%0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e67370 %T Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial %A Mancuso,Noah %A Michaels,Jenna %A Browne,Erica N %A Maragh-Bass,Allysha C %A Stocks,Jacob B %A Soberano,Zachary R %A Bond,C Lily %A Yigit,Ibrahim %A Comello,Maria Leonora G %A Larsen,Margo Adams %A Muessig,Kathryn E %A Pettifor,Audrey %A Hightow-Weidman,Lisa B %A Budhwani,Henna %A Stoner,Marie C D %K COVID-19 %K mHealth %K African American and Black %K young adults %K vaccination %K mobile health %D 2025 %7 16.4.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Negative attitudes toward vaccines and suboptimal vaccination rates among African American and Black (Black) Americans have been well documented, due to a history of medical racism and human rights violations in the United States. However, digital health interventions (DHI) have been shown to address racial disparities in several health outcomes, such as cardiovascular disease, HIV, and maternal health. The Tough Talks COVID (TT-C) study was a randomized controlled trial of a DHI designed to empower Black young adults in the United States South to make informed, autonomous decisions about COVID-19 vaccine uptake by addressing structural barriers and misinformation about vaccines. Objective: Our objective was to identify subgroups of Black young adults with various vaccine attitudes at baseline and determine the subgroups for which the TT-C DHI was most impactful. Methods: Black young adults aged 18‐29 years in Alabama, Georgia, and North Carolina who were unvaccinated or insufficiently vaccinated against COVID-19 completed three online surveys over three months (N=360). Latent profile analysis was used to identify subgroups based on general vaccine attitudes at baseline, including hesitancy, confidence, knowledge, conspiracy beliefs, and mistrust. Logistic regression was used to examine the associations between latent profiles and vaccine uptake, and linear regression was used to examine changes in vaccine attitudes at three months post-randomization. Modification of the TT-C DHI’s effects was assessed by latent profiles. Results: Three latent profiles emerged: vaccine-receptive (n=124), vaccine-neutral (n=155), and vaccine-resistant (n=81). Political affiliation, income, social support, and recent flu vaccination differed significantly between the three subgroups (P<.05). Vaccine uptake was not significantly different by subgroup, and the TTC-DHI did not have differing effects on uptake across subgroups. However, the DHI had the strongest effect—with statistically significant measures of association (P<.05) and interaction P values (P<.10)—among the baseline vaccine-resistant and vaccine-neutral subgroups compared to the vaccine-receptive subgroups at three months in improving vaccine hesitancy, confidence, and conspiracy beliefs at three months: vaccine-resistant difference: −0.40 (−0.76 to −0.37), 0.39 (0.02 to 0.75), and −0.47 (−0.86 to −0.09); vaccine neutral difference: −0.36 (−0.52 to −0.19), 0.35 (0.18 to 0.51), and −0.24 (−0.44 to −0.03). The DHI had no effects on these outcomes among the vaccine-receptive subgroup. Conclusions: Our findings revealed subgroups of Black young adults in the United States South with different vaccination attitudes, for which the TT-C intervention had differing effects. Black young adults who are vaccine-resistant or vaccine-neutral may experience larger gains from a digital vaccine intervention. Future work aimed at improving vaccination outcomes could target these populations to maximize resource efficiency and drive the greatest improvements in vaccine outcomes. Trial Registration: ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/study/NCT05490329 %R 10.2196/67370 %U https://publichealth.jmir.org/2025/1/e67370 %U https://doi.org/10.2196/67370 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e54753 %T Sociodemographic Differences in Logins and Engagement With the Electronic Health Coach Messaging Feature of a Mobile App to Support Opioid and Stimulant Use Recovery: Results From a 1-Month Observational Study %A Filiatreau,Lindsey M %A Szlyk,Hannah %A Ramsey,Alex T %A Kasson,Erin %A Li,Xiao %A Zhang,Zhuoran %A Cavazos-Rehg,Patricia %+ Division of Infectious Diseases, School of Medicine, Washington University in St Louis, 620 S Taylor Ave, St Louis, MO, 63110, United States, 1 3142737579, flindsey@wustl.edu %K substance misuse %K substance use recovery %K opioid use disorder %K stimulant use disorder %K uptake %K engagement %K mHealth %K digital health intervention %K sociodemographic %K mobile app %K stimulant use %K observational study %K mobile health %K smartphone %K St. Louis %K eCoach messaging %K Wilcoxon rank-sum tests %K Pearson chi-square %K recovery %K app %D 2025 %7 10.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps can serve as a critical tool in supporting the overall health of uninsured and underinsured individuals and groups who have been historically marginalized by the medical community and may be hesitant to seek health care. However, data on uptake and engagement with specific app features (eg, in-app messaging) are often lacking, limiting our ability to understand nuanced patterns of app use. Objective: This study aims to characterize sociodemographic differences in uptake and engagement with a smartphone app (uMAT-R) to support recovery efforts in a sample of individuals with opioid and stimulant use disorders in the Greater St. Louis area. Methods: We enrolled individuals into the uMAT-R service program from facilities providing recovery support in the Greater St. Louis area between January 2020 and April 2022. Study participants were recruited from service project enrollees. We describe the number of logins and electronic health coach (eCoach) messages participants sent in the first 30 days following enrollment using medians and IQRs and counts and proportions of those who ever (vs never) logged in and sent their eCoach a message. We compare estimates across sociodemographic subgroups, by insurance status, and for those who did and did not participate in the research component of the project using Wilcoxon rank-sum tests and Pearson chi-square tests. Results: Of all 695 participants, 446 (64.2%) logged into uMAT-R at least once during the 30 days following enrollment (median 2, IQR 0-8 logins). Approximately half of those who logged in (227/446) used the eCoach messaging feature (median 1, IQR 0-3 messages). Research participants (n=498), who could receive incentives for app engagement, were more likely to log in and use the eCoach messaging feature compared to others (n=197). Younger individuals, those with higher educational attainment, and White, non-Hispanic individuals were more likely to log in at least once compared to their counterparts. The median number of logins was higher among women, and those who were younger, employed, and not on Medicaid compared to their counterparts. Among those who logged in at least once, younger individuals and those with lower educational attainment were more likely to send at least one eCoach message compared to others. Conclusions: Mobile apps are a viable tool for supporting individuals in recovery from opioid and stimulant use disorders. However, older individuals, racial and ethnic minorities, and those with lower educational attainment may need additional login support, or benefit from alternative mechanisms of recovery support. In addition, apps may need to be tailored to achieve sustained engagement (ie, repeat logins) among men, and individuals who are older, unemployed, or on Medicaid. Older individuals and those with higher educational attainment who may be less likely to use eCoach messaging features could benefit from features tailored to their preferences. %M 40210205 %R 10.2196/54753 %U https://mhealth.jmir.org/2025/1/e54753 %U https://doi.org/10.2196/54753 %U http://www.ncbi.nlm.nih.gov/pubmed/40210205 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58377 %T Factors Determining Acceptance of Internet of Things in Medical Education: Mixed Methods Study %A Alhumaid,Khadija %A Ayoubi,Kevin %A Khalifa,Maha %A Salloum,Said %K collaborative learning %K student %K college %K university %K education %K Internet of Things %K IoT %K technology acceptance model %K technology optimism %K TAM %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %K adoption %K survey %K questionnaire %K ANN %K deep learning %K structural equation modeling %K neural network %K intent %K use %K medical education %K artificial neural network %K technology innovation %D 2025 %7 10.4.2025 %9 %J JMIR Hum Factors %G English %X Background: The global increase in the Internet of Things (IoT) adoption has sparked interest in its application within the educational sector, particularly in colleges and universities. Previous studies have often focused on individual attitudes toward IoT without considering a multiperspective approach and have overlooked the impact of IoT on the technology acceptance model outside the educational domain. Objective: This study aims to bridge the research gap by investigating the factors influencing IoT adoption in educational settings, thereby enhancing the understanding of collaborative learning through technology. It seeks to elucidate how IoT can facilitate learning processes and technology acceptance among college and university students in the United Arab Emirates. Methods: A questionnaire was distributed to students across various colleges and universities in the United Arab Emirates, garnering 463 participants. The data collected were analyzed using a hybrid approach that integrates structural equation modeling (SEM) and artificial neural network (ANN), along with importance-performance map analysis to evaluate the significance and performance of each factor affecting IoT adoption. Results: The study, involving 463 participants, identifies 2 primary levels at which factors influence the intention to adopt IoT technologies. Initial influences include technology optimism (TOP), innovation, and learning motivation, crucial for application engagement. Advanced influences stem from technology acceptance model constructs, particularly perceived ease of use (PE) and perceived usefulness (PU), which directly enhance adoption intentions. Detailed statistical analysis using partial least squares–SEM reveals significant relationships: TOP and innovativeness impact PE (β=.412, P=.04; β=.608, P=.002, respectively), and PU significantly influences TOP (β=.381, P=.04), innovativeness (β=.557, P=.003), and learning motivation (β=.752, P<.001). These results support our hypotheses (H1, H2, H3, H4, and H5). Further, the intention to use IoT is significantly affected by PE and usefulness (β=.619, P<.001; β=.598, P<.001, respectively). ANN modeling enhances these findings, showing superior predictive power (R2=89.7%) compared to partial least squares–SEM (R2=86.3%), indicating a more effective identification of nonlinear associations. Importance-performance map analysis corroborates these results, demonstrating the importance and performance of PU as most critical, followed by technology innovativeness and optimism, in shaping behavioral intentions to use IoT. Conclusions: This research contributes methodologically by leveraging deep ANN architecture to explore nonlinear relationships among factors influencing IoT adoption in education. The study underscores the importance of both intrinsic motivational factors and perceived technological attributes in fostering IoT adoption, offering insights for educational institutions considering IoT integration into their learning environments. %R 10.2196/58377 %U https://humanfactors.jmir.org/2025/1/e58377 %U https://doi.org/10.2196/58377 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70404 %T Primary Care Practice Factors Associated With Telehealth Adoption in the United States: Cross-Sectional Survey Analysis %A Mackwood,Matthew %A Fisher,Elliott %A Schmidt,Rachel O %A O'Malley,A James %A Rodriguez,Hector P %A Shortell,Stephen %A Akré,Ellesse-Roselee %A Berube,Alena %A Schifferdecker,Karen E %+ Department of Community & Family Medicine, Geisel School of Medicine, Dartmouth College, One Medical Center Drive, Hanover, NH, 03756, United States, 1 6036504000, matthew.b.mackwood@hitchcock.org %K telehealth %K telemedicine %K remote consultation %K primary health care %K general practice %K internet access %K health policy %K health care economics and organizations %K access to primary care %K digital divide %K vulnerable populations %K medically underserved area %D 2025 %7 28.3.2025 %9 Research Letter %J J Med Internet Res %G English %X In this national study of primary care practice–level factors associated with telehealth adoption in 2022, we found that training and assisting patients with the use of telehealth, broadband expansion efforts, and a higher proportion of low-income patients were associated with higher practice-level telehealth use, suggesting both opportunities for telehealth expansion and potential populations with higher need for its use. %M 40152920 %R 10.2196/70404 %U https://www.jmir.org/2025/1/e70404 %U https://doi.org/10.2196/70404 %U http://www.ncbi.nlm.nih.gov/pubmed/40152920 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 10 %N %P e64505 %T Examining How Adults With Diabetes Use Technologies to Support Diabetes Self-Management: Mixed Methods Study %A Bober,Timothy %A Garvin,Sophia %A Krall,Jodi %A Zupa,Margaret %A Low,Carissa %A Rosland,Ann-Marie %+ Caring for Complex Chronic Conditions Research Center, Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Schenley Place, Fourth Floor, 4420 Bayard Street, Pittsburgh, PA, 15213, United States, 1 412 648 4660, bobertm@upmc.edu %K diabetes %K self-management %K mobile health %K health technology %K continuous glucose monitors %K digital health literacy %D 2025 %7 25.3.2025 %9 Original Paper %J JMIR Diabetes %G English %X Background: Technologies such as mobile apps, continuous glucose monitors (CGMs), and activity trackers are available to support adults with diabetes, but it is not clear how they are used together for diabetes self-management. Objective: This study aims to understand how adults with diabetes with differing clinical profiles and digital health literacy levels integrate data from multiple behavior tracking technologies for diabetes self-management. Methods: Adults with type 1 or 2 diabetes who used ≥1 diabetes medications responded to a web-based survey about health app and activity tracker use in 6 categories: blood glucose level, diet, exercise and activity, weight, sleep, and stress. Digital health literacy was assessed using the Digital Health Care Literacy Scale, and general health literacy was assessed using the Brief Health Literacy Screen. We analyzed descriptive statistics among respondents and compared health technology use using independent 2-tailed t tests for continuous variables, chi-square for categorical variables, and Fisher exact tests for digital health literacy levels. Semistructured interviews examined how these technologies were and could be used to support daily diabetes self-management. We summarized interview themes using content analysis. Results: Of the 61 survey respondents, 21 (34%) were Black, 23 (38%) were female, and 29 (48%) were aged ≥45 years; moreover, 44 (72%) had type 2 diabetes, 36 (59%) used insulin, and 34 (56%) currently or previously used a CGM. Respondents had high levels of digital and general health literacy: 87% (46/53) used at least 1 health app, 59% (36/61) had used an activity tracker, and 62% (33/53) used apps to track ≥1 health behaviors. CGM users and nonusers used non-CGM health apps at similar rates (16/28, 57% vs 12/20, 60%; P=.84). Activity tracker use was also similar between CGM users and nonusers (20/33, 61% vs 14/22, 64%; P=.82). Respondents reported sharing self-monitor data with health care providers at similar rates across age groups (17/32, 53% for those aged 18-44 y vs 16/29, 55% for those aged 45-70 y; P=.87). Combined activity tracker and health app use was higher among those with higher Digital Health Care Literacy Scale scores, but this difference was not statistically significant (P=.09). Interviewees (18/61, 30%) described using blood glucose level tracking apps to personalize dietary choices but less frequently used data from apps or activity trackers to meet other self-management goals. Interviewees desired data that were passively collected, easily integrated across data sources, visually presented, and tailorable to self-management priorities. Conclusions: Adults with diabetes commonly used apps and activity trackers, often alongside CGMs, to track multiple behaviors that impact diabetes self-management but found it challenging to link tracked behaviors to glycemic and diabetes self-management goals. The findings indicate that there are untapped opportunities to integrate data from apps and activity trackers to support patient-centered diabetes self-management. %M 40131316 %R 10.2196/64505 %U https://diabetes.jmir.org/2025/1/e64505 %U https://doi.org/10.2196/64505 %U http://www.ncbi.nlm.nih.gov/pubmed/40131316 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e46149 %T Using Wear Time for the Analysis of Consumer-Grade Wearables’ Data: Case Study Using Fitbit Data %A Baroudi,Loubna %A Zernicke,Ronald Fredrick %A Tewari,Muneesh %A Carlozzi,Noelle E %A Choi,Sung Won %A Cain,Stephen M %K wear time %K wearables %K smartwatch %K mobile health %K physical activity %K engagement %K walking %K dataset %K wearable devices %K reliability %K behavior %K caregiver %K students %K Fitbit %K users %D 2025 %7 21.3.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Consumer-grade wearables allow researchers to capture a representative picture of human behavior in the real world over extended periods. However, maintaining users’ engagement remains a challenge and can lead to a decrease in compliance (eg, wear time in the context of wearable sensors) over time (eg, “wearables’ abandonment”). Objective: In this work, we analyzed datasets from diverse populations (eg, caregivers for various health issues, college students, and pediatric oncology patients) to quantify the impact that wear time requirements can have on study results. We found evidence that emphasizes the need to account for participants’ wear time in the analysis of consumer-grade wearables data. In Aim 1, we demonstrate the sensitivity of parameter estimates to different data processing methods with respect to wear time. In Aim 2, we demonstrate that not all research questions necessitate the same wear time requirements; some parameter estimates are not sensitive to wear time. Methods: We analyzed 3 Fitbit datasets comprising 6 different clinical and healthy population samples. For Aim 1, we analyzed the sensitivity of average daily step count and average daily heart rate at the population sample and individual levels to different methods of defining “valid” days using wear time. For Aim 2, we evaluated whether some research questions can be answered with data from lower compliance population samples. We explored (1) the estimation of the average daily step count and (2) the estimation of the average heart rate while walking. Results: For Aim 1, we found that the changes in the population sample average daily step count could reach 2000 steps for different methods of analysis and were dependent on the wear time compliance of the sample. As expected, population samples with a low daily wear time (less than 15 hours of wear time per day) showed the most sensitivity to changes in methods of analysis. On the individual level, we observed that around 15% of individuals had a difference in step count higher than 1000 steps for 4 of the 6 population samples analyzed when using different data processing methods. Those individual differences were higher than 3000 steps for close to 5% of individuals across all population samples. Average daily heart rate appeared to be robust to changes in wear time. For Aim 2, we found that, for 5 population samples out of 6, around 11% of individuals had enough data for the estimation of average heart rate while walking but not for the estimation of their average daily step count. Conclusions: We leveraged datasets from diverse populations to demonstrate the direct relationship between parameter estimates from consumer-grade wearable devices and participants’ wear time. Our findings highlighted the importance of a thorough analysis of wear time when processing data from consumer-grade wearables to ensure the relevance and reliability of the associated findings. %R 10.2196/46149 %U https://mhealth.jmir.org/2025/1/e46149 %U https://doi.org/10.2196/46149 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53823 %T Exploring Heart Disease–Related mHealth Apps in India: Systematic Search in App Stores and Metadata Analysis %A Dubbala,Keerthi %A Prizak,Roshan %A Metzler,Ingrid %A Rubeis,Giovanni %+ Division of Biomedical and Public Health Ethics, Department of General Health Studies, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria, 43 6646194677, keerthi.dubbala@kl.ac.at %K mobile health apps %K mHealth apps %K heart disease %K data collection methods %K natural language processing %K metadata analysis %K Apple App Store %K Google Play Store %K mobile phone %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone mobile health (mHealth) apps have the potential to enhance access to health care services and address health care disparities, especially in low-resource settings. However, when developed without attention to equity and inclusivity, mHealth apps can also exacerbate health disparities. Understanding and creating solutions for the disparities caused by mHealth apps is crucial for achieving health equity. There is a noticeable gap in research that comprehensively assesses the entire spectrum of existing health apps and extensively explores apps for specific health priorities from a health care and public health perspective. In this context, with its vast and diverse population, India presents a unique context for studying the landscape of mHealth apps. Objective: This study aimed to create a comprehensive dataset of mHealth apps available in India with an initial focus on heart disease (HD)–related apps. Methods: We collected individual app data from apps in the “medical” and “health and fitness” categories from the Google Play Store and the Apple App Store in December 2022 and July 2023, respectively. Using natural language processing techniques, we selected HD apps, performed statistical analysis, and applied latent Dirichlet allocation for clustering and topic modeling to categorize the resulting HD apps. Results: We collected 118,555 health apps from the Apple App Store and 108,945 health apps from the Google Play Store. Within these datasets, we found that approximately 1.7% (1990/118,555) of apps on the Apple App Store and 0.5% (548/108,945) on the Google Play Store included support for Indian languages. Using monograms and bigrams related to HD, we identified 1681 HD apps from the Apple App Store and 588 HD apps from the Google Play Store. HD apps make up only a small fraction of the total number of health apps available in India. About 90% (1496/1681 on Apple App Store and 548/588 on Google Play Store) of the HD apps were free of cost. However, more than 70% (1329/1681, 79.1% on Apple App Store and 423/588, 71.9% on Google Play Store) of HD apps had no reviews and rating-scores, indicating low overall use. Conclusions: Our study proposed a robust method for collecting and analyzing metadata from a wide array of mHealth apps available in India through the Apple App Store and Google Play Store. We revealed the limited representation of India’s linguistic diversity within the health and medical app landscape, evident from the negligible presence of Indian-language apps. We observed a scarcity of mHealth apps dedicated to HD, along with a lower level of user engagement, as indicated by reviews and app ratings. While most HD apps are financially accessible, uptake remains a challenge. Further research should focus on app quality assessment and factors influencing user adoption. %M 40063078 %R 10.2196/53823 %U https://www.jmir.org/2025/1/e53823 %U https://doi.org/10.2196/53823 %U http://www.ncbi.nlm.nih.gov/pubmed/40063078 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e63805 %T An Actor-Partner Interdependence Mediation Model for Assessing the Association Between Health Literacy and mHealth Use Intention in Dyads of Patients With Chronic Heart Failure and Their Caregivers: Cross-Sectional Study %A Jin,Xiaorong %A Zhang,Yimei %A Zhou,Min %A Mei,Qian %A Bai,Yangjuan %A Hu,Qiulan %A Wei,Wei %A Zhang,Xiong %A Ma,Fang %K chronic heart failure %K caregivers %K health literacy %K mHealth %K actor-partner interdependence mediation model %K mobile health %D 2025 %7 6.3.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Chronic heart failure (CHF) has become a serious threat to the health of the global population. Self-management is the key to treating CHF, and the emergence of mobile health (mHealth) has provided new ideas for the self-management of CHF. Despite the many potential benefits of mHealth, public utilization of mHealth apps is low, and poor health literacy (HL) is a key barrier to mHealth use. However, the mechanism of the influence is unclear. Objective: The aim of this study is to explore the dyadic associations between HL and mHealth usage intentions in dyads of patients with CHF and their caregivers, and the mediating role of mHealth perceived usefulness and perceived ease of use in these associations. Methods: This study had a cross-sectional research design, with a sample of 312 dyads of patients with CHF who had been hospitalized in the cardiology departments of 2 tertiary care hospitals in China from March to October 2023 and their caregivers. A general information questionnaire, the Chinese version of the Heart Failure-Specific Health Literacy Scale, and the mHealth Intention to Use Scale were used to conduct the survey; the data were analyzed using the actor-partner interdependence mediation model. Results: The results of the actor-partner interdependent mediation analysis of HL, perceived usefulness of mHealth, and mHealth use intention among patients with CHF and their caregivers showed that all of the model’s actor effects were valid (β=.26‐0.45; P<.001), the partner effects were partially valid (β=.08‐0.20; P<.05), and the mediation effects were valid (β=.002‐0.242, 95% CI 0.003‐0.321; P<.05). Actor-partner interdependent mediation analyses of HL, perceived ease of use of mHealth, and mHealth use intention among patients with CHF and caregivers showed that the model’s actor effect partially held (β=.17‐0.71; P<.01), the partner effect partially held (β=.15; P<.01), and the mediation effect partially held (β=.355‐0.584, 95% CI 0.234‐0.764; P<.001). Conclusions: Our study proposes that the HL of patients with CHF and their caregivers positively contributes to their own intention to use mHealth, suggesting that the use of mHealth by patients with CHF can be promoted by improving the HL of patients and caregivers. Our findings also suggest that the perceived usefulness of patients with CHF and caregivers affects patients’ mHealth use intention, and therefore patients with CHF and their caregivers should be involved throughout the mHealth development process to improve the usability of mHealth for both patients and caregivers. This study emphasizes the key role of patients’ perception that mHealth is easy to use in facilitating their use of mHealth. Therefore, it is recommended that the development of mHealth should focus on simplifying operational procedures and providing relevant operational training according to the needs of the patients when necessary. %R 10.2196/63805 %U https://mhealth.jmir.org/2025/1/e63805 %U https://doi.org/10.2196/63805 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63879 %T Usage Trends and Data Sharing Practices of Healthcare Wearable Devices Among US Adults: Cross-Sectional Study %A Chandrasekaran,Ranganathan %A Sadiq T,Muhammed %A Moustakas,Evangelos %+ Department of Information & Decision Sciences / Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, 2428 Univ Hall, 601 S Morgan St, Chicago, IL, 60607, United States, 1 3129962676, ranga@uic.edu %K healthcare wearable devices %K data-sharing behavior %K willingness to share wearable data %K activity trackers %K wearable use %K post-pandemic %K wearables %K healthcare delivery %K disease detection %K patient engagement %K digital literacy %K adults %K United States %K survey %K cross-sectional survey %K data sharing %D 2025 %7 21.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care wearable devices can transform health care delivery by enabling real-time, continuous monitoring that facilitates early disease detection, personalized treatments, and improved patient engagement. The COVID-19 pandemic has heightened awareness of the importance of health technology, accelerating interest in wearables as tools for monitoring health and managing chronic conditions. As we navigate the postpandemic era, understanding the adoption and data-sharing behaviors associated with wearable devices has become increasingly critical. Despite their potential, challenges and low adoption rates persist, with significant gaps in understanding the impact of sociodemographic factors, health conditions, and digital literacy on the use and data-sharing behaviors of these devices. Objective: This study aimed to explore the usage and data-sharing practices (willingness to share wearable data and actual data-sharing behavior) of wearable devices among US adults specifically during the later phases of the COVID-19 pandemic. Methods: Using cross-sectional data from the National Cancer Institute’s Health Information National Trends Survey 6, conducted from March to November 2022, this study uses responses from 5591 US adults to examine wearable use, willingness to share wearable data with providers, family, and friends, and the wearable data-sharing behavior. Results: The results indicate an increase in wearable device adoption to 36.36% (2033/5591) in 2022, up from 28%-30% in 2019. We also find a significant discrepancy between the willingness to share data, with 78.4% (1584/2020) of users open to sharing with health care providers, and the actual sharing behavior, where only 26.5% (535/ 2020) have done so. Higher odds of using wearables were associated with female gender (odds ratio [OR] 1.49, 95% CI 1.17-1.90, P<.01) and higher income levels (OR 2.65, 95% CI 1.42-4.93, P<.01 for incomes between US $50,000 and US $75,000, and OR 3.2, 95% CI 1.71-5.97, P<.01 for incomes above US $75,000). However, the likelihood of usage and data sharing declines significantly with age. Compared with African American respondents, Hispanic respondents were more willing to share wearable data with providers (OR 1.92, 95% CI 1.02-3.62, P<.05), though the odds of their actual sharing of wearable data with providers was relatively less (OR 0.44, 95% CI 0.20-0.97, P<.05). Frequency of provider visits (OR 1.23, 95% CI 1.08-1.39, P<.01), and total medical conditions (OR 1.35, 95% CI 1.05-1.73, P<.01) were significant predictors of data-sharing behavior. The study also identified weight, frequency of provider visits, technological self-efficacy and frequent physical activity as predictors for higher wearable use. Conclusions: Insights from this study are crucial for health care providers and policy makers aiming to leverage wearable technology to enhance health outcomes. Addressing the disparities and barriers identified can lead to more effective integration of these technologies in health care systems, thereby maximizing the potential of digital health tools to improve public health outcomes. %M 39982763 %R 10.2196/63879 %U https://www.jmir.org/2025/1/e63879 %U https://doi.org/10.2196/63879 %U http://www.ncbi.nlm.nih.gov/pubmed/39982763 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54608 %T Relative Preference for In-Person, Telehealth, Digital, and Pharmacologic Mental Health Care After the COVID-19 Pandemic: Cross-Sectional Questionnaire Study %A Parsons,E Marie %A Figueroa,Zoë G %A Hiserodt,Michele %A Cornelius,Talea %A Otto,Michael W %+ Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Boston, MA, 02115, United States, 1 617 353 9610, mariepar@bu.edu %K stigma %K digital CBT %K age %K generalized anxiety disorder %K insomnia %K adult %K telehealth %K digital health %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Most adults and children in the United States fail to receive timely care for mental health symptoms, with even worse rates of care access for individuals who belong to racial and ethnic minority groups. Digital (ie, app-based) care has proven to be an efficacious and empirically supported treatment option with the potential to address low rates of care and reduce care disparities, yet little is known about the relative preference for such treatment. Furthermore, the rapid adoption of telehealth care during the COVID-19 pandemic may have shifted care preferences. Objective: This study aimed to examine relative treatment preferences for 4 different types of mental health care: in-person psychological care, telehealth psychological care, digital treatment, or pharmacologic care. Care preferences were also examined relative to potential predictors of care use (ie, gender, race, age, stigma, discrimination, and level of shame). Methods: In this cross-sectional online survey study of adults (N=237, mean age 35 years, range 19-68 years), we ranked 4 mental health care modalities based on care preference: (1) in-person care, (2) telehealth care, (3) digital care, and (4) pharmacologic care. Preference for treatment modality was assessed based on vignette presentation for generalized anxiety disorder and insomnia. In addition, participants completed self-report questionnaires for demographics, symptom severity, and psychological and stigma-related variables. Results: We found no difference in overall preference for in-person versus both telehealth and digital care. For both generalized anxiety disorder and insomnia, participants preferred in-person care to telehealth care, although this finding was attenuated amongst older participants for insomnia treatment. Participants’ depressed mood was associated with a greater relative preference for pharmacologic care. There was no evidence of differential preference for digital care according to demographics, symptom severity, or psychological and stigma-related variables. Conclusions: These results indicate that digital care now competes well in terms of treatment preference with in-person, telehealth, and pharmacologic treatment options. %M 39946715 %R 10.2196/54608 %U https://www.jmir.org/2025/1/e54608 %U https://doi.org/10.2196/54608 %U http://www.ncbi.nlm.nih.gov/pubmed/39946715 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60495 %T mHealth App to Promote Healthy Lifestyles for Diverse Families Living in Rural Areas: Usability Study %A Perez Ramirez,Alejandra %A Ortega,Adrian %A Stephenson,Natalie %A Muñoz Osorio,Angel %A Kazak,Anne %A Phan,Thao-Ly %+ Center For Healthcare Delivery Science, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, United States, 1 302 358 5968, alejandra.perezramirez@nemours.org %K obesity %K user testing %K mHealth %K mobile health %K Spanish %K child %K rural population %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile Integrated Care for Childhood Obesity is a multicomponent intervention for caregivers of young children with obesity from rural communities that was developed in collaboration with community, parent, and health care partners. It includes community programming to promote healthy lifestyles and address social needs and health care visits with an interdisciplinary team. A digital mobile health platform—the Healthy Lifestyle (Nemours Children’s Health) dashboard—was designed as a self-management tool for caregivers to use as part of Mobile Integrated Care for Childhood Obesity. Objective: This study aimed to improve the usability of the English and Spanish language versions of the Healthy Lifestyle dashboard. Methods: During a 3-phased approach, usability testing was conducted with a diverse group of parents. In total, 7 mothers of children with obesity from rural communities (average age 39, SD 4.9 years; 4 Spanish-speaking and 3 English-speaking) provided feedback on a prototype of the dashboard. Participants verbalized their thoughts while using the prototype to complete 4 tasks. Preferences on the dashboard icon and resource page layout were also collected. Testing was done until feedback reached saturation and no additional substantive changes were suggested. Qualitative and quantitative data regarding usability, acceptability, and understandability were analyzed. Results: The dashboard was noted to be acceptable by 100% (N=7) of the participants. Overall, participants found the dashboard easy to navigate and found the resources, notifications, and ability to communicate with the health care team to be especially helpful. However, all (N=4) of the Spanish-speaking participants identified challenges related to numeracy (eg, difficulty interpreting the growth chart) and literacy (eg, features not fully available in Spanish), which informed iterative refinements to make the dashboard clearer and more literacy-sensitive. All 7 participants (100%) selected the same dashboard icon and 71% (5/7) preferred the final resource page layout. Conclusions: Conducting usability testing with key demographic populations, especially Spanish-speaking populations, was important to developing a mobile health intervention that is user-friendly, culturally relevant, and literacy-sensitive. %M 39932772 %R 10.2196/60495 %U https://formative.jmir.org/2025/1/e60495 %U https://doi.org/10.2196/60495 %U http://www.ncbi.nlm.nih.gov/pubmed/39932772 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67289 %T Community Caregivers’ Perspectives on Health IT Use for Children With Medical Complexity: Qualitative Interview Study %A Elkourdi,Farah %A Asan,Onur %+ Department of Systems and Enterprises, Stevens Institute of Technology, 1 Castle Point Terrace, Hoboken, NJ, 07030, United States, 1 2012165514, oasan@stevens.edu %K pediatric care %K children with medical complexity %K family-centered care %K health information technology %K health care software solutions %K mobile phone %K artificial intelligence %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Children with medical complexity represent a unique pediatric population requiring extensive health care needs and care coordination. Children with medical complexities have multiple significant chronic health problems that affect multiple organ systems and result in functional limitations and high health care needs or use. Often, there is a need for medical technology and total care for activities of daily living, much of which is provided at home by family and caregivers. Health IT (HIT) is a broad term that includes various technologies, such as patient portals, telemedicine, and mobile health apps. These tools can improve the care of children with medical complexity by enhancing communication, information exchange, medical safety, care coordination, and shared decision-making. In this study, we identified children with medical complexity as children aged <21 years who have >3 chronic health conditions. Community caregivers contribute to the care management of children with medical complexity, serving as advocates and coordinators, primary sources of information about children’s needs, and facilitators of access to care. They are often the first point of contact for the families of children with medical complexity, particularly in vulnerable communities, including families in rural areas, low-income households, and non–English-speaking immigrant populations. Objective: This study aims to introduce the HIT needs and preferences for children with medical complexity from the perspective of community caregivers. By including their perspective on HIT development, we can better appreciate the challenges they face, the insights they offer, and the ways in which they bridge gaps in care, support, and resources. Methods: We conducted semistructured interviews (n=12) with formal community caregivers of children with medical complexity populations from a parent advocacy network on the US East Coast. Interviews were audio recorded via Zoom and then transcribed. An inductive thematic analysis was conducted to reveal HIT challenges and preferences for improving the care of children with medical complexity. Results: We categorized the interview results into themes and subthemes. There are four main themes: (1) telehealth transforming care for children with medical complexity during the COVID-19 pandemic, (2) suggested tools and technologies for care for children with medical complexity, (3) HIT feature preferences, and (4) transition to adult care. Each theme had multiple subthemes capturing all details related to design features of needed technologies. Conclusions: The study emphasizes the need to develop and enhance HIT for the care of children with medical complexity. The identified themes can serve as design guidelines for designers by establishing a foundation for user-centered HIT tools to effectively support children with medical complexity and their families. Telehealth and mobile health apps could improve care management and quality of life for children with medical complexity. %M 39928943 %R 10.2196/67289 %U https://pediatrics.jmir.org/2025/1/e67289 %U https://doi.org/10.2196/67289 %U http://www.ncbi.nlm.nih.gov/pubmed/39928943 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59817 %T Perspectives of Hispanic and Latinx Community Members on AI-Enabled mHealth Tools: Qualitative Focus Group Study %A Kraft,Stephanie A %A Chopra,Shaan %A Duran,Miriana C %A Rojina,Janet A %A Beretta,Abril %A López,Katherine I %A Javan,Russell %A Wilfond,Benjamin S %A Rosenfeld,Margaret %A Fogarty,James %A Ko,Linda K %+ Department of Bioethics and Decision Sciences, Geisinger College of Health Sciences, 100 N. Academy Ave., Danville, PA, 17822, United States, 1 5702140506, skraft1@geisinger.edu %K wearable electronic devices %K qualitative research %K mobile health %K mHealth %K digital health %K privacy %K data sharing %K artificial intelligence %K AI %K community %K chronic conditions %K chronic disease %D 2025 %7 6.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) tools have the potential to reduce the burden of chronic conditions that disproportionately affect Hispanic and Latinx communities; however, digital divides in the access to and use of health technology suggest that mHealth has the potential to exacerbate, rather than reduce, these disparities. Objective: A key step toward developing health technology that is accessible and usable is to understand community member perspectives and needs so that technology is culturally relevant and appropriately contextualized. In this study, we aimed to examine the perspectives of Hispanic and Latinx community members in Washington State about mHealth. Methods: We recruited English- and Spanish-speaking Hispanic or Latinx adults to participate in web-based focus groups through existing community-based networks across rural and urban regions of Washington State. Focus groups included a presentation of narrative slideshow materials developed by the research team depicting mHealth use case examples of asthma in children and fall risk in older adults. Focus group questions asked participants to respond to the case examples and to further explore mHealth use preferences, benefits, barriers, and concerns. Focus group recordings were professionally transcribed, and Spanish transcripts were translated into English. We developed a qualitative codebook using deductive and inductive methods and then coded deidentified transcripts using the constant comparison method. The analysis team proposed themes based on review of coded data, which were validated through member checking with a community advisory board serving Latino individuals in the region and finalized through discussion with the entire research team. Results: Between May and September 2023, we conducted 8 focus groups in English or Spanish with 48 participants. Focus groups were stratified by language and region and included the following: 3 (n=18, 38% participants) Spanish urban groups, 2 (n=14, 29% participants) Spanish rural groups, 1 (n=6, 13% participants) English urban group, and 2 (n=10, 21% participants) English rural groups. We identified the following seven themes: (1) mHealth is seen as beneficial for promoting health and peace of mind; (2) some are unaware of, unfamiliar with, or uncomfortable with technology and may benefit from individualized support; (3) financial barriers limit access to mHealth; (4) practical considerations create barriers to using mHealth in daily life; (5) mHealth raises concern for overreliance on technology; (6) automated mHealth features are perceived as valuable but fallible, requiring human input to ensure accuracy; and (7) data sharing is seen as valuable for limited uses but raises privacy concerns. These themes illustrate key barriers to the benefits of mHealth that communities may face, provide insights into the role of mHealth within families, and examine the appropriate balance of data sharing and privacy protections. Conclusions: These findings offer important insights that can help advance the development of mHealth that responds to community values and priorities. %M 39912577 %R 10.2196/59817 %U https://www.jmir.org/2025/1/e59817 %U https://doi.org/10.2196/59817 %U http://www.ncbi.nlm.nih.gov/pubmed/39912577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59663 %T Long-Term Impact of Using Mobile Phones and Playing Computer Games on the Brain Structure and the Risk of Neurodegenerative Diseases: Large Population-Based Study %A Xiao,Yi %A Zhang,Sirui %A Ma,Yuanzheng %A Wang,Shichan %A Li,Chunyu %A Liang,Yan %A Shang,Huifang %+ Department of Neurology, West China Hospital, Sichuan University, No.17, Section 3, Renmin South Road, Chengdu, China, 86 18980602127, hfshang2002@126.com %K electronic device %K parkinsonism %K dementia %K aging %K brain MRI %K magnetic resonance imaging %D 2025 %7 28.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing popularity of electronic devices, the longitudinal effects of daily prolonged electronic device usage on brain health and the aging process remain unclear. Objective: The aim of this study was to investigate the impact of the daily use of mobile phones/computers on the brain structure and the risk of neurodegenerative diseases. Methods: We used data from the UK Biobank, a longitudinal population-based cohort study, to analyze the impact of mobile phone use duration, weekly usage time, and playing computer games on the future brain structure and the future risk of various neurodegenerative diseases, including all-cause dementia (ACD), Alzheimer disease (AD), vascular dementia (VD), all-cause parkinsonism (ACP), and Parkinson disease (PD). All the characteristics of using mobile phones and playing computer games were collected through face-to-face interviews at baseline, and outcomes were extracted from the algorithmic combinations of self-reported medical conditions, hospital admissions, and death registries. In addition, a group of participants underwent magnetic resonance imaging (MRI) at follow-up. Cox regression and linear regression were performed. Results: The study included over 270,000 participants for risk analysis, with a mean baseline age of approximately 55.85 (SD 8.07) years. The average follow-up duration was approximately 13.9 (SD 1.99) years. Lengthy mobile phone use was associated with a reduced risk of ACD (2-4 years: hazard ratio [HR] 0.815, 95% CI 0.729-0.912, P<.001; 5-8 years: HR 0.749, 95% CI 0.677-0.829, P<.001; >8 years: HR 0.830, 95% CI 0.751-0.918, P<.001), AD (5-8 years: HR 0.787, 95% CI 0.672-0.922, P=.003), and VD (2-4 years: HR 0.616, 95% CI 0.477-0.794, P<.001; 5-8 years: HR 0.729, 95% CI 0.589-0.902, P=.004; >8 years: HR 0.750, 95% CI 0.605-0.930, P=.009) compared to rarely using mobile phones. Additionally, lengthy mobile phone use was linked to a decreased risk of ACP (5-8 years: HR 0.747, 95% CI 0.637-0.875, P<.001; >8 years: HR 0.774, 95% CI 0.663-0.904, P=.001) and PD (5-8 years: HR 0.760, 95% CI 0.644-0.897, P=.001; >8 years: HR 0.777, 95% CI 0.660-0.913, P=.002) in participants older than 60 years. However, higher weekly usage time did not confer additional risk reduction compared to lower weekly usage of mobile phones. The neuroimaging analysis involved 35,643 participants, with an average duration of approximately 9.0 years between baseline and neuroimaging scans. Lengthy mobile phone use was related to a thicker cortex in different areas of the brain. Conclusions: Lengthy mobile phone use is associated with a reduced risk of neurodegenerative diseases and improved brain structure compared to minimal usage. Our research provides valuable background knowledge for future studies on the impact of modern electronic devices on brain health. %M 39874583 %R 10.2196/59663 %U https://www.jmir.org/2025/1/e59663 %U https://doi.org/10.2196/59663 %U http://www.ncbi.nlm.nih.gov/pubmed/39874583 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62645 %T The Association Between the Digital Divide and Health Inequalities Among Older Adults in China: Nationally Representative Cross-Sectional Survey %A Wu,Mengqiu %A Xue,Yongxi %A Ma,Chengyu %+ School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China, 86 10 83911576, machengyu@ccmu.edu.cn %K older adults %K digital divide %K internet use %K internet access %K health inequalities %D 2025 %7 15.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Health inequalities among older adults become increasingly pronounced as aging progresses. In the digital era, some researchers argue that access to and use of digital technologies may contribute to or exacerbate these existing health inequalities. Conversely, other researchers believe that digital technologies can help mitigate these disparities. Objective: This study aimed to investigate the relationship between the digital divide and health inequality among older adults and to offer recommendations for promoting health equity. Methods: Data were obtained from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) scale, the Instrumental Activities of Daily Living scale, the Mini-Mental State Examination scale, and a 5-point self-rated health scale, respectively. The chi-square and rank sum tests were used to explore whether internet use and access were associated with health inequality status. After controlling for confounders, multiple linear regression models were used to further determine this association. Sensitivity analysis was conducted using propensity score matching, and heterogeneity was analyzed for different influencing factors. Results: The 2018 analysis highlighted widening health disparities among older adults due to internet access and use, with statistically significant increases in inequalities in self-rated health (3.9%), ADL score (5.8%), and cognition (7.5%). Similarly, internet use widened gaps in self-rated health (7.5%) and cognition (7.6%). Conversely, the 2020 analysis demonstrated that internet access improved health disparities among older adults, reducing gaps in self-rated health (3.8%), ADL score (2.1%), instrumental ADL score (3.5%), and cognition (7.5%), with significant results, except for ADL. Internet use also narrowed disparities, with significant effects on self-rated health (4.8%) and cognition (12.8%). The robustness of the results was confirmed through propensity score–matching paired tests. In addition, the study found heterogeneity in the effects of internet access and use on health inequalities among older adults, depending on sex, age, education, and region. Conclusions: The impact of internet access and use on health inequalities among older adults showed different trends in 2018 and 2020. These findings underscore the importance of addressing the challenges and barriers to internet use among older adults, particularly during the early stages of digital adoption. It is recommended to promote equitable access to the health benefits of the internet through policy interventions, social support, and technological advancements. %M 39813666 %R 10.2196/62645 %U https://www.jmir.org/2025/1/e62645 %U https://doi.org/10.2196/62645 %U http://www.ncbi.nlm.nih.gov/pubmed/39813666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56954 %T Behavioral Factors Related to Participation in Remote Blood Pressure Monitoring Among Adults With Hypertension: Cross-Sectional Study %A Eze,Chinwe E %A Dorsch,Michael P %A Coe,Antoinette B %A Lester,Corey A %A Buis,Lorraine R %A Farris,Karen B %K remote blood pressure monitoring %K telemonitoring %K hypertension %K blood pressure %K technology %K health behaviors %K quantitative %K cross-sectional study %K United States %K lack of awareness %K health information %K health provider %K electronic communication channels %K adult %K aging %K mobile phone %D 2024 %7 23.12.2024 %9 %J JMIR Form Res %G English %X Background: Remote blood pressure (BP) monitoring (RBPM) or BP telemonitoring is beneficial in hypertension management. People with hypertension involved in telemonitoring of BP often have better BP control than those in usual care. However, most reports on RBPM are from intervention studies. Objective: This study aimed to assess participant characteristics and technology health behaviors associated with RBPM participation in a wider population with hypertension. This study will help us understand the predictors of RBPM participation and consider how to increase it. Methods: This was a quantitative, cross-sectional survey study of people with hypertension in the United States. The inclusion criteria included people aged ≥18 years with a hypertension diagnosis or who self-reported they have hypertension, had a prescription of at least one hypertension medication, understood the English language, and were willing to participate. The survey included demographics, technology health behaviors, and RBPM participation questions. The survey was self-administered on the Qualtrics platform and followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) checklist. The primary dependent variable was participation in RBPM. Results: In total, 507 people with hypertension participated in the survey. The mean age for all respondents was 60 (SD 14.7) years. The respondents were mostly female (306/507, 60.4%), non-Hispanic (483/507, 95.3%), and White (429/507, 84.6%). A little over half of the respondents reported having had hypertension for 5 years or more (287/507, 56.6%). About one-third of participants were aware of RBPM (165/507, 32.5%), and 11.8% (60/507) were enrolled in RBPM. The mean age of those engaging in RBPM and non-RBPM was 46.2 (SD 14.7) and 62 (SD 13.7) years, respectively. The most common reasons for not participating in RBPM were because their health provider did not ask the participant to participate (247/447, 55.3%) and their lack of awareness of RBPM (190/447, 42.5%). Most respondents in the RBPM group measure their BP at home (55/60, 91.7%), and 61.7% (37/60) engage in daily BP measurement, compared with 62.6% (280/447) and 25.1% (112/447), respectively, among the non-RBPM group. A greater number of those in the RBPM group reported tracking their BP measurements with mobile health (mHealth; 37/60, 61.7%) than those in the non-RBPM group (70/447, 15.6%). The electronic health records or patient portal was the most common channel of RBPM communication between the respondents and their health care providers. The significant predictors of participation in RBPM were RBPM awareness (adjusted odds ratio [AOR] 34.65, 95% CI 11.35‐150.31; P<.001) and sharing health information electronically with a health provider (AOR 4.90, 95% CI 1.39‐21.64; P=.01) among all participants. However, the significant predictor of participation in RBPM among participants who were aware of RBPM was sharing health information electronically with a health provider (AOR 6.99, 95% CI 1.62‐47.44; P=.007). Conclusions: Participation in RBPM is likely to increase with increased awareness, health providers’ recommendations, and tailoring RBPM services to patients’ preferred electronic communication channels. %R 10.2196/56954 %U https://formative.jmir.org/2024/1/e56954 %U https://doi.org/10.2196/56954 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e57702 %T Access to Primary Care Telemedicine and Visit Characterization in a Pediatric, Low-Income, Primarily Latino Population: Retrospective Study %A Pathak,Priya R %A Stockwell,Melissa S %A Lane,Mariellen M %A Robbins-Milne,Laura %A Friedman,Suzanne %A Pethe,Kalpana %A Krause,Margaret C %A Soren,Karen %A Matiz,Luz Adriana %A Solomon,Lauren B %A Burke,Maria E %A Bracho-Sanchez,Edith %+ Division of Child and Adolescent Health, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, 622 W 168th Street, VC 417, New York, NY, 10032, United States, 1 6084404396, pp2841@cumc.columbia.edu %K telemedicine %K telehealth %K pediatric primary care %K COVID-19 pandemic %K disparities %K primary care %K pediatrics %K portals %K access %K accessibility %K accessible %K use %K demographics %K low income %K Latino %K Hispanic %K Spanish %K mobile phone %D 2024 %7 17.12.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Since the COVID-19 pandemic, telemedicine has been widely integrated into primary care pediatrics. While initial studies showed some concern for disparities in telemedicine use, telemedicine uptake for pediatric patients in a low-income, primarily Latino community over a sustained period has yet to be described. Objective: We aimed to assess the relationship between demographics, patient portal activation, and telemedicine visits, as well as characterize diagnoses addressed in telemedicine, in a low-income, primarily Latino population over time. Methods: A multidisciplinary team conducted outreach for telemedicine and patient portal activation with the adoption of a new electronic health record. Data were collected on all in-person and telemedicine visits from February 2020 through April 2021 for 4 community-based pediatric practices. The outcomes included patient portal activation, telemedicine use, and reason for telemedicine visits. Bivariate tests and multivariate regression analyses were conducted to assess the independent effects of demographics on the likelihood of portal activation and having a telemedicine visit. Telemedicine diagnoses were categorized, and subanalyses were conducted to explore variations by age and month. Results: There were 12,377 unique patients and 7127 telemedicine visits. Latino patients made up 83.4% (n=8959) of the population. Nearly all patients (n=10,830, 87.5%) had an activated portal, and 33.8% (n=4169) had at least 1 telemedicine visit. Portal activation decreased with age >2 years (2-4 years: adjusted odds ratio [aOR] 0.62, 95% CI 0.51-0.76; 5-11 years: aOR 0.28, 95% CI 0.23-0.32; 12-14 years: aOR 0.29, 95% CI 0.23-0.35; and 15-17 years: aOR 0.46, 95% CI 0.36-0.58). Spanish-speaking (aOR 0.52, 95% CI 0.45-0.59) and non-Latino patients (aOR 0.64, 95% CI 0.54-0.76) had decreased odds of activation and having a telemedicine visit (aOR 0.81, 95% CI 0.74-0.89 and aOR 0.71, 95% CI 0.62-0.81, respectively). The top 5 diagnostic categories for telemedicine were infectious disease (n=1749, 26.1%), dermatology (n=1287, 19.5%), gastrointestinal (n=771, 11.7%), well and follow-up care (n=459, 7%), and other specialty-related care (n=415, 6.3%). Infectious disease showed the most variation over time. Age-based patterns included a decrease in the proportion of infectious disease diagnoses by increasing age group and a higher proportion of well and follow-up care in older ages. Additional telemedicine diagnoses included common infant concerns for patients younger than 2 years of age; pulmonary, asthma, and allergy concerns for toddler or school-age children; behavioral health concerns for younger adolescents; and genitourinary and gynecologic concerns for older adolescents. Conclusions: The high engagement across demographics suggests feasibility and interest in telemedicine in this low-income, primarily Latino population, which may be attributable to the strength of outreach. Language-based disparities were still present. Telemedicine was used for a wide range of diagnoses. As telemedicine remains a vital component of pediatric health care, targeted interventions may enhance engagement to serve diverse pediatric patient populations. %M 39689903 %R 10.2196/57702 %U https://pediatrics.jmir.org/2024/1/e57702 %U https://doi.org/10.2196/57702 %U http://www.ncbi.nlm.nih.gov/pubmed/39689903 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51536 %T Demographics and Health Characteristics Associated With the Likelihood of Participating in Digitally Delivered Exercise Rehabilitation for Improving Heart Health Among Breast Cancer Survivors: Cross-Sectional Survey Study %A Jones,Tamara %A Edbrooke,Lara %A Rawstorn,Jonathan C %A Denehy,Linda %A Hayes,Sandra %A Maddison,Ralph %A Sverdlov,Aaron L %A Koczwara,Bogda %A Kiss,Nicole %A Short,Camille E %K digital health %K breast cancer %K exercise %K rehabilitation %K cardiotoxicity %K demographic %K cancer survivor %K exercise rehabilitation %K home-based program %K pathologic process %K radiation %K physical phenomena %K heart care %K cardiovascular disease %K diagnosis %K cross-sectional study %K chronic disease %K statistics %D 2024 %7 16.12.2024 %9 %J JMIR Cancer %G English %X Background: Strong evidence supports the benefits of exercise following both cardiovascular disease and cancer diagnoses. However, less than one-third of Australians who are referred to exercise rehabilitation complete a program following a cardiac diagnosis. Technological advances make it increasingly possible to embed real-time supervision, tailored exercise prescription, behavior change, and social support into home-based programs. Objective: This study aimed to explore demographic and health characteristics associated with the likelihood of breast cancer survivors uptaking a digitally delivered cardiac exercise rehabilitation program and to determine whether this differed according to intervention timing (ie, offered generally, before, during, or after treatment). Secondary aims were to explore the knowledge of cardiac-related treatment side-effects, exercise behavior, additional intervention interests (eg, diet, fatigue management), and service fee capabilities. Methods: This cross-sectional study involved a convenience sample of breast cancer survivors recruited via social media. A self-reported questionnaire was used to collect outcomes of interests, including the likelihood of uptaking a digitally delivered cardiac exercise rehabilitation program, and demographic and health characteristics. Descriptive statistics were used to summarize sample characteristics and outcomes. Ordered logistic regression models were used to examine associations between demographic and health characteristics and likelihood of intervention uptake generally, before, during, and after treatment, with odds ratios (ORs) <0.67 or >1.5 defined as clinically meaningful and statistical significance a priori set at P≤.05. Results: A high proportion (194/208, 93%) of the sample (mean age 57, SD 11 years; median BMI=26, IQR 23‐31 kg/m2) met recommended physical activity levels at the time of the survey. Living in an outer regional area (compared with living in a major city) was associated with higher odds of uptake in each model (OR 3.86‐8.57, 95% CI 1.04-68.47; P=.01‐.04). Receiving more cardiotoxic treatments was also associated with higher odds of general uptake (OR 1.42, 95% CI 1.02-1.96; P=.04). There was some evidence that a higher BMI, more comorbid conditions, and lower education (compared with university education) were associated with lower odds of intervention uptake, but findings differed according to intervention timing. Respondents identified the need for better education about the cardiotoxic effects of breast cancer treatment, and the desire for multifaceted rehabilitation interventions that are free or low cost (median Aus $10, IQR 10-15 per session; Aus $1=US $0.69 at time of study). Conclusions: These findings can be used to better inform future research and the development of intervention techniques that are critical to improving the delivery of a digital service model that is effective, equitable, and accessible, specifically, by enhancing digital inclusion, addressing general exercise barriers experienced by chronic disease populations, incorporating multidisciplinary care, and developing affordable delivery models. %R 10.2196/51536 %U https://cancer.jmir.org/2024/1/e51536 %U https://doi.org/10.2196/51536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53720 %T Perceived Experiences and Needs of Digital Resources Among Postpartum Women in the United Arab Emirates: Qualitative Focus Group Study %A Hanach,Nivine %A Saqan,Roba %A Radwan,Hadia %A Baniissa,Wegdan %A de Vries,Nanne %+ Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, Netherlands, 31 43 388 5655, n.hanach@maastrichtuniversity.nl %K digital health %K social support %K telemedicine %K postpartum women %K focus group %K maternal health %K postpartum mental health %K postpartum depression %K emotional support %K health information %D 2024 %7 16.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The postpartum period is a critical phase in a woman's life, marked by various physical, psychological, and social challenges. In light of the rapid proliferation and uptake of digital technologies, particularly in the United Arab Emirates (UAE), mothers increasingly seek informational and emotional support from digital resources. No previous study has thoroughly explored the usage of various digital resources beyond telehealth services in the UAE. This literature gap is particularly relevant for the postpartum period, which remains largely understudied in the UAE. Objective: This study aims to delve into the digital experiences of postpartum women in the UAE by exploring the types of resources they navigate and the purposes those resources serve. In addition, it seeks to identify their perspectives and needs regarding digital resources that support their postpartum journey. Methods: Four focus groups were conducted synchronously on the web, involving a total of 27 multicultural mothers (mean age 32.47, SD 4.56 years), between 2 and 12 months post partum and living in the UAE. Descriptive interpretive thematic analysis was used to analyze the data. Results: Sixteen out of 27 women exhibited severe depressive symptoms at the time of the discussions (Edinburgh Postnatal Depression Scale score of >12). Two main themes were generated from the analysis: (1) Mothers’ Experiences with Digital Resources: Participants valued digital resources for providing immediate information, convenience, and support. They primarily used these resources to seek information on infant health, parenting advice, and emotional support through web-based communities. However, the abundance of conflicting information and the pressure to conform to health recommendations often created stress and anxiety. (2) The Perceived Need for Digital Resources: Despite their extensive use of digital resources, mothers articulated the need for a reliable UAE government digital platform tailored specifically to postpartum care, offering trusted information on infant health and postpartum mental well-being. They also emphasized the need for tailored postpartum telemedicine services and moderated web-based discussion forums to foster peer support among mothers. Conclusions: This study reveals the multifaceted role of digital resources in supporting mothers during the postpartum period, highlighting unmet needs that present opportunities for advancing postpartum care in the UAE. It demonstrates the importance of developing reliable digital solutions for postpartum women, especially regarding mental health and to enhance access to care through tailored telemedicine services. Collaborative efforts are required to ensure the implementation of user-centered digital platforms. Future research should focus on the diverse needs of postpartum women, including cultural sensitivity, the feasibility of telemedicine services, and the integration of partner support in digital interventions to improve maternal health outcomes. %M 39680428 %R 10.2196/53720 %U https://www.jmir.org/2024/1/e53720 %U https://doi.org/10.2196/53720 %U http://www.ncbi.nlm.nih.gov/pubmed/39680428 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65541 %T The Effects of the COVID-19 Pandemic on Age-Based Disparities in Digital Health Technology Use: Secondary Analysis of the 2017-2022 Health Information National Trends Survey %A Qiu,Yuanbo %A Huang,Huang %A Gai,Junjie %A De Leo,Gianluca %+ Department of Health Management, Economics, and Policy, School of Public Health, Augusta University, 2500 Walton Way, Science Hall, E-1031, Augusta, GA, 30904, United States, 1 859 551 9185, huhuang@augusta.edu %K age-based disparities %K health equity %K digital health technology use %K digital divide %K health policy %K COVID-19 %K mobile phone %D 2024 %7 4.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic accelerated the adoption of digital health technology, but it could also impact age-based disparities as existing studies have pointed out. Compared with the pre-pandemic period, whether the rapid digitalization of the health care system during the pandemic widened the age-based disparities over a long period remains unclear. Objective: This study aimed to analyze the long-term effects of the COVID-19 pandemic on the multifaceted landscape of digital health technology used across diverse age groups among US citizens. Methods: We conducted the retrospective observational study using the 2017-2022 Health Information National Trends Survey to identify the influence of the COVID-19 pandemic on a wide range of digital health technology use outcomes across various age groups. The sample included 15,505 respondents, which were categorized into 3 age groups: adults (18-44 years), middle-aged adults (45-64 years), and older adults (more than 65 years). We also designated the time point of March 11, 2020, to divide the pre- and post-pandemic periods. Based on these categorizations, multivariate linear probability models were used to assess pre-post changes in digital health technology use, controlling for demographic, socioeconomic, and health-related variables among different age groups. Results: Essentially, older adults were found to be significantly less likely to use digital health technology compared with adults, with a 26.28% lower likelihood of using the internet for health information (P<.001) and a 32.63% lower likelihood of using health apps (P<.001). The usage of digital health technology for all age groups had significantly increased after the onset of the pandemic, and the age-based disparities became smaller in terms of using the internet to look for health information. However, the disparities have widened for older adults in using the internet to look up test results (11.21%, P<.001) and make appointments (10.03%, P=.006) and using wearable devices to track health (8.31%, P=.01). Conclusions: Our study reveals a significant increase in the use of digital health technology among all age groups during the pandemic. However, while the disparities in accessing online information have narrowed, age-based disparities, particularly for older adults, have widened in most areas such as looking up test results and making appointments with doctors. Therefore, older adults are more likely left behind by the rapidly digitalized US health care system during the pandemic. Policy makers and health care providers should focus on addressing these disparities to ensure equitable access to digital health resources for US baby boomers. %M 39631070 %R 10.2196/65541 %U https://www.jmir.org/2024/1/e65541 %U https://doi.org/10.2196/65541 %U http://www.ncbi.nlm.nih.gov/pubmed/39631070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57009 %T The Role of Health in the Technology Acceptance Model Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis %A DeLange Martinez,Pauline %A Tancredi,Daniel %A Pavel,Misha %A Garcia,Lorena %A Young,Heather M %+ Betty Irene Moore School of Nursing, University of California, Davis, 2750 48th St, Sacramento, CA, 95817, United States, 1 916 426 2862, pdmartinez@ucdavis.edu %K aged %K older adults %K Asian American %K immigrant %K vulnerable populations %K internet %K information and communications technology %K ICT %K digital divide %K technology acceptance model %K mobile phone %D 2024 %7 3.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-rated health is associated with information and communications technology (ICT) use among older adults. Non–US born, older Asian American individuals are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the technology acceptance model for low-income, Asian American older adults, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of ICT use. However, the association between health and technology acceptance has not been explored among Asian American older adults. Objective: This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of ICTs among low-income, Asian American older adults. Methods: This cross-sectional survey included Asian American individuals aged ≥62 years living in affordable housing for older adults (N=392). Using hierarchical multiple regression, we explored the association between self-rated health and ICT use and technology acceptance model mediators (PU and PEOU) while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association between age and subjective cognitive decline and the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines, revealing that the relationship between subjective cognitive decline and ICT use varied in 3 age segments, which led to updating our analysis to estimate differences in ICT use among age categories with and without subjective cognitive decline. Results: Self-rated health was not significantly associated with ICT use (β=.087; P=.13), PU (β=.106; P=.10), or PEOU (β=.062; P=.31). However, the interaction terms of subjective cognitive decline and age significantly improved the model fit for ICT use (ΔR2=0.011; P=.04). In reviewing scatterplots, we determined that, in the youngest age group (62-74 years), ICT use increased with subjective cognitive decline, whereas in the older age groups (75-84 and ≥85 years), ICT use decreased with subjective cognitive decline, more so in the oldest age category. Through regression analysis, among participants with subjective cognitive decline, ICT use significantly decreased in the middle and older age groups as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant. Conclusions: This study contributes to the understanding of the complex relationship between health and ICT acceptance among low-income, Asian American older adults and suggests the need for tailored interventions to promote digital engagement and quality of life for this population. %M 39625744 %R 10.2196/57009 %U https://formative.jmir.org/2024/1/e57009 %U https://doi.org/10.2196/57009 %U http://www.ncbi.nlm.nih.gov/pubmed/39625744 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57301 %T Relationship Between Internet Use and Cognitive Function Among Middle-Aged and Older Chinese Adults: 5-Year Longitudinal Study %A Chen,Bowen %A Yang,Chun %A Ren,Shanshan %A Li,Penggao %A Zhao,Jin %+ Department of Hospital Epidemiology and Infection Control, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China, 86 571 86006435, enqizhao@zju.edu.cn %K aging %K cognitive function %K internet use %K longitudinal study %K fixed effects model %D 2024 %7 2.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the older adult population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet use among middle-aged and older adults. Objective: This study aims to explore the association between internet use and age-related cognitive decline among middle-aged and older Chinese adults. To gain a more comprehensive understanding of the effects of internet use, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet use on cognitive function for characteristics significantly linked to cognition in stratified analysis. Methods: We analyzed data based on 12,770 dementia-free participants aged ≥45 years from the China Health and Retirement Longitudinal Study. We used a fixed effects model to assess the relationship between internet use and cognitive decline and further validated it using multiple linear regression analysis, generalized estimating equations, propensity score matching, inverse probability of treatment weighting, and overlap weighting. We further examined the varying effects of internet device type and frequency on cognitive function using fixed effects models and Spearman rank correlations. The Karlson-Holm-Breen method was used to estimate the mediating role of internet use in the urban-rural cognitive gap. Results: Participants using the internet (n=1005) were younger, more likely to be male, more educated, married, retired and living in an urban area and had higher cognitive assessment scores than nonusers (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (β=0.551, 95% CI 0.391-0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases, at 2.2% (15/671), compared with nonusers, at 5.3% (379/7099; P<.001). The negative impact of aging (>50 years) on cognitive function was consistently less pronounced among internet users than among nonusers. Furthermore, increased frequency of internet use was associated with greater cognitive benefits for middle-aged and older adults (rs=0.378, P<.001). Among digital devices used for internet access, cell phones (β=0.398, 95% CI 0.283-0.495) seemed to have a higher level of cognitive protection than computers (β=0.147, 95% CI 0.091-0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effect, P<.001). Conclusions: This study revealed that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet use has the potential to be a viable, cost-effective, nonpharmacological intervention for cognitive decline among middle-aged and older adults. %M 39539034 %R 10.2196/57301 %U https://www.jmir.org/2024/1/e57301 %U https://doi.org/10.2196/57301 %U http://www.ncbi.nlm.nih.gov/pubmed/39539034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53932 %T Opportunities to Address Specialty Care Deserts and the Digital Divide through the Veterans Health Administration’s Telehealth Hub-and-Spoke Cardiology Clinic: Retrospective Cohort Study %A Tisdale,Rebecca Lauren %A Purmal,Colin %A Kalwani,Neil %A Sandhu,Alexander %A Heidenreich,Paul %A Zulman,Donna %A Hussain,Tanvir %+ Center for Innovation to Implementation (Ci2i), Health Services Research, VA Palo Alto Health Care System, 795 Willow Rd,152-MPD, Bldg 324, Menlo Park, CA, 94025, United States, 1 6502695193, rebecca.tisdale2@va.gov %K telehealth %K specialty care %K cardiovascular disease %K telemedicine %K cardiology %K veterans %K low income %K digital divide %K access %K Veterans Health Administration %K VA %K VHA %K rural %K clinical resource hub %K CRH %D 2024 %7 28.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: To address geographic barriers to specialty care access for services such as cardiology, the Veterans Health Administration (VA) has implemented a novel, regionalized telehealth care hub. The Clinical Resource Hub (CRH) model extends care, including cardiology services, to individuals in low-access communities across the region. Little is known, however, about the reach of such programs. Objective: This study aimed to describe the initial CRH program implementation in terms of growth in users and clinical encounters, as well as the association between user characteristics and the use of CRH cardiology care, in VA’s Sierra Pacific region (Northern California, Nevada, and the Pacific Islands). Methods: We compared patients who used CRH cardiology services (CRH users) to those using non-CRH cardiology services (CRH nonusers) in the Sierra Pacific region between July 15, 2021, and March 31, 2023. After characterizing changes in the numbers of CRH users and nonusers and clinical encounters over the study period, we used multivariable logistic regression to estimate the association between patient-level factors and the odds of being a CRH user. Results: There were 804 CRH users over the study period, with 1961 CRH encounters concentrated at 3 main CRH sites. The CRH program comprised a minority of cardiology users and encounters in the region, with 19,583 CRH nonusers with 83,489 encounters. The numbers of CRH patients and encounters both increased at a steady-to-increasing rate over the study period, with increases of 37% (n=292 vs n=213) in users and 64% (n=584 vs n=356) in encounters in the first quarter of 2023 compared with the last quarter of 2022. Among CRH users, 8.3% (67/804) were female and 41.4% (333/804) were aged ≥75 years, compared with 4.3% (840/19,583) and 49% (9600/19,583), respectively, among CRH nonusers. The proportions of rural (users: 205/804, 25.5%; nonusers: 4936/19,583, 25.2%), highly disabled (users: 387/804, 48.1%; nonusers: 9246/19,583, 47.2%), and low-income (users: 165/804, 20.5%; nonusers: 3941/19,583, 20.1%) veterans in both groups were similar. In multivariable logistic models, adjusted odds ratios of using CRH were higher for female veterans (1.70, 95% CI 1.29-2.24) and lower for older veterans (aged ≥75 years; 0.33, 95% CI 0.23-0.47). Rural veterans also had a higher adjusted odds ratio of using CRH (1.19, 95% CI 1.00-1.42; P=.046). Conclusions: The VA’s Sierra Pacific CRH cardiology program grew substantially in its first 2 years of operation, serving disproportionately more female and rural veterans and similar proportions of highly disabled and low-income veterans compared to conventional VA care. This model appears to be effective for overcoming specialty care access barriers for certain individuals, although targeted efforts may be required to reach older veterans. While this study focuses on a single region, specialty, and health care system, lessons from implementing regionalized telehealth hub models may be applicable to other settings. %M 39607997 %R 10.2196/53932 %U https://www.jmir.org/2024/1/e53932 %U https://doi.org/10.2196/53932 %U http://www.ncbi.nlm.nih.gov/pubmed/39607997 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54420 %T Recruitment for Voluntary Video and Mobile HIV Testing on Social Media Platforms During the COVID-19 Pandemic: Cross-Sectional Study %A Chiou,Piao-Yi %A Tsao,Wei-Wen %A Li,Chia-Lin %A Yu,Jheng-Min %A Su,Wen-Han %A Liu,Zhi-Hua %A He,Cheng-Ru %A Chang,Yu-Chun %A Tsai,Yi-Hsuan %+ School of Nursing, National Taiwan University College of Medicine, No. 2-1, Xuzhou Rd., Zhongzheng Dist.,, Taipei, 10051, Taiwan, 886 0935883722 ext 288427, purechiou2@gmail.com %K COVID-19 %K HIV testing %K mobile health %K risk-taking behavior %K social media %K video %K mobile phone %D 2024 %7 28.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic prompted social distancing policies and caused misinformation that hindered in-person HIV screening for high-risk groups. Social media platforms provide additional options for voluntary counseling and testing (VCT) for HIV, overcoming these limitations. However, there is a lack of data on HIV testing recruitment through social media platforms and its outcomes during the pandemic. Objective: This study aimed to measure the rate of face-to-face mobile and video VCT conducted after recruitment through social media platforms and friend referrals during the pandemic and compare the geographic distribution, risk feature targeting, testing outcome, and cost between the 2 models. Methods: Data were collected from March 3 to December 31, 2021, during the COVID-19 outbreak in Taiwan. Participants engaging in unprotected sex were recruited. After one-on-one message discussions through the platforms, the well-trained research assistants provided mobile or video VCT based on the participants’ availability. Primary outcomes were completion rate, testing results, and CD4 count. Secondary outcomes included demographic and HIV risk-taking and protective features from a questionnaire. Selection bias was controlled by adjusting for the testing site (Taipei vs non-Taipei) using univariable multinomial logistic regression. Results: This study gathered 5142 responses on the social media platforms, recruiting 1187 participants. Video VCT had a completion rate of 31.8% (207/651), higher than mobile VCT’s 21.8% (980/4491). Both rates were higher than those before the COVID-19 pandemic. Recruitment through friend referrals, instant messaging apps (eg, Line [LY Corporation]), and geosocial dating apps (eg, Hornet [Queer Networks Inc], Grindr [Grindr LLC], and Gsland [Tien-Hao Tsai]) resulted in higher acceptance and completion rates than social networks (eg, Facebook [Meta], X [formerly Twitter], and Instagram [Meta]). Mobile VCT had higher recruitment among urban residents and screening density, while video VCT reached a broader geographic area. The mobile group was more likely to have had more than 10 sexual partners (odds ratio [OR] 1.92, 95% CI 1.05-3.50; P=.03), history of sex work (OR 4.19, 95% CI 1.68-10.43; P=.002), and sexually transmitted diseases (OR 2.23, 95% CI 1.18-4.23; P=.01) within the past 3 months. The video group was more likely to meet sexual partners through social media. The HIV-positive rate in the mobile group was 0.7% (7/973) with an average CD4 count of 460/μL, while in the video group, it was 1% (2/205) with an average CD4 count of 347/μL, indicating a later diagnosis. Both positivity rates were higher than those before the COVID-19 pandemic, with no significant difference between the groups. The video group cost US $54.68 per participant, slightly higher than the US $50.36 for the mobile group. Conclusions: Recruiting through social media platforms that facilitate one-on-one message discussions can effectively target high-risk groups for mobile and video VCT. This approach should be integrated into the current screening model to enhance HIV case finding. %M 39607762 %R 10.2196/54420 %U https://www.jmir.org/2024/1/e54420 %U https://doi.org/10.2196/54420 %U http://www.ncbi.nlm.nih.gov/pubmed/39607762 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52498 %T Technology Acceptance Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis %A DeLange Martinez,Pauline %A Tancredi,Daniel %A Pavel,Misha %A Garcia,Lorena %A Young,Heather M %+ Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th St, Sacramento, CA, 95817, United States, 1 916 426 2862, pdmartinez@ucdavis.edu %K aged %K older adults %K Asian American %K immigrant %K vulnerable populations %K internet %K information and communications technology %K ICT %K digital divide %K technology acceptance model %K mobile phone %D 2024 %7 22.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies show that the use of information and communications technologies (ICTs), including smartphones, tablets, computers, and the internet, varies by demographic factors such as age, gender, and educational attainment. However, the connections between ICT use and factors such as ethnicity and English proficiency, especially among Asian American older adults, remain less explored. The technology acceptance model (TAM) suggests that 2 key attitudinal factors, perceived usefulness (PU) and perceived ease of use (PEOU), influence technology acceptance. While the TAM has been adapted for older adults in China, Taiwan, Singapore, and Korea, it has not been tested among Asian American older adults, a population that is heterogeneous and experiences language barriers in the United States. Objective: This study aims to examine the relationships among demographics (age, gender, educational attainment, ethnicity, and English proficiency), PU, PEOU, and ICT use among low-income Asian American older adults. Two outcomes were examined: smartphone use and ICT use, each measured by years of experience and current frequency of use. Methods: This was a secondary data analysis from a cross-sectional baseline survey of the Lighthouse Project, which provided free broadband, ICT devices, and digital literacy training to residents living in 8 affordable senior housing communities across California. This analysis focused on Asian participants aged ≥62 years (N=392), specifically those of Korean, Chinese, Vietnamese, Filipino, and other Asian ethnicities (eg, Hmong and Japanese). Hypotheses were examined using descriptive statistics, correlation analysis, and hierarchical regression analysis. Results: Younger age, higher education, and greater English proficiency were positively associated with smartphone use (age: β=–.202; P<.001; education: β=.210; P<.001; and English proficiency: β=.124; P=.048) and ICT use (age: β=–.157; P=.002; education: β=.215; P<.001; and English proficiency: β=.152; P=.01). Male gender was positively associated with PEOU (β=.111; P=.047) but not with PU (β=–.031; P=.59), smartphone use (β=.023; P=.67), or ICT use (β=.078; P=.16). Ethnicity was a significant predictor of PU (F4,333=5.046; P<.001), PEOU (F4,345=4.299; P=.002), and ICT use (F4,350=3.177; P=.01), with Chinese participants reporting higher levels than Korean participants, who were the reference group (β=.143; P=.007). PU and PEOU were positively correlated with each other (r=0.139, 95% CI=0.037-0.237; P=.007), and both were significant predictors of smartphone use (PU: β=.158; P=.002 and PEOU: β=.166; P=.002) and ICT use (PU: β=.117; P=.02 and PEOU: β=0.22; P<.001), even when controlling for demographic variables. Conclusions: The findings support the use of the TAM among low-income Asian American older adults. In addition, ethnicity and English proficiency are significant predictors of smartphone and ICT use among this population. Future interventions should consider heterogeneity and language barriers of this population to increase technology acceptance and use. %M 39576987 %R 10.2196/52498 %U https://www.jmir.org/2024/1/e52498 %U https://doi.org/10.2196/52498 %U http://www.ncbi.nlm.nih.gov/pubmed/39576987 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e56807 %T Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study %A Rivera Rivera,Jessica Nathalie %A AuBuchon,Katarina E %A Smith,Marjanna %A Starling,Claire %A Ganacias,Karen G %A Danielson,Aimee %A Patchen,Loral %A Rethy,Janine A %A Blumenthal,H Joseph %A Thomas,Angela D %A Arem,Hannah %+ Healthcare Delivery Research Network, MedStar Health Research Institute, 3007 Tilden Street NW, Suite 6N, Washington, DC, 20008, United States, 1 4436921138, jessica.n.riverarivera@medstar.net %K postpartum care %K newborn care %K health education %K chatbot %K mHealth %K mobile health %K feedback %K health equity %D 2024 %7 14.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The 42 days after delivery (“fourth trimester”) are a high-risk period for birthing individuals and newborns, especially those who are racially and ethnically marginalized due to structural racism. Objective: To fill a gap in the critical “fourth trimester,” we developed 2 ruled-based chatbots—one for birthing individuals and one for newborn caregivers—that provided trusted information about postbirth warning signs and newborn care and connected patients with health care providers. Methods: A total of 4370 individuals received the newborn chatbot outreach between September 1, 2022, and December 31, 2023, and 3497 individuals received the postpartum chatbot outreach between November 16, 2022, and December 31, 2023. We conducted surveys and interviews in English and Spanish to understand the acceptability and usability of the chatbot and identify areas for improvement. We sampled from hospital discharge lists that distributed the chatbot, stratified by prenatal care location, age, type of insurance, and racial and ethnic group. We analyzed quantitative results using descriptive analyses in SPSS (IBM Corp) and qualitative results using deductive coding in Dedoose (SocioCultural Research Consultants). Results: Overall, 2748 (63%) individuals opened the newborn chatbot messaging, and 2244 (64%) individuals opened the postpartum chatbot messaging. A total of 100 patients engaged with the chatbot and provided survey feedback; of those, 40% (n=40) identified as Black, 27% (n=27) identified as Hispanic/Latina, and 18% (n=18) completed the survey in Spanish. Payer distribution was 55% (n=55) for individuals with public insurance, 39% (n=39) for those with commercial insurance, and 2% (n=2) for uninsured individuals. The majority of surveyed participants indicated that chatbot messaging was timely and easy to use (n=80, 80%) and found the reminders to schedule the newborn visit (n=59, 59%) and postpartum visit (n=66, 66%) useful. Across 23 interviews (n=14, 61% Black; n=4, 17% Hispanic/Latina; n=2, 9% in Spanish; n=11, 48% public insurance), 78% (n=18) of interviewees engaged with the chatbot. Interviewees provided positive feedback on usability and content and recommendations for improving the outreach messages. Conclusions: Chatbots are a promising strategy to reach birthing individuals and newborn caregivers with information about postpartum recovery and newborn care, but intentional outreach and engagement strategies are needed to optimize interaction. Future work should measure the chatbot’s impact on health outcomes and reduce disparities. %M 39541147 %R 10.2196/56807 %U https://pediatrics.jmir.org/2024/1/e56807 %U https://doi.org/10.2196/56807 %U http://www.ncbi.nlm.nih.gov/pubmed/39541147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56320 %T Differences in Use of a Patient Portal Across Sociodemographic Groups: Observational Study of the NHS App in England %A KC,Sukriti %A Papoutsi,Chrysanthi %A Reidy,Claire %A Gudgin,Bernard %A Powell,John %A Majeed,Azeem %A Greaves,Felix %A Laverty,Anthony A %+ Imperial College London, School of Public Health, South Kensington, London, SW7 2BX, United Kingdom, 44 2075945312, a.laverty@imperial.ac.uk %K digital health %K patient portals %K technological health divide %K eHealth %K inequality %K observational %K ecological %K England %K app %K patient portal %K disparities %K deprivation %K demographics %K long-term health care %K negative binomial regression model %K intervention %K patient support %K general practice %K digital technology %K patient %K youth %K %D 2024 %7 13.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The adoption of patient portals, such as the National Health Service (NHS) App in England, may improve patient engagement in health care. However, concerns remain regarding differences across sociodemographic groups in the uptake and use of various patient portal features, which have not been fully explored. Understanding the use of various functions across diverse populations is essential to ensure any benefits are equally distributed across the population. Objective: This study aims to explore differences in the use of NHS App features across age, sex, deprivation, ethnicity, long-term health care needs, and general practice (GP) size categories. Methods: We used weekly NHS App use data from the NHS App dashboard for 6386 GPs in England from March 2020 to June 2022. Negative binomial regression models explored variations in weekly rates of NHS App features used (registrations, log-ins, prescriptions ordered, medical record views, and appointments booked). Outcomes were measured as weekly rates per 1000 GP-registered patients, and we conducted separate models for each outcome. Regression models included all covariates mentioned above and produced incident rate ratios, which we present here as relative percentages for ease of interpretation. GP-level covariate data on sociodemographic variables were used as categorical variables in 5 groups for deprivation (Q1=least deprived practices and Q5=most deprived practices) and 4 groups for all other variables (Q1=least deprived practices and Q4=most deprived practices). Results: We found variations in the use of different features overall and across sociodemographic categories. Fully adjusted regression models found lower use of features overall in more deprived practices (eg, Q5 vs Q1: registrations=–34%, log-ins=–34.9%, appointments booked=–39.7%, medical record views=–32.3%, and prescriptions ordered=–9.9%; P<.001). Practices with greater proportions of male patients also had lower levels of NHS App use (eg, Q4 vs Q1: registration=–7.1%, log-in=–10.4%, and appointments booked=–36.4%; P<.001). Larger practices had an overall higher use of some NHS App features (eg, Q4 vs Q1: registration=3.2%, log-ins=11.7%, appointments booked=73.4%, medical record views=23.9%, and prescriptions ordered=20.7%; P<.001), as well as those with greater proportions of White patients (eg, Q4 vs Q1: registration=1.9%, log-ins=9.1%, appointments booked=14.1%, medical record views=28.7%, and prescriptions ordered=130.4%; P<.001). Use patterns varied for practices with greater proportions of patients with long-term health care needs (eg, Q4 vs Q1: registrations=–3.6%, appointments booked=–20%, and medical record views=6%; P≤.001). Conclusions: This study highlights that the use of the NHS App features varied across sociodemographic groups. In particular, it is used less by people living in more deprived areas. Tailored interventions and patient support are required to ensure that any benefits from the NHS App are spread equally throughout the population. %M 39536310 %R 10.2196/56320 %U https://www.jmir.org/2024/1/e56320 %U https://doi.org/10.2196/56320 %U http://www.ncbi.nlm.nih.gov/pubmed/39536310 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50497 %T Clarifying the Concepts of Personalization and Tailoring of eHealth Technologies: Multimethod Qualitative Study %A ten Klooster,Iris %A Kip,Hanneke %A Beyer,Sina L %A van Gemert-Pijnen,Lisette J E W C %A Kelders,Saskia M %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 620730557, i.tenklooster@utwente.nl %K eHealth %K personalization %K tailoring %K segmentation %K adaptation %K interviews %K definition %D 2024 %7 13.