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P=.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P=.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems. Conclusions: A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection. %M 25100683 %R 10.2196/mhealth.2596 %U http://mhealth.jmir.org/2013/2/e11/ %U https://doi.org/10.2196/mhealth.2596 %U http://www.ncbi.nlm.nih.gov/pubmed/25100683 health.jmir.org/2014/2/e23/ %U https://doi.org/10.2196/mhealth.3209 %U http://www.ncbi.nlm.nih.gov/pubmed/25099632 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e12 %T Ideas and Enhancements Related to Mobile Applications to Support Type 1 Diabetes %A Pulman,Andy %A Taylor,Jacqui %A Galvin,Kathleen %A Masding,Mike %+ The School of Health & Social Care, Bournemouth University, R109, Royal London House, Christchurch Road, Bournemouth, BH1 3LT, United Kingdom, 44 1202 962749, apulman@bournemouth.ac.uk %K patient education %K type 1 diabetes %K mobile %K apps %K sociotechnical design %K lifeworld %K humanising healthcare %K patient voice %K empathy %K ideas %K enhancements %D 2013 %7 25.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile devices have become increasingly important to young people who now use them to access a wide variety of health-related information. Research and policy related to the integration of health information and support with this technology do not effectively consider the viewpoint of a younger patient. Views of young people with type 1 diabetes are vital in developing quality services and improving their own health-related quality of life (HRQOL), yet research on their lifestyle and use of Web and mobile technology to support their condition and in non–health-related areas is sparse. Objective: To develop insight into young people with type 1 diabetes and their current use of Web and mobile technology and its potential impact on HRQOL. This can be achieved by constructing an in-depth picture of their day-to-day experiences from qualitative interviewing and exploring how they make use of technology in their lives and in relation to their condition and treatment. The goal was then to build something to help them, using the researcher’s technical expertise and seeking users’ opinions during the design and build, utilizing sociotechnical design principles. Methods: Data were collected by semistructured, in-depth qualitative interviews (N=9) of young people with type 1 diabetes aged 18-21. Interviews were transcribed and loaded onto NVivo for theme identification. Data analysis was undertaken during initial interviews (n=4) to locate potential ideas and enhancements for technical development. Latter interviews (n=5) assisted in the iterative sociotechnical design process of the development and provided additional developmental ideas. Results: Six themes were identified providing an understanding of how participants lived with and experienced their condition and how they used technology. Four technological suggestions for improvement were taken forward for prototyping. One prototype was developed as a clinically approved app. A number of ideas for new mobile apps and enhancements to currently existing apps that did not satisfactorily cater to this age group’s requirements for use in terms of design and functionality were suggested by interviewees but were not prototyped. Conclusions: This paper outlines the nonprototyped suggestions from interviewees and argues that young people with type 1 diabetes have a key role to play in the design and implementation of new technology to support them and improve HRQOL. It is vital to include and reflect on their suggestions as they have a radically different view of technology than either their parents or practitioners. We need to consider the relationship to technology that young people with type 1 diabetes have, and then reflect on how this might make a difference to them and when it might not be a suitable mechanism to use. %M 25100684 %R 10.2196/mhealth.2567 %U http://mhealth.jmir.org/2013/2/e12/ %U https://doi.org/10.2196/mhealth.2567 %U http://www.ncbi.nlm.nih.gov/pubmed/25100684 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e10 %T iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions %A Parmanto,Bambang %A Pramana,Gede %A Yu,Daihua Xie %A Fairman,Andrea D %A Dicianno,Brad E %A McCue,Michael P %+ Department of Health Information Management, School of Health & Rehabilitation Sciences, University of Pittsburgh, 6026 Forbes Tower, University of Pittsburgh, Pittsburgh, PA, PA 15243, United States, 1 412 383 6649, parmanto@pitt.edu %K mobile health %K mhealth %K self-care %K clinician-directed self-care %K self-management %K telehealth %K telemedicine %K smartphone %K chronic disease management %K spina bifida %K patient-clinician communications %D 2013 %7 11.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population. Objective: The project’s goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians. Methods: We developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two. The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery. Results: There were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient’s self-care tasks, send adherence data to the clinician portal, and receive personalized regimens from the portal. The Web-based portal was designed for clinicians to monitor patients’ conditions and to support self-care regimens. The two-way communication protocol was developed to facilitate secure and efficient data exchange between the apps and the portal. The 3 phases of usability study discovered usability issues in the areas of self-care workflow, navigation and interface, and communications between the apps and the portal. The system was used by 14 patients in the first 6 months of the clinical implementation, with 1 drop out due to having a poor wireless connection. The apps have been highly utilized consistently by patients, even those addressing complex issues such as medication and skincare. The patterns of utilization showed an increase in use in the first month, followed by a plateau. Conclusions: The system was capable of supporting self-care and adherence to regimen, monitoring adherence, supporting clinician engagement with patients, and has been highly utilized. %M 25100682 %R 10.2196/mhealth.2391 %U http://mhealth.jmir.org/2013/2/e10/ %U https://doi.org/10.2196/mhealth.2391 %U http://www.ncbi.nlm.nih.gov/pubmed/25100682 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e11 %T Mobile Mental Wellness Training for Stress Management: Feasibility and Design Implications Based on a One-Month Field Study %A Ahtinen,Aino %A Mattila,Elina %A Välkkynen,Pasi %A Kaipainen,Kirsikka %A Vanhala,Toni %A Ermes,Miikka %A Sairanen,Essi %A Myllymäki,Tero %A Lappalainen,Raimo %+ VTT Technical Research Centre of Finland, Sinitaival 6, Tampere, 33720, Finland, 358 207223384, elina.m.mattila@vtt.fi %K stress %K mental health %K mobile phone %K acceptance and commitment therapy %K field studies %K user experience %K design %D 2013 %7 10.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens. Objective: The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management. Methods: Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week’s and one month’s use. In-depth user experience interviews were conducted after one month’s use to study the acceptance and user experiences of Oiva. Results: Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P=.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P=.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems. Conclusions: A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection. %M 25100683 %R 10.2196/mhealth.2596 %U http://mhealth.jmir.org/2013/2/e11/ %U https://doi.org/10.2196/mhealth.2596 %U http://www.ncbi.nlm.nih.gov/pubmed/25100683