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Although personalization and tailoring have been identified as alternatives to a “one-size-fits-all” approach for eHealth technologies, there is no common understanding of these two concepts and how they should be applied. Objective: This study aims to describe (1) how tailoring and personalization are defined in the literature and by eHealth experts, and what the differences and similarities are; (2) what type of variables can be used to segment eHealth users into more homogeneous groups or at the individual level; (3) what elements of eHealth technologies are adapted to these segments; and (4) how the segments are matched with eHealth adaptations. Methods: We used a multimethod qualitative study design. To gain insights into the definitions of personalization and tailoring, definitions were collected from the literature and through interviews with eHealth experts. In addition, the interviews included questions about how users can be segmented and how eHealth can be adapted accordingly, and responses to 3 vignettes of examples of eHealth technologies, varying in personalization and tailoring strategies to elicit responses about views from stakeholders on how the two components were applied and matched in different contexts. Results: A total of 28 unique definitions of tailoring and 16 unique definitions of personalization were collected from the literature and interviews. The definitions of tailoring and personalization varied in their components, namely adaptation, individuals, user groups, preferences, symptoms, characteristics, context, behavior, content, identification, feedback, channel, design, computerization, and outcomes. During the interviews, participants mentioned 9 types of variables that can be used to segment eHealth users, namely demographics, preferences, health variables, psychological variables, behavioral variables, individual determinants, environmental information, intervention interaction, and technology variables. In total, 5 elements were mentioned that can be adapted to those segments, namely channeling, content, graphical, functionalities, and behavior change strategy. Participants mentioned substantiation methods and variable levels as two components for matching the segmentations with adaptations. Conclusions: Tailoring and personalization are multidimensional concepts, and variability and technology affordances seem to determine whether and how personalization and tailoring should be applied to eHealth technologies. On the basis of our findings, tailoring and personalization can be differentiated by the way that segmentations and adaptations are matched. Tailoring matches segmentations and adaptations based on general group characteristics using if-then algorithms, whereas personalization involves the direct insertion of user information (such as name) or adaptations based on individual-level inferences. We argue that future research should focus on how inferences can be made at the individual level to further develop the field of personalized eHealth. %M 39536317 %R 10.2196/50497 %U https://www.jmir.org/2024/1/e50497 %U https://doi.org/10.2196/50497 %U http://www.ncbi.nlm.nih.gov/pubmed/39536317 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48696 %T Predictors of Engagement in Multiple Modalities of Digital Mental Health Treatments: Longitudinal Study %A Nowels,Molly Aideen %A McDarby,Meghan %A Brody,Lilla %A Kleiman,Evan %A Sagui Henson,Sara %A Castro Sweet,Cynthia %A Kozlov,Elissa %+ Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY, 10065, United States, 1 212 746 4888, mon2007@med.cornell.edu %K digital health %K mental health %K health care benefit %K prediction %K technology %K digital mental health %K employer-based %K teletherapy %K coaching %K utilization %K mobile phone %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge. Objective: This study aimed to examine predictors of engagement in self-directed digital mental health services offered as part of an employer-based mental health benefit that uses a technology-enabled care platform. Methods: Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the self-directed digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions. Results: In total 950 individuals enrolled in the study, with 38% using any self-directed digital mental health resources. Approximately 44% of the sample did not use the app during the study period. Those using both self-directed digital and 1:1 modalities made up about one-quarter of the sample (235/950, 24.7%). Those using only coaching or therapy (170/950, 17.9%) and those using only self-directed digital mental health resources (126/950, 13.3%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of self-directed digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82% (rate ratio [RR] 1.82, 95% CI 1.63-2.03) more self-directed digital mental health resource interactions while use of any teletherapy session was associated with 80% (RR 1.80, 95% CI 1.55-2.07) more digital mental health resources interactions (both P<.001). Each additional year of age was associated with increased digital mental health resources interactions (RR 1.04, 95% CI (1.03-1.05), and women had 23% more self-directed digital resources interactions than men (RR 1.23, 95% CI 1.09-1.39). Conclusions: Our key finding was that the use of coaching or teletherapy was associated with increased self-directed digital mental health resource use. Higher self-directed digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with 1 modality in the platform, they may be more likely to begin engaging with others, becoming “super users” of all resources. %R 10.2196/48696 %U https://www.jmir.org/2024/1/e48696 %U https://doi.org/10.2196/48696 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58196 %T Exploring the Landscape of Standards and Guidelines in AgeTech Design and Development: Scoping Review and Thematic Analysis %A Abhari,Shahabeddin %A McMurray,Josephine %A Randhawa,Tanveer %A Bin Noon,Gaya %A Hanjahanja-Phiri,Thokozani %A McNeil,Heather %A Manning,Fiona %A Debergue,Patricia %A Teague,Jennifer %A Pelegrini Morita,Plinio %+ School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567, plinio.morita@uwaterloo.ca %K aging in place %K technology %K gerontechnology %K AgeTech %K assistive technology %K older adult %K aging %K ambient assisted living %K active assisted living %D 2024 %7 31.10.2024 %9 Review %J JMIR Aging %G English %X Background: AgeTech (technology for older people) offers digital solutions for older adults supporting aging in place, including digital health, assistive technology, Internet of Things, medical devices, robotics, wearables, and sensors. This study underscores the critical role of standards and guidelines in ensuring the safety and effectiveness of these technologies for the health of older adults. As the aging demographic expands, the focus on robust standards becomes vital, reflecting a collective commitment to improving the overall quality of life for older individuals through thoughtful and secure technology integration. Objective: This scoping review aims to investigate the current state of standards and guidelines applied in AgeTech design and development as reported in academic literature. We explore the existing knowledge of these standards and guidelines and identify key gaps in the design and development of AgeTech guidelines and standards in scholarly publications. Methods: The literature review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Searches were carried out across multiple databases, including Scopus, IEEE, PubMed, Web of Science, EBSCO, CINAHL, Cochrane, and Google Scholar, using a search string incorporating concepts such as “older people,” “technology,” and “standards or guidelines.” Alternative terms, Boolean operators, and truncation were used for comprehensive coverage in each database. The synthesis of results and data analysis involved both quantitative and qualitative methods. Results: Initially, 736 documents were identified across various databases. After applying specific inclusion and exclusion criteria and a screening process, 58 documents were selected for full-text review. The findings highlight that the most frequently addressed aspect of AgeTech standards or guidelines is related to “design and development,” constituting 36% (21/58) of the literature; “usability and user experience” was the second most prevalent aspect, accounting for 19% (11/58) of the documents. In contrast, “privacy and security” (1/58, 2%) and “data quality” (1/58, 2%) were the least addressed aspects. Similarly, “ethics,” “integration and interoperability,” “accessibility,” and “acceptance or adoption” each accounted for 3% (2/58) of the documents. In addition, a thematic analysis identified qualitative themes that warrant further exploration of variables. Conclusions: This study investigated the available knowledge regarding standards and guidelines in AgeTech design and development to evaluate their current status in academic literature. The substantial focus on assistive technologies and ambient assisted living technologies confirmed their vital role in AgeTech. The findings provide valuable insights for interested parties and point to prioritized areas for further development and research in the AgeTech domain. %M 39481099 %R 10.2196/58196 %U https://aging.jmir.org/2024/1/e58196 %U https://doi.org/10.2196/58196 %U http://www.ncbi.nlm.nih.gov/pubmed/39481099 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e64525 %T Digital Storytelling for People With Cognitive Impairment Using Available Mobile Apps: Systematic Search in App Stores and Content Analysis %A Zhu,Di %A Al Mahmud,Abdullah %A Liu,Wei %A Wang,Dahua %+ Centre for Design Innovation, School of Design and Architecture, Swinburne University of Technology, John St, Hawthorn, Melbourne, 3122, Australia, 61 392143830, aalmahmud@swin.edu.au %K mobile apps %K digital storytelling %K older adults %K mobile phone %K cognitive impairment %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Growing evidence suggests cognitive and social health benefits can be derived from digital storytelling for older adults with cognitive impairment. Digital storytelling apps offer the potential to serve as an on-demand, easy-to-access platform for enhancing cognitive abilities and promoting social well-being. Yet, despite the increasing quantity of such apps being available on the market, there is a gap in research investigating their quality. Objective: This app review aims to assess the digital storytelling apps available in the Chinese market and evaluate them in accordance with the Mobile Application Rating Scale (MARS). The goal was to identify key features and evaluate the overall quality in the context of cognitively impaired users. Methods: A systematic search was conducted in both the Google Play store (Google LLC) and iTunes store (Apple Inc), using English and Chinese keywords. Apps were chosen according to specific criteria that included features, including (but not limited to) memory capture, story saving, cue-based reminiscing, and the ability to share stories or memories with others. The MARS was used by 3 individual researchers to independently assess app quality across several domains, such as engagement, functionality, aesthetics, and information quality, for both Android and iOS apps. Results: From an initial screening of 297 apps, only 9 (3%) met the criteria for detailed evaluation using MARS. The reviewed apps featured capture memory, save, reminisce, and share functions, which are critical in supporting cognitive functions and enhancing user engagement. The analysis revealed patterns in platform diversity and geographical distribution of developers, with apps available on both iOS and Android. Memoirs of Life and Memorize: Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile) had the highest mean MARS scores of 3.35, indicating strong engagement, functionality, and information quality, while the lowest score was 2.33. The overall mean score across all apps was only 3.03 (SD 0.60), highlighting significant variation, particularly in information quality. User feedback also showed considerable variability, ranging from 0 comments for apps such as Grand Storyteller (VarIT Inc) and PWI Storyteller (Project World Impact, LLC) to as many as 5361 comments for FamilySearch, which received extensive positive reviews. This wide range of user feedback underscores the importance of continuous improvement and user-centered design, particularly in enhancing information quality and content accuracy. Conclusions: The systematic search and evaluation highlight the diverse capabilities yet variable quality of digital storytelling apps available within the Chinese market, reflecting user experiences, satisfaction levels, and efficacy in supporting cognitively impaired users. While some apps excel in engagement and functionality, others need significant improvements in information quality and user interface design to better serve those with cognitive impairments. Future research is recommended to investigate regional limitations and features that would result in more inclusive and effective digital storytelling apps. %M 39446478 %R 10.2196/64525 %U https://aging.jmir.org/2024/1/e64525 %U https://doi.org/10.2196/64525 %U http://www.ncbi.nlm.nih.gov/pubmed/39446478 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51291 %T Associations of Wearable Activity Tracker Use With Physical Activity and Health Outcomes in Patients With Cancer: Findings from a Population-Based Survey Study %A Zhou,Weijiao %A Shang,Shaomei %A Cho,Youmin %+ College of Nursing, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea, 82 42 580 8336, youmcho@cnu.ac.kr %K physical activity %K exercise %K wearable tracker %K wearable device %K cancer %K oncology %K cancer survivorship %K wearable %K wearables %K tracker %K trackers %K health outcome %K health outcomes %K HINTS %K survey %K surveys %K national %K bivariate %K epidemiology %K epidemiological %K association %K associations %D 2024 %7 22.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical inactivity is a global issue for cancer survivors. Wearable activity trackers are promising to address physical inactivity by providing real-time feedback on physical activity and offering opportunities for self-monitoring and goal setting. Meta-analysis has reported the effects of interventions that incorporate wearable activity trackers on improved physical inactivity and related health outcomes (eg, BMI, anxiety and depression, and self-rated health status). However, wearable activity trackers were often used as an adjunct to physical activity interventions, and the effectiveness of wearable activity trackers alone is unknown. Objective: This study aims to determine the association of wearable activity trackers with physical activity and health outcomes in patients with cancer. Methods: Data from 957 cancer survivors from the Health Information National Trends Survey–Surveillance, Epidemiology, and End Results (HINTS-SEER) were analyzed. The outcome variables examined were time spent in moderate to vigorous physical activity, weekly frequency of strength training, BMI, anxiety and depression levels, and self-assessed health status. The primary independent variable was whether cancer survivors had used wearable activity trackers within the past 12 months. Design-based linear regression for continuous outcome variables and ordinal logistic regression for ordinal outcome variables were conducted to determine the associations after controlling for sociodemographic, cancer-related, and health-related factors. All data analyses accounted for the complex survey design and sample weights. Results: Only 29% of cancer survivors reported wearable activity tracker use. Bivariate analyses showed that younger age (P<.001), higher education (P=.04), higher income (P<.001), and an employed status (P<.001) were significantly associated with wearable activity tracker use. Wearable activity tracker use was significantly associated with higher time spent in moderate to vigorous physical activity (adjusted =37.94, 95% CI 8.38-67.5; P=.01), more frequent strength training per week (adjusted odds ratio [OR] 1.50, 95% CI 1.09-2.06; P=.01), and better self-rated health status (adjusted OR 1.58, 95% CI 1.09-2.29; P=.01), but not with BMI or anxiety and depression. Conclusions: This study suggests that the uptake of wearable activity trackers is low and highlights the digital divide among patients with cancer. This study has confirmed the associations of wearable activity tracker use with physical activity and self-rated health, supporting using wearable activity trackers as a promising tool to facilitate physical activity promotion. %M 39436693 %R 10.2196/51291 %U https://www.jmir.org/2024/1/e51291 %U https://doi.org/10.2196/51291 %U http://www.ncbi.nlm.nih.gov/pubmed/39436693 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e58079 %T Italian Version of the mHealth App Usability Questionnaire (Ita-MAUQ): Translation and Validation Study in People With Multiple Sclerosis %A Podda,Jessica %A Grange,Erica %A Susini,Alessia %A Tacchino,Andrea %A Di Antonio,Federica %A Pedullà,Ludovico %A Brichetto,Giampaolo %A Ponzio,Michela %K mHealth %K multiple sclerosis %K cognitive assessment %K questionnaire validation %K usability %K mHealth app %K mHealth application %K validation study %K MAUQ %K app usability %K telemedicine %K disability %K usability questionnaire %K mobile health %D 2024 %7 30.9.2024 %9 %J JMIR Hum Factors %G English %X Background: Telemedicine and mobile health (mHealth) apps have emerged as powerful tools in health care, offering convenient access to services and empowering participants in managing their health. Among populations with chronic and progressive disease such as multiple sclerosis (MS), mHealth apps hold promise for enhancing self-management and care. To be used in clinical practice, the validity and usability of mHealth tools should be tested. The most commonly used method for assessing the usability of electronic technologies are questionnaires. Objective: This study aimed to translate and validate the English version of the mHealth App Usability Questionnaire into Italian (ita-MAUQ) in a sample of people with MS. Methods: The 18-item mHealth App Usability Questionnaire was forward- and back-translated from English into Italian by an expert panel, following scientific guidelines for translation and cross-cultural adaptation. The ita-MAUQ (patient version for stand-alone apps) comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. After interacting with DIGICOG-MS (Digital Assessment of Cognitive Impairment in Multiple Sclerosis), a novel mHealth app for cognitive self-assessment in MS, people completed the ita-MAUQ and the System Usability Scale, included to test construct validity of the translated questionnaire. Confirmatory factor analysis, internal consistency, test-retest reliability, and construct validity were assessed. Known-groups validity was examined based on disability levels as indicated by the Expanded Disability Status Scale (EDSS) score and gender. Results: In total, 116 people with MS (female n=74; mean age 47.2, SD 14 years; mean EDSS 3.32, SD 1.72) were enrolled. The ita-MAUQ demonstrated acceptable model fit, good internal consistency (Cronbach α=0.92), and moderate test-retest reliability (intraclass coefficient correlation 0.84). Spearman coefficients revealed significant correlations between the ita-MAUQ total score; the ease of use (5 items), interface and satisfaction (7 items), and usefulness subscales; and the System Usability Scale (all P values <.05). Known-group analysis found no difference between people with MS with mild and moderate EDSS (all P values >.05), suggesting that ambulation ability, mainly detected by the EDSS, did not affect the ita-MAUQ scores. Interestingly, a statistical difference between female and male participants concerning the ease of use ita-MAUQ subscale was found (P=.02). Conclusions: The ita-MAUQ demonstrated high reliability and validity and it might be used to evaluate the usability, utility, and acceptability of mHealth apps in people with MS. %R 10.2196/58079 %U https://humanfactors.jmir.org/2024/1/e58079 %U https://doi.org/10.2196/58079 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e41093 %T Investigating Older Adults' Use of a Socially Assistive Robot via Time Series Clustering and User Profiling: Descriptive Analysis Study %A Yoo,In-jin %A Park,Do-Hyung %A Lee,Othelia EunKyoung %A Park,Albert %+ Department of Software and Information Systems, University of North Carolina at Charlotte, 9201 University City Boulevard, Woodward 310H, Charlotte, NC, 28223-0001, United States, 1 7046878668, al.park@uncc.edu %K socially assistive robot %K older adults %K robot use pattern %K time series clustering %K profiling analysis %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The aging population and the shortage of geriatric care workers are major global concerns. Socially assistive robots (SARs) have the potential to address these issues, but developing SARs for various types of users is still in its infancy. Objective: This study aims to examine the characteristics and use patterns of SARs. Methods: This study analyzed log data from 64 older adults who used a SAR called Hyodol for 60 days to understand use patterns and their relationship with user characteristics. Data on user interactions, robot-assisted content use, demographics, physical and mental health, and lifestyle were collected. Time series clustering was used to group users based on use patterns, followed by profiling analysis to relate these patterns to user characteristics. Results: Overall, 4 time series clusters were created based on use patterns: helpers, friends, short-term users, and long-term users. Time series and profiling analyses revealed distinct patterns for each group. We found that older adults use SARs differently based on factors beyond demographics and health. This study demonstrates a data-driven approach to understanding user needs, and the findings can help tailor SAR interventions for specific user groups. Conclusions: This study extends our understanding of the factors associated with the long-term use of SARs for geriatric care and makes methodological contributions. %M 39298762 %R 10.2196/41093 %U https://formative.jmir.org/2024/1/e41093 %U https://doi.org/10.2196/41093 %U http://www.ncbi.nlm.nih.gov/pubmed/39298762 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45530 %T Messenger Use and Video Calls as Correlates of Depressive and Anxiety Symptoms: Results From the Corona Health App Study of German Adults During the COVID-19 Pandemic %A Edler,Johanna-Sophie %A Terhorst,Yannik %A Pryss,Rüdiger %A Baumeister,Harald %A Cohrdes,Caroline %+ Mental Health Research Unit, Department of Epidemiology and Health Monitoring, Robert Koch Institute, PO Box 650261, Berlin, 12101, Germany, 49 30187542692, cohrdesc@rki.de %K passive data %K depression %K anxiety %K predicting mental health %K mobile phone %D 2024 %7 16.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Specialized studies have shown that smartphone-based social interaction data are predictors of depressive and anxiety symptoms. Moreover, at times during the COVID-19 pandemic, social interaction took place primarily remotely. To appropriately test these objective data for their added value for epidemiological research during the pandemic, it is necessary to include established predictors. Objective: Using a comprehensive model, we investigated the extent to which smartphone-based social interaction data contribute to the prediction of depressive and anxiety symptoms, while also taking into account well-established predictors and relevant pandemic-specific factors. Methods: We developed the Corona Health App and obtained participation from 490 Android smartphone users who agreed to allow us to collect smartphone-based social interaction data between July 2020 and February 2021. Using a cross-sectional design, we automatically collected data concerning average app use in terms of the categories video calls and telephony, messenger use, social media use, and SMS text messaging use, as well as pandemic-specific predictors and sociodemographic covariates. We statistically predicted depressive and anxiety symptoms using elastic net regression. To exclude overfitting, we used 10-fold cross-validation. Results: The amount of variance explained (R2) was 0.61 for the prediction of depressive symptoms and 0.57 for the prediction of anxiety symptoms. Of the smartphone-based social interaction data included, only messenger use proved to be a significant negative predictor of depressive and anxiety symptoms. Video calls were negative predictors only for depressive symptoms, and SMS text messaging use was a negative predictor only for anxiety symptoms. Conclusions: The results show the relevance of smartphone-based social interaction data in predicting depressive and anxiety symptoms. However, even taken together in the context of a comprehensive model with well-established predictors, the data only add a small amount of value. %M 39283658 %R 10.2196/45530 %U https://www.jmir.org/2024/1/e45530 %U https://doi.org/10.2196/45530 %U http://www.ncbi.nlm.nih.gov/pubmed/39283658 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55384 %T Digital Health Technology Use Across Socioeconomic Groups Prior to and During the COVID-19 Pandemic: Panel Study %A Tuitert,Inge %A Marinus,Jesse D %A Dalenberg,Jelle R %A van 't Veer,Job TB %+ Academy of Health & Social Studies, NHL Stenden University of Applied Sciences, Rengerslaan 10, Leeuwarden, 8917 DD, Netherlands, 31 889917000, inge.tuitert@nhlstenden.com %K digital divide %K vulnerable groups %K digital health apps %K adoption %K socioeconomics %K health technology %K digital health %K longitudinal %K surveys %K technology use %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital technologies have become more important in the health care sector in the past decades. This transition from conventional to digital health care has been accelerated by the impact of the COVID-19 pandemic, which poses the risk of creating a “digital divide,” inadvertently placing those who are older, economically disadvantaged, and have a lower level of education at a disadvantage. Objective: This study focuses on the influence of socioeconomic factors on the adoption of digital health technology in the Frisian population and how this relation is affected by the COVID-19 pandemic. Methods: In 2019 and 2020, a panel study was conducted on digital health in the Frisian population in the Netherlands. In the survey, the use of digital health technology was operationalized in a broad sense, going beyond the care context by also including preventative health-promoting solutions generally available on the consumer market, such as wearables and lifestyle apps. First, to assess the influence of socioeconomic factors on the total use of digital health apps, a generalized linear model was fitted with use of digital health app as the dependent variable and socioeconomic factors as between-subject factors on the 2019 data. Second, to analyze whether the use of separate health apps increased from 2019 to 2020, we conducted chi-square tests on different digital health app types. Third, to examine the influence of COVID-19 on the use of digital health apps, a generalized linear mixed model was fitted with the use of digital health apps as the dependent variable, COVID-19 as the within-subject variable, and socioeconomic factors as between-subject factors. Results: The results indicated that prior to the COVID-19 pandemic, digital health technology use was higher in women, younger people, and those who are well educated and economically more privileged. Moreover, the percentage of people who reported using digital health technology rose from 70% (1580/2258) to 82.5% (1812/2197) due to the COVID-19 pandemic. This increase was significant for all separate types of digital health technology (all P<.001). In addition, we found the interaction effects of COVID-19 with age and education attainment, indicating that the lower total use among older people and people with lower education attainment became slightly less apparent from 2019 to 2020. Conclusions: These findings on the influence of the COVID-19 pandemic on the digital divide indicated that the use of all types of digital health apps increased and that older individuals and people with a lower level of education caught up a little during COVID-19. Future research should gain more insight into this effect and examine whether it persists beyond the COVID-19 pandemic. Additionally, future endeavors should focus on vulnerable groups, ensuring they receive adequate attention to guarantee access to health care, preventative health-promoting solutions, and social services. %M 39269755 %R 10.2196/55384 %U https://publichealth.jmir.org/2024/1/e55384 %U https://doi.org/10.2196/55384 %U http://www.ncbi.nlm.nih.gov/pubmed/39269755 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54215 %T Racial and Ethnic Differences in Mobile App Use for Meeting Sexual Partners Among Young Men Who Have Sex With Men and Young Transgender Women: Cross-Sectional Study %A Risher,Kathryn %A Janulis,Patrick %A McConnell,Elizabeth %A Motley,Darnell %A Serrano,Pedro Alonso %A Jackson,Joel D %A Brown,Alonzo %A Williams,Meghan %A Mendez,Daniel %A Phillips II,Gregory %A Melville,Joshua %A Birkett,Michelle %K young men who have sex with men and young transgender women %K hookup or dating apps %K sexual partners %K race and ethnicity %K race %K ethnicity %K mobile app %K racial bias %K sexual partner %K young %K transgender %K Chicago %K United States %K online %K dating app %K racism %K analysis %K youth %K social network %K hookup %K black %K Hispanic %K Tinder %K Grindr %K Scruff %K sexual mixing patterns %K sexual patterns %K sexual pattern %K sexually transmitted infection %K sexually transmitted infections %D 2024 %7 11.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Young men who have sex with men and young transgender women (YMSM-YTW) use online spaces to meet sexual partners with increasing regularity, and research shows that experiences of racism online mimics the real world. Objective: We analyzed differences by race and ethnicity in web-based and mobile apps used to meet sexual partners as reported by Chicago-based YMSM-YTW in 2016‐2017. Methods: A racially and ethnically diverse sample of 643 YMSM-YTW aged 16‐29 years were asked to name websites or mobile apps used to seek a sexual partner in the prior 6 months, as well as provide information about sexual partnerships from the same period. We used logistic regression to assess the adjusted association of race and ethnicity with (1) use of any website or mobile apps to find a sexual partner, (2) use of a “social network” to find a sexual partner compared to websites or mobile apps predominantly used for dating or hookups, (3) use of specific websites or mobile apps, and (4) reporting successfully meeting a sexual partner online among website or mobile app users. Results: While most YMSM-YTW (454/643, 70.6%) used websites or mobile apps to find sexual partners, we found that Black non-Hispanic YMSM-YTW were significantly less likely to report doing so (comparing White non-Hispanic to Black non-Hispanic: adjusted odds ratio [aOR] 1.74, 95% CI 1.10‐2.76). Black non-Hispanic YMSM-YTW were more likely to have used a social network site to find a sexual partner (comparing White non-Hispanic to Black non-Hispanic: aOR 0.20, 95% CI 0.11‐0.37), though this was only reported by one-third (149/454, 32.8%) of all app-using participants. Individual apps used varied by race and ethnicity, with Grindr, Tinder, and Scruff being more common among White non-Hispanic YMSM-YTW (93/123, 75.6%; 72/123, 58.5%; and 30/123, 24.4%, respectively) than among Black non-Hispanic YMSM-YTW (65/178, 36.5%; 25/178, 14%; and 4/178, 2.2%, respectively) and Jack’d and Facebook being more common among Black non-Hispanic YMSM-YTW (105/178, 59% and 64/178, 36%, respectively) than among White non-Hispanic YMSM-YTW (6/123, 4.9% and 8/123, 6.5%, respectively). Finally, we found that while half (230/454, 50.7%) of YMSM-YTW app users reported successfully meeting a new sexual partner on an app, Black non-Hispanic YMSM-YTW app users were less likely to have done so than White non-Hispanic app users (comparing White non-Hispanic to Black non-Hispanic: aOR 2.46, 95% CI 1.50‐4.05). Conclusions: We found that Black non-Hispanic YMSM-YTW engaged with websites or mobile apps and found sexual partners systematically differently than White non-Hispanic YMSM-YTW. Our findings give a deeper understanding of how racial and ethnic sexual mixing patterns arise and have implications for the spread of sexually transmitted infections among Chicago’s YMSM-YTW. %R 10.2196/54215 %U https://publichealth.jmir.org/2024/1/e54215 %U https://doi.org/10.2196/54215 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50356 %T Real-World Outcomes of a Digital Behavioral Coaching Intervention to Improve Employee Health Status: Retrospective Observational Study %A Abdul Aziz,Amani Fadzlina %A Ong,Tiffanie %+ Naluri Hidup Sdn Bhd, 22, Persiaran Damansara Endah, Bukit Damansara, Kuala Lumpur, 50490, Malaysia, 60 123072922, tiffanie@naluri.life %K digital behavioral coaching %K chronic disease management %K digital health %K mHealth %K workplace interventions %K mobile phone %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic noncommunicable diseases (NCDs) account for major disability and premature mortality worldwide, with low- and middle-income countries being disproportionately burdened. Given the negative impact of NCDs on employee performance and work productivity, there is a rising need for stakeholders to identify effective workplace solutions that can improve employee health outcomes. As the workplace becomes more dispersed post pandemic, digital behavioral coaching offers a scalable, personalized, and cost-effective method of managing chronic disease risk factors among employees. Objective: This study aimed to retrospectively evaluate the impact of a digital behavioral coaching program on year-to-year changes in employee health status in a cohort of Indonesian employees. Methods: This retrospective real-world exploratory analysis of secondary health data followed 774 employees of an Indonesian company who completed company-sponsored health screenings between 2021 and 2022 and were given access to Naluri (Naluri Hidup Sdn Bhd), a holistic digital therapeutics platform offering digital behavioral health coaching and self-help tools. Participants were retrospectively classified as those who received active coaching (n=177), passive coaching (n=108), and no coaching (n=489). Linear mixed-effects models were used to evaluate the year-to-year changes in health outcomes across the 3 employee groups, with post hoc analyses evaluating within-group differences between the 2 time points and between-group differences at follow-up. Results: Significant time×group interaction effects were detected for body weight, BMI, hemoglobin A1c, low-density lipoprotein, total cholesterol, and systolic and diastolic blood pressure. Post hoc pairwise comparisons revealed significant improvements in hemoglobin A1c (mean difference [Mdiff]=–0.14, P=.008), high-density lipoprotein (Mdiff=+2.14, P<.001), and total cholesterol (Mdiff=–11.45, P<.001) for employees in the Active Coaching group between 2021 and 2022, with the other 2 groups reporting deteriorations in multiple health outcomes throughout the 2 time points. At follow-up, those who received active coaching between 2021 and 2022 reported significantly lower body weight (P<.001), BMI (P=.001), low-density lipoprotein (P=.045), and total cholesterol (P<.001) than the No Coaching group. Conclusions: This study demonstrates real-world outcomes and implications supporting the use of workplace digital behavioral coaching in improving employee health status. Given the rising burden of NCDs in the Southeast Asian region, our findings underscore the role that workplace digital health interventions can play in preventing and managing chronic disease risk factors. %M 39255013 %R 10.2196/50356 %U https://mhealth.jmir.org/2024/1/e50356 %U https://doi.org/10.2196/50356 %U http://www.ncbi.nlm.nih.gov/pubmed/39255013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49688 %T Mediating Effects of Information Access on Internet Use and Multidimensional Health Among Middle-Aged and Older Adults: Nationwide Cross-Sectional Study %A Fu,Liping %A Liu,Caiping %A Dong,Yongqing %A Ma,Xiaodong %A Cai,Quanling %A Li,Dongli %A Di,Kaisheng %+ College of Management and Economics, Tianjin University, Weijin Road Campus No. 92, Xuefu Street, Nankai District, Tianjin, 300072, China, 86 13997138522, liucaiping@tju.edu.cn %K internet use %K health %K middle-aged and older adults %K information access %K mediation analysis %D 2024 %7 9.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the exacerbation of population aging, the health issues of middle-aged and older adults have increasingly become a focus of attention. The widespread use of the internet has created conditions for promoting the health of this demographic. However, little is known about the effects of information access in promoting the relationship between internet use and the health of middle-aged and older adults. Objective: This study aims to examine the relationship between internet use and multidimensional health in middle-aged and older adults, as well as the mediating effect of information access. Moreover, this study will explore the relationship between other dimensions of internet use (purposes and frequency) and health. Methods: Data were sourced from the China General Social Survey conducted in 2018. Health outcomes, including self-rated, physical, and mental health, were assessed using the 5-level self-rated health scale, the 5-level basic activities of daily living scale, and the 5-level depression scale, respectively. The ordinal logistic regression model was used to examine the relationship between internet use and health among middle-aged and older adults. Additionally, the Karlson-Holm-Breen decomposition method was used to examine the mediation effect of information access. To address endogeneity issues, the two-stage least squares approach was applied. Results: In our sample, nearly half (n=3036, 46.3%) of the respondents use the internet. Regression analyses revealed that internet use was positively associated with self-rated health (odds ratio [OR] 1.55, 95% CI 1.39-1.74; P<.001), physical health (OR 1.39, 95% CI 1.25-1.56; P<.001), and mental health (OR 1.33, 95% CI 1.19-1.49; P<.001) of middle-aged and older adults. Various dimensions of internet use positively contribute to health. In addition, information access significantly mediated the relationship between internet use and self-rated health (β=.28, 95% CI 0.23-0.32), physical health (β=.40, 95% CI 0.35-0.45), and mental health (β=.16, 95% CI 0.11-0.20). Furthermore, there were significant differences in the relationship between internet use and health among advantaged and disadvantaged groups. Conclusions: The study showed that different dimensions of internet use are associated with better self-rated health, better physical health, and better mental health in middle-aged and older adults. Information access mediates the relationship between internet use and health. This result emphasizes the significance of promoting internet access as a means to enhance the health of middle-aged and older adults in China. %M 39250790 %R 10.2196/49688 %U https://www.jmir.org/2024/1/e49688 %U https://doi.org/10.2196/49688 %U http://www.ncbi.nlm.nih.gov/pubmed/39250790 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e49029 %T Gamification in Mobile Apps for Children With Disabilities: Scoping Review %A Mahmoudi,Ebrahim %A Yejong Yoo,Paul %A Chandra,Ananya %A Cardoso,Roberta %A Denner Dos Santos,Carlos %A Majnemer,Annette %A Shikako,Keiko %+ School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 488 5552 ext 1141, keiko.thomas@mcgill.ca %K mobile health %K mHealth %K gamification %K children with disabilities %K mobile phone %D 2024 %7 6.9.2024 %9 Review %J JMIR Serious Games %G English %X Background: Children with disabilities face numerous challenges in accessing health services. Mobile health is an emerging field that could significantly reduce health inequities by providing more accessible services. Many mobile apps incorporate gamification elements such as feedback, points, and stories to increase engagement and motivation; however, little is known about how gamification has been incorporated in mobile apps for children with disabilities. Objective: This scoping review aims to identify and synthesize the existing research evidence on the use of gamification in mobile apps for children with disabilities. Specifically, the objectives were to (1) identify the categories of these mobile apps (eg, treatment and educational) (2), describe the health-related outcomes they target, (3) assess the types and levels of gamification elements used within these apps, and (4) determine the reasons for incorporating gamification elements into mobile apps. Methods: We searched MEDLINE, PsycINFO, CINAHL, Embase, the ACM Digital Library, and IEEE Xplore databases to identify papers published between 2008 and 2023. Original empirical research studies reporting on gamified mobile apps for children with disabilities that implemented at least 1 gamification strategy or tactic were included. Studies investigating serious games or full-fledged games were excluded. Results: A total of 38 studies reporting on 32 unique gamified mobile apps were included. Findings showed that gamified apps focus on communication skills and oral health in children with autism spectrum disorder while also addressing self-management and academic skills for other disability groups. Gamified mobile apps have demonstrated potential benefits across different populations and conditions; however, there were mixed results regarding their impact. The gamification strategies included fun and playfulness (23/32, 72%), feedback on performance (17/32, 53%), and reinforcement (17/32, 53%) in more than half of apps, whereas social connectivity was used as a gamification strategy in only 4 (12%) mobile apps. There were 2 main reasons for integrating gamification elements into mobile apps described in 16 (42%) studies: increasing user engagement and motivation and enhancing intervention effects. Conclusions: This scoping review offers researchers a comprehensive review of the gamification elements currently used in mobile apps for the purposes of treatment, education, symptom management, and assessment for children with disabilities. In addition, it indicates that studies on certain disability groups and examinations of health-related outcomes have been neglected, highlighting the need for further investigations in these areas. Furthermore, research is needed to investigate the effectiveness of mobile-based gamification elements on health and health behavior outcomes, as well as the healthy development of children with disabilities. %M 39240675 %R 10.2196/49029 %U https://games.jmir.org/2024/1/e49029 %U https://doi.org/10.2196/49029 %U http://www.ncbi.nlm.nih.gov/pubmed/39240675 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57827 %T Value of Engagement in Digital Health Technology Research: Evidence Across 6 Unique Cohort Studies %A Goodday,Sarah M %A Karlin,Emma %A Brooks,Alexa %A Chapman,Carol %A Harry,Christiana %A Lugo,Nelly %A Peabody,Shannon %A Rangwala,Shazia %A Swanson,Ella %A Tempero,Jonell %A Yang,Robin %A Karlin,Daniel R %A Rabinowicz,Ron %A Malkin,David %A Travis,Simon %A Walsh,Alissa %A Hirten,Robert P %A Sands,Bruce E %A Bettegowda,Chetan %A Holdhoff,Matthias %A Wollett,Jessica %A Szajna,Kelly %A Dirmeyer,Kallan %A Dodd,Anna %A Hutchinson,Shawn %A Ramotar,Stephanie %A Grant,Robert C %A Boch,Adrien %A Wildman,Mackenzie %A Friend,Stephen H %+ 4YouandMe, 2901 3rd Ave, Seattle, WA, 98121, United States, 1 (206) 928 8243, sarah@4youandme.org %K wearables %K wearable %K mHealth %K mobile health %K app %K apps %K application %K applications %K engagement %K adherence %K retention %K participatory medicine %K participatory %K DHT %K digital health technology %K DHTs %K digital health technologies %K digital health %K mobile phone %D 2024 %7 3.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Wearable digital health technologies and mobile apps (personal digital health technologies [DHTs]) hold great promise for transforming health research and care. However, engagement in personal DHT research is poor. Objective: The objective of this paper is to describe how participant engagement techniques and different study designs affect participant adherence, retention, and overall engagement in research involving personal DHTs. Methods: Quantitative and qualitative analysis of engagement factors are reported across 6 unique personal DHT research studies that adopted aspects of a participant-centric design. Study populations included (1) frontline health care workers; (2) a conception, pregnant, and postpartum population; (3) individuals with Crohn disease; (4) individuals with pancreatic cancer; (5) individuals with central nervous system tumors; and (6) families with a Li-Fraumeni syndrome affected member. All included studies involved the use of a study smartphone app that collected both daily and intermittent passive and active tasks, as well as using multiple wearable devices including smartwatches, smart rings, and smart scales. All studies included a variety of participant-centric engagement strategies centered on working with participants as co-designers and regular check-in phone calls to provide support over study participation. Overall retention, probability of staying in the study, and median adherence to study activities are reported. Results: The median proportion of participants retained in the study across the 6 studies was 77.2% (IQR 72.6%-88%). The probability of staying in the study stayed above 80% for all studies during the first month of study participation and stayed above 50% for the entire active study period across all studies. Median adherence to study activities varied by study population. Severely ill cancer populations and postpartum mothers showed the lowest adherence to personal DHT research tasks, largely the result of physical, mental, and situational barriers. Except for the cancer and postpartum populations, median adherences for the Oura smart ring, Garmin, and Apple smartwatches were over 80% and 90%, respectively. Median adherence to the scheduled check-in calls was high across all but one cohort (50%, IQR 20%-75%: low-engagement cohort). Median adherence to study-related activities in this low-engagement cohort was lower than in all other included studies. Conclusions: Participant-centric engagement strategies aid in participant retention and maintain good adherence in some populations. Primary barriers to engagement were participant burden (task fatigue and inconvenience), physical, mental, and situational barriers (unable to complete tasks), and low perceived benefit (lack of understanding of the value of personal DHTs). More population-specific tailoring of personal DHT designs is needed so that these new tools can be perceived as personally valuable to the end user. %M 39226552 %R 10.2196/57827 %U https://www.jmir.org/2024/1/e57827 %U https://doi.org/10.2196/57827 %U http://www.ncbi.nlm.nih.gov/pubmed/39226552 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59659 %T Accelerometer-Based Physical Activity and Health-Related Quality of Life in Korean Adults: Observational Study Using the Korea National Health and Nutrition Examination Survey %A Han,Sujeong %A Oh,Bumjo %A Kim,Ho Jun %A Hwang,Seo Eun %A Kim,Jong Seung %+ Department of Family Medicine, SMG-SNU Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea, 82 2 870 2681, atenae68@nate.com %K Health-Related Quality of Life (HRQoL) %K physical activity %K Accelerometer %K Korea National Health and Nutrition Examination Survey (KNHANES) %K mobile phone %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health-related quality of life (HRQoL) reflects an individual's perception of their physical and mental health over time. Despite numerous studies linking physical activity to improved HRQoL, most rely on self-reported data, limiting the accuracy and generalizability of findings. This study leverages objective accelerometer data to explore the association between physical activity and HRQoL in Korean adults. Objective: The objective of this study is to analyze the relationship between objectively measured physical activity using accelerometers and HRQoL among Korean adults, aiming to inform targeted interventions for enhancing HRQoL through physical activity. Methods: This observational study included 1298 participants aged 19-64 years from the Korea National Health and Nutrition Examination Survey (KNHANES) VI, who wore an accelerometer for 7 consecutive days. HRQoL was assessed using the EQ-5D questionnaire, and physical activity was quantified as moderate-to-vigorous physical activity accelerometer-total (MVPA-AT) and accelerometer-bout (MVPA-AB). Data were analyzed using logistic regression to determine the odds ratio (ORs) for low HRQoL, adjusting for socioeconomic variables and mental health factors. Results: Participants with higher HRQoL were younger, more likely to be male, single, highly educated, employed in white-collar jobs, and had higher household incomes. They also reported less stress and better subjective health status. The high HRQoL group had significantly more participants meeting MVPA-AB ≥600 metabolic equivalents (P<.01). Logistic regression showed that participants meeting MVPA-AB ≥600 metabolic equivalents had higher odds of high HRQoL (OR 1.55, 95% CI 1.11-2.17). Adjusted models showed consistent results, although the association weakened when adjusting for mental health factors (OR 1.45, 95% CI 1.01-2.09). Conclusions: The study demonstrates a significant association between HRQoL and moderate to vigorous physical activity sustained for at least 10 minutes, as measured by accelerometer. These findings support promoting physical activity, particularly sustained moderate to vigorous activity, to enhance HRQoL. Further interventional studies focusing on specific physical activity domains such as occupational, leisure-time, and commuting activities are warranted. %M 39226099 %R 10.2196/59659 %U https://humanfactors.jmir.org/2024/1/e59659 %U https://doi.org/10.2196/59659 %U http://www.ncbi.nlm.nih.gov/pubmed/39226099 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59013 %T Digital Health Applications (DiGAs) on a Fast Track: Insights From a Data-Driven Analysis of Prescribable Digital Therapeutics in Germany From 2020 to Mid-2024 %A Goeldner,Moritz %A Gehder,Sara %+ Working Group for Data-Driven Innovation, Hamburg University of Technology, Am Schwarzenberg-Campus 4, Hamburg, 21073, Germany, 49 40428784777, moritz.goeldner@tuhh.de %K digital health application %K DiGA %K data-driven analysis %K clinical evidence %K health economics %K positive care effect %K medical benefit %K patient-relevant structural and procedural improvements %K pSVV %K digital health care act %D 2024 %7 29.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: This study aimed to analyze the rapidly evolving ecosystem of digital health applications (Digitale Gesundheitsanwendung; DiGAs) in Germany, spurred by the 2019 Digital Healthcare Act. With over 73 million people in Germany now having access to DiGAs, these prescribable digital health apps and web-based applications represent a substantial stride in health care modernization, supporting both patients and health care providers with digital solutions for disease management and care improvement. Objective: Through a data-driven approach, this research aimed to unpack the complexities of DiGA market dynamics, economic factors, and clinical evidence, offering insights into their impact over the past years. Methods: The analysis draws from a range of public data sources, including the DiGA directory, statutory health insurance reports, app store feedback, and clinical study results. Results: As of July 1, 2024, there are 56 DiGAs listed by the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte), divided into 35 permanently and 21 preliminarily listed applications. Our findings reveal that a majority of DiGAs extend beyond the intended 1-year period to achieve permanent listing, reflecting the extensive effort required to demonstrate clinical efficacy. Economic analysis uncovered a dynamic pricing landscape, with initial prices ranging from approximately €200 to €700 (€1=US $1.07), averaging at a median of €514 for a 3-month DiGA prescription. Following negotiations or arbitration board decisions, prices typically see a 50% reduction, settling at a median of €221. Prescription data offer valuable insights into DiGA acceptance, with total prescriptions jumping from around 41,000 in the first period to 209,000 in the latest reporting period. The analysis of the top 15 DiGAs, representing 82% of the total prescriptions, shows that these best-performing apps receive from a minimum of 8 to a maximum of 77 daily prescriptions, with native apps and early market entrants achieving higher rates. Clinical evidence from all 35 permanently listed DiGAs indicates a uniform preference for randomized controlled trials to validate primary end points, with no noteworthy use of alternative study designs encouraged in the Digital Healthcare Act and related regulations. Moreover, all evaluated DiGAs focused on medical benefits, with health status improvement as a key end point, suggesting an underuse of patient-relevant structural and procedural improvement in demonstrating health care impact. Conclusions: This study highlights the growth and challenges within the DiGA sector, suggesting areas for future research, such as the exploration of new study designs and the potential impact of patient-relevant structural and procedural improvements. For DiGA manufacturers, the strategic advantage of early market entry is emphasized. Overall, this paper underscores the evolving landscape of digital health, advocating for a nuanced understanding of digital health technology integration in Germany and beyond. %M 39208415 %R 10.2196/59013 %U https://www.jmir.org/2024/1/e59013 %U https://doi.org/10.2196/59013 %U http://www.ncbi.nlm.nih.gov/pubmed/39208415 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54745 %T Sociodemographic Factors Associated With Using eHealth for Information Seeking in the United States: Cross-Sectional Population-Based Study With 3 Time Points Using Health Information National Trends Survey Data %A Vazquez,Christian Elias %A Mauldin,Rebecca L %A Mitchell,Denise N %A Ohri,Faheem %+ School of Social Work, The University of Texas at Arlington, 501 W Mitchell St, Arlington, TX, 76010, United States, 1 8052596963, christian.vazquez@uta.edu %K health information seeking %K eHealth use %K disparities %K sex %K age %K education %K mobile phone %D 2024 %7 14.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the potential benefits of using eHealth, sociodemographic disparities exist in eHealth use, which threatens to further widen health equity gaps. The literature has consistently shown age and education to be associated with eHealth use, while the findings for racial and ethnic disparities are mixed. However, previous disparities may have narrowed as health care interactions shifted to web-based modalities for everyone because of the COVID-19 pandemic. Objective: This study aims to provide an updated examination of sociodemographic disparities that contribute to the health equity gap related to using eHealth for information seeking using 3 time points. Methods: Data for this study came from the nationally representative 2018 (n=3504), 2020 (n=3865), and 2022 (n=6252) time points of the Health Information National Trends Survey. Logistic regression was used to regress the use of eHealth for information seeking on race and ethnicity, sex, age, education, income, health status, and year of survey. Given the consistent association of age with the dependent variable, analyses were stratified by age cohort (millennials, Generation X, baby boomers, and silent generation) to compare individuals of similar age. Results: For millennials, being female, attaining some college or a college degree, and reporting an annual income of US $50,000-$74,999 or >US $75,000 were associated with the use of eHealth for information seeking. For Generation X, being female, having attained some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, better self-reported health, and completing the survey in 2022 (vs 2018; odds ratio [OR] 1.80, 95% CI 1.11-2.91) were associated with the use of eHealth for information seeking. For baby boomers, being female, being older, attaining a high school degree, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2020 (OR 1.56, 95% CI 1.15-2.12) and 2022 (OR 4.04, 95% CI 2.77-5.87) were associated with the use of eHealth for information seeking. Among the silent generation, being older, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2022 (OR 5.76, 95% CI 3.05-10.89) were associated with the use of eHealth for information seeking. Conclusions: Baby boomers may have made the most gains in using eHealth for information seeking over time. The race and ethnicity findings, or lack thereof, may indicate a reduction in racial and ethnic disparities. Disparities based on sex, education, and income remained consistent across all age groups. This aligns with health disparities literature focused on individuals with lower socioeconomic status, and more recently on men who are less likely to seek health care compared to women. %M 39141905 %R 10.2196/54745 %U https://www.jmir.org/2024/1/e54745 %U https://doi.org/10.2196/54745 %U http://www.ncbi.nlm.nih.gov/pubmed/39141905 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e52676 %T Barriers and Facilitators to the Use of Wearable Robots as Assistive Devices: Qualitative Study With Older Adults and Physiotherapists %A Reicherzer,Leah %A Scheermesser,Mandy %A Kläy,Adrian %A Duarte,Jaime E %A Graf,Eveline S %K assistive device %K barriers %K facilitators %K mobility %K older adults %K wearable robots %D 2024 %7 9.8.2024 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Light wearable robots have the potential to assist older adults with mobility impairments in daily life by compensating for age-related decline in lower extremity strength. Physiotherapists may be the first point of contact for older adults with these devices. Objective: The aims of this study were to explore views of older adults and physiotherapists on wearable robots as assistive devices for daily living and to identify the barriers and facilitators to their use. Methods: Six older adults (aged 72‐88 years) tested a wearable robot (Myosuit) and participated in semistructured interviews. A focus group with 6 physiotherapists who had a minimum of 5 years of professional experience and specialized in geriatrics was conducted. Data were analyzed using thematic qualitative text analysis. Results: Older adults perceived benefits and had positive use experiences, yet many saw no need to use the technology for themselves. Main barriers and facilitators to its use were the perception of usefulness, attitudes toward technology, ease of use, and environmental factors such as the support received. Physiotherapists named costs, reimbursement schemes, and complexity of the technology as limiting factors. Conclusions: A light wearable robot—the Myosuit—was found to be acceptable to study participants as an assistive device. Although characteristics of the technology are important, the use and acceptance by older adults heavily depend on perceived usefulness and need. %R 10.2196/52676 %U https://rehab.jmir.org/2024/1/e52676 %U https://doi.org/10.2196/52676 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56528 %T Exploring How Patients Are Supported to Use Online Services in Primary Care in England Through “Digital Facilitation”: Survey Study %A Winder,Rachel %A Campbell,John L %A Akter,Nurunnahar %A Aminu,Abodunrin Q %A Lambert,Jeffrey %A Cockcroft,Emma %A Thomas,Chloe %A Clark,Christopher E %A Bryce,Carol %A Sussex,Jon %A Atherton,Helen %A Marriott,Christine %A Abel,Gary %+ University of Exeter Medical School, University of Exeter, Smeall Building, St Luke's Campus, Exeter, EX1 2LU, United Kingdom, 44 44 1392 722821, john.campbell@exeter.ac.uk %K primary care %K online services %K access to online health care services %K general practice %K survey %K digital support %K inequalities %K remote consultation %K health services research %K digital technology %D 2024 %7 7.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Health service policy in many jurisdictions is driving greater investment into digital primary care services. While some patients and practices may benefit, there are concerns that not all are able or wish to access primary care services online. “Digital facilitation” is the “range of processes, procedures, and personnel seeking to support patients in their uptake and use of online services” and may address such concerns. Objective: As part of a multimethod research program, we undertook surveys of practice staff and patients to gain insight into the support being offered by practices and explore patients’ experiences of this support. Methods: General practices from 4 regions of England were sent a questionnaire exploring the modes of digital facilitation offered, the personnel involved in its delivery, and views on the motivations and drivers for providing support. Moreover, 12,822 patients registered with 62 general practices (predominantly those providing practice survey responses) were sent a questionnaire exploring their experiences of any support offered by their practice to use online services. Results: Almost one-third of practices (156/500, 31.2%) responded to the practice survey, with most reporting using passive modes of digital facilitation (eg, display, leaflets, and SMS text messages) and few using active modes (eg, offering tablets or computers or using practice champions). However, 90.9% (130/143) reported providing ad hoc support. Practices agreed that it was the responsibility of both the practice (105/144, 72.9%) and the wider National Health Service (118/143, 82.5%) to support patients in using online services and that providing such support benefited the practice (126/144, 87.5%) and their patients (132/144, 91.7%). Nearly a quarter of the patients (3051/12,822, 23.8%) responded to the patient survey, with few (522/3051, 17.11% or less) reporting awareness of any modes of digital facilitation apart from text messages and emails (1205/3051, 39.5%) and only 13.36% (392/2935) reporting receiving support to use online services. Adjusted logistic regression analyses showed that older patients had a lower likelihood of 4 outcomes: being aware of, or of using, digital facilitation efforts, or being told about or being helped to use online services (all P<.05), particularly with regard to being helped to use online services (adjusted odds ratio for patients aged 85 years versus those aged 55-64 years: 0.08, 95% CI 0.02-0.36). However, ethnic minority participants or those for whom their first language was not English had positive associations with these outcomes. Conclusions: General practices recognize that patients would benefit from support to access online services. However, the support provided is often passive or ad hoc, and patients were seldom aware of digital facilitation efforts that their practice provided. There is potential to increase engagement with online primary care services by providing more support for all patients, particularly to provide targeted support for older patients. %M 39110960 %R 10.2196/56528 %U https://www.jmir.org/2024/1/e56528 %U https://doi.org/10.2196/56528 %U http://www.ncbi.nlm.nih.gov/pubmed/39110960 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51206 %T Physical Activity, Body Composition, and Fitness Variables in Adolescents After Periods of Mandatory, Promoted or Nonmandatory, Nonpromoted Use of Step Tracker Mobile Apps: Randomized Controlled Trial %A Mateo-Orcajada,Adrián %A Vaquero-Cristóbal,Raquel %A Mota,Jorge %A Abenza-Cano,Lucía %+ Research Group Movement Sciences and Sport (MS&SPORT), Department of Physical Activity and Sport, Faculty of Sport Sciences, University of Murcia, C. Argentina 19, San Javier, Murcia, 30720, Spain, 34 868 88 86 84, raquel.vaquero@um.es %K body composition %K detraining %K new technologies %K physical education subject %K physical fitness %K youth %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It is not known whether an intervention made mandatory as a physical education (PE) class assignment and aimed at promoting physical activity (PA) in adolescents can create a healthy walking habit, which would allow further improvements to be achieved after the mandatory and promoted intervention has been completed. Objective: The aims of this study were to (1) investigate whether, after a period of using a step tracker mobile app made mandatory and promoted as a PE class assignment, adolescents continue to use it when its use is no longer mandatory and promoted; (2) determine whether there are changes in the PA level, body composition, and fitness of adolescents when the use of the app is mandatory and promoted and when it is neither mandatory nor promoted; and (3) analyze whether the covariates maturity status, gender, and specific app used can have an influence. Methods: A total of 357 students in compulsory secondary education (age: mean 13.92, SD 1.91 y) participated in the study. A randomized controlled trial was conducted consisting of 2 consecutive 10-week interventions. Participants’ PA level, body composition, and fitness were measured at baseline (T1), after 10 weeks of mandatory and promoted app use (T2), and after 10 weeks of nonmandatory and nonpromoted app use (T3). Each participant in the experimental group (EG) used 1 of 4 selected step tracker mobile apps after school hours. Results: The results showed that when the use of the apps was neither mandatory nor promoted as a PE class assignment, only a few adolescents (18/216, 8.3%) continued the walking practice. After the mandatory and promoted intervention period (T1 vs T2), a decrease in the sum of 3 skinfolds (mean difference [MD] 1.679; P=.02) as well as improvements in the PA level (MD –0.170; P<.001), maximal oxygen uptake (MD –1.006; P<.001), countermovement jump test (MD –1.337; P=.04), curl-up test (MD –3.791; P<.001), and push-up test (MD –1.920; P<.001) in the EG were recorded. However, the changes between T1 and T2 were significantly greater in the EG than in the control group only in the PA level and curl-up test. Thus, when comparing the measurements taken between T1 and T3, no significant changes in body composition (P=.07) or fitness (P=.84) were observed between the EG and the control group. The covariates maturity status, gender, and specific app used showed a significant effect in most of the analyses performed. Conclusions: A period of mandatory and promoted use of step tracker mobile apps benefited the variables of body composition and fitness in adolescents but did not create a healthy walking habit in this population; therefore, when the use of these apps ceased to be mandatory and promoted, the effects obtained disappeared. Trial Registration: ClinicalTrials.gov NCT06164041; https://clinicaltrials.gov/study/NCT06164041 %M 39079110 %R 10.2196/51206 %U https://mhealth.jmir.org/2024/1/e51206 %U https://doi.org/10.2196/51206 %U http://www.ncbi.nlm.nih.gov/pubmed/39079110 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56504 %T Patterns of Ownership and Usage of Wearable Devices in the United States, 2020-2022: Survey Study %A Nagappan,Ashwini %A Krasniansky,Adriana %A Knowles,Madelyn %+ Department of Health Policy and Management, University of California, Los Angeles, 650 Charles E Young Dr S, 31-269 CHS, Los Angeles, CA, 90095, United States, 1 3108252594, ashwininagappan@ucla.edu %K digital health %K health equity %K adoption %K usage patterns %K wearable devices %K United States %K adoption %K technology %K sociodemographic %K survey %K health insurance %K public health %D 2024 %7 26.7.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: Although wearable technology has become increasingly common, comprehensive studies examining its ownership across different sociodemographic groups are limited.  Objective: The aims of this study were to (1) measure wearable device ownership by sociodemographic characteristics in a cohort of US consumers and (2) investigate how these devices are acquired and used for health-related purposes. Methods: Data from the Rock Health Digital Health Consumer Adoption Survey collected from 2020 to 2022 with 23,974 US participants were analyzed. The sample was US Census–matched for demographics, including age, race/ethnicity, gender, and income. The relationship between sociodemographic factors and wearable ownership was explored using descriptive analysis and multivariate logistic regression. Results: Of the 23,974 respondents, 10,679 (44.5%) owned wearables. Ownership was higher among younger individuals, those with higher incomes and education levels, and respondents living in urban areas. Compared to those aged 18-24 years, respondents 65 years and older had significantly lower odds of wearable ownership (odds ratio [OR] 0.18, 95% CI 0.16-0.21). Higher annual income (≥US $200,000; OR 2.27, 95% CI 2.01-2.57) and advanced degrees (OR 2.23, 95% CI 2.01-2.48) were strong predictors of ownership. Living in rural areas reduced ownership odds (OR 0.65, 95% CI 0.60-0.72). There was a notable difference in ownership based on gender and health insurance status. Women had slightly higher ownership odds than men (OR 1.10, 95% CI 1.04-1.17). Private insurance increased ownership odds (OR 1.28, 95% CI 1.17-1.40), whereas being uninsured (OR 0.41, 95% CI 0.36-0.47) or on Medicaid (OR 0.75, 95% CI 0.68-0.82) decreased the odds of ownership. Interestingly, minority groups such as non-Hispanic Black (OR 1.14, 95% CI 1.03-1.25) and Hispanic/Latine (OR 1.20, 95% CI 1.10-1.31) respondents showed slightly higher ownership odds than other racial/ethnic groups. Conclusions: Our findings suggest that despite overall growth in wearable ownership, sociodemographic divides persist. The data indicate a need for equitable access strategies as wearables become integral to clinical and public health domains. %M 39058548 %R 10.2196/56504 %U https://www.jmir.org/2024/1/e56504 %U https://doi.org/10.2196/56504 %U http://www.ncbi.nlm.nih.gov/pubmed/39058548 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51307 %T Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial %A Grahlher,Kristin %A Morgenstern,Matthis %A Pietsch,Benjamin %A Gomes de Matos,Elena %A Rossa,Monika %A Lochbühler,Kirsten %A Daubmann,Anne %A Thomasius,Rainer %A Arnaud,Nicolas %+ German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Martinistr 52, Hamburg, 20246, Germany, 49 40741059307, n.arnaud@uke.de %K prevention %K vocational students %K adolescents %K mobile intervention %K voluntary commitment %K substance use %K internet-related problems %K mobile phone %K adolescent %K youths %K student %K students %K use %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app (“Meine Zeit ohne”) has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. Objective: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants’ characteristics, and (3) to study how variations in app use were related to participants’ baseline characteristics. Methods: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection (“congruent use”: eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. Results: The intervention group consisted of 2367 vocational students, and 1458 (61.6%; mean age 19.0, SD 3.5 years; 830/1458, 56.9% male) of them provided full data. Of these 1458 students, 894 (61.3%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6% female). Of these 894 students, 466 (52.1%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1%). A total of 407 (45.5%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. Conclusions: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users’ characteristics. Trial Registration: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06231-x %M 39042436 %R 10.2196/51307 %U https://mhealth.jmir.org/2024/1/e51307 %U https://doi.org/10.2196/51307 %U http://www.ncbi.nlm.nih.gov/pubmed/39042436 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56687 %T The Relationship Between Static Characteristics of Physicians and Patient Consultation Volume in Internet Hospitals: Quantitative Analysis %A Wang,Ye %A Shi,Changjing %A Wang,Xinyun %A Meng,Hua %A Chen,Junqiang %+ Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Qingxiu District, Nanning, 530021, China, 86 07715347234, chenjunqiang@gxmu.edu.cn %K static characteristics of physicians %K internet hospitals %K telemedicine %K statistical analysis %K online consultation %K web-based consultation %K teleconsultation %K physician %K patient %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet medical treatment, also known as telemedicine, represents a paradigm shift in health care delivery. This contactless model allows patients to seek medical advice remotely, often before they physically visit a doctor’s clinic. Herein, physicians are in a relatively passive position, as patients browse and choose their health care providers. Although a wealth of experience is undoubtedly a draw for many patients, it remains unclear which specific facets of a doctor’s credentials and accomplishments patients prioritize during their selection process. Objective: Our primary aim is to delve deeper into the correlation between physicians’ static characteristics—such as their qualifications, experiences, and profiles on the internet—and the number of patient visits they receive. We seek to achieve this by analyzing comprehensive internet hospital data from public hospitals. Furthermore, we aim to offer insights into how doctors can present themselves more effectively on web-based platforms, thereby attracting more patients and improving overall patient satisfaction. Methods: We retrospectively gathered web-based diagnosis and treatment data from the First Affiliated Hospital of Guangxi Medical University in 2023. These data underwent rigorous analysis, encompassing basic descriptive statistics, correlation analyses between key factors in doctors’ internet-based introductions, and the number of patient consultation visits. Additionally, we conducted subgroup analyses to ascertain the independence of these vital factors. To further distill the essence from these data, we used nonnegative matrix factorization to identify crucial demographic characteristics that significantly impact patient choice. Results: The statistical results suggested that there were significant differences in the distribution of consultation volume (P<.001), and the correlation analysis results suggested that there was a strong correlation between the two groups of data (ρ=0.93; P<.001). There was a correlation between the richness of a profile and popularity (P<.001). Patients were more interested in physicians with advanced titles, doctoral degrees, social activities, and scientific achievements (P<.001) as well as other institutional visit experiences (P=.003). More prosperous social activities, scientific achievements, experiences of other institutional visits, and awards were more common among people with advanced professional titles. Doctoral degrees remained attractive to patients when data were limited to senior physicians (P<.001). Patients trusted the medical staff with advanced titles, social activities, scientific achievements, and doctoral degrees (P<.001). Conclusions: Patient preferences for choosing a health care provider differed significantly between free and paid consultations. Notably, patients tended to trust doctors with advanced professional titles more and were more likely to seek out those with doctoral qualifications over other professional ranks. Additionally, physicians who actively participated in social events and scientific endeavors often had an advantage in attracting new patients. Given these insights, doctors who invest in enhancing their personal and professional experiences within these domains are likely to see increased popularity and patient satisfaction. %M 38885498 %R 10.2196/56687 %U https://formative.jmir.org/2024/1/e56687 %U https://doi.org/10.2196/56687 %U http://www.ncbi.nlm.nih.gov/pubmed/38885498 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49040 %T Doctors’ Personal Preference and Adoption of Mobile Apps to Communicate with Patients in China: Qualitative Study %A Chen,Dongjin %A Han,Wenchao %A Yang,Yili %A Pan,Jay %+ West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China, 86 28 85501096, panjie.jay@scu.edu.cn %K medical platforms %K doctor-patient communication %K social networking apps %K thematic content analysis %K China %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Different kinds of mobile apps are used to promote communications between patients and doctors. Studies have investigated patients’ mobile app adoption behavior; however, they offer limited insights into doctors’ personal preferences among a variety of choices of mobile apps. Objective: This study aimed to investigate the nuanced adoption behaviors among doctors in China, which has a robust adoption of mobile apps in health care, and to explore the constraints influencing their selection of specific mobile apps. This paper addressed 3 research questions: (1) Which doctors opt to adopt mobile apps to communicate with patients? (2) What types of mobile apps do they choose? (3) To what degree do they exercise personal choice in adopting specific mobile apps? Methods: We used thematic content analysis of qualitative data gathered from semistructured interviews with 11 doctors in Hangzhou, which has been recognized for its advanced adoption of mobile technology in social services, including health care services. The selection of participants was purposive, encompassing diverse departments and hospitals. Results: In total, 5 themes emerged from the data analysis. First, the interviewees had a variety of options for communicating with patients via mobile apps, with the predominant ones being social networking apps (eg, WeChat) and medical platforms (eg, Haodf). Second, all interviewees used WeChat to facilitate communication with patients, although their willingness to share personal accounts varied (they are more likely to share with trusty intermediaries). Third, fewer than half of the doctors adopted medical platforms, and they were all from tertiary hospitals. Fourth, the preferences for in-person, WeChat, or medical platform communication reflected the interviewees’ perceptions of different patient cohorts. Lastly, the selection of a particular kind of mobile app was significantly influenced by the doctors’ affiliation with hospitals, driven by their professional obligations to fulfill multiple tasks assigned by the hospitals or the necessity of maintaining social connections with their colleagues. Conclusions: Our findings contribute to a nuanced understanding of doctors’ adoption behavior regarding specific types of mobile apps for patient communication, instead of addressing such adoption behavior of a wide range of mobile apps as equal. Their choices of a particular kind of app were positioned within a social context where health care policies (eg, limited funding for public hospitals, dominance of public health care institutions, and absence of robust referral systems) and traditional culture (eg, trust based on social connections) largely shape their behavioral patterns. %M 38857491 %R 10.2196/49040 %U https://mhealth.jmir.org/2024/1/e49040 %U https://doi.org/10.2196/49040 %U http://www.ncbi.nlm.nih.gov/pubmed/38857491 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53855 %T Centering Digital Health Equity During Technology Innovation: Protocol for a Comprehensive Scoping Review of Evidence-Based Tools and Approaches %A Burns,Kara %A Bloom,Shoshana %A Gilbert,Cecily %A Merner,Bronwen %A Kalla,Mahima %A Sheri,Sreshta %A Villanueva,Cleva %A Matenga Ikihele,Amio %A Nazer,Lama %A Sarmiento,Raymond Francis %A Stevens,Lindsay %A Blow,Ngaree %A Chapman,Wendy %+ Centre for Digital Transformation of Health, University of Melbourne, 700 Swanston St, Carlton, 3053, Australia, kara.burns@unimelb.edu.au %K digital health technology %K eHealth %K mHealth %K health informatics %K equity %K inclusion %K participatory design %K universal design %K Validitron %K digital health %K cost %K technology %K technology innovation %K innovation %K evidence-based tools %K evidence-based %K tools %K digital innovation %K cost-effective %K accessibility %K digital inequity %K digital health equity %D 2024 %7 5.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the rush to develop health technologies for the COVID-19 pandemic, the unintended consequence of digital health inequity or the inability of priority communities to access, use, and receive equal benefits from digital health technologies was not well examined. Objective: This scoping review will examine tools and approaches that can be used during digital technology innovation to improve equitable inclusion of priority communities in the development of digital health technologies. The results from this study will provide actionable insights for professionals in health care, health informatics, digital health, and technology development to proactively center equity during innovation. Methods: Based on the Arksey and O’Malley framework, this scoping review will consider priority communities’ equitable involvement in digital technology innovation. Bibliographic databases in health, medicine, computing, and information sciences will be searched. Retrieved citations will be double screened against the inclusion and exclusion criteria using Covidence (Veritas Health Innovation). Data will be charted using a tailored extraction tool and mapped to a digital health innovation pathway defined by the Centre for eHealth Research roadmap for eHealth technologies. An accompanying narrative synthesis will describe the outcomes in relation to the review’s objectives. Results: This scoping review is currently in progress. The search of databases and other sources returned a total of 4868 records. After the initial screening of titles and abstracts, 426 studies are undergoing dual full-text review. We are aiming to complete the full-text review stage by May 30, 2024, data extraction in October 2024, and subsequent synthesis in December 2024. Funding was received on October 1, 2023, from the Centre for Health Equity Incubator Grant Scheme, University of Melbourne, Australia. Conclusions: This paper will identify and recommend a series of validated tools and approaches that can be used by health care stakeholders and IT developers to produce equitable digital health technology across the Centre for eHealth Research roadmap. Identified evidence gaps, possible implications, and further research will be discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/53855 %M 38838333 %R 10.2196/53855 %U https://www.researchprotocols.org/2024/1/e53855 %U https://doi.org/10.2196/53855 %U http://www.ncbi.nlm.nih.gov/pubmed/38838333 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50376 %T eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey %A Turnbull,Joanne %A Prichard,Jane %A MacLellan,Jennifer %A Pope,Catherine %+ School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, United Kingdom, 44 2380597940, j.c.turnbull@soton.ac.uk %K urgent care %K digital health %K access to health care %K eHealth %K health care system %K COVID-19 %K urgent %K emergency %K health literacy %K eHealth literacy %K digital literacy %K access %K cross-sectional %D 2024 %7 4.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. “Digital first” may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. Objective: This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. Methods: A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. Results: Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). Conclusions: These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand. %M 38833297 %R 10.2196/50376 %U https://www.jmir.org/2024/1/e50376 %U https://doi.org/10.2196/50376 %U http://www.ncbi.nlm.nih.gov/pubmed/38833297 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54010 %T Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial %A Dinh,Mackenzie %A Lin,Chun Chieh %A Whitfield,Candace %A Farhan,Zahera %A Meurer,William J %A Bailey,Sarah %A Skolarus,Lesli E %+ Davee Department of Neurology, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, United States, 1 312 503 0399, lesli.skolarus@northwestern.edu %K hypertension %K cognition %K mobile health %K Bluetooth %K remote %K monitoring %K monitor %K low income %K mHealth %K hypertensive %K cardiology %K cardiovascular %K feasibility %K acceptability %K satisfaction %K RCT %K randomized controlled trial %K assessment %K blood pressure %K neurological %K mobile health %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease–related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. Objective: The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. Methods: Reach Out was a randomized, controlled, mobile health–based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message–linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). Results: Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. Conclusions: Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 %M 38805251 %R 10.2196/54010 %U https://formative.jmir.org/2024/1/e54010 %U https://doi.org/10.2196/54010 %U http://www.ncbi.nlm.nih.gov/pubmed/38805251 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51728 %T Quality Improvement Intervention Using Social Prescribing at Discharge in a University Hospital in France: Quasi-Experimental Study %A Cailhol,Johann %A Bihan,Hélène %A Bourovali-Zade,Chloé %A Boloko,Annie %A Duclos,Catherine %+ Laboratoire Educations et Promotion de la Santé, University Sorbonne Paris Nord, 74 rue marcel cachin, Bobigny, 93007, France, 33 148955426, johann.cailhol@aphp.fr %K social prescription %K discharge coordination %K language barriers %K readmission rates %K ethnic matching %K trust %K personalized care %K discharge %K social determinant %K social need %K tool %K quality of care %K readmission %K quality improvement %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social prescription is seen as a public health intervention tool with the potential to mitigate social determinants of health. On one side, social prescription is not yet well developed in France, where social workers usually attend to social needs, and historically, there is a deep divide between the health and social sectors. On the other side, discharge coordination is gaining attention in France as a critical tool to improve the quality of care, assessed indirectly using unplanned rehospitalization rates. Objective: This study aims to combine social prescription and discharge coordination to assess the need for social prescription and its effect on unplanned rehospitalization rates. Methods: We conducted a quasi-experimental study in two departments of medicine in a French university hospital in a disadvantaged suburb of Paris over 2 years (October 2019-October 2021). A discharge coordinator screened patients for social prescribing needs and provided services on the spot or referred the patient to the appropriate service when needed. The primary outcome was the description of the services delivered by the discharge coordinator and of its process, as well as the characteristics of the patients in terms of social needs. The secondary outcome was the comparison of unplanned rehospitalization rates after data chaining. Results: A total of 223 patients were included in the intervention arm, with recruitment being disrupted by the COVID-19 pandemic. More than two-thirds of patients (n=154, 69.1%) needed help understanding discharge information. Slightly less than half of the patients (n=98, 43.9%) seen by the discharge coordinator needed social prescribing, encompassing language, housing, health literacy, and financial issues. The social prescribing covered a large range of services, categorized into finding a general practitioner or private sector nurse, including language-matching; referral to a social worker; referral to nongovernmental organization or group activities; support for transportation issues; support for health-related administrative procedures; and support for additional appointments with nonmedical clinicians. All supports were delivered in a highly personalized way. Ethnic data collection was not legally permitted, but for 81% (n=182) of the patients, French was not the mother tongue. After data chaining, rehospitalization rates were compared between 203 patients who received the intervention (n=5, 3.1%) versus 2095 patients who did not (n=51, 2.6%), and there was no statistical difference. Conclusions: First, our study revealed the breadth of patient’s unmet social needs in our university hospital, which caters to an area where the immigrant population is high. The study also revealed the complexity of the discharge coordinator’s work, who provided highly personalized support and managed to gain trust. Hospital discharge could be used in France as an opportunity in disadvantaged settings. Eventually, indicators other than the rehospitalization rate should be devised to evaluate the effect of social prescribing and discharge coordination. %M 38739912 %R 10.2196/51728 %U https://formative.jmir.org/2024/1/e51728 %U https://doi.org/10.2196/51728 %U http://www.ncbi.nlm.nih.gov/pubmed/38739912 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52124 %T Prevalence and Disparities in Telehealth Use Among US Adults Following the COVID-19 Pandemic: National Cross-Sectional Survey %A Spaulding,Erin M %A Fang,Michael %A Commodore-Mensah,Yvonne %A Himmelfarb,Cheryl R %A Martin,Seth S %A Coresh,Josef %+ Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, United States, 1 4109554766, espauld2@jhu.edu %K telehealth %K telemedicine %K delivery of health care %K health care disparities %K COVID-19 %D 2024 %7 10.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine expanded during the COVID-19 pandemic, though use differed by age, sex, race or ethnicity, educational attainment, income, and location. It is unclear if high telehealth use or inequities persisted late into the pandemic. Objective: This study aims to evaluate the prevalence of, inequities in, and primary reasons for telehealth visits a year after telemedicine expansion. Methods: We used cross-sectional data from the 2022 Health Information National Trends Survey (HINTS 6), the first cycle with data on telemedicine. In total, 4830 English- and Spanish-speaking US adults (aged ≥18 years) were included in this study. The primary outcomes were telehealth visit attendance in the 12 months before March 7, 2022, to November 8, 2022, and the primary reason for the most recent telehealth visit. We evaluated sociodemographic and clinical predictors of telehealth visit attendance and the primary reason for the most recent telehealth visit through Poisson regression. Analyses were weighted according to HINTS 6 standards. Results: We included 4830 participants (mean age 48.3, SD 17.5 years; 50.28% women; 65.21% White). Among US adults, 38.78% reported having a telehealth visit in the previous year. Telehealth visit attendance rates were similar across age, race or ethnicity, income, and urban versus rural location. However, individuals with a telehealth visit were less likely to live in the Midwest (adjusted prevalence ratio [aPR] 0.65, 95% CI 0.54-0.77), and more likely to be women (aPR 1.21, 95% CI 1.06-1.38), college graduates or postgraduates (aPR 1.24, 95% CI 1.05-1.46), covered by health insurance (aPR 1.56, 95% CI 1.08-2.26), and married or cohabitating (aPR 1.17, 95% CI 1.03-1.32), adjusting for sociodemographic characteristics, frequency of health care visits, and comorbidities. Among participants with a telehealth visit in the past year, the primary reasons for their most recent visit were minor or acute illness (32.15%), chronic disease management (21%), mental health or substance abuse (16.94%), and an annual exam (16.22%). Older adults were more likely to report that the primary reason for their most recent telehealth visit was for chronic disease management (aPR 2.08, 95% CI 1.33-3.23), but less likely to report that it was for a mental health or substance abuse issue (aPR 0.19, 95% CI 0.10-0.35), adjusting for sociodemographic characteristics and frequency of health care visits. Conclusions: Among US adults, telehealth visit attendance was high more than a year after telemedicine expansion and did not differ by age, race or ethnicity, income, or urban versus rural location. Telehealth could continue to be leveraged following COVID-19 to improve access to care and health equity. %M 38728070 %R 10.2196/52124 %U https://www.jmir.org/2024/1/e52124 %U https://doi.org/10.2196/52124 %U http://www.ncbi.nlm.nih.gov/pubmed/38728070 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50826 %T Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study %A Cruz,Stefany %A Lu,Claire %A Ulloa,Mara %A Redding,Alexander %A Hester,Josiah %A Jacobs,Maia %+ Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, 633 Clark Street, Evanston, IL, 60208, United States, 1 8474913741, stefanycruz2024@u.northwestern.edu %K mHealth %K mobile health %K wearable %K wearables %K Health wearables %K COVID-19 %K digital divide %K low-socioeconomic status %K socioeconomic %K adoption %K underserved %K poverty %K low income %K low resource %K marginalized %K equity %K attitude %K attitudes %K opinion %K opinions %K perception %K perceptions %K perspective %K perspectives %K acceptance %K Spanish %K Hispanic %K Latinx %K Hispanics %K interview %K interviews %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low–socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. Objective: This study’s aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. Methods: We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. Results: Through qualitative analysis, we identified 4 main themes. Participants’ perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants’ interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. Conclusions: The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices. %M 38717816 %R 10.2196/50826 %U https://mhealth.jmir.org/2024/1/e50826 %U https://doi.org/10.2196/50826 %U http://www.ncbi.nlm.nih.gov/pubmed/38717816 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e50759 %T Technology Use Among Older Adults and Their Caregivers: Cross-Sectional Survey Study %A Lee,Shinduk %A Ory,Marcia G %A Vollmer Dahlke,Deborah %A Smith,Matthew Lee %K technology %K caregiving %K social determinants of health %K health disparities %K disparity %K disparities %K caregiver %K caregivers %K carers %K technology use %K usage %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K cross-sectional %K survey %K surveys %K computer use %K device %K devices %K adoption %K dyad %K dyads %D 2024 %7 1.5.2024 %9 %J JMIR Aging %G English %X Background: Informal caregivers are called upon to provide substantial care, but more needs to be known about technology use among older adult and caregiver dyads. Objective: This study described technology use among older adults and their caregivers, explored potential correlates of technology use, and highlighted implications for practice. Methods: A cross-sectional survey was conducted among unpaid caregivers of older adults (n=486). Primary outcomes were self-reported technology (devices and functions) use among caregivers and their oldest care recipient. The concordance of technology use among caregivers and care recipients was also examined. Multivariable regression models were conducted separately for caregivers and care recipients. Results: Greater proportions of caregivers used all examined technologies, except for the medication alerts or tracking function, than care recipients. Caregivers used an average of 3.4 devices and 4.2 functions, compared to 1.8 devices and 1.6 functions used by their care recipients. Among caregivers, younger age, higher income, and higher education were associated with more technology use (P<.05). Among care recipients, younger age, not having cognitive dysfunction, and caregiver’s technology use were associated with more technology use (P<.05). Conclusions: Understanding technology use patterns and device adoption across diverse caregiver and care recipient populations is increasingly important for enhancing geriatric care. Findings can guide recommendations about appropriate technology interventions and help providers communicate and share information more effectively with patients and their caregivers. %R 10.2196/50759 %U https://aging.jmir.org/2024/1/e50759 %U https://doi.org/10.2196/50759 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e51637 %T Use of Electronic Patient Messaging by Pregnant Patients Receiving Prenatal Care at an Academic Health System: Retrospective Cohort Study %A Holder,Kai %A Feinglass,Joe %A Niznik,Charlotte %A Yee,Lynn M %K patient portal %K secure messaging %K telehealth %K health literacy %K health disparities %K disparity %K disparities %K telemedicine %K information and communication technology %K ICT %K portals %K messaging %K use %K technology use %K pregnant %K pregnancy %K maternal %K obstetric %K obstetrics %K prenatal %K antenatal %K demographic %K demographics %D 2024 %7 26.4.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic accelerated telemedicine and mobile app use, potentially changing our historic model of maternity care. MyChart is a widely adopted mobile app used in health care settings specifically for its role in facilitating communication between health care providers and patients with its messaging function in a secure patient portal. However, previous studies analyzing portal use in obstetric populations have demonstrated significant sociodemographic disparities in portal enrollment and messaging, specifically showing that patients who have a low income and are non-Hispanic Black, Hispanic, and uninsured are less likely to use patient portals. Objective: The study aimed to estimate changes in patient portal use and intensity in prenatal care before and during the pandemic period and to identify sociodemographic and clinical disparities that continued during the pandemic. Methods: This retrospective cohort study used electronic medical record (EMR) and administrative data from our health system’s Enterprise Data Warehouse. Records were obtained for the first pregnancy episode of all patients who received antenatal care at 8 academically affiliated practices and delivered at a large urban academic medical center from January 1, 2018, to July 22, 2021, in Chicago, Illinois. All patients were aged 18 years or older and attended ≥3 clinical encounters during pregnancy at the practices that used the EMR portal. Patients were categorized by the number of secure messages sent during pregnancy as nonusers or as infrequent (≤5 messages), moderate (6-14 messages), or frequent (≥15 messages) users. Monthly portal use and intensity rates were computed over 43 months from 2018 to 2021 before, during, and after the COVID-19 pandemic shutdown. A logistic regression model was estimated to identify patient sociodemographic and clinical subgroups with the highest portal nonuse. Results: Among 12,380 patients, 2681 (21.7%) never used the portal, and 2680 (21.6%), 3754 (30.3%), and 3265 (26.4%) were infrequent, moderate, and frequent users, respectively. Portal use and intensity increased significantly over the study period, particularly after the pandemic. The number of nonusing patients decreased between 2018 and 2021, from 996 of 3522 (28.3%) in 2018 to only 227 of 1743 (13%) in the first 7 months of 2021. Conversely, the number of patients with 15 or more messages doubled, from 642 of 3522 (18.2%) in 2018 to 654 of 1743 (37.5%) in 2021. The youngest patients, non-Hispanic Black and Hispanic patients, and, particularly, non–English-speaking patients had significantly higher odds of continued nonuse. Patients with preexisting comorbidities, hypertensive disorders of pregnancy, diabetes, and a history of mental health conditions were all significantly associated with higher portal use and intensity. Conclusions: Reducing disparities in messaging use will require outreach and assistance to low-use patient groups, including education addressing health literacy and encouraging appropriate and effective use of messaging. %R 10.2196/51637 %U https://mhealth.jmir.org/2024/1/e51637 %U https://doi.org/10.2196/51637 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51859 %T Landscape of Digital Technologies Used in the National Health Service in England: Content Analysis %A Allcock,Jake Alan %A Zhuang,Mengdie %A Li,Shuyang %A Zhao,Xin %+ Information School, University of Sheffield, The Wave, 2 Whitham Road, Sheffield, S10 2AH, United Kingdom, 44 114 222 6339, m.zhuang@sheffield.ac.uk %K digital health %K healthcare service %K regional difference %K National Health Service %K NHS %K digital technology %K health equity %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In England, digital technologies are exploited to transform the way health and social care is provided and encompass a wide range of hardware devices and software that are used in all aspects of health care. However, little is known about the extent to which health care providers differ in digital health technology capabilities and how this relates to geographical and regional differences in health care capacities and resources. Objective: This paper aims to identify the set of digital technologies that have been deployed by the National Health Services clinical commissioning groups (NHS CCGs) in England. In doing this, we respond to calls to shed light on the internal dynamics and variation in the form of digital capability in England in terms of health service regional differences and health diversity, equity, and inclusion. Methods: We collected 135 annual reports that belong to 106 NHS CCGs in England, comprising more than 18,000 pages in total, released from 2020 to 2021. Using this data set, we identified 2163 pages related to digital technologies and labeled them using content analysis. We follow the construct taxonomy used by digital options theory, a theory from the management information systems field analyzing organizational resource investment choices, in classifying observed technologies according to digital themes—inherent design patterns that we identified and explained. We then used a hierarchical clustering method to extract groups of NHS CCGs that implement similar technology themes. Results: We found 31 technologies from the reports and grouped them into 9 digital themes. The 9 themes were further assigned to 1 of the 3 constructs of digital options theory, the identification of patients’ requirements (we identified information portals [76/106], digital health engagement [67/106], and digital inclusion support [45/106]), the development of new work patterns (we identified telehealth [87/106], telemedicine [35/106], and care home technologies [40/106]), the realization of improvements in efficiency and public accessibility (we identified online booking [26/106], online triage [104/106], and digital mental health services [74/106]). The 3 clusters of CCGs are identified based on the 8 themes (Hopkins=0.9914, silhouette=0.186), namely (1) digitally disengaged, (2) digitally engaged, and (3) digital torchbearer. Conclusions: Our findings show prominent digital themes within each construct group, namely information portals, telehealth, and online triage, covering people’s fundamental health information needs. Almost half of CCGs fell into the digitally disengaged group, and all London CCGs (5/106) belonged to this group. We propose that practitioners should offer specialized assistance to regions with limited digital engagement, emphasizing digital health literacy, inclusion support, and ongoing evaluation, rather than concentrating solely on technical advancements. %M 38639996 %R 10.2196/51859 %U https://formative.jmir.org/2024/1/e51859 %U https://doi.org/10.2196/51859 %U http://www.ncbi.nlm.nih.gov/pubmed/38639996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53336 %T Professional Social Media Use Among Orthopedic and Trauma Surgeons in Germany: Cross-Sectional Questionnaire-Based Study %A Youssef,Yasmin %A Gehlen,Tobias %A Ansorg,Jörg %A Back,David Alexander %A Scherer,Julian %+ Department of Traumatology, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland, 41 762030775, julian.scherer@usz.ch %K social media %K digitalization %K digital communication %K orthopedics %K traumatology %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media (SM) has been recognized as a professional communication tool in the field of orthopedic and trauma surgery that can enhance communication with patients and peers, and increase the visibility of research and offered services. The specific purposes of professional SM use and the benefits and concerns among orthopedic and trauma surgeons, however, remain unexplored. Objective: This study aims to demonstrate the specific uses of different SM platforms among orthopedic and trauma surgeons in Germany as well as the advantages and concerns. Methods: A web-based questionnaire was developed on the use of SM in a professional context by considering the current literature and the authors’ topics of interest. The final questionnaire consisted of 33 questions and was distributed among German orthopedic and trauma surgeons via the mail distributor of the Berufsverband für Orthopädie und Unfallchirurgie (Professional Association of Orthopaedic Surgeons in Germany). The study was conducted between June and July 2022. A subgroup analysis was performed for sex (male vs female), age (<60 years vs ≥60 years), and type of workplace (practice vs hospital). Results: A total of 208 participants answered the questionnaire (male: n=166, 79.8%; younger than 60 years: n=146, 70.2%). In total, all of the participants stated that they use SM for professional purposes. In contrast, the stated specific uses of SM were low. Overall, the most used platforms were employment-oriented SM, messenger apps, and Facebook. Instagram emerged as a popular choice among female participants and participants working in hospital settings. The highest specific use of SM was for professional networking, followed by receiving and sharing health-related information. The lowest specific use was for education and the acquisition of patients. Conventional websites occupied a dominating position, exceeding the use of SM across all specific uses. The key benefit of SM was professional networking. Under 50% of the participants stated that SM could be used to enhance communication with their patients, keep up-to-date, or increase their professional visibility. In total, 65.5% (112/171) of participants stated that SM use was time-consuming, 43.9% (76/173) stated that they lacked application knowledge, and 45.1% (78/173) stated that they did not know what content to post. Additionally, 52.9% (91/172) mentioned medicolegal concerns. Conclusions: Overall, SM did not seem to be used actively in the professional context among orthopedic and trauma surgeons in Germany. The stated advantages were low, while the stated concerns were high. Adequate education and information material are needed to elucidate the possible professional applications of SM and to address legal concerns. %M 38639987 %R 10.2196/53336 %U https://formative.jmir.org/2024/1/e53336 %U https://doi.org/10.2196/53336 %U http://www.ncbi.nlm.nih.gov/pubmed/38639987 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50410 %T Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study %A Choy,Melinda Ada %A O'Brien,Kathleen %A Barnes,Katelyn %A Sturgiss,Elizabeth Ann %A Rieger,Elizabeth %A Douglas,Kirsty %+ School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia, 61 51244947, melinda.choy@gmail.com %K digital health %K eHealth %K primary care %K general practice %K digital divide %K health inequities %K health inequality %K disparities %K digital cost %K financial cost %K health technology %K mixed methods %K barriers %K barrier %D 2024 %7 11.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. Objective: This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. Methods: We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. Results: In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7% (52/487) were low- to medium-frequency users and 48.5% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. Conclusions: While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide. %M 38602768 %R 10.2196/50410 %U https://www.jmir.org/2024/1/e50410 %U https://doi.org/10.2196/50410 %U http://www.ncbi.nlm.nih.gov/pubmed/38602768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49780 %T Race and Socioeconomic Status as Predictors of Willingness to Use Digital Mental Health Interventions or One-On-One Psychotherapy: National Survey Study %A Lorenzo-Luaces,Lorenzo %A Wasil,Akash %A Kacmarek,Corinne N %A DeRubeis,Robert %+ Indiana University-Bloomington, 1101 E 10th St, Bloomington, IN, 47405, United States, 1 8128560866, lolorenz@indiana.edu %K digital mental health %K ethnicity %K health disparities %K internet-based CBT %K cognitive behavioral therapy %K intervention %K mental health %K mental health care %K race %K therapy %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an ongoing debate about whether digital mental health interventions (DMHIs) can reduce racial and socioeconomic inequities in access to mental health care. A key factor in this debate involves the extent to which racial and ethnic minoritized individuals and socioeconomically disadvantaged individuals are willing to use, and pay for, DMHIs. Objective: This study examined racial and ethnic as well as socioeconomic differences in participants’ willingness to pay for DMHIs versus one-on-one therapy (1:1 therapy). Methods: We conducted a national survey of people in the United States (N=423; women: n=204; mean age 45.15, SD 16.19 years; non-Hispanic White: n=293) through Prolific. After reading descriptions of DMHIs and 1:1 therapy, participants rated their willingness to use each treatment (1) for free, (2) for a small fee, (3) as a maximum dollar amount, and (4) as a percentage of their total monthly income. At the end of the study, there was a decision task to potentially receive more information about DMHIs and 1:1 therapy. Results: Race and ethnicity was associated with willingness to pay more of one’s income, as a percent or in dollar amounts, and was also associated with information-seeking for DMHIs in the behavioral task. For most outcomes, race and ethnicity was not associated with willingness to try 1:1 therapy. Greater educational attainment was associated to willingness to try DMHIs for free, the decision to learn more about DMHIs, and willingness to pay for 1:1 therapy. Income was inconsistently associated to willingness to try DMHIs or 1:1 therapy. Conclusions: If they are available for free or at very low costs, DMHIs may reduce inequities by expanding access to mental health care for racial and ethnic minoritized individuals and economically disadvantaged groups. %M 38602769 %R 10.2196/49780 %U https://formative.jmir.org/2024/1/e49780 %U https://doi.org/10.2196/49780 %U http://www.ncbi.nlm.nih.gov/pubmed/38602769 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e54823 %T Cardiac Rehabilitation During the COVID-19 Pandemic and the Potential for Digital Technology to Support Physical Activity Maintenance: Qualitative Study %A Park,Linda G %A Chi,Serena %A Pitsenbarger,Susan %A Johnson,Julene K %A Shah,Amit J %A Elnaggar,Abdelaziz %A von Oppenfeld,Julia %A Cho,Evan %A Harzand,Arash %A Whooley,Mary A %+ Department of Community Health Systems, University of California San Francisco, 2 Koret Way, Room 531A, San Francisco, CA, 94143-0610, United States, 1 415 502 6616, linda.park@ucsf.edu %K cardiac rehabilitation %K cardiac rehab %K COVID-19 %K digital health %K digital technology %K physical activity %K physical activity maintenance %K social media %K older adults %K pandemic %K social distancing %K technology %K wearables %K CR %K exercise %K cardiovascular disease %K gerontology %K geriatric %K geriatrics %K hospital %K medical facility %K California %K interview %K thematic analysis %K anxiety %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Social distancing from the COVID-19 pandemic may have decreased engagement in cardiac rehabilitation (CR) and may have had possible consequences on post-CR exercise maintenance. The increased use of technology as an adaptation may benefit post-CR participants via wearables and social media. Thus, we sought to explore the possible relationships of both the pandemic and technology on post-CR exercise maintenance. Objective: This study aimed to (1) understand CR participation during the COVID-19 pandemic, (2) identify perceived barriers and facilitators to physical activity after CR completion, and (3) assess willingness to use technology and social media to support physical activity needs among older adults with cardiovascular disease. Methods: We recruited participants aged 55 years and older in 3 different CR programs offered at both public and private hospitals in Northern California. We conducted individual interviews on CR experiences, physical activity, and potential for using technology. We used thematic analysis to synthesize the data. Results: In total, 22 participants (n=9, 41% female participants; mean age 73, SD 8 years) completed in-depth interviews. Themes from participants’ feedback included the following: (1) anxiety and frustration about the wait for CR caused by COVID-19 conditions, (2) positive and safe participant experience once in CR during the pandemic, (3) greater attention needed to patients after completion of CR, (4) notable demand for technology during the pandemic and after completion of CR, and (5) social media networking during the CR program considered valuable if training is provided. Conclusions: Individuals who completed CR identified shared concerns about continuing physical activity despite having positive experiences during the CR program. There were significant challenges during the pandemic and heightened concerns for safety and health. The idea of providing support by leveraging digital technology (wearable devices and social media for social support) resonated as a potential solution to help bridge the gap from CR to more independent physical activity. More attention is needed to help individuals experience a tailored and safe transition to home to maintain physical activity among those who complete CR. %M 38483450 %R 10.2196/54823 %U https://cardio.jmir.org/2024/1/e54823 %U https://doi.org/10.2196/54823 %U http://www.ncbi.nlm.nih.gov/pubmed/38483450 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54732 %T Development of a Social Risk Score in the Electronic Health Record to Identify Social Needs Among Underserved Populations: Retrospective Study %A Hatef,Elham %A Chang,Hsien-Yen %A Richards,Thomas M %A Kitchen,Christopher %A Budaraju,Janya %A Foroughmand,Iman %A Lasser,Elyse C %A Weiner,Jonathan P %+ Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, 624 N Broadway, Room 502, Baltimore, MD, 21205, United States, 1 4109788006, ehatef1@jhu.edu %K AI %K algorithms %K artificial intelligence %K community health %K deep learning %K EHR %K electronic health record %K machine learning %K ML %K population demographics %K population health %K practical models %K predictive analytics %K predictive modeling %K predictive modelling %K predictive models %K predictive system %K public health %K public surveillance %K SDOH %K social determinants of health %K social needs %K social risks %D 2024 %7 12.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with unmet social needs and social determinants of health (SDOH) challenges continue to face a disproportionate risk of increased prevalence of disease, health care use, higher health care costs, and worse outcomes. Some existing predictive models have used the available data on social needs and SDOH challenges to predict health-related social needs or the need for various social service referrals. Despite these one-off efforts, the work to date suggests that many technical and organizational challenges must be surmounted before SDOH-integrated solutions can be implemented on an ongoing, wide-scale basis within most US-based health care organizations. Objective: We aimed to retrieve available information in the electronic health record (EHR) relevant to the identification of persons with social needs and to develop a social risk score for use within clinical practice to better identify patients at risk of having future social needs. Methods: We conducted a retrospective study using EHR data (2016-2021) and data from the US Census American Community Survey. We developed a prospective model using current year-1 risk factors to predict future year-2 outcomes within four 2-year cohorts. Predictors of interest included demographics, previous health care use, comorbidity, previously identified social needs, and neighborhood characteristics as reflected by the area deprivation index. The outcome variable was a binary indicator reflecting the likelihood of the presence of a patient with social needs. We applied a generalized estimating equation approach, adjusting for patient-level risk factors, the possible effect of geographically clustered data, and the effect of multiple visits for each patient. Results: The study population of 1,852,228 patients included middle-aged (mean age range 53.76-55.95 years), White (range 324,279/510,770, 63.49% to 290,688/488,666, 64.79%), and female (range 314,741/510,770, 61.62% to 278,488/448,666, 62.07%) patients from neighborhoods with high socioeconomic status (mean area deprivation index percentile range 28.76-30.31). Between 8.28% (37,137/448,666) and 11.55% (52,037/450,426) of patients across the study cohorts had at least 1 social need documented in their EHR, with safety issues and economic challenges (ie, financial resource strain, employment, and food insecurity) being the most common documented social needs (87,152/1,852,228, 4.71% and 58,242/1,852,228, 3.14% of overall patients, respectively). The model had an area under the curve of 0.702 (95% CI 0.699-0.705) in predicting prospective social needs in the overall study population. Previous social needs (odds ratio 3.285, 95% CI 3.237-3.335) and emergency department visits (odds ratio 1.659, 95% CI 1.634-1.684) were the strongest predictors of future social needs. Conclusions: Our model provides an opportunity to make use of available EHR data to help identify patients with high social needs. Our proposed social risk score could help identify the subset of patients who would most benefit from further social needs screening and data collection to avoid potentially more burdensome primary data collection on all patients in a target population of interest. %M 38470477 %R 10.2196/54732 %U https://formative.jmir.org/2024/1/e54732 %U https://doi.org/10.2196/54732 %U http://www.ncbi.nlm.nih.gov/pubmed/38470477 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50012 %T Media Use Behavior Mediates the Association Between Family Health and Intention to Use Mobile Health Devices Among Older Adults: Cross-Sectional Study %A Chang,Jinghui %A Mai,Yanshan %A Zhang,Dayi %A Yang,Xixi %A Li,Anqi %A Yan,Wende %A Wu,Yibo %A Chen,Jiangyun %+ School of Health Management, Southern Medical University, Number 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, China, 86 1 858 822 0304, cjy112@i.smu.edu.cn %K older adults %K family health %K media use %K intention to use mobile health devices %K China %D 2024 %7 19.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the advent of a new era for health and medical treatment, characterized by the integration of mobile technology, a significant digital divide has surfaced, particularly in the engagement of older individuals with mobile health (mHealth). The health of a family is intricately connected to the well-being of its members, and the use of media plays a crucial role in facilitating mHealth care. Therefore, it is important to examine the mediating role of media use behavior in the connection between the family health of older individuals and their inclination to use mHealth devices. Objective: This study aims to investigate the impact of family health and media use behavior on the intention of older individuals to use mHealth devices in China. The study aims to delve into the intricate dynamics to determine whether media use behavior serves as a mediator in the relationship between family health and the intention to use mHealth devices among older adults. The ultimate goal is to offer well-founded and practical recommendations to assist older individuals in overcoming the digital divide. Methods: The study used data from 3712 individuals aged 60 and above, sourced from the 2022 Psychology and Behavior Investigation of Chinese Residents study. Linear regression models were used to assess the relationships between family health, media use behavior, and the intention to use mHealth devices. To investigate the mediating role of media use behavior, we used the Sobel-Goodman Mediation Test. This analysis focused on the connection between 4 dimensions of family health and the intention to use mHealth devices. Results: A positive correlation was observed among family health, media use behavior, and the intention to use mHealth devices (r=0.077-0.178, P<.001). Notably, media use behavior was identified as a partial mediator in the relationship between the overall score of family health and the intention to use mHealth devices, as indicated by the Sobel test (z=5.451, P<.001). Subgroup analysis further indicated that a complete mediating effect was observed specifically between family health resources and the intention to use mHealth devices in older individuals with varying education levels. Conclusions: The study revealed the significance of family health and media use behavior in motivating older adults to adopt mHealth devices. Media use behavior was identified as a mediator in the connection between family health and the intention to use mHealth devices, with more intricate dynamics observed among older adults with lower education levels. Going forward, the critical role of home health resources must be maximized, such as initiatives to develop digital education tailored for older adults and the creation of media products specifically designed for them. These measures aim to alleviate technological challenges associated with using media devices among older adults, ultimately bolstering their inclination to adopt mHealth devices. %M 38373031 %R 10.2196/50012 %U https://www.jmir.org/2024/1/e50012 %U https://doi.org/10.2196/50012 %U http://www.ncbi.nlm.nih.gov/pubmed/38373031 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51510 %T Health Care Professionals’ Experiences With a Mobile Self-Care Solution for Low Complex Orthopedic Injuries: Mixed Methods Study %A Spierings,Jelle %A Willinge,Gijs %A Kokke,Marike %A Twigt,Bas %A de Lange,Wendela %A Geerdink,Thijs %A van der Velde,Detlef %A Repping,Sjoerd %A Goslings,Carel %+ Department of Traumasurgery, St Antonius Hospital, Soestwetering 1, Utrecht, 3543AZ, Netherlands, 31 883203000, j.spierings@antoniusziekenhuis.nl %K application %K direct discharge %K eHealth %K experience %K healthcare professional %K mixed method study %K orthopaedic surgery %K orthopaedic %K policy %K policymaker %K self-care application %K self-care %K trauma surgery %K utilization %K virtual fracture clinic %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To cope with the rising number of patients with trauma in an already constrained Dutch health care system, Direct Discharge (DD) has been introduced in over 25 hospitals in the Netherlands since 2019. With DD, no routine follow-up appointments are scheduled after the emergency department (ED) visit, and patients are supported through information leaflets, a smartphone app, and a telephone helpline. DD reduces secondary health care use, with comparable patient satisfaction and primary health care use. Currently, little is known about the experiences of in-hospital health care professionals with DD. Objective: The aim of this study was to explore the experiences of health care professionals with the DD protocol to enhance durable adoption and improve the protocol. Methods: We conducted a mixed methods study parallel to the implementation of DD in 3 hospitals. Data were collected through a preimplementation survey, a postimplementation survey, and semistructured interviews. Quantitative data were reported descriptively, and qualitative data were reported using thematic analysis. Outcomes included the Bowen feasibility parameters: implementation, acceptability, preliminary efficacy, demand, and applicability. Preimplementation expectations were compared with postimplementation experiences. Health care professionals involved in the daily clinical care of patients with low-complex, stable injuries were eligible for this study. Results: Of the 217 eligible health care professionals, 128 started the primary survey, 37 completed both surveys (response rate of 17%), and 15 participated in semistructured interviews. Health care professionals expressed satisfaction with the DD protocol (median 7.8, IQR 6.8-8.9) on a 10-point scale, with 82% (30/37) of participants noting improved information quality and uniformity and 73% (27/37) of patients perceiving reduced outpatient follow-up and imaging. DD was perceived as safe by 79% (28/37) of participants in its current form, but a feedback system to reassure health care professionals that patients had recovered adequately was suggested to improve DD. The introduction of DD had varying effects on workload and job satisfaction among different occupations. Health care professionals expressed intentions to continue using DD due to increased efficiency, patient empowerment, and self-management. Conclusions: Health care professionals perceive DD as an acceptable, applicable, safe, and efficacious alternative to traditional treatment. A numerical in-app feedback system (eg, in-app communication tools or recovery scores) could alleviate health care professionals’ concerns about adequate recovery and further improve DD protocols. DD can reduce health care use, which is important in times of constrained resources. Nonetheless, both advantages and disadvantages should be considered while evaluating this type of treatment. In the future, clinicians and policy makers can use these insights to further optimize and implement DD in clinical practice and guidelines. %M 38306162 %R 10.2196/51510 %U https://mhealth.jmir.org/2024/1/e51510 %U https://doi.org/10.2196/51510 %U http://www.ncbi.nlm.nih.gov/pubmed/38306162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52560 %T Mental Health and Well-Being in Racial or Ethnic Minority Individuals After Using a Faith and Prayer Mobile App (Pray.com): Feasibility and Preliminary Efficacy Trial %A Laird,Breanne %A Zuniga,Sabrina %A Hook,Joshua N %A Van Tongeren,Daryl R %A Joeman,Lynda %A Huberty,Jennifer %+ Pray, Inc, 4607 Lakeview Canyon Rd #456, Westlack Village, CA, 91361, United States, 1 9095574002, breanne.laird@pray.com %K religion %K spirituality %K mobile apps %K mental health %K well-being %K app %K ethnic %K technology %K engagement %K stress %K depression %K anxiety %K quality of life %K spiritual well-being %K racial %K spiritual practices %K spiritual practice %K mobile phone %K mobile health %K mHealth %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research is needed on how faith and prayer apps fit within the values of racial and ethnic minority (REM) groups, as well as whether such apps are effective in promoting mental health and well-being. Objective: This study aims to determine the feasibility and preliminary effectiveness of using the mobile app Pray.com on mental health and well-being among REM participants. Methods: This study was a single-group (N=77), 4-week feasibility trial in REM groups (65/77, 84% Black or African American). Participants were asked to use the Pray.com app at no cost for at least 5 times per week for 5 minutes per day. Participants completed questionnaires at the baseline and postintervention time points. Feasibility questionnaires were only completed at the postintervention time point, including qualitative interviews (n=15). The feasibility questions included acceptability (ie, satisfaction, intent to continue use, perceived appropriateness, and fit within culture), demand (ie, self-reported app use, expressed interest, and perceived demand), and practicality (ie, ease or difficulty of use, ability to use the app, and cost-effectiveness). Frequency and descriptive statistics were used to analyze feasibility outcomes. Changes in dependent variables were analyzed using paired-sample 2-tailed t tests. Partial correlations were conducted to explore the association between app use and outcomes, controlling for baseline scores. Results: Participants reported (54/72, 75% responded with “very likely” or “likely” to the feasibility questions) that they perceived the Pray.com app as acceptable. These findings were supported by qualitative interviews (n=15). Most participants (62/72, 86%) did not meet the app use prescription but expressed interest in using the app in the future and perceived demand for it in their communities. In addition, participants reported that the app was easy to use and perceived it to be inexpensive (US $7.99). Participants reported improved mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) at postintervention despite relatively low average levels and high variability of app use (average total of 45.83, SD 111.90 min over the course of the study). Greater app use was significantly associated with improvements in mental health and spiritual well-being. However, app use and study methodology limitations suggest that the study results may not accurately capture the full impact of Pray.com use. Conclusions: This is the first study to assess the feasibility of a faith and prayer app for mental health and well-being in a sample of REM individuals. Our findings suggest that the use of a faith and prayer app (ie, Pray.com) could be feasible and significantly impactful for the improvement of mental health symptoms and well-being in REM individuals and their communities, especially Black and African American individuals with a Christian affiliation. Further research is warranted. %M 38306173 %R 10.2196/52560 %U https://formative.jmir.org/2024/1/e52560 %U https://doi.org/10.2196/52560 %U http://www.ncbi.nlm.nih.gov/pubmed/38306173 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e47321 %T Use and Engagement With Low-Intensity Cognitive Behavioral Therapy Techniques Used Within an App to Support Worry Management: Content Analysis of Log Data %A Farrand,Paul %A Raue,Patrick J %A Ward,Earlise %A Repper,Dean %A Areán,Patricia %+ Clinical Education, Development and Research, Faculty of Health and Life Sciences, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Reserach, Perry Road, Exeter, EX4 4QG, United Kingdom, 44 01392725793, p.a.farrand@exeter.ac.uk %K cognitive behavioral therapy %K low-intensity %K mCBT %K app %K log data %K worry management %K CBT %K management %K application %K therapy %K implementation %K treatment %K symptoms %K anxiety %K worry %K engagement %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low-intensity cognitive behavioral therapy (LICBT) has been implemented by the Improving Access to Psychological Therapies services across England to manage excessive worry associated with generalized anxiety disorder and support emotional well-being. However, barriers to access limit scalability. A solution has been to incorporate LICBT techniques derived from an evidence-based protocol within the Iona Mind Well-being app for Worry management (IMWW) with support provided through an algorithmically driven conversational agent. Objective: This study aims to examine engagement with a mobile phone app to support worry management with specific attention directed toward interaction with specific LICBT techniques and examine the potential to reduce symptoms of anxiety. Methods: Log data were examined with respect to a sample of “engaged” users who had completed at least 1 lesson related to the Worry Time and Problem Solving in-app modules that represented the “minimum dose.” Paired sample 2-tailed t tests were undertaken to examine the potential for IMWW to reduce worry and anxiety, with multivariate linear regressions examining the extent to which completion of each of the techniques led to reductions in worry and anxiety. Results: There was good engagement with the range of specific LICBT techniques included within IMWW. The vast majority of engaged users were able to interact with the cognitive behavioral therapy model and successfully record types of worry. When working through Problem Solving, the conversational agent was successfully used to support the user with lower levels of engagement. Several users engaged with Worry Time outside of the app. Forgetting to use the app was the most common reason for lack of engagement, with features of the app such as completion of routine outcome measures and weekly reflections having lower levels of engagement. Despite difficulties in the collection of end point data, there was a significant reduction in severity for both anxiety (t53=5.5; P<.001; 95% CI 2.4-5.2) and low mood (t53=2.3; P=.03; 95% CI 0.2-3.3). A statistically significant linear model was also fitted to the Generalized Anxiety Disorder–7 (F2,51=6.73; P<.001), while the model predicting changes in the Patient Health Questionnaire–8 did not reach significance (F2,51=2.33; P=.11). This indicates that the reduction in these measures was affected by in-app engagement with Worry Time and Problem Solving. Conclusions: Engaged users were able to successfully interact with the LICBT-specific techniques informed by an evidence-based protocol although there were lower completion rates of routine outcome measures and weekly reflections. Successful interaction with the specific techniques potentially contributes to promising data, indicating that IMWW may be effective in the management of excessive worry. A relationship between dose and improvement justifies the use of log data to inform future developments. However, attention needs to be directed toward enhancing interaction with wider features of the app given that larger improvements were associated with greater engagement. %M 38029300 %R 10.2196/47321 %U https://mhealth.jmir.org/2024/1/e47321 %U https://doi.org/10.2196/47321 %U http://www.ncbi.nlm.nih.gov/pubmed/38029300 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e46656 %T The Association of eHealth Literacy Skills and mHealth Application Use Among US Adults With Obesity: Analysis of Health Information National Trends Survey Data %A Shaw Jr,George %A Castro,Bianca A %A Gunn,Laura H %A Norris,Keith %A Thorpe Jr,Roland J %+ Department of Public Health Sciences, School of Data Science, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223-0001, United States, 1 7045620021, gshaw11@charlotte.edu %K accessibility %K eHealth literacy %K mHealth %K multivariable logistic regression %K obesity %K smartphones %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use. Objective: The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (≥18 years of age) with obesity (BMI ≥30 kg/m2). Methods: Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95% CI. Results: A majority of respondents were female (550/923, 59.6%) or non-Hispanic White (543/923, 58.8%). Individuals in households earning less than US $50,000 comprised 41.4% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor’s office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ≥7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees. Conclusions: This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps. %M 38198196 %R 10.2196/46656 %U https://mhealth.jmir.org/2024/1/e46656 %U https://doi.org/10.2196/46656 %U http://www.ncbi.nlm.nih.gov/pubmed/38198196 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46277 %T Association Between the Composite Cardiovascular Risk and mHealth Use Among Adults in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study %A Chen,Yuling %A Turkson-Ocran,Ruth-Alma %A Koirala,Binu %A Davidson,Patricia M %A Commodore-Mensah,Yvonne %A Himmelfarb,Cheryl Dennison %+ Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, United States, 1 443 514 7323, chimmelfarb@jhu.edu %K mobile health %K usage %K cardiovascular risk %K association %K mobile phone %D 2024 %7 4.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous studies have suggested that the relationship between cardiovascular disease (CVD) risk and the usage of mobile health (mHealth) technology may vary depending on the total number of CVD risk factors present. However, whether higher CVD risk is associated with a greater likelihood of engaging in specific mHealth use among US adults is currently unknown. Objective: We aim to assess the associations between the composite CVD risk and each component of mHealth use among US adults regardless of whether they have a history of CVD or not. Methods: This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey. The exposure was CVD risk (diabetes, hypertension, smoking, physical inactivity, and overweight or obesity). We defined low, moderate, and high CVD risk as having 0-1, 2-3, and 4-5 CVD risk factors, respectively. The outcome variables of interest were each component of mHealth use, including using mHealth to make health decisions, track health progress, share health information, and discuss health decisions with health providers. We used multivariable logistic regression models to examine the association between CVD risk and mHealth use adjusted for demographic factors. Results: We included 10,531 adults, with a mean age of 54 (SD 16.2) years. Among the included participants, 50.2% were men, 65.4% were non-Hispanic White, 41.9% used mHealth to make health decisions, 50.8% used mHealth to track health progress toward a health-related goal, 18.3% used mHealth to share health information with health providers, and 37.7% used mHealth to discuss health decisions with health providers (all are weighted percentages). Adults with moderate CVD risk were more likely to use mHealth to share health information with health providers (adjusted odds ratio 1.49, 95% CI 1.24-1.80) and discuss health decisions with health providers (1.22, 95% CI 1.04-1.44) compared to those with low CVD risk. Similarly, having high CVD risk was associated with higher odds of using mHealth to share health information with health providers (2.61, 95% CI 1.93-3.54) and discuss health decisions with health providers (1.56, 95% CI 1.17-2.10) compared to those with low CVD risk. Upon stratifying by age and gender, we observed age and gender disparities in the relationship between CVD risk and the usage of mHealth to discuss health decisions with health providers. Conclusions: Adults with a greater number of CVD risk factors were more likely to use mHealth to share health information with health providers and discuss health decisions with health providers. These findings suggest a promising avenue for enhancing health care communication and advancing both primary and secondary prevention efforts related to managing CVD risk factors through the effective usage of mHealth technology. %M 38175685 %R 10.2196/46277 %U https://www.jmir.org/2024/1/e46277 %U https://doi.org/10.2196/46277 %U http://www.ncbi.nlm.nih.gov/pubmed/38175685 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e53268 %T A Brief, Digital Music-Based Mindfulness Intervention for Black Americans With Elevated Race-Based Anxiety and Little-to-No Meditation Experience (“healing attempt"): Replication and Extension Study %A Jones,Grant %A Castro-Ramirez,Franchesca %A Al-Suwaidi,Maha %A McGuire,Taylor %A Herrmann,Felipe %+ Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, United States, gmj005@g.harvard.edu %K Black music %K mindfulness %K meditation %K music %K song %K psychotherapy %K self-compassion %K ethnic %K cultural %K single-case experiment %K race %K anxiety %K digital health intervention %K Black %K digital health %K low income %K racial disparity %K mental health %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Race-based anxiety is a critical health issue within the Black community. Mindfulness interventions hold promise for treating race-based anxiety in Black Americans; however, there are many barriers that prevent Black Americans from using these treatments, such as low cultural relevance, significant time burdens, and excessive costs. Objective: This study is a replication and extension of findings that “healing attempt”—a brief (<60-minute), digital, music-based mindfulness intervention—is a feasible and acceptable intervention for race-based anxiety in Black Americans. In this study, we tested this research question among those with little-to-no meditation experience. Methods: The participants were 4 Black American adults with elevated race-based trait anxiety and little-to-no meditation experience. We used a series of multiple-baseline single-case experiments and conducted study visits on Zoom (Zoom Video Communications) to assess whether the intervention can decrease state anxiety and increase mindfulness and self-compassion in Black Americans. We also assessed feasibility and acceptability using quantitative and qualitative scales. Results: In line with our hypotheses, “healing attempt” increased mindfulness/self-compassion (Tau-U range: 0.57-0.86; P<.001) and decreased state anxiety (Tau-U range: –0.93 to –0.66; P<.001), with high feasibility and acceptability (the average likelihood of recommending “healing attempt” was 88 out of 100). Conclusions: “healing attempt” may represent a feasible intervention for race-based anxiety in Black Americans with elevated race-based anxiety and little or no mindfulness experience. Future between-subjects randomized feasibility trials can assess whether the intervention can give rise to lasting improvements in race-based anxiety, mindfulness, and self-compassion. Trial Registration: OSF Registries osf.io/k5m93; https://osf.io/k5m93 %M 37999941 %R 10.2196/53268 %U https://formative.jmir.org/2023/1/e53268 %U https://doi.org/10.2196/53268 %U http://www.ncbi.nlm.nih.gov/pubmed/37999941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48864 %T Digitally Enabled Peer Support Intervention to Address Loneliness and Mental Health: Prospective Cohort Analysis %A Bravata,Dena M %A Kim,Joseph %A Russell,Daniel W %A Goldman,Ron %A Pace,Elizabeth %+ Department of Human Development & Family Studies, Iowa State University, 86 Lebaron Hall, Ames, IA, 50011, United States, 1 515 294 6316, jkim7@iastate.edu %K peer-support %K social isolation %K loneliness %K companionship %K depression %K anxiety %K quality of life %K occupational health %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Social isolation and loneliness affect 61% of US adults and are associated with significant increases in excessive mental and physical morbidity and mortality. Annual health care spending is US $1643 higher for socially isolated individuals than for those not socially isolated. Objective: We prospectively evaluated the effects of participation with a digitally enabled peer support intervention on loneliness, depression, anxiety, and health-related quality of life among adults with loneliness. Methods: Adults aged 18 years and older living in Colorado were recruited to participate in a peer support program via social media campaigns. The intervention included peer support, group coaching, the ability to become a peer helper, and referral to other behavioral health resources. Participants were asked to complete surveys at baseline, 30, 60, and 90 days, which included questions from the validated University of California, Los Angeles Loneliness Scale, Patient Health Questionnaire 2-Item Scale, General Anxiety Disorder 7-Item Scale, and a 2-item measure assessing unhealthy days due to physical condition and mental condition. A growth curve modeling procedure using multilevel regression analyses was conducted to test for linear changes in the outcome variables from baseline to the end of the intervention. Results: In total, 815 ethnically and socially diverse participants completed registration (mean age 38, SD 12.7; range 18-70 years; female: n=310, 38%; White: n=438, 53.7%; Hispanic: n=133, 16.3%; Black: n=51, 6.3%; n=263, 56.1% had a high social vulnerability score). Participants most commonly joined the following peer communities: loneliness (n=220, 27%), building self-esteem (n=187, 23%), coping with depression (n=179, 22%), and anxiety (n=114, 14%). Program engagement was high, with 90% (n=733) engaged with the platform at 60 days and 86% (n=701) at 90 days. There was a statistically (P<.001 for all outcomes) and clinically significant improvement in all clinical outcomes of interest: a 14.6% (mean 6.47) decrease in loneliness at 90 days; a 50.1% (mean 1.89) decline in depression symptoms at 90 days; a 29% (mean 1.42) reduction in anxiety symptoms at 90 days; and a 13% (mean 21.35) improvement in health-related quality of life at 90 days. Based on changes in health-related quality of life, we estimated a reduction in annual medical costs of US $615 per participant. The program was successful in referring participants to behavioral health educational resources, with 27% (n=217) of participants accessing a resource about how to best support those experiencing psychological distress and 15% (n=45) of women accessing a program about the risks of excessive alcohol use. Conclusions: Our results suggest that a digitally enabled peer support program can be effective in addressing loneliness, depression, anxiety, and health-related quality of life among a diverse population of adults with loneliness. Moreover, it holds promise as a tool for identifying and referring members to relevant behavioral health resources. %M 37930770 %R 10.2196/48864 %U https://formative.jmir.org/2023/1/e48864 %U https://doi.org/10.2196/48864 %U http://www.ncbi.nlm.nih.gov/pubmed/37930770 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50584 %T Amplifying Older Aboriginal and Torres Strait Islander Women’s Perspectives to Promote Digital Health Equity: Co-Designed Qualitative Study %A Henson,Connie %A Chapman,Felicity %A Shepherd,Gina %A Carlson,Bronwyn %A Rambaldini,Boe %A Gwynne,Kylie %+ Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Rm 422 Walanga Muru, 6 First Walk, Macquarie University, 2113, Australia, 61 410598585, connie.henson@mq.edu.au %K digital health %K Aboriginal and Torres Strait Islander %K Indigenous %K health technology %K co-design %K cultural safety %K older Indigenous women %K social media %K wearables %K mobile phone %D 2023 %7 17.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health is becoming ubiquitous, and we must ensure equity in access. Indigenous people across most high-income countries typically have not benefited as much as other citizens from usual health care systems and technologies. Despite Aboriginal and Torres Strait Islander people’s clear interest in, and enthusiastic use of, new technologies, little research has examined the needs or interests of older Aboriginal and Torres Strait Islander women. Objective: This study prioritizes the perspectives of older Aboriginal and Torres Strait Islander women, tapping into their expertise associated with Indigenous ways of knowing, being, and doing, as well as their unique position within their families and communities, to design a model for using digital technologies to improve health for themselves and their families as well as their communities. Methods: Older Aboriginal and Torres Strait Islander women from 4 partner organizations were recruited for this study. This co-designed qualitative research included citizen scientists in shaping the protocol as well as collecting, analyzing, and interpreting data. We used yarning, an Indigenous research method validated for use in health research with Indigenous people and seen as respectful and culturally safe, as a primary research tool. The use of Indigenous methodologies and our iterative process enabled us to deeply explore and incorporate perspectives from all participants and ensure that the perspectives of Indigenous citizen scientists with lived experience were privileged. The data-checking methods also used a yarning methodology, which ensured that the findings and translational model derived from the findings were validated by the participants. Results: Participants comprised 24 Aboriginal and Torres Strait Islander women aged ≥41 years and including 3 generations that did not grow up with the internet: seniors, baby boomers, and Generation X. The key findings in this research were that older women use various digital technologies to improve health and well-being for themselves and their families as well as their communities. Older Aboriginal women want a culturally sensitive cyberspace that caters specifically to their needs and includes relevant content and functionality that are accessible and efficient. Our translational model highlights the conditions necessary for anyone to use digital health technologies, summarizes the essential elements needed to promote equity in digital health, and illuminates the unmet needs and requirements for older Aboriginal and Torres Strait Islander women to fully benefit from digital health technologies. Conclusions: Health is a fundamental right. As we move toward greater reliance on digital health solutions, we must recognize and address the concerns of the smaller populations of people who differ in their needs. We must urgently address the financial, connectivity, and other limiting factors highlighted by older Aboriginal and Torres Strait Islander women in this study that limit equitable access to digital health tools. International Registered Report Identifier (IRRID): RR2-10.1177/20552076221084469 %M 37847550 %R 10.2196/50584 %U https://www.jmir.org/2023/1/e50584 %U https://doi.org/10.2196/50584 %U http://www.ncbi.nlm.nih.gov/pubmed/37847550 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46473 %T Engagement, Satisfaction, and Mental Health Outcomes Across Different Residential Subgroup Users of a Digital Mental Health Relational Agent: Exploratory Single-Arm Study %A Forman-Hoffman,Valerie L %A Pirner,Maddison C %A Flom,Megan %A Kirvin-Quamme,Andrew %A Durden,Emily %A Kissinger,Jennifer A %A Robinson,Athena %+ Woebot Health, 535 Mission Street, 14th Floor, San Francisco, CA, 94105, United States, 1 415 273 9742, valerie_hoffman@woebothealth.com %K adoption %K anxiety %K chatbot %K cognitive behavioral therapy %K conversational agent %K CBT %K depression %K digital health %K medically underserved area %K mental health %K mhealth %K mobile app %K mobile health %K mobile phone %K mood %K psychotherapy %K relational agent %K rural %K satisfaction %K smartphone app %K smartphone %K underserved %K usage %K vulnerable %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental illness is a pervasive worldwide public health issue. Residentially vulnerable populations, such as those living in rural medically underserved areas (MUAs) or mental health provider shortage areas (MHPSAs), face unique access barriers to mental health care. Despite the growth of digital mental health interventions using relational agent technology, little is known about their use patterns, efficacy, and favorability among residentially vulnerable populations. Objective: This study aimed to explore differences in app use, therapeutic alliance, mental health outcomes, and satisfaction across residential subgroups (metropolitan, nonmetropolitan, or rural), MUAs (yes or no), and MHPSAs (yes or no) among users of a smartphone-based, digital mental health intervention, Woebot LIFE (WB-LIFE). WB-LIFE was designed to help users better understand and manage their moods and features a relational agent, Woebot, that converses through text-based messages. Methods: We used an exploratory study that examined data from 255 adults enrolled in an 8-week, single-arm trial of WB-LIFE. Analyses compared levels of app use and therapeutic alliance total scores as well as subscales (goal, task, and bond), mental health outcomes (depressive and anxiety symptoms, stress, resilience, and burnout), and program satisfaction across residential subgroups. Results: Few study participants resided in nonmetropolitan (25/255, 10%) or rural (3/255, 1%) areas, precluding estimates across this variable. Despite a largely metropolitan sample, nearly 39% (99/255) resided in an MUA and 55% (141/255) in an MHPSA. There were no significant differences in app use or satisfaction by MUA or MHPSA status. There also were no differences in depressive symptoms, anxiety, stress, resilience, or burnout, with the exception of MUA participants having higher baseline depressive symptoms among those starting in the moderate range or higher (Patient Health Questionnaire-8 item scale≥10) than non-MUA participants (mean 16.50 vs 14.41, respectively; P=.01). Although working alliance scores did not differ by MHPSA status, those who resided in an MUA had higher goal (2-tailed t203.47=2.21; P=.03), and bond (t203.47=1.94; P=.05) scores at day 3 (t192.98=2.15; P=.03), and higher goal scores at week 8 (t186.19=2.28; P=.02) as compared with those not living in an MUA. Conclusions: Despite the study not recruiting many participants from rural or nonmetropolitan populations, sizable proportions resided in an MUA or an MHPSA. Analyses revealed few differences in app use, therapeutic alliance, mental health outcomes (including baseline levels), or satisfaction across MUA or MHPSA status over the 8-week study. Findings suggest that vulnerable residential populations may benefit from using digital agent–guided cognitive behavioral therapy. Trial Registration: ClinicalTrials.gov NCT05672745; https://clinicaltrials.gov/study/NCT05672745 %M 37756047 %R 10.2196/46473 %U https://formative.jmir.org/2023/1/e46473 %U https://doi.org/10.2196/46473 %U http://www.ncbi.nlm.nih.gov/pubmed/37756047 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47566 %T Racial Disparities in Shared Decision-Making and the Use of mHealth Technology Among Adults With Hypertension in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study in the United States %A Chen,Yuling %A Kruahong,Suratsawadee %A Elias,Sabrina %A Turkson-Ocran,Ruth-Alma %A Commodore-Mensah,Yvonne %A Koirala,Binu %A Himmelfarb,Cheryl R Dennison %+ Johns Hopkins School of Nursing, 525 N Wolfe St, Baltimore, MD, 21215, United States, ychen408@jh.edu %K mobile health %K disparities %K shared decision-making %K hypertension %K association %K decision-making %K mHealth %K technology %K health disparity %K adult %K smartphone %K racial %K ethnic %K health literacy %K digital literacy %D 2023 %7 13.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) technology has the potential to support shared decision-making (SDM) and improve hypertension control. However, our understanding of the variations in individuals’ involvement in SDM and mHealth usage across different racial and ethnic groups in the United States is still limited. Objective: This study aimed to investigate the extent of involvement in SDM and the usage of mHealth technology in health-related activities among US adults with hypertension from diverse racial and ethnic backgrounds and to examine whether the mHealth usage differed by individuals’ level of engagement in SDM. Methods: This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey, which was conducted on US adults with self-reported hypertension, and race and ethnicity data were included. The exposure of interest was race and ethnicity. The outcomes were SDM and mHealth usage. SDM was assessed using an item: “In the past 12 months, how often did your health professional: involve you in decisions about your healthcare as much as you wanted?” mHealth usage was defined as using a smartphone or tablet to engage in (1) making health decisions, (2) discussing health decisions with health providers, (3) tracking health progress, and (4) sharing health information. Weighted multivariable logistic regression models were used to examine the association between race and ethnicity and SDM or mHealth usage adjusted for covariates and stratified by the level of engagement in SDM. Results: This study included 4893 adults with hypertension, and the mean age was 61 (SD 13) years. The sample was 53% female, 61% (n=3006) non-Hispanic White, 19% (n=907) non-Hispanic Black or African American, 12% (n=605) Hispanic, 4% (n=193) non-Hispanic Asian, and 4% (n=182) non-Hispanic other. Compared to the non-Hispanic White adults, non-Hispanic Black adults were more likely to use mHealth to make health decisions (adjusted odds ratio [aOR] 1.70, 95% CI 1.23-2.34), share health information (aOR 1.46, 95% CI 1.02-2.08), and discuss health decisions with health providers (aOR 1.38, 95% CI 1.02-1.87). Significant associations were observed specifically among those who were always involved in SDM. Asian adults were less likely to be involved in SDM (aOR 0.51, 95% CI 0.26-0.99) and were more likely to use mHealth to track progress on a health-related goal (aOR 2.07, 95% CI 1.28-3.34) than non-Hispanic White adults. Hispanic adults were less likely to use mHealth to share health information (aOR 0.47, 95% CI 0.33-0.67) and discuss health decisions with health providers (aOR 0.65, 95% CI 0.46-0.94) compared to non-Hispanic White adults. Conclusions: This study observed racial and ethnic disparities in SDM and mHealth usage among US adults with hypertension. These findings emphasize the significance of comprehending the involvement of SDM and the usage of mHealth technology within racially and ethnically diverse populations. %M 37703088 %R 10.2196/47566 %U https://www.jmir.org/2023/1/e47566 %U https://doi.org/10.2196/47566 %U http://www.ncbi.nlm.nih.gov/pubmed/37703088 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44981 %T The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study %A Mai,Feng %A Ko,Dong-Gil %A Shan,Zhe %A Zhang,Dawei %+ Department of Information Systems and Analytics, Miami University, 800 E High St, Rm 3035, Oxford, OH, 45056, United States, 1 (513) 529 2135, shanz3@miamioh.edu %K digital divide %K race %K health care %K patient portal %K mobile health %K accelerated digitization %K COVID-19 %K mobile phone %D 2023 %7 9.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected. Objective: We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19–induced digital acceleration? Does the effect differ across racial lines? Methods: We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE). Results: Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, β=−.158; P<.001; RE, β=−.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, β=.028; P=.002; RE, β=.037; P<.001; FE, β=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, β=−.020; P=.02; mobile, β=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, β=−.004; P<.001; RE, β=−.004; P<.001; FE, β=−.003; P=.001). Conclusions: Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world. %M 37384810 %R 10.2196/44981 %U https://www.jmir.org/2023/1/e44981 %U https://doi.org/10.2196/44981 %U http://www.ncbi.nlm.nih.gov/pubmed/37384810 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41815 %T Trajectories of Symptoms in Digital Interventions for Depression and Anxiety Using Routine Outcome Monitoring Data: Secondary Analysis Study %A Cumpanasoiu,Diana Catalina %A Enrique,Angel %A Palacios,Jorge E %A Duffy,Daniel %A McNamara,Scott %A Richards,Derek %+ SilverCloud Science, SilverCloud Health, One Stephen Street Upper, Dublin, D08 DR9P, Ireland, 353 6467031051, catalina.cumpanasoiu@amwell.com %K internet-delivered cognitive behavioral therapy %K iCBT %K depression %K anxiety %K trajectory of symptom change %K routine outcome monitoring data %D 2023 %7 12.7.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research suggests there is heterogeneity in treatment response for internet-delivered cognitive behavioral therapy (iCBT) users, but few studies have investigated the trajectory of individual symptom change across iCBT treatment. Large patient data sets using routine outcome measures allows the investigation of treatment effects over time as well as the relationship between outcomes and platform use. Understanding trajectories of symptom change, as well as associated characteristics, may prove important for tailoring interventions or identifying patients who may not benefit from the intervention. Objective: We aimed to identify latent trajectories of symptom change during the iCBT treatment course for depression and anxiety and to investigate the patients’ characteristics and platform use for each of these classes. Methods: This is a secondary analysis of data from a randomized controlled trial designed to examine the effectiveness of guided iCBT for anxiety and depression in the UK Improving Access to Psychological Therapies (IAPT) program. This study included patients from the intervention group (N=256) and followed a longitudinal retrospective design. As part of the IAPT’s routine outcome monitoring system, patients were prompted to complete the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) after each supporter review during the treatment period. Latent class growth analysis was used to identify the underlying trajectories of symptom change across the treatment period for both depression and anxiety. Differences in patient characteristics were then evaluated between these trajectory classes, and the presence of a time-varying relationship between platform use and trajectory classes was investigated. Results: Five-class models were identified as optimal for both PHQ-9 and GAD-7. Around two-thirds (PHQ-9: 155/221, 70.1%; GAD-7: 156/221, 70.6%) of the sample formed various trajectories of improvement classes that differed in baseline score, the pace of symptom change, and final clinical outcome score. The remaining patients were in 2 smaller groups: one that saw minimal to no gains and another with consistently high scores across the treatment journey. Baseline severity, medication status, and program assigned were significantly associated (P<.001) with different trajectories. Although we did not find a time-varying relationship between use and trajectory classes, we found an overall effect of time on platform use, suggesting that all participants used the intervention significantly more in the first 4 weeks (P<.001). Conclusions: Most patients benefit from treatment, and the various patterns of improvement have implications for how the iCBT intervention is delivered. Identifying predictors of nonresponse or early response might inform the level of support and monitoring required for different types of patients. Further work is necessary to explore the differences between these trajectories to understand what works best for whom and to identify early on those patients who are less likely to benefit from treatment. %M 37436812 %R 10.2196/41815 %U https://mhealth.jmir.org/2023/1/e41815 %U https://doi.org/10.2196/41815 %U http://www.ncbi.nlm.nih.gov/pubmed/37436812 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45414 %T Usage and Daily Attrition of a Smartphone-Based Health Behavior Intervention: Randomized Controlled Trial %A Egilsson,Erlendur %A Bjarnason,Ragnar %A Njardvik,Urdur %+ Department of Psychology, University of Iceland, Saemundargata 12, Reykjavik, 102, Iceland, 354 5254240, erlendu@hi.is %K mHealth intervention %K mobile health %K adolescent %K attrition %K mental health %K physical activity %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although most adolescents have access to smartphones, few of them use mobile health (mHealth) apps for health improvement, highlighting the apparent lack of interest in mHealth apps among adolescents. Adolescent mHealth interventions have been burdened with high attrition rates. Research on these interventions among adolescents has frequently lacked detailed time-related attrition data alongside analysis of attrition reasons through usage. Objective: The objective was to obtain daily attrition rates among adolescents in an mHealth intervention to gain a deeper understanding of attrition patterns, including the role of motivational support, such as altruistic rewards, through analysis of app usage data. Methods: A randomized controlled trial was conducted with 304 adolescent participants (152 boys and 152 girls) aged 13-15 years. Based on 3 participating schools, participants were randomly assigned to control, treatment as usual (TAU), and intervention groups. Measures were obtained at baseline, continuously throughout the 42-day trial period (research groups), and at the trial end. The mHealth app is called SidekickHealth and is a social health game with the following 3 main categories: nutrition, mental health, and physical health. Primary measures were attrition based on time from launch, and the type, frequency, and time of health behavior exercise usage. Outcome differences were obtained through comparison tests, while regression models and survival analyses were used for attrition measures. Results: Attrition differed significantly between the intervention and TAU groups (44.4% vs 94.3%; χ21=61.220; P<.001). The mean usage duration was 6.286 days in the TAU group and 24.975 days in the intervention group. In the intervention group, male participants were active significantly longer than female participants (29.155 vs 20.433 days; χ21=6.574; P<.001). Participants in the intervention group completed a larger number of health exercises in all trial weeks, and a significant decrease in usage was observed from the first to second week in the TAU group (t105=9.208; P<.001) but not in the intervention group. There was a significant increase in health exercises in the intervention group from the fifth to sixth week (t105=3.446; P<.001). Such a significant increase in usage was not evident in the TAU group. The research group was significantly related to attrition time (hazard ratio 0.308, 95% CI 0.222-0.420), as well as the numbers of mental health exercises (P<.001) and nutrition exercises (P<.001). Conclusions: Differences in attrition rates and usage between groups of adolescents were identified. Motivational support is a significant factor for lowering attrition in adolescent mHealth interventions. The results point to sensitivity periods in the completion of diverse health tasks, and emphasis on time-specific attrition, along with the type, frequency, and time of health behavior exercise usage, is likely a fruitful avenue for further research on mHealth interventions for adolescent populations, in which attrition rates remain excessive. Trial Registration: ClinicalTrials.gov NCT05912439; https://clinicaltrials.gov/study/NCT05912439 %M 37358888 %R 10.2196/45414 %U https://mhealth.jmir.org/2023/1/e45414 %U https://doi.org/10.2196/45414 %U http://www.ncbi.nlm.nih.gov/pubmed/37358888 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45162 %T Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review %A Goodman,Andrew %A Mahoney,Ray %A Spurling,Geoffrey %A Lawler,Sheleigh %+ School of Public Health, The University of Queensland, 266 Herston Road, Turrbal, Jagera Country, Herston, 4006, Australia, 61 733655393, Andrew.Goodman@csiro.au %K mHealth %K Indigenous %K Canada %K Australia %K New Zealand %K United States %K Papua New Guinea %K Samoa %K qualitative %K systematic review %K feasibility %K acceptability %K users %K design %K workflow %D 2023 %7 23.6.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations. Objective: This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the Sápmi region of northern Europe. Methods: In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies. Results: Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients’ and service providers’ perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity. Conclusions: This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery. %M 37351947 %R 10.2196/45162 %U https://mhealth.jmir.org/2023/1/e45162 %U https://doi.org/10.2196/45162 %U http://www.ncbi.nlm.nih.gov/pubmed/37351947 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41919 %T Use and Acceptance of Smart Elderly Care Apps Among Chinese Medical Staff and Older Individuals: Web-Based Hybrid Survey Study %A Zhu,Jieting %A Weng,Huiting %A Ou,Peng %A Li,Lezhi %+ Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, China, 86 0731 85295888, lilezhi@csu.edu.cn %K smart elderly care app %K mobile health %K smartphone %D 2023 %7 13.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: With the advent of China’s aging population and the popularization of smartphones, there is a huge demand for smart elderly care apps. Along with older adults and their dependents, medical staff also need to use a health management platform to manage the health of patients. However, the development of health apps and the large and growing app market pose a problem of declining quality; in fact, important differences can be observed between apps, and patients currently do not have adequate information and formal evidence to discriminate among them. Objective: The aim of this study was to investigate the cognition and usage status of smart elderly care apps among older individuals and medical staff in China. Methods: From March 1, 2022, to March 30, 2022, we used the web survey tool Sojump to conduct snowball sampling through WeChat. The survey links were initially sent to communities in 23 representative major cities in China. We asked the medical staff of community clinics to post the survey link on their WeChat Moments. From April 1 to May 10, 2022, we contacted those who selected “Have used a smart elderly care app” in the questionnaire through WeChat for a request to participate in semistructured interviews. Participants provided informed consent in advance and interviews were scheduled. After the interviews, the audio recordings were transcribed into text and the emerging themes were analyzed and summarized. Results: A total of 810 individuals participated in this study, 54.8% (n=444) of whom were medical staff, 33.1% (n=268) were older people, and the remaining participants were certified nursing assistants (CNAs) and community workers. Overall, 60.5% (490/810) of the participants had used a smart elderly care app on their smartphone. Among the 444 medical staff who participated in the study, the vast majority (n=313, 70.5%) had never used a smart elderly care app, although 34.7% of them recommended elderly care–related apps to patients. Among the 542 medical staff, CNAs, and community workers that completed the questionnaire, only 68 (12.6%) had used a smart elderly care app. We further interviewed 23 people about their feelings and opinions about smart elderly care apps. Three themes emerged with eight subthemes, including functional design, operation interface, and data security. Conclusions: In this survey, there was a huge difference in the usage rate and demand for smart elderly care apps by the participants. Respondents are mainly concerned with app function settings, interface simplicity, and data security. %M 37310777 %R 10.2196/41919 %U https://formative.jmir.org/2023/1/e41919 %U https://doi.org/10.2196/41919 %U http://www.ncbi.nlm.nih.gov/pubmed/37310777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42097 %T Cervical Myelopathy and Social Media: Mixed Methods Analysis %A Elkaim,Lior M %A Levett,Jordan J %A Niazi,Farbod %A Alvi,Mohammed A %A Shlobin,Nathan A %A Linzey,Joseph R %A Robertson,Faith %A Bokhari,Rakan %A Alotaibi,Naif M %A Lasry,Oliver %+ Department of Neurology and Neurosurgery, McGill University, 1001 Boulevard Decarie, Montreal, QC, H4A 3J1, Canada, 1 5148392895, lior.elkaim@mail.mcgill.ca %K social media %K twitter %K cervical %K myelopathy %K spine %K neurological %K condition %K degenerative %K patient %K caretaker %K clinician %K researcher %K user %K tweets %K engagement %K online %K education %K support %D 2023 %7 22.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Degenerative cervical myelopathy (DCM) is a progressive neurologic condition caused by age-related degeneration of the cervical spine. Social media has become a crucial part of many patients’ lives; however, little is known about social media use pertaining to DCM. Objective: This manuscript describes the landscape of social media use and DCM in patients, caretakers, clinicians, and researchers. Methods: A comprehensive search of the entire Twitter application programing interface database from inception to March 2022 was performed to identify all tweets about cervical myelopathy. Data on Twitter users included geographic location, number of followers, and number of tweets. The number of tweet likes, retweets, quotes, and total engagement were collected. Tweets were also categorized based on their underlying themes. Mentions pertaining to past or upcoming surgical procedures were recorded. A natural language processing algorithm was used to assign a polarity score, subjectivity score, and analysis label to each tweet for sentiment analysis. Results: Overall, 1859 unique tweets from 1769 accounts met the inclusion criteria. The highest frequency of tweets was seen in 2018 and 2019, and tweets decreased significantly in 2020 and 2021. Most (888/1769, 50.2%) of the tweets’ authors were from the United States, United Kingdom, or Canada. Account categorization showed that 668 of 1769 (37.8%) users discussing DCM on Twitter were medical doctors or researchers, 415 of 1769 (23.5%) were patients or caregivers, and 201 of 1769 (11.4%) were news media outlets. The 1859 tweets most often discussed research (n=761, 40.9%), followed by spreading awareness or informing the public on DCM (n=559, 30.1%). Tweets describing personal patient perspectives on living with DCM were seen in 296 (15.9%) posts, with 65 (24%) of these discussing upcoming or past surgical experiences. Few tweets were related to advertising (n=31, 1.7%) or fundraising (n=7, 0.4%). A total of 930 (50%) tweets included a link, 260 (14%) included media (ie, photos or videos), and 595 (32%) included a hashtag. Overall, 847 of the 1859 tweets (45.6%) were classified as neutral, 717 (38.6%) as positive, and 295 (15.9%) as negative. Conclusions: When categorized thematically, most tweets were related to research, followed by spreading awareness or informing the public on DCM. Almost 25% (65/296) of tweets describing patients’ personal experiences with DCM discussed past or upcoming surgical interventions. Few posts pertained to advertising or fundraising. These data can help identify areas for improvement of public awareness online, particularly regarding education, support, and fundraising. %M 37213188 %R 10.2196/42097 %U https://www.jmir.org/2023/1/e42097 %U https://doi.org/10.2196/42097 %U http://www.ncbi.nlm.nih.gov/pubmed/37213188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42287 %T Predicting Internet Use and Digital Competence Among Older Adults Using Performance Tests of Visual, Physical, and Cognitive Functioning: Longitudinal Population-Based Study %A Heponiemi,Tarja %A Kainiemi,Emma %A Virtanen,Lotta %A Saukkonen,Petra %A Sainio,Päivi %A Koponen,Päivikki %A Koskinen,Seppo %+ Finnish Institute for Health and Welfare, PO Box 30, Helsinki, 00271, Finland, 358 295247434, tarja.heponiemi@thl.fi %K internet services %K digital exclusion %K digital skills %K older adults %K physical and cognitive decline %K mobile phone %D 2023 %7 5.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapidly increasing role of the internet in obtaining basic services poses challenges, especially for older adults’ capabilities of getting the services they need. Research on the predictors of older adults’ internet use and digital competence is especially relevant given that people are living longer than before, and the age profile of many societies is changing rapidly. Objective: We aimed to examine the associations of objective measures of physical and cognitive impairment with the nonuse of the internet for services and low digital competence among older adults. Methods: A longitudinal population-based design was used that combined data from performance tests and self-rated questionnaires. Data were gathered in 2017 and 2020 among 1426 older adults aged between 70 and 100 years in Finland. Logistic regression analyses were used to examine the associations. Results: Those who had poor near (odds ratio [OR] 1.90, 95% CI 1.36-2.66) or distant vision (OR 1.81, 95% CI 1.21-2.71), restricted or failed abduction of upper arms (OR 1.81, 95% CI 1.28-2.85), and poor results from the word list memory (OR 3.77, 95% CI 2.65-5.36) or word list delayed recall (OR 2.12, 95% CI 1.48-3.02) tests had greater odds for nonuse of the internet for services than their counterparts. Moreover, those who had poor near (OR 2.18, 95% CI 1.57-3.02) or distant vision (OR 2.14, 95% CI 1.43-3.19), poor results from the chair stand test (OR 1.57, 95% CI 1.06-2.31), restricted or failed abduction of upper arms (OR 1.74, 95% CI 1.10-2.76), and poor results from the word list memory (OR 3.41, 95% CI 2.32-5.03) or word list delayed recall (OR 2.05, 95% CI 1.39-3.04) tests had greater odds of low digital competence than their counterparts. Conclusions: According to our results, older adults’ impaired physical and cognitive functioning may hamper their possibilities of accessing internet services such as digital health care services. Our results should be considered when planning digital health care services intended to be used by older adults; that is, digital solutions should also be suitable for older adults with impairments. Furthermore, face-to-face services should be provided for those who cannot use digital services, even if they are assisted properly. %M 37145836 %R 10.2196/42287 %U https://www.jmir.org/2023/1/e42287 %U https://doi.org/10.2196/42287 %U http://www.ncbi.nlm.nih.gov/pubmed/37145836 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e43709 %T Health-Seeking Behavior and Its Associated Technology Use: Interview Study Among Community-Dwelling Older Adults %A Zhang,Yichi %A Lee,Edmund W J %A Teo,Wei-Peng %+ Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore, 637616, Singapore, 65 67903704, weipeng.teo@nie.edu.sg %K health %K health-seeking behavior %K aging %K technology %K telehealth %K mobile health %K mHealth %K eHealth %K health access %K qualitative study %K mobile phone %D 2023 %7 4.5.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Understanding older people’s health-seeking behavior (HSB) is crucial for uncovering their health needs and priorities and developing appropriate policies to address them and avert their disease progression. Technologies play an active role in our daily lives and have been incorporated into health activities to support the older population and facilitate their HSB. However, previous studies of HSB have mainly focused on behaviors during illness, and there are limited studies on how technologies have been used in older people’s health-seeking activities. Objective: This study aimed to investigate HSB and the associated technology use among the older population, ultimately proposing implications for practice to address their unmet health needs. Methods: This paper presents partial data from a large qualitative study, which has been approved by the institutional review board and used a phenomenological approach. Semistructured interviews were conducted between April 2022 and July 2022, either via Zoom (Zoom Video Communications Inc) or face-to-face sessions. Inclusion criteria were being aged ≥50 years, long-term residence in Singapore, and being able to speak English or Mandarin. The interviews were manually transcribed verbatim, and thematic analysis was performed, with the individual as the unit of analysis to understand the patterns of behaviors. Results: In total, 15 interviews were conducted to reach thematic saturation. We identified 5 main consequences of HSB, which were aligned with the original HSB model. Regarding technology use in health seeking, 4 themes were extracted: the most widely used digital technologies are the mobile health apps and wearable devices with the associated wellness programs launched by the government and local companies, and they have the potential to enhance health communication, promote health maintenance, and increase access to health services; information communication technologies and social media, though not primarily designed for health purposes, play a substantial role in easing the process of seeking health information and managing symptoms. Although the outbreak of the COVID-19 pandemic has resulted in some alterations to older adults’ well-being, it has catalyzed the adoption of telehealth as a complement to access health care services, and older adults have different considerations when selecting technologies to facilitate their health seeking and fulfill their health needs. Moreover, 4 archetypes were proposed based on our findings and the insights gained from our participants’ observations in their social networks. These findings led to several implications for practice regarding health communication and promotion, health education, technology design and improvement, telemonitoring service implementation, and solutions to address the needs of each proposed archetype. Conclusions: Unlike the commonly held belief that older adults resist technologies and lack technological proficiency, our findings showed that technologies could play a promising role in facilitating older adults’ health seeking. Our findings have implications for the design and implementation of health services and policies. %M 36996003 %R 10.2196/43709 %U https://aging.jmir.org/2023/1/e43709 %U https://doi.org/10.2196/43709 %U http://www.ncbi.nlm.nih.gov/pubmed/36996003 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44316 %T Engagement and Utilization of a Complete Remote Digital Care Program for Musculoskeletal Pain Management in Urban and Rural Areas Across the United States: Longitudinal Cohort Study %A Scheer,Justin %A Areias,Anabela C %A Molinos,Maria %A Janela,Dora %A Moulder,Robert %A Lains,Jorge %A Bento,Virgílio %A Yanamadala,Vijay %A Dias Correia,Fernando %A Costa,Fabíola %+ Sword Health Inc, 13937 Sprague Lane, Draper, UT, 84020, United States, 1 1 385 308 8034, f.costa@swordhealth.com %K physical therapy %K physiotherapy %K remote care %K telerehabilitation %K digital therapy %K eHealth %K telehealth %K telemedicine %K musculoskeletal %K musculoskeletal conditions %K urban %K rural %K pain %K health inequity %K digital care %K pain management %K clinical outcome %K health equity %K engagement %D 2023 %7 16.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have arisen as alternative care delivery models to circumvent challenges in accessibility of conventional therapy. Despite the potential of DCPs to reduce inequities in accessing care, the outcomes of such interventions in rural and urban populations have yet to be studied. Objective: The aim of this study was to assess the impact of urban or rural residency on engagement and clinical outcomes after a multimodal DCP for MSK pain. Methods: This study consists of an ad hoc analysis of a decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were coded according to their zip codes to a specific rural-urban commuting area code and grouped into rural and urban cohorts. Changes in their engagement and clinical outcomes from baseline to program end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, BMI, employment status, and pain acuity. Outcomes included engagement, self-reported pain, and the results of the Generalized Anxiety Disorder 7-item, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment scales. A minimum clinically important difference (MCID) of 30% was considered for pain. Results: Patients with urban and rural residency across the United States participated in the program (n=9992). A 73.8% (7378/9992) completion rate was observed. Both groups reported high satisfaction scores and similar engagement with exercise sessions, with rural residents showing higher engagement with educational content (P<.001) and higher program completion rates (P=.02). All groups showed a significant improvement in all clinical outcomes, including pain, mental health, and work productivity, without statistically significant intergroup differences. The percentage of patients meeting the MCID was similar in both groups (urban: 67.1%, rural: 68.3%; P=.30). Conclusions: This study advocates for the utility of a DCP in improving access to MSK care in urban and rural areas alike, showcasing its potential to promote health equity. High engagement, satisfaction, and completion rates were noted in both groups, as well as significant improvements in clinical outcomes. Trial Registration: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946 %M 36735933 %R 10.2196/44316 %U https://mhealth.jmir.org/2023/1/e44316 %U https://doi.org/10.2196/44316 %U http://www.ncbi.nlm.nih.gov/pubmed/36735933 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42719 %T Barriers to and Facilitators of Digital Health Among Culturally and Linguistically Diverse Populations: Qualitative Systematic Review %A Whitehead,Lara %A Talevski,Jason %A Fatehi,Farhad %A Beauchamp,Alison %+ School of Rural Health, Faculty of Medicine, Nursing and Health Science, Monash University, 15 Sargeant St, Warragul, VIC 3820, Australia, 61 414411296, alison.beauchamp@monash.edu %K culturally and linguistically diverse %K ethnicity %K indigenous %K digital health %K technology %K eHealth %K qualitative %K mobile phone %D 2023 %7 28.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Health care systems have become increasingly more reliant on patients’ ability to navigate the digital world. However, little research has been conducted on why some communities are less able or less likely to successfully engage with digital health technologies (DHTs), particularly among culturally and linguistically diverse (CaLD) populations. Objective: This systematic review aimed to determine the barriers to and facilitators of interacting with DHTs from the perspectives of CaLD population groups, including racial or ethnic minority groups, immigrants and refugees, and Indigenous or First Nations people. Methods: A systematic review and thematic synthesis of qualitative studies was conducted. Peer-reviewed literature published between January 2011 and June 2022 was searched across 3 electronic databases. Terms for digital health were combined with terms for cultural or linguistic diversity, ethnic minority groups, or Indigenous and First Nations people and terms related to barriers to accessing digital technologies. A qualitative thematic synthesis was conducted to identify descriptive and analytical themes of barriers to and facilitators of interacting with DHTs. Quality appraisal was performed using the Mixed Methods Appraisal Tool. Results: Of the 1418 studies identified in the electronic search, a total of 34 (2.4%) were included in this review. Half of the included studies (17/34, 50%) were conducted in the United States. There was considerable variation in terms of the CaLD backgrounds of the participants. In total, 26% (9/34) of the studies focused on Indigenous or First Nations communities, 41% (14/34) were conducted among ethnic minority populations, 15% (5/34) of the studies were conducted among immigrants, and 18% (6/34) were conducted in refugee communities. Of the 34 studies, 21 (62%) described the development or evaluation of a digital health intervention, whereas 13 (38%) studies did not include an intervention but instead focused on elucidating participants’ views and behaviors in relation to digital health. From the 34 studies analyzed, 18 descriptive themes were identified, each describing barriers to and facilitators of interacting with DHTs, which were grouped into 7 overarching analytical themes: using technology, design components, language, culture, health and medical, trustworthiness, and interaction with others. Conclusions: This study identified several analytic and descriptive themes influencing access to and uptake of DHTs among CaLD populations, including Indigenous and First Nations groups. We found that cultural factors affected all identified themes to some degree and that cultural and linguistic perspectives should be considered in the design and delivery of DHTs, with this best served through the inclusion of the target communities at all stages of development. This may improve the potential of DHTs to be more acceptable, appropriate, and accessible to population groups currently at risk of not obtaining the full benefits of digital health. %M 36853742 %R 10.2196/42719 %U https://www.jmir.org/2023/1/e42719 %U https://doi.org/10.2196/42719 %U http://www.ncbi.nlm.nih.gov/pubmed/36853742 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41939 %T The Use of Technology to Provide Mental Health Services to Youth Experiencing Homelessness: Scoping Review %A Lal,Shalini %A Elias,Sarah %A Sieu,Vida %A Peredo,Rossana %+ School of Rehabilitation, Faculty of Medicine, University of Montréal, C.P. 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada, 1 5148908000 ext 31581, shalini.lal@umontreal.ca %K digital equity %K homelessness %K telemedicine %K telehealth %K cellular phone %K internet %K e-mental health %K digital health %K mobile health %K mHealth %K literature review %K mobile phone %D 2023 %7 16.1.2023 %9 Review %J J Med Internet Res %G English %X Background: There is growing interest in using information and communication technologies (ICTs) to improve access to mental health services for youth experiencing homelessness (YEH); however, limited efforts have been made to synthesize this literature. Objective: This study aimed to review the research on the use of ICTs to provide mental health services and interventions for YEH. Methods: We used a scoping review methodology following the Arksey and O’Malley framework and guidelines from the Joanna Briggs Institute Manual for Evidence Synthesis. The results are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A systematic search was conducted from 2005 to 2021 in MEDLINE, Embase, CINAHL, PsycInfo, Cochrane, Web of Science, and Maestro and in ProQuest Thesis and Dissertations, Papyrus, Homeless Hub, and Google Scholar for gray literature. Studies were included if participants’ mean age was between 13 and 29 years, youth with mental health issues were experiencing homelessness or living in a shelter, ICTs were used as a means of intervention, and the study provided a description of the technology. The exclusion criteria were technology that did not allow for interaction (eg, television) and languages other than French or English. The data were analyzed using descriptive statistics and qualitative approaches. Two reviewers were involved in the screening and data extraction process in consultation with a third reviewer. The data were summarized in tables and by narrative synthesis. Results: From the 2153 abstracts and titles screened, 12 were included in the analysis. The most common types of ICTs used were communication technologies (eg, phone, video, and SMS text messages) and mobile apps. The intervention goals varied widely across studies; the most common goal was reducing risky behaviors, followed by addressing cognitive functioning, providing emotional support, providing vital resources, and reducing anxiety. Most studies (9/11, 82%) focused on the feasibility of interventions. Almost all studies reported high levels of acceptability (8/9, 89%) and moderate to high frequency of use (5/6, 83%). The principal challenges were related to technical problems such as the need to replace phones, issues with data services, and phone charging. Conclusions: Our results indicate the emerging role of ICTs in the delivery of mental health services to YEH and that there is a high level of acceptability based on early feasibility studies. However, our results should be interpreted cautiously, considering the limited number of studies included in the analysis and the elevated levels of dropout. There is a need to advance efficacy and effectiveness research in this area with larger and longer studies. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-061313 %M 36645703 %R 10.2196/41939 %U https://www.jmir.org/2023/1/e41939 %U https://doi.org/10.2196/41939 %U http://www.ncbi.nlm.nih.gov/pubmed/36645703 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e41767 %T Factors Associated With Self-reported Use of Web and Mobile Health Apps Among US Military Veterans: Cross-sectional Survey %A Hogan,Timothy P %A Etingen,Bella %A Lipschitz,Jessica M %A Shimada,Stephanie L %A McMahon,Nicholas %A Bolivar,Derek %A Bixler,Felicia R %A Irvin,Dawn %A Wacks,Rachel %A Cutrona,Sarah %A Frisbee,Kathleen L %A Smith,Bridget M %+ Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, 200 Springs Road (152), Building 70, Bedford, MA, 01730, United States, 1 781 687 3181, timothy.hogan@va.gov %K mobile health apps %K patient engagement %K consumer health informatics %K provider encouragement %K veterans %D 2022 %7 30.12.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite their prevalence and reported patient interest in their use, uptake of health-related apps is limited. The Veterans Health Administration (VHA) has developed a variety of apps to support veterans; however, uptake remains low nationally. Objective: We examined the prevalence of VHA health-related app use and how veterans learned about these apps in order to identify factors associated with their use. Methods: As part of a VHA quality improvement initiative, we recruited a national cohort of veterans to obtain feedback on their use of technology for health and collected data from them via a cross-sectional survey. The survey data were supplemented with VHA administrative data. We used descriptive statistics to examine demographic and health characteristics, health-related technology use, and how veterans learned about apps. We assessed factors associated with app use using bivariate analyses and multiple logistic regression models. Results: We had complete data on 1259 veterans. A majority of the sample was male (1069/1259, 84.9%), aged older than 65 years (740/1259, 58.8%), White (1086/1259, 86.3%), and non-Hispanic (1218/1259, 96.7%). Most respondents (1125/1259, 89.4%) reported being very comfortable and confident using computers, over half (675/1259, 53.6%) reported being an early adopter of technology, and almost half (595/1259, 47.3%) reported having used a VHA health-related app. Just over one-third (435/1259, 34.6%) reported that their VHA care team members encouraged them to use health-related apps. Respondents reported learning about available VHA health-related apps by reading about them on the VHA’s patient portal (468/1259, 37.2%), being told about them by their VHA health care team (316/1259, 25.1%), and reading about them on the VHA’s website (139/1259, 11%). Veterans who self-reported having used VHA health-related apps were more likely to receive care at the VHA (OR [odds ratio] 1.3, 95% CI 1.0-1.7), be in worse health (as assessed by Hierarchical Condition Community score; OR 1.1, 95% CI 1.0-1.2), report owning a desktop or laptop computer (OR 1.8, 95% CI 1.1-3.1), have posttraumatic stress disorder (OR 1.4, 95% CI 1.1-1.9), and report having VHA health care team members encourage them to use the apps (OR 2.7, 95% CI 2.1-3.4). Conclusions: We found strong associations between self-reported use by veterans of VHA health-related apps and multiple variables in our survey. The strongest association was observed between a veteran self-reporting app use and having received encouragement from their VHA health care team to use the apps. Veterans who reported receiving encouragement from their VHA care team members had nearly 3 times higher odds of using VHA apps than veterans who did not report receiving such encouragement. Our results add to growing evidence suggesting that endorsement of apps by a health care system or health care team can positively impact patient uptake and use. %M 36583935 %R 10.2196/41767 %U https://mhealth.jmir.org/2022/12/e41767 %U https://doi.org/10.2196/41767 %U http://www.ncbi.nlm.nih.gov/pubmed/36583935 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e40340 %T Individual and Parental Factors of Adolescents’ mHealth App Use: Nationally Representative Cross-sectional Study %A Gulec,Hayriye %A Smahel,David %+ Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Joštova 10, Brno, 602 00, Czech Republic, 420 549 49 4180, hayriyegulec@uludag.edu.tr %K mobile health %K mHealth %K eHealth literacy %K parental mediation %K health anxiety %K sleep %K body mass index %K digital skills %K phone attitudes %K mobile phone %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Knowledge of the characteristics of adolescents who use mobile health (mHealth) apps to monitor health and how these characteristics differ from those of app nonusers is limited. Objective: We aimed to determine mHealth app use based on adolescent and parental factors, including sociodemographics, digital skills, and health indicators, in a nationally representative sample of Czech adolescents (N=2500). Methods: Adolescents aged 11 to 16 years and one of their parents participated in an online survey in 2021. A professional research agency recruited the participants. Quotas were used to ensure the sample’s representativeness. The sociodemographic factors were the adolescents’ age, gender, and parental perceived financial security. The adolescents also provided information about their screen time, eHealth literacy, BMI, health anxiety, physical activity, and sleep quality. Parents reported their digital skills, mobile phone attitudes, and the mediation of their children’s online health information–seeking behaviors. We evaluated the differences between the users and nonusers of mHealth apps and identified the significant predictors of mHealth app use. Next, we separately examined how these factors were associated with the use of mHealth apps that track calorie intake or expenditure, number of steps, weight, or sports activity (eg, exercise, running, and working out), as well as other mHealth apps (eg, those that track sleep and heart rate). Results: More than half of the adolescents (1429/2455, 58.21%) reported using mHealth apps. App users were relatively older and, more often, girls. Apps that counted the number of steps were used most frequently, and adolescents whose parents reported higher perceived financial security used them more regularly. Overall, being older and physically active and having higher eHealth literacy skills were associated with using mHealth apps. Adolescents with higher BMI, health anxiety, and lower sleep quality more frequently used mHealth apps to track calorie intake or expenditure, weight, and health indicators. mHealth apps to track physical activity were used more regularly by girls. There was a positive association between parental mediation of online health information–seeking behaviors and adolescents’ mHealth app use. Conclusions: These findings demonstrated that older age, physical activity, and eHealth literacy skills were the common underlying factors of adolescents’ mHealth app use. We initially showed parents as significant role models for their children’s adoption of, and engagement with, mHealth apps when they actively mediate their online health information–seeking behaviors. Improving the eHealth literacy skills of adolescents through parental guidance might enhance health technology use in this population. Tracking eating behaviors, weight, and health were more prevalent for adolescents who reported higher BMI, health anxiety, and lower sleep quality. Future research studies should examine the determinants and health outcomes of adolescents’ mHealth app use longitudinally. %M 36525286 %R 10.2196/40340 %U https://mhealth.jmir.org/2022/12/e40340 %U https://doi.org/10.2196/40340 %U http://www.ncbi.nlm.nih.gov/pubmed/36525286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39647 %T Social Determinants of Digital Health Adoption: Pilot Cross-sectional Survey %A Patel,Sharvil Piyush %A Sun,Elizabeth %A Reinhardt,Alec %A Geevarghese,Sanjaly %A He,Simon %A Gazmararian,Julie A %+ Omnimed Inc, 5363 Veterans Parkway, Suite C, Columbus, GA, 31904, United States, 1 706 905 2971, spatel@omnimedinc.org %K digital health %K health accessibility %K utilization %K mobile health %K mHealth %K telemedicine %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Interest in and funding for digital health interventions have rapidly grown in recent years. Despite the increasing familiarity with mobile health from regulatory bodies, providers, and patients, overarching research on digital health adoption has been primarily limited to morbidity-specific and non-US samples. Consequently, there is a limited understanding of what personal factors hold statistically significant relationships with digital health uptake. Moreover, this limits digital health communities’ knowledge of equity along digital health use patterns. Objective: This study aims to identify the social determinants of digital health tool adoption in Georgia. Methods: Web-based survey respondents in Georgia 18 years or older were recruited from mTurk to answer primarily closed-ended questions within the following domains: participant demographics and health consumption background, telehealth, digital health education, prescription management tools, digital mental health services, and doctor finder tools. Participants spent around 15 to 20 minutes on a survey to provide demographic and personal health care consumption data. This data was analyzed with multivariate linear and logistic regressions to identify which of these determinants, if any, held statistically significant relationships with the total number of digital health tool categories adopted and which of these determinants had absolute relationships with specific categories. Results: A total of 362 respondents completed the survey. Private insurance, residence in an urban area, having a primary care provider, fewer urgent emergency room (ER) visits, more ER visits leading to inpatient stays, and chronic condition presence were significantly associated with the number of digital health tool categories adopted. The separate logistic regressions exhibited substantial variability, with 3.5 statistically significant predictors per model, on average. Age, federal poverty level, number of primary care provider visits in the past 12 months, number of nonurgent ER visits in the past 12 months, number of urgent ER visits in the past 12 months, number of ER visits leading to inpatient stays in the past 12 months, race, gender, ethnicity, insurance, education, residential area, access to the internet, difficulty accessing health care, usual source of care, status of primary care provider, and status of chronic condition all had at least one statistically significant relationship with the use of a specific digital health category. Conclusions: The results demonstrate that persons who are socioeconomically disadvantaged may not adopt digital health tools at disproportionately higher rates. Instead, digital health tools may be adopted along social determinants of health, providing strong evidence for the digital health divide. The variability of digital health adoption necessitates investing in and building a common framework to increase mobile health access. With a common framework and a paradigm shift in the design, evaluation, and implementation strategies around digital health, disparities can be further mitigated and addressed. This likely will begin with a coordinated effort to determine barriers to adopting digital health solutions. %M 36472905 %R 10.2196/39647 %U https://formative.jmir.org/2022/12/e39647 %U https://doi.org/10.2196/39647 %U http://www.ncbi.nlm.nih.gov/pubmed/36472905 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e38536 %T A Digital Health Intervention for Stress and Anxiety Relief in Perioperative Care: Protocol for a Feasibility Randomized Controlled Trial %A Kondylakis,Haridimos %A Chicchi Giglioli,Irene Alice %A Katehakis,Dimitrios G %A Aldemir,Hatice %A Zikas,Paul %A Papagiannakis,George %A Hors-Fraile,Santiago %A González-Sanz,Pedro L %A Apostolakis,Konstantinos C %A Stephanidis,Constantine %A Núñez-Benjumea,Francisco J %A Baños-Rivera,Rosa M %A Fernandez-Luque,Luis %A Kouroubali,Angelina %+ Adhera Health, Inc, 1001 Page Mill Rd Building One, Suite 200, Palo Alto, CA, 94304, United States, 1 656930901, luis@adherahealth.com %K CARINAE %K digital health %K perioperative process %K patient empowerment %K stress and anxiety management %K mobile health %K mHealth %K virtual reality %K VR %K health recommender system %K HRS %D 2022 %7 29.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress and anxiety are psychophysiological responses commonly experienced by patients during the perioperative process that can increase presurgical and postsurgical complications to a comprehensive and positive recovery. Preventing and intervening in stress and anxiety can help patients achieve positive health and well-being outcomes. Similarly, the provision of education about surgery can be a crucial component and is inversely correlated with preoperative anxiety levels. However, few patients receive stress and anxiety relief support before surgery, and resource constraints make face-to-face education sessions untenable. Digital health interventions can be helpful in empowering patients and enhancing a more positive experience. Digital health interventions have been shown to help patients feel informed about the possible benefits and risks of available treatment options. However, they currently focus only on providing informative content, neglecting the importance of personalization and patient empowerment. Objective: This study aimed to explore the feasibility of a digital health intervention called the Adhera CARINAE Digital Health Program, designed to provide evidence-based, personalized stress- and anxiety-management methods enabled by a comprehensive digital ecosystem that incorporates wearable, mobile, and virtual reality technologies. The intervention program includes the use of advanced data-driven techniques for tailored patient education and lifestyle support. Methods: The trial will include 5 hospitals across 3 European countries and will use a randomized controlled design including 30 intervention participants and 30 control group participants. The involved surgeries are cardiopulmonary and coronary artery bypass surgeries, cardiac valve replacement, prostate or bladder cancer surgeries, hip and knee replacement, maxillofacial surgery, or scoliosis. The control group will receive standard care, and the intervention group will additionally be exposed to the digital health intervention program. Results: The recruitment process started in January 2022 and has been completed. The primary impact analysis is currently ongoing. The expected results will be published in early 2023. Conclusions: This manuscript details a comprehensive protocol for a study that will provide valuable information about the intervention program, such as the measurement of comparative intervention effects on stress; anxiety and pain management; and usability by patients, caregivers, and health care professionals. This will contribute to the evidence planning process for the future adoption of diverse digital health solutions in the field of surgery. Trial Registration: ClinicalTrials.gov NCT05184725; https://www.clinicaltrials.gov/ct2/show/NCT05184725 International Registered Report Identifier (IRRID): DERR1-10.2196/38536 %M 36445734 %R 10.2196/38536 %U https://www.researchprotocols.org/2022/11/e38536 %U https://doi.org/10.2196/38536 %U http://www.ncbi.nlm.nih.gov/pubmed/36445734 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e40391 %T Wearable Activity Tracker Use and Physical Activity Among Informal Caregivers in the United States: Quantitative Study %A Mahmood,Asos %A Kim,Hyunmin %A Kedia,Satish %A Dillon,Patrick %+ School of Health Professions, The University of Southern Mississippi, 118 College Drive #5122, Hattiesburg, MS, 39406, United States, 1 6015969087, hyunmin.kim@usm.edu %K informal caregivers %K caregiving %K health and activity trackers %K wearables %K physical activity %K health-promoting behavior %K mobile phone %D 2022 %7 24.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With an increase in aging population and chronic medical conditions in the United States, the role of informal caregivers has become paramount as they engage in the care of their loved ones. Mounting evidence suggests that such responsibilities place substantial burden on informal caregivers and can negatively impact their health. New wearable health and activity trackers (wearables) are increasingly being used to facilitate and monitor healthy behaviors and to improve health outcomes. Although prior studies have examined the efficacy of wearables in improving health and well-being in the general population, little is known about their benefits among informal caregivers. Objective: This study aimed to examine the association between use of wearables and levels of physical activity (PA) among informal caregivers in the United States. Methods: We used data from the National Cancer Institute’s Health Information National Trends Survey 5 (cycle 3, 2019 and cycle 4, 2020) for a nationally representative sample of 1273 community-dwelling informal caregivers—aged ≥18 years, 60% (757/1273) female, 75.7% (990/1273) had some college or more in education, and 67.3% (885/1273) had ≥1 chronic medical condition—in the United States. Using jackknife replicate weights, a multivariable logistic regression was fit to assess an independent association between the use of wearables and a binary outcome: meeting or not meeting the current World Health Organization’s recommendation of PA for adults (≥150 minutes of at least moderate-intensity PA per week). Results: More than one-third (466/1273, 37.8%) of the informal caregivers met the recommendations for adult PA. However, those who reported using wearables (390/1273, 31.7%) had slightly higher odds of meeting PA recommendations (adjusted odds ratios 1.1, 95% CI 1.04-1.77; P=.04) compared with those who did not use wearables. Conclusions: The results demonstrated a positive association between the use of wearables and levels of PA among informal caregivers in the United States. Therefore, efforts to incorporate wearable technology into the development of health-promoting programs or interventions for informal caregivers could potentially improve their health and well-being. However, any such effort should address the disparities in access to innovative digital technologies, including wearables, to promote health equity. Future longitudinal studies are required to further support the current findings of this study. %M 36422886 %R 10.2196/40391 %U https://mhealth.jmir.org/2022/11/e40391 %U https://doi.org/10.2196/40391 %U http://www.ncbi.nlm.nih.gov/pubmed/36422886 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e36074 %T Digital Tools Designed to Obtain the History of Present Illness From Patients: Scoping Review %A Berdahl,Carl T %A Henreid,Andrew J %A Pevnick,Joshua M %A Zheng,Kai %A Nuckols,Teryl K %+ Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, United States, 1 310 423 3091, Carl.Berdahl@csmc.edu %K anamnesis %K informatics %K emergency medicine %K human-computer interaction %K medical history taking %K mobile phone %D 2022 %7 17.11.2022 %9 Review %J J Med Internet Res %G English %X Background: Many medical conditions, perhaps 80% of them, can be diagnosed by taking a thorough history of present illness (HPI). However, in the clinical setting, situational factors such as interruptions and time pressure may cause interactions with patients to be brief and fragmented. One solution for improving clinicians’ ability to collect a thorough HPI and maximize efficiency and quality of care could be to use a digital tool to obtain the HPI before face-to-face evaluation by a clinician. Objective: Our objective was to identify and characterize digital tools that have been designed to obtain the HPI directly from patients or caregivers and present this information to clinicians before a face-to-face encounter. We also sought to describe outcomes reported in testing of these tools, especially those related to usability, efficiency, and quality of care. Methods: We conducted a scoping review using predefined search terms in the following databases: MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, IEEE Xplore Digital Library, ACM Digital Library, and ProQuest Dissertations & Theses Global. Two reviewers screened titles and abstracts for relevance, performed full-text reviews of articles meeting the inclusion criteria, and used a pile-sorting procedure to identify distinguishing characteristics of the tools. Information describing the tools was primarily obtained from identified peer-reviewed sources; in addition, supplementary information was obtained from tool websites and through direct communications with tool creators. Results: We identified 18 tools meeting the inclusion criteria. Of these 18 tools, 14 (78%) used primarily closed-ended and multiple-choice questions, 1 (6%) used free-text input, and 3 (17%) used conversational (chatbot) style. More than half (10/18, 56%) of the tools were tailored to specific patient subpopulations; the remaining (8/18, 44%) tools did not specify a target subpopulation. Of the 18 tools, 7 (39%) included multilingual support, and 12 (67%) had the capability to transfer data directly into the electronic health record. Studies of the tools reported on various outcome measures related to usability, efficiency, and quality of care. Conclusions: The HPI tools we identified (N=18) varied greatly in their purpose and functionality. There was no consensus on how patient-generated information should be collected or presented to clinicians. Existing tools have undergone inconsistent levels of testing, with a wide variety of different outcome measures used in evaluation, including some related to usability, efficiency, and quality of care. There is substantial interest in using digital tools to obtain the HPI from patients, but the outcomes measured have been inconsistent. Future research should focus on whether using HPI tools can lead to improved patient experience and health outcomes, although surrogate end points could instead be used so long as patient safety is monitored. %M 36394945 %R 10.2196/36074 %U https://www.jmir.org/2022/11/e36074 %U https://doi.org/10.2196/36074 %U http://www.ncbi.nlm.nih.gov/pubmed/36394945 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e38690 %T Outcomes With a Mobile Digital Health Platform for Patients Undergoing Spine Surgery: Retrospective Analysis %A Venkatraman,Vishal %A Kirsch,Elayna P %A Luo,Emily %A Kunte,Sameer %A Ponder,Madison %A Gellad,Ziad F %A Liu,Beiyu %A Lee,Hui-Jie %A Jung,Sin-Ho %A Haglund,Michael M %A Lad,Shivanand P %+ Department of Neurosurgery, Duke University Medical Center, 200 Trent Drive, Blue Zone, Durham, NC, 27710, United States, 1 919 681 1973, nandan.lad@duke.edu %K digital health %K spine surgery %K surgical outcomes %K mobile health %K mobile application %K surgery %K postoperative %K mobile health %K mobile app %K mHealth %K recovery %D 2022 %7 26.10.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Digital health solutions have been shown to enhance outcomes for individuals with chronic medical illnesses, but few have been validated for surgical patients. The digital health platform ManageMySurgery (MMS) has been validated for spine surgery as a feasible method for patients along their surgical journey through in-app education and completion of patient-reported outcomes surveys. Objective: The aim of this study is to determine the rates of 90-day emergency room (ER) visits, readmissions, and complications in patients undergoing spine surgery using MMS compared to patients using traditional perioperative care alone. Methods: Patients undergoing spine surgery at a US-based academic hospital were invited to use MMS perioperatively between December 2017 and September 2021. All patients received standard perioperative care and were classified as MMS users if they logged into the app. Demographic information and 90-day outcomes were acquired via electronic health record review. The odds ratios of having 90-day ER visits, readmissions, mild complications, and severe complications between the MMS and non-MMS groups were estimated using logistic regression models. Results: A total of 1015 patients were invited, with 679 using MMS. MMS users and nonusers had similar demographics: the average ages were 57.9 (SD 12.5) years and 61.5 (SD 12.7) years, 54.1% (367/679) and 47.3% (159/336) were male, and 90.1% (612/679) and 88.7% (298/336) had commercial or Medicare insurance, respectively. Cervical fusions (559/1015, 55.07%) and single-approach lumbar fusions (231/1015, 22.76%) were the most common procedures for all patients. MMS users had a lower 90-day readmission rate (55/679, 8.1%) than did nonusers (30/336, 8.9%). Mild complications (MMS: 56/679, 8.3%; non-MMS: 32/336, 9.5%) and severe complications (MMS: 66/679, 9.7%; non-MMS: 43/336, 12.8%) were also lower in MMS users. MMS users had a lower 90-day ER visit rate (MMS: 62/679, 9.1%; non-MMS: 45/336, 13.4%). After adjustments were made for age and sex, the odds of having 90-day ER visits for MMS users were 32% lower than those for nonusers, but this difference was not statistically significant (odds ratio 0.68, 95% CI 0.45-1.02; P=.06). Conclusions: This is one of the first studies to show differences in acute outcomes for people undergoing spine surgery who use a digital health app. This study found a correlation between MMS use and fewer postsurgical ER visits in a large group of spine surgery patients. A planned randomized controlled trial will provide additional evidence of whether this digital health tool can be used as an intervention to improve patient outcomes. %M 36287589 %R 10.2196/38690 %U https://periop.jmir.org/2022/1/e38690 %U https://doi.org/10.2196/38690 %U http://www.ncbi.nlm.nih.gov/pubmed/36287589 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35538 %T User Behavior of a Publicly Available, Free-to-Use, Self-guided mHealth App for Depression: Observational Study in a Global Sample %A Su,Langting %A Anderson,Page Lyn %+ Department of Psychology, Georgia State University, Psychology Department, Urban Life Building, 140 Decatur Street, Atlanta, GA, 30033, United States, 1 404 822 7009, panderson@gsu.edu %K mHealth %K depression %K smartphone %K mobile app %K digital health %K global mental health %K MoodTools %K mobile health %K mental health %K mobile phone %K low- and middle-income countries %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Reducing the burden of depression is a global health concern. Self-guided mobile health (mHealth) apps are one approach to address this problem. However, there is little research on self-guided mHealth apps in a global sample or on how they are used in the real world. These gaps in our knowledge must be addressed to bring the promise of mHealth apps for reducing the global burden of depression closer to reality. Objective: The purpose of this study is to examine the naturalistic user behavior of MoodTools, a publicly available, free-to-use, self-guided mHealth app designed to improve symptoms of depression, in a global community sample. Methods: Mobile analytics data were collected from all unique downloads of the Android version of MoodTools between March 1, 2016, and February 28, 2018. Due to the deidentification and data aggregation process, no demographic or personal identifying information was tied to individual user data. All information was stored in aggregated, anonymized data files on Google Analytics’ storage database. Google’s software development kit was used to securely capture data about the number of downloads, location of downloads, number of app sessions, frequency and duration of app sessions, time between app sessions, and user retention, allowing for examination of which app’s tools were viewed and for how long, including Information (psychoeducation), Test (self-monitoring using the Patient Health Questionnaire [PHQ-9]), Thought Diary (targeting negative cognitions), Activities (behavioral activation), Videos (curated from YouTube), and Safety Plan (safety plan development and links to quickly access crisis management resources). Results: MoodTools was used by 158,930 people from 198 countries, including countries where English was not the primary language and in low- and middle-income countries. After the initial download, 51.14% (n=81,277) of users returned to the app after the initial download, and retention rates decreased with each subsequent app session. The typical person used the app for 3 sessions for a total of 12 minutes over 90 days. The most frequently visited tools were Test and Thought Diary (n=393,549, 24.32%). On average, users completed and reviewed the results of the PHQ-9 for 49 seconds and 53 seconds, respectively, and spent 3 minutes and 5 seconds on Thought Diary. Conclusions: Self-guided mHealth apps could be one approach (among the many needed) to reduce the burden of depression. Observational data collected in this study show a global interest in MoodTools, including in low- and middle-income countries and countries where English is not the primary language. Future research is needed to determine whether people who use self-guided apps experience improvement in depressive symptoms, and if so, what “dosage” provides a meaningful benefit. %M 36282559 %R 10.2196/35538 %U https://formative.jmir.org/2022/10/e35538 %U https://doi.org/10.2196/35538 %U http://www.ncbi.nlm.nih.gov/pubmed/36282559 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e35896 %T Retention, Fasting Patterns, and Weight Loss With an Intermittent Fasting App: Large-Scale, 52-Week Observational Study %A Torres,Luisa %A Lee,Joy L %A Park,Seho %A Di Lorenzo,R Christian %A Branam,Jonathan P %A Fraser,Shelagh A %A Salisbury,Benjamin A %+ LifeOmic, 351 W. 10th St, Indianapolis, IN, 46202, United States, 1 9377512962, ben.salisbury@lifeomic.com %K intermittent fasting %K time-restricted eating %K weight loss %K obesity %K mobile apps %K diet trackers %K retention %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Intermittent fasting (IF) is an increasingly popular approach to dietary control that focuses on the timing of eating rather than the quantity and content of caloric intake. IF practitioners typically seek to improve their weight and other health factors. Millions of practitioners have turned to purpose-built mobile apps to help them track and adhere to their fasts and monitor changes in their weight and other biometrics. Objective: This study aimed to quantify user retention, fasting patterns, and weight loss by users of 2 IF mobile apps. We also sought to describe and model starting BMI, amount of fasting, frequency of weight tracking, and other demographics as correlates of retention and weight change. Methods: We assembled height, weight, fasting, and demographic data of adult users (ages 18-100 years) of the LIFE Fasting Tracker and LIFE Extend apps from 2018 to 2020. Retention for up to 52 weeks was quantified based on recorded fasts and correlated with user demographics. Users who provided height and at least 2 readings of weight and whose first fast and weight records were contemporaneous were included in the weight loss analysis. Fasting was quantified as extended fasting hours (EFH; hours beyond 12 in a fast) averaged per day (EFH per day). Retention was modeled using a Cox proportional hazards regression. Weight loss was analyzed using linear regression. Results: A total of 792,692 users were followed for retention based on 26 million recorded fasts. Of these, 132,775 (16.7%) users were retained at 13 weeks, 54,881 (6.9%) at 26 weeks, and 16,478 (2.1%) at 52 weeks, allowing 4 consecutive weeks of inactivity. The survival analysis using Cox regression indicated that retention was positively associated with age and exercise and negatively associated with stress and smoking. Weight loss in the qualifying cohort (n=161,346) was strongly correlated with starting BMI and EFH per day, which displayed a positive interaction. Users with a BMI ≥40 kg/m2 lost 13.9% of their starting weight by 52 weeks versus a slight weight gain on average for users with starting BMI <23 kg/m2. EFH per day was an approximately linear predictor of weight loss. By week 26, users lost over 1% of their starting weight per EFH per day on average. The regression analysis using all variables was highly predictive of weight change at 26 weeks (R2=0.334) with starting BMI and EFH per day as the most significant predictors. Conclusions: IF with LIFE mobile apps appears to be a sustainable approach to weight reduction in the overweight and obese population. Healthy weight and underweight individuals do not lose much weight on average, even with extensive fasting. Users who are obese lose substantial weight over time, with more weight loss in those who fast more. %M 36194463 %R 10.2196/35896 %U https://mhealth.jmir.org/2022/10/e35896 %U https://doi.org/10.2196/35896 %U http://www.ncbi.nlm.nih.gov/pubmed/36194463 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e37343 %T Mobile Health Use by Older Individuals at Risk of Cardiovascular Disease and Type 2 Diabetes Mellitus in an Australian Cohort: Cross-sectional Survey 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 7 3253 3603, vera.buss@csiro.au %K cardiovascular diseases %K diabetes mellitus type 2 %K cohort studies %K telemedicine %K mobile applications %K mHealth %K mobile health %K mobile app %K aging %K digital health %K cardiovascular %K diabetes %D 2022 %7 7.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The digital transformation has the potential to change health care toward more consumers’ involvement, for example, in the form of health-related apps which are already widely available through app stores. These could be useful in helping people understand their risk of chronic conditions and helping them to live more healthily. Objective: With this study, we assessed mobile health app use among older Australians in general and among those who were at risk of cardiovascular disease or type 2 diabetes mellitus. Methods: In this cross-sectional analysis, we used data from the second follow-up wave of the 45 and Up Study. It is a cohort study from New South Wales, Australia, with 267,153 participants aged 45 years and older that is based on a random sample from the Services Australia (formerly the Australian Government Department of Human Services) Medicare enrollment database. The 2019 follow-up questionnaire contained questions about technology and mobile health use. We further used data on prescribed drugs and hospitalizations to identify participants who already had cardiovascular disease or diabetes or who were at risk of these conditions. Our primary outcome measure was mobile health use, defined as having used a mobile health app before. We used descriptive statistics and multivariate logistic regression to answer the research questions. Results: Overall, 31,946 individuals with a median age of 69 (IQR 63-76) years had completed the follow-up questionnaire in 2019. We classified half (16,422/31,946, 51.41%) of these as being at risk of cardiovascular disease or type 2 diabetes mellitus and 38.04% (12,152/31,946) as having cardiovascular disease or type 1 or type 2 diabetes mellitus. The proportion of mobile health app users among the at-risk group was 31.46% (5166/16,422) compared to 29.16% (9314/31,946) in the total sample. Those who used mobile health apps were more likely to be female, younger, without physical disability, and with a higher income. People at risk of cardiovascular disease or type 2 diabetes mellitus were not statistically significantly more likely to use mobile health than were people without risk (odds ratio 1.06, 95% CI 0.97-1.16; P=.18; adjusted for age, sex, income, and physical disability). Conclusions: People at risk of cardiovascular disease or type 2 diabetes mellitus were not more likely to use mobile health apps than were people without risk. Those who used mobile health apps were less likely to be male, older, with a physical disability, and with a lower income. From the results, we concluded that aspects of equity must be considered when implementing a mobile health intervention to reach all those that can potentially benefit from it. %M 36069764 %R 10.2196/37343 %U https://mhealth.jmir.org/2022/9/e37343 %U https://doi.org/10.2196/37343 %U http://www.ncbi.nlm.nih.gov/pubmed/36069764 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e39851 %T The Effects of a Digital Well-being Intervention on Older Adults: Retrospective Analysis of Real-world User Data %A Boucher,Eliane %A Honomichl,Ryan %A Ward,Haley %A Powell,Tyler %A Stoeckl,Sarah Elizabeth %A Parks,Acacia %+ Twill, 114 Fifth Avenue, 10th floor, New York, NY, 10011, United States, 1 432 258 5233, eliane@twill.health %K mobile apps %K mental health %K older adults %K technology adoption %K digital health %K mobile phone %D 2022 %7 2.9.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Digital interventions have been shown to be effective for a variety of mental health disorders and problems. However, few studies have examined the effects of digital interventions in older adults; therefore, little is known about how older adults engage with or benefit from these interventions. Given that adoption rates for technology among people aged ≥65 years remain substantially lower than in the general population and that approximately 20% of older adults are affected by mental health disorders, research exploring whether older adults will use and benefit from digital interventions is needed. Objective: This study aimed to examine the extent to which older adults engaged with a digital well-being intervention (Happify) and whether engaging with this program led to improvements in both subjective well-being and anxiety symptoms. Methods: In this retrospective analysis, we analyzed data from 375 real-world Happify users aged ≥65 years who signed up for the platform between January 1, 2019, and December 23, 2021. Changes in well-being and anxiety symptoms across 42 to 182 days were assessed using responses to the in-app assessment, which users were prompted to take every 2 weeks, and were compared among users who engaged with the program at the recommended level (ie, 2 or more activities per week) or below the recommended level. Results: In all, 30% (113/375) of the sample engaged with the platform at the recommended level (ie, completed an average of 2 or more activities per week), and overall, users completed an average of 43.35 (SD 87.80) activities, ranging from 1 to 786, between their first and last assessment. Users were also active on the platform for an average of 19.36 (SD 27.16) days, ranging from 1 to 152 days. Moreover, older adults who engaged at the recommended level experienced significantly greater improvements in subjective well-being (P=.002) and anxiety symptoms (P<.001) relative to those who completed fewer activities. Conclusions: These data provide preliminary evidence that older adults engage with and benefit from digital well-being interventions. We believe that these findings highlight the importance of considering older adult populations in digital health research. More research is needed to understand potential barriers to using digital interventions among older adults and whether digital interventions should be modified to account for this population’s particular needs (eg, ensuring that the intervention is accessible using a variety of devices). However, these results are an important step in demonstrating the feasibility of such interventions in a population that is assumed to be less inclined toward digital approaches. %M 36053569 %R 10.2196/39851 %U https://aging.jmir.org/2022/3/e39851 %U https://doi.org/10.2196/39851 %U http://www.ncbi.nlm.nih.gov/pubmed/36053569 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e35015 %T Digital Health Screening in People With HIV in Uganda to Increase Alcohol Use Reporting: Qualitative Study on the Development and Testing of the Self-administered Digital Screener for Health %A Emenyonu,Nneka %A Kekibiina,Allen %A Woolf-King,Sarah %A Kyampire,Catherine %A Fatch,Robin %A Dawson-Rose,Carol %A Muyindike,Winnie %A Hahn,Judith %+ Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, 550 16th Street, UCSF Mission Hall, 3rd Floor, San Francisco, CA, 94158, United States, 1 6505751465, nneka.emenyonu@ucsf.edu %K unhealthy alcohol use %K HIV %K digital screening %K Uganda %K mobile phone %D 2022 %7 1.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol consumption is a critical driver of the HIV epidemic worldwide, particularly in sub-Saharan Africa, where unhealthy alcohol use and HIV are prevalent. Brief alcohol interventions are effective in reducing alcohol use; however, they depend on effective screening for unhealthy alcohol use, which is often underreported. Thus, there is a need to develop methods to improve reporting of unhealthy alcohol use as an essential step toward referral to brief alcohol interventions. Self-administered digital health screeners may improve reporting. Objective: This study aimed to develop and test a digital, easy-to-use self-administered health screener. The health screener was designed to be implemented in a busy, underresourced HIV treatment setting and used by patients with varying levels of literacy. Methods: We conducted a qualitative study at the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in Uganda to develop and test a digital self-administered health screener. The health screener included a training module and assessed behaviors regarding general health, HIV care, and mental health as well as sensitive topics such as alcohol use and sexual health. We conducted focus group discussions with clinicians and patients with HIV of the Mbarara ISS Clinic who consumed alcohol to obtain input on the need for and content, format, and feasibility of the proposed screener. We iteratively revised a tablet-based screener with a subset of these participants, piloted the revised screener, and conducted individual semistructured in-depth interviews with 20 participants who had taken part in our previous studies on alcohol and HIV, including those who had previously underreported alcohol use and with low literacy. Results: A total of 45 people (n=5, 11% clinicians and n=40, 89% Mbarara ISS Clinic patients) participated in the study. Of the patient participants, 65% (26/40) were male, 43% (17/40) had low literacy, and all (40/40, 100%) had self-reported alcohol use in previous studies. Clinicians and patients cited benefits such as time savings, easing of staff burden, mitigation of patient-provider tension around sensitive issues, and information communication, but also identified areas of training required, issues of security of the device, and confidentiality concerns. Patients also stated fear of forgetting how to use the tablet, making mistakes, and losing information as barriers to uptake. In pilot tests of the prototype, patients liked the feature of a recorded voice in the local language and found the screener easy to use, although many required additional help and training from the study staff to complete the screener. Conclusions: We found a self-administered digital health screener to be appealing to patients and clinicians and usable in a busy HIV clinic setting, albeit with concerns about confidentiality and training. Such a screener may be useful in improving reporting of unhealthy alcohol use for referral to interventions. %M 36048519 %R 10.2196/35015 %U https://formative.jmir.org/2022/9/e35015 %U https://doi.org/10.2196/35015 %U http://www.ncbi.nlm.nih.gov/pubmed/36048519 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e31099 %T Factors Associated With Using the COVID-19 Mobile Contact-Tracing App Among Individuals Diagnosed With SARS-CoV-2 in Amsterdam, the Netherlands: Observational Study %A Ritsema,Feiko %A Bosdriesz,Jizzo R %A Leenstra,Tjalling %A Petrignani,Mariska W F %A Coyer,Liza %A Schreijer,Anja J M %A van Duijnhoven,Yvonne T H P %A van de Wijgert,Janneke H H M %A Schim van der Loeff,Maarten F %A Matser,Amy %+ Department of Infectious Diseases, GGD Amsterdam, Nieuwe Achtergracht 100, Amsterdam, 1018WT, Netherlands, 31 649616442, jbosdriesz@ggd.amsterdam.nl %K COVID-19 %K contact tracing %K mobile contact tracing app %K pandemic %K mHealth %K digital health %K contact tracing app %K mobile applications %K health applications %K public health %K surveillance %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Worldwide, efforts are being made to stop the COVID-19 pandemic caused by SARS-CoV-2. Contact tracing and quarantining are key in limiting SARS-CoV-2 transmission. Mathematical models have shown that the time between infection, isolation of cases, and quarantining of contacts are the most important components that determine whether the pandemic can be controlled. Mobile contact-tracing apps could accelerate the tracing and quarantining of contacts, including anonymous contacts. However, real-world observational data on the uptake and determinants of contact-tracing apps are limited. Objective: The aim of this paper is to assess the use of a national Dutch contact-tracing app among notified cases diagnosed with SARS-CoV-2 infection and investigate which characteristics are associated with the use of the app. Methods: Due to privacy regulations, data from the app could not be used. Instead, we used anonymized SARS-CoV-2 routine contact-tracing data collected between October 28, 2020, and February 26, 2021, in the region of Amsterdam, the Netherlands. Complete case logistic regression analysis was performed to identify which factors (age, gender, country of birth, municipality, number of close contacts, and employment in either health care or education) were associated with using the app. Age and number of close contacts were modelled as B-splines due to their nonlinear relationship. Results: Of 29,766 SARS-CoV-2 positive cases, 4824 (16.2%) reported app use. Median age of cases was 41 (IQR 29-55) years, and 46.7% (n=13,898) were male. In multivariable analysis, males (adjusted odds ratio [AOR] 1.11, 95% CI 1.04-1.18) and residents of municipalities surrounding Amsterdam were more likely to use the app (Aalsmeer AOR 1.34, 95% CI 1.13-1.58; Ouder-Amstel AOR 1.96, 95% CI 1.54-2.50), while people born outside the Netherlands, particularly those born in non-Western countries (AOR 0.33, 95% CI 0.30-0.36), were less likely to use the app. Odds of app use increased with age until the age of 58 years and decreased sharply thereafter (P<.001). Odds of app use increased with number of contacts, peaked at 8 contacts, and then decreased (P<.001). Individuals working in day care, home care, and elderly nursing homes were less likely to use the app. Conclusions: Contact-tracing app use among people with confirmed SARS-CoV-2 infection was low in the region of Amsterdam. This diminishes the potential impact of the app by hampering the ability to warn contacts. Use was particularly low among older people, people born outside the Netherlands, and people with many contacts. Use of the app was also relatively low compared to those from some other European countries, some of which had additional features beyond contact tracing, making them potentially more appealing. For the Dutch contact-tracing app to have an impact, uptake needs to be higher; therefore, investing more into promotional efforts and additional features could be considered. %M 35867842 %R 10.2196/31099 %U https://mhealth.jmir.org/2022/8/e31099 %U https://doi.org/10.2196/31099 %U http://www.ncbi.nlm.nih.gov/pubmed/35867842 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e39520 %T The Use of Digital Health Tools for Health Promotion Among Women With and Without Chronic Diseases: Insights From the 2017-2020 Health Information National Trends Survey %A Ajayi,Kobi V %A Wachira,Elizabeth %A Onyeaka,Henry K %A Montour,Tyra %A Olowolaju,Samson %A Garney,Whitney %+ Department of Health & Kinesiology, Texas A&M University, 2929 Research Parkway, College Station, TX, 77843, United States, 1 9797396250, omo_debare@tamu.edu %K mHealth %K health promotion %K chronic disease %K women %K digital health %K USA %K United States %K patient engagement %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the United States, almost 90% of women are at risk of at least one chronic condition. However, the awareness, management, and monitoring of these conditions are low and present a substantial public health problem. Digital health tools can be leveraged to reduce the alarmingly high rates of chronic condition–related mortality and morbidity in women. Objective: This study aimed to investigate the 4-year trend of digital health use for health promotion among women with chronic conditions in the United States. Methods: Data for this study were obtained from the 2017 to 2020 iterations of the Health Information Trends Survey 5. Separate weighted logistic regression models were conducted to test the unadjusted and adjusted association of the study variables and each digital health use. The 95% CI, adjusted odds ratio (aOR), and P value (.05) were reported. Analysis was conducted using Stata 17 software. Results: In total, 8573 women were included in this study. The weighted prevalence of the use of a smartphone or tablet for various activities were as follows: track health goals, 50.3% (95% CI 48.4%-52.2%; 3279/7122); make a health decision, 43.6% (95% CI 41.9%-45.3%; 2998/7101); and discuss with a provider, 40% (95% CI 38.2%-41.8%; 2834/7099). In the preceding 12 months, 33% (95% CI 30.9%-35.2%; 1395/4826) of women used an electronic wearable device, 18.7% (95% CI 17.3%-20.2%; 1532/7653) shared health information, and 35.2% (95% CI 33.2%-37.3%; 2262/6349) sent or received an SMS text message with a health professional. Between 2017 and 2020, the weighted prevalence of having 0, 1, and multiple chronic conditions were 37.4% (2718/8564), 33.4% (2776/8564), and 29.3% (3070/8564), respectively. However, slightly above half (52.2%, 95% CI 0.50%-0.53%; 4756/8564) of US women reported having at least one chronic disease. Women with multiple chronic conditions had higher odds of using their tablet or smartphone to achieve a health-related goal (aOR 1.43, 95% CI 1.16-1.77; P=.001) and discuss with their provider (aOR 1.55 95% CI 1.20-2.00; P=.001) than those without any chronic conditions. Correspondingly, in the past 12 months, the odds of using an electronic wearable device (aOR 1.40, 95% CI 1.00-1.96; P=.04), sharing health information (aOR 1.91, 95% CI 1.46-2.51; P<.001), and communicating via SMS text messaging with a provider (aOR 1.31, 95% CI 1.02-1.68; P=.03) were significantly higher among women with chronic conditions than those without a chronic condition. Conclusions: This study suggests that women with chronic conditions accept and integrate digital health tools to manage their care. However, certain subpopulations experience a digital disconnect that may exacerbate existing health inequities. Implications for research and opportunities to leverage and integrate digital health tools to prevent, monitor, manage, and treat chronic conditions in women are discussed. %M 35984680 %R 10.2196/39520 %U https://mhealth.jmir.org/2022/8/e39520 %U https://doi.org/10.2196/39520 %U http://www.ncbi.nlm.nih.gov/pubmed/35984680 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e38331 %T Quality of Life and Physical Activity in 629 Individuals With Sarcoidosis: Prospective, Cross-sectional Study Using Smartphones (Sarcoidosis App) %A Chu,Brian %A O'Connor,Daniel M %A Wan,Marilyn %A Barnett,Ian %A Shou,Haochang %A Judson,Marc %A Rosenbach,Misha %+ Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 2nd Floor, Maloney Building, Philadelphia, PA, 19104, United States, 1 2156627883, misha.rosenbach@uphs.upenn.edu %K sarcoidosis %K smartphone %K quality of life %K mobile app %K mobile health %K mHealth %K digital health %K rare disease %K physical activity %K exercise %K fitness %K development %K tracking %K recruit %K enroll %D 2022 %7 10.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Large gaps exist in understanding the symptomatic and functional impact of sarcoidosis, a rare multisystem granulomatous disease affecting fewer than 200,000 individuals in the United States. Smartphones could be used for prospective research, especially for rare diseases where organizing large cohorts can be challenging, given their near ubiquitous ownership and ability to track objective and subjective data with increasingly sophisticated technology. Objective: We aimed to investigate whether smartphones could assess the quality of life (QoL) and physical activity of a large cohort of individuals with sarcoidosis. Methods: We developed a mobile app (Sarcoidosis App) for a prospective, cross-sectional study on individuals with sarcoidosis. The Sarcoidosis App was made available on both Apple and Android smartphones. Individuals with sarcoidosis were recruited, consented, and enrolled entirely within the app. Surveys on sarcoidosis history, medical history, and medications were administered. Patients completed modules from the Sarcoidosis Assessment Tool, a validated patient-reported outcomes assessment of physical activity, fatigue, pain, skin symptoms, sleep, and lungs symptoms. Physical activity measured by smartphones was tracked as available. Results: From April 2018 to May 2020, the App was downloaded 2558 times, and 629 individuals enrolled (404, 64.2% female; mean age 51 years; 513, 81.6% White; 86, 13.7% Black). Two-thirds of participants had a college or graduate degree, and more than half of them reported an income greater than US $60,000. Both QoL related to physical activity (P<.001, ρ=0.250) and fatigue (P<.01, ρ=–0.203) correlated with actual smartphone-tracked physical activity. Overall, 19.0% (98/517) of participants missed at least 1 week of school or work in an observed month owing to sarcoidosis, and 44.4% (279/629) reported that finances “greatly” or “severely” affected by sarcoidosis. Furthermore, 71.2% (437/614) of participants reported taking medications for sarcoidosis, with the most common being prednisone, methotrexate, hydroxychloroquine, and infliximab. Moreover, 46.4% (244/526) reported medication side effects, most commonly due to prednisone. Conclusions: We demonstrate that smartphones can prospectively recruit, consent, and study physical activity, QoL, and medication usage in a large sarcoidosis cohort, using both passively collected objective data and qualitative surveys that did not require any in-person encounters. Our study’s limitations include the study population being weighted toward more educated and wealthier individuals, suggesting that recruitment was not representative of the full spectrum of patients with sarcoidosis in the United States. Our study provides a model for future smartphone-enabled clinical research for rare diseases and highlights key technical challenges that future research teams interested in smartphone-based research for rare diseases should anticipate. %M 35947439 %R 10.2196/38331 %U https://mhealth.jmir.org/2022/8/e38331 %U https://doi.org/10.2196/38331 %U http://www.ncbi.nlm.nih.gov/pubmed/35947439 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37666 %T Improving Health Knowledge Through Provision of Free Digital Health Education to Rural Communities in Iringa, Tanzania: Nonrandomized Intervention Study %A Holst,Christine %A Stelzle,Dominik %A Diep,Lien My %A Sukums,Felix %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, PO Box 1130, Blinderen, Oslo, 0318, Norway, 47 48234044, christine.holst@medisin.uio.no %K digital health %K digital health promotion %K eHealth %K mobile health %K mHealth %K Tanzania %K health education %K HIV/AIDS %K tuberculosis %K cysticercosis %K tapeworm %K mobile phone %D 2022 %7 28.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Community health education is one of the most effective measures to increase health literacy worldwide and can contribute to the achievement of specific targets of the Sustainable Development Goal 3. Digitalized health education materials can improve health knowledge as a dimension of health literacy and play an important role in disease prevention in rural sub-Saharan settings. Objective: The objective of this research is to assess the effect of a digital health education intervention on the uptake and retention of knowledge related to HIV/AIDS, tuberculosis (TB), and Taenia solium (neuro)cysticercosis and taeniosis in rural communities in Iringa, Tanzania. Methods: We conducted a nonrandomized intervention study of participants aged 15 to 45 years, randomly selected from 4 villages in Iringa, Tanzania. The intervention consisted of 2 parts. After the baseline assessment, we showed the participants 3 animated health videos on a tablet computer. After a period of 6 months, free access to community information spots (InfoSpots) with an integrated digital health education platform was provided to the intervention villages. Participants in the control group did not receive the intervention. The primary outcome was the difference in disease knowledge between the intervention and control groups, 12 months after baseline. Data were collected using an open-ended questionnaire, with correct or incorrect answers before and after intervention. Results: Between April and May 2019, a total of 600 participants were recruited into the intervention (n=298, 49.7%) or control (n=302, 50.3%) groups. At baseline, no statistically significant differences in knowledge of the target diseases were observed. At 12 months after intervention, knowledge about HIV/AIDS, TB, and T. solium (neuro)cysticercosis and taeniosis was 10.2% (95% CI 5.0%-15.4%), 12% (95% CI 7.7%-16.2%), and 31.5% (95% CI 26.8%-36.2%) higher in the intervention group than in the control group, respectively. In all 4 domains (transmission, symptoms, treatment, and prevention), an increase in knowledge was observed in all the 3 diseases, albeit to varying degrees. The results were adjusted for potential confounders, and the significance of the primary results was maintained in the sensitivity analysis to assess dropouts. The participants who reported using the InfoSpots in the 12-month assessment further increased their knowledge about the target diseases by 6.8% (HIV/AIDS), 7.5% (TB), and 13.9% higher mean proportion of correct answers compared with the participants who did not use the InfoSpots. Conclusions: Digital health education based on animated health videos and the use of free InfoSpots has significant potential to improve health knowledge, especially in rural areas of low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597 International Registered Report Identifier (IRRID): RR2-10.2196/25128 %M 35900820 %R 10.2196/37666 %U https://www.jmir.org/2022/7/e37666 %U https://doi.org/10.2196/37666 %U http://www.ncbi.nlm.nih.gov/pubmed/35900820 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e29725 %T Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis %A Hardy,Amy %A Ward,Thomas %A Emsley,Richard %A Greenwood,Kathryn %A Freeman,Daniel %A Fowler,David %A Kuipers,Elizabeth %A Bebbington,Paul %A Garety,Philippa %+ Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Henry Wellcome Building, London, SE5 8AF, United Kingdom, 44 2078485178, amy.hardy@kcl.ac.uk %K paranoia %K psychosis %K digital health %K apps %K human-centered design %K user experience %K adherence %K engagement %K therapy %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes. Trial Registration: ISRCTN Registry ISRCTN32448671; https://www.isrctn.com/ISRCTN32448671 %M 35776506 %R 10.2196/29725 %U https://humanfactors.jmir.org/2022/3/e29725 %U https://doi.org/10.2196/29725 %U http://www.ncbi.nlm.nih.gov/pubmed/35776506 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e37086 %T Fitbit Use and Activity Levels From Intervention to 2 Years After: Secondary Analysis of a Randomized Controlled Trial %A Hartman,Sheri J %A Chen,Ruohui %A Tam,Rowena M %A Narayan,Hari K %A Natarajan,Loki %A Liu,Lin %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 3855 Health Sciences Drive, #0901, La Jolla, CA, 92037, United States, 1 8585349235, sjhartman@ucsd.edu %K physical activity %K fitness %K exercise %K Fitbit %K wearable %K health technology %K mHealth %K digital health %K activity tracker %K maintenance %K adherence %K tracker %K use pattern %K activity level %K behavior change %K cancer %K breast %K survivor %K long-term use %K sustained use %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been a rapid increase in the use of commercially available activity trackers, such as Fitbit, in physical activity intervention research. However, little is known about the long-term sustained use of trackers and behavior change after short-term interventions. Objective: This study aims to use minute-level data collected from a Fitbit tracker for up to 2 years after the end of a randomized controlled trial to examine patterns of Fitbit use and activity over time. Methods: Participants in this secondary data analysis were 75 female breast cancer survivors who had been enrolled in a 12-week physical activity randomized controlled trial. Participants randomized to the exercise intervention (full intervention arm) received a Fitbit One, which was worn daily throughout the 12-week intervention, and then were followed for 2 years after the intervention. Participants randomized to the waitlist arm, after completing the randomized controlled trial, received a Fitbit One and a minimal version of the exercise intervention (light intervention arm), and then were followed for 2 years after the intervention. Average and daily adherence and MVPA were compared between the 2 groups in the interventional and postinterventional periods using both linear and generalized additive mixed effects models. Results: Adherence to wearing the Fitbit during the 12-week intervention period was significantly higher in the full intervention arm than in the light intervention arm (85% vs 60%; P<.001). Average adherence was significantly lower for both study arms during the follow-up period than in the intervention period; however, there were statistically different patterns of adherence during the follow-up period, with the light intervention arm having steeper declines than the full intervention arm over time (P<.001). Similar to the adherence results, mean minutes of Fitbit-measured MVPA was higher for the full intervention arm than for the light intervention arm during the 12-week intervention period (mean MVPA 27.89 minutes/day, SD 16.38 minutes/day vs 18.35 minutes/day, SD 12.64 minutes/day; P<.001). During the follow-up period, average MVPA was significantly lower than the 12-week intervention period for both the full intervention arm (21.74 minutes/day, SD 24.65 minutes/day; P=.002) and the light intervention arm (15.03 minutes/day, SD 13.27 minutes/day; P=.004). Although the mean MVPA in each arm was similar across the follow-up period (P=.33), the pattern of daily MVPA was significantly different between the 2 groups (P<.001). Conclusions: While adherence to wearing activity trackers and maintaining physical activities declined after completion of a 12-week exercise intervention, a more active interventional strategy resulted in greater wear time and activity levels during the intervention and more stable patterns of adherence and activity in the long term. An improved understanding of long-term maintenance patterns may inform improved exercise interventions that result in sustained increases in physical activity. Trial Registration: ClinicalTrials.gov NCT02332876; https://clinicaltrials.gov/ct2/show/NCT02332876 %M 35771607 %R 10.2196/37086 %U https://mhealth.jmir.org/2022/6/e37086 %U https://doi.org/10.2196/37086 %U http://www.ncbi.nlm.nih.gov/pubmed/35771607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38162 %T Digital Screening and Automated Resource Identification System to Address COVID-19–Related Behavioral Health Disparities: Feasibility Study %A Stiles-Shields,Colleen %A Batts,Kathryn R %A Reyes,Karen M %A Archer,Joseph %A Crosby,Sharad %A Draxler,Janel M %A Lennan,Nia %A Held,Philip %+ Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd, Suite 302, Chicago, IL, 60612, United States, 1 312 942 9998, colleen_stiles-shields@rush.edu %K digital mental health %K underserved %K health disparities %K COVID-19 %K screening %K referral %K mental health %K digital health %K feasibility study %K mobile app %K mHealth %K mobile health %K emotional need %K digital health tool %K health resource %K health care cost %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health (DMH) tools use technology (eg, websites and mobile apps) to conveniently deliver mental health resources to users in real time, reducing access barriers. Underserved communities facing health care provider shortages and limited mental health resources may benefit from DMH tools, as these tools can help improve access to resources. Objective: This study described the development and feasibility evaluation of the Emotional Needs Evaluation and Resource Guide for You (ENERGY) System, a DMH tool to meet the mental health and resource needs of youth and their families developed in the context of the COVID-19 pandemic. The ENERGY System offers a brief assessment of resource needs; problem-solving capabilities; and symptoms of depression, anxiety, trauma, and alcohol and substance use followed by automated, personalized feedback based on the participant’s responses. Methods: Individuals aged ≥15 years were recruited through community partners, community events, targeted electronic health record messages, and social media. Participants completed screening questions to establish eligibility, entered demographic information, and completed the ENERGY System assessment. Based on the participant’s responses, the ENERGY System immediately delivered digital resources tailored to their identified areas of need (eg, relaxation). A subset of participants also voluntarily completed the following: COVID-19 Exposure and Family Impact Survey (CEFIS) or COVID-19 Exposure and Family Impact Survey Adolescent and Young Adult Version (CEFIS-AYA); resource needs assessment; and feedback on their experience using the ENERGY System. If resource needs (eg, housing and food insecurity) were endorsed, lists of local resources were provided. Results: A total of 212 individuals accessed the ENERGY System link, of which 96 (45.3%) completed the screening tool and 86 (40.6%) received resources. Participant responses on the mental health screening questions triggered on average 2.04 (SD 1.94) intervention domains. Behavioral Activation/Increasing Activities was the most frequently launched intervention domain (56%, 54/96), and domains related to alcohol or substance use were the least frequent (4%, 4/96). The most frequently requested support areas were finances (33%, 32/96), transportation (26%, 25/96), and food (24%, 23/96). The CEFIS and CEFIS-AYA indicated higher than average impacts from the pandemic (ie, average scores >2.5). Participants were satisfied with the ENERGY System overall (65%, 39/60) as well as the length of time it took to answer the questions (90%, 54/60), which they found easy to answer (87%, 52/60). Conclusions: This study provided initial support for the feasibility of the ENERGY System, a DMH tool capable of screening for resource and mental health needs and providing automated, personalized, and free resources and techniques to meet the identified needs. Future studies should seek direct feedback from community members to further improve the ENERGY System and its dissemination to encourage use. %M 35696607 %R 10.2196/38162 %U https://formative.jmir.org/2022/6/e38162 %U https://doi.org/10.2196/38162 %U http://www.ncbi.nlm.nih.gov/pubmed/35696607 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e38991 %T Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial %A Leightley,Daniel %A Williamson,Charlotte %A Rona,Roberto J %A Carr,Ewan %A Shearer,James %A Davis,Jordan P %A Simms,Amos %A Fear,Nicola T %A Goodwin,Laura %A Murphy,Dominic %+ Institute of Psychiatry, Psychology & Neuroscience, King’s Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 78485351, daniel.leightley@kcl.ac.uk %K military %K veteran %K digital health %K alcohol misuse %K smartphone %K mobile health %K mHealth %K alcohol intervention %K digital intervention %K mental health %K smartphone application %K health intervention %K alcohol consumption %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction intervention that is personalized to support the UK AF. Objective: To address this gap, we investigated the efficacy of a 28-day brief alcohol intervention delivered via a mobile app in reducing weekly self-reported alcohol consumption among UK veterans seeking help for mental health difficulties. Methods: We performed a 2-arm participant-blinded randomized controlled trial (RCT). We compared a mobile app that included interactive features designed to enhance participants’ motivation and personalized messaging (intervention arm) with a version that provided government guidance on alcohol consumption only (control arm). Adults were eligible if they had served in the UK AF, were currently receiving or had received clinical support for mental health symptoms, and consumed 14 units (approximately 112 g of ethanol) or more of alcohol per week. Participants received the intervention or the control mobile app (1:1 ratio). The primary outcome was a change in self-reported weekly alcohol consumption between baseline and day 84 assessed using the validated Timeline Follow Back for Alcohol Consumption (TLFB) (prior 7 days), with a secondary outcome exploring self-reported change in the Alcohol Use Disorder Identification Test (AUDIT) score. Results: Between October 2020 and April 2021, 2708 individuals were invited to take part, of which 2531 (93.5%) did not respond, 54 (2%) were ineligible, and 123 (4.5%) responded and were randomly allocated (62, 50.4%, intervention; 61, 49.6%, control). At day 84, 41 (66.1%) participants in the intervention arm and 37 (60.7%) in the control arm completed the primary outcome assessment. Between baseline and day 84, weekly alcohol consumption reduced by –10.5 (95% CI –19.5 to –1.5) units in the control arm and –28.2 (95% CI –36.9 to –19.5) units in the intervention arm (P=.003, Cohen d=0.35). We also found a significant reduction in the AUDIT score of –3.9 (95% CI –6.2 to –1.6) in the intervention arm (Cohen d=0.48). Our primary and secondary effects did not persist over the longer term (day 168). Two adverse events were detected during the trial. Conclusions: This study examined the efficacy of a fully automated 28-day brief alcohol intervention delivered via a mobile app in a help-seeking sample of UK veterans with hazardous alcohol consumption. We found that participants receiving Drinks:Ration reduced their alcohol consumption more than participants receiving guidance only (at day 84). In the short term, we found Drinks:Ration is efficacious in reducing alcohol consumption in help-seeking veterans. Trial Registration: ClinicalTrials.gov NCT04494594; https://tinyurl.com/34em6n9f International Registered Report Identifier (IRRID): RR2-10.2196/19720 %M 35724966 %R 10.2196/38991 %U https://mhealth.jmir.org/2022/6/e38991 %U https://doi.org/10.2196/38991 %U http://www.ncbi.nlm.nih.gov/pubmed/35724966 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34882 %T Use of Smartphone Health Apps Among Patients Aged 18 to 69 Years in Primary Care: Population-Based Cross-sectional Survey %A Paradis,Sabrina %A Roussel,Jeremy %A Bosson,Jean-Luc %A Kern,Jean-Baptiste %+ Translational Innovation in Medicine and Complexity, National Institute of Health and Medical Research, Laboratoire TIMC, Bâtiment Taillefer, Rond-Point de la Croix de Vie, Domaine de la Merci, La Tronche, 38706, France, 33 678863377, sabrina.paradis@univ-grenoble-alpes.fr %K smartphone %K health applications %K mHealth %K apps %K mobile health %K digital health %K well-being %K epidemiology %K primary care %K population survey %K fitness %K physical activity %K health behavior %K patient %D 2022 %7 16.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization has defined mobile health (mHealth) as the “use of mobile and wireless technologies to support the achievement of health objectives.” Smartphones currently represent one of the main media forms for mHealth democratization. Health apps can be an interesting tool for changing health behaviors. However, their use in France is still poorly documented. Objective: The main aim of this study was to evaluate the frequency of use of health apps among patients consulting in the primary care setting in France. The secondary aims were to evaluate the use of health apps according to the sociodemographic and medical characteristics of patients and to determine their use. Methods: A population-based cross-sectional survey was carried out between November 2017 and January 2018 in the Grenoble area of France among patients aged between 18 and 69 years who were consulting at 13 primary care physician offices. Patients were provided with anonymous paper self-questionnaires. The main criterion for participation was the use of a smartphone health app, defined for the purpose of this study as any app supporting patients in efforts to be healthy. Results: The participation rate was 49.27% (739/1500; 95% CI 46.7%-51.8%). The smartphone use was estimated at 82.6% (597/723; 95% CI 79.6%-85.2%). Of 597 smartphone owners, 47.7% (283/595; CI 43.6%-51.6%) used at least one smartphone health app. Health apps identified in this study were mainly related to wellness, prevention, and fitness (66.1%), as well as medication, treatments, and follow-up care (50.0%). The main factors associated with health app use were: use of social networks (odds ratio [OR] 3.4, 95% CI 2.1-5.3), age under 30 years (OR 2.7, CI 1.4-4.9), city size between 5001 and 10,000 inhabitants (OR 1.8, CI 1.1-2.8), and city size more than 10,000 inhabitants (OR 2.1, CI 1.4-3.2). Conclusions: In this survey, nearly one out of two patients reported the use of smartphone health apps, which are currently focused on wellness, prevention, and fitness, and are largely used by the younger population. Trial Registration: ClinicalTrials.gov NCT03351491; https://clinicaltrials.gov/ct2/show/NCT03351491 %M 35708744 %R 10.2196/34882 %U https://formative.jmir.org/2022/6/e34882 %U https://doi.org/10.2196/34882 %U http://www.ncbi.nlm.nih.gov/pubmed/35708744 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e31764 %T Real-world Benefits of Diabetes Management App Use and Self-monitoring of Blood Glucose on Glycemic Control: Retrospective Analyses %A Chang,Ya-Ting %A Tu,Yu-Zhen %A Chiou,Hung-Yi %A Lai,Ken %A Yu,Neng Chun %+ H2 Inc, 4F, No 32, Aly 18, Ln 478, Ruiguang Rd, Neihu Dist, Taipei, 114063, Taiwan, 886 287976661 ext 105, klai@health2sync.com %K diabetes care %K digital intervention %K mobile app %K real-world data %K glycemic control %K mobile health %K digital therapeutics %K diabetes %K therapy %K app %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Among self-care measures, the self-monitoring of blood glucose (SMBG) is a critical component for checking blood glucose levels. In addition, there is growing evidence suggesting that digital technologies are being adopted as an additional method for health care systems to increase patient contact. However, for patients with non–insulin-treated diabetes mellitus type 2 (DMT2), the value of SMBG was inconsistent among studies, and the evidence for digital technologies from real-world clinical practice is still limited. Objective: Our study aimed to assess patients with non–insulin-treated DMT2 who were receiving care from a single clinic and analyze whether the use of a diabetes management app and SMBG behavior would affect glycemic control in a real-world clinical setting. Methods: We collaborated with a large clinic focused on diabetes care in Taiwan that had been using the Health2Sync mobile app and web-based Patient Management Platform to collect the data. The patients were divided into 2 groups (app-engaged-user group and only-data-uploader group) according to different activities in the app, and blood glucose was recorded every month from 1 to 6 months after registration in the app. A sample of 420 patients was included in the analysis, and a linear mixed model was built to investigate which factors affected the patients’ blood glucose percentage change. Results: Using the mixed model coefficient estimates, we found that the percentage change was significantly negative when the only-data-uploader group was set as the baseline (t=–3.873, df=1.81 × 104; P<.001 for the patients of the app-engaged-user group). We found that for patients with shorter diabetes duration, their blood glucose decreased more than patients with longer diabetes duration (t=2.823, df=1.71 × 104; P=.005 for the number of years of diabetes duration). In addition, we found that for younger patients, their blood glucose decreased more than older patients (t=2.652, df=1.71 × 104; P=.008 for the age of the patients). Furthermore, the patients with an education level of junior high school or lower saw a significantly greater decrease in blood glucose percentage change than the patients with an education level of senior high school or higher (t=4.996, df=1.72 × 104; P<.001 for the patients with an education level of senior high school or higher). We also found that the count of blood glucose measured enlarged the decrease along the interaction months (t=–8.266, df=1.97 × 104; P<.001 for the nth month × the count of blood glucose in the nth month). Lastly, the gender of the patients did not significantly affect the percentage change (t=0.534, df=1.74 × 104; P=.59 for female patients). Conclusions: Our analysis showed the following: the blood glucose percentage change of the patients in the app-engaged-user group dropped more than that in the only-data-uploader group; shorter diabetes duration is associated with a steeper decrease in the patients’ blood glucose percentage change; the percentage decrease in blood glucose change in younger patients is greater than older patients; the blood glucose percentage change of the patients with an education level of junior high school or lower dropped more than those with an education level of senior high school or higher; and the more frequently the patients test SMBG each month, the greater the decrease in the patients’ blood glucose percentage. Further studies can be performed to consider the differences in daily behaviors such as exercise and diet across the patients and whether these factors could have vital effects on glycemic control. %M 35704371 %R 10.2196/31764 %U https://mhealth.jmir.org/2022/6/e31764 %U https://doi.org/10.2196/31764 %U http://www.ncbi.nlm.nih.gov/pubmed/35704371 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34080 %T Patient Onboarding and Engagement to Build a Digital Study After Enrollment in a Clinical Trial (TAILOR-PCI Digital Study): Intervention Study %A Avram,Robert %A So,Derek %A Iturriaga,Erin %A Byrne,Julia %A Lennon,Ryan %A Murthy,Vishakantha %A Geller,Nancy %A Goodman,Shaun %A Rihal,Charanjit %A Rosenberg,Yves %A Bailey,Kent %A Farkouh,Michael %A Bell,Malcolm %A Cagin,Charles %A Chavez,Ivan %A El-Hajjar,Mohammad %A Ginete,Wilson %A Lerman,Amir %A Levisay,Justin %A Marzo,Kevin %A Nazif,Tamim %A Olgin,Jeffrey %A Pereira,Naveen %+ Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94117, United States, 1 451 476 1325, Jeffrey.Olgin@ucsf.edu %K digital study %K clinical trial %K cardiology %K smartphone %K digital health %K mobile health %K clinical trial %K mobile phone %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response After Percutaneous Coronary Intervention (TAILOR-PCI) Digital Study is a novel proof-of-concept study that evaluated the feasibility of extending the TAILOR-PCI randomized controlled trial (RCT) follow-up period by using a remote digital platform. Objective: The aim of this study is to describe patients’ onboarding, engagement, and results in a digital study after enrollment in an RCT. Methods: In this intervention study, previously enrolled TAILOR-PCI patients in the United States and Canada within 24 months of randomization were invited by letter to download the study app. Those who did not respond to the letter were contacted by phone to survey the reasons for nonparticipation. A direct-to-patient digital research platform (the Eureka Research Platform) was used to onboard patients, obtain consent, and administer activities in the digital study. The patients were asked to complete health-related surveys and digitally provide follow-up data. Our primary end points were the consent rate, the duration of participation, and the monthly activity completion rate in the digital study. The hypothesis being tested was formulated before data collection began. Results: After the parent trial was completed, letters were mailed to 907 eligible patients (representing 18.8% [907/4837] of total enrolled in the RCT) within 15.6 (SD 5.2) months of randomization across 24 sites. Among the 907 patients invited, 290 (32%) visited the study website and 110 (12.1%) consented—40.9% (45/110) after the letter, 33.6% (37/110) after the first phone call, and 25.5% (28/110) after the second call. Among the 47.4% (409/862) of patients who responded, 41.8% (171/409) declined to participate because of a lack of time, 31.2% (128/409) declined because of the lack of a smartphone, and 11.5% (47/409) declined because of difficulty understanding what was expected of them in the study. Patients who consented were older (aged 65.3 vs 62.5 years; P=.006) and had a lower prevalence of diabetes (19% vs 30%; P=.02) or tobacco use (6.4% vs 24.8%; P<.001). A greater proportion had bachelor’s degrees (47.2% vs 25.7%; P<.001) and were more computer literate (90.5% vs 62.3% of daily internet use; P<.001) than those who did not consent. The average completion rate of the 920 available monthly electronic visits was 64.9% (SD 7.6%); there was no decrease in this rate throughout the study duration. Conclusions: Extended follow-up after enrollment in an RCT by using a digital study was technically feasible but was limited because of the inability to contact most eligible patients or a lack of time or access to a smartphone. Among the enrolled patients, most completed the required electronic visits. Enhanced recruitment methods, such as the introduction of a digital study at the time of RCT consent, smartphone provision, and robust study support for onboarding, should be explored further. Trial Registration: Clinicaltrails.gov NCT01742117; https://clinicaltrials.gov/ct2/show/NCT01742117 %M 35699977 %R 10.2196/34080 %U https://formative.jmir.org/2022/6/e34080 %U https://doi.org/10.2196/34080 %U http://www.ncbi.nlm.nih.gov/pubmed/35699977 %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 5 %P e33985 %T Use and Perception of Digital Health Technologies by Surgical Patients in Germany in the Pre–COVID-19 Era: Survey Study %A Korn,Sandra %A Böttcher,Maximilian David %A Busse,Theresa Sophie %A Kernebeck,Sven %A Breucha,Michael %A Ehlers,Jan %A Kahlert,Christoph %A Weitz,Jürgen %A Bork,Ulrich %+ Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, Dresden, 01307, Germany, 49 3514582742, Sandra.Korn@ukdd.de %K digital equity %K eHealth %K electronic health %K mobile health %K health apps %K mobile health apps %K eHealth literacy %K mobile phone %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: This survey study investigates surgical patients’ use and perception of digital health technologies in Germany in the pre–COVID-19 era. Objective: The objective of this study was to relate surgical patients’ characteristics to the use and perception of several digital health technologies. Methods: In this single-center, cross-sectional survey study in the outpatient department of a university hospital in Germany, 406 patients completed a questionnaire with the following three domains: general information and use of the internet, smartphones, and general digital health aspects. Analyses were stratified by age group and highest education level achieved. Results: We found significant age-based differences in most of the evaluated aspects. Younger patients were more open to using new technologies in private and medical settings but had more security concerns. Although searching for information on illnesses on the web was common, the overall acceptance of and trust in web-based consultations were rather low, with <50% of patients in each age group reporting acceptance and trust. More people with academic qualifications than without academic qualifications searched for information on the web before visiting physicians (73/121, 60.3% and 100/240, 41.7%, respectively). Patients with academic degrees were also more engaged in health-related information and communication technology use. Conclusions: These results support the need for eHealth literacy, health literacy, and available digital devices and internet access to support the active, meaningful use of information and communication technologies in health care. Uncertainties and a lack of knowledge exist, especially regarding telemedicine and the use of medical and health apps. This is especially pronounced among older patients and patients with a low education status. %M 35594072 %R 10.2196/33985 %U https://formative.jmir.org/2022/5/e33985 %U https://doi.org/10.2196/33985 %U http://www.ncbi.nlm.nih.gov/pubmed/35594072 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e34508 %T Technology-Based Interventions in Substance Use Treatment to Promote Health Equity Among People Who Identify as African American/Black, Hispanic/Latinx, and American Indian/Alaskan Native: Protocol for a Scoping Review %A Hichborn,Emily G %A Moore,Sarah K %A Gauthier,Phoebe R %A Agosti,Nico O %A Bell,Kathleen D %A Boggis,Jesse S %A Lambert-Harris,Chantal A %A Saunders,Elizabeth C %A Turner,Avery M %A McLeman,Bethany M %A Marsch,Lisa A %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, United States, 1 603 646 7081, Emily.G.Hichborn@Dartmouth.Edu %K health disparities %K scoping review %K social determinants of health %K substance use %K treatment %K technology-based interventions %K underrepresented %D 2022 %7 17.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Technology-based interventions (TBIs; ie, web-based and mobile interventions) have the potential to promote health equity in substance use treatment (SUTx) for underrepresented groups (people who identify as African American/Black, Hispanic/Latinx, and American Indian/Alaskan Native) by removing barriers and increasing access to culturally relevant effective treatments. However, technologies (emergent and more long-standing) may have unintended consequences that could perpetuate health care disparities among people who identify as a member of one of the underrepresented groups. Health care research, and SUTx research specifically, is infrequently conducted with people who identify with these groups as the main focus. Therefore, an improved understanding of the literature at the intersection of SUTx, TBIs, and underrepresented groups is warranted to avoid exacerbating inequities and to promote health equity. Objective: This study aims to explore peer-reviewed literature (January 2000-March 2021) that includes people who identify as a member of one of the underrepresented groups in SUTx research using TBIs. We further seek to explore whether this subset of research is race/ethnicity conscious (does the research consider members of underrepresented groups beyond their inclusion as study participants in the introduction, methods, results, or discussion). Methods: Five electronic databases (MEDLINE, Scopus, Cochrane Library, CINAHL, and PsycInfo) were searched to identify SUTx research using TBIs, and studies were screened for eligibility at the title/abstract and full-text levels. Studies were included if their sample comprised of people who identify as a member of one of the underrepresented groups at 50% or more when combined. Results: Title/abstract and full-text reviews were completed in 2021. These efforts netted a sample of 185 studies that appear to meet inclusionary criteria. Due to the uniqueness of tobacco relative to other substances in the SUTx space, as well as the large number of studies netted, we plan to separately publish a scoping review on tobacco-focused studies that meet all other criteria. Filtering for tobacco-focused studies (n=31) netted a final full-text sample for a main scoping review of 154 studies. The tobacco-focused scoping review manuscript is expected to be submitted for peer review in Spring 2022. The main scoping review data extraction and data validation to confirm the accuracy and consistency of data extraction across records was completed in March 2022. We expect to publish the main scoping review findings by the end of 2022. Conclusions: Research is needed to increase our understanding of the range and nature of TBIs being used in SUTx research studies with members of underrepresented groups. The planned scoping review will highlight research at this intersection to promote health equity. International Registered Report Identifier (IRRID): DERR1-10.2196/34508 %M 35579930 %R 10.2196/34508 %U https://www.researchprotocols.org/2022/5/e34508 %U https://doi.org/10.2196/34508 %U http://www.ncbi.nlm.nih.gov/pubmed/35579930 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e30716 %T Ownership, Use of, and Interest in Digital Mental Health Technologies Among Clinicians and Young People Across a Spectrum of Clinical Care Needs: Cross-sectional Survey %A Bell,Imogen H %A Thompson,Andrew %A Valentine,Lee %A Adams,Sophie %A Alvarez-Jimenez,Mario %A Nicholas,Jennifer %+ Orygen, 35 Poplar Rd, Parkville, 3052, Australia, 61 430156222, imogen.bell@orygen.org.au %K adolescent %K youth mental health %K mental health %K attitude %K digital technology %K internet-based interventions %K digital mental health %K mental health services %K clinician %K mobile phone %D 2022 %7 11.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is currently an increased interest in and acceptance of technology-enabled mental health care. To adequately harness this opportunity, it is critical that the design and development of digital mental health technologies be informed by the needs and preferences of end users. Despite young people and clinicians being the predominant users of such technologies, few studies have examined their perspectives on different digital mental health technologies. Objective: This study aims to understand the technologies that young people have access to and use in their everyday lives and what applications of these technologies they are interested in to support their mental health. The study also explores the technologies that youth mental health clinicians currently use within their practice and what applications of these technologies they are interested in to support their clients’ mental health. Methods: Youth mental health service users (aged 12-25 years) from both primary and specialist services, young people from the general population (aged 16-25 years), and youth mental health clinicians completed a web-based survey exploring technology ownership, use of, and interest levels in using different digital interventions to support their mental health or that of their clients. Results: A total of 588 young people and 73 youth mental health clinicians completed the survey. Smartphone ownership or private access among young people within mental health services and the general population was universal (611/617, 99%), with high levels of access to computers and social media. Youth technology use was frequent, with 63.3% (387/611) using smartphones several times an hour. Clinicians reported using smartphones (61/76, 80%) and video chat (69/76, 91%) commonly in clinical practice and found them to be helpful. Approximately 50% (296/609) of the young people used mental health apps, which was significantly less than the clinicians (χ23=28.8, n=670; P<.001). Similarly, clinicians were significantly more interested in using technology for mental health support than young people (H3=55.90; P<.001), with 100% (73/73) of clinicians being at least slightly interested in technology to support mental health compared with 88% (520/591) of young people. Follow-up tests revealed no difference in interest between young people from the general population, primary mental health services, and specialist mental health services (all P>.23). Young people were most interested in web-based self-help, mobile self-help, and blended therapy. Conclusions: Technology access is pervasive among young people within and outside of youth mental health services; clinicians are already using technology to support clinical care, and there is widespread interest in digital mental health technologies among these groups of end users. These findings provide important insights into the perspectives of young people and clinicians regarding the value of digital mental health interventions in supporting youth mental health. %M 35544295 %R 10.2196/30716 %U https://mental.jmir.org/2022/5/e30716 %U https://doi.org/10.2196/30716 %U http://www.ncbi.nlm.nih.gov/pubmed/35544295 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e36404 %T Nonusage Attrition of Adolescents in an mHealth Promotion Intervention and the Role of Socioeconomic Status: Secondary Analysis of a 2-Arm Cluster-Controlled Trial %A Maenhout,Laura %A Peuters,Carmen %A Cardon,Greet %A Crombez,Geert %A DeSmet,Ann %A Compernolle,Sofie %+ Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 92646363, laura.maenhout@ugent.be %K mHealth %K nonusage attrition %K adolescents %K socioeconomic status %K mobile phone %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) interventions may help adolescents adopt healthy lifestyles. However, attrition in these interventions is high. Overall, there is a lack of research on nonusage attrition in adolescents, particularly regarding the role of socioeconomic status (SES). Objective: The aim of this study was to focus on the role of SES in the following three research questions (RQs): When do adolescents stop using an mHealth intervention (RQ1)? Why do they report nonusage attrition (RQ2)? Which intervention components (ie, self-regulation component, narrative, and chatbot) prevent nonusage attrition among adolescents (RQ3)? Methods: A total of 186 Flemish adolescents (aged 12-15 years) participated in a 12-week mHealth program. Log data were monitored to measure nonusage attrition and usage duration for the 3 intervention components. A web-based questionnaire was administered to assess reasons for attrition. A survival analysis was conducted to estimate the time to attrition and determine whether this differed according to SES (RQ1). Descriptive statistics were performed to map the attrition reasons, and Fisher exact tests were used to determine if these reasons differed depending on the educational track (RQ2). Mixed effects Cox proportional hazard regression models were used to estimate the associations between the use duration of the 3 components during the first week and attrition. An interaction term was added to the regression models to determine whether associations differed by the educational track (RQ3). Results: After 12 weeks, 95.7% (178/186) of the participants stopped using the app. 30.1% (56/186) of the adolescents only opened the app on the installation day, and 44.1% (82/186) stopped using the app in the first week. Attrition at any given time during the intervention period was higher for adolescents from the nonacademic educational track compared with those from the academic track. The other SES indicators (family affluence and perceived financial situation) did not explain attrition. The most common reasons for nonusage attrition among participants were perceiving that the app did not lead to behavior change, not liking the app, thinking that they already had a sufficiently healthy lifestyle, using other apps, and not being motivated by the environment. Attrition reasons did not differ depending on the educational track. More time spent in the self-regulation and narrative components during the first week was associated with lower attrition, whereas chatbot use duration was not associated with attrition rates. No moderating effects of SES were observed in the latter association. Conclusions: Nonusage attrition was high, especially among adolescents in the nonacademic educational track. The reported reasons for attrition were diverse, with no statistical differences according to the educational level. The duration of the use of the self-regulation and narrative components during the first week may prevent attrition for both educational tracks. Trial Registration: ClinicalTrials.gov NCT04719858; http://clinicaltrials.gov/ct2/show/NCT04719858 %M 35536640 %R 10.2196/36404 %U https://mhealth.jmir.org/2022/5/e36404 %U https://doi.org/10.2196/36404 %U http://www.ncbi.nlm.nih.gov/pubmed/35536640 %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 e29780 %T Health Professionals’ eHealth Literacy and System Experience Before and 3 Months After the Implementation of an Electronic Health Record System: Longitudinal Study %A Kayser,Lars %A Karnoe,Astrid %A Duminski,Emily %A Jakobsen,Svend %A Terp,Rikke %A Dansholm,Susanne %A Roeder,Michael %A From,Gustav %+ Section of Health Service Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1353, Denmark, 45 28757291, lk@sund.ku.dk %K health care professionals %K eHealth literacy %K electronic health record %K implementation %K digital health %K eHealth %K health literacy %K health records %K eHealth records %K patient care %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The implementation of an integrated electronic health record (EHR) system can potentially provide health care providers with support standardization of patient care, pathways, and workflows, as well as provide medical staff with decision support, easier access, and the same interface across features and subsystems. These potentials require an implementation process in which the expectations of the medical staff and the provider of the new system are aligned with respect to the medical staff’s knowledge and skills, as well as the interface and performance of the system. Awareness of the medical staff’s level of eHealth literacy may be a way of understanding and aligning these expectations and following the progression of the implementation process. Objective: The objective of this study was to investigate how a newly developed and modified instrument measuring the medical staff’s eHealth literacy (staff eHealth Literacy Questionnaire [eHLQ]) can be used to inform the system provider and the health care organization in the implementation process and evaluate whether the medical staff’s perceptions of the ease of use change and how this may be related to their level of eHealth literacy. Methods: A modified version of the eHLQ was distributed to the staff of a medical department in Denmark before and 3 months after the implementation of a new EHR system. The survey also included questions related to users’ perceived ease of use and their self-reported information technology skills. Results: The mean age of the 194 participants before implementation was 43.1 (SD 12.4) years, and for the 198 participants after implementation, it was 42.3 (SD 12.5) years. After the implementation, the only difference compared with the preimplementation data was a small decrease in staff eHLQ5 (motivated to engage with digital services; unpaired 2-tailed t test; P=.009; effect size 0.267), and the values of the scales relating to the medical staff’s knowledge and skills (eHLQ1-3) were approximately ≥3 both before and after implementation. The range of scores was narrower after implementation, indicating that some of those with the lowest ability benefited from the training and new experiences with the EHR. There was an association between perceived ease of use and the 3 tested staff eHLQ scales, both before and after implementation. Conclusions: The staff eHLQ may be a good candidate for monitoring the medical staff’s digital competence in and response to the implementation of new digital solutions. This may enable those responsible for the implementation to tailor efforts to the specific needs of segments of users and inform them if the process is not going according to plan with respect to the staff’s information technology–related knowledge and skills, trust in data security, motivation, and experience of a coherent system that suits their needs and supports the workflows and data availability. %M 35486414 %R 10.2196/29780 %U https://humanfactors.jmir.org/2022/2/e29780 %U https://doi.org/10.2196/29780 %U http://www.ncbi.nlm.nih.gov/pubmed/35486414 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35641 %T Understanding the Potential of Mental Health Apps to Address Mental Health Needs of the Deaf and Hard of Hearing Community: Mixed Methods Study %A Borghouts,Judith %A Neary,Martha %A Palomares,Kristina %A De Leon,Cinthia %A Schueller,Stephen M %A Schneider,Margaret %A Stadnick,Nicole %A Mukamel,Dana B %A Sorkin,Dara H %A Brown,Dakota %A McCleerey-Hooper,Shannon %A Moriarty,Gloria %A Eikey,Elizabeth V %+ Department of Medicine, University of California, Irvine, 100 Theory, Irvine, CA, 92617, United States, 1 9498240246, jborghou@uci.edu %K mental health %K deaf and hard of hearing community %K mHealth %K digital health %K needs assessment %K deaf %K hard of hearing %K hearing %K focus group %K survey %K mixed methods %K intervention %K health app %K user needs %D 2022 %7 11.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mental health concerns are a significant issue among the deaf and hard of hearing (D/HH) community, but community members can face several unique challenges to accessing appropriate resources. Objective: The aim of this study was to investigate the mental health needs of the D/HH community and how mental health apps may be able to support these needs. Methods: A total of 10 members of the D/HH community participated in a focus group and survey to provide their perspectives and experiences. Participants were members of the Center on Deafness Inland Empire team, which comprises people with lived experience as members of and advocates for the D/HH community. Results: Findings identified a spectrum of needs for mental health apps, including offering American Sign Language and English support, increased education of mental health to reduce stigma around mental health, direct communication with a Deaf worker, and apps that are accessible to a range of community members in terms of culture, resources required, and location. Conclusions: These findings can inform the development of digital mental health resources and outreach strategies that are appropriate for the D/HH community. %M 35404259 %R 10.2196/35641 %U https://humanfactors.jmir.org/2022/2/e35641 %U https://doi.org/10.2196/35641 %U http://www.ncbi.nlm.nih.gov/pubmed/35404259 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e33586 %T Uncovering Important Drivers of the Increase in the Use of Virtual Care Technologies in Nursing Care: Quantitative Analysis From the 2020 National Survey of Canadian Nurses %A Beauséjour,Waldo %A Hagens,Simon %+ Canada Health Infoway, 150 King St W, Toronto, ON, M5H 1J9, Canada, 1 416 595 3449 ext 3421, wbeausejour@infoway-inforoute.ca %K adoption of virtual care %K secure messaging %K nurses %K nursing %K telehealth %K telehomecare %K telemonitoring %K remote patient monitoring %K virtual videoconferencing %K uptake of virtual care %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Canadian nurses are at the forefront of patient care delivery. Although the use of digital health technologies for care delivery is gaining momentum in Canada, nurses are encouraged to integrate virtual care into their practice. In early 2020, more Canadian nurses delivered care virtually compared with 3 years ago. Objective: This study seeks to uncover the professional characteristics of Canadian nurses accessing virtual care in 2020, understand how these characteristics differ across types of technologies, investigate whether the nurses accessing virtual care possess the skills and knowledge needed to use these technologies, and determine the important drivers of the uptake of virtual care observed in 2020. Methods: We used data from the 2017 and 2020 National Survey of Canadian Nurses. This survey collected data on the use of digital health technologies in nursing practice. It concerned regulated nursing professionals working in different health care settings and from different domains of nursing practice. We combined the chi-square independence test and logistic regression analysis to uncover the most relevant drivers of virtual care uptake by nurses in 2020. Results: In early 2020, before the declaration of the COVID-19 pandemic, nurses who delivered care virtually were predominantly nurse practitioners (135/159, 84.9%) and more likely to work in a primary or community care setting (202/367, 55%) and in an urban setting (194/313, 61.9%). Factors such as nursing designation (P<.001), perceived quality of care at the health facility where the nurses practiced (P<.001), and the type of patient record–keeping system they had access to (P=.04) had a statistically significant effect on the probability of nurses to deliver care virtually in early 2020. Furthermore, nurses’ perception of the quality of care they delivered through virtual technologies was statistically associated with their perception of the skills (χ24=308.7; P<.001) and knowledge (χ24=283.4; P<.001) to use these technologies. Conclusions: This study emphasizes the critical importance of nursing designation, geographic location, and type of patient record–keeping system in predicting virtual care integration in nursing practice. The findings related to geographic location can be used by decision-makers for better allocation of digital health resources among care settings in rural and urban areas. Similarly, the disparities observed across nursing designations have some implications for the digital training of nurses at all levels of practice. Finally, the association between electronic medical record use and uptake of virtual care could accelerate the implementation of more modernized record-keeping systems in care settings. Hence, this could advance interoperability and improve health care delivery. %M 35357326 %R 10.2196/33586 %U https://nursing.jmir.org/2022/1/e33586 %U https://doi.org/10.2196/33586 %U http://www.ncbi.nlm.nih.gov/pubmed/35357326 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31419 %T Efficacy, Benefits, and Harms of a Self-management App in a Swedish Trauma-Exposed Community Sample (PTSD Coach): Randomized Controlled Trial %A Hensler,Ida %A Sveen,Josefin %A Cernvall,Martin %A Arnberg,Filip K %+ National Centre for Disaster Psychiatry, Department of Medical Sciences, Uppsala University, Akademiska sjukhuset ing. 10 van. 3, Uppsala, 75185, Sweden, 46 186170896, ida.hensler@neuro.uu.se %K PTSD %K self-management app %K mHealth %K RCT %K negative effects %K mobile phone %D 2022 %7 30.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-guided interventions may complement and overcome obstacles to in-person treatment options. The efficacy of app interventions targeting posttraumatic stress disorder (PTSD) is unclear, and results from previous studies on PTSD Coach—an app for managing trauma-related distress—are inconsistent. Objective: This study investigates whether access to the Swedish version of the PTSD Coach affects posttraumatic stress, depressive, and somatic symptoms. In addition, we aim to assess the perceived helpfulness, satisfaction, negative effects, response, and remission related to PTSD Coach. Methods: Adults who had experienced potentially traumatic events in the past 2 years were randomized (1:1) to have access to PTSD Coach (n=89) or be on the waitlist (n=90). We assessed clinical characteristics at baseline (semistructured interviews and self-rating scales) and after 3 months (self-rating scales). We analyzed the data in R software using linear mixed effects models, chi-square tests, and Fisher exact test. Results: Intention-to-treat analyses indicated that access to PTSD Coach decreased posttraumatic stress and depressive symptoms but not somatic symptoms. More participants who had access to PTSD Coach responded with clinically significant improvement and fewer instances of probable PTSD after 3 months compared with waitlist controls. Overall, participants found that PTSD Coach was slightly to moderately helpful and moderately satisfactory. Half of the intervention group (36/71, 51%) reported at least one negative reaction related to using PTSD Coach (eg, disappointment with the app or its results, arousal of stress, or distressing memories). Conclusions: Using PTSD Coach may trigger symptoms among a few users; however, most of them perceived PTSD Coach as helpful and satisfactory. This study showed that having access to PTSD Coach helped improve psychological trauma-related symptoms. In addition, we have discussed implications for future research and clinical practice. Trial Registration: ClinicalTrials.gov NCT04094922; https://clinicaltrials.gov/ct2/show/NCT04094922 %M 35353052 %R 10.2196/31419 %U https://www.jmir.org/2022/3/e31419 %U https://doi.org/10.2196/31419 %U http://www.ncbi.nlm.nih.gov/pubmed/35353052 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27890 %T Demographic and Psychosocial Characteristics Associated With Use of a Prostate Cancer Survivorship Website: Implications From a Multisite Randomized Controlled Trial %A Marziliano,Allison %A Diefenbach,Michael A %A Hudson,Shawna V %A Tagai,Erin K %A Handorf,Elizabeth A %A Bator,Alicja %A Miller,Suzanne M %+ Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, United States, 1 1 215 728 4069, Suzanne.Miller@fccc.edu %K prostate cancer %K cancer survivorship %K web-based resource %K monitoring style of coping %K cancer %K survivorship %K eHealth %K emotions %K interpersonal %D 2022 %7 21.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Many prostate cancer (PC) survivors experience disease and treatment-related symptomatology in both the physical and psychosocial domains. Although the benefits and barriers to using web-based resources for cancer patients are well-documented, less research has focused on the personal characteristics important for efficient tailoring and targeting of information that are associated with usage. Objective: We used the Cognitive-Social Health Information Processing (C-SHIP) framework to guide our exploration of personal characteristics associated with use of PROGRESS, an informational PC survivorship website that addresses physical, emotional, interpersonal, and practical concerns relevant for PC survivors. Methods: PC survivors (N=217) were randomized to the intervention arm (PROGRESS) of a randomized controlled trial. Of those randomized to the intervention arm, 84 used PROGRESS, and 133 did not use PROGRESS. Multivariable analyses evaluated demographic and psychosocial characteristics (eg, style of coping, health literacy, self-efficacy, affective states of depression, anxiety, and fatigue) associated with website use. Results: A larger proportion of non-Hispanic White (68/160, 42.5%), compared with non-Hispanic Black (9/40, 23%), participants used PROGRESS (P<.001). Further, PROGRESS users were older in age (P<.001), had a monitoring style of coping (P=.01), and were less depressed (P=.004), anxious (P=.02), and fatigued (P<.001) than nonusers. Education, income, health literacy, blunting style of coping, self-efficacy, and treatment type (radiation therapy or surgery) were not significantly related to use. On multivariable analyses, race (OR 0.28, P<.001), age (OR 1.05, P<.001), monitoring style of coping (OR 1.27, P=.02), and overall mood (OR 0.98, P<.001) remained significant. Conclusions: A combination of monitoring and low levels of negative affect were associated with website use. Additionally, users were older, non-Hispanic White survivors. To ensure that important survivorship-relevant information reaches users, future efforts need to focus on enhancing patient engagement. Trial Registration: ClinicalTrials.gov NCT02224482; https://clinicaltrials.gov/ct2/show/NCT02224482 %M 35311678 %R 10.2196/27890 %U https://www.jmir.org/2022/3/e27890 %U https://doi.org/10.2196/27890 %U http://www.ncbi.nlm.nih.gov/pubmed/35311678 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e32538 %T Digital Health Intervention Design and Deployment for Engaging Demographic Groups Likely to Be Affected by the Digital Divide: Protocol for a Systematic Scoping Review %A Jenkins,Catherine L %A Imran,Sumayyah %A Mahmood,Aamina %A Bradbury,Katherine %A Murray,Elizabeth %A Stevenson,Fiona %A Hamilton,Fiona L %+ eHealth Unit, Research Department of Primary Care & Population Health, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 2037940272, flodocs@hotmail.com %K digital divide %K digital health interventions %K DHIs %K eHealth %K digital health literacy %K health inequalities %K health inequities %K mHealth %K mobile health %D 2022 %7 18.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health interventions refer to interventions designed to support health-related knowledge transfer and are delivered via digital technologies, such as mobile apps. Digital health interventions are a double-edged sword: they have the potential to reduce health inequalities, for example, by making treatments available remotely to rural populations underserved by health care facilities or by helping to overcome language barriers via in-app translation services; however, if not designed and deployed with care, digital health interventions also have the potential to increase health inequalities and exacerbate the effects of the digital divide. Objective: The aim of this study is to review ways to mitigate the digital divide through digital health intervention design, deployment, and engagement mechanisms sensitive to the needs of digitally excluded populations. Methods: This protocol outlines the procedure for a systematic scoping review that follows the methodology recommended by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidance. The following databases will be searched for primary research studies published in English from October 1, 2011, to October 1, 2021: Cochrane Library, Epistemonikos, NICE Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC), and Trip. In addition, the following sources of gray literature will be searched: Conference Proceedings Citation Index, Health Management Information Consortium, International HTA Database, OpenGrey, The Grey Literature Report, Google Scholar Basic Search UK, MedNar Deep Web Search Engine, and Carrot2. We will select publications that meet the following inclusion criteria: primary research papers that evaluated digital health interventions that describe features of digital health intervention design and deployment that enable or hinder access to and engagement with digital health interventions by adults from demographic groups likely to be affected by the digital divide (eg, older age, minority ethnic groups, lower income, and lower education level). A random selection of 25 publications identified from the search will be double screened by four reviewers. If there is >75% agreement for included/excluded publications, the team will continue to screen all the identified publications. For all included publications, study characteristics will be extracted by one author and checked for agreement by a second author, with any disagreements resolved by consensus among the study team. Consultation digital health intervention design and deployment, and digital health intervention users will also be conducted in parallel. Results: The review is underway and is anticipated to be completed by September 2022. Conclusions: The results will have implications for researchers and policy makers using digital health interventions for health improvement peripandemic and post pandemic, and will inform best practices in the design and delivery of digital health interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/32538 %M 35302946 %R 10.2196/32538 %U https://www.researchprotocols.org/2022/3/e32538 %U https://doi.org/10.2196/32538 %U http://www.ncbi.nlm.nih.gov/pubmed/35302946 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e33940 %T Use of an mHealth Ketogenic Diet App Intervention and User Behaviors Associated With Weight Loss in Adults With Overweight or Obesity: Secondary Analysis of a Randomized Clinical Trial %A Falkenhain,Kaja %A Locke,Sean R %A Lowe,Dylan A %A Lee,Terry %A Singer,Joel %A Weiss,Ethan J %A Little,Jonathan P %+ School of Health and Exercise Sciences, The University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 250 807 9876, jonathan.little@ubc.ca %K acetone %K biofeedback %K psychology %K diet %K ketogenic %K mobile apps %K overweight %K technology %K telemedicine %K weight loss %K mobile phone %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low-carbohydrate ketogenic diets are a viable method to lose weight that have regained popularity in recent years. Technology in the form of mobile health (mHealth) apps allows for scalable and remote delivery of such dietary interventions and are increasingly being used by the general population without direct medical supervision. However, it is currently unknown which factors related to app use and user behavior are associated with successful weight loss. Objective: First, to describe and characterize user behavior, we aim to examine characteristics and user behaviors over time of participants who were enrolled in a remotely delivered clinical weight loss trial that tested an mHealth ketogenic diet app paired with a breath acetone biofeedback device. Second, to identify variables of importance to weight loss at 12 weeks that may offer insight for future development of dietary mHealth interventions, we aim to explore which app- and adherence-related user behaviors characterized successful weight loss. Methods: We analyzed app use and self-reported questionnaire data from 75 adults with overweight or obesity who participated in the intervention arm of a previous weight loss study. We examined data patterns over time through linear mixed models and performed correlation, linear regression, and causal mediation analyses to characterize diet-, weight-, and app-related user behavior associated with weight loss. Results: In the context of a low-carbohydrate ketogenic diet intervention delivered remotely through an mHealth app paired with a breath acetone biofeedback device, self-reported dietary adherence seemed to be the most important factor to predict weight loss (β=–.31; t54=–2.366; P=.02). Furthermore, self-reported adherence mediated the relationship between greater app engagement (from c=–0.008, 95% CI –0.014 to –0.0019 to c’=–0.0035, 95% CI –0.0094 to 0.0024) or higher breath acetone levels (from c=–1.34, 95% CI –2.28 to –0.40 to c’=–0.40, 95% CI –1.42 to 0.62) and greater weight loss, explaining a total of 27.8% and 28.8% of the variance in weight loss, respectively. User behavior (compliance with weight measurements and app engagement) and adherence-related aspects (breath acetone values and self-reported dietary adherence) over time differed between individuals who achieved a clinically significant weight loss of >5% and those who did not. Conclusions: Our in-depth examination of app- and adherence-related user behaviors offers insight into factors associated with successful weight loss in the context of mHealth interventions. In particular, our finding that self-reported dietary adherence was the most important metric predicting weight loss may aid in the development of future mHealth dietary interventions. Trial Registration: ClinicalTrials.gov NCT04165707; https://clinicaltrials.gov/ct2/show/NCT04165707 International Registered Report Identifier (IRRID): RR2-10.2196/19053 %M 35285809 %R 10.2196/33940 %U https://mhealth.jmir.org/2022/3/e33940 %U https://doi.org/10.2196/33940 %U http://www.ncbi.nlm.nih.gov/pubmed/35285809 %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 %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e33038 %T Lessons for Uptake and Engagement of a Smartphone App (SURE Recovery) for People in Recovery From Alcohol and Other Drug Problems: Interview Study of App Users %A Neale,Joanne %A Bowen,Alice May %+ National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, United Kingdom, 44 7511319855, alice.m.bowen@kcl.ac.uk %K apps %K digital literacy %K mHealth %K substance use %K recovery %K qualitative %K mobile phone %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health apps promoting health and well-being have substantial potential but low uptake and engagement. Barriers common to addiction treatment app uptake and engagement include poor access to mobile technology, Wi-Fi, or mobile data, plus low motivation among non–treatment-seeking users to cut down or quit. Working with people who used substances, we had previously designed and published an app to support recovery from alcohol and other drug problems. The app, which is available for free from the Apple App Store and Google Play, is called SURE Recovery. Objective: The aim of this paper is to undertake a qualitative study to ascertain end users’ views and experiences of the SURE Recovery app, including how it might be improved, and present the findings on uptake and engagement to assist other researchers and app developers working on similar apps for people experiencing alcohol and other drug problems. Methods: Semistructured telephone interviews were conducted with 20 people (n=12, 60%, men and n=8, 40%, women aged 25-63 years; all identifying as White British) who had varied patterns of using the app. The audio recordings were transcribed, and the data were coded and analyzed through Iterative Categorization. Results: Analyses identified three main factors relevant to uptake (discoverability of the app, personal relevance, and expectations and motivations) and three main factors relevant to engagement (the appeal and relevance of specific features, perceived benefits, and the need for improvements). The findings on uptake and engagement were largely consistent with our own earlier developmental work and with other published literature. However, we additionally found that uptake was strongly affected by first impressions, including trust and personal recommendations; that users were attracted to the app by their need for support and curiosity but had relatively modest expectations; that engagement increased if the app made users feel positive; and that people were unlikely to download, or engage with, the app if they could not relate to, or identify with, aspects of its content. Conclusions: Incorporating end-user views into app design and having a network of supportive partners (ie, credible organizations and individuals who will champion the app) seem to increase uptake and engagement among people experiencing alcohol and other drug problems. Although better digital literacy and access to devices and mobile data are needed if addiction recovery apps are to reach their full potential, we should not evaluate them based only on observable changes in substance use behaviors. How using an app makes a person feel is more transient and difficult to quantify but also relevant to uptake and engagement. %M 35258474 %R 10.2196/33038 %U https://humanfactors.jmir.org/2022/1/e33038 %U https://doi.org/10.2196/33038 %U http://www.ncbi.nlm.nih.gov/pubmed/35258474 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32664 %T Patient Digital Health Technologies to Support Primary Care Across Clinical Contexts: Survey of Primary Care Providers, Behavioral Health Consultants, and Nurses %A Zaslavsky,Oleg %A Chu,Frances %A Renn,Brenna N %+ School of Nursing, University of Washington, 1959 Pacific Ave, Seattle, WA, 98195, United States, 1 2068493301, ozasl@uw.edu %K survey %K primary care %K acceptance %K nurses %K primary care providers %K behavioral health consultants %K mobile health %K technology %K health promotion %K attitudes %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The acceptance of digital health technologies to support patient care for various clinical conditions among primary care providers and staff has not been explored. Objective: The purpose of this study was to explore the extent of potential differences between major groups of providers and staff in primary care, including behavioral health consultants (BHCs; eg, psychologists, social workers, and counselors), primary care providers (PCPs; eg, physicians and nurse practitioners), and nurses (registered nurses and licensed practical nurses) in the acceptance of various health technologies (ie, mobile apps, wearables, live video, phone, email, instant chats, text messages, social media, and patient portals) to support patient care across a variety of clinical situations. Methods: We surveyed 151 providers (51 BHCs, 52 PCPs, and 48 nurses) embedded in primary care clinics across the United States who volunteered to respond to a web-based survey distributed in December 2020 by a large health care market research company. Respondents indicated the technologies they consider appropriate to support patients’ health care needs across the following clinical contexts: acute and chronic disease, medication management, health-promoting behaviors, sleep, substance use, and common and serious mental health conditions. We used descriptive statistics to summarize the distribution of demographic characteristics by provider type. We used contingency tables to compile summaries of the proportion of provider types endorsing each technology within and across clinical contexts. This study was exploratory in nature, with the intent to inform future research. Results: Most of the respondents were from urban and suburban settings (125/151, 82.8%), with 12.6% (n=19) practicing in rural or frontier settings and 4.6% (n=7) practicing in rural-serving clinics. Respondents were dispersed across the United States, including the Northeast (31/151, 20.5%), Midwest (n=32, 21.2%), South (n=49, 32.5%), and West (n=39, 25.8%). The highest acceptance for technologies across clinical contexts was among BHCs (32/51, 63%) and PCPs (30/52, 58%) for live video and among nurses for mobile apps (30/48, 63%). A higher percentage of nurses accepted all other technologies relative to BHCs and PCPs. Similarly, relative to other groups, PCPs indicated lower levels of acceptance. Within clinical contexts, the highest acceptance rates were reported among 80% (41/51) of BHCs and 69% (36/52) of PCPs endorsing live video for common mental health conditions and 75% (36/48) of nurses endorsing mobile apps for health-promoting behaviors. The lowest acceptance across providers was for social media in the context of medication management (9.3% [14/151] endorsement across provider type). Conclusions: The survey suggests potential differences in the way primary care clinicians and staff envision using technologies to support patient care. Future work must attend to reasons for differences in the acceptance of various technologies across providers and clinical contexts. Such an understanding will help inform appropriate implementation strategies to increase acceptability and gain greater adoption of appropriate technologies across conditions and patient populations. %M 35212642 %R 10.2196/32664 %U https://formative.jmir.org/2022/2/e32664 %U https://doi.org/10.2196/32664 %U http://www.ncbi.nlm.nih.gov/pubmed/35212642 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e28372 %T Willingness of French General Practitioners to Prescribe mHealth Apps and Devices: Quantitative Study %A Della Vecchia,Claire %A Leroy,Tanguy %A Bauquier,Charlotte %A Pannard,Myriam %A Sarradon-Eck,Aline %A Darmon,David %A Dufour,Jean-Charles %A Preau,Marie %+ Institut de Psychologie, Université Lyon 2, 5 Avenue Pierre Mendes France, Bron, 69676, France, 33 0672303682, dellavecchia.claire@gmail.com %K mHealth %K health applications %K connected health and wellness devices %K general practitioners %K patients %K prescription %K quantitative study %K mobile phone %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The field of mobile health (mHealth) is constantly expanding. Integrating mHealth apps and devices in clinical practice is a major and complex challenge. General practitioners (GPs) are an essential link in a patient’s care pathway. As they are patients’ preferred health care intermediaries, GPs play an important role in supporting patients’ transition to mHealth. Objective: This study aims to identify the factors associated with the willingness of French GPs to prescribe mHealth apps and devices to their patients. Methods: This study was part of the ApiAppS project whose overall objective was to help remove barriers GPs face when prescribing mHealth apps and devices by developing a custom-built platform to aid them. The study included GPs recruited from the general practice department of several medical faculties in France (Lyon, Nice, and Rouen) and mailing lists of academic GPs, health care professional associations, and social and professional networks. Participants were asked to complete a web-based questionnaire that collected data on various sociodemographic variables, indicators of their involvement in continued education programs and the amount of time they dedicated to promoting healthy behaviors during patient consultations, and indicators characterizing their patient population. Data on their perceptions of mHealth apps and devices were also collected. Finally, the questionnaire included items to measure GPs’ acceptability of prescribing mHealth apps and devices for several health-related dimensions. Results: Of the 174 GPs, 129 (74.1%) declared their willingness to prescribe mHealth apps and devices to their patients. In multivariate analysis, involvement in continued education programs (odds ratio [OR] 6.17, 95% CI 1.52-28.72), a better patient base command of the French language (OR 1.45, 95% CI 1.13-1.88), GP-perceived benefits of mHealth apps and devices for both patients and their medical practice and GP-perceived drivers for mHealth apps and device implementation in their medical practice (OR 1.04, 95% CI 1.01-1.07), and validation of mHealth apps and devices through randomized clinical trials (OR 1.02, 95% CI 1.00-1.04) were all associated with GPs’ willingness to prescribe mHealth apps and devices. In contrast, older GPs (OR 0.95, 95% CI 0.91-0.98), female GPs (OR 0.26, 95% CI 0.09-0.69), and those who perceived risks for the patient or their medical practice (OR 0.96, 95% CI 0.94-0.99) were less inclined to prescribe mHealth apps and devices. Conclusions: mHealth apps and devices were generally seen by GPs as useful in general medicine and were, for the most part, favorable to prescribing them. Their full integration in general medicine will be conditioned by the need for conclusive certification, transparency (reliable and precise data concerning mHealth app and device methods of construction and clinical validation), software aids to assist GPs prescribe them, and dedicated training programs. %M 35147508 %R 10.2196/28372 %U https://mhealth.jmir.org/2022/2/e28372 %U https://doi.org/10.2196/28372 %U http://www.ncbi.nlm.nih.gov/pubmed/35147508 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e20702 %T Factors Associated With Willingness to Share Health Information: Rapid Review %A Naeem,Iffat %A Quan,Hude %A Singh,Shaminder %A Chowdhury,Nashit %A Chowdhury,Mohammad %A Saini,Vineet %A TC,Turin %+ O'Brien Institute of Public Health, University of Calgary, GD01, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N4N1, Canada, 1 5877787866, Iffat.naeem1@ucalgary.ca %K health information %K information sharing %K health data %K EMR %K PHR %K mobile phone %D 2022 %7 9.2.2022 %9 Review %J JMIR Hum Factors %G English %X Background: To expand research and strategies to prevent disease, comprehensive and real-time data are essential. Health data are increasingly available from platforms such as pharmaceuticals, genomics, health care imaging, medical procedures, wearable devices, and internet activity. Further, health data are integrated with an individual’s sociodemographic information, medical conditions, genetics, treatments, and health care. Ultimately, health information generation and flow are controlled by the patient or participant; however, there is a lack of understanding about the factors that influence willingness to share health information. A synthesis of the current literature on the multifactorial nature of health information sharing preferences is required to understand health information exchange. Objective: The objectives of this review are to identify peer-reviewed literature that reported factors associated with health information sharing and to organize factors into cohesive themes and present a narrative synthesis of factors related to willingness to share health information. Methods: This review uses a rapid review methodology to gather literature regarding willingness to share health information within the context of eHealth, which includes electronic health records, personal health records, mobile health information, general health information, or information on social determinants of health. MEDLINE and Google Scholar were searched using keywords such as electronic health records AND data sharing OR sharing preference OR willingness to share. The search was limited to any population that excluded health care workers or practitioners, and the participants aged ≥18 years within the US or Canadian context. The data abstraction process using thematic analysis where any factors associated with sharing health information were highlighted and coded inductively within each article. On the basis of shared meaning, the coded factors were collated into major themes. Results: A total of 26 research articles met our inclusion criteria and were included in the qualitative analysis. The inductive thematic coding process revealed multiple major themes related to sharing health information. Conclusions: This review emphasized the importance of data generators’ viewpoints and the complex systems of factors that shape their decision to share health information. The themes explored in this study emphasize the importance of trust at multiple levels to develop effective information exchange partnerships. In the case of improving precision health care, addressing the factors presented here that influence willingness to share information can improve sharing capacity for individuals and allow researchers to reorient their methods to address hesitation in sharing health information. %M 35138263 %R 10.2196/20702 %U https://humanfactors.jmir.org/2022/1/e20702 %U https://doi.org/10.2196/20702 %U http://www.ncbi.nlm.nih.gov/pubmed/35138263 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e33189 %T Exploring and Characterizing Patient Multibehavior Engagement Trails and Patient Behavior Preference Patterns in Pathway-Based mHealth Hypertension Self-Management: Analysis of Use Data %A Wu,Dan %A Huyan,Xiaoyuan %A She,Yutong %A Hu,Junbin %A Duan,Huilong %A Deng,Ning %+ 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, 310000, China, 86 571 2295 2693, zju.dengning@gmail.com %K hypertension %K mobile health %K patient behavior %K engagement %K data analysis %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hypertension is a long-term medical condition. Mobile health (mHealth) services can help out-of-hospital patients to self-manage. However, not all management is effective, possibly because the behavior mechanism and behavior preferences of patients with various characteristics in hypertension management were unclear. Objective: The purpose of this study was to (1) explore patient multibehavior engagement trails in the pathway-based hypertension self-management, (2) discover patient behavior preference patterns, and (3) identify the characteristics of patients with different behavior preferences. Methods: This study included 863 hypertensive patients who generated 295,855 use records in the mHealth app from December 28, 2016, to July 2, 2020. Markov chain was used to infer the patient multibehavior engagement trails, which contained the type, quantity, time spent, sequence, and transition probability value (TP value) of patient behavior. K-means algorithm was used to group patients by the normalized behavior preference features: the number of behavioral states that a patient performed in each trail. The pages in the app represented the behavior states. Chi-square tests, Z-test, analyses of variance, and Bonferroni multiple comparisons were conducted to characterize the patient behavior preference patterns. Results: Markov chain analysis revealed 3 types of behavior transition (1-way transition, cycle transition, and self-transition) and 4 trails of patient multibehavior engagement. In perform task trail (PT-T), patients preferred to start self-management from the states of task blood pressure (BP), task drug, and task weight (TP value 0.29, 0.18, and 0.20, respectively), and spent more time on the task food state (35.87 s). Some patients entered the states of task BP and task drug (TP value 0.20, 0.25) from the reminder item state. In the result-oriented trail (RO-T), patients spent more energy on the ranking state (19.66 s) compared to the health report state (13.25 s). In the knowledge learning trail (KL-T), there was a high probability of cycle transition (TP value 0.47, 0.31) between the states of knowledge list and knowledge content. In the support acquisition trail (SA-T), there was a high probability of self-transition in the questionnaire (TP value 0.29) state. Cluster analysis discovered 3 patient behavior preference patterns: PT-T cluster, PT-T and KL-T cluster, and PT-T and SA-T cluster. There were statistically significant associations between the behavior preference pattern and gender, education level, and BP. Conclusions: This study identified the dynamic, longitudinal, and multidimensional characteristics of patient behavior. Patients preferred to focus on BP, medications, and weight conditions and paid attention to BP and medications using reminders. The diet management and questionnaires were complicated and difficult to implement and record. Competitive methods such as ranking were more likely to attract patients to pay attention to their own self-management states. Female patients with lower education level and poorly controlled BP were more likely to be highly involved in hypertension health education. %M 35113032 %R 10.2196/33189 %U https://mhealth.jmir.org/2022/2/e33189 %U https://doi.org/10.2196/33189 %U http://www.ncbi.nlm.nih.gov/pubmed/35113032 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 2 %P e30040 %T Electricity, Computing Hardware, and Internet Infrastructures in Health Facilities in Sierra Leone: Field Mapping Study %A Chukwu,Emeka %A Garg,Lalit %A Foday,Edward %A Konomanyi,Abdul %A Wright,Royston %A Smart,Francis %+ Department of Computer Information Systems, Faculty of Information Communications Technology, University of Malta, Tal-Qroqq, Msida, 2080, Malta, 356 99330888, nnaemeka_ec@hotmail.com %K digital health %K mHealth %K eHealth infrastructure %K health ICT %K SpaceX %K connectivity %K Sierra Leone %K rural-urban divide %K rural areas %K internet %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Years of health information system investment in many countries have facilitated service delivery, surveillance, reporting, and monitoring. Electricity, computing hardware, and internet networks are vital for health facility–based information systems. Availability of these infrastructures at health facilities is crucial for achieving national digital health visions. Objective: The aim of this study was to gain insight into the state of computing hardware, electricity, and connectivity infrastructure at health facilities in Sierra Leone using a representative sample. Methods: Stratified sampling of 72 (out of 1284) health facilities distributed in all districts of Sierra Leone was performed, factoring in the rural-urban divide, digital health activity, health facility type, and health facility ownership. Enumerators visited each health facility over a 2-week period. Results: Among the 72 surveyed health facilities, 59 (82%) do not have institutionally provided internet. Among the 15 Maternal and Child Health Posts, as a type of primary health care unit (PHU), 9 (60%) use solar energy as their only electricity source and the other 6 (40%) have no electricity source. Similarly, among the 13 hospitals, 5 (38%) use a generator as a primary electricity source. All hospitals have at least one functional computer, although only 7 of the 13 hospitals have four or more functional computers. Similarly, only 2 of the 59 (3%) PHUs have one computer each, and 37 (63%) of the PHUs have one tablet device each. We consider this health care computing infrastructure mapping to be representative with a 95% confidence level within an 11% margin of error. Two-thirds of the PHUs have only alternate solar electricity, only 10 of the 72 surveyed health facilities have functional official internet, and most use suboptimal computing hardware. Overall, 43% of the surveyed health facilities believe that inadequate electricity is the biggest threat to digitization. Similarly, 16 (22%) of the 72 respondents stated that device theft is a primary hindrance to digitization. Conclusions: Electricity provision for off-electricity-grid health facilities using alternative and renewable energy sources is emerging. The current trend where GSM (Global System for Mobile Communication) service providers provide the internet to all health facilities may change to other promising alternatives. This study provides evidence of the critical infrastructure gaps in health facilities in Sierra Leone. %M 35113026 %R 10.2196/30040 %U https://medinform.jmir.org/2022/2/e30040 %U https://doi.org/10.2196/30040 %U http://www.ncbi.nlm.nih.gov/pubmed/35113026 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e32112 %T Adoption of the Website and Mobile App of a Preventive Health Program Across Neighborhoods With Different Socioeconomic Conditions in the Netherlands: Longitudinal Study %A Agachi,Elena %A Bijmolt,Tammo H A %A Mierau,Jochen O %A van Ittersum,Koert %+ Department of Marketing, Faculty of Economics and Business, University of Groningen, PO Box 800, Groningen, 9700 AV, Netherlands, 31 50 363 3686, e.agachi@rug.nl %K eHealth %K mHealth %K mobile health %K mobile app %K internet %K preventive health program %K health disparities %K NSES %K program adoption %K survival analysis %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Socioeconomic disparities in the adoption of preventive health programs represent a well-known challenge, with programs delivered via the web serving as a potential solution. The preventive health program examined in this study is a large-scale, open-access web-based platform operating in the Netherlands, which aims to improve the health behaviors and wellness of its participants. Objective: This study aims to examine the differences in the adoption of the website and mobile app of a web-based preventive health program across socioeconomic groups. Methods: The 83,466 participants in this longitudinal, nonexperimental study were individuals who had signed up for the health program between July 2012 and September 2019. The rate of program adoption per delivery means was estimated using the Prentice, Williams, and Peterson Gap–Time model, with the measure of neighborhood socioeconomic status (NSES) used to distinguish between population segments with different socioeconomic characteristics. Registration to the health program was voluntary and free, and not within a controlled study setting, allowing the observation of the true rate of adoption. Results: The estimation results indicate that program adoption across socioeconomic groups varies depending on the program’s delivery means. For the website, higher NSES groups have a higher likelihood of program adoption compared with the lowest NSES group (hazard ratio 1.03, 95% CI 1.01-1.05). For the mobile app, the opposite holds: higher NSES groups have a lower likelihood of program adoption compared with the lowest NSES group (hazard ratio 0.94, 95% CI 0.91-0.97). Conclusions: Promoting preventive health programs using mobile apps can help to increase program adoption among the lowest socioeconomic segments. Given the increasing use of mobile phones among disadvantaged population groups, structuring future health interventions to include mobile apps as means of delivery can support the stride toward diminishing health disparities. %M 35107433 %R 10.2196/32112 %U https://humanfactors.jmir.org/2022/1/e32112 %U https://doi.org/10.2196/32112 %U http://www.ncbi.nlm.nih.gov/pubmed/35107433 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e27355 %T Mobile Device Ownership, Current Use, and Interest in Mobile Health Interventions Among Low-Income Older Chinese Immigrants With Type 2 Diabetes: Cross-sectional Survey Study %A Hu,Lu %A Trinh-Shevrin,Chau %A Islam,Nadia %A Wu,Bei %A Cao,Shimin %A Freeman,Jincong %A Sevick,Mary Ann %+ Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, 180 Madison Ave, New York, NY, 10016, United States, 1 6465013438, lu.hu@nyumc.org %K technology use %K Chinese immigrants %K type 2 diabetes %K mHealth %K health disparities %K immigrant health %K diabetes %K mobile health %K intervention %K smartphone %K immigrant %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D. Objective: This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D. Methods: In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant’s preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use. Results: The sample (N=91) was predominantly female (n=57, 63%), married (n=68, 75%), and had a high school education or less (n=58, 64%); most participants had an annual household income of less than US $25,000 (n=63, 69%) and had limited English proficiency (n=78, 86%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69%) reported health care providers, followed by 13 who reported the internet (14%), and 10 who reported family, friends, and coworkers (11%). Less than one-quarter (21/91, 23%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management. Conclusions: Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group. %M 35107426 %R 10.2196/27355 %U https://aging.jmir.org/2022/1/e27355 %U https://doi.org/10.2196/27355 %U http://www.ncbi.nlm.nih.gov/pubmed/35107426 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30583 %T Investigating When, Which, and Why Users Stop Using a Digital Health Intervention to Promote an Active Lifestyle: Secondary Analysis With A Focus on Health Action Process Approach–Based Psychological Determinants %A Schroé,Helene %A Crombez,Geert %A De Bourdeaudhuij,Ilse %A Van Dyck,Delfien %+ Department of Movement and Sports Sciences, Faculty of Medicine and Health, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 9264 63 63, helene.schroe@ugent.be %K digital health %K psychosocial determinants %K health action process approach %K physical activity %K sedentary behavior %K attrition %K dropout %K mobile health %K healthy life style %K health behaviors %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health interventions have gained momentum to change health behaviors such as physical activity (PA) and sedentary behavior (SB). Although these interventions show promising results in terms of behavior change, they still suffer from high attrition rates, resulting in a lower potential and accessibility. To reduce attrition rates in the future, there is a need to investigate the reasons why individuals stop using the interventions. Certain demographic variables have already been related to attrition; however, the role of psychological determinants of behavior change as predictors of attrition has not yet been fully explored. Objective: The aim of this study was to examine when, which, and why users stopped using a digital health intervention. In particular, we aimed to investigate whether psychological determinants of behavior change were predictors for attrition. Methods: The sample consisted of 473 healthy adults who participated in the intervention MyPlan 2.0 to promote PA or reduce SB. The intervention was developed using the health action process approach (HAPA) model, which describes psychological determinants that guide individuals in changing their behavior. If participants stopped with the intervention, a questionnaire with 8 question concerning attrition was sent by email. To analyze when users stopped using the intervention, descriptive statistics were used per part of the intervention (including pre- and posttest measurements and the 5 website sessions). To analyze which users stopped using the intervention, demographic variables, behavioral status, and HAPA-based psychological determinants at pretest measurement were investigated as potential predictors of attrition using logistic regression models. To analyze why users stopped using the intervention, descriptive statistics of scores to the attrition-related questionnaire were used. Results: The study demonstrated that 47.9% (227/473) of participants stopped using the intervention, and drop out occurred mainly in the beginning of the intervention. The results seem to indicate that gender and participant scores on the psychological determinants action planning, coping planning, and self-monitoring were predictors of first session, third session, or whole intervention completion. The most endorsed reasons to stop using the intervention were the time-consuming nature of questionnaires (55%), not having time (50%), dissatisfaction with the content of the intervention (41%), technical problems (39%), already meeting the guidelines for PA/SB (31%), and, to a lesser extent, the experience of medical/emotional problems (16%). Conclusions: This study provides some directions for future studies. To decrease attrition, it will be important to personalize interventions on different levels, questionnaires (either for research purposes or tailoring) should be kept to a minimum especially in the beginning of interventions by, for example, using objective monitoring devices, and technical aspects of digital health interventions should be thoroughly tested in advance. Trial Registration: ClinicalTrials.gov NCT03274271; https://clinicaltrials.gov/ct2/show/NCT03274271 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3456-7 %M 35099400 %R 10.2196/30583 %U https://mhealth.jmir.org/2022/1/e30583 %U https://doi.org/10.2196/30583 %U http://www.ncbi.nlm.nih.gov/pubmed/35099400 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e15413 %T Understanding Current Needs and Future Expectations of Informal Caregivers for Technology to Support Health and Well-being: National Survey Study %A Egan,Kieren J %A Clark,Patricia %A Deen,Zahid %A Paputa Dutu,Carmen %A Wilson,Graham %A McCann,Lisa %A Lennon,Marilyn %A Maguire,Roma %+ Digital Health and Wellness Group, Department of Computing and Information Sciences, University of Strathclyde, 16 Richmond Street, Glasgow, G1 1XQ, United Kingdom, 44 141 548 3589, roma.maguire@strath.ac.uk %K caregiving %K technology %K health %K well-being %K digital health %K co-design %K mobile phone %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: There are approximately 6.5 million informal (unpaid) caregivers in the United Kingdom. Each caregiver plays a critical role in the society, supporting the health and well-being of those who are ill, disabled, or older and who need frequent support. Digital technologies are becoming a ubiquitous part of everyday life for many, but little is known about the real-world impact of technology for those in a caring role, including the abilities of technologies to address the mental and physical impacts of caregiving. Objective: This study aims to understand the current and future technology use of caregivers, including digital technologies used to care for themselves and the person they look after. Methods: We codeveloped a wide range of questions with caregivers and care professionals and delivered this survey both on the web and in paper format (eg, using social networks such as Twitter alongside in-person events). Questions were focused on providing care and looking after caregiver health and well-being. Analyses focused on both quantitative outcomes (frequency counts and Likert questions) and explored free text entries (thematic analysis). Results: From 356 respondents, we identified that caregivers were receptive to, and largely positive about current and future use of technology both for their own care and their caring role (eg, checking in from distance). There were notable concerns, including the risk that technology could replace human contact. We identified several key areas for future work, including communication with health and social care professionals, and the potential for technology to help caregivers with their own health. We also identified several stakeholders (eg, care workers, pharmacy staff, and general practitioners) who could act as suitable points for technology signposting and support. Conclusions: Caregivers are a transient, often difficult to reach population, and this work has collated a large body of knowledge across a diverse group of individuals. Many caregivers, like the rest of society, are realizing the benefits of using everyday technology to help deliver care. It is clear that there is already a high level of dependency on technologies, where future expectations will grow. However, many barriers to digital technology use remain, including a lack of ongoing technology support. Preventive measures linked to technology that can help look after a caregiver’s own health appear acceptable, particularly for communicative tools. This collated caregiver knowledge is a call for all stakeholders—academics, policy makers, and practitioners—to take note of these specific challenges, and to ensure that caregiver voices are both heard and fully integrated within the emerging digital health agenda. %M 35084339 %R 10.2196/15413 %U https://aging.jmir.org/2022/1/e15413 %U https://doi.org/10.2196/15413 %U http://www.ncbi.nlm.nih.gov/pubmed/35084339 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31857 %T Attitudes Toward Mobile Apps for Pandemic Research Among Smartphone Users in Germany: National Survey %A Buhr,Lorina %A Schicktanz,Silke %A Nordmeyer,Eike %+ Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, Göttingen, 37073, Germany, 49 5513969009, sschick@gwdg.de %K user %K pandemic %K smartphone apps %K mobile apps %K telephone-based survey %K Germany %K data sharing %K data donation %K ethics %K trust %K COVID-19 %K mHealth %K mobile applications %K digital health %K health applications %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During the COVID-19 pandemic, but also in the context of previous epidemic diseases, mobile apps for smartphones were developed with different goals and functions, such as digital contact tracing, test management, symptom monitoring, quarantine compliance, and epidemiological and public health research. Objective: The aim of this study was to explore the potential for the acceptance of research-orientated apps (ROAs) in the German population. To this end, we identified distinctive attitudes toward pandemic apps and data sharing for research purposes among smartphone users in general and with a focus on differences in attitudes between app users and nonusers in particular. Methods: We conducted a cross-sectional, national, telephone-based survey of 1003 adults in Germany, of which 924 were useable for statistical analysis. The 17-item survey assessed current usage of pandemic apps, motivations for using or not using pandemic apps, trust in app distributors and attitudes toward data handling (data storage and transmission), willingness to share coded data with researchers using a pandemic app, social attitudes toward app use, and demographic and personal characteristics. Results: A vast majority stated that they used a smartphone (778/924, 84.2%), but less than half of the smartphone users stated that they used a pandemic app (326/778, 41.9%). The study focused on the subsample of smartphone users. Interestingly, when asked about preferred organizations for data storage and app distribution, trust in governmental (federal or state government, regional health office), public-appointed (statutory health insurance), or government-funded organizations (research institutes) was much higher than in private organizations (private research institutions, clinics, health insurances, information technology [IT] companies). Having a university degree significantly (P<.001) increased the likelihood of using a pandemic app, while having a migration background significantly (P<.001) decreased it. The overwhelming majority (653/778, 83.9%) of smartphone users were willing to provide their app data for state-funded research. Regarding attitudes toward app usage, striking differences between users and nonusers were found. Almost all app users (317/327, 96.9%) stated they would be willing to share data, whereas only 74.3% (336/452) of nonusers supported data sharing via an app. Two-thirds (216/326, 66.3%) of app users fully or rather agreed with the statement that using a pandemic app is a social duty, whereas almost the same proportion of nonusers entirely or rather disagreed with that statement (273/451, 60.5%). Conclusions: These findings indicate a high potential for the adoption of ROAs among smartphone users in Germany as long as organizational providers engaged in development, operation, and distribution are state-funded or governmental institutions and transparency about data-using research institutions is provided. %M 35072646 %R 10.2196/31857 %U https://mhealth.jmir.org/2022/1/e31857 %U https://doi.org/10.2196/31857 %U http://www.ncbi.nlm.nih.gov/pubmed/35072646 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e24086 %T The Digital Divide and Seeking Health Information on Smartphones in Asia: Survey Study of Ten Countries %A Wang,Xiaohui %A Shi,Jingyuan %A Lee,Kwan Min %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, Room 03-44, WKWSCI Building, 31 Nanyang Link, Singapore, 637718, Singapore, 65 63168816, kwanminlee@ntu.edu.sg %K smartphone %K health information seeking %K Asia %K user profile %K digital divide %D 2022 %7 13.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although recent developments in mobile health have elevated the importance of how smartphones empower individuals to seek health information, research investigating this phenomenon in Asian countries has been rare. Objective: The goal of our study was to provide a comprehensive profile of mobile health information seekers and to examine the individual- and country-level digital divide in Asia. Methods: With survey data from 10 Asian countries (N=9086), we ran multilevel regression models to assess the effect of sociodemographic factors, technological factors, and country-level disparities on using smartphones to seek health information. Results: Respondents who were women (β=.13, P<.001), parents (β=.16, P<.001), employed (β=.08, P=.002), of higher social status (β=.08, P<.001), and/or from countries with low health expenditures (β=.19, P=.02) were more likely to use smartphones to seek health information. In terms of technological factors, technology innovativeness (β=.10, P<.001) and frequency of smartphone use (β=.42, P<.001) were important factors of health information seeking, whereas the effect of online information quality was marginal (β=–.04, P<.001). Conclusions: Among smartphone users in Asia, health information seeking varies according to individuals’ socioeconomic status, their innovativeness toward technology, and their frequency of smartphone use. Although smartphones widen the digital divide among individuals with different socioeconomic status, they also bridge the divide between countries with varying health expenditures. Smartphones appear to be a particularly useful complement to manage health in developing countries. %M 35023845 %R 10.2196/24086 %U https://www.jmir.org/2022/1/e24086 %U https://doi.org/10.2196/24086 %U http://www.ncbi.nlm.nih.gov/pubmed/35023845 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e27220 %T Use of Health Information Technology by Adults With Diabetes in the United States: Cross-sectional Analysis of National Health Interview Survey Data (2016-2018) %A Wang,Seamus Y %A Yeh,Hsin-Chieh %A Stein,Arielle Apfel %A Miller,Edgar R %+ Department of Medicine, Johns Hopkins University, 2024 E Monument St, Suite 1-500L, Baltimore, MD, 21205, United States, 1 410 502 6444, ermiller@jhmi.edu %K health information technology %K National Health Interview Survey %K diabetes %K Healthy People 2020 %K Healthy People 2030 %K mobile phone %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: The use of health information technology (HIT) has been proposed to improve disease management in patients with type 2 diabetes mellitus. Objective: This study aims to report the prevalence of HIT use in adults with diabetes in the United States and examine the factors associated with HIT use. Methods: We analyzed data from 7999 adults who self-reported a diabetes diagnosis as collected by the National Health Interview Survey (2016-2018). All analyses were weighted to account for the complex survey design. Results: Overall, 41.2% of adults with diabetes reported looking up health information on the web, and 22.8% used eHealth services (defined as filled a prescription on the web, scheduled an appointment with a health care provider on the web, or communicated with a health care provider via email). In multivariable models, patients who were female (vs male: prevalence ratio [PR] 1.16, 95% CI 1.10-1.24), had higher education (above college vs less than high school: PR 3.61, 95% CI 3.01-4.33), had higher income (high income vs poor: PR 1.40, 95% CI 1.23-1.59), or had obesity (vs normal weight: PR 1.11, 95% CI 1.01-1.22) were more likely to search for health information on the web. Similar associations were observed among age, race and ethnicity, education, income, and the use of eHealth services. Patients on insulin were more likely to use eHealth services (on insulin vs no medication: PR 1.21, 95% CI 1.04-1.41). Conclusions: Among adults with diabetes, HIT use was lower in those who were older, were members of racial minority groups, had less formal education, or had lower household income. Health education interventions promoted through HIT should account for sociodemographic factors. %M 35019844 %R 10.2196/27220 %U https://diabetes.jmir.org/2022/1/e27220 %U https://doi.org/10.2196/27220 %U http://www.ncbi.nlm.nih.gov/pubmed/35019844 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e26563 %T Prioritization of Quality Principles for Health Apps Using the Kano Model: Survey Study %A Malinka,Christin %A von Jan,Ute %A Albrecht,Urs-Vito %+ Peter L Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany, 49 511 532 ext 4412, ute.von.jan@plri.de %K Kano %K quality principles %K mobile apps %K physicians %K surveys and questionnaires %K evaluation studies %K mHealth %K health apps %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health apps are often used without adequately taking aspects related to their quality under consideration. This may partially be due to inadequate awareness about necessary criteria and how to prioritize them when evaluating an app. Objective: The aim of this study was to introduce a method for prioritizing quality attributes in the mobile health context. To this end, physicians were asked about their assessment of nine app quality principles relevant in health contexts and their responses were used as a basis for designing a method for app prioritization. Ultimately, the goal was to aid in making better use of limited resources (eg, time) by assisting with the decision as to the specific quality principles that deserve priority in everyday medical practice and those that can be given lower priority, even in cases where the overall principles are rated similarly. Methods: A total of 9503 members of two German professional societies in the field of orthopedics were invited by email to participate in an anonymous online survey over a 1-month period. Participants were asked to rate a set of nine app quality principles using a Kano survey with functional and dysfunctional (ie, positively and negatively worded) questions. The evaluation was based on the work of Kano (baseline), supplemented by a self-designed approach. Results: Among the 9503 invited members, 382 completed relevant parts of the survey (return rate of 4.02%). These participants were equally and randomly assigned to two groups (test group and validation group, n=191 each). Demographic characteristics did not significantly differ between groups (all P>.05). Participants were predominantly male (328/382, 85.9%) and older than 40 years (290/382, 75.9%). Given similar ratings, common evaluation strategies for Kano surveys did not allow for conclusive prioritization of the principles, and the same was true when using the more elaborate approach of satisfaction and dissatisfaction indices following the work of Timko. Therefore, an extended, so-called “in-line-of-sight” method was developed and applied for this evaluation. Modified from the Timko method, this approach is based on a “point of view” (POV) metric, which generates a ranking coefficient. Although the principles were previously almost exclusively rated as must-be (with the exception of resource efficiency), which was not conducive to their prioritization, the new method applied from the must-be POV resulted in identical rankings for the test and validation groups: (1) legal conformity, (2) content validity, (3) risk adequacy, (4) practicality, (5) ethical soundness, (6) usability, (7) transparency, (8) technical adequacy, and (9) resource efficiency. Conclusions: Established survey methodologies based on the work of Kano predominantly seek to categorize the attributes to be evaluated. The methodology presented here is an interesting option for prioritization, and enables focusing on the most important criteria, thus saving valuable time when reviewing apps for use in the medical field, even with otherwise largely similar categorization results. The extent to which this approach is applicable beyond the scenario presented herein requires further investigation. %M 35014965 %R 10.2196/26563 %U https://mhealth.jmir.org/2022/1/e26563 %U https://doi.org/10.2196/26563 %U http://www.ncbi.nlm.nih.gov/pubmed/35014965 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e27809 %T Knowledge and Expectations of Hearing Aid Apps Among Smartphone Users and Hearing Professionals: Cross-sectional Survey %A Han,Jae Sang %A Park,Yong-Ho %A Song,Jae-Jun %A Moon,Il Joon %A Lee,Woojoo %A Kim,Yoonjoong %A Cho,Young Sang %A Seo,Jae-Hyun %A Park,Moo Kyun %+ Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 2 2258 6210, revivalseo@catholic.ac.kr %K smartphone %K hearing aids %K app %K perception %K survey %K hearing loss %K mobile phone %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing prevalence of hearing loss, the cost and psychological barriers to the use of hearing aids may prevent their use in individuals with hearing loss. Patients with hearing loss can benefit from smartphone-based hearing aid apps (SHAAs), which are smartphone apps that use a mobile device as a sound amplifier. Objective: The aim of this study is to determine how ear, nose, and throat outpatients perceive SHAAs, analyze the factors that affect their perceptions, and estimate the costs of an annual subscription to an app through a self-administered questionnaire survey of smartphone users and hearing specialists. Methods: This study used a cross-sectional, multicenter survey of both ear, nose, and throat outpatients and hearing specialists. The questionnaire was designed to collect personal information about the respondents and their responses to 18 questions concerning SHAAs in five domains: knowledge, needs, cost, expectations, and information. Perception questions were rated on a scale of 1 (strongly disagree) to 5 (strongly agree). Questions about the expected cost of SHAAs were included in the questionnaire distributed to hearing experts. Results: Among the 219 smartphone users and 42 hearing specialists, only 8 (3.7%) respondents recognized SHAAs, whereas 18% (47/261) of respondents reported considering the use of an assistive device to improve their hearing capacity. The average perception score was 2.81 (SD 1.22). Among the factors that shaped perceptions of SHAAs, the needs category received the lowest scores (2.02, SD 1.42), whereas the cost category received the highest scores (3.29, SD 1.14). Age was correlated with the information domain (P<.001), and an increased level of hearing impairment resulted in significantly higher points in the needs category (P<.001). Patients expected the cost of an annual app subscription to an SHAA to be approximately US $86, and the predicted cost was associated with economic status (P=.02) and was higher than the prices expected by hearing specialists (P<.001). Conclusions: Outpatients expected SHAAs to cost more than hearing specialists. However, the perception of the SHAA was relatively low. In this regard, enhanced awareness is required to popularize SHAAs. %M 34994699 %R 10.2196/27809 %U https://mhealth.jmir.org/2022/1/e27809 %U https://doi.org/10.2196/27809 %U http://www.ncbi.nlm.nih.gov/pubmed/34994699 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e29107 %T Comparison of Daily Routines Between Middle-aged and Older Participants With and Those Without Diabetes in the Electronic Framingham Heart Study: Cohort Study %A Zhang,Yuankai %A Pathiravasan,Chathurangi H %A Hammond,Michael M %A Liu,Hongshan %A Lin,Honghuang %A Sardana,Mayank %A Trinquart,Ludovic %A Borrelli,Belinda %A Manders,Emily S %A Kornej,Jelena %A Spartano,Nicole L %A Nowak,Christopher %A Kheterpal,Vik %A Benjamin,Emelia J %A McManus,David D %A Murabito,Joanne M %A Liu,Chunyu %+ Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, United States, 1 (617) 638 5104, liuc@bu.edu %K diabetes %K mobile health %K smartwatch %K daily physical activities %K daily routine pattern %K sleep %K step counts %K diabetes self-management %K mobile phone %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Daily routines (eg, physical activity and sleep patterns) are important for diabetes self-management. Traditional research methods are not optimal for documenting long-term daily routine patterns in participants with glycemic conditions. Mobile health offers an effective approach for collecting users’ long-term daily activities and analyzing their daily routine patterns in relation to diabetes status. Objective: This study aims to understand how routines function in diabetes self-management. We evaluate the associations of daily routine variables derived from a smartwatch with diabetes status in the electronic Framingham Heart Study (eFHS). Methods: The eFHS enrolled the Framingham Heart Study participants at health examination 3 between 2016 and 2019. At baseline, diabetes was defined as fasting blood glucose level ≥126 mg/dL or as a self-report of taking a glucose-lowering medication; prediabetes was defined as fasting blood glucose level of 100-125 mg/dL. Using smartwatch data, we calculated the average daily step counts and estimated the wake-up times and bedtimes for the eFHS participants on a given day. We compared the average daily step counts and the intraindividual variability of the wake-up times and bedtimes of the participants with diabetes and prediabetes with those of the referents who were neither diabetic nor prediabetic, adjusting for age, sex, and race or ethnicity. Results: We included 796 participants (494/796, 62.1% women; mean age 52.8, SD 8.7 years) who wore a smartwatch for at least 10 hours/day and remained in the study for at least 30 days after enrollment. On average, participants with diabetes (41/796, 5.2%) took 1611 fewer daily steps (95% CI 863-2360; P<.001) and had 12 more minutes (95% CI 6-18; P<.001) in the variation of their estimated wake-up times, 6 more minutes (95% CI 2-9; P=.005) in the variation of their estimated bedtimes compared with the referents (546/796, 68.6%) without diabetes or prediabetes. Participants with prediabetes (209/796, 26.2%) also walked fewer daily steps (P=.04) and had a larger variation in their estimated wake-up times (P=.04) compared with the referents. Conclusions: On average, participants with diabetes at baseline walked significantly fewer daily steps and had larger variations in their wake-up times and bedtimes than the referent group. These findings suggest that modifying the routines of participants with poor glycemic health may be an important approach to the self-management of diabetes. Future studies should be designed to improve the remote monitoring and self-management of diabetes. %M 34994694 %R 10.2196/29107 %U https://diabetes.jmir.org/2022/1/e29107 %U https://doi.org/10.2196/29107 %U http://www.ncbi.nlm.nih.gov/pubmed/34994694 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e25251 %T Exploring Barriers to and Enablers of the Adoption of Information and Communication Technology for the Care of Older Adults With Chronic Diseases: Scoping Review %A Zaman,Sojib Bin %A Khan,Raihan Kabir %A Evans,Roger G %A Thrift,Amanda G %A Maddison,Ralph %A Islam,Sheikh Mohammed Shariful %+ Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, 27-31 Wright Street, Clayton, VIC, Melbourne, 3168, Australia, 61 414026891, sojib.zaman@monash.edu %K older adults %K gerontechnology %K usability challenges %K chronic disease %K information technology %K mobile phone %D 2022 %7 7.1.2022 %9 Review %J JMIR Aging %G English %X Background: Information and communication technology (ICT) offers considerable potential for supporting older adults in managing their health, including chronic diseases. However, there are mixed opinions about the benefits and effectiveness of ICT interventions for older adults with chronic diseases. Objective: We aim to map the use of ICT interventions in health care and identified barriers to and enablers of its use among older adults with chronic disease. Methods: A scoping review was conducted using 5 databases (Ovid MEDLINE, Embase, Scopus, PsycINFO, and ProQuest) to identify eligible articles from January 2000 to July 2020. Publications incorporating the use of ICT interventions, otherwise known as eHealth, such as mobile health, telehealth and telemedicine, decision support systems, electronic health records, and remote monitoring in people aged ≥55 years with chronic diseases were included. We conducted a strengths, weaknesses, opportunities, and threats framework analysis to explore the implied enablers of and barriers to the use of ICT interventions. Results: Of the 1149 identified articles, 31 (2.7%; n=4185 participants) met the inclusion criteria. Of the 31 articles, 5 (16%) mentioned the use of various eHealth interventions. A range of technologies was reported, including mobile health (8/31, 26%), telehealth (7/31, 23%), electronic health record (2/31, 6%), and mixed ICT interventions (14/31, 45%). Various chronic diseases affecting older adults were identified, including congestive heart failure (9/31, 29%), diabetes (7/31, 23%), chronic respiratory disease (6/31, 19%), and mental health disorders (8/31, 26%). ICT interventions were all designed to help people self-manage chronic diseases and demonstrated positive effects. However, patient-related and health care provider–related challenges, in integrating ICT interventions in routine practice, were identified. Barriers to using ICT interventions in older adults included knowledge gaps, a lack of willingness to adopt new skills, and reluctance to use technologies. Implementation challenges related to ICT interventions such as slow internet connectivity and lack of an appropriate reimbursement policy were reported. Advantages of using ICT interventions include their nonpharmacological nature, provision of health education, encouragement for continued physical activity, and maintenance of a healthy diet. Participants reported that the use of ICT was a fun and effective way of increasing their motivation and supporting self-management tasks. It gave them reassurance and peace of mind by promoting a sense of security and reducing anxiety. Conclusions: ICT interventions have the potential to support the care of older adults with chronic diseases. However, they have not been effectively integrated with routine health care. There is a need to improve awareness and education about ICT interventions among those who could benefit from them, including older adults, caregivers, and health care providers. More sustainable funding is required to promote the adoption of ICT interventions. We recommend involving clinicians and caregivers at the time of designing ICT interventions. %M 34994695 %R 10.2196/25251 %U https://aging.jmir.org/2022/1/e25251 %U https://doi.org/10.2196/25251 %U http://www.ncbi.nlm.nih.gov/pubmed/34994695 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e31617 %T Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey %A Breil,Bernhard %A Salewski,Christel %A Apolinário-Hagen,Jennifer %+ Faculty of Health Care, Hochschule Niederrhein, University of Applied Sciences, Reinarzstraße 49, Krefeld, 47805, Germany, 49 21518226710, bernhard.breil@hs-niederrhein.de %K patient acceptance of health care %K mobile apps %K blood pressure %K mobile health %K health applications %K technology acceptance %K patients %K physicians %K digital health %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison. Objective: The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients’ preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc). Methods: Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses. Results: As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians. Conclusions: In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research. %M 34989683 %R 10.2196/31617 %U https://cardio.jmir.org/2022/1/e31617 %U https://doi.org/10.2196/31617 %U http://www.ncbi.nlm.nih.gov/pubmed/34989683 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30474 %T Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology %A Mariakakis,Alex %A Karkar,Ravi %A Patel,Shwetak N %A Kientz,Julie A %A Fogarty,James %A Munson,Sean A %+ Department of Computer Science, University of Toronto, Bahen Centre for Information Technology, Room 4283, 40 St. George Street, Toronto, ON, M5S 2E4, Canada, 1 416 978 5359, mariakakis@cs.toronto.edu %K mobile health %K survey instrument %K health screening %K health belief model %K path analysis %K user design %K health technology %K health intervention technology %K digital health %K mobile phone %D 2022 %7 3.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs. Objective: In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community. Methods: We proposed a method called health concept surveying for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables. Results: We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people’s decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition. Conclusions: Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations. %M 34982038 %R 10.2196/30474 %U https://humanfactors.jmir.org/2022/1/e30474 %U https://doi.org/10.2196/30474 %U http://www.ncbi.nlm.nih.gov/pubmed/34982038 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e22107 %T Effectiveness and Moderators of an Internet-Based Mobile-Supported Stress Management Intervention as a Universal Prevention Approach: Randomized Controlled Trial %A Ebert,David Daniel %A Franke,Marvin %A Zarski,Anna-Carlotta %A Berking,Matthias %A Riper,Heleen %A Cuijpers,Pim %A Funk,Burkhardt %A Lehr,Dirk %+ Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, TUM Campus D, Munich, 80992, Germany, 49 15116781057, david.daniel.ebert@tum.de %K stress management intervention %K universal prevention %K occupational health %K moderators %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Emerging evidence indicates the effectiveness of internet-based mobile-supported stress management interventions (iSMIs) in highly stressed employees. It is yet unclear, however, whether iSMIs are also effective without a preselection process in a universal prevention approach, which more closely resembles routine occupational health care. Moreover, evidence for whom iSMIs might be suitable and for whom not is scarce. Objective: The aim of this study was to evaluate the iSMI GET.ON Stress in a universal prevention approach without baseline inclusion criteria and to examine the moderators of the intervention effects. Methods: A total of 396 employees were randomly assigned to the intervention group or the 6-month waiting list control group. The iSMI consisted of 7 sessions and 1 booster session and offered no therapeutic guidance. Self-report data were assessed at baseline, 7 weeks, and at 6 months following randomization. The primary outcome was perceived stress. Several a priori defined moderators were explored as potential effect modifiers. Results: Participants in the intervention group reported significantly lower perceived stress at posttreatment (d=0.71, 95% CI 0.51-0.91) and at 6-month follow-up (d=0.61, 95% CI 0.41-0.81) compared to those in the waiting list control group. Significant differences with medium-to-large effect sizes were found for all mental health and most work-related outcomes. Resilience (at 7 weeks, P=.04; at 6 months, P=.01), agreeableness (at 7 weeks, P=.01), psychological strain (at 6 months, P=.04), and self-regulation (at 6 months, P=.04) moderated the intervention effects. Conclusions: This study indicates that iSMIs can be effective in a broad range of employees with no need for preselection to achieve substantial effects. The subgroups that might not profit had extreme values on the respective measures and represented only a very small proportion of the investigated sample, thereby indicating the broad applicability of GET.ON Stress. Trial Registration: German Clinical Trials Register DRKS00005699; https://www.drks.de/DRKS00005699 %M 34941541 %R 10.2196/22107 %U https://www.jmir.org/2021/12/e22107 %U https://doi.org/10.2196/22107 %U http://www.ncbi.nlm.nih.gov/pubmed/34941541 %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 %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32660 %T Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study %A Acharya,Amish %A Judah,Gaby %A Ashrafian,Hutan %A Sounderajah,Viknesh %A Johnstone-Waddell,Nick %A Stevenson,Anne %A Darzi,Ara %+ Institute of Global Health Innovation, Imperial College London, 10th Floor QEQM Building St Mary's Hospital, London, W2 1NY, United Kingdom, 44 2033126666, aa2107@ic.ac.uk %K mobile messaging %K digital communication %K population screening %K SMS %K implementation %D 2021 %7 22.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. Objective: The aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England. Methods: This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public’s perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible being eligible for inclusion in the final recommendation. A list of desirable items (ie, important but not currently feasible) will be developed to guide future work. Results: The Institutional Review Board at Imperial College London has granted ethical approval for this study (reference 20IC6088). Results are expected to involve a list of recommendations to screening services, with findings being made available to screening services through Public Health England. This study will, thus, provide a formal guideline for the use of mobile messaging in screening services and will provide future directions in this field. Conclusions: The use of mobile messaging has grown significantly across health care services, especially given the COVID-19 pandemic, but its implementation in screening programs remains challenging. This modified Delphi approach with leading experts will provide invaluable insights into facilitating the incorporation of messaging into these programs and will create awareness of future developments in this area. International Registered Report Identifier (IRRID): PRR1-10.2196/32660 %M 34941542 %R 10.2196/32660 %U https://www.researchprotocols.org/2021/12/e32660 %U https://doi.org/10.2196/32660 %U http://www.ncbi.nlm.nih.gov/pubmed/34941542 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27599 %T A Comparison of the Use of Smart Devices, Apps, and Social Media Between Adults With and Without Hearing Impairment: Cross-sectional Web-Based Study %A van Wier,Marieke F %A Urry,Emily %A Lissenberg-Witte,Birgit I %A Kramer,Sophia E %+ Ear & Hearing, Otolaryngology-Head and Neck Surgery, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, Netherlands, 31 20 4440952, m.vanwier1@amsterdamumc.nl %K hearing impairment %K social media use %K app use %K benefits from social media %K eHealth %K mobile phone %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth and social media could be of particular benefit to adults with hearing impairment, but it is unknown whether their use of smart devices, apps, and social media is similar to that of the general population. Objective: Our aim is to study whether adults with normal hearing and those with impaired hearing differ in their weekly use of smart devices, apps, and social media; reasons for using social media; and benefits from using social media. Methods: We used data from a Dutch cohort, the National Longitudinal Study on Hearing. Data were collected from September 2016 to April 2020 using a web-based questionnaire and speech-in-noise test. The results from this test were used to categorize normal hearing and hearing impairment. Outcomes were compared using (multiple) logistic regression models. Results: Adults with impaired hearing (n=384) did not differ from normal hearing adults (n=341) in their use of a smartphone or tablet. They were less likely to make use of social media apps on a smartphone, tablet, or smartwatch (age-adjusted odds ratio [OR] 0.67, 95% CI 0.48-0.92; P=.02). Use of social media on all devices and use of other apps did not differ. Adults with hearing impairment were more likely to agree with using social media to stay in touch with family members (OR 1.54, 95% CI 1.16-2.07; P=.003) and friends (age-adjusted OR 1.35, 95% CI 1.01-1.81; P=.046). Furthermore, they were more likely to agree with using social media to perform their work (age-adjusted OR 1.51, 95% CI 1.04-2.18; P=.03). There were no differences in the experienced benefits from social media. Conclusions: The potential for eHealth is confirmed because adults with hearing impairment are not less likely to use smart devices than their normal hearing peers. Adults with hearing impairment are less likely to use social media apps on a smart device but not less likely to use social media on all types of internet-connected devices. This warrants further research on the types of social media platforms that adults with hearing impairment use and on the type of device on which they prefer to use social media. Given that participants with hearing impairment are more likely than their normal hearing peers to use social media to perform their work, use of social media may be seen as an opportunity to enhance vocational rehabilitation services for persons with hearing impairment. %M 34932013 %R 10.2196/27599 %U https://www.jmir.org/2021/12/e27599 %U https://doi.org/10.2196/27599 %U http://www.ncbi.nlm.nih.gov/pubmed/34932013 %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 %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e29098 %T Perceptions of Factors Influencing Engagement With Health and Well-being Apps in the United Kingdom: Qualitative 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 Research Park, Earlham Road, Norwich, NR4 7TJ, United Kingdom, 44 1603593064, d.szinay@uea.ac.uk %K behavior change %K health apps %K mHealth %K smartphone app %K framework analysis %K COM-B %K TDF %K user engagement %K motivation %K usability %K engagement %K mobile phone %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health devices, such as health and well-being smartphone apps, could offer an accessible and cost-effective way to deliver health and well-being interventions. A key component of the effectiveness of health and well-being apps is user engagement. However, engagement with health and well-being apps is typically poor. Previous studies have identified a list of factors that could influence engagement; however, most of these studies were conducted on a particular population or for an app targeting a particular behavior. An understanding of the factors that influence engagement with a wide range of health and well-being apps can inform the design and the development of more engaging apps in general. Objective: The aim of this study is to explore user experiences of and reasons for engaging and not engaging with a wide range of health and well-being apps. Methods: A sample of adults in the United Kingdom (N=17) interested in using a health or well-being app participated in a semistructured interview to explore experiences of engaging and not engaging with these apps. Participants were recruited via social media platforms. Data were analyzed with the framework approach, informed by the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework, which are 2 widely used frameworks that incorporate a comprehensive set of behavioral influences. Results: Factors that influence the capability of participants included available user guidance, statistical and health information, reduced cognitive load, well-designed reminders, self-monitoring features, features that help establish a routine, features that offer a safety net, and stepping-stone app characteristics. Tailoring, peer support, and embedded professional support were identified as important factors that enhance user opportunities for engagement with health and well-being apps. Feedback, rewards, encouragement, goal setting, action planning, self-confidence, and commitment were judged to be the motivation factors that affect engagement with health and well-being apps. Conclusions: Multiple factors were identified across all components of the COM-B model that may be valuable for the development of more engaging health and well-being apps. Engagement appears to be influenced primarily by features that provide user guidance, promote minimal cognitive load, support self-monitoring (capability), provide embedded social support (opportunity), and provide goal setting with action planning (motivation). This research provides recommendations for policy makers, industry, health care providers, and app developers for increasing effective engagement. %M 34927597 %R 10.2196/29098 %U https://mhealth.jmir.org/2021/12/e29098 %U https://doi.org/10.2196/29098 %U http://www.ncbi.nlm.nih.gov/pubmed/34927597 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e33364 %T Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions %A Alkureishi,Maria Alcocer %A Choo,Zi-Yi %A Rahman,Ali %A Ho,Kimberly %A Benning-Shorb,Jonah %A Lenti,Gena %A Velázquez Sánchez,Itzel %A Zhu,Mengqi %A Shah,Sachin D %A Lee,Wei Wei %+ Department of Pediatrics, University of Chicago, 5841 S Maryland Avenue, MC 6082 Room C124, Chicago, IL, 60637, United States, 1 773 834 8927, malkureishi@peds.bsd.uchicago.edu %K telemedicine %K digital divide %K patient experience %K qualitative study %D 2021 %7 15.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As telemedicine utilization increased during the COVID-19 pandemic, divergent usage patterns for video and audio-only telephone visits emerged. Older, low-income, minority, and non-English speaking Medicaid patients are at highest risk of experiencing technology access and digital literacy barriers. This raises concern for disparities in health care access and widening of the “digital divide,” the separation of those with technological access and knowledge and those without. While studies demonstrate correlation between racial and socioeconomic demographics and technological access and ability, individual patients’ perspectives of the divide and its impacts remain unclear. Objective: We aimed to interview patients to understand their perspectives on (1) the definition, causes, and impact of the digital divide; (2) whose responsibility it is to address this divide, and (3) potential solutions to mitigate the digital divide. Methods: Between December 2020 and March 2021, we conducted 54 semistructured telephone interviews with adult patients and parents of pediatric patients who had virtual visits (phone, video, or both) between March and September 2020 at the University of Chicago Medical Center (UCMC) primary care clinics. A grounded theory approach was used to analyze interview data. Results: Patients were keenly aware of the digital divide and described impacts beyond health care, including employment, education, community and social contexts, and personal economic stability. Patients described that individuals, government, libraries, schools, health care organizations, and even private businesses all shared the responsibility to address the divide. Proposed solutions to address the divide included conducting community technology needs assessments and improving technology access, literacy training, and resource awareness. Recognizing that some individuals will never cross the divide, patients also emphasized continued support of low-tech communication methods and health care delivery to prevent widening of the digital divide. Furthermore, patients viewed technology access and literacy as drivers of the social determinants of health (SDOH), profoundly influencing how SDOH function to worsen or improve health disparities. Conclusions: Patient perspectives provide valuable insight into the digital divide and can inform solutions to mitigate health and resulting societal inequities. Future work is needed to understand the digital needs of disconnected individuals and communities. As clinical care and delivery continue to integrate telehealth, studies are needed to explore whether having a video or audio-only phone visit results in different patient outcomes and utilization. Advocacy efforts to disseminate public and private resources can also expand device and broadband internet access, improve technology literacy, and increase funding to support both high- and low-tech forms of health care delivery for the disconnected. %M 34705664 %R 10.2196/33364 %U https://humanfactors.jmir.org/2021/4/e33364 %U https://doi.org/10.2196/33364 %U http://www.ncbi.nlm.nih.gov/pubmed/34705664 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e29190 %T Willingness to Share Data From Wearable Health and Activity Trackers: Analysis of the 2019 Health Information National Trends Survey Data %A Rising,Camella J %A Gaysynsky,Anna %A Blake,Kelly D %A Jensen,Roxanne E %A Oh,April %+ Behavioral Research Program, Division of Cancer Control and Population Sciences, US National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, United States, 1 240 276 5262, camella.rising@nih.gov %K mobile health %K population health %K health communication %K survey methodology %K mobile apps %K devices %K online social networking %K mobile phone %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sharing data from wearable health and activity trackers (wearables) with others may improve the health and behavioral outcomes of wearable users by generating social support and improving their ability to manage their health. Investigating individual factors that influence US adults’ willingness to share wearable data with different types of individuals may provide insights about the population subgroups that are most or least likely to benefit from wearable interventions. Specifically, it is necessary to identify digital health behaviors potentially associated with willingness to share wearable data given that the use of and engagement with various technologies may broadly influence web-based health information–sharing behaviors. Objective: This study aims to identify sociodemographic, health, and digital health behavior correlates of US adults’ willingness to share wearable data with health care providers and family or friends. Methods: Data for the analytic sample (N=1300) were obtained from the 2019 Health Information National Trends Survey of the National Cancer Institute. Digital health behavior measures included frequency of wearable device use, use of smartphones or tablets to help communicate with providers, use of social networking sites to share health information, and participation in a web-based health community. Multivariable logistic regression analysis of weighted data examined the associations between digital health behaviors and willingness to share wearable device data, controlling for sociodemographics and health-related characteristics. Results: Most US adults reported willingness to share wearable data with providers (81.86%) and with family or friends (69.51%). Those who reported higher health self-efficacy (odds ratio [OR] 1.97, 95% CI 1.11-3.51), higher level of trust in providers as a source of health information (OR 1.98, 95% CI 1.12-3.49), and higher level of physical activity (OR 2.00, 95% CI 1.21-3.31) had greater odds of willingness to share data with providers. In addition, those with a higher frequency of wearable use (OR 2.15, 95% CI 1.35-3.43) and those who reported use of smartphones or tablets to help communicate with providers (OR 1.99, 95% CI 1.09-3.63) had greater odds of willingness to share data with providers. Only higher level of physical activity was associated with greater odds of willingness to share wearable data with family or friends (OR 1.70, 95% CI 1.02-2.84). Sociodemographic factors were not significantly associated with willingness to share wearable data. Conclusions: The findings of this study suggest that, among US adult wearable users, behavior-related factors, rather than sociodemographic characteristics, are key drivers of willingness to share health information obtained from wearables with others. Moreover, behavioral correlates of willingness to share wearable data are unique to the type of recipient (ie, providers vs family or friends). Future studies could use these findings to inform the development of interventions that aim to improve the use of patient-generated data from wearable devices in health care settings. %M 34898448 %R 10.2196/29190 %U https://mhealth.jmir.org/2021/12/e29190 %U https://doi.org/10.2196/29190 %U http://www.ncbi.nlm.nih.gov/pubmed/34898448 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e27988 %T Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study %A Schroeder,Kristin %A Maiarana,James %A Gisiri,Mwitasrobert %A Joo,Emma %A Muiruri,Charles %A Zullig,Leah %A Masalu,Nestory %A Vasudevan,Lavanya %+ Department of Pediatric Oncology, Duke University Medical Center, Box 102382, Durham, NC, 27710, United States, 1 9196686288, kristin.schroeder@duke.edu %K mHealth %K literacy %K smartphone use %K developing countries %K pediatric cancer %K cancer %K pediatrics %K children %K parents %K caregivers %K mobile health %K smartphone %K SMS %K education %K knowledge transfer %K communication %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: There is a 60% survival gap between children diagnosed with cancer in low- and middle-income countries (LMICs) and those in high-income countries. Low caregiver knowledge about childhood cancer and its treatment results in presentation delays and subsequent treatment abandonment in LMICs. However, in-person education to improve caregiver knowledge can be challenging due to health worker shortages and inadequate training. Due to the rapid expansion of mobile phone use worldwide, mobile health (mHealth) technologies offer an alternative to delivering in-person education. Objective: The aim of this study is to assess patterns of mobile phone ownership and use among Tanzanian caregivers of children diagnosed with cancer as well as their acceptability of an mHealth intervention for cancer education, patient communication, and care coordination. Methods: In July 2017, caregivers of children <18 years diagnosed with cancer and receiving treatment at Bugando Medical Centre (BMC) were surveyed to determine mobile phone ownership, use patterns, technology literacy, and acceptability of mobile phone use for cancer education, patient communication, and care coordination. Descriptive statistics were generated from the survey data by using mean and SD values for continuous variables and percentages for binary or categorical variables. Results: All eligible caregivers consented to participate and completed the survey. Of the 40 caregivers who enrolled in the study, most used a mobile phone (n=34, 85%) and expressed high acceptability in using these devices to communicate with a health care provider regarding treatment support (n=39, 98%), receiving laboratory results (n=37, 93%), receiving reminders for upcoming appointments (n=38, 95%), and receiving educational information on cancer (n=35, 88%). Although only 9% (3/34) of mobile phone owners owned phones with smartphone capabilities, about 74% (25/34) self-reported they could view and read SMS text messages. Conclusions: To our knowledge, this is the first study to assess patterns of mobile phone ownership and use among caregivers of children with cancer in Tanzania. The high rate of mobile phone ownership and caregiver acceptability for a mobile phone–based education and communication strategy suggests that a mobile phone–based intervention, particularly one that utilizes SMS technology, could be feasible in this setting. %M 34889763 %R 10.2196/27988 %U https://pediatrics.jmir.org/2021/4/e27988 %U https://doi.org/10.2196/27988 %U http://www.ncbi.nlm.nih.gov/pubmed/34889763 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28040 %T Test-Retest Reliability of Home-Based Fitness Assessments Using a Mobile App (R Plus Health) in Healthy Adults: Prospective Quantitative Study %A Lin,I-I %A Chen,You-Lin %A Chuang,Li-Ling %+ School of Physical Therapy & Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, No. 259 Wen-hua 1st Rd, Guishan Dist, Taoyuan, 33302, Taiwan, 886 3 2118800 ext 3177, lchuang@gap.cgu.edu.tw %K mobile health app %K reliability %K home-based fitness assessments %K healthy adults %K mobile phone %K digital health %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor physical fitness has a negative impact on overall health status. An increasing number of health-related mobile apps have emerged to reduce the burden of medical care and the inconvenience of long-distance travel. However, few studies have been conducted on home-based fitness tests using apps. Insufficient monitoring of physiological signals during fitness assessments have been noted. Therefore, we developed R Plus Health, a digital health app that incorporates all the components of a fitness assessment with concomitant physiological signal monitoring. Objective: The aim of this study is to investigate the test-retest reliability of home-based fitness assessments using the R Plus Health app in healthy adults. Methods: A total of 31 healthy young adults self-executed 2 fitness assessments using the R Plus Health app, with a 2- to 3-day interval between assessments. The fitness assessments included cardiorespiratory endurance, strength, flexibility, mobility, and balance tests. The intraclass correlation coefficient was computed as a measure of the relative reliability of the fitness assessments and determined their consistency. The SE of measurement, smallest real difference at a 90% CI, and Bland–Altman analyses were used to assess agreement, sensitivity to real change, and systematic bias detection, respectively. Results: The relative reliability of the fitness assessments using R Plus Health was moderate to good (intraclass correlation coefficient 0.8-0.99 for raw scores, 0.69-0.99 for converted scores). The SE of measurement and smallest real difference at a 90% CI were 1.44-6.91 and 3.36-16.11, respectively, in all fitness assessments. The 95% CI of the mean difference indicated no significant systematic error between the assessments for the strength and balance tests. The Bland–Altman analyses revealed no significant systematic bias between the assessments for all tests, with a few outliers. The Bland–Altman plots illustrated narrow limits of agreement for upper extremity strength, abdominal strength, and right leg stance tests, indicating good agreement between the 2 assessments. Conclusions: Home-based fitness assessments using the R Plus Health app were reliable and feasible in young, healthy adults. The results of the fitness assessments can offer a comprehensive understanding of general health status and help prescribe safe and suitable exercise training regimens. In future work, the app will be tested in different populations (eg, patients with chronic diseases or users with poor fitness), and the results will be compared with clinical test results. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000030905; http://www.chictr.org.cn/showproj.aspx?proj=50229 %M 34657835 %R 10.2196/28040 %U https://formative.jmir.org/2021/12/e28040 %U https://doi.org/10.2196/28040 %U http://www.ncbi.nlm.nih.gov/pubmed/34657835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e29167 %T Gender-Specific Impact of Self-Monitoring and Social Norm Information on Walking Behavior Among Chinese College Students Assessed Using WeChat: Longitudinal Tracking Study %A Xu,Yuepei %A Yue,Ling-Zi %A Wang,Wei %A Wu,Xiao-Ju %A Liang,Zhu-Yuan %+ CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, 100101, China, 86 10 64841536, liangzy@psych.ac.cn %K self-monitoring %K social norm %K group identity %K gender differences %K mHealth %K mobile health %D 2021 %7 7.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Walking is a simple but beneficial form of physical activity (PA). Self-monitoring and providing information about social norms are the 2 most widely used “mobile health (mHealth)” strategies to promote walking behavior. However, previous studies have failed to discriminate the effect of self-monitoring from the combination of the 2 strategies, and provide practical evidence within Chinese culture. Some essential moderators, such as gender and group identity, were also overlooked. Objective: We aimed to investigate the effectiveness of social norm and self-monitoring interventions for walking behavior and assess the moderating effects of gender and group identity, which could guide optimal mHealth intervention projects in China. Methods: In 2 longitudinal tracking studies (study 1, 22 days; study 2, 31 days), Chinese college students wore trackers for at least 8 hours per day (MASAI 3D Pedometer and Xiaomi Wristband 2) to record their daily step counts in baseline, intervention, and follow-up stages. In each study, participants (study 1: n=117, 54% female, mean age 25.60 years; study 2: n=180, 51% female, mean age 22.60 years) were randomly allocated to 1 of the following 3 groups: a self-monitoring group and 2 social norm intervention groups. In the 2 intervention groups and during the intervention stage, participants received different social norm information regarding group member step rankings corresponding to their grouping type of social norm information. In study 1, participants were grouped by within-group member PA levels (PA consistent vs PA inconsistent), and in study 2, participants were grouped by their received gender-specific social norm information (gender consistent vs gender inconsistent). Piece-wise linear mixed models were used to compare the difference in walking steps between groups. Results: In study 1, for males in the self-monitoring group, walking steps significantly decreased from the baseline stage to the intervention stage (change in slope=−1422.16; P=.02). However, additional social norm information regardless of group consistency kept their walking unchanged. For females, social norm information did not provide any extra benefit beyond self-monitoring. Females exposed to PA-inconsistent social norm information even walked less (slope during the intervention=−122.18; P=.03). In study 2, for males, a similar pattern was observed, with a decrease in walking steps in the self-monitoring group (change in slope=−151.33; P=.08), but there was no decrease in the 2 social norm intervention groups. However, for females, gender-consistent social norm information decreased walking steps (slope during the intervention=−143.68; P=.03). Conclusions: Both gender and group identity moderated the effect of social norm information on walking. Among females, social norm information showed no benefit for walking behavior and may have exerted a backfire effect. Among males, while walking behavior decreased with self-monitoring only, the inclusion of social norm information held the level of walking behavior steady. %M 34878992 %R 10.2196/29167 %U https://www.jmir.org/2021/12/e29167 %U https://doi.org/10.2196/29167 %U http://www.ncbi.nlm.nih.gov/pubmed/34878992 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25012 %T Establishing a Working Definition of User Experience for eHealth Interventions of Self-reported User Experience Measures With eHealth Researchers and Adolescents: Scoping Review %A Newton,Amanda S %A March,Sonja %A Gehring,Nicole D %A Rowe,Arlen K %A Radomski,Ashley D %+ Department of Pediatrics, University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 7802485581, mandi.newton@ualberta.ca %K eHealth %K internet %K design %K development %K user experience %K health care %K scoping review %K Delphi %D 2021 %7 2.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Across eHealth intervention studies involving children, adolescents, and their parents, researchers have measured user experience to assist with intervention development, refinement, and evaluation. To date, no widely accepted definitions or measures of user experience exist to support a standardized approach for evaluation and comparison within or across interventions. Objective: We conduct a scoping review with subsequent Delphi consultation to identify how user experience is defined and measured in eHealth research studies, characterize the measurement tools used, and establish working definitions for domains of user experience that could be used in future eHealth evaluations. Methods: We systematically searched electronic databases for published and gray literature available from January 1, 2005, to April 11, 2019. We included studies assessing an eHealth intervention that targeted any health condition and was designed for use by children, adolescents, and their parents. eHealth interventions needed to be web-, computer-, or mobile-based, mediated by the internet with some degree of interactivity. We required studies to report the measurement of user experience as first-person experiences, involving cognitive and behavioral factors reported by intervention users. We appraised the quality of user experience measures in included studies using published criteria: well-established, approaching well-established, promising, or not yet established. We conducted a descriptive analysis of how user experience was defined and measured in each study. Review findings subsequently informed the survey questions used in the Delphi consultations with eHealth researchers and adolescent users for how user experience should be defined and measured. Results: Of the 8634 articles screened for eligibility, 129 articles and 1 erratum were included in the review. A total of 30 eHealth researchers and 27 adolescents participated in the Delphi consultations. On the basis of the literature and consultations, we proposed working definitions for 6 main user experience domains: acceptability, satisfaction, credibility, usability, user-reported adherence, and perceived impact. Although most studies incorporated a study-specific measure, we identified 10 well-established measures to quantify 5 of the 6 domains of user experience (all except for self-reported adherence). Our adolescent and researcher participants ranked perceived impact as one of the most important domains of user experience and usability as one of the least important domains. Rankings between adolescents and researchers diverged for other domains. Conclusions: Findings highlight the various ways in which user experience has been defined and measured across studies and what aspects are most valued by researchers and adolescent users. We propose incorporating the working definitions and available measures of user experience to support consistent evaluation and reporting of outcomes across studies. Future studies can refine the definitions and measurement of user experience, explore how user experience relates to other eHealth outcomes, and inform the design and use of human-centered eHealth interventions. %M 34860671 %R 10.2196/25012 %U https://www.jmir.org/2021/12/e25012 %U https://doi.org/10.2196/25012 %U http://www.ncbi.nlm.nih.gov/pubmed/34860671 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e23659 %T The Baby Steps Web Program for the Well-Being of New Parents: Randomized Controlled Trial %A Kavanagh,David John %A Connolly,Jennifer %A Fisher,Jane %A Halford,W Kim %A Hamilton,Kyra %A Hides,Leanne %A Milgrom,Jeannette %A Rowe,Heather %A Scuffham,Paul A %A White,Katherine M %A Wittkowski,Anja %A Appleton,Shelley %A Sanders,Davina %+ Centre for Children’s Health Research, Queensland University of Technology, 62 Raymond Terrace, South Brisbane Qld, 4101, Australia, 61 419 479227, david.kavanagh@qut.edu.au %K perinatal %K depression %K prevention %K men %K self-guided %K internet %D 2021 %7 26.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. Objective: This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. Methods: The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks’ gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples’ randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. Results: Selection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ≥50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9%; P<.001). The EPDS, quality of life, and social support did not show differential improvements between programs, but Baby Steps Wellbeing gave a greater linear increase in self-efficacy for support provision (P=.01; Cohen d=0.26) and lower reduction in relationship satisfaction (P=.03; Cohen d=0.20) than Baby Care alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving Baby Steps Wellbeing rather than Baby Care (P=.01; Cohen d=0.51). However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time. Conclusions: Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277 %M 34842534 %R 10.2196/23659 %U https://www.jmir.org/2021/11/e23659 %U https://doi.org/10.2196/23659 %U http://www.ncbi.nlm.nih.gov/pubmed/34842534 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e29181 %T To Use or Not to Use a COVID-19 Contact Tracing App: Mixed Methods Survey in Wales %A Jones,Kerina %A Thompson,Rachel %+ Swansea University, Population Data Science, Swansea University Medical School, Singleton Park, Swansea, SA28PP, United Kingdom, 44 01792602764, k.h.jones@swansea.ac.uk %K COVID-19 %K survey %K Wales %K contact tracing %K app %K mHealth %K mobile apps %K digital health %K public health %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many countries remain in the grip of the COVID-19 global pandemic, with a considerable journey still ahead toward normalcy and free mobility. Contact tracing smartphone apps are among a raft of measures introduced to reduce spread of the virus, but their uptake depends on public choice. Objective: The objective of this study was to ascertain the views of citizens in Wales on their intended use of a COVID-19 contact tracing smartphone app, including self-proposed reasons for or against use and what could lead to a change of decision. Methods: We distributed an anonymous survey among 4000 HealthWise Wales participants in May 2020. We adopted a mixed methods approach: responses to closed questions were analyzed using descriptive and inferential statistics; open question responses were analyzed and grouped into categories. Results: A total of 976 (24.4%) people completed the survey. Smartphone usage was 91.5% overall, but this varied among age groups. In total, 97.1% were aware of contact tracing apps, but only 67.2% felt sufficiently informed. Furthermore, 55.7% intended to use an app, 23.3% refused, and 21.0% were unsure. The top reasons for app use were as follows: controlling the spread of the virus, mitigating risks for others and for oneself, and increasing freedoms. The top reasons against app use were as follows: mistrusting the government, concerns about data security and privacy, and doubts about efficacy. The top response for changing one’s mind about app use from being willing to being unwilling was that nothing would; that is, they felt that nothing would cause them to become unwilling to use a contact tracing app. This was also the top response for changing one’s mind from being unwilling to being willing to use contact tracing apps. Among those who were unsure of using contact tracing apps, the top response was the need for more information. Conclusions: Respondents demonstrated a keenness to help themselves, others, society, and the government to avoid contracting the virus and to control its spread. However, digital inclusion varied among age groups, precluding participation for some people. Nonetheless, unwillingness was significant, and considering the nature of the concerns raised and the perceived lack of information, policy and decision-makers need to do more to act openly, increase communication, and demonstrate trustworthiness if members of the public are to be confident in using an app. %M 34698645 %R 10.2196/29181 %U https://mhealth.jmir.org/2021/11/e29181 %U https://doi.org/10.2196/29181 %U http://www.ncbi.nlm.nih.gov/pubmed/34698645 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e32951 %T Digitization and Health in Germany: Cross-sectional Nationwide Survey %A De Santis,Karina Karolina %A Jahnel,Tina %A Sina,Elida %A Wienert,Julian %A Zeeb,Hajo %+ Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, Bremen, 28359, Germany, 49 42121856 ext 908, desantis@leibniz-bips.de %K digital health %K literacy %K survey %K attitude %K usage %K eHEALS %K COVID-19 %K physical activity %K general population %K misinformation %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital technologies are shaping medicine and public health. Objective: The aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey. Methods: We performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use. Results: The participants included 1014 internet users (n=528, 52.07% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47% (674/1014) completed up to tertiary (primary and secondary) education and 45.07% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US $1.18). Over half (579/1014, 57.10%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56%) noted that digitization will be important for therapy and health care, in the future. Only 25.64% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0%) found such technologies easy to use and 140 (63.6%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95% CI 0.94-0.96) and more education (OR 1.22, 95% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age (β=–.22, P<.001), higher household income (β=.21, P<.001), and more education (β=.14, P<.001). Conclusions: Internet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions. %M 34813493 %R 10.2196/32951 %U https://publichealth.jmir.org/2021/11/e32951 %U https://doi.org/10.2196/32951 %U http://www.ncbi.nlm.nih.gov/pubmed/34813493 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e30420 %T Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation %A Pan,Jing %A Dong,Hua %A Bryan-Kinns,Nick %+ Brunel Design School, Brunel University London, Kingston Lane, Uxbridge, Middlesex UB8 3PH, London, United Kingdom, 44 01895 257254, Hua.Dong@brunel.ac.uk %K older adults %K mHealth %K initial adoption %K technology acceptance %K design %K mobile phone %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective: The aims of this study are to understand older adults’ perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods: This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults’ perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results: In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults’ perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults’ adoption of mHealth services. Conclusions: The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults. %M 34807836 %R 10.2196/30420 %U https://aging.jmir.org/2021/4/e30420 %U https://doi.org/10.2196/30420 %U http://www.ncbi.nlm.nih.gov/pubmed/34807836 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e27016 %T Usability and Perceived Usefulness of the AFib 2gether Mobile App in a Clinical Setting: Single-Arm Intervention Study %A Kapoor,Alok %A Hayes,Anna %A Patel,Jay %A Patel,Harshal %A Andrade,Andreza %A Mazor,Kathleen %A Possidente,Carl %A Nolen,Kimberly %A Hegeman-Dingle,Rozelle %A McManus,David %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 North Lake Ave, Worcester, MA, 01655, United States, 1 9178564538, alok.kapoor@umassmemorial.org %K shared decision-making %K mobile health %K stroke risk %K anticoagulation risk %K anticoagulation %K atrial fibrillation %K anticoagulation therapy %K atrial flutter %K mobile phone %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: Although the American Heart Association and other professional societies have recommended shared decision-making as a way for patients with atrial fibrillation (AF) or atrial flutter to make informed decisions about using anticoagulation (AC), the best method for facilitating shared decision-making remains uncertain. Objective: The aim of this study is to assess the AFib 2gether mobile app for usability, perceived usefulness, and the extent and nature of shared decision-making that occurred for clinical encounters between patients with AF and their cardiology providers in which the app was used. Methods: We identified patients visiting a cardiology provider between October 2019 and May 2020. We measured usability from patients and providers using the Mobile App Rating Scale. From the 8 items of the Mobile App Rating Scale, we reported the average score (out of 5) for domains of functionality, esthetics, and overall quality. We administered a 3-item questionnaire to patients relating to their perceived usefulness of the app and a separate 3-item questionnaire to providers to measure their perceived usefulness of the app. We performed a chart review to track the occurrence of AC within 6 months of the index visit. We also audio recorded a subset of the encounters to identify evidence of shared decision-making. Results: We facilitated shared decision-making visits for 37 patients visiting 13 providers. In terms of usability, patients’ average ratings of functionality, esthetics, and overall quality were 4.51 (SD 0.61), 4.26 (SD 0.51), and 4.24 (SD 0.89), respectively. In terms of usefulness, 41% (15/37) of patients agreed that the app improved their knowledge regarding AC, and 62% (23/37) agreed that the app helped clarify to their provider their preferences regarding AC. Among providers, 79% (27/34) agreed that the app helped clarify their patients’ preferences, 82% (28/34) agreed that the app saved them time, and 59% (20/34) agreed that the app helped their patients make decisions about AC. In addition, 32% (12/37) of patients started AC after their shared decision-making visits. We audio recorded 25 encounters. Of these, 84% (21/25) included the mention of AC for AF, 44% (11/25) included the discussion of multiple options for AC, 72% (18/25) included a provider recommendation for AC, and 48% (12/25) included the evidence of patient involvement in the discussion. Conclusions: Patients and providers rated the app with high usability and perceived usefulness. Moreover, one-third of the patients began AC, and approximately 50% (12/25) of the encounters showed evidence of patient involvement in decision-making. In the future, we plan to study the effect of the app on a larger sample and with a controlled study design. Trial Registration: ClinicalTrials.gov NCT04118270; https://clinicaltrials.gov/ct2/show/NCT04118270 International Registered Report Identifier (IRRID): RR2-21986 %M 34806997 %R 10.2196/27016 %U https://cardio.jmir.org/2021/2/e27016 %U https://doi.org/10.2196/27016 %U http://www.ncbi.nlm.nih.gov/pubmed/34806997 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e20964 %T Digital Technical and Informal Resources of Breast Cancer Patients From 2012 to 2020: Questionnaire-Based Longitudinal Trend Study %A Mallmann,Christoph A %A Domröse,Christian M %A Schröder,Lars %A Engelhardt,David %A Bach,Frederik %A Rueckel,Helena %A Abramian,Alina %A Kaiser,Christina %A Mustea,Alexander %A Faridi,Andree %A Malter,Wolfram %A Mallmann,Peter %A Rudlowski,Christian %A Zivanovic,Oliver %A Mallmann,Michael R %+ Department of Obstetrics & Gynecology, University Hospital of Cologne, Kerpener St 34, Cologne, 50924, Germany, 49 221 478 4910, mallmann.michael@gmail.com %K digitalization %K eHealth %K breast cancer %K internet %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Digitalization offers enormous potential in medicine. In the era of digitalization, the development of the use of digital, technical, and informal resources of breast cancer patients and factors influencing the degree of digitization of patients has been insufficiently researched. Objective: The aim of this study was to assess the development of the use of digital technical and informal resources in a well-defined patient cohort. Methods: A longitudinal study on 513 breast cancer patients from 2012 to 2020 was conducted using a questionnaire that included the main aspects of the degree of digitalization, including digital device availability and use, stationary and mobile internet access and use, and communication and information seeking regarding breast cancer diagnosis and treatment. Results: The majority of patients (421/513, 82.1%) owned the technical resources to benefit from eHealth, used the internet to obtain information (292/509, 57.4%), and were willing to use new eHealth solutions (379/426, 89%). Two-thirds of the patients discussed information about their cancer on the internet with their doctor, one-third found additional treatment options on the internet, and 15.3% (44/287) of the patients stated that this had changed their cancer therapy. The degree of digitization is increasing yet still significantly depends on 3 factors: (1) age (whereas 100% [39/39] of the <59-year-old group used the internet in 2020, 92% of the 60 to 69-year-old group [11/12] and only 47% [6/13] of the >70-year-old group used the internet), (2) education (internet use significantly depended on education, as only 51.8% [59/114] of patients with primary school education used the internet, but 82.4% [126/153] with middle school education and 90.3% [213/236] with high school education used the internet; P<.001), and (3) household size (67.7% [111/164] of patients living alone used the internet, whereas 84.7% [287/339] of patients living in a house with ≥2 people used the internet; P<.001). Conclusions: To implement digital solutions in health care, knowledge of the composition and degree of the use of digital technical and informal resources of the patient group for which the respective solution is developed is crucial for success. Trial Registration: German Register of Clinical Studies DRKS00012364; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012364 %M 34792468 %R 10.2196/20964 %U https://cancer.jmir.org/2021/4/e20964 %U https://doi.org/10.2196/20964 %U http://www.ncbi.nlm.nih.gov/pubmed/34792468 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 4 %P e33027 %T Use of an iPad App (Aid for Decision-making in Occupational Choice) for Collaborative Goal Setting in Interprofessional Rehabilitation: Qualitative Descriptive Study %A Strubbia,Carla %A Levack,William MM %A Grainger,Rebecca %A Takahashi,Kayoko %A Tomori,Kounosuke %+ Department of Medicine, University of Otago, 23A Mein street, Wellington, 6242, New Zealand, 64 02041604900, carla.strubbia@postgrad.otago.ac.nz %K rehabilitation %K goals %K digital technology %K mobile health %K mobile phone %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Goal setting is a key part of the rehabilitation process. The use of technology and electronic tools such as smartphone apps and websites has been suggested as a way of improving the engagement of users in meaningful goal setting and facilitating shared decision-making between patients and health professionals. Objective: This study aims to describe experiences of health professionals and patients in the use of the English language version of the iPad app Aid for Decision-making in Occupational Choice (ADOC) to facilitate collaborative goal setting in rehabilitation. Methods: We recruited participants from 3 acute and postacute care rehabilitation wards in both public and private organizations in New Zealand. Participants were registered allied health professionals, including physiotherapists, occupational therapists, and speech-language therapists, who engage in goal setting as part of their normal work, and their adult patients. We collected data via semistructured interviews to gather information about the experiences of the participants in the use of ADOC for goal setting. Data were analyzed with thematic analysis. Results: A total of 8 health professionals and 8 patients participated in the study. Six main themes emerged from the data: changing patients’ perspective on what is possible, changing health professionals’ perspective on what is important, facilitating shared decision-making, lack of guides for users, logistic and organizational barriers, and app-related and technical issues. Conclusions: Health professionals and patients found ADOC to be a valuable tool when setting shared rehabilitation goals. The use of ADOC promoted a patient-centered approach that empowered patients to engage in collaborative goal setting. The technological limitations of the app that negatively impacted experiences can be addressed in the future implementation of ADOC in rehabilitation settings. %M 34792475 %R 10.2196/33027 %U https://rehab.jmir.org/2021/4/e33027 %U https://doi.org/10.2196/33027 %U http://www.ncbi.nlm.nih.gov/pubmed/34792475 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e29207 %T Identification of the Most Suitable App to Support the Self-Management of Hypertension: Systematic Selection Approach and Qualitative Study %A Alessa,Tourkiah %A Hawley,Mark %A de Witte,Luc %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield City Centre, Sheffield, S1 4DA, United Kingdom, 44 114 222 1726, talessa@KSU.EDU.SA %K app %K hypertension %K self-management %K mHealth %K blood pressure %K support %K Saudi Arabia %K cardiology %K heart %K effective %K security %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps are increasingly being used to aid in hypertension self-management, and a large and ever-growing number of self-management apps have been commercially released. However, very few of these are potentially effective and secure, and researchers have yet to establish the suitability of specific hypertension apps to particular contexts. Objective: The aim of this study is to identify the most suitable hypertension app in the context of Saudi Arabia and its health system. Methods: This study used a 2-stage approach to selecting the most suitable app for hypertension self-management. First, a systematic selection approach was followed to identify a shortlist of the most suitable apps according to the criteria of potential effectiveness, theoretical underpinning, and privacy and security. Second, an exploratory qualitative study was conducted to select the most suitable from the shortlist: 12 doctors were interviewed, and 22 patients participated in 4 focus groups. These explored participants’ attitudes towards self-management apps in general, and their views towards the apps identified via the systematic selection process. The qualitative data were analyzed using framework analysis. Results: In the first stage, only 5 apps were found to be potentially effective while also having a theoretical underpinning and protecting users’ data. In the second stage, both doctors and patients were generally interested in using hypertension apps, but most had no experience with these apps due to a lack of awareness of their availability and suitability. Patients and doctors liked apps that combine intuitive interfaces with a pleasant and clear visual design, in-depth features (eg, color-coded feedback accompanied with textual explanations), activity-specific reminders, and educational content regarding hypertension and potential complications. When the pros and cons of the 5 apps were discussed, 3 apps were identified as being more suitable, with Cora Health rated the highest by the participants. Conclusions: Only 5 apps were deemed potentially effective and secure. Patients’ and doctors’ discussions of the pros and cons of these 5 apps revealed that 3 out of the 5 are clearly more suitable, with the Cora Health app being judged most suitable overall. %M 34787586 %R 10.2196/29207 %U https://mhealth.jmir.org/2021/11/e29207 %U https://doi.org/10.2196/29207 %U http://www.ncbi.nlm.nih.gov/pubmed/34787586 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e28024 %T Improvements in Diet and Physical Activity–Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study %A Cyriac,Jissy %A Jenkins,Sarah %A Patten,Christi A %A Hayes,Sharonne N %A Jones,Clarence %A Cooper,Lisa A %A Brewer,LaPrincess C %+ Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, United States, 1 507 266 1376, brewer.laprincess@mayo.edu %K African Americans %K cardiovascular health disparities %K mHealth lifestyle intervention %K diet %K physical activity %K mobile phone %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: African Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans. Objective: This study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change. Methods: This study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory–informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression. Results: Participants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=−0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively). Conclusions: Our findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans. %M 34766917 %R 10.2196/28024 %U https://mhealth.jmir.org/2021/11/e28024 %U https://doi.org/10.2196/28024 %U http://www.ncbi.nlm.nih.gov/pubmed/34766917 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e22218 %T Predicting Participant Compliance With Fitness Tracker Wearing and Ecological Momentary Assessment Protocols in Information Workers: Observational Study %A Martinez,Gonzalo J %A Mattingly,Stephen M %A Robles-Granda,Pablo %A Saha,Koustuv %A Sirigiri,Anusha %A Young,Jessica %A Chawla,Nitesh %A De Choudhury,Munmun %A D'Mello,Sidney %A Mark,Gloria %A Striegel,Aaron %+ Computer Science and Engineering, University of Notre Dame, 400 Main Building, Notre Dame, IN, 46556, United States, 1 574 631 5000, gmarti11@nd.edu %K adherence %K compliance %K wearables %K smartphones %K research design %K ecological momentary assessment %K mobile sensing %K mobile phone %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Studies that use ecological momentary assessments (EMAs) or wearable sensors to track numerous attributes, such as physical activity, sleep, and heart rate, can benefit from reductions in missing data. Maximizing compliance is one method of reducing missing data to increase the return on the heavy investment of time and money into large-scale studies. Objective: This paper aims to identify the extent to which compliance can be prospectively predicted from individual attributes and initial compliance. Methods: We instrumented 757 information workers with fitness trackers for 1 year and conducted EMAs in the first 56 days of study participation as part of an observational study. Their compliance with the EMA and fitness tracker wearing protocols was analyzed. Overall, 31 individual characteristics (eg, demographics and personalities) and behavioral variables (eg, early compliance and study portal use) were considered, and 14 variables were selected to create beta regression models for predicting compliance with EMAs 56 days out and wearable compliance 1 year out. We surveyed study participation and correlated the results with compliance. Results: Our modeling indicates that 16% and 25% of the variance in EMA compliance and wearable compliance, respectively, could be explained through a survey of demographics and personality in a held-out sample. The likelihood of higher EMA and wearable compliance was associated with being older (EMA: odds ratio [OR] 1.02, 95% CI 1.00-1.03; wearable: OR 1.02, 95% CI 1.01-1.04), speaking English as a first language (EMA: OR 1.38, 95% CI 1.05-1.80; wearable: OR 1.39, 95% CI 1.05-1.85), having had a wearable before joining the study (EMA: OR 1.25, 95% CI 1.04-1.51; wearable: OR 1.50, 95% CI 1.23-1.83), and exhibiting conscientiousness (EMA: OR 1.25, 95% CI 1.04-1.51; wearable: OR 1.34, 95% CI 1.14-1.58). Compliance was negatively associated with exhibiting extraversion (EMA: OR 0.74, 95% CI 0.64-0.85; wearable: OR 0.67, 95% CI 0.57-0.78) and having a supervisory role (EMA: OR 0.65, 95% CI 0.54-0.79; wearable: OR 0.66, 95% CI 0.54-0.81). Furthermore, higher wearable compliance was negatively associated with agreeableness (OR 0.68, 95% CI 0.56-0.83) and neuroticism (OR 0.85, 95% CI 0.73-0.98). Compliance in the second week of the study could help explain more variance; 62% and 66% of the variance in EMA compliance and wearable compliance, respectively, was explained. Finally, compliance correlated with participants’ self-reflection on the ease of participation, usefulness of our compliance portal, timely resolution of issues, and compensation adequacy, suggesting that these are avenues for improving compliance. Conclusions: We recommend conducting an initial 2-week pilot to measure trait-like compliance and identify participants at risk of long-term noncompliance, performing oversampling based on participants’ individual characteristics to avoid introducing bias in the sample when excluding data based on noncompliance, using an issue tracking portal, and providing special care in troubleshooting to help participants maintain compliance. %M 34766911 %R 10.2196/22218 %U https://mhealth.jmir.org/2021/11/e22218 %U https://doi.org/10.2196/22218 %U http://www.ncbi.nlm.nih.gov/pubmed/34766911 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e29866 %T The Influence of Gender and Age on the Outcomes of and Adherence to a Digital Interdisciplinary Mental Health Promotion Intervention in an Australasian Nonclinical Setting: Cohort Study %A Przybylko,Geraldine %A Morton,Darren %A Morton,Jason %A Renfrew,Melanie %+ Lifestyle Medicine and Health Research Centre, Avondale University, 582 Freemans Drive, Cooranbong, 2265, Australia, 61 418574001, geraldineprzybylko@eliawellness.com %K age %K gender %K adherence %K digital health %K interdisciplinary %K mental health %K promotion %K intervention %K lifestyle medicine %K positive psychology %K multicomponent %K lifestyle %K outcome %K cohort study %D 2021 %7 11.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The global prevalence of mental health disorders is at a crisis point, particularly in the wake of COVID-19, prompting calls for the development of digital interdisciplinary mental health promotion interventions (MHPIs) for nonclinical cohorts. However, the influence of gender and age on the outcomes of and adherence to MHPIs is not well understood. Objective: The aim of this study was to determine the influence of gender and age on the outcomes of and adherence to a 10-week digital interdisciplinary MHPI that integrates strategies from positive psychology and lifestyle medicine and utilizes persuasive systems design (PSD) principles in a nonclinical setting. Methods: This study involved 488 participants who completed the digital interdisciplinary MHPI. Participants completed a pre and postintervention questionnaire that used: (1) the “mental health” and “vitality” subscales from the Short Form 36 (SF-36) Health Survey; (2) the Depression, Anxiety and Stress Scale (DASS-21); and (3) Satisfaction With Life Scale (SWL). Adherence to the digital interdisciplinary MHPI was measured by the number of educational videos the participants viewed and the extent to which they engaged in experiential challenge activities offered as part of the program. Results: On average, the participants (N=488; mean age 47.1 years, SD 14.1; 77.5% women) demonstrated statistically significant improvements in all mental health and well-being outcome measures, and a significant gender and age interaction was observed. Women tended to experience greater improvements than men in the mental health and well-being measures, and older men experienced greater improvements than younger men in the mental health and vitality subscales. Multiple analysis of variance results of the adherence measures indicated a significant difference for age but not gender. No statistically significant interaction between gender and age was observed for adherence measures. Conclusions: Digital interdisciplinary MHPIs that utilize PSD principles can improve the mental health and well-being of nonclinical cohorts, regardless of gender or age. Hence, there may be a benefit in utilizing PSD principles to develop universal MHPIs such as that employed in this study, which can be used across gender and age groups. Future research should examine which PSD principles optimize universal digital interdisciplinary MHPIs. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000993190; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377889 and Australian New Zealand Clinical Trials Registry ACTRN12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx %M 34762058 %R 10.2196/29866 %U https://mental.jmir.org/2021/11/e29866 %U https://doi.org/10.2196/29866 %U http://www.ncbi.nlm.nih.gov/pubmed/34762058 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30605 %T A Program to Improve Digital Access and Literacy Among Community Stakeholders: Cohort Study %A Drazich,Brittany F %A Nyikadzino,Yeukai %A Gleason,Kelly T %+ School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, United States, 1 3023530657, bdrazich@umaryland.edu %K technology %K disparities %K digital access %K digital literacy %K community %K stakeholders %K digital health %K digital divide %K patient-centered outcomes %D 2021 %7 10.11.2021 %9 Early Report %J JMIR Form Res %G English %X Background: For many research teams, the role of community stakeholders is critical. However, community stakeholders, especially those in low-income settings, are at risk of being excluded from research and community engagement initiatives during and after the COVID-19 pandemic because of the rapid transition to digital operations. Objective: We aimed to describe the implementation and feasibility of a program called Addressing the Digital Divide to Improve Patient-Centered Outcomes Research, which was designed to address barriers to technology use, and to examine changes in participants’ perceived comfort with digital technology before and after the program. Methods: To promote full engagement, we worked with 20 existing community leaders to cocreate a training course on using digital technology. We assessed the frequency of technology use and comfort with technology through an adapted 8-item version of the Functional Assessment of Comfort Employing Technology Scale and used the Wilcoxon signed-rank test for survey analysis. We also conducted a focus group session with 10 participants and then performed reflective journaling and content analysis to determine emergent themes. Results: We found that the program was feasible to implement and worthwhile for participants (15/16, 94%). After the program, the participants perceived an increase in the frequency of technology use (z=2.76, P=.006). The participants reported that the program was successful because of the technology training program, but recommended that the program have a slower pace and include a helpline number that they could call with questions. Conclusions: Future programs should consider that populations with low literacy view technology training as a core element to decreasing technology disparity. This study demonstrates that through low-cost input, community members can be provided the resources and training needed to virtually participate in research studies or community engagement initiatives. %M 34757316 %R 10.2196/30605 %U https://formative.jmir.org/2021/11/e30605 %U https://doi.org/10.2196/30605 %U http://www.ncbi.nlm.nih.gov/pubmed/34757316 %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 %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25777 %T Effectiveness of Smartphone-Based Community Case Management on the Urgent Referral, Reconsultation, and Hospitalization of Children Aged Under 5 Years in Malawi: Cluster-Randomized, Stepped-Wedge Trial %A Chirambo,Griphin Baxter %A Thompson,Matthew %A Hardy,Victoria %A Ide,Nicole %A Hwang,Phillip H %A Dharmayat,Kanika %A Mastellos,Nikolaos %A Heavin,Ciara %A O'Connor,Yvonne %A Muula,Adamson S %A Andersson,Bo %A Carlsson,Sven %A Tran,Tammy %A Hsieh,Jenny Chen-Ling %A Lee,Hsin-Yi %A Fitzpatrick,Annette %A Joseph Wu,Tsung-Shu %A O'Donoghue,John %+ Faculty of Health Sciences, Mzuzu University, Private Bag 201, Luwinga, Mzuzu 2, Mzuzu, Malawi, 265 0999236092, gbchirambo@yahoo.co.uk %K community case management %K mobile health %K pediatrics %K childhood infection %K mobile phone %D 2021 %7 20.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Objective: We determined the impact of an electronic version of a smartphone-based CCM (e-CCM) app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Methods: We used a stepped-wedge, cluster-randomized trial to compare paper-based CCM (control) with and without the use of an e-CCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from 2 districts in northern Malawi were assigned to 1 of 6 clusters, which were randomized on the sequencing of the crossover from the control phase to the intervention phase as well as the duration of exposure in each phase. Children aged ≥2 months to <5 years who presented with acute illness were enrolled consecutively by health surveillance assistants. The primary outcome of urgent referrals to higher-level facilities was evaluated by using multilevel mixed effects models. A logistic regression model with the random effects of the cluster and the fixed effects for each step was fitted. The adjustment for potential confounders included baseline factors, such as patient age, sex, and the geographical location of the village clinics. Calendar time was adjusted for in the analysis. Results: A total of 6965 children were recruited—49.11% (3421/6965) in the control phase and 50.88% (3544/6965) in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility than children in the control phase (odds ratio [OR] 2.02, 95% CI 1.27-3.23; P=.003). Overall, children in the intervention arm had lower odds of attending a repeat health surveillance assistant consultation (OR 0.45, 95% CI 0.34-0.59; P<.001) or being admitted to a hospital (OR 0.75, 95% CI 0.62-0.90; P=.002), but after adjusting for time, these differences were not significant (P=.07 for consultation; P=.30 for hospital admission). Conclusions: The addition of e-CCM decision support by using smartphones led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of e-CCM tools in Malawi and other low- and middle-income countries with a need for ongoing assessments of effectiveness and integration with national digital health strategies. Trial Registration: ClinicalTrials.gov NCT02763345; https://clinicaltrials.gov/ct2/show/NCT02763345 %M 34668872 %R 10.2196/25777 %U https://www.jmir.org/2021/10/e25777 %U https://doi.org/10.2196/25777 %U http://www.ncbi.nlm.nih.gov/pubmed/34668872 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29441 %T Characteristics of Acute Childhood Illness Apps for Parents: Environmental Scan %A Benoit,James %A Hartling,Lisa %A Chan,Michelle %A Scott,Shannon %+ Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 4-472 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada, 1 780 492 6124, hartling@ualberta.ca %K internet %K mHealth %K mobile health %K digital health %K ehealth %K app %K mobile application %K Android %K Apple %K marketplace %K environmental scan %K review %K acute childhood illness %K knowledge translation %K child %K parent %K caregiver %K mobile phone %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Providing parents with resources that aid in the identification and management of acute childhood illnesses helps those parents feel better equipped to assess their children’s health and significantly changes parental health-seeking behaviors. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access their child’s health information. Mobile health apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices.  Objective: The aim of our study is to create an inventory of acute childhood illness apps that are available to North American parents and caregivers, assess their quality, and identify the areas in which future apps can be improved. Methods: We conducted an environmental scan to identify and summarize app information for parents and digital health researchers. The Google and Apple app marketplaces were used as search platforms. We built a list of search terms and searched the platforms for apps targeted at parents and related to acute pediatric illnesses in the United States and Canada. We assessed apps meeting the inclusion criteria using the Mobile App Rating Scale (MARS), a validated tool for assessing the quality of health apps. The MARS examines apps on 5 subscales: engagement, functionality, aesthetics, information quality, and subjective quality. Data were analyzed by MARS subscale averages and individual item scores. Results: Overall, 650 unique apps were screened, and 53 (8.2%) were included. On a scale of 1-5, apps had an average engagement score of 2.82/5 (SD 0.86), functionality score of 3.98/5 (SD 0.72), aesthetics score of 3.09/5 (SD 0.87), information quality score of 2.73/5 (SD 1.32), and subjective quality score of 2.20/5 (SD 0.79). On the same scale of 1-5, app scores ranged from 2.2/5 to 4.5/5 (mean 3.2, SD 0.6). The top 3 MARS-scored apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top 3 apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces; this space was filled with content originating primarily in the United Kingdom and the United States. In addition, published evidence of the impact of the included apps was poor: of 53 apps, only 5 (9%) had an evidence base showing that the app had been trialed for usability or efficacy. Conclusions: There is a need for evidence-based acute childhood illness apps of Canadian origin. This environmental scan offers a comprehensive picture of the health app landscape by examining trends in acute childhood illness apps that are readily available to parents and by identifying gaps in app design. %M 34665144 %R 10.2196/29441 %U https://www.jmir.org/2021/10/e29441 %U https://doi.org/10.2196/29441 %U http://www.ncbi.nlm.nih.gov/pubmed/34665144 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27723 %T National-Level Disparities in Internet Access Among Low-Income and Black and Hispanic Youth: Current Population Survey %A Dolcini,M Margaret %A Canchola,Jesse A %A Catania,Joseph A %A Song Mayeda,Marissa M %A Dietz,Erin L %A Cotto-Negrón,Coral %A Narayanan,Vasudha %+ Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 2631 SW Campus Way, Corvallis, OR, 97331, United States, 1 541 737 3829, Peggy.Dolcini@oregonstate.edu %K internet access %K smartphone use %K Black youth %K Hispanic youth %K low-income youth %K disparities %K mobile phone %D 2021 %7 12.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. Objective: The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. Methods: Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). Results: Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23%) and for Black youth (no home access=18%) and Hispanic youth (no home access=14%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29%; low SES Hispanic youth=21%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. Conclusions: Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities. %M 34636728 %R 10.2196/27723 %U https://www.jmir.org/2021/10/e27723 %U https://doi.org/10.2196/27723 %U http://www.ncbi.nlm.nih.gov/pubmed/34636728 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29963 %T Attitudes About COVID-19 and Health (ATTACH): Online Survey and Mixed Methods Study %A Hood,Anna M %A Stotesbury,Hanne %A Murphy,Jennifer %A Kölbel,Melanie %A Slee,April %A Springall,Charlie %A Paradis,Matthew %A Corral-Frías,Nadia Saraí %A Reyes-Aguilar,Azalea %A Cuellar Barboza,Alfredo B %A Noser,Amy E %A Gomes,Stacey %A Mitchell,Monica %A Watkins,Sharon M %A Butsch Kovacic,Melinda %A Kirkham,Fenella J %A Crosby,Lori E %+ Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom, 44 02079052744, a.hood@ucl.ac.uk %K COVID-19 %K mental health %K international %K mitigation strategies %K deprivation %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Behavioral mitigation strategies to slow the spread of COVID-19 have resulted in sweeping lifestyle changes, with short- and long-term psychological, well-being, and quality of life implications. The Attitudes About COVID-19 and Health (ATTACH) study focuses on understanding attitudes and beliefs while considering the impact on mental and physical health and the influence of broader demographic and geographic factors on attitudes, beliefs, and mental health burden. Objective: In this assessment of our first wave of data collection, we provide baseline cohort description of the ATTACH study participants in the United Kingdom, the United States, and Mexico. Additionally, we assess responses to daily poll questions related to COVID-19 and conduct a cross-sectional analysis of baseline assessments collected in the UK between June 26 and October 31, 2020. Methods: The ATTACH study uses smartphone app technology and online survey data collection. Participants completed poll questions related to COVID-19 2 times daily and a monthly survey assessing mental health, social isolation, physical health, and quality of life. Poll question responses were graphed using 95% Clopper–Pearson (exact) tests with 95% CIs. Pearson correlations, hierarchical linear regression analyses, and generalized linear models assessed relationships, predictors of self-reported outcomes, and group differences, respectively. Results: By October 31, 2020, 1405, 80, and 90 participants had consented to participate in the UK, United States, and Mexico, respectively. Descriptive data for the UK daily poll questions indicated that participants generally followed social distancing measures, but worry and negative impacts on families increased as the pandemic progressed. Although participants generally reported feeling that the reasons for current measures had been made clear, there was low trust that the government was doing everything in its power to meet public needs. In the UK, 1282 participants also completed a monthly survey (94.99% [1326/1396] White, 72.22% [1014/1404] female, and 20.12% [277/1377] key or essential workers); 18.88% (242/1282) of UK participants reported a preexisting mental health disorder, 31.36% (402/1282) reported a preexisting chronic medical illness, and 35.11% (493/1404) were aged over 65; 57.72% (740/1282) of participants reported being more sedentary since the pandemic began, and 41.89% (537/1282) reported reduced access to medical care. Those with poorer mental health outcomes lived in more deprived neighborhoods, in larger households (Ps<.05), had more preexisting mental health disorders and medical conditions, and were younger than 65 years (all Ps<.001). Conclusions: Communities who have been exposed to additional harm during the COVID-19 pandemic were experiencing worse mental outcomes. Factors including having a medical condition, or living in a deprived neighborhood or larger household were associated with heightened risk. Future longitudinal studies should investigate the link between COVID-19 exposure, mental health, and sociodemographic and residential characteristics. %M 34357877 %R 10.2196/29963 %U https://mental.jmir.org/2021/10/e29963 %U https://doi.org/10.2196/29963 %U http://www.ncbi.nlm.nih.gov/pubmed/34357877 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27093 %T Exploring the Associations Between Self-reported Tendencies Toward Smartphone Use Disorder and Objective Recordings of Smartphone, Instant Messaging, and Social Networking App Usage: Correlational Study %A Marengo,Davide %A Sariyska,Rayna %A Schmitt,Helena Sophia %A Messner,Eva-Maria %A Baumeister,Harald %A Brand,Matthias %A Kannen,Christopher %A Montag,Christian %+ Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Helmholtzstraße 8/1, Ulm, 89081, Germany, 49 07315026550, christian.montag@uni-ulm.de %K smartphone use disorder %K smartphone use %K social media %K objective measures %K mediation model %K smartphone %K web-based communication %K social networking %K mobile phone %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social communication via instant messaging (IM) and social networking (SN) apps makes up a large part of the time that smartphone users spend on their devices. Previous research has indicated that the excessive use of these apps is positively associated with problematic smartphone use behaviors. In particular, image-based SN apps, such as Instagram (Facebook Inc) and Snapchat (Snap Inc), have been shown to exert stronger detrimental effects than those exerted by traditional apps, such as Facebook (Facebook Inc) and Twitter (Twitter Inc). Objective: In this study, we investigated the correlation between individuals’ tendencies toward smartphone use disorder (SmUD) and objective measures of the frequency of smartphone usage. Additionally, we put to test the hypothesis that the pathway linking the frequency of actual smartphone usage to self-reported tendencies toward SmUD was mediated by the increased frequency of IM and SN app usage. Methods: We recruited a sample of 124 adult smartphone users (females: 78/124, 62.9%; age: mean 23.84 years, SD 8.29 years) and collected objective information about the frequency of smartphone and SN app usage over 1 week. Participants also filled in a self-report measure for assessing the multiple components of tendencies toward SmUD. Bivariate associations were investigated by using Spearman correlation analyses. A parallel mediation analysis was conducted via multiple regression analysis. Results: The frequency of smartphone usage, as well as the use of IM apps (Messenger, Telegram, and WhatsApp [Facebook Inc]), Facebook, and image-based apps (Instagram and Snapchat), had significant positive associations with at least 1 component of SmUD, and the cyberspace-oriented relationships factor exhibited the strongest associations overall. We found support for an indirect effect that linked actual smartphone usage to SmUD tendencies via the frequency of the use of image-based SN apps. Conclusions: Our novel results shed light on the factors that promote SmUD tendencies and essentially indicate that image-based SN apps seem to be more strongly associated with problematic smartphone behaviors compared to IM apps and traditional SN apps, such as Facebook. %M 34591025 %R 10.2196/27093 %U https://www.jmir.org/2021/9/e27093 %U https://doi.org/10.2196/27093 %U http://www.ncbi.nlm.nih.gov/pubmed/34591025 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e20520 %T Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study %A Chew,Chu Shan Elaine %A Davis,Courtney %A Lim,Jie Kai Ethel %A Lim,Chee Meng Micheal %A Tan,Yi Zhen Henny %A Oh,Jean Yin %A Rajasegaran,Kumudhini %A Chia,Yong Hwa Michael %A Finkelstein,Eric Andrew %+ KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore, 65 62255554, elaine.chew.c.s@singhealth.com.sg %K pediatric obesity %K mobile health %K apps %K health behavior %K mHealth %K obesity %K adolescent %K lifestyle %K well-being %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective: This study aims to assess the effectiveness of and adolescent engagement with a mobile app–based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods: This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo’s health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results: Of the 73 adolescents who were approached for enrollment, 40 (55%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83% (33/40) of participants completing at least 7 coaching sessions. In total, 78% (18/23) of participants rated the app as good to excellent and 70% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions: The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake. %M 34581672 %R 10.2196/20520 %U https://www.jmir.org/2021/9/e20520 %U https://doi.org/10.2196/20520 %U http://www.ncbi.nlm.nih.gov/pubmed/34581672 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25472 %T Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies %A Neves,Ana Luísa %A Jácome,Cristina %A Taveira-Gomes,Tiago %A Pereira,Ana Margarida %A Almeida,Rute %A Amaral,Rita %A Alves-Correia,Magna %A Mendes,Sandra %A Chaves-Loureiro,Cláudia %A Valério,Margarida %A Lopes,Cristina %A Carvalho,Joana %A Mendes,Ana %A Ribeiro,Carmelita %A Prates,Sara %A Ferreira,José Alberto %A Teixeira,Maria Fernanda %A Branco,Joana %A Santalha,Marta %A Vasconcelos,Maria João %A Lozoya,Carlos %A Santos,Natacha %A Cardia,Francisca %A Moreira,Ana Sofia %A Taborda-Barata,Luís %A Pinto,Cláudia Sofia %A Ferreira,Rosário %A Morais Silva,Pedro %A Monteiro Ferreira,Tania %A Câmara,Raquel %A Lobo,Rui %A Bordalo,Diana %A Guimarães,Cristina %A Espírito Santo,Maria %A Ferraz de Oliveira,José %A Cálix Augusto,Maria José %A Gomes,Ricardo %A Vieira,Inês %A da Silva,Sofia %A Marques,Maria %A Cardoso,João %A Morete,Ana %A Aroso,Margarida %A Cruz,Ana Margarida %A Nunes,Carlos %A Câmara,Rita %A Rodrigues,Natalina %A Abreu,Carmo %A Albuquerque,Ana Luísa %A Vieira,Claúdia %A Santos,Carlos %A Páscoa,Rosália %A Chaves-Loureiro,Carla %A Alves,Adelaide %A Neves,Ângela %A Varanda Marques,José %A Reis,Bruno %A Ferreira-Magalhães,Manuel %A Almeida Fonseca,João %+ Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Praça de Gomes Teixeira, Porto, 4099-002, Portugal, 351 225513622, cristinajacome.ft@gmail.com %K mobile apps %K smartphone %K patient participation %K self-management %K asthma %D 2021 %7 22.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use. %M 34550077 %R 10.2196/25472 %U https://www.jmir.org/2021/9/e25472 %U https://doi.org/10.2196/25472 %U http://www.ncbi.nlm.nih.gov/pubmed/34550077 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e28123 %T Digital Community Inclusion of Individuals With Serious Mental Illness: A National Survey to Map Digital Technology Use and Community Participation Patterns in the Digital Era %A Shpigelman,Carmit Noa %A Tal,Amir %A Zisman-Ilani,Yaara %+ Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba-Khoushy Ave, Mount Carmel, Haifa, 3498838, Israel, 972 522817774, carmits@univ.haifa.ac.il %K mobile health %K technology %K digital community participation %K digital community inclusion %K serious mental illness %K recovery %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the growing interest in developing and using mobile health (mHealth) and digital technologies in mental health, little is known about the scope and nature of virtual community inclusion. Objective: The overarching goal of this study was to understand and conceptualize virtual community inclusion of individuals with serious mental illness (SMI). Specific objectives of this study were as follows: (1) mapping the prevalence, trends, and experiences related to mHealth and digital technology use among individuals with SMI; (2) comparing patterns of technology use by individuals with and those without SMI; and (3) examining whether use of mHealth and digital technologies predicts recovery among individuals with SMI. Methods: A web-based survey of technology use and virtual participation was developed and distributed among adults with and those without SMI via social media, national email discussion lists, nonprofit organizations, and advocacy groups. Results: A total of 381 adults aged 18 years or older participated in the survey, of whom 199 (52%) identified as having a SMI. Participants with SMI reported significantly greater access to technology and significantly fewer days of face-to-face participation in community activities than those without SMI. Among participants with SMI, greater technology use was positively associated with positive emotions and significantly predicted recovery. Conclusions: This study is the first to explore, map, and conceptualize virtual community inclusion among adults with SMI. Our findings indicate a gap in the literature and research on community inclusion and participation, and emphasize the need for virtual community inclusion, particularly during the COVID-19 pandemic and its future implications. %M 34546177 %R 10.2196/28123 %U https://mental.jmir.org/2021/9/e28123 %U https://doi.org/10.2196/28123 %U http://www.ncbi.nlm.nih.gov/pubmed/34546177 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e30240 %T Mobile Technology Access and Use Among Adolescent Mothers in Lima, Peru: Mixed Methods Study %A Levey,Elizabeth J %A Onyeaka,Henry %A Bartles,Sophia M %A Sanchez Calderon,Elena %A Sanchez,Sixto E %A Prom,Maria C %A Fesseha,Eden M %A Gelaye,Bizu %+ Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, 151 Merrimac St, Boston, MA, 02114, United States, 1 617 726 2000, elevey@mgh.harvard.edu %K access to care %K adolescent motherhood %K LMICs %K mobile phone %K perinatal mental health %K telehealth %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Research shows promise for the use of mobile health interventions to improve access to care for mothers and infants. Although adolescent mothers in particular are comfortable with technology and often face barriers to accessing care, data on the use of digital interventions with young mothers are limited. Objective: This study aims to examine technology access and use behavior among adolescent mothers in Lima, Peru, to inform the development of technology-mediated perinatal interventions for high-risk mothers and infants in low- and middle-income countries and other areas with limited access to care. Methods: This mixed methods study consisted of a phone survey about technology access (N=29), focus group discussions with clinicians (N=25), and semistructured in-depth interviews with adolescent mothers (N=10) and their family members (N=8) in Lima. Results: All adolescent mothers surveyed had access to a smartphone, and nearly half had access to a computer or tablet. However, participants reported a number of obstacles to consistent smartphone access related to the financial precarity of their situations. Examples of this included difficulty affording phone services, using shared plans, and losing smartphones because of theft. Conclusions: These findings indicate that adolescent mothers are connected to technology, highlighting the potential scalability of technology-based health interventions for adolescent mothers in low- and middle-income countries while identifying barriers that need to be addressed. %M 34533473 %R 10.2196/30240 %U https://pediatrics.jmir.org/2021/3/e30240 %U https://doi.org/10.2196/30240 %U http://www.ncbi.nlm.nih.gov/pubmed/34533473 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27576 %T A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study %A Yu,Jing %A Wu,Jiayi %A Huang,Ou %A Chen,Xiaosong %A Shen,Kunwei %+ Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China, 86 13564497086, chenxiaosong0156@hotmail.com %K breast cancer %K adherence %K multidisciplinary treatment %K adjuvant treatment %K smartphone-based app %K mobile phone %D 2021 %7 16.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. Objective: This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. Methods: Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. Results: A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). Conclusions: This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy. %M 34528890 %R 10.2196/27576 %U https://www.jmir.org/2021/9/e27576 %U https://doi.org/10.2196/27576 %U http://www.ncbi.nlm.nih.gov/pubmed/34528890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27162 %T Effectiveness of a Dyadic Buddy App for Smoking Cessation: Randomized Controlled Trial %A Schwaninger,Philipp %A Berli,Corina %A Scholz,Urte %A Lüscher,Janina %+ Applied Social and Health Psychology, Department of Psychology, University of Zurich, Binzmühlestrasse 14/14, Zurich, 8050, Switzerland, 41 44 635 72 25, philipp.schwaninger@psychologie.uzh.ch %K mHealth %K smartphone app %K smoking cessation %K buddy %K social support %K mobile phone %D 2021 %7 9.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco smoking is one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real time. This randomized controlled trial investigated the effectiveness of an app that encourages individuals to quit smoking with the help of a social network member (buddy) in daily life. Objective: The objective of this study is to test the effectiveness of the SmokeFree buddy app compared with a control group with self-reported smoking abstinence and carbon monoxide (CO)–verified smoking abstinence as primary outcomes and self-reports of smoked cigarettes per day (CPD) as a secondary outcome. Methods: A total of 162 adults who smoked participated in this single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Around a self-set quit date (ie, 7 days before the self-set quit date and 20 days after) and 6 months later, participants of the intervention and control groups reported on daily smoking abstinence and CPD in end-of-day diaries. Daily smoking abstinence was verified via daily exhaled CO assessments. This assessment was administered via an app displaying results of exhaled CO, thus addressing self-monitoring in both groups. In addition, participants in the intervention group used the SmokeFree buddy app, a multicomponent app that facilitates social support from a buddy of choice. Results: A significant reduction in CPD from baseline to the 6-month follow-up was observed among participants in both groups. Multilevel analyses revealed no significant intervention effect on self-reported and CO-verified daily smoking abstinence at the quit date and 3 weeks later. However, CPD was lower at the quit date and 3 weeks later in the intervention group than in the control group. No significant differences between groups were found for any outcome measures 6 months after the quit date. Overall, low app engagement and low perceived usefulness were observed. Conclusions: Despite some encouraging short-term findings on the amount of smoking, the SmokeFree buddy app did not have beneficial effects on smoking abstinence over and above the self-monitoring control condition. Future studies should examine whether and what support processes can be effectively stimulated and how app use can be improved to better achieve this goal. Trial Registration: ISRCTN Registry 11154315; https://www.isrctn.com/ISRCTN11154315 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7723-z %M 34499045 %R 10.2196/27162 %U https://www.jmir.org/2021/9/e27162 %U https://doi.org/10.2196/27162 %U http://www.ncbi.nlm.nih.gov/pubmed/34499045 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e27021 %T Toward a Better Understanding of the Intention to Use mHealth Apps: Exploratory Study %A Palos-Sanchez,Pedro R %A Saura,Jose Ramon %A Rios Martin,Miguel Ángel %A Aguayo-Camacho,Mariano %+ Department of Financial Economy and Operations Management, Faculty of Economic and Business Sciences, University of Seville, Av. Ramon y Cajal, 1, Seville, 41017, Spain, 34 954557515, ppalos@us.es %K mHealth apps %K mobile apps %K eHealth %K promotion of health %K TAM %K PLS–SEM %K COVID-19 %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: An increasing number of mobile health (mHealth) apps are becoming available for download and use on mobile devices. Even with the increase in availability and use of mHealth apps, there has still not been a lot of research into understanding the intention to use this kind of apps. Objective: The purpose of this study was to investigate a technology acceptance model (TAM) that has been specially designed for primary health care applications. Methods: The proposed model is an extension of the TAM, and was empirically tested using data obtained from a survey of mHealth app users (n=310). The research analyzed 2 additional external factors: promotion of health and health benefits. Data were analyzed with a PLS–SEM software and confirmed that gender moderates the adoption of mHealth apps in Spain. The explanatory capacity (R2 for behavioral intention to use) of the proposed model was 76.4%. Likewise, the relationships of the external constructs of the extended TAM were found to be significant. Results: The results show the importance of healthy habits developed by using mHealth apps. In addition, communication campaigns for these apps should be aimed at transferring the usefulness of eHealth as an agent for transforming attitudes; additionally, as more health benefits are obtained, ease of use becomes greater. Perceived usefulness (PU; β=.415, t0.001;4999=3.442, P=.001), attitude toward using (β=.301, t0.01;499=2.299, P=.02), and promotion of health (β=.210, t0.05;499=2.108, P=.03) were found to have a statistically significant impact on behavior intention to use eHealth apps (R2=76.4%). Perceived ease of use (PEOU; β=.179, t0.01;499=2.623, P=.009) and PU (β=.755, t0.001;499=12.888, P<.001) were found to have a statistically significant impact on attitude toward using (R2>=78.2%). Furthermore, PEOU (β=.203, t0.01;499=2.810, P=.005), health benefits (β=.448, t0.001;499=4.010, P<.001), and promotion of health (β=.281, t0.01;499=2.393, P=.01) exerted a significant impact on PU (R2=72.7%). Finally, health benefits (β=.640, t0.001;499=14.948, P<.001) had a statistically significant impact on PEOU (R2=40.9%), while promotion of health (β=.865, t0.001;499=29.943, P<.001) significantly influenced health benefits (R2=74.7%). Conclusions: mHealth apps could be used to predict the behavior of patients in the face of recommendations to prevent pandemics, such as COVID-19 or SARS, and to track users’ symptoms while they stay at home. Gender is a determining factor that influences the intention to use mHealth apps, so perhaps different interfaces and utilities could be designed according to gender. %M 34499044 %R 10.2196/27021 %U https://mhealth.jmir.org/2021/9/e27021 %U https://doi.org/10.2196/27021 %U http://www.ncbi.nlm.nih.gov/pubmed/34499044 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e29498 %T Nursing Interns’ Attitudes Toward, Preferences for, and Use of Diabetes Virtual Simulation Teaching Applications in China: National Web-Based Survey %A Liu,Fang %A Weng,Huiting %A Xu,Rong %A Li,Xia %A Zhang,Zhe %A Zhao,Kuaile %A Zhou,Zhiguang %A Wang,Qin %+ Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China, 86 18774806226, wangqin3421@csu.edu.cn %K nursing interns %K virtual simulation %K China %K nursing education %K diabetes %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Diabetes has placed heavy social and economic burdens on society and families worldwide. Insufficient knowledge and training of frontline medical staff, such as nurses, interns, and residents, may lead to an increase in acute and chronic complications among patients with diabetes. However, interns have insufficient knowledge about diabetes management. The factors that affect interns’ current level of diabetes-related knowledge are still unclear. Therefore, understanding the behavioral intentions of interns is essential to supporting the development and promotion of the use of virtual simulation teaching applications. Objective: This study aimed to identify the determinants of nursing interns’ intentions to use simulation-based education applications. Methods: From December 1, 2020, to February 28, 2021, the web-based survey tool Sojump (Changsha Xingxin Information Technology Co) was used to survey nursing interns in hospitals across China. Two survey links were sent to 37 partner schools in 23 major cities in China, and they were disseminated through participants’ WeChat networks. Multiple regression analysis was used to determine the association between demographic information and basic disease information and the use of the application for treating adult patients. Results: Overall, 883 nursing interns from 23 provinces in China responded to the survey. Among them, the virtual simulation utilization rate was 35.6% (314/883) and the awareness rate was 10.2% (90/883). In addition, among the interns, only 10.2% (90/883) correctly understood the concept of virtual simulation, and most of them (793/883, 89.8%) believed that scenario-simulation training or the use of models for teaching are all the same. Multiple regression analysis showed that the educational level, independent learning ability, and professional identity of the interns were related to use of the application (P<.05). Skills and knowledge that the interns most wanted to acquire included the treatment of hypoglycemia (626/883, 70.9%), functional test simulation (610/883, 69.1%), and blood glucose monitoring technology (485/883, 54.9%). A total of 60.5% (534/883) of the interns wanted to acquire clinical thinking skills, while 16.0% (141/883) wanted to acquire operational skills. Nursing trainees believed that the greatest obstacles to virtual simulation included limited time (280/883, 31.7%), the degree of simulation (129/883, 14.6%), the demand for satisfaction (108/883, 12.2%), and test scores (66/883, 7.5%). Conclusions: The understanding and usage rate of diabetes virtual simulation teaching applications by Chinese nursing interns is very low. However, they have high requirements regarding this teaching method. Conducting high-quality randomized controlled trials and designing applications that are suitable for the needs of different nurse trainees will increase students’ interest in learning and help improve diabetes knowledge among nursing interns. %M 34499047 %R 10.2196/29498 %U https://mhealth.jmir.org/2021/9/e29498 %U https://doi.org/10.2196/29498 %U http://www.ncbi.nlm.nih.gov/pubmed/34499047 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 3 %P e31149 %T Awareness, Views, Perceptions, and Beliefs of Pharmacy Interns Regarding Digital Health in Saudi Arabia: Cross-sectional Study %A Alsahali,Saud %+ Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Qassim, 56215, Saudi Arabia, 966 505161171, s.alsahali@qu.edu.sa %K digital health %K eHealth %K mHealth %K telehealth %K telemedicine %K attitude %K awareness %K pharmacy interns %D 2021 %7 3.9.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Digital health technologies and apps are rapidly advancing in recent years. It is expected to have more roles in transforming the health care system in this era of digital services. However, limited research is available regarding delivering digital health education in pharmacy and the pharmacy students’ perspectives on digital health. Objective: This study aims to assess pharmacy interns’ awareness of digital health apps in Saudi Arabia and their views regarding the coverage of digital health in the education of pharmacists. In addition, we assessed the interns’ perceptions and beliefs about the concepts, benefits, and implementation of digital health in practice settings. Methods: A cross-sectional study using a web-based survey was conducted among pharmacy interns at Unaizah College of Pharmacy, Qassim University, Saudi Arabia. An invitation with a link to the web-based survey was sent to all interns registered at the college between January and March 2021. Results: A total of 68 out of 77 interns registered in the internship year participated in this study, giving a response rate of 88%. The mean total score for pharmacy interns’ awareness of digital health apps in Saudi Arabia was 5.66 (SD 1.74; maximum attainable score=7). The awareness with different apps ranged from 97% (66/68) for the Tawakkalna app to 65% (44/68) for the Ministry of Health 937 call center. The mean total score for attitude and beliefs toward concepts and benefits of telehealth and telemedicine apps was 58.25 (SD 10.44; maximum attainable score=75). In this regard, 84% (57/68) of the interns believed that telehealth could enhance the quality of care, 71% (48/68) believed that it could help effectively provide patient counseling, and 69% (47/68) believed it could improve patients’ adherence to therapy. In this study, 41% (28/68) believed that the current coverage of digital health in the curriculum was average, whereas only 18% (12/68) believed it was high or very high coverage. Moreover, only 38% (26/68) attended additional educational activities related to digital health. Consequently, the majority (43/68, 63%) were of the opinion that there is a high or very high need to educate and train pharmacists in the field of digital health. Conclusions: Overall, the interns showed good awareness of common digital health apps in Saudi Arabia. Moreover, the majority of the interns had positive perceptions and beliefs about the concepts, benefits, and implementation of digital health. However, the findings showed that there is still scope for improvement in some areas. Moreover, most interns indicated that there is a need for more education and training in the field of digital health. Consequently, early exposure to content related to digital health and pharmacy informatics is an important step to help in the wide use of these technologies in the graduates’ future careers. %M 34338649 %R 10.2196/31149 %U https://mededu.jmir.org/2021/3/e31149 %U https://doi.org/10.2196/31149 %U http://www.ncbi.nlm.nih.gov/pubmed/34338649 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e26845 %T Relationship Between Perceived Risks of Using mHealth Applications and the Intention to Use Them Among Older Adults in the Netherlands: Cross-sectional Study %A Klaver,Nicky Sabine %A van de Klundert,Joris %A van den Broek,Roy Johannes Gerardus Maria %A Askari,Marjan %+ Erasmus School of Health Policy & Management, Erasmus University, PO Box 1738, Rotterdam, 3000 DR, Netherlands, 31 104088641, m.askari@askari.nl %K mHealth %K older adults %K perceived risks %K intention to use %K adoption %K covid-19 %K digital health %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Considering the increasing demand for health services by older people and the ongoing COVID-19 pandemic, digital health is commonly viewed to offer a pathway to provide safe and affordable health services for older adults, thus enabling self-management of their health while health care systems are struggling. However, several factors cause older people to be particularly reluctant to adopt digital health technologies such as mobile health (mHealth) tools. In addition to previously studied technology acceptance factors, those related to perceived risks of mHealth use (eg, leakage of sensitive information or receiving incorrect health recommendations) may further diminish mHealth adoption by older adults. Objective: The aim of this study was to explore the relationship between perceived risks of using mHealth applications and the intention to use these applications among older adults. Methods: We designed a cross-sectional study wherein a questionnaire was used to collect data from participants aged 65 years and older in the Netherlands. Perceived risk was divided into four constructs: privacy risk, performance risk, legal concern, and trust. Linear regression analyses were performed to determine the associations between these perceived risk constructs and the intention to use mHealth applications. Results: Linear regression per perceived risk factor showed that each of the four constructs is significantly associated with the intention to use mobile medical applications among older adults (adjusted for age, sex, education, and health status). Performance risk (β=–.266; P=<.001), legal concern (β=–.125; P=.007), and privacy risk (β=–.100; P=.03) were found to be negatively correlated to intention to use mHealth applications, whereas trust (β=.352; P=<.001) was found to be positively correlated to the intention to use mHealth applications. Conclusions: Performance risk, legal concern, and privacy risk as perceived by older adults may substantially and significantly decrease their intention to use mHealth applications. Trust may significantly and positively affect this intention. Health care professionals, designers of mHealth applications, and policy makers can use these findings to diminish performance risks, and tailor campaigns and applications to address legal and privacy concerns and promote mHealth uptake and health care access for older adults, especially during the COVID-19 pandemic. %M 34459745 %R 10.2196/26845 %U https://mhealth.jmir.org/2021/8/e26845 %U https://doi.org/10.2196/26845 %U http://www.ncbi.nlm.nih.gov/pubmed/34459745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26223 %T Factors That Help and Hinder the Implementation of Digital Depression Prevention Programs: School-Based Cross-sectional Study %A Beames,Joanne R %A Johnston,Lara %A O'Dea,Bridianne %A Torok,Michelle %A Christensen,Helen %A Boydell,Katherine M %A Werner-Seidler,Aliza %+ Black Dog Institute, University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 2 9382 ext 8776, j.beames@blackdog.org.au %K secondary school %K depression %K prevention %K digital %K barrier %K facilitator %K teacher %K counselor %K principal %K student %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital prevention programs that are delivered in a school environment can inoculate young people against depression. However, little is known about the school-based factors that help and hinder the implementation of these programs. Staff members are integral for supporting mental health programs in schools and are likely to have a wealth of expertise and knowledge about the factors that affect implementation. Objective: The primary objective of this study was to explore the barriers and facilitators to implementing a digital depression prevention program in Australian secondary schools with teachers, counselors, and principals. The secondary objective was to explore variations in these factors across different school contexts, including the school type (government or nongovernment), location (capital city, regional/or rural areas), and socioeconomic status (SES) (low, medium, high). Methods: This quantitative cross-sectional survey study assessed the barriers and facilitators to implementing a hypothetical digital prevention program in Australian schools. The survey was taken by 97 teachers (average age 38.3 years), 93 counselors (average age 39.5 years), and 11 principals (average age 50.9 years) across Australia between November 2017 and July 2018. Results: A range of barriers and facilitators relating to logistics and resources, staff support, and program factors were endorsed by the surveyed staff. Consistent with prior research, common barriers included a lack of time and resources (ie, staff and rooms). These barriers were particularly evident in government, rural/regional, and low socioeconomic schools. Other barriers were specific to digital delivery, including privacy issues and a lack of clarity around staff roles and responsibilities. Facilitators included upskilling staff through training, embedding the program into the curriculum, and other program factors including universal delivery, screening of students’ mental health, and clear referral pathways. Knowledge about the program efficacy was also perceived as important by a large proportion of the respondents. Conclusions: The digital depression prevention program was perceived as suitable for use within different schools in Australia, although certain factors need to be considered to enable effective implementation. Logistics and resources, support, and program factors were identified as particularly important for school-based implementation. To maximize the effectiveness in delivering digital programs, implementation may need to be tailored to the staff roles and school types. %M 34448701 %R 10.2196/26223 %U https://www.jmir.org/2021/8/e26223 %U https://doi.org/10.2196/26223 %U http://www.ncbi.nlm.nih.gov/pubmed/34448701 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e22909 %T Digital Natives’ Preferences on Mobile Artificial Intelligence Apps for Skin Cancer Diagnostics: Survey Study %A Haggenmüller,Sarah %A Krieghoff-Henning,Eva %A Jutzi,Tanja %A Trapp,Nicole %A Kiehl,Lennard %A Utikal,Jochen Sven %A Fabian,Sascha %A Brinker,Titus Josef %+ Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg, 69120, Germany, 49 6221 32 19 304, titus.brinker@dkfz.de %K artificial intelligence %K skin cancer %K skin cancer screening %K diagnostics %K digital natives %K acceptance %K concerns %K preferences %K online survey %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Artificial intelligence (AI) has shown potential to improve diagnostics of various diseases, especially for early detection of skin cancer. Studies have yet to investigate the clear application of AI technology in clinical practice or determine the added value for younger user groups. Translation of AI-based diagnostic tools can only be successful if they are accepted by potential users. Young adults as digital natives may offer the greatest potential for successful implementation of AI into clinical practice, while at the same time, representing the future generation of skin cancer screening participants. Objective: We conducted an anonymous online survey to examine how and to what extent individuals are willing to accept AI-based mobile apps for skin cancer diagnostics. We evaluated preferences and relative influences of concerns, with a focus on younger age groups. Methods: We recruited participants below 35 years of age using three social media channels—Facebook, LinkedIn, and Xing. Descriptive analysis and statistical tests were performed to evaluate participants’ attitudes toward mobile apps for skin examination. We integrated an adaptive choice-based conjoint to assess participants’ preferences. We evaluated potential concerns using maximum difference scaling. Results: We included 728 participants in the analysis. The majority of participants (66.5%, 484/728; 95% CI 0.631-0.699) expressed a positive attitude toward the use of AI-based apps. In particular, participants residing in big cities or small towns (P=.02) and individuals that were familiar with the use of health or fitness apps (P=.02) were significantly more open to mobile diagnostic systems. Hierarchical Bayes estimation of the preferences of participants with a positive attitude (n=484) revealed that the use of mobile apps as an assistance system was preferred. Participants ruled out app versions with an accuracy of ≤65%, apps using data storage without encryption, and systems that did not provide background information about the decision-making process. However, participants did not mind their data being used anonymously for research purposes, nor did they object to the inclusion of clinical patient information in the decision-making process. Maximum difference scaling analysis for the negative-minded participant group (n=244) showed that data security, insufficient trust in the app, and lack of personal interaction represented the dominant concerns with respect to app use. Conclusions: The majority of potential future users below 35 years of age were ready to accept AI-based diagnostic solutions for early detection of skin cancer. However, for translation into clinical practice, the participants’ demands for increased transparency and explainability of AI-based tools seem to be critical. Altogether, digital natives between 18 and 24 years and between 25 and 34 years of age expressed similar preferences and concerns when compared both to each other and to results obtained by previous studies that included other age groups. %M 34448722 %R 10.2196/22909 %U https://mhealth.jmir.org/2021/8/e22909 %U https://doi.org/10.2196/22909 %U http://www.ncbi.nlm.nih.gov/pubmed/34448722 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e29923 %T Prosociality and the Uptake of COVID-19 Contact Tracing Apps: Survey Analysis of Intergenerational Differences in Japan %A Shoji,Masahiro %A Ito,Asei %A Cato,Susumu %A Iida,Takashi %A Ishida,Kenji %A Katsumata,Hiroto %A McElwain,Kenneth Mori %+ Institute of Social Science, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 4927, shoji@iss.u-tokyo.ac.jp %K COVID-19 %K contact tracing app %K place attachment %K place identity %K contact tracing %K pandemic %K mHealth %K health policy %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To control the COVID-19 pandemic, it is essential to trace and contain infection chains; for this reason, policymakers have endorsed the usage of contact tracing apps. To date, over 50 countries have released such apps officially or semiofficially, but those that rely on citizens’ voluntary uptake suffer from low adoption rates, reducing their effectiveness. Early studies suggest that the low uptake is driven by citizens’ concerns about security and privacy, as well as low perceptions of infection risk and benefits from the usage. However, these do not explore important generational differences in uptake decision or the association between individuals’ prosociality and uptake. Objective: The objective of our study was to examine the role of individuals’ prosociality and other factors discussed in the literature, such as perceived risk and trust in government, in encouraging the usage of contact tracing apps in Japan. We paid particular attention to generational differences. Methods: A web-based survey was conducted in Japan 6 months after the release of a government-sponsored contact tracing app. Participants were recruited from individuals aged between 20 and 69 years. Exploratory factor analyses were conducted to measure prosociality, risk perception, and trust in government. Logistic regression was used to examine the association between these factors and uptake. Results: There was a total of 7084 respondents, and observations from 5402 respondents were used for analysis, of which 791 respondents (14.6%) had ever used the app. Two factors of prosociality were retained: agreeableness and attachment to the community. Full-sample analysis demonstrated app uptake was determined by agreeableness, attachment to the community, concern about health risks, concern about social risks, and trust in the national government; however, important differences existed. The uptake decision of respondents aged between 20 and 39 years was attributed to their attachment to the community (odds ratio [OR] 1.28, 95% CI 1.11-1.48). Agreeable personality (OR 1.18, 95% CI 1.02-1.35), concern about social risk (OR 1.17, 95% CI 1.02-1.35), and trust in national government (OR 1.16, 95% CI 1.05-1.28) were key determinants for those aged between 40 and 59 years. For those aged over 60 years, concerns about health risks determined the uptake decision (OR 1.49, 95% CI 1.24-1.80). Conclusions: Policymakers should implement different interventions for each generation to increase the adoption rate of contact tracing apps. It may be effective to inform older adults about the health benefits of the apps. For middle-age adults, it is important to mitigate concerns about security and privacy issues, and for younger generations, it is necessary to boost their attachment to their community by utilizing social media and other web-based network tools. %M 34313601 %R 10.2196/29923 %U https://mhealth.jmir.org/2021/8/e29923 %U https://doi.org/10.2196/29923 %U http://www.ncbi.nlm.nih.gov/pubmed/34313601 %0 Journal Article %@ 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 %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26852 %T Patients’ Experiences of Using a Self-help App for Posttraumatic Stress Disorder: Qualitative Study %A Riisager,Lisa H G %A Christensen,Anne Bryde %A Scharff,Frederik Bernt %A Arendt,Ida-Marie T P %A Ismail,Israa %A Lau,Marianne Engelbrecht %A Moeller,Stine Bjerrum %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 25300977, lisagr@health.sdu.dk %K app %K PTSD %K mHealth %K qualitative analysis %K patient experience %K posttraumatic stress disorder %K thematic analysis %K smartphone %K intervention %K mobile phone %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Posttraumatic stress disorder (PTSD) is a common disorder that requires more treatment options. Mobile health (mHealth) app interventions are promising for patients with PTSD, as they can provide easily accessible support, strategies, and information. However, knowledge about mHealth interventions is sparse and primarily based on quantitative studies. Objective: The aim of this study is to qualitatively explore the experiences of patients with PTSD with regard to using an mHealth app as a stand-alone intervention before commencing psychotherapeutic treatment. Methods: We conducted semistructured interviews with 14 participants 6 weeks after they received the app. The participants were all referred to PTSD treatment and were waiting to commence psychotherapeutic treatment. During this waiting time, the participants had no contact with the health staff. Interviews were transcribed and were analyzed using thematic analysis. Results: A total of 3 themes were identified—the use of app, being a patient, and the overall evaluation of the app. The use of the app was described with the subtheme of habits, and the theme of being a patient included the subthemes of having negative experiences with the app and being a part of a research project. The use of the app encompassed how psychological factors and technical problems could interfere with the use of the app. The theme of being a patient depicted that the waiting time before starting treatment was long, and a subgroup of patients experienced feeling worse during this time, which they partly attributed to using the app. Several suggestions for change have been described in the overall evaluation of the app. Conclusions: The findings in this study revealed that emotional arousal influenced the use of the app and that it was difficult for participants to establish a habit of using the app, thus reflecting the importance of supporting habit formation when implementing an mHealth app in mental health care services. This study makes an important contribution to the field of mHealth research, as it revealed that some participants had negative experiences resulting from using the app, thus reflecting the potential harm of having an mHealth app without the support of a clinician. It is therefore recommended to use a blended care treatment or an approach in which mental health care professionals prescribe an mHealth app for relevant patients to avoid increased suicidal risk. %M 34346896 %R 10.2196/26852 %U https://formative.jmir.org/2021/8/e26852 %U https://doi.org/10.2196/26852 %U http://www.ncbi.nlm.nih.gov/pubmed/34346896 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e27885 %T Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study %A Vasiloglou,Maria F %A Christodoulidis,Stergios %A Reber,Emilie %A Stathopoulou,Thomai %A Lu,Ya %A Stanga,Zeno %A Mougiakakou,Stavroula %+ ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland, 41 316327592, stavroula.mougiakakou@artorg.unibe.ch %K dietary assessment %K end-users %K mHealth %K mobile apps %K smartphone %K survey %K apps %K nutrition %K diet %K mobile health %K users %K behavior %K behavior change %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital technologies have evolved dramatically in recent years, finding applications in a variety of aspects of everyday life. Smartphones and mobile apps are being used for a steadily increasing number of tasks, including health monitoring. A large number of nutrition and diet apps are available, and some of them are very popular in terms of user downloads, highlighting a trend toward diet monitoring and assessment. Objective: We sought to explore the perspectives of end users on the features, current use, and acceptance of nutrition and diet mHealth apps with a survey. We expect that this study can provide user insights to assist researchers and developers in achieving innovative dietary assessments. Methods: A multidisciplinary team designed and compiled the survey. Before its release, it was pilot-tested by 18 end users. A 19-question survey was finally developed and was translated into six languages: English, German, French, Spanish, Italian, and Greek. The participants were mainly recruited via social media platforms and mailing lists of universities, university hospitals, and patient associations. Results: A total of 2382 respondents (1891 female, 79.4%; 474 male, 19.9%; and 17 neither, 0.7%) with a mean age of 27.2 years (SD 8.5) completed the survey. Approximately half of the participants (1227/2382, 51.5%) had used a nutrition and diet app. The primary criteria for selecting such an app were ease of use (1570/2382, 65.9%), free cost (1413/2382, 59.3%), and ability to produce automatic readings of caloric content (1231/2382, 51.7%) and macronutrient content (1117/2382, 46.9%) (ie, food type and portion size are estimated by the system without any contribution from the user). An app was less likely to be selected if it incorrectly estimated portion size, calories, or nutrient content (798/2382, 33.5%). Other important limitations included the use of a database that does not include local foods (655/2382, 27.5%) or that may omit major foods (977/2382, 41%). Conclusions: This comprehensive study in a mostly European population assessed the preferences and perspectives of potential nutrition and diet app users. Understanding user needs will benefit researchers who develop tools for innovative dietary assessment as well as those who assist research on behavioral changes related to nutrition. %M 34328425 %R 10.2196/27885 %U https://mhealth.jmir.org/2021/7/e27885 %U https://doi.org/10.2196/27885 %U http://www.ncbi.nlm.nih.gov/pubmed/34328425 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e13496 %T Effect of Adherence to Smartphone App Use on the Long-term Effectiveness of Weight Loss in Developing and OECD Countries: Retrospective Cohort Study %A Han,Myeunghee %A Rhee,Sang Youl %+ Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Seoul, 02447, Korea, Seoul, Republic of Korea, 82 029610274, bard95@hanmail.net %K low-income countries %K Organization for Economic Co-operation and Development %K body weight %K mobile app self-management %K diet %K exercise %K mobile phone %D 2021 %7 12.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Globally, 71% of deaths occur due to noncommunicable diseases (NCDs). Poor diet quality and physical activity have a significant impact on NCDs. At present, behavior change interventions using smartphone apps have rapidly increased worldwide to prevent NCDs. However, most previous studies on the use and effectiveness of apps have been conducted in Organization for Economic Co-operation and Development (OECD) countries. As such, relevant research in low-income countries is scarce. Objective: This retrospective cohort study aims to investigate the characteristics of adherence to the use of the Noom app. We also aim to compare the effects of using the app on body weight changes over time according to adherence to the use of the app between users in low-income and OECD countries. In addition, the differences in weight loss are compared among users who use the free and paid versions of the app. Methods: A secondary data analysis was conducted using repeated measures. The data were collected from users in low-income countries (n=312) and OECD countries (n=8041) who used the app for 12 months. The app provided programs for the self-monitoring of physical activity, dietary intake, and body weight. Descriptive statistics, independent two-tailed t tests, chi-square tests, and linear mixed models were used for the analysis. Results: During the first 3 months of using the Noom app, users from OECD countries entered data into the app more frequently; however, users in low-income countries entered data more frequently from 3 months to 12 months. Users in OECD countries consumed significantly more calories than those in low-income countries for 12 months. The body weight of all users significantly decreased over time (−1.8 kg; P<.001); however, no statistically significant differences in the change in body weight for 12 months were observed between users from low-income and OECD countries (β=−.2; P=.19). The users who frequently monitored their lunch (β=−.1; P<.001), dinner (β=−.1; P<.001), body weight (β=−.1; P<.001), evening snack (β=−.1; P<.001), and exercise (β=−.03; P<.001) exhibited significant weight loss over time. We found no significant differences in the body weight changes between users who used the free and paid versions of the app (β=−.2; P=.19). Conclusions: This study found that using the app has a significant effect on weight loss regardless of users’ country of residence. The results of this study suggest that the frequency of monitoring health-related behaviors by entering data into the app plays a pivotal role in losing weight. In conclusion, regardless of where users live and what versions of the app they use, it is important to monitor health-related behaviors by frequently entering data into the app to efficiently lose weight. %M 34255708 %R 10.2196/13496 %U https://mhealth.jmir.org/2021/7/e13496 %U https://doi.org/10.2196/13496 %U http://www.ncbi.nlm.nih.gov/pubmed/34255708 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e27581 %T A Mobile App for Self-Triage for Pediatric Emergency Patients in Japan: 4 Year Descriptive Epidemiological Study %A Katayama,Yusuke %A Kiyohara,Kosuke %A Hirose,Tomoya %A Matsuyama,Tasuku %A Ishida,Kenichiro %A Nakao,Shunichiro %A Tachino,Jotaro %A Ojima,Masahiro %A Noda,Tomohiro %A Kiguchi,Takeyuki %A Hayashida,Sumito %A Kitamura,Tetsuhisa %A Mizobata,Yasumitsu %A Shimazu,Takeshi %+ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamada-oka, Suita, 5650871, Japan, 81 16 6879 5707, orion13@hp-emerg.med.osaka-u.ac.jp %K emergency medicine %K self-triage %K mobile app %K children %K telemedicine %K app %K mobile health %K mHealth %K epidemiology %D 2021 %7 30.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: When children suffer sudden illness or injury, many parents wonder whether they should go to the hospital immediately or call an ambulance. In 2015, we developed a mobile app that allows parents or guardians to determine the urgency of their child’s condition or call an ambulance and that indicates available hospitals and clinics when their child is suddenly sick or injured by simple selection of the child’s chief complaints and symptoms. However, the effectiveness of medical apps used by the general public has not been well evaluated. Objective: The purpose of this study was to clarify the use profile of this mobile app based on data usage in the app. Methods: This study was a descriptive epidemiological study with a 4-year study period running from January 2016 to December 2019. We included cases in which the app was used either by the children themselves or by their parents and other guardians. Cases in which the app was downloaded but never actually used were excluded from this study. Continuous variables are presented as median and IQR, and categorical variables are presented as actual number and percentages. Results: The app was used during the study period for 59,375 children whose median age was 1 year (IQR 0-3 years). The app was used for 33,874 (57.05%) infants, 16,228 (27.33%) toddlers, 8102 (13.65%) elementary school students, and 1117 (1.88%) junior high school students, with 54 (0.09%) having an unknown status. Furthermore, 31,519 (53.08%) were male and 27,329 (46.03%) were female, with sex being unknown for 527 (0.89%) children. “Sickness” was chosen for 49,101 (78.51%) patients, and “injury, poisoning, foreign, substances and others” was chosen for 13,441 (21.49%). For “sickness,” “fever” was the most commonly selected option (22,773, 36.41%), followed by “cough” (4054, 6.48%), and “nausea/vomiting” (3528, 5.64%), whereas for “injury, poisoning, foreign substances and others,” “head and neck injury” was the most commonly selected option (3887, 6.22%), followed by “face and extremities injury” (1493, 2.39%) and “injury and foreign substances in eyes” (1255, 2.01%). Conclusions: This study clarified the profile of use of a self-triage app for pediatric emergency patients in Japan. %M 34255709 %R 10.2196/27581 %U https://pediatrics.jmir.org/2021/2/e27581 %U https://doi.org/10.2196/27581 %U http://www.ncbi.nlm.nih.gov/pubmed/34255709 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26085 %T The Use of Information and Communication Technologies by Sex Workers to Manage Occupational Health and Safety: Scoping Review %A Bernier,Thérèse %A Shah,Amika %A Ross,Lori E %A Logie,Carmen H %A Seto,Emily %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 1P8, Canada, 1 4167232089, therese.bernier@mail.utoronto.ca %K sex work %K smartphone %K mobile phone %K occupational health and safety %K online %K internet %K website %D 2021 %7 24.6.2021 %9 Review %J J Med Internet Res %G English %X Background: In many countries, sex work is criminalized, driving sex work underground and leaving sex workers vulnerable to a number of occupational health and safety risks, including violence, assault, and robbery. With the advent of widely accessible information and communication technologies (ICTs), sex workers have begun to use electronic occupational health and safety tools to mitigate these risks. Objective: This study aims to explore the use of ICTs by sex workers for managing occupational health and safety risks and strategies for reducing these risks. This paper aims to answer the following question: what is known about sex workers’ use of ICTs in the delivery of occupational health and safety strategies? Methods: A literature review following the methodological framework for scoping reviews was conducted to analyze studies describing the use of ICTs by sex workers to mitigate occupational health and safety risks. Experimental, observational, and descriptive studies, as well as protocol papers, were included in this scoping review. Results: Of the 2477 articles initially identified, 41 (1.66%) met the inclusion criteria. Of these studies, 71% (29/41) were published between 2015 and 2019. In these studies, the internet was the predominant ICT (24/41, 58%), followed by text messaging (10/41, 24%) and assorted communication technologies associated with mobile phones without internet access (7/41, 17%; eg, voice mail). In 56% (23/41) of the studies, sex workers located in high-income countries created occupational health and safety strategies (eg, bad date lists) and shared them through the internet. In 24% (10/41) of the studies, mostly in low- and middle-income countries, organizations external to sex work developed and sent (through text messages) occupational health and safety strategies focused on HIV. In 20% (8/41) of the studies, external organizations collaborated with the sex worker community in the development of occupational health and safety strategies communicated through ICTs; through this collaboration, concerns other than HIV (eg, mental health) emerged. Conclusions: Although there has been an increase in the number of studies on the use of ICTs by sex workers for managing occupational health and safety over the past 5 years, knowledge of how to optimally leverage ICTs for this purpose remains scarce. Recommendations for expanding the use of ICTs by sex workers for occupational health and safety include external organizations collaborating with sex workers in the design of ICT interventions to mitigate occupational health and safety risks; to examine whether ICTs used in low- and middle-income countries would have applications in high-income countries as a substitute to the internet for sharing occupational health and safety strategies; and to explore the creation of innovative, secure, web-based communities that use existing or alternative digital technologies that could be used by sex workers to manage their occupational health and safety. %M 34185001 %R 10.2196/26085 %U https://www.jmir.org/2021/6/e26085/ %U https://doi.org/10.2196/26085 %U http://www.ncbi.nlm.nih.gov/pubmed/34185001 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24947 %T Association of Smartphone Ownership and Internet Use With Markers of Health Literacy and Access: Cross-sectional Survey Study of Perspectives From Project PLACE (Population Level Approaches to Cancer Elimination) %A Oshima,Sachiko M %A Tait,Sarah D %A Thomas,Samantha M %A Fayanju,Oluwadamilola M %A Ingraham,Kearston %A Barrett,Nadine J %A Hwang,E Shelley %+ Department of Surgery, Duke University School of Medicine, 465 Seeley Mudd Building, Durham, NC, 27710, United States, 1 919 684 6849, shelley.hwang@duke.edu %K telehealth %K technology %K health literacy %K access to health care %K mobile phone %D 2021 %7 9.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth is an increasingly important component of health care delivery in response to the COVID-19 pandemic. However, well-documented disparities persist in the use of digital technologies. Objective: This study aims to describe smartphone and internet use within a diverse sample, to assess the association of smartphone and internet use with markers of health literacy and health access, and to identify the mediating factors in these relationships. Methods: Surveys were distributed to a targeted sample designed to oversample historically underserved communities from April 2017 to December 2017. Multivariate logistic regression was used to estimate the association of internet and smartphone use with outcomes describing health care access and markers of health literacy for the total cohort and after stratifying by personal history of cancer. Health care access was captured using multiple variables, including the ability to obtain medical care when needed. Markers of health literacy included self-reported confidence in obtaining health information. Results: Of the 2149 participants, 1319 (61.38%) were women, 655 (30.48%) were non-Hispanic White, and 666 (30.99%) were non-Hispanic Black. The median age was 51 years (IQR 38-65). Most respondents reported using the internet (1921/2149, 89.39%) and owning a smartphone (1800/2149, 83.76%). Compared with the respondents with smartphone or internet access, those without smartphone or internet access were more likely to report that a doctor was their most recent source of health information (344/1800, 19.11% vs 116/349, 33.2% for smartphone and 380/1921, 19.78% vs 80/228, 35.1% for internet, respectively; both P<.001). Internet use was associated with having looked for information on health topics from any source (odds ratio [OR] 3.81, 95% CI 2.53-5.75) and confidence in obtaining health information when needed (OR 1.83, 95% CI 1.00-3.34) compared with noninternet users. Smartphone owners had lower odds of being unable to obtain needed medical care (OR 0.62, 95% CI 0.40-0.95) than nonsmartphone owners. Among participants with a prior history of cancer, smartphone ownership was significantly associated with higher odds of confidence in ability to obtain needed health information (OR 5.63, 95% CI 1.05-30.23) and lower odds of inability to obtain needed medical care (OR 0.17, 95% CI 0.06-0.47), although these associations were not significant among participants without a prior history of cancer. Conclusions: We describe widespread use of digital technologies in a community-based cohort, although disparities persist. In this cohort, smartphone ownership was significantly associated with ability to obtain needed medical care, suggesting that the use of smartphone technology may play a role in increasing health care access. Similarly, major illnesses such as cancer have the potential to amplify health engagement. Finally, special emphasis must be placed on reaching patient populations with limited digital access, so these patients are not further disadvantaged in the new age of telehealth. %M 34106076 %R 10.2196/24947 %U https://www.jmir.org/2021/6/e24947 %U https://doi.org/10.2196/24947 %U http://www.ncbi.nlm.nih.gov/pubmed/34106076 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e23832 %T Older Adults’ Experiences With Using Wearable Devices: Qualitative Systematic Review and Meta-synthesis %A Moore,Kevin %A O'Shea,Emma %A Kenny,Lorna %A Barton,John %A Tedesco,Salvatore %A Sica,Marco %A Crowe,Colum %A Alamäki,Antti %A Condell,Joan %A Nordström,Anna %A Timmons,Suzanne %+ Centre for Gerontology and Rehabilitation, University College Cork, The Bungalow, Block 13, St Finbarrs Hospital, Douglas Road, Cork, T12 Y319, Ireland, 353 857070042, kevin.moore@ucc.ie %K wearable device %K older adult %K digital health %K meta-synthesis %K qualitative review %K acceptance %K adherence %K mobile phone %D 2021 %7 3.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Older adults may use wearable devices for various reasons, ranging from monitoring clinically relevant health metrics or detecting falls to monitoring physical activity. Little is known about how this population engages with wearable devices, and no qualitative synthesis exists to describe their shared experiences with long-term use. Objective: This study aims to synthesize qualitative studies of user experience after a multi-day trial with a wearable device to understand user experience and the factors that contribute to the acceptance and use of wearable devices. Methods: We conducted a systematic search in CINAHL, APA PsycINFO, PubMed, and Embase (2015-2020; English) with fixed search terms relating to older adults and wearable devices. A meta-synthesis methodology was used. We extracted themes from primary studies, identified key concepts, and applied reciprocal and refutational translation techniques; findings were synthesized into third-order interpretations, and finally, a “line-of-argument” was developed. Our overall goal was theory development, higher-level abstraction, and generalizability for making this group of qualitative findings more accessible. Results: In total, we reviewed 20 papers; 2 evaluated fall detection devices, 1 tested an ankle-worn step counter, and the remaining 17 tested activity trackers. The duration of wearing ranged from 3 days to 24 months. The views of 349 participants (age: range 51-94 years) were synthesized. Four key concepts were identified and outlined: motivation for device use, user characteristics (openness to engage and functional ability), integration into daily life, and device features. Motivation for device use is intrinsic and extrinsic, encompassing many aspects of the user experience, and appears to be as, if not more, important than the actual device features. To overcome usability barriers, an older adult must be motivated by the useful purpose of the device. A device that serves its intended purpose adds value to the user’s life. The user’s needs and the support structure around the device—aspects that are often overlooked—seem to play a crucial role in long-term adoption. Our “line-of-argument” model describes how motivation, ease of use, and device purpose determine whether a device is perceived to add value to the user’s life, which subsequently predicts whether the device will be integrated into the user’s life. Conclusions: The added value of a wearable device is the resulting balance of motivators (or lack thereof), device features (and their accuracy), ease of use, device purpose, and user experience. The added value contributes to the successful integration of the device into the daily life of the user. Useful device features alone do not lead to continued use. A support structure should be placed around the user to foster motivation, encourage peer engagement, and adapt to the user’s preferences. %M 34081020 %R 10.2196/23832 %U https://mhealth.jmir.org/2021/6/e23832 %U https://doi.org/10.2196/23832 %U http://www.ncbi.nlm.nih.gov/pubmed/34081020 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26110 %T Person-Generated Health Data in Women’s Health: Protocol for a Scoping Review %A Karim,Jalisa Lynn %A Talhouk,Aline %+ Department of Obstetrics and Gynecology, University of British Columbia, 593-828 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 4111, a.talhouk@ubc.ca %K digital health %K women’s health %K mobile health %K health app %K wearables %K femtech %K self-tracking %K personalized health %K person-generated health data %K patient-generated health data %K scoping review %D 2021 %7 28.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to their ability to collect person-generated health data, digital tools and connected health devices may hold great utility in disease prevention, chronic disease self-monitoring and self-tracking, as well as in tailoring information and educational content to fit individual needs. Facilitators and barriers to the use of digital health technologies vary across demographics, including sex. The “femtech” market is growing rapidly, and women are some of the largest adopters of digital health technologies. Objective: This paper aims to provide the background and methods for conducting a scoping review on the use of person-generated health data from connected devices in women’s health. The objectives of the scoping review are to identify the various contexts of digital technologies in women’s health and to consolidate women’s views on the usability and acceptability of the devices. Methods: Searches were conducted in the following databases: Medline, Embase, APA PsycInfo, CINAHL Complete, and Web of Science Core Collection. We included articles from January 2015 to February 2020. Screening of articles was done independently by at least two authors in two stages. Data charting is being conducted in duplicate. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Results: Our search identified 9102 articles after deduplication. As of November 2020, the full-text screening stage is almost complete and data charting is in progress. The scoping review is expected to be completed by Fall 2021. Conclusions: This scoping review will broadly map the literature regarding the contexts and acceptability of digital health tools for women. The results from this review will be useful in guiding future digital health and women’s health research. International Registered Report Identifier (IRRID): DERR1-10.2196/26110 %M 34047708 %R 10.2196/26110 %U https://www.researchprotocols.org/2021/5/e26110 %U https://doi.org/10.2196/26110 %U http://www.ncbi.nlm.nih.gov/pubmed/34047708 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26037 %T Associations Between Rural or Urban Status, Health Outcomes and Behaviors, and COVID-19 Perceptions Among Meditation App Users: Longitudinal Survey Study %A Bhuiyan,Nishat %A Puzia,Megan %A Stecher,Chad %A Huberty,Jennifer %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, United States, 1 480 406 2644, nbhuiyan@asu.edu %K mHealth %K rural health %K physical activity %K mental health %K COVID-19 %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rural and urban differences in health outcomes and behaviors have been well-documented, with significant rural health disparities frequently highlighted. Mobile health (mHealth) apps, such as meditation apps, are a novel method for improving health and behaviors. These apps may be a critical health promotion strategy during the COVID-19 pandemic and could potentially be used to address rural health disparities. However, limited research has assessed whether meditation app health outcomes are associated with rural and urban residence, and it is unclear whether disparities in health and behaviors between rural and urban populations would persist among meditation app users. Objective: We aimed to explore associations between rural or urban status, psychological outcomes, and physical activity among users of a mobile meditation app. We further aimed to explore associations between rural or urban status and perceived effects of COVID-19 on stress, mental health, and physical activity, and to explore changes in these outcomes in rural versus urban app users over time. Methods: This study was a secondary analysis of a national survey conducted among subscribers to the meditation app Calm. Eligible participants completed online baseline surveys from April to June 2020, and follow-up surveys from June to September 2020, assessing demographics, psychological outcomes, physical activity, and perceived effects of COVID-19 on stress, mental health, and physical activity. Results: Participants (N=8392) were mostly female (7041/8392, 83.9%), non-Hispanic (7855/8392, 93.6%), and White (7704/8392, 91.8%); had high socioeconomic status (income ≥US $100,000: 4389/8392, 52.3%; bachelor’s degree or higher: 7251/8392, 86.4%); and resided in a metropolitan area core (rural-urban commuting area code 1: 7192/8392, 85.7%). Rural or urban status was not associated with baseline stress, depression, anxiety, pre–COVID-19 and current physical activity, or perceived effects of COVID-19 on stress, mental health, and physical activity. Repeated-measures models showed overall decreases in depression, anxiety, and perceived effects of COVID-19 on physical activity from baseline to follow-up, and no significant changes in stress or perceived effects of COVID-19 on stress and mental health over time. Models also showed no significant main effects of rural or urban status, COVID-19 statewide prevalence at baseline, or change in COVID-19 statewide prevalence. Conclusions: We did not find associations between rural or urban status and psychological outcomes (ie, stress, depression, and anxiety), physical activity, or perceived effects of COVID-19 on stress, mental health, and physical activity. Rural or urban status does not appear to drive differences in outcomes among meditation app users, and the use of mHealth apps should continue to be explored as a health promotion strategy in both rural and urban populations. Furthermore, our results did not show negative cumulative effects of COVID-19 on psychological outcomes and physical activity among app users in our sample, the majority of whom were urban, White, female, and of high socioeconomic status. Further research is needed to investigate meditation app use as a health promotion strategy in rural and urban populations. %M 33900930 %R 10.2196/26037 %U https://mhealth.jmir.org/2021/5/e26037 %U https://doi.org/10.2196/26037 %U http://www.ncbi.nlm.nih.gov/pubmed/33900930 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e21763 %T Smartphone and Tablet Software Apps to Collect Data in Sport and Exercise Settings: Cross-sectional International Survey %A Shaw,Matthew Peter %A Satchell,Liam Paul %A Thompson,Steve %A Harper,Ed Thomas %A Balsalobre-Fernández,Carlos %A Peart,Daniel James %+ Sports, Physical Activity and Food, Western Norway University of Applied Sciences, Røyrgata 6, Sogndal, 6856, Norway, 47 57676391, matthew.shaw@hvl.no %K mobile apps %K sports %K smartphone %K mobile phone %K questionnaire %K survey %D 2021 %7 13.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in smartphone technology have facilitated an increase in the number of commercially available smartphone and tablet apps that enable the collection of physiological and biomechanical variables typically monitored in sport and exercise settings. Currently, it is not fully understood whether individuals collect data using mobile devices and tablets, independent of additional hardware, in their practice. Objective: This study aims to explore the use of smartphone and tablet software apps to collect data by individuals working in various sport and exercise settings, such as sports coaching, strength and conditioning, and personal training. Methods: A total of 335 practitioners completed an electronic questionnaire that surveyed their current training practices, with a focus on 2 areas: type of data collection and perceptions of reliability and validity regarding app use. An 18-item questionnaire, using a 5-point Likert scale, evaluated the perception of app use. Results: A total of 204 respondents reported using apps to directly collect data, with most of them (196/335, 58.5%) collecting biomechanical data, and 41.2% (138/335) respondents reported using at least one evidence-based app. A binomial general linear model determined that evidence accessibility (β=.35, 95% CI 0.04-0.67; P=.03) was significantly related to evidence-based app use. Age (β=−.03, 95% CI −0.06 to 0.00; P=.03) had a significant negative effect on evidence-based app use. Conclusions: This study demonstrates that practitioners show a greater preference for using smartphones and tablet devices to collect biomechanical data such as sprint velocity and jump performance variables. When it is easier to access information on the quality of apps, practitioners are more likely to use evidence-based apps. App developers should seek independent research to validate their apps. In addition, app developers should seek to provide clear signposting to the scientific support of their software in alternative ways. %M 33983122 %R 10.2196/21763 %U https://mhealth.jmir.org/2021/5/e21763 %U https://doi.org/10.2196/21763 %U http://www.ncbi.nlm.nih.gov/pubmed/33983122 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e13391 %T Predictors of Walking App Users With Comparison of Current Users, Previous Users, and Informed Nonusers in a Sample of Dutch Adults: Questionnaire Study %A De Bruijn,Gert-Jan %A Dallinga,Joan Martine %A Deutekom,Marije %+ Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Nieuwe Achtergracht 166, Amsterdam, 1018 WV, Netherlands, 31 205252636, g.j.debruijn@uva.nl %K technology %K walking %K health %K adult %K survey %K questionnaires %D 2021 %7 12.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The last decade has seen a substantial increase in the use of mobile health apps and research into the effects of those apps on health and health behaviors. In parallel, research has aimed at identifying population subgroups that are more likely to use those health apps. Current evidence is limited by two issues. First, research has focused on broad health apps, and little is known about app usage for a specific health behavior. Second, research has focused on comparing current users and current nonusers, without considering subgroups of nonusers. Objective: We aimed to provide profile distributions of current users, previous users, and informed nonusers, and to identify predictor variables relevant for profile classification. Methods: Data were available from 1683 people who participated in a Dutch walking event in Amsterdam that was held in September 2017. They provided information on demographics, self-reported walking behavior, and walking app usage, as well as items from User Acceptance of Information Technology, in an online survey. Data were analyzed using discriminant function analysis and multinomial logistic regression analysis. Results: Most participants were current walking app users (899/1683, 53.4%), while fewer participants were informed nonusers (663/1683, 39.4%) and very few were previous walking app users (121/1683, 7.2%). Current walking app users were more likely to report walking at least 5 days per week and for at least 30 minutes per bout (odds ratio [OR] 1.44, 95% CI 1.11-1.85; P=.005) and more likely to be overweight (OR 1.72, 95% CI 1.24-2.37; P=.001) or obese (OR 1.49, 95% CI 1.08-2.08; P=.005) as compared with informed nonusers. Further, current walking app users perceived their walking apps to be less boring, easy to use and retrieve information, and more helpful to achieve their goals. Effect sizes ranged from 0.10 (95% CI 0.08-0.30) to 1.58 (95% CI 1.47-1.70). Conclusions: The distributions for walking app usage appeared different from the distributions for more general health app usage. Further, the inclusion of two specific subgroups of nonusers (previous users and informed nonusers) provides important information for health practitioners and app developers to stimulate continued walking app usage, including making information in those apps easy to understand and making it easy to obtain information from the apps, as well as preventing apps from becoming boring and difficult to use for goal attainment. %M 33978595 %R 10.2196/13391 %U https://mhealth.jmir.org/2021/5/e13391 %U https://doi.org/10.2196/13391 %U http://www.ncbi.nlm.nih.gov/pubmed/33978595 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25503 %T Feasibility of a Voice-Enabled Medical Diary App (SpeakHealth) for Caregivers of Children With Special Health Care Needs and Health Care Providers: Mixed Methods Study %A Sezgin,Emre %A Noritz,Garey %A Lin,Simon %A Huang,Yungui %+ The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, United States, 1 6143556814, esezgin1@gmail.com %K children with special health care needs %K care management %K care coordination %K voice-enabled mobile app %K health information technology %K voice assistant %K voice interaction %K mobile phone %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Children with special health care needs (CSHCN) require more than the usual care management and coordination efforts from caregivers and health care providers (HCPs). Health information and communication technologies can potentially facilitate these efforts to increase the quality of care received by CSHCN. Objective: In this study, we aim to assess the feasibility of a voice-enabled medical diary app (SpeakHealth) by investigating its potential use among caregivers and HCPs. Methods: Following a mixed methods approach, caregivers of CSHCN were interviewed (n=10) and surveyed (n=86) about their care management and communication technology use. Only interviewed participants were introduced to the SpeakHealth app prototype, and they tested the app during the interview session. In addition, we interviewed complex care HCPs (n=15) to understand their perception of the value of a home medical diary such as the SpeakHealth app. Quantitative data were analyzed using descriptive statistics and correlational analyses. Theoretical thematic analysis was used to analyze qualitative data. Results: The survey results indicated a positive attitude toward voice-enabled technology and features; however, there was no strong correlation among the measured items. The caregivers identified communication, information sharing, tracking medication, and appointments as fairly and highly important features of the app. Qualitative analysis revealed the following two overarching themes: enablers and barriers in care communication and enablers and barriers in communication technologies. The subthemes included parent roles, care communication technologies, and challenges. HCPs found the SpeakHealth app to be a promising tool for timely information collection that could be available for sharing information with the health system. Overall, the findings demonstrated a variety of needs and challenges for caregivers of CSHCN and opportunities for voice-enabled, interactive medical diary apps in care management and coordination. Caregivers fundamentally look for better information sharing and communication with HCPs. Health care and communication technologies can potentially improve care communication and coordination in addressing the patient and caregiver needs. Conclusions: The perspectives of caregivers and providers suggested both benefits and challenges in using the SpeakHealth app for medical note-taking and tracking health events at home. Our findings could inform researchers and developers about the potential development and use of a voice-enabled medical diary app. %M 33865233 %R 10.2196/25503 %U https://formative.jmir.org/2021/5/e25503 %U https://doi.org/10.2196/25503 %U http://www.ncbi.nlm.nih.gov/pubmed/33865233 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e22599 %T Smartphone Usage Among Doctors in the Clinical Setting in Two Culturally Distinct Countries: Cross-sectional Comparative Study %A Nair,Anjali Ajay %A Afroz,Samreen %A Ahmed,Bushra Urooj %A Ahmed,Uzma Urooj %A Foo,Chi Chung %A Zaidan,Hind %A Corbally,Martin %+ School of Medicine, RCSI Bahrain, Building No. 2441, Road 2835, Busaiteen, Bahrain, 852 6759 5753, 14034735@rcsi.com %K smartphone use %K mobile phone %K mobile technology %K smartphone technology %K medical apps %K mobile applications %K smartphone applications %K mHealth %K mobile health %K digital health %K medical informatics %K internet %K doctors %K patient care %K point of care %K Bahrain %K Hong Kong %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones and mobile applications have seen a surge in popularity in recent years, a pattern that has also been reflected in the health care system. Despite increased reliance among clinicians however, limited research has been conducted on the uptake and impact of smartphone usage in medical practice, especially outside the Western world. Objective: This study aimed to identify the usage of smartphones and medical apps by doctors in the clinical setting in 2 culturally distinct countries: King Hamad University Hospital (KHUH), Bahrain and Queen Mary Hospital (QMH), Hong Kong. Methods: A cross-sectional, comparative study was conducted where doctors in both hospitals were asked to take part in a 15-item online survey. The questions were categorized into the following groups: demographics of the study population, ownership and main use of smartphones, number and names of medical apps currently owned, rating usage of smartphones for medical purposes, time spent on a smartphone related to clinical use, clinical reliance on smartphones, and views on further integration of smartphones. The results were then tabulated and analyzed using SPSS Statistics 25 for Mac (IBM Corp Inc, Armonk, NY). Results: A total of 200 doctors were surveyed, with a total of 99.0% (99/100) of the doctors owning a smartphone in both KHUH and QMH; 58% (57/99) and 55% (54/99) of the doctors from KHUH and QMH, respectively, identified communication as their main use of smartphones in the clinical setting (P=.004). Doctors from KHUH were likely to spend more time on medical apps than doctors from QMH (P=.002). According to the overall results of both hospitals, 48% (32/67) of the junior doctors claimed high reliance on smartphones, whereas only 32.3% (41/127) of the senior doctors said the same (P=.03). Of doctors in KHUH and QMH, 78.0% (78/100) and 69.0% (69/100), respectively, either strongly agreed or agreed that smartphones need to be integrated into the clinical setting. In terms of preferences for future apps, 48% (48/100) and 56% (56/100) of the doctors in KHUH and QMH, respectively, agreed that more medical applications need to be created in order to support smartphone use in the clinical setting. Conclusions: These results suggest a substantial acceptance of smartphones by doctors in the clinical setting. It also elicits the need to establish policies to officially integrate smartphone technology into health care in accordance with ethical guidelines. More emphasis should be placed on creating medical applications that aid health care professionals in attaining their information from accurate sources and also regulate a system to monitor the usage of mobile devices within hospitals to prevent a breach of patient privacy and confidentiality. %M 33970119 %R 10.2196/22599 %U https://mhealth.jmir.org/2021/5/e22599 %U https://doi.org/10.2196/22599 %U http://www.ncbi.nlm.nih.gov/pubmed/33970119 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26289 %T Postmarketing Safety Monitoring After Influenza Vaccination Using a Mobile Health App: Prospective Longitudinal Feasibility Study %A Nguyen,Minh Tam H %A Krause,Gérard %A Keller-Stanislawski,Brigitte %A Glöckner,Stephan %A Mentzer,Dirk %A Ott,Jördis J %+ PhD Programme Epidemiology, Hannover Biomedical Research School, Hannover Medical School, Hannover, Germany, 49 531 6181 3115, joerdis.ott@helmholtz-hzi.de %K mHealth %K mobile health %K digital health %K adverse event %K adverse event following immunization %K active reporting %K pharmacovigilance %K therapeutic use %K adverse effect %D 2021 %7 7.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: For the safety monitoring of vaccinations postlicensure, reports of adverse events after immunization (AEFIs) are crucial. New technologies such as digital mobile apps can be used as an active approach to capture these events. We therefore conducted a feasibility study among recipients of the influenza vaccination using an app for assessment of the reporting of AEFIs. Objective: The goal of the research was to determine factors influencing adherence to and correct use of a newly developed app for individuals to report AEFI for 3 months using regular reminder functions, to identify determinants of AEFI occurrence and define reported AEFI types. Methods: We developed the app (SafeVac) and offered it to recipients of the influenza vaccination in 3 occupational settings in fall 2018. In this prospective longitudinal feasibility study, data on AEFIs were generated through SafeVac for 3 months. Using logistic and Cox regression, we assessed associations between app adherence, correct app entry, AEFIs, and sociodemographic parameters. Results: Of the individuals who logged into SafeVac, 61.4% (207/337) used the app throughout a 3-month period. App use adherence was negatively associated with female sex (odds ratio [OR] 0.47; CI 0.25-0.91) and correct app entry was negatively associated with older age (OR 0.96; CI 0.93-0.99) and lower education (OR 0.31; CI 0.13-0.76). AEFI occurrence was associated with female sex (hazard ratio 1.41; CI 1.01-1.96) and negatively with older age (hazard ratio 0.98; CI 0.97-0.99). The most common AEFIs reported were injection site pain (106/337), pain in extremity (103/337), and fatigue/asthenia (73/337). Conclusions: Digital AEFI reporting was feasible with SafeVac and generated plausible results for this observation period and setting. Studies directly comparing SafeVac with conventional passive reporting schemes could determine whether such digital approaches improve completeness, timeliness, and sensitivity of vaccine vigilance. Further studies should evaluate if these results are transferable to other vaccinations and populations and if introduction of such a tool has an influence on vaccination readiness and therefore vaccine safety. %M 33960950 %R 10.2196/26289 %U https://mhealth.jmir.org/2021/5/e26289 %U https://doi.org/10.2196/26289 %U http://www.ncbi.nlm.nih.gov/pubmed/33960950 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23866 %T Differential Effects of Outpatient Portal User Status on Inpatient Portal Use: Observational Study %A Fareed,Naleef %A Jonnalagadda,Pallavi %A MacEwan,Sarah R %A Di Tosto,Gennaro %A Scarborough,Seth %A Huerta,Timothy R %A McAlearney,Ann Scheck %+ The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 512, Columbus, OH, 43210, United States, 1 614 366 0283, naleef.fareed@osumc.edu %K patient portals %K technology experience %K health information technology %K technology acceptance %K technology use %K log files %K mobile phone %D 2021 %7 30.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The decision to use patient portals can be influenced by multiple factors, including individuals’ perceptions of the tool, which are based on both their personal skills and experiences. Prior experience with one type of portal may make individuals more comfortable with using newer portal technologies. Experienced outpatient portal users in particular may have confidence in their ability to use inpatient portals that have similar functionality. In practice, the use of both outpatient and inpatient portal technologies can provide patients with continuity of access to their health information across care settings, but the influence of one type of portal use on the use of other portals has not been studied. Objective: This study aims to understand how patients’ use of an inpatient portal is influenced by outpatient portal use. Methods: This study included patients from an academic medical center who were provided access to an inpatient portal during their hospital stays between 2016 and 2018 (N=1571). We analyzed inpatient portal log files to investigate how inpatient portal use varied by using 3 categories of outpatient portal users: prior users, new users, and nonusers. Results: Compared with prior users (695/1571, 44.24%) of an outpatient portal, new users (214/1571, 13.62%) had higher use of a select set of inpatient portal functions (messaging function: incidence rate ratio [IRR] 1.33, 95% CI 1.06-1.67; function that provides access to the outpatient portal through the inpatient portal: IRR 1.34, 95% CI 1.13-1.58). Nonusers (662/1571, 42.14%), compared with prior users, had lower overall inpatient portal use (all active functions: IRR 0.68, 95% CI 0.60-0.78) and lower use of specific functions, which included the function to review vitals and laboratory results (IRR 0.51, 95% CI 0.36-0.73) and the function to access the outpatient portal (IRR 0.53, 95% CI 0.45-0.62). In comparison with prior users, nonusers also had lower odds of being comprehensive users (defined as using 8 or more unique portal functions; odds ratio [OR] 0.57, 95% CI 0.45-0.73) or composite users (defined as comprehensive users who initiated a 75th or greater percentile of portal sessions) of the inpatient portal (OR 0.42, 95% CI 0.29-0.60). Conclusions: Patients’ use of an inpatient portal during their hospital stay appeared to be influenced by a combination of factors, including prior outpatient portal use. For new users, hospitalization itself, a major event that can motivate behavioral changes, may have influenced portal use. In contrast, nonusers might have lower self-efficacy in their ability to use technology to manage their health, contributing to their lower portal use. Understanding the relationship between the use of outpatient and inpatient portals can help direct targeted implementation strategies that encourage individuals to use these tools to better manage their health across care settings. %M 33929328 %R 10.2196/23866 %U https://www.jmir.org/2021/4/e23866 %U https://doi.org/10.2196/23866 %U http://www.ncbi.nlm.nih.gov/pubmed/33929328 %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 e21087 %T Feasibility and Preliminary Efficacy of a Community-Based Addiction Rehabilitation Electronic System in Substance Use Disorder: Pilot Randomized Controlled Trial %A Xu,Xiaomin %A Chen,Shujuan %A Chen,Junning %A Chen,Zhikang %A Fu,Liming %A Song,Dingchen %A Zhao,Min %A Jiang,Haifeng %+ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, , China, 86 180 1731 1330, dragonjhf@hotmail.com %K mobile health %K drug use %K rehabilitation %K community health service %K China %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Drug use disorder has high potential for relapse and imposes an enormous burden on public health in China. Since the promulgation of the Anti-drug law in 2008, community-based rehabilitation has become the primary approach to treat drug addiction. However, multiple problems occurred in the implementation process, leading to a low detoxification rate in the community. Mobile health (mHealth) serves as a promising tool to improve the effectiveness and efficiency of community-based rehabilitation. Community-based addiction rehabilitation electronic system (CAREs) is an interactive system for drug users and their assigned social workers. Objective: The study aimed to examine the feasibility and preliminary efficacy of CAREs in community-based rehabilitation from the perspective of drug users and social workers in Shanghai, China. Methods: In this pilot randomized controlled trial, 40 participants were recruited from the community in Shanghai from January to May 2019. Participants randomized to the intervention group (n=20) received CAREs + community-based rehabilitation, while participants in the control group (n=20) received community-based rehabilitation only for 6 months. CAREs provided education, assessment, and SOS (support) functions for drug users. The assigned social workers provided service and monitored drug use behavior as usual except that the social workers in the intervention group could access the webpage end to obtain drug users’ information and fit their routine workflow into CAREs. The primary outcome was the feasibility of CAREs, reflected in the overall proportion and frequency of CAREs features used in both app and webpage end. The secondary outcomes were the effectiveness of CAREs, including the percentage of drug-positive samples, longest period of abstinence, contact times with social workers, and the change of Addiction Severity Index (ASI) from baseline to the 6-month follow-up. Results: The number of participants logged in to the app ranged from 7 to 20 per week, and CAREs had relatively high levels of continued patient use. Drug users preferred assessment and education features in the app end while their social workers showed high levels of use in urine results record and viewing assessment results on the webpage end. After the 6-month intervention, 3.3% (17/520) of samples in the intervention group and 7.5% (39/520) in the control group were drug-positive (F=4.358, P=.04). No significant differences were noted between the control and intervention groups in terms of longest duration of abstinence, number of contact times and ASI composite scores. Conclusions: The study preliminarily demonstrated that with relatively good feasibility and acceptability, CAREs may improve the effectiveness and efficiency of the community-based rehabilitation, which provided instruction for further improvement of the system. Trial Registration: ClinicalTrials.gov NCT03451344; https://clinicaltrials.gov/ct2/show/NCT03451344 International Registered Report Identifier (IRRID): RR2-10.3389/fpsyt.2018.00556 %M 33861211 %R 10.2196/21087 %U https://mhealth.jmir.org/2021/4/e21087 %U https://doi.org/10.2196/21087 %U http://www.ncbi.nlm.nih.gov/pubmed/33861211 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e24828 %T Associations Among Wearable Activity Tracker Use, Exercise Motivation, and Physical Activity in a Cohort of Cancer Survivors: Secondary Data Analysis of the Health Information National Trends Survey %A De La Torre,Steven %A Spruijt-Metz,Donna %A Farias,Albert J %+ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA, 90033, United States, 1 323 442 7252, albertfa@usc.edu %K mHealth %K mobile health %K cancer survivors %K exercise %K physical activity %K motivation %K wearable electronic devices %K fitness trackers %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer survivors who meet physical activity (PA) recommendations (≥150 minutes of moderate-to-vigorous physical activity [MVPA] per week) experience better health outcomes. With the growing availability of wearable activity trackers (WATs), it may be easier to track PA. However, it is unknown what motivates survivors to use these devices. Objective: The aim of this study is to investigate the associations among motivations for exercise, previous WAT use for tracking a health goal or activity, and meeting the recommended amount of PA among a cohort of cancer survivors. Methods: Data on WAT users who reported having a previous cancer diagnosis were analyzed from the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 3. All survivors with complete information on demographics, exercise motivations (internal guilt, external pressure, physical appearance, and exercise enjoyment), previous WAT use (yes or no), and minutes of MVPA per week (N=608) were included. Multivariate logistic regression models were used to test these associations. A separate cluster analysis was conducted to identify the profiles of exercise motivation that were associated with reporting WAT use. Results: The mean age of the cohort was 66.9 years (SD 12.1). The majority were non-Hispanic White (473/608, 78.8%) and female (322/608, 54.9%), and skin cancer was the most commonly reported diagnosed cancer (154/608, 27.8%). Survivors who reported using WATs to track a health goal or activity were 1.6 times more likely to meet MVPA recommendations than those who did not use WATs (odds ratio [OR] 1.65, 95% CI 1.03-2.65; P=.04). When exercise motivations were assessed independently, survivors who reported not feeling any internal guilt as an exercise motivation were 73% less likely to report having used a WAT than those who felt any internal guilt (OR 0.27, 95% CI 0.14-0.54; P<.001). A total of 3 distinct motivational profiles emerged from the cluster analysis. WAT users had an increased probability of membership in profile 3, which was characterized as being strongly motivated to exercise by internal guilt, physical appearance, and exercise enjoyment (OR 4.5, 95% CI 2.1-9.7; P<.001). Conclusions: Among this cohort, survivors who reported using WATs to track a health goal or activity were significantly more likely to report meeting PA recommendations. Survivors who reported feeling internal guilt as an exercise motivation were significantly more likely to report using WATs to track a health goal or activity. When examining clusters of motivation, survivors who reported previous WAT use were more likely to report being motivated to exercise by a mix of intrinsic and extrinsic motivations, including internal guilt, exercise enjoyment, and physical appearance. Given the health benefits of PA for cancer survivors, technology-focused interventions that use WATs and target exercise motivation may aid in cancer survivors meeting the level of recommended PA. %M 33843595 %R 10.2196/24828 %U https://cancer.jmir.org/2021/2/e24828 %U https://doi.org/10.2196/24828 %U http://www.ncbi.nlm.nih.gov/pubmed/33843595 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23914 %T Prescribing Phones to Address Health Equity Needs in the COVID-19 Era: The PHONE-CONNECT Program %A Kazevman,Gill %A Mercado,Marck %A Hulme,Jennifer %A Somers,Andrea %+ Department of Emergency Medicine, University Health Network, 200 Elizabeth St, RFE-GS-480, Toronto, ON, M5G 2C4, Canada, 1 416 340 3856, Andrea.Somers@uhn.ca %K digital health equity %K health inequity %K digital determinants of health %K emergency medicine %K COVID-19 %K public health %K health policy %K primary care %K cell phone %D 2021 %7 6.4.2021 %9 Viewpoint %J J Med Internet Res %G English %X Vulnerable populations have been identified as having higher infection rates and poorer COVID-19–related outcomes, likely due to their inability to readily access primary care, follow public health directives, and adhere to self-isolation guidelines. As a response to the COVID-19 pandemic, many health care services have adopted new digital solutions, which rely on phone and internet connectivity. However, persons who are digitally inaccessible, such as those experiencing poverty or homelessness, are often unable to use these services. In response to this newly highlighted social disparity known as “digital health inequity,” emergency physicians at the University Health Network in Toronto, Canada, initiated a program called PHONE-CONNECT (Phones for Healthier Ontarians iN EDs – COvid NEeds met by Cellular Telephone). This novel approach attempts to improve patients’ access to health care, information, and social services, as well as improve their ability to adhere to public health directives (social isolation and contact tracing). Although similar programs addressing the same emerging issues have been recently described in the media, this is the first time phones have been provided as a health care intervention in an emergency department. This innovative emergency department point-of-care intervention may have a significant impact on improving health outcomes for vulnerable people during the COVID-19 pandemic and beyond. %M 33760753 %R 10.2196/23914 %U https://www.jmir.org/2021/4/e23914 %U https://doi.org/10.2196/23914 %U http://www.ncbi.nlm.nih.gov/pubmed/33760753 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e19310 %T Smartphone Medical App Use and Associated Factors Among Physicians at Referral Hospitals in Amhara Region, North Ethiopia, in 2019: Cross-sectional Study %A Teferi,Gizaw Hailiye %A Tilahun,Binyam Cheklu %A Guadie,Habtamu Alganeh %A Amare,Ashenafi Tazebew %+ Department of Health Informatics, College of Medicine and Health Science, Debre-Markos University, PO Box: 269, Debre Markos, Ethiopia, 251 921493560, ghailiye463@gmail.com %K application %K medical %K physician %K smartphone %K mobile phone %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Information in health care is rapidly expanding and is updated very regularly, especially with the increasing use of technology in the sector. Due to this, health care providers require timely access to the latest scientific evidence anywhere. Smartphone medical apps are tools to access the latest reputable scientific evidence in the discipline. In addition, smartphone medical apps could lead to improved decision making, reduced numbers of medical errors, and improved communication between hospital medical staff. Objective: The aim of this study was to assess smartphone medical app use and associated factors among physicians working at referral hospitals of the Amhara region, Ethiopia. Methods: An institution-based cross-sectional study design was conducted among physicians working at 5 referral hospitals in the Amhara region, Ethiopia, from February 5 to May 27, 2019. A simple random sampling method was used to select 423 physicians. A self-administered questionnaire was used to collect the data and analyzed using SPSS, version 21 (IBM Corp). Binary and multivariable logistic regression analysis was performed to assess factors associated with smartphone medical app use among physicians. A value of P<.05, corresponding to a 95% CI, was considered statistically significant. The validity of the questionnaire was determined based on the view of experts and the reliability of it obtained by calculating the value of Cronbach alpha (α=.78) Results: In this study, most of the 417 respondents (375, 89.9%) had medical apps installed on their smartphones. Of those 375 respondents, 264 (70.4%) had used medical apps during clinical practice. The medical apps most commonly used by the respondents were UpToDate, Medscape, MedCalc, and Doximity. According to multivariable logistic regression analysis, attitude (adjusted odds ratio [AOR] 1.64, 95% CI 1.05-2.55), internet access (AOR 2.82, 95% CI 1.75-4.54), computer training (AOR 1.71, 95% CI 1.09-2.67), perceived usefulness of the app (AOR 1.64, 95% CI 1.05-2.54), information technology support staff (AOR 2.363, 95% CI 1.5-3.08), and technical skill (AOR 2.52, 95% CI 1.50-4.25) were significantly associated with smartphone medical app use. Conclusions: Most respondents have a smartphone medical app and have used it in clinical practice. Attitude, internet access, computer training, perceived usefulness of the app, information technology support staff, and technical skill are the most notable factors that are associated with smartphone medical app use by physicians.  %M 33769303 %R 10.2196/19310 %U https://mhealth.jmir.org/2021/3/e19310 %U https://doi.org/10.2196/19310 %U http://www.ncbi.nlm.nih.gov/pubmed/33769303 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24755 %T Intention to Adopt mHealth Apps Among Informal Caregivers: Cross-Sectional Study %A Ghahramani,Fereshteh %A Wang,Jingguo %+ College of Computing and Digital Media, DePaul University, 243 South Wabash Ave, Chicago, IL, 60604, United States, 1 3123628381, fereshteh.ghahramani@depaul.edu %K mobile health %K cross-sectional study %K informal caregivers %K mobile app %K caregiving app %K mobile phone %D 2021 %7 17.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Caregiving responsibility can change caregivers’ lives; modify their emotions; and make them feel frustrated, fearful, and nervous, thereby imposing physical and mental stress. Caregiving-related mobile apps provide a platform for obtaining valuable and trusted information, connecting more easily with other caregivers, monitoring medications, and managing appointments, and assessing health requirements and conditions of care receivers. Such apps also incorporate valuable resources that address care for the caregivers. Despite the potential benefits of caregiving-related apps, only a limited number of caregivers have adopted and used them. Objective: The aim of this study is to explore the important factors that affect caregivers’ intentions to integrate related mobile apps into their routine caregiving responsibilities. Methods: Using the protection motivation theory, we conducted a cross-sectional study among 249 participants. Purposive sampling was used to target participants who met 4 inclusion criteria: US residents, owning and using a smartphone, informal caregivers (individuals who give care to a friend or family member without payment) who provided at least 8 hours of care per week in the past year, and those currently not using any mobile app for caregiving purposes. We created a survey using Qualtrics and posted it on Amazon’s Mechanical Turk website. Participants received monetary compensation after successful completion of the survey. Results: We found that capabilities and skills of caregivers to use mobile apps, the app’s effectiveness in responding to the needs of caregivers, the degree of control of caregivers over their responsibilities, and the decisions they make for their care receivers can predict their willingness to adopt caregiving-related apps. In addition, the severity of health status and vulnerability of care receivers to unexpected health changes indirectly shape their caregivers’ decisions to adopt and use mobile apps for caregiving purposes. Conclusions: This study explores the important factors that affect informal caregivers’ intentions to adopt related mobile apps into their routine caregiving responsibilities. The results contribute to both mobile health adoption and the caregiving literature, and they offer significant implications for developers, health care practitioners, and policy makers. %M 33729166 %R 10.2196/24755 %U https://mhealth.jmir.org/2021/3/e24755 %U https://doi.org/10.2196/24755 %U http://www.ncbi.nlm.nih.gov/pubmed/33729166 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e21795 %T Attitudes of General Practitioners Toward Prescription of Mobile Health Apps: Qualitative Study %A Sarradon-Eck,Aline %A Bouchez,Tiphanie %A Auroy,Lola %A Schuers,Matthieu %A Darmon,David %+ Aix Marseille University, INSERM, IRD, SESSTIM, UMR1252-CanBios-SESSTIM, 232 Bb Ste Marguerite, Marseille, 13009, France, 33 4 91 22 33 09, aline.sarradon@inserm.fr %K mobile applications %K qualitative research %K general practitioners %K France %K mobile phone %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps are a potential means of empowering patients, especially in the case of multimorbidity, which complicates patients’ care needs. Previous studies have shown that general practitioners (GPs) have both expectations and concerns regarding patients’ use of mHealth apps that could impact their willingness to recommend the apps to patients. Objective: The aim of this qualitative study is to investigate French GPs’ attitudes toward the prescription of mHealth apps or devices aimed toward patients by analyzing GPs’ perceptions and expectations of mHealth technologies. Methods: A total of 36 GPs were interviewed individually (n=20) or in a discussion group (n=16). All participants were in private practice. A qualitative analysis of each interview and focus group was conducted using grounded theory analysis. Results: Considering the value assigned to mHealth apps by participants and their willingness or resistance to prescribe them, 3 groups were defined based on the attitudes or positions adopted by GPs: digital engagement (favorable attitude; mHealth apps are perceived as additional resources and complementary tools that facilitate the medical work, the follow-up care, and the monitoring of patients; and apps increase patients’ compliance and empowerment); patient protection (related to the management of patient care and fear of risks for patients, concerns about patient data privacy and security, doubt about the usefulness for empowering patients, standardization of the medical decision process, overmedicalization, risks for individual freedom, and increasing social inequalities in health); doctor protection (fear of additional tasks and burden, doubt about the actionability of patient-gathered health data, risk for medical liability, dehumanization of the patient-doctor relationship, fear of increased drug prescription, and commodification of patient data). Conclusions: A deep understanding of both the expectations and fears of GPs is essential to motivate them to recommend mHealth apps to their patients. The results of this study show the need to provide appropriate education and training to enhance GPs’ digital skills. Certification of the apps by an independent authority should be encouraged to reassure physicians about ethical and data security issues. Our results highlight the need to overcome technical issues such as interoperability between data collection and medical records to limit the disruption of medical work because of data flow. %M 33661123 %R 10.2196/21795 %U https://mhealth.jmir.org/2021/3/e21795 %U https://doi.org/10.2196/21795 %U http://www.ncbi.nlm.nih.gov/pubmed/33661123 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23362 %T Barriers to the Large-Scale Adoption of a COVID-19 Contact Tracing App in Germany: Survey Study %A Blom,Annelies G %A Wenz,Alexander %A Cornesse,Carina %A Rettig,Tobias %A Fikel,Marina %A Friedel,Sabine %A Möhring,Katja %A Naumann,Elias %A Reifenscheid,Maximiliane %A Krieger,Ulrich %+ School of Social Sciences, University of Mannheim, A5, 6, Mannheim, 68131, Germany, 49 621 181 2298, a.wenz@uni-mannheim.de %K digital health %K mobile health %K smartphone %K mobile phone %K app %K digital technology %K contact tracing %K coronavirus %K COVID-19 %K survey %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, one way to reduce further transmissions of SARS-CoV-2 is the widespread use of contact tracing apps. Such apps keep track of proximity contacts and warn contacts of persons who tested positive for an infection. Objective: In this study, we analyzed potential barriers to the large-scale adoption of the official contact tracing app that was introduced in Germany on June 16, 2020. Methods: Survey data were collected from 3276 adults during the week the app was introduced using an offline-recruited, probability-based online panel of the general adult population in Germany. Results: We estimate that 81% of the population aged 18 to 77 years possess the devices and ability to install the official app and that 35% are also willing to install and use it. Potential spreaders show high access to devices required to install the app (92%) and high ability to install the app (91%) but low willingness (31%) to correctly adopt the app, whereas for vulnerable groups, the main barrier is access (62%). Conclusions: The findings suggest a pessimistic view on the effectiveness of app-based contact tracing to contain the COVID-19 pandemic. We recommend targeting information campaigns at groups with a high potential to spread the virus but who are unwilling to install and correctly use the app, in particular men and those aged between 30 and 59 years. In addition, vulnerable groups, in particular older individuals and those in lower-income households, may be provided with equipment and support to overcome their barriers to app adoption. %M 33577466 %R 10.2196/23362 %U https://www.jmir.org/2021/3/e23362 %U https://doi.org/10.2196/23362 %U http://www.ncbi.nlm.nih.gov/pubmed/33577466 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e19239 %T Interplay of Support, Comparison, and Surveillance in Social Media Weight Management Interventions: Qualitative Study %A Chang,Leanne %A Chattopadhyay,Kaushik %A Li,Jialin %A Xu,Miao %A Li,Li %+ Department of Endocrinology and Metabolism, Ningbo First Hospital, 59 Liuting Street, Ningbo, Zhejiang 315010, China, 86 574 8708 5588, lilyningbo@163.com %K obesity %K social comparison %K social media %K social support %K surveillance %K weight control %D 2021 %7 1.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been a significant increase in the trend of using social media as a platform to deliver weight management interventions. This illustrates a need to develop a holistic understanding of doctor-patient communication and peer-to-peer communication in social media interventions and to determine their influences on weight management for people with overweight or obesity. Such studies will highlight how social media can be more effectively integrated into weight management programs to enhance individuals’ short-term and long-term weight management behaviors. Objective: The aim of this study was to examine patients’ experiences with doctor-patient communication and peer interactions in a social media–based (WeChat) weight management program, and to describe the interplay of three social influence factors—social support, social comparison, and surveillance—in their weight control practices. The program, designed and implemented by the research team located in a tertiary referral hospital in a southeastern province in China, included both diet and physical activity components that targeted people with overweight or obesity. Methods: We conducted in-depth interviews with 32 program participants of different ages (mean 35.6, SD 7.7 years), gender (18 women), duration of program membership (mean 1.4 years), and weight loss outcomes (54% weight loss to 9% weight gain). All interview data were audio-recorded, transcribed, and translated using the translation-backtranslation technique. Nvivo software was used to facilitate the coding process. Results: Results of thematic analysis indicated the distinct functions of professionally led support and peer support. Professional support was presented in the form of knowledge infusion, efficacy enhancement, and provision of timely feedback. Peer support fostered empathy and sense of belonging, and had a mutually reinforcing relationship with peer comparison and peer-based surveillance. Peer comparison enhanced motivation and positive competition. However, it also reinforced negative group norms, and resulted in downturns in reference standards and collective inactivity. Social media surveillance prompted participants’ reactions to the gaze from medical professionals and peers that could be encouraging or inhibiting. Surveillance enhanced vigilance with weight control norms; however, its influence weakened when participants chose to fake weight data and turn off notifications. Findings from this study illustrated the interrelated and fluctuating influences of support, comparison, and surveillance. Conclusions: The interactive traits of social media eased the practices of social support and social comparison, and created new forms of surveillance. This study contributes to an in-depth understanding of social media influences on individuals’ weight control behaviors. Practical implications of the study concern improved strategies for maintaining the positive dynamics of social media interactions and preventing negative resistance to surveillance technology. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900025861; http://www.chictr.org.cn/showprojen.aspx?proj=42497 %M 33646130 %R 10.2196/19239 %U https://mhealth.jmir.org/2021/3/e19239 %U https://doi.org/10.2196/19239 %U http://www.ncbi.nlm.nih.gov/pubmed/33646130 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e17573 %T A Novel User Utility Score for Diabetes Management Using Tailored Mobile Coaching: Secondary Analysis of a Randomized Controlled Trial %A Lee,Min-Kyung %A Lee,Da Young %A Ahn,Hong-Yup %A Park,Cheol-Young %+ Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea, 82 2 2001 1869, cydoctor@chol.com %K type 2 diabetes %K mobile applications %K diabetes management %K patient engagement %D 2021 %7 24.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health applications have been developed to support diabetes self-management, but their effectiveness could depend on patient engagement. Therefore, patient engagement must be examined through multifactorial tailored behavioral interventions from an individual perspective. Objective: This study aims to evaluate the usefulness of a novel user utility score (UUS) as a tool to measure patient engagement by using a mobile health application for diabetes management. Methods: We conducted a subanalysis of results from a 12-month randomized controlled trial of a tailored mobile coaching (TMC) system among insurance policyholders with type 2 diabetes. UUS was calculated as the sum of the scores for 4 major core components (range 0-8): frequency of self-monitoring blood glucose testing, dietary and exercise records, and message reading rate. We explored the association between UUS for the first 3 months and glycemic control over 12 months. In addition, we investigated the relationship of UUS with blood pressure, lipid profile, and self-report scales assessing diabetes self-management. Results: We divided 72 participants into 2 groups based on UUS for the first 3 months: UUS:0-4 (n=38) and UUS:5-8 (n=34). There was a significant between-group difference in glycated hemoglobin test (HbA1c) levels for the 12-months study period (P=.011). The HbA1c decrement at 12 months in the UUS:5-8 group was greater than that of the UUS:0-4 group [–0.92 (SD 1.24%) vs –0.33 (SD 0.80%); P=.049]. After adjusting for confounding factors, UUS was significantly associated with changes in HbA1c at 3, 6, and 12 months; the regression coefficients were –0.113 (SD 0.040; P=.006), –0.143 (SD 0.045; P=.002), and –0.136 (SD 0.052; P=.011), respectively. Change differences in other health outcomes between the 2 groups were not observed throughout a 12-month follow-up. Conclusions: UUS as a measure of patient engagement was associated with changes in HbA1c over the study period of the TMC system and could be used to predict improved glycemic control in diabetes self-management through mobile health interventions. Trial Registration: ClinicalTrial.gov NCT03033407; https://clinicaltrials.gov/ct2/show/NCT03033407 %M 33625363 %R 10.2196/17573 %U https://mhealth.jmir.org/2021/2/e17573 %U https://doi.org/10.2196/17573 %U http://www.ncbi.nlm.nih.gov/pubmed/33625363 %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 %@ 2369-3762 %I JMIR Publications %V 7 %N 1 %P e18590 %T Willingness to Use Digital Health Tools in Patient Care Among Health Care Professionals and Students at a University Hospital in Saudi Arabia: Quantitative Cross-sectional Survey %A Thapa,Subash %A Nielsen,Jesper Bo %A Aldahmash,Abdullah M %A Qadri,Fatima R %A Leppin,Anja %+ Research Unit of General Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, Odense, 5000, Denmark, 45 65504931, sthapa@health.sdu.dk %K attitude %K digital health %K electronic medical record %K health care professionals %K health care students %K Saudi Arabia %K self-efficacy %K telemedicine %K willingness to use %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: The adoption rate of digital health in the health care sector is low in many countries. A facilitating factor for successful implementation and adoption of digital health is acceptance by current and future health care professionals. Objective: This study was conducted to identify factors associated with willingness to use digital health tools in patient care among health care professionals and students. Methods: This was a quantitative cross-sectional survey study conducted among health care professionals and students at a university hospital in Riyadh, Saudi Arabia. A nonprobability convenience sampling procedure was used to recruit participants. Data were collected using a self-completed e-questionnaire that was distributed by email. Chi-square tests, t tests, and logistic regression were used to analyze the data. Results: We found that 181 out of 218 health care professionals (83.0%; 75.6% [59/78] physicians; 87.1% [122/140] nurses) and 115 out of 154 students (74.7%; 80.0% [76/95] medical students and 66.1% [39/59] nursing students) were willing to use digital tools in patient care. Willingness to use digital tools was significantly associated with attitude (Adjusted Odds Ratios [AOR] 1.96; 95% CI 1.14-3.36) and self-efficacy (AOR 1.64; 95% CI 1.17-2.30) among health care professionals, and with current year of study (AOR 2.08; 95% CI 1.18-3.68) and self-efficacy (AOR 1.77; 95% CI 1.17-2.69) among students. No significant difference in willingness to use digital tools was found between physicians and nurses (P=.113), and between medical and nursing students (P=.079). Conclusions: The findings of this study should encourage policy makers and hospital managers to implement relevant eHealth interventions within routine health care systems in Saudi Arabia. For successful implementation, digital health education programs should be implemented simultaneously, so that current and future health care professionals are able to develop required positive attitudes as well as practical skills and competencies. %M 33605896 %R 10.2196/18590 %U http://mededu.jmir.org/2021/1/e18590/ %U https://doi.org/10.2196/18590 %U http://www.ncbi.nlm.nih.gov/pubmed/33605896 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24570 %T Digital Medicine Community Perspectives and Challenges: Survey Study %A Bent,Brinnae %A Sim,Ida %A Dunn,Jessilyn P %+ Department of Biostatistics & Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Durham, NC, 27705, United States, 1 9196689798, jessilyn.dunn@duke.edu %K digital medicine %K digital health %K interoperability %K mHealth %K wearables %K sensors %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The field of digital medicine has seen rapid growth over the past decade. With this unfettered growth, challenges surrounding interoperability have emerged as a critical barrier to translating digital medicine into practice. In order to understand how to mitigate challenges in digital medicine research and practice, this community must understand the landscape of digital medicine professionals, which digital medicine tools are being used and how, and user perspectives on current challenges in the field of digital medicine. Objective: The primary objective of this study is to provide information to the digital medicine community that is working to establish frameworks and best practices for interoperability in digital medicine. We sought to learn about the background of digital medicine professionals and determine which sensors and file types are being used most commonly in digital medicine research. We also sought to understand perspectives on digital medicine interoperability. Methods: We used a web-based survey to query a total of 56 digital medicine professionals from May 1, 2020, to July 10, 2020, on their educational and work experience, the sensors, file types, and toolkits they use professionally, and their perspectives on interoperability in digital medicine. Results: We determined that the digital medicine community comes from diverse educational backgrounds and uses a variety of sensors and file types. Sensors measuring physical activity and the cardiovascular system are the most frequently used, and smartphones continue to be the dominant source of digital health information collection in the digital medicine community. We show that there is not a general consensus on file types in digital medicine, and data are currently handled in multiple ways. There is consensus that interoperability is a critical impediment in digital medicine, with 93% (52) of survey respondents in agreement. However, only 36% (20) of respondents currently use tools for interoperability in digital medicine. We identified three key interoperability needs to be met: integration with electronic health records, implementation of standard data schemas, and standard and verifiable methods for digital medicine research. We show that digital medicine professionals are eager to adopt new tools to solve interoperability problems, and we suggest tools to support digital medicine interoperability. Conclusions: Understanding the digital medicine community, the sensors and file types they use, and their perspectives on interoperability will enable the development and implementation of solutions that fill critical interoperability gaps in digital medicine. The challenges to interoperability outlined by this study will drive the next steps in creating an interoperable digital medicine community. Establishing best practices to address these challenges and employing platforms for digital medicine interoperability will be essential to furthering the field of digital medicine. %M 33533721 %R 10.2196/24570 %U http://mhealth.jmir.org/2021/2/e24570/ %U https://doi.org/10.2196/24570 %U http://www.ncbi.nlm.nih.gov/pubmed/33533721 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24539 %T Examining an Integrative Cognitive Model of Predicting Health App Use: Longitudinal Observational Study %A Kim,Kwanho %A Lee,Chul-Joo %+ Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA, 19104, United States, 1 215 898 7041, kwanho.kim@asc.upenn.edu %K mHealth %K health apps %K digital divide %K integrative model of behavioral prediction %K path analysis %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Specifying the determinants of using health apps has been an important research topic for health scholars as health apps have proliferated during the past decade. Socioeconomic status (SES) has been revealed as a significant determinant of using health apps, but the cognitive mechanisms underlying the relationship between SES and health app use are unknown. Objective: This study aims to examine the cognitive mechanisms underlying the relationships between SES and use of health apps, applying the integrative model of behavioral prediction (IM). The model hypothesizes the indirect influences of SES on intentions to use health apps, which in turn predict actual use of health apps. The relationships between SES and intentions to use health apps were assumed to be mediated by proximal variables (attitudes, perceived behavioral control [PBC], injunctive norms, and descriptive norms). Methods: We conducted path analyses using data from a two-wave opt-in panel survey of Korean adults who knew about health apps. The number of respondents was 605 at baseline and 440 at follow-up. We compared our model with two alternative theoretical models based on modified IM to further clarify the roles of determinants of health app use. Results: Attitudes (β=.220, P<.001), PBC (β=.461, P<.001), and injunctive norms (β=.186, P<.001) were positively associated with intentions to use health apps, which, in turn, were positively related to actual use of health apps (β=.106, P=.03). Income was positively associated with intentions to use health apps, and this relationship was mediated by attitudes (B=0.012, 95% CI 0.001-0.023) and PBC (B=0.026, 95% CI 0.004-0.048). Education was positively associated with descriptive norms (β=.078, P=.03), but descriptive norms were not significantly related to intentions to use health apps. We also found that PBC interacted with attitudes (B=0.043, SE 0.022, P=.046) and jointly influenced intentions to use health apps, whereas the results did not support direct influences of education, income, and PBC on health app use. Conclusions: We found that PBC over using health apps may be the most important factor in predicting health app use. This suggests the necessity of designing and promoting health apps in a user-friendly way. Our findings also imply that socioeconomic inequalities in using health apps may be reduced by increasing positive attitudes toward, and boosting PBC over, health app use among individuals with low income. %M 33533724 %R 10.2196/24539 %U https://mhealth.jmir.org/2021/2/e24539 %U https://doi.org/10.2196/24539 %U http://www.ncbi.nlm.nih.gov/pubmed/33533724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e17837 %T The Promise and Peril of Mobile Phones for Youth in Rural Uganda: Multimethod Study of Implications for Health and HIV %A Kreniske,Philip %A Basmajian,Alyssa %A Nakyanjo,Neema %A Ddaaki,William %A Isabirye,Dauda %A Ssekyewa,Charles %A Nakubulwa,Rosette %A Hirsch,Jennifer S %A Deisher,Andrea %A Nalugoda,Fred %A Chang,Larry W %A Santelli,John S %+ HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 722 West 168th Street, New York, NY, New York, United States, 1 646 774 6947, pk2361@columbia.edu %K adolescence %K youth %K mobile phones %K cell phones %K mobility %K HIV %K East Africa %D 2021 %7 2.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In East Africa, where landlines are used by 1% of the population and access to the internet is limited, owning a cell phone is rapidly becoming essential for acquiring information and resources. Our analysis illuminates the perils and potential promise of mobile phones with implications for future interventions to promote the health of adolescents and young adults (AYAs) and to prevent HIV infection. Objective: The aim of this study is to describe the current state of AYAs’ phone use in the region and trace out the implications for mobile health interventions. Methods: We identified 2 trading centers that were representative of southern Uganda in terms of key demographics, proportion of cell phone ownership, and community HIV prevalence. We stratified the sample of potential informants by age group (15-19 years and 20-24 years), gender, and phone ownership and randomly sampled 31 key informant interview participants within these categories. In addition, we conducted 24 ethnographic participant observations among AYAs in the communities of study. Results: AYA frequently reported barriers to using their phones, such as difficulty accessing electricity. Nearly all AYAs used mobile phones to participate in the local economy and communicate with sexual partners. Phone use was frequently a point of contention between sexual partners, with many AYAs reporting that their sexual partners associated phone use with infidelity. Few AYAs reported using their phones for health-related purposes, with most getting health information in person from health workers. However, most AYAs reported an instance when they used their phone in an emergency, with childbirth-related emergencies being the most common. Finally, most AYAs reported that they would like to use their phones for health purposes and specifically stated that they would like to use their mobile phones to access current HIV prevention information. Conclusions: This study demonstrates how mobile phones are related to income-generating practices in the region and communication with sexual partners but not access to health and HIV information. Our analysis offers some explanation for our previous study, which suggested an association between mobile phone ownership, having multiple sexual partners, and HIV risk. Mobile phones have untapped potential to serve as tools for health promotion and HIV prevention. %M 33528375 %R 10.2196/17837 %U https://www.jmir.org/2021/2/e17837 %U https://doi.org/10.2196/17837 %U http://www.ncbi.nlm.nih.gov/pubmed/33528375 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e25456 %T It Is Time to REACT: Opportunities for Digital Mental Health Apps to Reduce Mental Health Disparities in Racially and Ethnically Minoritized Groups %A Friis-Healy,Elsa A %A Nagy,Gabriela A %A Kollins,Scott H %+ Department of Psychiatry and Behavioral Services, Duke University School of Medicine, 2608 Erwin Road, Durham, NC, 27705, United States, 1 919 681 0014, eaf23@duke.edu %K digital health %K app %K public mental health %K health disparities %K COVID-19 %K pandemic %K mental health %K disparity %K behavior %D 2021 %7 26.1.2021 %9 Viewpoint %J JMIR Ment Health %G English %X The behavioral health toll of the COVID-19 pandemic and systemic racism has directed increased attention to the potential of digital health as a way of improving access to and quality of behavioral health care. However, as the pandemic continues to widen health disparities in racially and ethnically minoritized groups, concerns arise around an increased reliance on digital health technologies exacerbating the digital divide and reinforcing rather than mitigating systemic health inequities in communities of color. As funding for digital mental health continues to surge, we offer five key recommendations on how the field can “REACT” to ensure the development of approaches that increase health equity by increasing real-world evidence, educating consumers and providers, utilizing adaptive interventions to optimize care, creating for diverse populations, and building trust. Recommendations highlight the need to take a strengths-based view when designing for racially and ethnically diverse populations and embracing the potential of digital approaches to address complex challenges. %M 33406050 %R 10.2196/25456 %U http://mental.jmir.org/2021/1/e25456/ %U https://doi.org/10.2196/25456 %U http://www.ncbi.nlm.nih.gov/pubmed/33406050 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e20314 %T Mobile Phone Use and Acceptability for the Delivery of Mental Health Information Among Perinatal Adolescents in Nigeria: Survey Study %A Kola,Lola %A Abiona,Dolapo %A Adefolarin,Adeyinka Olufolake %A Ben-Zeev,Dror %+ University of Ibadan, Department of Psychiatry, College of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Ibadan, , Nigeria, 234 8057943775, lola_kola2004@yahoo.com %K mHealth %K perinatal adolescent %K perinatal depression %K community %K low income %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: There are several barriers that may hamper adolescent mothers’ utilization of available health interventions for perinatal depression. Innovative treatment approaches are needed to increase adolescent mothers’ access to mental health care for improved maternal and child health outcomes. Mobile phones have the potential to serve as important conduits to mental health care in Africa. However, mobile phone use patterns and needs among young mothers in Nigeria are not well documented. Objective: This study sought to determine the prevalence of mobile phone use among perinatal adolescents and report patterns of use, as well as to assess the openness of young mothers to mobile health (mHealth) mental health interventions. Methods: We surveyed 260 adolescent mothers (ages 16-19 years) in their perinatal or postnatal periods of pregnancies in 33 primary health care clinics in Ibadan, Oyo State, Nigeria in 2020. Respondents were included if they were pregnant with a gestation age of greater than or equal to 4 weeks, or had babies (which they had birthed) that were younger than 12 months. Results: The total study sample consisted of 260 adolescent mothers with a mean age of 18.4 (SD 0.88) years. The majority of the respondents (233/260, 89.6%) owned mobile phones (eg, keypad, keypad and internet, smartphones); 22 (8.5%) of the 260 mothers had access to phones that belonged to relatives who lived in the same household, while 5 (1.9%) had access only to public paid phones. Only 23% (54/233) of phone owners (which is 20.5% of the total study population) had smartphones. On average, respondents reported first using mobile phones at 15.5 (SD 2.06) years old. The majority of respondents (222/260, 85.4%) reported using their phones for an average of 45 minutes daily for calls to family members. Facebook was the social media platform that was most often used among respondents who had phones with internet access (122/146 minutes per day, 83.4%). The majority of the sample responded as being “interested” and “very interested” in the use of mobile phones for preventive interventions (250/260, 96.2%) and treatment (243/260, 93.5%) information on mental illness such as depression and “hearing voices.” Half of the respondents (126/233, 50.4%) preferred to receive such information in the form of text messages. Conclusions: Findings from this study suggest that the vast majority of perinatal adolescents in Nigeria own and use mobile phones and that they are interested in leveraging these devices for prevention, treatment, and informational campaigns focused on mental health. The use of smartphones in this population is relatively low, and health intervention through text messages were favored by the women. %M 33496678 %R 10.2196/20314 %U http://mental.jmir.org/2021/1/e20314/ %U https://doi.org/10.2196/20314 %U http://www.ncbi.nlm.nih.gov/pubmed/33496678 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e21244 %T Mobile Phone Access and Implications for Digital Health Interventions Among Adolescents and Young Adults in Zimbabwe: Cross-Sectional Survey %A Doyle,Aoife M %A Bandason,Tsitsi %A Dauya,Ethel %A McHugh,Grace %A Grundy,Chris %A Dringus,Stefanie %A Dziva Chikwari,Chido %A Ferrand,Rashida A %+ MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E7HT, United Kingdom, 44 207 927 2041, aoife.doyle@lshtm.ac.uk %K adolescent %K young adult %K young person %K young people %K cross-sectional studies %K humans %K female %K male %K mobile phone %K smartphone %K cell phones %K technology %K internet %K safety %K health-related internet use %K Zimbabwe %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phones may help young people (YP) access health information and support health service engagement. However, in low-income settings there is limited knowledge on YP’s phone and internet access to inform the feasibility of implementing digital health interventions. Objective: We investigated access to information and communication technologies among adolescents and young adults in Zimbabwe. Methods: A cross-sectional population-based survey was conducted from October to December 2018 among YP aged 13-24 years in 5 communities in urban and peri-urban Harare and Mashonaland East, Zimbabwe. Consenting YP completed a self-completed tablet-based questionnaire on mobile phone ownership and use, and use of the internet. The primary outcome was the proportion who reported owning a mobile phone. Secondary outcomes included phone and internet access and use behavior, and ownership and use of other technological devices. Multivariable logistic regression was used to investigate factors associated with mobile phone ownership and with internet access, with adjustment for the one-stage cluster sampling design. A priori exploratory variables were age, sex, marital status, and urban/peri-urban residence. Results: A total of 634/719 (88.2%) eligible YP, mean age 18.0 years (SD 3.3) and 62.6% (397/634) females, participated. Of the YP interviewed, 62.6% (396/633; 95% CI 58.5-66.5) reported owning a phone and a further 4.3% (27/633) reported having access to a shared phone. Phone ownership increased with age: 27.0% (43/159) of 13-15-year olds, 61.0% (72/118) of 16-17-year olds, 71.5% (103/144) of 18-19-year olds, and 84.7% (171/202) of 20-24-year olds (odds ratio [OR] 1.4, 95% CI 1.3-1.5) per year increase. Ownership was similar among females and males: 61.0% (236/387; 95% CI 55.6-66.1) versus 64.8% (153/236; 95% CI 57.8-71.2), age-adjusted OR 0.7 (95% CI 0.5-1.1); higher in those with secondary level education compared to primary or no education: 67.1% (346/516; 95% CI 62.6-71.2) versus 26% (21/82; 95% CI 16.4-37.7), age-adjusted OR 2.3 (95% CI 1.1-4.8); and similar across other sociodemographic factors. YP reported that 85.3% (361/423) of phones, either owned or shared, were smartphones. Among phone owners, the most commonly used phone app was WhatsApp (71.2%, 282/396), and 16.4% (65/396) reported having ever used their phone to track their health. A total of 407/631 (64.5%; 95% CI 60.3-68.5) currently had access to the internet (used in last 3 months on any device) with access increasing with age (OR 1.2, 95% CI 1.2-1.3 per year increase). In age-adjusted analysis, internet access was higher among males, the unmarried, those with a higher level of education, phone owners, and those who had lived in the community for more than 1 year. The aspect of the internet that YP most disliked was unwanted sexual (29.2%, 136/465) and violent (13.1%, 61/465) content. Conclusions: Mobile phone–based interventions may be feasible in this population; however, such interventions could increase inequity, especially if they require access to the internet. Internet-based interventions should consider potential risks for participants and incorporate skill-building sessions on safe internet and phone use. %M 33439136 %R 10.2196/21244 %U https://mhealth.jmir.org/2021/1/e21244 %U https://doi.org/10.2196/21244 %U http://www.ncbi.nlm.nih.gov/pubmed/33439136 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e17538 %T Patterns of Use of Smartphone-Based Interventions Among Latina Breast Cancer Survivors: Secondary Analysis of a Pilot Randomized Controlled Trial %A Baik,Sharon H %A Oswald,Laura B %A Buscemi,Joanna %A Buitrago,Diana %A Iacobelli,Francisco %A Perez-Tamayo,Alejandra %A Guitelman,Judith %A Penedo,Frank J %A Yanez,Betina %+ Department of Supportive Care Medicine, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, United States, 1 626 256 4673, shbaik@coh.org %K breast cancer %K cancer survivorship %K Hispanics/Latinas %K eHealth %K psychosocial intervention %K mobile phone %D 2020 %7 8.12.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Latina breast cancer survivors experience poorer health-related quality of life (HRQoL), greater symptom burden, and more psychosocial needs compared to non-Latina breast cancer survivors. eHealth platforms such as smartphone apps are increasingly being used to deliver psychosocial interventions to cancer survivors. However, few psychosocial eHealth interventions have been developed specifically for Latina breast cancer survivors. Further, little is known about how Latinas, in general, engage with eHealth interventions and whether specific participant characteristics are associated with app use in this population. We evaluated the use of 2 culturally informed, evidence-based smartphone apps for Latina breast cancer survivors—one that was designed to improve HRQoL and reduce symptom burden (My Guide) and the other to promote healthy lifestyle behaviors (My Health). Objective: The objectives of our study were to explore the patterns of use of the My Guide intervention app and My Health attention-control app among Latina breast cancer survivors. Methods: Eighty Latina breast cancer survivors were randomized to use the My Guide or My Health app for 6 weeks. Assessments were collected at baseline (T1), immediately after the 6-week intervention (T2), and 2 weeks after T2 (T3). Specific study outcomes included subdomains of HRQoL, symptom burden, cancer-specific distress, cancer-relevant self-efficacy, and breast cancer knowledge. Results: On average, participants used their assigned app for more than 1 hour per week. Sociodemographic or psychological characteristics were not significantly associated with app use, except for employment status in the My Health group. Content related to common physical and emotional symptoms of breast cancer survivors as well as recommendations for nutrition and physical activity were most frequently accessed by My Guide and My Health participants, respectively. Lastly, clinically meaningful improvements were demonstrated in breast cancer well-being among low app users (ie, <60 minutes of use/week) of My Guide and social well-being among high app users (ie, ≥60 minutes of use/week) of My Health. Conclusions: The favorable rates of participant use across both apps suggest that Latina breast cancer survivors are interested in the content delivered across both My Guide and My Health. Furthermore, since sociodemographic variables, excluding employment status, and baseline HRQoL (psychological variable) were not related to app use, My Guide and My Health may be accessible to diverse Latina breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03645005; https://clinicaltrials.gov/ct2/show/NCT03645005 %M 33289669 %R 10.2196/17538 %U http://cancer.jmir.org/2020/2/e17538/ %U https://doi.org/10.2196/17538 %U http://www.ncbi.nlm.nih.gov/pubmed/33289669 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e14787 %T Smartphone and App Usage in Orthopedics and Trauma Surgery: Survey Study of Physicians Regarding Acceptance, Risks, and Future Prospects in Germany %A Dittrich,Florian %A Back,David Alexander %A Harren,Anna Katharina %A Landgraeber,Stefan %A Reinecke,Felix %A Serong,Sebastian %A Beck,Sascha %+ Department for Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstraße 100, Building 37, Homburg, 66421, Germany, 49 68411624520, Florian.Dittrich@uks.eu %K mHealth %K smartphone %K communication %K medicine %K surveys and questionnaires %K technology %K orthopedics %K trauma surgery %D 2020 %7 30.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In the course of digitization, smartphones are affecting an increasing number of areas of users’ lives, giving them almost ubiquitous access to the internet and other web applications. Mobile health (mHealth) has become an integral part of some areas of patient care. In contrast to other disciplines, routine integration of mobile devices in orthopedics and trauma surgery in Germany is still in its infancy. Objective: This study aimed to investigate physicians’ current state of opinion regarding acceptance, future prospects, and risks of medical apps in the field of orthopedics and trauma surgery in Germany. Methods: A web-based survey among orthopedics and trauma surgeons in German university hospitals on the use of medical apps in everyday clinical practice was conducted between September 2018 and February 2019. The survey consisted of 13 open- and closed-ended or multiple-choice questions. A logistic regression analysis was performed to ascertain the effects of interindividual characteristics on the likelihood of participants’ app and smartphone usage behavior. Results: A total of 206 physicians participated in the survey. All of the participants (206/206, 100%) owned a smartphone, and 79.1% (159/201) used the device, while 64.7% (130/201) used apps regularly in everyday clinical practice. Medical apps were perceived as beneficial, given their substantial future promise, by 90.1% (181/201) of the participants. However, 62.5% (120/192) of the participants were not satisfied with the current supply of medical apps in app stores. Desired specifications for future apps were “intuitive usability” (167/201, 83.1%), “no advertising” (145/201, 72.1%), and “free apps” (92/201, 45.8%). The attributes “transparent app development and app sponsoring” (75/201, 37.3%) and the existence of an “easy-to-understand privacy statement” (50/201, 24.9%) were of minor relevance. The majority of the participants (162/194, 83.5%) considered that future apps in the field of “medical research” would provide the greatest benefit. The greatest predicted risks were “data misuse” (147/189, 77.8%), “usage of untrustworthy apps” (135/189, 71.4%), and “alienation from patients” (51/189, 27.0%). Increasing age was significantly associated with a reduction in the likelihood of regular smartphone (odds ratio [OR] 0.91, 95% CI 0.86-0.97; P=.002) and app (OR 0.90, 95% CI 0.85-0.96; P=.001) usage, while the medical profession grade had no significant impact on the usage behavior. Conclusions: The study demonstrates that young German doctors in orthopedics and trauma surgery already use smartphones and apps in everyday clinical practice. Medical apps are considered to play an important role in the future. However, a significant discrepancy exists between the supply and demand of mHealth applications, which creates a legal and ethical vacuum with regard to data protection. %M 33252340 %R 10.2196/14787 %U http://formative.jmir.org/2020/11/e14787/ %U https://doi.org/10.2196/14787 %U http://www.ncbi.nlm.nih.gov/pubmed/33252340 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e24718 %T Comparison of Mobile Health Technology Use for Self-Tracking Between Older Adults and the General Adult Population in Canada: Cross-Sectional Survey %A Jaana,Mirou %A Paré,Guy %+ Telfer School of Management, University of Ottawa, 55 Laurier Ave East, Ottawa, ON, K1N 6N5, Canada, 1 16135625800 ext 3400, jaana@telfer.uottawa.ca %K mobile health %K older adults %K self-tracking %K wearable technology %K smart devices %K mobile apps %K survey %K mobile phone %K seniors %K elderly %D 2020 %7 27.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The burden of population aging and chronic conditions has been reported worldwide. Older adults, especially those with high needs, experience social isolation and have high rates of emergency visits and limited satisfaction with the care they receive. Mobile health (mHealth) technologies present opportunities to address these challenges. To date, limited information is available on Canadian older adults’ attitudes toward and use of mHealth technologies for self-tracking purposes—an area that is increasingly important and relevant during the COVID-19 era. Objective: This study presents contributions to an underresearched area on older adults and mHealth technology use. The aim of this study was to compare older adults’ use of mHealth technologies to that of the general adult population in Canada and to investigate the factors that affect their use. Methods: A cross-sectional survey on mHealth and digital self-tracking was conducted. A web-based questionnaire was administered to a national sample of 4109 Canadian residents who spoke either English or French. The survey instrument consisted of 3 sections assessing the following items: (1) demographic characteristics, health status, and comorbidities; (2) familiarity with and use of mHealth technologies (ie, mobile apps, consumer smart devices/wearables such as vital signs monitors, bathroom scales, fitness trackers, intelligent clothing); and (3) factors influencing the continued use of mHealth technologies. Results: Significant differences were observed between the older adults and the general adult population in the use of smart technologies and internet (P<.001). Approximately 47.4% (323/682) of the older adults in the community reported using smartphones and 49.8% (340/682) indicated using digital tablets. Only 19.6% (91/463) of the older adults using smartphones/digital tablets reported downloading mobile apps, and 12.3% (47/383) of the older adults who heard of smart devices/wearables indicated using them. The majority of the mobile apps downloaded by older adults was health-related; interestingly, their use was sustained over a longer period of time (P=.007) by the older adults compared to that by the general population. Approximately 62.7% (428/682) of the older adults reported tracking their health measures, but the majority did so manually. Older adults with one or more chronic conditions were mostly nontrackers (odds ratio 0.439 and 0.431 for traditional trackers and digital trackers, respectively). No significant differences were observed between the older adults and the general adult population with regard to satisfaction with mHealth technologies and their intention to continue using them. Conclusions: Leveraging mHealth technologies in partnership with health care providers and sharing of health/well-being data with health care professionals and family members remain very limited. A culture shift in the provision of care to older adults is deemed necessary to keep up with the development of mHealth technologies and the changing demographics and expectations of patients and their caregivers. %M 33104517 %R 10.2196/24718 %U http://mhealth.jmir.org/2020/11/e24718/ %U https://doi.org/10.2196/24718 %U http://www.ncbi.nlm.nih.gov/pubmed/33104517 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e18774 %T Nurses’ Use of Personal Smartphone Technology in the Workplace: Scoping Review %A de Jong,Andrea %A Donelle,Lorie %A Kerr,Michael %+ Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, FNB Rm 2356 Faculty of Health Science Western Uni, 1115 Richmond St, London, ON, N6A 5B9, Canada, 1 5196612111 ext 86565, ldonelle@uwo.ca %K nurses %K digital health %K smartphone %K evidence-informed practice %D 2020 %7 26.11.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: There has been an increase in the technological infrastructures of many health care organizations to support the practice of health care providers. However, many nurses are using their personal digital devices, such as smartphones, while at work for personal and professional purposes. Despite the proliferation of smartphone use in the health care setting, there is limited research on the clinical use of these devices by nurses. It is unclear as to what extent and for what reasons nurses are using their personal smartphones to support their practice. Objective: This review aimed to understand the current breadth of research on nurses’ personal smartphone use in the workplace and to identify implications for research, practice, and education. Methods: A scoping review using Arksey and O’Malley’s methodological framework was conducted, and the following databases were used in the literature search: CINAHL, PubMed, ProQuest Dissertations and Theses, Embase, MEDLINE, Nursing and Allied Health Database, Scopus, Web of Science, and Cochrane Reviews. Search terms used were Nurs* AND (personal digital technology OR smartphone OR cellphone OR mobile phone OR cellular phone). Inclusion criteria included research focused on nurses’ use of their own digital technologies, reported in English, and published between January 2010 and January 2020. Exclusion criteria were if the device or app was implemented for research purposes, if it was provided by the organization, if it focused on infection control, and if it was focused on nursing students or nursing education. Results: A total of 22 out of 2606 articles met the inclusion criteria. Two main themes from the thematic analyses included personal smartphone use for patient care and implications of personal smartphone use. Nurses used their smartphones to locate information about medications, procedures, diagnoses, and laboratory tests. Downloaded apps were used by nurses to locate patient care–related information. Nurses reported improved communication among health team members and used their personal devices to communicate patient information via text messaging, calling, and picture and video functions. Nurses expressed insight into personal smartphone use and challenges related to distraction, information privacy, organizational policies, and patient perception. Conclusions: Nurses view personal smartphones as an efficient method to gather patient care information and to communicate with the health care team. This review highlights knowledge gaps regarding nurses’ personal device use and information safety, patient care outcomes, and communication practices. This scoping review facilitates critical reflection on patient care practices within the digital context. We infer that nurses’ use of their personal devices to communicate among the health care team may demonstrate a technological “work-around” meant to reconcile health system demands for cost-efficiency with efforts to provide quality patient care. The current breadth of research is focused on acute care, with little research focus in other practices settings. Research initiatives are needed to explore personal device use across the continuum of health care settings. %M 33242012 %R 10.2196/18774 %U https://mhealth.jmir.org/2020/11/e18774 %U https://doi.org/10.2196/18774 %U http://www.ncbi.nlm.nih.gov/pubmed/33242012 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e19508 %T Use of the Consumer-Based Meditation App Calm for Sleep Disturbances: Cross-Sectional Survey Study %A Huberty,Jennifer %A Puzia,Megan E %A Larkey,Linda %A Irwin,Michael R %A Vranceanu,Ana-Maria %+ College of Health Solutions, Arizona State University, 550 North 3rd St., Phoenix, AZ, 85004, United States, 1 602 827 2456, jennifer.huberty@asu.edu %K insomnia %K mental health %K mindfulness %K meditation %K mobile apps %K consumer behavior %K mobile phone %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Over 30% of Americans report regular sleep disturbance, and consumers are increasingly seeking strategies to improve sleep. Self-guided mindfulness mobile apps may help individuals improve their sleep. Despite the recent proliferation of sleep content within commercially available mindfulness apps, there is little research on how consumers are using these apps for sleep. Objective: We conducted a cross-sectional survey among subscribers to Calm, a popular, consumer-based, mindfulness-based meditation app, and described and compared how good sleepers, poor sleepers, and those with self-reported insomnia use the app for sleep. Methods: Participants who were paying subscribers of Calm and had used a sleep component of Calm in the last 90 days were invited to complete an investigator-developed survey that included questions about sleep disturbance and the use of Calm for sleep. Based on self-reports of sleep disturbances and of insomnia diagnosis, participants were categorized as “good sleepers,” “poor sleepers,” or “those with insomnia diagnosis.” Chi-square tests compared reasons for downloading the app and usage patterns across participants with and without sleep disturbance. Results: There was a total of 9868 survey respondents. Approximately 10% of participants (1008/9868, 10.21%) were good sleepers, 78% were poor sleepers (7565/9868, 77.66%), and 11% reported a diagnosis of insomnia (1039/9868, 10.53%). The sample was mostly White (8185/9797, 83.55%), non-Hispanic (8929/9423, 94.76%), and female (8166/9578, 85.26%). The most common reasons for sleep disturbances were racing thoughts (7084/8604, 82.33%), followed by stress or anxiety (6307/8604, 73.30%). Poor sleepers and those with insomnia were more likely than good sleepers to have downloaded Calm to improve sleep (χ22=1548.8, P<.001), reduce depression or anxiety (χ22=15.5, P<.001), or improve overall health (χ22=57.6, P<.001). Respondents with insomnia used Calm most often (mean 5.417 days/week, SD 1.936), followed by poor sleepers (mean 5.043 days/week, SD 2.027; F2=21.544, P<.001). The most common time to use Calm was while lying down to sleep (7607/9686, 78.54%), and bedtime use was more common among poor sleepers and those with insomnia (χ22=382.7, P<.001). Compared to good and poor sleepers, those with insomnia were more likely to use Calm after waking up at night (χ22=410.3, P<.001). Most participants tried to use Calm on a regular basis (5031/8597, 58.52%), but regular nighttime use was most common among those with insomnia (646/977, 66.1%), followed by poor sleepers (4040/6930, 58.30%; χ22=109.3, P<.001). Conclusions: Of the paying subscribers to Calm who have used one of the sleep components, approximately 90% have sleep difficulties, and 77% started using Calm primarily for sleep. These descriptive data point to areas of focus for continued refinement of app features and content, followed by prospective trials testing efficacy of consumer-based meditation mobile apps for improving sleep. %M 33185552 %R 10.2196/19508 %U http://formative.jmir.org/2020/11/e19508/ %U https://doi.org/10.2196/19508 %U http://www.ncbi.nlm.nih.gov/pubmed/33185552 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18312 %T Comparison of Older and Younger Adults’ Attitudes Toward the Adoption and Use of Activity Trackers %A Kim,Sunyoung %A Choudhury,Abhishek %+ School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 8489327585, sunyoung.kim@rutgers.edu %K older adults %K technology acceptance %K activity tracker %K fitness tracker %K mHealth %K health care %K quality of life %D 2020 %7 22.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Activity tracking devices have significant potential in assisting older adults’ health care and quality of life, but this population lags behind in the adoption of these devices. While theoretical frameworks have been introduced to explain and increase the adoption of this technology by older adults, little effort has been made to validate the frameworks with people in other age groups. Objective: The goal of this study was to validate the theoretical framework of technology acceptance by older adults that we previously proposed through a direct comparison of the attitudes to and experiences of activity trackers in older and younger users. Methods: Semistructured interviews were conducted with 2 groups of 15 participants to investigate their experiences of using activity trackers. The recruitment criteria included age (between 18 years and 24 years for the younger participant group or 65 years and older for the older participant group) and prior experiences of using mobile devices or apps for activity tracking for 2 months and longer. Results: Our findings showed that the phase of perceived ease of learning as a significant influencer of the acceptance of activity trackers existed only in the older participant group, but this phase never emerged in the younger participant group. In addition, this study confirmed that other phases exist in both age groups, but 2 distinct patterns emerged according to age groups: (1) the social influence construct influenced the older participants positively but the younger participants negatively and (2) older participants’ exploration in the system experiment phase was purpose-driven by particular needs or benefits but for younger participants, it was a phase to explore a new technology. Conclusions: This study confirms the validity of the proposed theoretical framework to account for the unique aspect of older adults’ technology adoption. This framework can provide theoretical guidelines when designing technology for older adults as well as when generating new investigations and experiments for older adults and technology use. %M 33090116 %R 10.2196/18312 %U https://mhealth.jmir.org/2020/10/e18312 %U https://doi.org/10.2196/18312 %U http://www.ncbi.nlm.nih.gov/pubmed/33090116 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20099 %T eHealth Literacy of German Physicians in the Pre–COVID-19 Era: Questionnaire Study %A Kirchberg,Johanna %A Fritzmann,Johannes %A Weitz,Jürgen %A Bork,Ulrich %+ Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, Dresden, 01307, Germany, 49 3514585400, ulrich.bork@ukdd.de %K eHealth %K electronic health %K mobile health %K health apps %K mobile health apps %K eHealth literacy %D 2020 %7 16.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digitalization is a disruptive technology that changes the way we deliver diagnostic procedures and treatments in medicine. Different stakeholders have varying interests in and expectations of the digitalization of modern medicine. Many recent digital advances in the medical field, such as the implementation of electronic health records, telemedical services, and mobile health apps, are increasingly used by medical professionals and patients. During the current pandemic outbreak of a novel coronavirus-caused respiratory disease (COVID-19), many modern information and communication technologies (ICT) have been used to overcome the physical barriers and limitations caused by government-issued curfews and workforce shortages. Therefore, the COVID-19 pandemic has led to a surge in the usage of modern ICT in medicine. At the same time, the eHealth literacy of physicians working with these technologies has probably not improved since our study. Objective: This paper describes a representative cohort of German physicians before the COVID-19 pandemic and their eHealth literacy and attitude towards modern ICT. Methods: A structured, self-developed questionnaire about user behavior and attitudes towards eHealth applications was administered to a representative cohort of 93 German physicians. Results: Of the 93 German physicians who participated in the study, 97% (90/93) use a mobile phone. Medical apps are used by 42% (39/93). Half of the surveyed physicians (47/93, 50%) use their private mobile phones for official purposes on a daily basis. Telemedicine is part of the daily routine for more than one-third (31/93, 33%) of all participants. More than 80% (76/93, 82%) of the trial participants state that their knowledge regarding the legal aspects and data safety of medical apps and cloud computing is insufficient. Conclusions: Modern ICT is frequently used and mostly welcomed by German physicians. However, there is a tremendous lack of eHealth literacy and knowledge about the safe and secure implementation of these technologies in routine clinical practice. %M 33064102 %R 10.2196/20099 %U http://mhealth.jmir.org/2020/10/e20099/ %U https://doi.org/10.2196/20099 %U http://www.ncbi.nlm.nih.gov/pubmed/33064102 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22443 %T Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights from a National Survey %A Chandrasekaran,Ranganathan %A Katthula,Vipanchi %A Moustakas,Evangelos %+ Department of Information & Decision Sciences, University of Illinois at Chicago, 601 S Morgan St, Chicago, IL, 60607, United States, 1 3129962847, ranga@uic.edu %K wearable healthcare devices %K mobile health %K HINTS %K health technology adoption and use %K smart wearables %D 2020 %7 16.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the growing popularity of wearable health care devices (from fitness trackes such as Fitbit to smartwatches such as Apple Watch and more sophisticated devices that can collect information on metrics such as blood pressure, glucose levels, and oxygen levels), we have a limited understanding about the actual use and key factors affecting the use of these devices by US adults. Objective: The main objective of this study was to examine the use of wearable health care devices and the key predictors of wearable use by US adults. Methods: Using a national survey of 4551 respondents, we examined the usage patterns of wearable health care devices (use of wearables, frequency of their use, and willingness to share health data from a wearable with a provider) and a set of predictors that pertain to personal demographics (age, gender, race, education, marital status, and household income), individual health (general health, presence of chronic conditions, weight perceptions, frequency of provider visits, and attitude towards exercise), and technology self-efficacy using logistic regression analysis. Results: About 30% (1266/4551) of US adults use wearable health care devices. Among the users, nearly half (47.33%) use the devices every day, with a majority (82.38% weighted) willing to share the health data from wearables with their care providers. Women (16.25%), White individuals (19.74%), adults aged 18-50 years (19.52%), those with some level of college education or college graduates (25.60%), and those with annual household incomes greater than US $75,000 (17.66%) were most likely to report using wearable health care devices. We found that the use of wearables declines with age: Adults aged >50 years were less likely to use wearables compared to those aged 18-34 years (odds ratios [OR] 0.46-0.57). Women (OR 1.26, 95% CI 0.96-1.65), White individuals (OR 1.65, 95% CI 0.97-2.79), college graduates (OR 1.05, 95% CI 0.31-3.51), and those with annual household incomes greater than US $75,000 (OR 2.6, 95% CI 1.39-4.86) were more likely to use wearables. US adults who reported feeling healthier (OR 1.17, 95% CI 0.98-1.39), were overweight (OR 1.16, 95% CI 1.06-1.27), enjoyed exercise (OR 1.23, 95% CI 1.06-1.43), and reported higher levels of technology self-efficacy (OR 1.33, 95% CI 1.21-1.46) were more likely to adopt and use wearables for tracking or monitoring their health. Conclusions: The potential of wearable health care devices is under-realized, with less than one-third of US adults actively using these devices. With only younger, healthier, wealthier, more educated, technoliterate adults using wearables, other groups have been left behind. More concentrated efforts by clinicians, device makers, and health care policy makers are needed to bridge this divide and improve the use of wearable devices among larger sections of American society. %M 33064083 %R 10.2196/22443 %U http://www.jmir.org/2020/10/e22443/ %U https://doi.org/10.2196/22443 %U http://www.ncbi.nlm.nih.gov/pubmed/33064083 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20720 %T Association Between Usage of an App to Redeem Prescribed Food Benefits and Redemption Behaviors Among the Special Supplemental Nutrition Program for Women, Infants, and Children Participants: Cross-Sectional Study %A Zhang,Qi %A Zhang,Junzhou %A Park,Kayoung %A Tang,Chuanyi %+ School of Community and Environmental Health, Old Dominion University, 3130 Health Sciences Building, Old Dominion University, Norfolk, VA, 23529, United States, 1 7576836870, qzhang@odu.edu %K mobile phone app %K WIC %K EBT %K benefit redemption %K mobile phone %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one of the most important food assistance programs in the United States, serving 6.4 million low-income, eligible women, infants, and children under 5 years of age in 2019. In the program, participants are prescribed a list of food benefits, which can be redeemed in WIC-authorized stores. However, there are multiple behavioral barriers in the program and the stores that prevent participants from redeeming the benefits fully. Objective: This study aims to examine the relationship between the use of a widely used mobile phone app, WICShopper, and the redemption of the prescribed food packages. Methods: WIC administrative data were obtained from West Virginia for the period January 2019 to January 2020 and included 30,440 WIC households that had received food benefits in that period. The redemption rates of 18 WIC food benefits were compared between app users and nonapp users, that is, those who never used the app in the study period. The use behaviors were defined for the app users, including the number of active use benefit cycles, active benefit cycle rates, number of active use days in the cycle, and proportion rates of daytime use. Panel linear regressions were applied to examine how the redemption rates were related to these behaviors over time. Results: App users consistently had higher average redemption rates than nonapp users; the difference ranged from 3.6% (4.8% relative) for infant formula to 14.3% (40.7% relative) for fish. After controlling for sociodemographics, the coefficients of app use were significantly positive for all benefit categories except for WIC-eligible nutritionals. More active cycles and active days in the cycle were significantly related to redemption rates for all categories, except for frozen juice (coefficient=−0.002, P=.09). Daytime app access was positively associated with redemption rates for most food benefits except only a few, such as infant formula (coefficient=−0.03, P<.001). Conclusions: Use of the WIC app was significantly related to higher redemption rates across food benefits, although the association varied across benefit categories. More active days were positively related to benefit redemptions across food categories, and the app’s daytime use was positively associated with the redemption of most benefit categories. These findings suggest that the WIC app can be an important tool for the promotion of benefit redemption among WIC participants. %M 33052133 %R 10.2196/20720 %U http://mhealth.jmir.org/2020/10/e20720/ %U https://doi.org/10.2196/20720 %U http://www.ncbi.nlm.nih.gov/pubmed/33052133 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e20529 %T The Association Between Electronic Device Use During Family Time and Family Well-Being: Population-Based Cross-Sectional Study %A Zhao,Sheng Zhi %A Guo,Ningyuan %A Wang,Man Ping %A Fong,Daniel Yee Tak %A Lai,Agnes Yuen Kwan %A Chan,Sophia Siu-Chee %A Lam,Tai Hing %A Ho,Daniel Sai Yin %+ School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, HK, Hong Kong, 000000, China (Hong Kong), 852 39176636, mpwang@hku.hk %K eDevice %K smartphone %K mobile phone %K well-being %K family dinner %K family communication %K public health %D 2020 %7 14.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic devices (eDevices) may have positive or negative influences on family communication and well-being depending on how they are used. Objective: We examined eDevice use during family time and its association with the quality of family communication and well-being in Hong Kong Chinese adults. Methods: In 2017, a probability-based 2-stage random sampling landline telephone survey collected data on eDevice use in daily life and during family time (eg, family dinner) and the presence of rules banning eDevice use during family dinner. Family communication quality was rated from 0 to 10 with higher scores being favorable. Family well-being was calculated as a composite mean score of 3 items each using the same scale from 0 to 10. The associations of family communication quality and well-being with eDevice use in daily life and during family time were estimated using beta-coefficient (β) adjusting for sociodemographics. The mediating role of family communication quality in the association between eDevice use and family well-being was analyzed. Results: Of the 2064 respondents (mean age 56.4 [SD 19.2] years, 1269/2064 [61.48%] female), 1579/2059 (76.69%) used an eDevice daily for a mean of 3.6 hours (SD 0.1) and 257/686 (37.5%) used it for 30+ minutes before sleep. As much as 794/2046 (38.81%) often or sometimes used an eDevice during family time including dinner (311/2017, 15.42%); 713/2012 (35.44%) reported use of an eDevice by family members during dinner. Lower family communication quality was associated with hours of eDevice use before sleep (adjusted β=–.25; 95% CI –0.44 to –0.05), and often use (vs never use) of eDevice during family dinner by oneself (adjusted β=–.51; 95% CI –0.91 to –0.10) and family members (adjusted β=–.54; 95% CI –0.79 to –0.29). Similarly, lower family well-being was associated with eDevice use before sleep (adjusted β=–.26; 95% CI –0.42 to –0.09), and often use during family dinner by oneself (adjusted β=–.48; 95% CI –0.83 to –0.12) and family members (adjusted β=–.50; 95% CI –0.72 to –0.28). Total ban of eDevice use during family dinner was negatively associated with often use by oneself (adjusted odds ratio 0.49; 95% CI 0.29 to 0.85) and family members (adjusted odds ratio 0.41; 95% CI 0.28, 0.60) but not with family communication and well-being. Lower family communication quality substantially mediated the total effect of the association of eDevice use time before sleep (61.2%) and often use at family dinner by oneself (87.0%) and by family members (67.8%) with family well-being. Conclusions: eDevice use before sleep and during family dinner was associated with lower family well-being, and the association was substantially mediated by family communication quality. Our results suggest that interventions on smart use of eDevice may improve family communication and well-being. %M 33052120 %R 10.2196/20529 %U http://www.jmir.org/2020/10/e20529/ %U https://doi.org/10.2196/20529 %U http://www.ncbi.nlm.nih.gov/pubmed/33052120 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18080 %T Intention to use Medical Apps Among Older Adults in the Netherlands: Cross-Sectional Study %A Askari,Marjan %A Klaver,Nicky Sabine %A van Gestel,Thimon Johannes %A van de Klundert,Joris %+ Erasmus School of Health Policy & Management, Erasmus University, PO Box 1738, Rotterdam, 3000 DR, Netherlands, 31 104088641, askari@eshpm.eur.nl %K Senior Technology Acceptance Model %K intention to use %K elderly %K older adults %K medical apps %K mHealth %K adoption %D 2020 %7 4.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing health service demand driven by the aging of the global population calls for the development of modes of health service delivery that are less human resource–intensive. Electronic health (eHealth) and medical apps are expected to play an important role in this development. Although evidence shows mobile medical apps might be effective in improving the care, self-management, self-efficacy, health-related behavior, and medication adherence of older adults, little is known about older adults’ intention to use these technologies when needed, or the factors influencing this intention. Objective: The objective of this study was to investigate the relationship of technology acceptance factors and intention to use mobile medical apps among community-dwelling older adults. Methods: Data was collected using questionnaires. The factors selected from the literature have been validated using Cronbach α and tested for significance using logistic regressions. Results: Almost half (49.7%) of the included older adults reported no intention to use medical apps. Adjusted logistic regression analysis per factor showed that the factors Attitude toward use (odds ratio [OR] 8.50), Perceived usefulness (OR 5.25), Perceived ease of use (OR 4.22), Service availability (OR 3.46), Sense of control (OR 3.40), Self-perceived effectiveness (OR 2.69), Facilities (OR 2.45), Personal innovativeness (OR 2.08), Social relationships (OR 1.79), Subjective norm (OR 1.48), and Feelings of anxiety (OR 0.62) significantly influenced the intention to use mobile medical apps among older adults, whereas the factor Finance (OR 0.98) did not. When considered together, a controlled multivariate logistic regression yielded high explained variances of 0.542 (Cox-Snell R2) and 0.728 (Nagelkerke R2). Conclusions: The high odds ratios and explained variance indicate that the factors associated with the intention to use medical apps are largely understood and the most important factors have been identified. To advance the evidence base, experimental controlled research should investigate the causality between the factors, intention to use, and actual use. For this purpose, our evidence suggests that policies designed to improve Attitude toward use appear most effective, followed by policies addressing Perceived usefulness, Perceived ease of use, Service availability, and Sense of control. %M 32624465 %R 10.2196/18080 %U https://www.jmir.org/2020/9/e18080 %U https://doi.org/10.2196/18080 %U http://www.ncbi.nlm.nih.gov/pubmed/32624465 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19661 %T Mobile Health Usage, Preferences, Barriers, and eHealth Literacy in Rheumatology: Patient Survey Study %A Knitza,Johannes %A Simon,David %A Lambrecht,Antonia %A Raab,Christina %A Tascilar,Koray %A Hagen,Melanie %A Kleyer,Arnd %A Bayat,Sara %A Derungs,Adrian %A Amft,Oliver %A Schett,Georg %A Hueber,Axel J %+ Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 913185 ext 35000, johannes.knitza@uk-erlangen.de %K mobile applications %K eHealth %K rheumatology %K mHealth %K eHEALS %K telemedicine %D 2020 %7 12.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) defines the support and practice of health care using mobile devices and promises to improve the current treatment situation of patients with chronic diseases. Little is known about mHealth usage and digital preferences of patients with chronic rheumatic diseases. Objective: The aim of the study was to explore mHealth usage, preferences, barriers, and eHealth literacy reported by German patients with rheumatic diseases. Methods: Between December 2018 and January 2019, patients (recruited consecutively) with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis were asked to complete a paper-based survey. The survey included questions on sociodemographics, health characteristics, mHealth usage, eHealth literacy using eHealth Literacy Scale (eHEALS), and communication and information preferences. Results: Of the patients (N=193) who completed the survey, 176 patients (91.2%) regularly used a smartphone, and 89 patients (46.1%) regularly used social media. Patients (132/193, 68.4%) believed that using medical apps could be beneficial for their own health. Out of 193 patients, only 8 (4.1%) were currently using medical apps, and only 22 patients (11.4%) stated that they knew useful rheumatology websites/mobile apps. Nearly all patients (188/193, 97.4%) would agree to share their mobile app data for research purposes. Out of 193 patients, 129 (66.8%) would regularly enter data using an app, and 146 patients (75.6%) would welcome official mobile app recommendations from the national rheumatology society. The preferred duration for data entry was not more than 15 minutes (110/193, 57.0%), and the preferred frequency was weekly (59/193, 30.6%). Medication information was the most desired app feature (150/193, 77.7%). Internet was the most frequently utilized source of information (144/193, 74.6%). The mean eHealth literacy was low (26.3/40) and was positively correlated with younger age, app use, belief in benefit of using medical apps, and current internet use to obtain health information. Conclusions: Patients with rheumatic diseases are very eager to use mHealth technologies to better understand their chronic diseases. This open-mindedness is counterbalanced by low mHealth usage and competency. Personalized mHealth solutions and clear implementation recommendations are needed to realize the full potential of mHealth in rheumatology. %M 32678796 %R 10.2196/19661 %U http://mhealth.jmir.org/2020/8/e19661/ %U https://doi.org/10.2196/19661 %U http://www.ncbi.nlm.nih.gov/pubmed/32678796 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19531 %T Use of Tablets and Smartphones to Support Medical Decision Making in US Adults: Cross-Sectional Study %A Langford,Aisha %A Orellana,Kerli %A Kalinowski,Jolaade %A Aird,Carolyn %A Buderer,Nancy %+ Department of Population Health, NYU Langone Health, 30 E 30th Street, Room 611, New York, NY, 10016, United States, 1 646 501 2914, aisha.langford@nyulangone.org %K smartphone %K mHealth %K eHealth %K mobile phone %K cell phone %K tablets %K ownership %K decision making %K health communication %K telemedicine %K monitoring %K physiologic %K surveys and questionnaires %D 2020 %7 12.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tablet and smartphone ownership have increased among US adults over the past decade. However, the degree to which people use mobile devices to help them make medical decisions remains unclear. Objective: The objective of this study is to explore factors associated with self-reported use of tablets or smartphones to support medical decision making in a nationally representative sample of US adults. Methods: Cross-sectional data from participants in the 2018 Health Information National Trends Survey (HINTS 5, Cycle 2) were evaluated. There were 3504 responses in the full HINTS 5 Cycle 2 data set; 2321 remained after eliminating respondents who did not have complete data for all the variables of interest. The primary outcome was use of a tablet or smartphone to help make a decision about how to treat an illness or condition. Sociodemographic factors including gender, race/ethnicity, and education were evaluated. Additionally, mobile health (mHealth)- and electronic health (eHealth)-related factors were evaluated including (1) the presence of health and wellness apps on a tablet or smartphone, (2) use of electronic devices other than tablets and smartphones to monitor health (eg, Fitbit, blood glucose monitor, and blood pressure monitor), and (3) whether people shared health information from an electronic monitoring device or smartphone with a health professional within the last 12 months. Descriptive and inferential statistics were conducted using SAS version 9.4. Weighted population estimates and standard errors, univariate odds ratios, and 95% CIs were calculated, comparing respondents who used tablets or smartphones to help make medical decisions (n=944) with those who did not (n=1377), separately for each factor. Factors of interest with a P value of <.10 were included in a subsequent multivariable logistic regression model. Results: Compared with women, men had lower odds of reporting that a tablet or smartphone helped them make a medical decision. Respondents aged 75 and older also had lower odds of using a tablet or smartphone compared with younger respondents aged 18-34. By contrast, those who had health and wellness apps on tablets or smartphones, used other electronic devices to monitor health, and shared information from devices or smartphones with health care professionals had higher odds of reporting that tablets or smartphones helped them make a medical decision, compared with those who did not. Conclusions: A limitation of this research is that information was not available regarding the specific health condition for which a tablet or smartphone helped people make a decision or the type of decision made (eg, surgery, medication changes). In US adults, mHealth and eHealth use, and also certain sociodemographic factors are associated with using tablets or smartphones to support medical decision making. Findings from this study may inform future mHealth and other digital health interventions designed to support medical decision making. %M 32784181 %R 10.2196/19531 %U https://mhealth.jmir.org/2020/8/e19531 %U https://doi.org/10.2196/19531 %U http://www.ncbi.nlm.nih.gov/pubmed/32784181 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16215 %T Potential of Mobile Technology to Relieve the Urgent Mental Health Needs in China: Web-Based Survey %A Tan,Yuxi %A Teng,Ziwei %A Qiu,Yan %A Tang,Hui %A Xiang,Hui %A Chen,Jindong %+ Department of Psychiatry, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, China, 86 0731 85292158, chenjindong@csu.edu.cn %K mental health %K mobile health %K mobile phone %K mobile app %K needs %D 2020 %7 7.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the rapid development of information technology and mobile devices, an increasing number of mobile medical services and platforms have emerged. However, China’s current mental health situation necessitates further discussion and research on how to provide more patient-centered services in the face of many challenges and opportunities. Objective: This study aims to explore the attitudes and preferences of mental health service stakeholders regarding mobile mental health services and discuss the challenges and opportunities faced by mobile technology developers in China. Methods: A web-based survey was conducted by following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist. A total of 586 valid questionnaires were collected. Respondents included 184 patients or their family members, 225 mental health professionals, and 177 people from the general population. Data analysis was completed using SPSS 24.0. Results: Among the various problems perceived regarding the current mental health medical environment, difficulty in finding appropriate psychologists and limited visit times ranked highest. Social media (n=380/586, 64.9%) was the most preferred platform among all participants, whereas professionals showed a higher preference for smartphone apps (n=169/225, 75.1%). Professional instruction, psychological consultation, and mental health education (ranked top 3) were the most commonly identified needs. Mental health professionals generally emphasized more on treatment-related mobile mental health service needs, especially medication reminders (χ22=70.7; P<.001), symptom monitoring (χ22=24.0; P<.001), and access to mental health resources (χ22=38.6; P<.001). However, patients and their family members focused more on convenient web-based prescriptions (χ22=7.7; P=.02), with the general population interested in web-based psychological consultation (χ22=23.1; P<.001) and mental health knowledge (χ22=9.1; P=.01). Almost half of the participants regarded mobile mental health services as highly acceptable or supported their use, but less than 30% of participants thought mobile mental health services might be very helpful. Concerns about mobile mental health mainly focused on information security. Service receivers also suspected the quality and professionalism of content, and mental health professionals were worried about time and energy consumption as well as medical safety. Conclusions: In terms of service flow, mobile services could be used to expand service time and improve efficiency before and after diagnosis. More individualized mobile mental health service content in more acceptable forms should be developed to meet the various needs of different mental health stakeholders. Multidisciplinary training and communication could be incorporated to facilitate the integration and cooperation of more well-rounded service teams. A standard medical record system and data format would better promote the development of future intelligent medical care. Issues such as ensuring service quality, solving safety risks, and better integrating mobile services with regular medical workflows also need to be addressed. %M 32673239 %R 10.2196/16215 %U https://mhealth.jmir.org/2020/7/e16215 %U https://doi.org/10.2196/16215 %U http://www.ncbi.nlm.nih.gov/pubmed/32673239 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17704 %T Barriers and Facilitators to the Adoption of Mobile Health Among Health Care Professionals From the United Kingdom: Discrete Choice Experiment %A Leigh,Simon %A Ashall-Payne,Liz %A Andrews,Tim %+ The Organisation for the Review of Care and Health Applications, Sci-Tech Daresbury, Vanguard House, Keckwick Lane, Daresbury, WA4 4AB, United Kingdom, 44 07503955592, simon.leigh@orcha.co.uk %K digital health %K mHealth %K discrete-choice %K preferences %K mobile phone %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing availability of mobile health services, clinical engagement remains minimal. Objective: This study aims to identify and weight barriers to and drivers of health app use among health care professionals (HCPs) from the United Kingdom. Methods: A discrete choice experiment was conducted with 222 HCPs using a web-based survey between March 2019 and June 2019. Participants were recruited to take part via social media and asked to choose their preferred option of 2 hypothetical health apps to prescribe to a hypothetical patient or to prescribe neither. Choices were characterized by differing levels of patient age, cost, published evidence bases, whether they had a National Health Service (NHS) stamp of approval, personal familiarity with the technology, and whether they were recommended by a fellow HCP. The results were analyzed using a mixed logit model, with subgroup analyses to account for heterogeneity. Results: We received 230 responses, a total of 96.5% (n=222/230) of respondents understood the survey task and passed the test of rationality. The median age was between 36 and 45 years, and 62.6% (n=139/222) of the health care providers responding to the survey had previously recommended the use of health apps to patients. Health apps were most likely to be prescribed to patients if they had an NHS stamp of approval or if they were recommended by another HCP (both P<.001). Published studies detailing clinical effectiveness were important (P<.001), but it would take five published studies to have the same impact on prescribing behavior as an NHS stamp of approval and two studies to be as convincing as having used the technology personally. Increasing patient age and costs resulted in significant reductions in digital health prescribing (P<.001), none more so than among allied health professionals. Willingness-to-pay for health apps increased by £124.61 (US $151.14) if an NHS stamp of approval was present and by £29.20 (US $35.42) for each published study. Overall, 8.1% (n=18/222) of respondents were reluctant to use health apps, always choosing the I would prescribe neither option, particularly among older HCPs, nurses, and those who do not use health apps personally. Subgroup analyses revealed significant differences in preferences among HCPs of differing ages and clinical backgrounds. Conclusions: An NHS stamp of approval, published studies, and recommendations from fellow HCPs are significant facilitators of digital prescribing, whereas increasing costs and patient age are significant barriers to engagement. These findings suggest that demonstrating assurances of health apps and supporting both the dissemination and peer-to-peer recommendation of evidence-based technologies are critical if the NHS is to achieve its long-term digital transformation ambitions. %M 32628118 %R 10.2196/17704 %U https://mhealth.jmir.org/2020/7/e17704 %U https://doi.org/10.2196/17704 %U http://www.ncbi.nlm.nih.gov/pubmed/32628118 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e19494 %T Influence of the SARS-CoV-2 Outbreak on the Uptake of a Popular Smoking Cessation App in UK Smokers: Interrupted Time Series Analysis %A Perski,Olga %A Herbeć,Aleksandra %A Shahab,Lion %A Brown,Jamie %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 020 7679 1258, olga.perski@ucl.ac.uk %K SARS-CoV-2 %K COVID-19 %K smoking cessation %K mobile health %K smartphone app %K time series analysis %K smoking %K public health %K app %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak may motivate smokers to attempt to stop in greater numbers. However, given the temporary closure of UK stop smoking services and vape shops, smokers attempting to quit may instead seek out mobile health support, such as smartphone apps. Objective: We examined, using an interrupted time series approach, whether the SARS-CoV-2 outbreak has been associated with a step change or increasing trend in UK downloads of an otherwise popular smoking cessation app, Smoke Free. Methods: Data were from daily and nondaily adult smokers in the United Kingdom who had downloaded the Smoke Free app between January 1, 2020, and March 31, 2020 (primary analysis), and January 1, 2019, and March 31, 2020 (secondary analysis). The outcome variable was the number of downloads aggregated at the 12-hourly (primary analysis) or daily level (secondary analysis). The explanatory variable was the start of the SARS-CoV-2 outbreak, operationalized as March 1, 2020 (primary analysis), and January 15, 2020 (secondary analysis). Generalized additive mixed models adjusted for relevant covariates were fitted. Results: Data were collected on 45,105 (primary analysis) and 119,881 (secondary analysis) users. In both analyses, there was no evidence for a step change or increasing trend in downloads attributable to the start of the SARS-CoV-2 outbreak. Calculation of Bayes factors (BFs) indicated that the data for the primary analysis favored the null hypothesis compared with large associations (for level, BF=0.25; for slope, BF=0.26) but were insensitive to the detection of small associations (for level, BF=0.78; for slope, BF=1.35). Conclusions: In the United Kingdom, between January 1, 2020, and March 31, 2020, and between January 1, 2019, and March 31, 2020, there was no evidence that the SARS-CoV-2 outbreak has been associated with a large step change or increasing trend in downloads of a popular smoking cessation app. Findings on the association of the SARS-CoV-2 outbreak with a small step change or increasing trend were inconclusive. %M 32463375 %R 10.2196/19494 %U http://mhealth.jmir.org/2020/6/e19494/ %U https://doi.org/10.2196/19494 %U http://www.ncbi.nlm.nih.gov/pubmed/32463375 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e15403 %T Associations of Electronic Device Use Before and After Sleep With Psychological Distress Among Chinese Adults in Hong Kong: Cross-Sectional Study %A Lee,Jung Jae %A Wang,Man Ping %A Luk,Tzu Tsun %A Guo,Ningyuan %A Chan,Sophia Siu-Chee %A Lam,Tai Hing %+ School of Nursing, University of Hong Kong, 4/F William MW Mong Block Building,, 21 Sassoon Rd, Pokfulam,, Hong Kong, , China (Hong Kong), 852 3917 6636, mpwang@hku.hk %K addictive behavior %K anxiety %K computers %K depression %K devices %K internet %K smartphone %K withdrawal symptoms %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Hong Kong has a high rate of electronic device (e-device; computer, smartphone, and tablet) use. However, little is known about the associations of the duration of e-device use before and after sleep with psychological symptoms. Objective: This study aimed to investigate the associations of the duration of e-device use before and after sleep with psychological distress. Methods: A probability-based telephone survey was conducted on 3162 Hong Kong adults (54.6% female; mean age 47.4 years, SD 18.3 years) in 2016. Multivariate linear and Poisson regressions were used to calculate adjusted regression coefficients (aBs) and prevalence ratios (aPRs) of anxiety and depressive symptoms (measured by Patient Health Questionnaire-4) for the duration from waking to the first e-device use (≥61, 31-60, 6-30, and ≤5 minutes) and the duration of e-device use before sleeping (≤5, 6-30, 31-60, and ≥61 minutes). Results: The first e-device use in ≤5 (vs ≥61) minutes after waking was associated with anxiety (aB 0.35, 95% CI 0.24-0.46; aPR 1.74, 95% CI 1.34-2.25) and depressive symptoms (aB 0.27, 95% CI 0.18-0.37; aPR 1.84, 95% CI 1.33-2.54). Using e-devices for ≥61 (vs ≤5) minutes before sleeping was also associated with anxiety (aB 0.17, 95% CI 0.04-0.31; aPR 1.32, 95% CI 1.01-1.73) and depressive symptoms (aB 0.17, 95% CI 0.05-0.28; aPR 1.47, 95% CI 1.07-2.02). E-device use both ≤5 minutes after waking and for ≥61 minutes before sleeping was strongly associated with anxiety (aB 0.68, 95% CI 0.47-0.90; aPR 2.64, 95% CI 1.90-3.67) and depressive symptoms (aB 0.55, 95% CI 0.36-0.74; aPR 2.56, 95% CI 1.69-3.88). Conclusions: E-device use immediately (≤5 minutes) after waking and use for a long duration (≥61 minutes) before sleeping were associated with anxiety and depressive symptoms among Chinese adults in Hong Kong. %M 32525489 %R 10.2196/15403 %U http://mental.jmir.org/2020/6/e15403/ %U https://doi.org/10.2196/15403 %U http://www.ncbi.nlm.nih.gov/pubmed/32525489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17253 %T Attitudes and Use of Information and Communication Technologies in Older Adults With Mild Cognitive Impairment or Early Stages of Dementia and Their Caregivers: Cross-Sectional Study %A Guzman-Parra,Jose %A Barnestein-Fonseca,Pilar %A Guerrero-Pertiñez,Gloria %A Anderberg,Peter %A Jimenez-Fernandez,Luis %A Valero-Moreno,Esperanza %A Goodman-Casanova,Jessica Marian %A Cuesta-Vargas,Antonio %A Garolera,Maite %A Quintana,Maria %A García-Betances,Rebeca I %A Lemmens,Evi %A Sanmartin Berglund,Johan %A Mayoral-Cleries,Fermin %+ Mental Health Department, Instituto de Investigación Biomédica de Málaga, University Regional Hospital of Malaga, Plaza Hospital Civil s/n Hospital Civil 1ª Planta Pabellón 4, Malaga, Spain, 34 951 29 03 07, jgp00004@hotmail.com %K aging %K mild cognitive impairment %K dementia eHealth %K information and communication technology %K technophilia %D 2020 %7 1.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Information and communication technologies are promising tools to increase the quality of life of people with dementia or mild cognitive impairment and that of their caregivers. However, there are barriers to their use associated with sociodemographic factors and negative attitudes, as well as inadequate knowledge about technologies. Objective: The aim of this study was to analyze technophilia (attitudes toward new technologies) and the use of smartphones and tablets along with associated factors in people with dementia/mild cognitive impairment and their caregivers. Methods: Data from the first visit of the Support Monitoring and Reminder for Mild Dementia (SMART4MD) randomized multicenter clinical trial were used for this analysis. Data were obtained from two European countries, Spain and Sweden, and from three centers: Consorci Sanitari de Terrassa (Catalonia, Spain), Servicio Andaluz de Salud (Andalusia, Spain), and the Blekinge Institute of Technology (Sweden). Participants with a score between 20 and 28 in the Mini Mental State Examination, with memory problems (for more than 6 months), and who were over the age of 55 years were included in the study, along with their caregivers. The bivariate Chi square and Mann-Whitney tests, and multivariate linear and logistic regression models were used for statistical analysis. Results: A total of 1086 dyads were included (N=2172). Overall, 299 (27.53%) of people with dementia/mild cognitive impairment had a diagnosis of dementia. In addition, 588 (54.14%) of people with dementia/mild cognitive impairment reported using a smartphone almost every day, and 106 (9.76%) used specific apps or software to support their memory. Among the caregivers, 839 (77.26%) used smartphones and tablets almost every day, and 181 (16.67%) used specific apps or software to support their memory. The people with dementia/mild cognitive impairment showed a lower level of technophilia in comparison to that of their caregivers after adjusting for confounders (B=0.074, P=.02) with differences in technology enthusiasm (B=0.360, P<.001), but not in technology anxiety (B=–0.042, P=.37). Technophilia was associated with lower age (B=–0.009, P=.004), male gender (B=–0.160, P<.001), higher education level (P=.01), living arrangement (living with children vs single; B=–2.538, P=.01), country of residence (Sweden vs Spain; B=0.256, P<.001), lower depression (B=–0.046, P<.001), and better health status (B=0.004, P<.001) in people with dementia/mild cognitive impairment. Among caregivers, technophilia was associated with comparable sociodemographic factors (except for living arrangement), along with a lower caregiver burden (B=–0.005, P=.04) and better quality of life (B=0.348, P<.001). Conclusions: Technophilia was associated with a better quality of life and sociodemographic variables in people with dementia/mild cognitive impairment and caregivers, suggesting potential barriers for technological interventions. People with dementia/mild cognitive impairment frequently use smartphones and tablets, but the use of specific apps or software to support memory is limited. Interventions using these technologies are needed to overcome barriers in this population related to sociodemographic characteristics and the lack of enthusiasm for new technologies. Trial Registration: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699 %M 32442136 %R 10.2196/17253 %U https://www.jmir.org/2020/6/e17253 %U https://doi.org/10.2196/17253 %U http://www.ncbi.nlm.nih.gov/pubmed/32442136 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 5 %N 2 %P e14396 %T Health App Use and Its Correlates Among Individuals With and Without Type 2 Diabetes: Nationwide Population-Based Survey %A Stühmann,Lena M %A Paprott,Rebecca %A Heidemann,Christin %A Baumert,Jens %A Hansen,Sylvia %A Zahn,Daniela %A Scheidt-Nave,Christa %A Gellert,Paul %+ Institute for Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 529215, lena.stuehmann@charite.de %K mobile app %K smartphone %K diabetes mellitus %K type 2 diabetes %K risk factors %K health-related behavior %K health promotion %D 2020 %7 20.5.2020 %9 Original Paper %J JMIR Diabetes %G English %X Background: Evidence suggests that mobile health app use is beneficial for the prevention and management of type 2 diabetes (T2D) and its associated complications; however, population-based research on specific determinants of health app use in people with and without T2D is scarce. Objective: This cross-sectional study aimed to provide population-based evidence on rates and determinants of health app use among adults with and without T2D, thereby covering a prevention perspective and a diabetes management perspective, respectively. Methods: The study population included 2327 adults without a known diabetes diagnosis and 1149 adults with known T2D from a nationwide telephone survey in Germany conducted in 2017. Rates of smartphone ownership and health app use were estimated based on weighted sample proportions. Among smartphone owners, determinants of health app use were identified for both groups separately in multivariable logistic regression models. Sociodemographic factors, diabetes-related factors or indicators, psychological and health-related factors, and physician-provided information were selected as potential determinants. Results: Among participants without known diabetes, 74.72% (1690/2327) were smartphone owners. Of those, 49.27% (717/1690) used health apps, most often to improve regular physical activity. Among participants with T2D, 42.26% (481/1149) were smartphone owners. Of those, 41.1% (171/481) used health apps, most commonly to target a healthy diet. Among people without known diabetes, determinants significantly (all P values <.05) associated with an increased likelihood of health app use compared with their reference group were as follows: younger and middle age of 18 to 44 or 45 to 64 years (odds ratios [ORs] 3.89; P<.001 and 1.76; P=.004, respectively), overweight or obesity (ORs 1.58; P<.001 and 2.07; P<.001, respectively), hypertension diagnosis (OR 1.31; P=.045), former or current smoking (ORs 1.51; P=.002 and 1.58; P<.001, respectively), perceiving health as very good (OR 2.21; P<.001), other chronic diseases (OR 1.48; P=.002), and having received health advice from a physician (OR 1.48; P<.001). A slight or high perceived diabetes risk (ORs 0.78; P=.04 and 0.23; P<.001, respectively) was significantly associated with a decreased likelihood of health app use. Among people with T2D, younger and middle age (18-64 years; OR 1.84; P=.007), female gender (OR 1.61; P=.02), and using a glucose sensor in addition or instead of a glucose meter (OR 2.74; P=.04) were significantly positively associated with health app use. Conclusions: In terms of T2D prevention, age, diabetes-related risk factors, psychological and health-related factors, and medical health advice may inform app development for specific target groups. In addition, health professionals may encourage health app use when giving advice on health behaviors. Concerning T2D management, only a few determinants seem relevant for explaining health app use among people with T2D, indicating a need for more future research on which people with T2D use health apps and why. %M 32432555 %R 10.2196/14396 %U http://diabetes.jmir.org/2020/2/e14396/ %U https://doi.org/10.2196/14396 %U http://www.ncbi.nlm.nih.gov/pubmed/32432555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16299 %T Characterizing the US Population by Patterns of Mobile Health Use for Health and Behavioral Tracking: Analysis of the National Cancer Institute's Health Information National Trends Survey Data %A Rising,Camella J %A Jensen,Roxanne E %A Moser,Richard P %A Oh,April %+ Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9606 Medical Center Drive, 3E636, Rockville, MD, 20850, United States, 1 240 276 5262, camella.rising@nih.gov %K mobile health %K population health %K health communication %K survey methodology %K mobile applications %K devices %D 2020 %7 14.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Multiple types of mobile health (mHealth) technologies are available, such as smartphone health apps, fitness trackers, and digital medical devices. However, despite their availability, some individuals do not own, do not realize they own, or own but do not use these technologies. Others may use mHealth devices, but their use varies in tracking health, behaviors, and goals. Examining patterns of mHealth use at the population level can advance our understanding of technology use for health and behavioral tracking. Moreover, investigating sociodemographic and health-related correlates of these patterns can provide direction to researchers about how to target mHealth interventions for diverse audiences. Objective: The aim of this study was to identify patterns of mHealth use for health and behavioral tracking in the US adult population and to characterize the population according to those patterns. Methods: We combined data from the 2017 and 2018 National Cancer Institute Health Information National Trends Survey (N=6789) to characterize respondents according to 5 mutually exclusive reported patterns of mHealth use for health and behavioral tracking: (1) mHealth nonowners and nonusers report not owning or using devices to track health, behaviors, or goals; (2) supertrackers track health or behaviors and goals using a smartphone or tablet plus other devices (eg, Fitbit); (3) app trackers use only a smartphone or tablet; (4) device trackers use only nonsmartphone or nontablet devices and do not track goals; and (5) nontrackers report having smartphone or tablet health apps but do not track health, behaviors, or goals. Results: Being in the mHealth nonowners and nonusers category (vs all mHealth owners and users) is associated with males, older age, lower income, and not being a health information seeker. Among mHealth owners and users, characteristics of device trackers and supertrackers were most distinctive. Compared with supertrackers, device trackers have higher odds of being male (odds ratio [OR] 2.22, 95% CI 1.55-3.19), older age (vs 18-34 years; 50-64 years: OR 2.83, 95% CI 1.52-5.30; 65+ years: OR 6.28, 95% CI 3.35-11.79), have an annual household income of US $20,000 to US $49,999 (vs US $75,000+: OR 2.31, 95% CI 1.36-3.91), and have a chronic condition (OR 1.69, 95% CI 1.14-2.49). Device trackers also have higher odds of not being health information seekers than supertrackers (OR 2.98, 95% CI 1.66-5.33). Conclusions: Findings revealed distinctive sociodemographic and health-related characteristics of the population by pattern of mHealth use, with notable contrasts between those who do and do not use devices to track goals. Several characteristics of individuals who track health or behaviors but not goals (device trackers) are similar to those of mHealth nonowners and nonusers. Our results suggest patterns of mHealth use may inform how to target mHealth interventions to enhance reach and facilitate healthy behaviors. %M 32406865 %R 10.2196/16299 %U https://www.jmir.org/2020/5/e16299 %U https://doi.org/10.2196/16299 %U http://www.ncbi.nlm.nih.gov/pubmed/32406865 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e16140 %T Adoption and Attitudes of eHealth Among People Living With HIV and Their Physicians: Online Multicenter Questionnaire Study %A Jacomet,Christine %A Ologeanu-Taddei,Roxana %A Prouteau,Justine %A Lambert,Céline %A Linard,Françoise %A Bastiani,Pascale %A Dellamonica,Pierre %+ Infectious Diseases Department, Clermont-Ferrand University Hospital, Hôpital Gabriel Montpied, 58 rue Montalembert, Clermont-Ferrand, France, 33 473754931, cjacomet@chu-clermontferrand.fr %K survey %K HIV %K eHealth %K internet for information retrieval %K health applications %K connected objects %K telemedicine %K collection of digitized personal information %D 2020 %7 15.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The development of electronic health (eHealth) has offered the opportunity for remote care provision. eHealth addresses issues for patients and professionals favoring autonomy and compliance, respectively, while fostering closer links both between patients and health care professionals and among health care professionals themselves. Objective: The aim of this study was to analyze the patterns of use, benefits, and perceived obstacles in eHealth among people living with HIV (PLHIV) and their caring physicians at hospitals. Methods: An online multicenter observational survey was conducted October 15-19, 2018 in 51 medical units across France by means of self-administered questionnaires to collect sociodemographic and medical data, and perceptions of eHealth. Multiple correspondence analysis followed by mixed unsupervised classification were performed to analyze data of the respondents. Results: A total of 279 PLHIV and 219 physicians responded to all parts of the questionnaire. Three groups of PLHIV were identified based on multivariate analysis. Group 1 comprised “eHealth believers” (121/279, 43.4%), who were more frequently above 60 years old and more likely to be receiving treatments other than antiretrovirals. Group 2, the “technology skeptics” (86/279, 30.8%), comprised more women with at least one child. Group 3, the “internet adopters” (72/279, 25.8%), were more frequently under 49 years of age, men who have sex with men, and more likely to use mobile apps for obtaining wellness/health information and related subjects. Three groups of physicians also emerged. Group 1 comprised those “strongly confident in eHealth” (95/219, 43.4%), who more frequently used mobile apps for wellness/health information and were more likely to accept prescription assistance software. Group 2 comprised physicians “strongly opposed to eHealth” (80/219, 36.5%), frequently asserting that eHealth challenges confidentiality. Group 3 were “open to eHealth” (44/219, 20.1%), comprising a higher proportion of infectious disease specialists, and were more likely to believe that medical apps are useful for patient education and information. No link was found between the groups of PLHIV and physicians. Conclusions: The literature on eHealth mainly classifies people as enthusiasts and skeptics; however, we identified a third profile among both PLHIV and physicians, albeit without a direct link between them. For PLHIV, this third group is attentive to eHealth for improving their health condition, and for physicians, this group considers eHealth to offer benefits to patients and their own practice. %M 32293581 %R 10.2196/16140 %U http://mhealth.jmir.org/2020/4/e16140/ %U https://doi.org/10.2196/16140 %U http://www.ncbi.nlm.nih.gov/pubmed/32293581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16951 %T The Use of Technology for Communicating With Clinicians or Seeking Health Information in a Multilingual Urban Cohort: Cross-Sectional Survey %A Khoong,Elaine C %A Rivadeneira,Natalie A %A Hiatt,Robert A %A Sarkar,Urmimala %+ Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Building 10, Ward 13, San Francisco, CA, 94110, United States, 1 6282063188, elaine.khoong@ucsf.edu %K vulnerable populations %K health information technology %K physician patient relations %K consumer health information %K digital divide %K social media %K internet %D 2020 %7 6.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology is being increasingly used to communicate health information, but there is limited knowledge on whether these strategies are effective for vulnerable populations, including non–English speaking or low-income individuals. Objective: This study assessed how language preferences (eg, English, Spanish, or Chinese), smartphone ownership, and the type of clinic for usual source of care (eg, no usual source of care, nonintegrated safety net, integrated safety net, private or community clinic, academic tertiary medical center, or integrated payer-provider) affect technology use for health-related communication. Methods: From May to September 2017, we administered a nonrandom, targeted survey to 1027 English-, Spanish-, and Chinese-speaking San Francisco residents and used weighted multivariable logistic regression analyses to assess predictors of five technology use outcomes. The three primary predictors of interest—language preference, smartphone ownership, and type of clinic for usual care—were adjusted for age, gender, race or ethnicity, limited English proficiency, educational attainment, health literacy, and health status. Three outcomes focused on use of email, SMS text message, or phone apps to communicate with clinicians. The two other outcomes were use of Web-based health videos or online health support groups. Results: Nearly one-third of participants watched Web-based health videos (367/1027, 35.74%) or used emails to communicate with their clinician (318/1027, 30.96%). In adjusted analyses, individuals without smartphones had significantly lower odds of texting their clinician (adjusted odds ratio [aOR] 0.27, 95% CI 0.13-0.56), using online health support groups (aOR 0.14, 95% CI 0.04-0.55), or watching Web-based health videos (aOR 0.31, 95% CI 0.15-0.64). Relative to English-speaking survey respondents, individuals who preferred Chinese had lower odds of texting their clinician (aOR 0.25, 95% CI 0.08-0.79), whereas Spanish-speaking survey respondents had lower odds of using apps to communicate with clinicians (aOR 0.34, 95% CI 0.16-0.75) or joining an online support group (aOR 0.30, 95% CI 0.10-0.92). Respondents who received care from a clinic affiliated with the integrated safety net, academic tertiary medical center, or integrated payer-provider systems had higher odds than individuals without a usual source of care at using emails, SMS text messages, or apps to communicate with clinicians. Conclusions: In vulnerable populations, smartphone ownership increases the use of many forms of technology for health purposes, but device ownership itself is not sufficient to increase the use of all technologies for communicating with clinicians. Language preference impacts the use of technology for health purposes even after considering English proficiency. Health system factors impact patients’ use of technology-enabled approaches for communicating with clinicians. No single factor was associated with higher odds of using technology for all health purposes; therefore, existing disparities in the use of digital health tools among diverse and vulnerable populations can only be addressed using a multipronged approach. %M 32250280 %R 10.2196/16951 %U https://www.jmir.org/2020/4/e16951 %U https://doi.org/10.2196/16951 %U http://www.ncbi.nlm.nih.gov/pubmed/32250280 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15678 %T Wound Care Knowledge, Attitudes, and Practices and Mobile Health Technology Use in the Home Environment: Cross-Sectional Survey of Social Network Users %A Kuan,Ya-Ting %A Wang,Tze-Fang %A Guo,Chao-Yu %A Tang,Fu-In %A Hou,I-Ching %+ School of Nursing, National Yang-Ming University, Rm 407 Nursing Building, No 155, Sec 2, Li-Nong St, Beitou District, Taipei, Taiwan, 886 2 28267315, evita@ym.edu.tw %K mobile health %K wound %K knowledge %K attitudes %K practices %K home environment %D 2020 %7 26.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Injury causing wounds is a frequent event. Inadequate or inappropriate treatment of injuries can threaten individual health. However, little is known about wound care knowledge, attitudes, and practices and mobile health (mHealth) use in the home environment in Taiwan. Objective: This study aimed to evaluate wound care knowledge, attitudes, and practices and mHealth technology use among social network users. Methods: A cross-sectional survey on social media platforms was conducted on adults aged 20 years and older. Data were collected from social network users in the home environment. Results: A total of 361 participants were enrolled. The mHealth technology use of participants was positively correlated with wound care knowledge (r=.132, P=.01), attitudes (r=.239, P<.001), and practices (r=.132, P=.01). Participants did not have adequate knowledge (correct rate 69.1%) and were unfamiliar with the guidelines of proper wound care (correct rate 74.5%). Most participants had positive attitudes toward wound care and mHealth technology use. A total of 95.6% (345/361) of participants perceived that the use of mHealth technology can improve wound care outcomes, and 93.9% (339/361) perceived that wound care products should be optimized to be used with a mobile device. However, 93.6% (338/361) of participants had no experience using mHealth technology for wound care. Conclusions: Our study shows the potential of mHealth technology to enhance wound care knowledge among social network users. Thus, government agencies and medical institutions in Taiwan should provide easy-to-use information products that enhance wound care knowledge, promote adequate behavior toward wound care, and prevent unpredictable or undesirable outcomes. %M 32213478 %R 10.2196/15678 %U http://mhealth.jmir.org/2020/3/e15678/ %U https://doi.org/10.2196/15678 %U http://www.ncbi.nlm.nih.gov/pubmed/32213478 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 11 %P e14018 %T Acceptance and Expectations of Medical Experts, Students, and Patients Toward Electronic Mental Health Apps: Cross-Sectional Quantitative and Qualitative Survey Study %A Mayer,Gwendolyn %A Gronewold,Nadine %A Alvarez,Simone %A Bruns,Bastian %A Hilbel,Thomas %A Schultz,Jobst-Hendrik %+ Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 62215635685, gwendolyn.mayer@med.uni-heidelberg.de %K acceptance %K telemedicine %K telehealth %K eHealth %K mHealth %K interventions %K depression %K patients %K students %K experts %K expectation %K risk %D 2019 %7 25.11.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: The acceptability of electronic mental (e-mental) health apps has already been studied. However, the attitudes of medical experts, students, and patients taking into account their knowledge of and previous experiences with e-mental health apps have not been investigated. Objective: The aim of this study was to explore the attitudes, expectations, and concerns of medical experts, including physicians, psychotherapists and nursing staff, students of medicine or psychology, and patients toward e-mental health apps when considering their knowledge of and former experiences with e-mental health apps. Methods: This cross-sectional quantitative and qualitative survey was based on a self-developed questionnaire. A total of 269 participants were included (104 experts, 80 students, and 85 patients), and 124 eligible participants answered a paper version and 145 answered an identical online version of the questionnaire. The measures focused on existing knowledge of and experiences with e-mental health apps, followed by a question on whether electronic health development was generally accepted or disliked. Further, we asked about the expectations for an ideal e-mental health app and possible concerns felt by the participants. All items were either presented on a 5-point Likert scale or as multiple-choice questions. Additionally, 4 items were presented as open text fields. Results: Although 33.7% (35/104) of the experts, 15.0% (12/80) of the students, and 41.2% (35/85) of the patients knew at least one e-mental health app, few had already tried one (9/104 experts [8.7%], 1/80 students [1.3%], 22/85 patients [25.9%]). There were more advocates than skeptics in each group (advocates: 71/104 experts [68.3%], 50/80 students [62.5%], 46/85 patients [54.1%]; skeptics: 31/104 experts [29.8%], 20/80 students [25.0%], 26/85 patients [30.6%]). The experts, in particular, believed, that e-mental health apps will gain importance in the future (mean 1.08, SD 0.68; 95% CI 0.94-1.21). When asked about potential risks, all groups reported slight concerns regarding data security (mean 0.85, SD 1.09; 95% CI 0.72-0.98). Patient age was associated with several attitudes toward e-mental health apps (future expectations: r=–0.31, P=.005; total risk score: r=0.22, P=.05). Attitudes toward e-mental health apps correlated negatively with the professional experience of the experts (rs(94)=–0.23, P=.03). Conclusions: As opposed to patients, medical experts and students lack knowledge of and experience with e-mental health apps. If present, the experiences were assessed positively. However, experts show a more open-minded attitude with less fear of risks. Although some risks were perceived regarding data security, the attitudes and expectations of all groups were rather positive. Older patients and medical experts with long professional experience tend to express more skepticism. Trial Registration: German Clinical Trials Register DRKS00013095; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00013095 %M 31763990 %R 10.2196/14018 %U http://mental.jmir.org/2019/11/e14018/ %U https://doi.org/10.2196/14018 %U http://www.ncbi.nlm.nih.gov/pubmed/31763990 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13741 %T Exploring the Patterns of Use and Acceptability of Mobile Phones Among People Living With HIV to Improve Care and Treatment: Cross-Sectional Study in Three Francophone West African Countries %A Lepère,Phillipe %A Touré,Yélamikan %A Bitty-Anderson,Alexandra M %A Boni,Simon P %A Anago,Gildas %A Tchounga,Boris %A Touré,Pendadiago %A Minga,Albert %A Messou,Eugène %A Kanga,Guillaume %A Koule,Serge %A Poda,Armel %A Calmy,Alexandra %A Ekouevi,Didier K %A Coffie,Patrick A %+ Institut de Santé Globale, Université de Genève, Suisse, 24 rue du Général-Dufour, 1205 Genève, Genève, Switzerland, 41 +33673777280, lepere.p@wanadoo.fr %K acceptability %K mHealth %K PLHIV %K West Africa %D 2019 %7 13.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile technology in health care (mobile health [mHealth]) could be an innovative way to improve health care, especially for increasing retention in HIV care and adherence to treatment. However, there is a scarcity of studies on mHealth among people living with HIV (PLHIV) in West and Central Africa. Objective: The aim of this study was to assess the acceptability of an mHealth intervention among PLHIV in three countries of West Africa. Methods: A cross-sectional study among PLHIV was conducted in 2017 in three francophone West African countries: Côte d’Ivoire, Burkina Faso, and Togo. PLHIV followed in the six preselected HIV treatment and care centers, completed a standardized questionnaire on mobile phone possession, acceptability of mobile phone for HIV care and treatment, preference of mobile phone services, and phone sharing. Descriptive statistics and logistic regression were used to describe variables and assess factors associated with mHealth acceptability. Results: A total of 1131 PLHIV—643 from Côte d’Ivoire, 239 from Togo, and 249 from Burkina Faso—participated in the study. Median age was 44 years, and 76.1% were women (n=861). Almost all participants owned a mobile phone (n=1107, 97.9%), and 12.6% (n=140) shared phones with a third party. Acceptability of mHealth was 98.8%, with the majority indicating their preference for both phone calls and text messages. Factors associated with mHealth acceptability were having a primary school education or no education (adjusted odds ratio=7.15, 95% CI 5.05-10.12; P<.001) and waiting over one hour before meeting a medical doctor on appointment day (adjusted odds ratio=1.84, 95% CI 1.30-2.62; P=.01). Conclusions: The use of mHealth in HIV treatment and care is highly acceptable among PLHIV and should be considered a viable tool to allow West and Central African countries to achieve the Joint United Nations Programme on HIV/AIDS 90-90-90 goals. %M 31719023 %R 10.2196/13741 %U https://mhealth.jmir.org/2019/11/e13741 %U https://doi.org/10.2196/13741 %U http://www.ncbi.nlm.nih.gov/pubmed/31719023 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e11915 %T A Model for Assessing Necessary Conditions for Rural Health Care’s Mobile Health Readiness: Qualitative Assessment of Clinician-Perceived Barriers %A Weichelt,Bryan %A Bendixsen,Casper %A Patrick,Timothy %+ Marshfield Clinic Research Institute, National Farm Medicine Center, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 2217276, weichelt.bryan@marshfieldresearch.org %K mHealth %K clinician %K physician %K rural %K patient %K mobile health %K health care %D 2019 %7 8.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) technology dissemination has penetrated rural and urban areas alike. Yet, health care organization oversight and clinician adoption have not kept pace with patient use. mHealth could have a unique impact on health and quality of life for rural populations. If organizations are prepared to manage mHealth, clinicians may improve the quality of care for their patients, both rural and urban. However, many organizations are not yet prepared to prescribe or prohibit third-party mHealth technologies. Objective: This study explored organizational readiness for rural mHealth adoption, the use of patient-reported data by clinical care teams, and potential impact on improving rural health care delivery. Methods: Semistructured, open-ended interviews were used to investigate clinicians’ current practices, motivators, and perceived barriers to their use of mHealth technologies in rural settings. Results: A total of 13 clinicians were interviewed, and 53.8% (7/13) reported encouraging use of mHealth apps or wearable devices with rural patients. Perceived barriers to adoption were categorized into three primary themes: (1) personal (clinician), (2) patient, and (3) organizational. Organizational was most prominent, with subcodes of time, uniformity, and policy or direction. Thematic analysis revealed code-category linkages that identify the complex nature of a rural health care organization’s current climate from a clinician’s perspective. A thematic map was developed to visualize the flow from category to code. Identified linkages guided the development of a refined rural mHealth readiness model. Conclusions: Clinicians (including physicians) have limited time for continuing education, research, or exploration of emerging technologies. Clinicians are motivated to learn more, but they need guidance through organization-led directives. Rural health care institutions should consider investing in mHealth analysis, tool development, and formal recommendations of sanctioned tools for clinicians to use with patients. %M 31702564 %R 10.2196/11915 %U http://mhealth.jmir.org/2019/11/e11915/ %U https://doi.org/10.2196/11915 %U http://www.ncbi.nlm.nih.gov/pubmed/31702564 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14203 %T Wise Practices for Cultural Safety in Electronic Health Research and Clinical Trials With Indigenous People: Secondary Analysis of a Randomized Clinical Trial %A Maar,Marion A %A Beaudin,Valerie %A Yeates,Karen %A Boesch,Lisa %A Liu,Peter %A Madjedi,Kian %A Perkins,Nancy %A Hua-Stewart,Diane %A Beaudin,Faith %A Wabano,Mary Jo %A Tobe,Sheldon W %+ Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada, 1 705 662 7233, mmaar@nosm.ca %K mobile health %K process evaluation %K implementation science %K Indigenous peoples %K health care texting %K SMS %K hypertension %K task shifting %K community-based participatory research %K DREAM-GLOBAL %D 2019 %7 4.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a paucity of controlled clinical trial data based on research with Indigenous peoples. A lack of data specific to Indigenous peoples means that new therapeutic methods, such as those involving electronic health (eHealth), will be extrapolated to these groups based on research with other populations. Rigorous, ethical research can be undertaken in collaboration with Indigenous communities but requires careful attention to culturally safe research practices. Literature on how to involve Indigenous peoples in the development and evaluation of eHealth or mobile health apps that responds to the needs of Indigenous patients, providers, and communities is still scarce; however, the need for community-based participatory research to develop culturally safe technologies is emerging as an essential focus in Indigenous eHealth research. To be effective, researchers must first gain an in-depth understanding of Indigenous determinants of health, including the harmful consequences of colonialism. Second, researchers need to learn how colonialism affects the research process. The challenge then for eHealth researchers is to braid Indigenous ethical values with the requirements of good research methodologies into a culturally safe research protocol. Objective: A recent systematic review showed that Indigenous peoples are underrepresented in randomized controlled trials (RCTs), primarily due to a lack of attention to providing space for Indigenous perspectives within the study frameworks of RCTs. Given the lack of guidelines for conducting RCTs with Indigenous communities, we conducted an analysis of our large evaluation data set collected in the Diagnosing Hypertension-Engaging Action and Management in Getting Lower Blood Pressure in Indigenous Peoples and Low- and Middle- Income Countries (DREAM-GLOBAL) trial over a period of five years. Our goal is to identify wise practices for culturally safe, collaborative eHealth and RCT research with Indigenous communities. Methods: We thematically analyzed survey responses and qualitative interview/focus group data that we collected over five years in six culturally diverse Indigenous communities in Canada during the evaluation of the clinical trial DREAM-GLOBAL. We established themes that reflect culturally safe approaches to research and then developed wise practices for culturally safe research in pragmatic eHealth research. Results: Based on our analysis, successful eHealth research in collaboration with Indigenous communities requires a focus on cultural safety that includes: (1) building a respectful relationship; (2) maintaining a respectful relationship; (3) good communication and support for the local team during the RCT; (4) commitment to co-designing the innovation; (5) supporting task shifting with the local team; and (6) reflecting on our mistakes and lessons learned or areas for improvement that support learning and cultural safety. Conclusions: Based on evaluation data collected in the DREAM-GLOBAL RCT, we found that there are important cultural safety considerations in Indigenous eHealth research. Building on the perspectives of Indigenous staff and patients, we gleaned wise practices for RCTs in Indigenous communities. Trial Registration: ClinicalTrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226 %M 31682574 %R 10.2196/14203 %U https://www.jmir.org/2019/11/e14203 %U https://doi.org/10.2196/14203 %U http://www.ncbi.nlm.nih.gov/pubmed/31682574 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15648 %T Characteristics and Usage Patterns Among 12,151 Paid Subscribers of the Calm Meditation App: Cross-Sectional Survey %A Huberty,Jennifer %A Vranceanu,Ana-Maria %A Carney,Colleen %A Breus,Michael %A Gordon,Michael %A Puzia,Megan Elizabeth %+ College of Health Solutions, Arizona State University, 550 3rd St, Phoenix, AZ, 85004, United States, 1 6028272456, jhuberty@asu.edu %K health %K psychological stress %K sleep %K mindfulness %K meditation %K consumer behavior %K mobile health %K mhealth %K digital health %D 2019 %7 3.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Meditation has become increasingly popular due to its health benefits; however, barriers to delivering meditation programs in traditional group-based formats limit the accessibility of these benefits. Smartphone-based meditation may increase the availability of these programs to larger, more diverse audiences; however, research on subscriber characteristics and usage patterns in meditation mobile apps is lacking. Objective: This study aimed to describe the demographics, clinical characteristics, and usage patterns of a convenience sample of Calm subscribers and explore the relationship between self-reported app usage and changes in health, stress, and sleep. Methods: Participants were 12,151 paying Calm subscribers (response rate=12.08%, 12,151/100,594) who completed an anonymous Web-based survey with 11 quantitative questions related to user engagement, reasons for starting Calm, and changes after using the app. Demographic characteristics, chronic health diagnoses, and sleep difficulties were also assessed. Chi-square tests were used to examine differences in app usage. Logistic regression models were used to examine demographic and health characteristics that may predict changes in health, stress, and sleep. Results: Respondents were 18-96 years old (mean 48.57 [SD 13.79]), primarily female (79.94%, 8778/10,981), white (81.41%, 8959/11,005), and most reported a chronic health diagnosis (56.86%, 6289/11,061). Mental health diagnoses (41.13%, 4549/11,061) were more common than physical health diagnoses (32.19%, 3560/11,061). Most respondents (76.31%, 8684/11,360) reported difficulties falling or staying asleep. On average, respondents had been using Calm for 11.49 months (SD 10.49), and 60.03% (7281/12,129) used it 5 or more times per week. Meditations (used by 80.02%, 9497/11,841) and Sleep Stories (55.66%, 6591/11,841) were the most popular components. The frequency of using Calm was associated with incremental increases in the likelihood of noticing changes in mental health (χ22=136.8; P<.001), physical health (χ22=102.8; P<.001), stress (χ22=128.1; P<.001), and sleep (χ22=141.4; P<.001). Respondents who had used Calm longer were also more likely to notice changes in mental health (OR 1.06 [95% CI 1.05 to 1.06]), physical health (OR 1.01 [95% CI 1.01 to 1.02]), stress (OR 1.04 [95% CI 1.04 to 1.05]), and sleep (OR 1.004 [95% CI 1.00 to 1.01]). Subscribers with sleep difficulties used Calm more frequently (χ82=11.5; P=.003), were more likely to use Sleep Stories (χ12=1590.2; P<.001), and were more likely to notice changes in their physical health (χ12=49.2; P<.001) and sleep (χ12=2391.1; P<.001). Conclusions: Results highlight important demographic characteristics and usage patterns among a self-selected sample of Calm subscribers. Mental health concerns and sleep appear to be top reasons for downloading Calm. Sleep Stories and meditations are the most popular app components. The frequency of using Calm was associated with incremental changes in outcomes. Findings support future randomized controlled trials testing the efficacy of Calm for health, stress, and sleep. Studies should also explore strategies to attract a more diverse sample of subscribers. %M 31682582 %R 10.2196/15648 %U https://mhealth.jmir.org/2019/11/e15648 %U https://doi.org/10.2196/15648 %U http://www.ncbi.nlm.nih.gov/pubmed/31682582 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15195 %T Use of Health Apps by Nurses for Professional Purposes: Web-Based Survey Study %A Mayer,Miguel Angel %A Rodríguez Blanco,Octavi %A Torrejon,Antonio %+ Col·legi Oficial d'Infermeres i Infermers de Barcelona, Pujades 350, Barcelona, 08019, Spain, 34 932128108, atorrejon@coib.cat %K nurse’s role %K smartphones %K mobile phone %K mobile apps %K mHealth %D 2019 %7 1.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the last few years, the number of mobile apps for health professionals has increased exponentially. Nevertheless, there is a lack of knowledge about the professional use, training requirements, and quality perception of these apps among health care professionals such as nurses. Considering that the nursing profession is the largest segment of health care workforce in many countries such as Spain, the impact of the use of health apps by these professionals can be critical to the future of modern health care. Objective: The main objective of this study was to determine if nurses were using health apps professionally and what types of apps they were using. The secondary objectives were (1) to find out if, among nurses, there is a need for training in the use of health apps and (2) to explore nurses’ perceptions of health professional apps, determining whether there is a need for a certification process for health apps and the type of institution or organization that should review and validate these apps for professional use. Methods: After an initial piloting survey, all registered nurses at the Nursing Association of Barcelona were invited to participate in a 34-item online survey. Eventually, 1293 nurses participated in the survey; however, 52 did not complete the survey properly, omitting both age or gender information, and they were excluded from the analysis. Results: About half of the respondents (600/1241, 48.35%) had health professional apps installed on their devices and were included for analysis. Most participants in the survey were women (474/600, 79.0%) and the remaining were men (126/600, 21.0%). The most popular types of apps used and installed among nurses were related to drug information, health calculators, and health guidelines. Overall, 97.0% (582/600) of nurses thought that the health apps should be certified, and 80.0% (480/600) agreed that the certification process should be carried out by professional or health institutions. Furthermore, 14.5% (87/600) of participants mentioned that they were asked by their patients to prescribe a health app and only 6.5% (28/430) recommended them often. Most nurses (354/433, 81.8%) who answered the question about the importance of receiving specific training on using and prescribing health apps considered this point a very relevant issue. Conclusions: About half of the nurses in Catalonia use health apps for professional purposes, and they believe that these types of tools should be validated and certified by health or professional institutions before using them in clinical environments. Although the prescription of health apps in clinical environments is infrequent among nurses, they would be willing to prescribe apps if they were certified by a health organization. Finally, among nurses, there is a need for training in using and prescribing health apps for health care purposes. %M 31682587 %R 10.2196/15195 %U https://mhealth.jmir.org/2019/11/e15195 %U https://doi.org/10.2196/15195 %U http://www.ncbi.nlm.nih.gov/pubmed/31682587 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12606 %T The Association Among Social Support, Self-Efficacy, Use of Mobile Apps, and Physical Activity: Structural Equation Models With Mediating Effects %A Wang,Taotao %A Ren,Mengyuan %A Shen,Ying %A Zhu,Xiaorou %A Zhang,Xing %A Gao,Min %A Chen,Xueying %A Zhao,Ai %A Shi,Yuhui %A Chai,Weizhong %A Liu,Xinchuan %A Sun,Xinying %+ Department of Social Medicine and Health Education, School of Public Health, Peking University, No 38, Xueyuan Road, Haidian District, Beijing, 100191, China, 86 13691212050, xysun@bjmu.edu.cn %K mobile apps %K physical activity %K social support %K self-efficacy %K structural equation modeling %D 2019 %7 25.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is a risk factor for chronic noncommunicable diseases. Insufficient physical activity has become an important public health problem worldwide. As mobile apps have rapidly developed, physical activity apps have the potential to improve the level of physical activity among populations. Objective: This study aimed to evaluate the effect of physical activity apps on levels of physical activity among college students. Methods: A Web-based questionnaire was used to survey college students in Beijing from December 27, 2017, to January 5, 2018. According to a previous survey, 43% of college students using physical activity apps and 36% of those who never used such apps achieved the physical activity recommendations. In this study, the sample size was calculated to be 500. The questionnaire consisted of 5 parts: the use of physical activity apps, sports habits, social support, self-efficacy, and social demographic information. Structural equation modeling was used to test the relationships between the use of physical activity apps, self-efficacy, social support, and level of physical activity. Results: Of the 1245 participants, 384 college students (30.8%) used physical activity apps (in the past month). Of these 384 students, 191 (49.7%) gained new friends via the app. College students who were using physical activity apps had a higher level of physical activity and higher scores for social support and self-efficacy (P<.001) than those who did not use such apps. The use of physical activity apps significantly affected the mediating effect of physical activity level through social support (beta=.126; P<.001) and self-efficacy (beta=.294; P<.001). Gender played an important role in app use, self-efficacy, and physical activity in the mediation model: male users spent more time on physical activity and had higher self-efficacy scores (P<.001). Conclusions: This study focused on college students in Beijing and found that the use of physical activity apps is associated with higher physical activity levels among these students. This effect is mainly through the mediation effect of social support and self-efficacy, rather than the direct effect of physical activity apps. The use of physical activity apps is associated with a higher social support level and higher self-efficacy score. Furthermore, a high social support level and high self-efficacy score are associated with higher physical activity levels. %M 31573936 %R 10.2196/12606 %U http://mhealth.jmir.org/2019/9/e12606/ %U https://doi.org/10.2196/12606 %U http://www.ncbi.nlm.nih.gov/pubmed/31573936 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e13584 %T Mobile Health Divide Between Clinicians and Patients in Cancer Care: Results From a Cross-Sectional International Survey %A Tarricone,Rosanna %A Cucciniello,Maria %A Armeni,Patrizio %A Petracca,Francesco %A Desouza,Kevin C %A Hall,Leslie Kelly %A Keefe,Dorothy %+ Department of Social and Political Science, Bocconi University, Via Roentgen, 1, Milan, 20136, Italy, 39 3351250616, rosanna.tarricone@unibocconi.it %K mHealth %K cancer %K mobile phone %K survey %K mobile app %K digital health %K mhealth %D 2019 %7 06.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technologies are increasingly being used to manage chronic diseases, including cancer, with the promise of improving the efficiency and effectiveness of care. Among the myriad of mobile technologies in health care, we have seen an explosion of mobile apps. The rapid increase in digital health apps is not paralleled by a similar trend in usage statistics by clinicians and patients. Little is known about how much and in what ways mobile health (mHealth) apps are used by clinicians and patients for cancer care, what variables affect their use of mHealth, and what patients’ and clinicians’ expectations of mHealth apps are. Objective: This study aimed to describe the patient and clinician population that uses mHealth in cancer care and to provide recommendations to app developers and regulators to generally increase the use and efficacy of mHealth apps. Methods: Through a cross-sectional Web-based survey, we explored the current utilization rates of mHealth in cancer care and factors that explain the differences in utilization by patients and clinicians across the United States and 5 different countries in Europe. In addition, we conducted an international workshop with more than 100 stakeholders and a roundtable with key representatives of international organizations of clinicians and patients to solicit feedback on the survey results and develop insights into mHealth app development practices. Results: A total of 1033 patients and 1116 clinicians participated in the survey. The proportion of cancer patients using mHealth (294/1033, 28.46%) was far lower than that of clinicians (859/1116, 76.97%). Accounting for age and salary level, the marginal probabilities of use at means are still significantly different between the 2 groups and were 69.8% for clinicians and 38.7% for patients using the propensity score–based regression adjustment with weighting technique. Moreover, our analysis identified a gap between basic and advanced users, with a prevalent use for activities related to the automation of processes and the interaction with other individuals and a limited adoption for side-effect management and compliance monitoring in both groups. Conclusions: mHealth apps can provide access to clinical and economic data that are low cost, easy to access, and personalized. The benefits can go as far as increasing patients’ chances of overall survival. However, despite its potential, evidence on the actual use of mobile technologies in cancer care is not promising. If the promise of mHealth is to be fulfilled, clinician and patient usage rates will need to converge. Ideally, cancer apps should be designed in ways that strengthen the patient-physician relationship, ease physicians’ workload, be tested for validity and effectiveness, and fit the criteria for reimbursement. %M 31493318 %R 10.2196/13584 %U https://mhealth.jmir.org/2019/9/e13584/ %U https://doi.org/10.2196/13584 %U http://www.ncbi.nlm.nih.gov/pubmed/31493318 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e12983 %T The Continued Use of Mobile Health Apps: Insights From a Longitudinal Study %A Vaghefi,Isaac %A Tulu,Bengisu %+ Seidenberg School of Computer Science and Information Systems, Pace University, 1 Pace Plaza, New York, NY, 10038, United States, 1 (212) 346 1687, sashrafvaghefi@pace.edu %K mobile health %K mHealth %K digital health %K attrition %K law of attrition %K continued use %K use decisions %K goal persistence %K IT assessment %K smartphone %K mobile app %D 2019 %7 29.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps that support individuals pursuing health and wellness goals, such as weight management, stress management, smoking cessation, and self-management of chronic conditions have been on the rise. Despite their potential benefits, the use of these tools has been limited, as most users stop using them just after a few times of use. Under this circumstance, achieving the positive outcomes of mHealth apps is less likely. Objective: The objective of this study was to understand continued use of mHealth apps and individuals’ decisions related to this behavior. Methods: We conducted a qualitative longitudinal study on continued use of mHealth apps. We collected data through 34 pre- and postuse interviews and 193 diaries from 17 participants over two weeks. Results: We identified 2 dimensions that help explain continued use decisions of users of mHealth apps: users’ assessment of mHealth app and its capabilities (user experience) and their persistence at their health goals (intent). We present the key factors that influence users’ assessment of an mHealth app (interface design, navigation, notifications, data collection methods and tools, goal management, depth of knowledge, system rules, actionable recommendations, and user system fit) and relate these factors to previous literature on behavior change technology design. Using these 2 dimensions, we developed a framework that illustrated 4 decisions users might make after initial interaction with mHealth apps (to abandon use, limit use, switch app, and continue use). We put forth propositions to be explored in future research on mHealth app use. Conclusions: This study provides insight into the factors that shape users’ decisions to continue using mHealth apps, as well as other likely decision scenarios after the initial use experience. The findings contribute to extant knowledge of mHealth use and provide important implications for design of mHealth apps to increase long-term engagement of the users. %M 31469081 %R 10.2196/12983 %U http://mhealth.jmir.org/2019/8/e12983/ %U https://doi.org/10.2196/12983 %U http://www.ncbi.nlm.nih.gov/pubmed/31469081 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 2 %P e12809 %T Media Use Among Students From Different Health Curricula: Survey Study %A Zupanic,Michaela %A Rebacz,Patrick %A Ehlers,Jan P %+ Personality Psychology and Diagnostics, Department of Psychology, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str 50, Witten, 58448, Germany, 49 2302926 ext 756, michaela.zupanic@uni-wh.de %K social media %K medical education %K computers %K interprofessional relations %K distance education %K health occupations %D 2019 %7 19.08.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: Mobile devices such as smartphones, tablets, and laptop computers enable users to search for information and communicate with others at any place and any time. Such devices are increasingly being used at universities for teaching and learning. The use of mobile devices by students depends, among others, on the individual media literacy level and the curricular framework. Objective: The objective of this study was to explore whether there were differences in media use in students from various curricula at the Faculty of Health, Witten/Herdecke University. Methods: During the 2015-16 winter term, a survey was conducted at the Faculty of Health, Witten/Herdecke University, in which a total of 705 students (out of 1091 students; response rate: 705/1091, 64.61%) from 4 schools participated voluntarily: medicine (346/598), dentistry (171/204), psychology (142/243), and nursing science (46/46). The questionnaire developed for the study included 132 questions on 4 topics: (1) electronic and mobile devices (19 questions), (2) communication and organization of learning (45 questions), (3) apps/programs/websites/media (34 questions), and (4) media literacy (34 questions). The questionnaire was distributed and anonymously completed during in-class courses. Results: Students from all 4 schools had at least two electronic devices, with smartphones (97.4%, 687/705) and laptops (94.8%, 669/705) being the most common ones. Students agreed that electronic devices enabled them to effectively structure the learning process (mean 3.16, SD 0.62) and shared the opinion that university teaching should include imparting media literacy (mean 2.84, SD 0.84). Electronic device ownership was the highest among medical students (mean 2.68, SD 0.86) and medical students were the only ones to use a tutorial (36.1%, 125/346). Dental students most widely used text messages (mean 3.41, SD 0.49) and social media (mean 2.57, SD 1.10) to organize learning. Psychology students considered mobile devices to be most ineffective (mean 2.81, SD 0.83). Nursing science students used emails (mean 3.47, SD 0.73) and desktop computers (39%, 18/46) most widely. Conclusions: The results show that almost all students use electronic learning (e-learning) tools. At the same time, different profiles for different degree programs become apparent, which are to be attributed to not only the varying curricula and courses but also to the life circumstances of different age groups. Universities should, therefore, pay attention to the diverse user patterns and media literacy levels of students when planning courses to enable successful use of e-learning methods. %M 31429412 %R 10.2196/12809 %U http://mededu.jmir.org/2019/2/e12809/ %U https://doi.org/10.2196/12809 %U http://www.ncbi.nlm.nih.gov/pubmed/31429412 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13491 %T How Resource Scarcity and Accessibility Affect Patients’ Usage of Mobile Health in China: Resource Competition Perspective %A Ye,Qing %A Deng,Zhaohua %A Chen,Yanyan %A Liao,Jiazhi %A Li,Gang %A Lu,Yaobin %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 19945036079, zh-deng@hust.edu.cn %K mobile health %K technology adoption %K moderating effect %K resource scarcity %K resource accessibility %K resource competition %D 2019 %7 09.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The last decade has witnessed many achievements in China’s health care industry, but the industry still faces major challenges among which the uneven distribution of medical resources and the imbalance between supply and demand are the most pressing problems. Although mobile health (mHealth) services play a significant role in mitigating problems associated with health care delivery, their adoption rates have been low. Objective: The objective of this study was to explore the impact of resource scarcity and resource accessibility on the adoption of mHealth from the perspective of resource competition, to examine the concerning factors, and to provide a theoretical basis for promoting mHealth in China. Methods: We used 229,516 original registration records of outpatients to conduct an empirical analysis to examine the adoption of mHealth services from the perspective of resource competition. Results: The adoption rate of mobile services for outpatients was low, accounting for only 31.5% (N=71,707). The empirical results indicated that resource scarcity (beta=.435, P=.01) and accessibility (beta=−.134, P=.02) have a significant impact on the adoption of mHealth. In addition, gender (beta=.073, P=.01) and age (beta=−.009, P<.001) are significantly related to adoption of mHealth. Experience with mHealth has a moderating role in the relationship between resource scarcity (beta=−.129, P=.02), accessibility (beta=.138, P=.04), and adoption of mHealth. Conclusions: In this study we demonstrate that the external environment (resource scarcity and resource accessibility) has a significant impact on the adoption of mHealth. This study also demonstrates that experience with mHealth has a moderating role in the relationship between the elements of the external environment. Finally, we confirm that mHealth is a key factor in the delivery and allocation of medical resources and provide a theoretical basis for government agencies to develop policies on mHealth. %M 31400104 %R 10.2196/13491 %U https://mhealth.jmir.org/2019/8/e13491/ %U https://doi.org/10.2196/13491 %U http://www.ncbi.nlm.nih.gov/pubmed/31400104 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 7 %P e13152 %T Exploring Young People’s Perceptions of the Effectiveness of Text-Based Online Counseling: Mixed Methods Pilot Study %A Navarro,Pablo %A Bambling,Matthew %A Sheffield,Jeanie %A Edirippulige,Sisira %+ Kids Helpline, Yourtown, 5 Cordova St, Milton, Brisbane, 4064, Australia, 61 800 555 079, pablo.fernandez@uqconnect.edu.au %K mental health %K child health %K adolescent health %K distance counseling %K mhealth %K applied psychology %K psychological processes %D 2019 %7 03.07.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Young people aged 10-24 years are at the highest risk for mental health problems and are the least likely to seek professional treatment. Owing to this population’s high consumption of internet content, electronic mental (e-mental) health services have increased globally, with an aim to address barriers to treatment. Many of these services use text-based online counseling (TBOC), which shows promising results in supporting young people but also greater variance in outcomes compared with adult comparators. Objective: This pilot study qualitatively explored the characteristics of users aged 15-25 years accessing TBOC services, their motivations for access, and their perceptions about factors believed to influence the effectiveness of these modalities. Methods: E-surveys were administered naturalistically to 100 young service users aged 15-25 years who accessed webchat and email counseling services via an Australian e-mental health service. Thematic analysis of qualitative themes and quantitative descriptive and proportional data presented in electronic surveys were examined across the areas of user characteristics, motivations for selecting TBOC modalities, and their perceptions of TBOC effectiveness. Results: Participants were predominately female high school students of Caucasian or European descent from middle socioeconomic status, living with their parents in major cities. Four domains and various themes and subthemes were related to participants’ reasons for accessing TBOC and perceptions of its effectiveness: user characteristics (ie, physical and mental health syndrome and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), factors perceived to increase effectiveness (ie, general therapeutic benefits, positive modality and service factors, and persisting with counseling to increase benefit), and factors perceived to decrease effectiveness (ie, negative modality and service factors, and persisting with counseling despite benefit). Conclusions: Participants were motivated to use TBOC to increase their sense of safety in response to negative perceptions of their social skills and the response of the online counsellor to their presenting problem. By using TBOC services, they also sought to improve their access to mental health services that better met their expectations. Factors that increased effectiveness of TBOC were the counsellor’s interpersonal skills, use of text-based communication, and persisting with beneficial counseling sessions. Factors that reduced TBOC effectiveness were poor timeliness in response to service requests, experiencing no change in their presenting problem, not knowing what postcounseling action to take, and persisting with ineffective counseling sessions. %M 31271149 %R 10.2196/13152 %U https://mental.jmir.org/2019/7/e13152/ %U https://doi.org/10.2196/13152 %U http://www.ncbi.nlm.nih.gov/pubmed/31271149 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13844 %T Patient Attitudes and Their Awareness Towards Skin Cancer–Related Apps: Cross-Sectional Survey %A Steeb,Theresa %A Wessely,Anja %A Mastnik,Sebastian %A Brinker,Titus Josef %A French,Lars Einar %A Niesert,Anne-Charlotte %A Berking,Carola %A Heppt,Markus Vincent %+ Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, Munich, 80337, Germany, 49 89440056387, Markus.Heppt@med.uni-muenchen.de %K skin cancer %K melanoma %K mobile applications %K telemedicine %K awareness %K patient education %D 2019 %7 02.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the emerging era of digitalization and electronic health, skin cancer–related apps represent useful tools to support dermatologic consultation and examination. Yet, little is known about how patients perceive the value of such apps. Objective: The aim of this study was to investigate patient attitudes and their awareness toward skin cancer–related apps. Methods: A cross-sectional study including 200 patients from the oncological outpatient unit was conducted at the University Hospital (LMU Munich, Germany) between September and December 2018. Patients were asked to complete a self-administered questionnaire on the popularity and usefulness of health-related and skin cancer–related apps. A descriptive analysis was performed with the expression of categorical variables as frequencies and percentages. For continuous variables, the median and range were indicated. Contingency tables and chi-square tests were performed to investigate associations between sociodemographic data and selected items of the questionnaire. Results: A total of 98.9% (195/197) of patients had never used skin cancer–related apps or could not remember. In 49.7% (93/187) of cases, patients were unsure about the usefulness of skin cancer apps, whereas 42.6% (78/183) thought that skin cancer apps could supplement or support the professional skin examination performed by a physician. However, 47.9% (90/188) were interested in acquiring more information by their dermatologists about skin cancer apps. Young age (P=.002), male gender (P=.02), a previous history of melanoma (P=.004), and higher educational level (P=.002) were significantly associated with a positive attitude. Nevertheless, 55.9% (105/188) preferred a printed patient brochure on skin cancer to downloading and using an app. Conclusions: The experience and knowledge of skin cancer–related apps was surprisingly low in this population, although there was a high general interest in more information about such apps. Printed patient brochures were the preferred information source. %M 31267978 %R 10.2196/13844 %U https://mhealth.jmir.org/2019/7/e13844/ %U https://doi.org/10.2196/13844 %U http://www.ncbi.nlm.nih.gov/pubmed/31267978 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e12631 %T Understanding the Use of Smartphone Apps for Health Information Among Pregnant Chinese Women: Mixed Methods Study %A Wang,Na %A Deng,Zequn %A Wen,Li Ming %A Ding,Yan %A He,Gengsheng %+ Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, No. 130 Dongan Road, Shanghai, 200032, China, 86 21 54237229, gshe@shmu.edu.cn %K mobile applications %K pregnancy %K consumer health information %K health promotion %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hospital-based health promotion resources to assist pregnant women in adopting a healthy lifestyle and optimizing gestational weight gain are important, but with limited effects. Increasingly, women are using mobile apps to access health information during the antenatal period. Objective: The aims of the study were to investigate app-usage by Chinese women during pregnancy and to gain a better understanding of their views and attitudes toward apps containing health information. Methods: A mixed methods study design was applied. Study participants were recruited from 2 maternity hospitals in Shanghai, China, between March and July 2018. A self-administered Web-based survey was conducted with 535 pregnant Chinese women on their sources of health information and reasons for using apps during pregnancy. A total of 4 semistructured focus groups were also conducted with the pregnant women (n=28). Results: The use of pregnancy-related apps and the internet was common among the respondents. Almost half of the women had used pregnancy-related apps. Specifically, the use of apps for health information declined as pregnancy progressed from 70% (35/50) in the first trimester to 41.3% (143/346) in the third trimester. The main reason for using an app was to monitor fetal development (436/535, 81.5%), followed by learning about nutrition and recording diet in pregnancy (140/535, 26.2%). The women found that the apps were useful and convenient and can support lifestyle modifications during pregnancy. However, some apps also contained misinformation or incorrect information that could cause anxiety as reported by the participants. Many women expressed the need for developing an app containing evidence-based, well-informed, and tailored health information to support them during pregnancy. Conclusions: The study suggests that apps were widely used by many Chinese women during pregnancy to monitor fetal development, to obtain diet and physical activity information, and to track their body changes. The women highly appreciated the evidence-based information, expert opinions, and tailored advice available on apps. Smartphone apps have the potential to deliver health information for pregnant women. %M 31215516 %R 10.2196/12631 %U http://mhealth.jmir.org/2019/6/e12631/ %U https://doi.org/10.2196/12631 %U http://www.ncbi.nlm.nih.gov/pubmed/31215516 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13772 %T Factors Determining Patients’ Choice Between Mobile Health and Telemedicine: Predictive Analytics Assessment %A Khairat,Saif %A Liu,Songzi %A Zaman,Tanzila %A Edson,Barbara %A Gianforcaro,Robert %+ Carolina Health Informatics Program, University of North Carolina at Chapel Hill, 428 Carrington Hall, Chapel Hill, NC, 27514, United States, 1 9198435413, saif@unc.edu %K mHealth %K telemedicine %K urgent care %K predictive analytics %D 2019 %7 8.6.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The solution to the growing problem of rural residents lacking health care access may be found in the use of telemedicine and mobile health (mHealth). Using mHealth or telemedicine allows patients from rural or remote areas to have better access to health care. Objective: The objective of this study was to understand factors influencing the choice of communication medium for receiving care, through the analysis of mHealth versus telemedicine encounters with a virtual urgent clinic. Methods: We conducted a postdeployment evaluation of a new virtual health care service, Virtual Urgent Clinic, which uses mHealth and telemedicine modalities to provide patient care. We used a multinomial logistic model to test the significance and predictive power of a set of features in determining patients’ preferred method of telecare encounters—a nominal outcome variable of two levels (mHealth and telemedicine). Results: Postdeployment, 1403 encounters were recorded, of which 1228 (87.53%) were completed with mHealth and 175 (12.47%) were telemedicine encounters. Patients’ sex (P=.004) and setting (P<.001) were the most predictive determinants of their preferred method of telecare delivery, with significantly small P values of less than .01. Pearson chi-square test returned a strong indication of dependency between chief concern and encounter mediums, with an extremely small P<.001. Of the 169 mHealth patients who responded to the survey, 154 (91.1%) were satisfied by their encounter, compared with 31 of 35 (89%) telemedicine patients. Conclusions: We studied factors influencing patients’ choice of communication medium, either mHealth or telemedicine, for a virtual care clinic. Sex and geographic location, as well as their chief concern, were strong predictors of patients’ choice of communication medium for their urgent care needs. This study suggests providing the option of mHealth or telemedicine to patients, and suggesting which medium would be a better fit for the patient based on their characteristics. %M 31199332 %R 10.2196/13772 %U http://mhealth.jmir.org/2019/6/e13772/ %U https://doi.org/10.2196/13772 %U http://www.ncbi.nlm.nih.gov/pubmed/31199332 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13614 %T The Use of Smart Devices by Care Providers in Emergency Departments: Cross-Sectional Survey Design %A Alameddine,Mohamad %A Soueidan,Hussein %A Makki,Maha %A Tamim,Hani %A Hitti,Eveline %+ American University of Beirut, Faculty of Medicine, Department of Emergency Medicine, Bliss Street, Beirut, 11-0236, Lebanon, 961 350000, eh16@aub.edu.lb %K health personnel %K smart phones %K emergency departments %K healthcare quality %K policy %D 2019 %7 5.5.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of smart devices (SDs) by health care providers in care settings is a common practice nowadays. Such use includes apps related to patient care and often extends to personal calls and applications with frequent prompts and interruptions. These prompts and interruptions enhance the risk of distractions caused by SDs and raise concerns about service quality and patient safety. Such concerns are exacerbated in complex care settings such as the emergency department (ED). Objective: The objective of this study was to measure the frequency and patterns of SD use among health care providers in the ED of a large academic health center in Lebanon. The perceived consequences of care providers using SDs on provider-to-provider communication and the care quality of patients in the ED were assessed. Additionally, factors associated with the use of SDs and the approval for regulating such use were also investigated. Methods: The study was carried out at the ED of an academic health center with the highest volume of patient visits in Lebanon. The data were collected using a cross-sectional electronic survey sent to all ED health care providers (N=236). The target population included core ED faculty members, attending physicians, residents, medical students, and the nursing care providers. The regression model developed in this study was used to find predictors of medical errors in the ED because of the use of SDs. Results: Half of the target population responded to the questionnaire. A total of 83 of 97 respondents (86%) used one or more medical applications on their SDs. 71 out of 87 respondents (82%) believed that using SDs in the ED improved the coordination among the care team, and 71 out of 90 (79%) respondents believed that it was beneficial to patient care. In addition, 37 out of 90 respondents (41%) acknowledged that they were distracted when using their SDs for nonwork purposes. 51 out of 93 respondents (55%) witnessed a colleague committing a near miss or an error owing to the SD-caused distractions. Regression analysis revealed that age (P=.04) and missing information owing to the use of SDs (P=.02) were major predictors of committing an error in the ED. Interestingly, more than 40% of the respondents were significantly addicted to using SDs and more than one-third felt the need to cut down their use. Conclusions: The findings of this study make it imperative to ensure the safety and wellbeing of patients, especially in high intensity, high volume departments like the ED. Irrespective of the positive role SDs play in the health care process, the negative effects of their use mandate proper regulation, in particular, an ethical mandate that takes into consideration the significant consequences that the use of SDs may have on care processes and outcomes. %M 31199328 %R 10.2196/13614 %U https://mhealth.jmir.org/2019/6/e13614/ %U https://doi.org/10.2196/13614 %U http://www.ncbi.nlm.nih.gov/pubmed/31199328 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13364 %T Smartphone, Social Media, and Mental Health App Use in an Acute Transdiagnostic Psychiatric Sample %A Beard,Courtney %A Silverman,Alexandra L %A Forgeard,Marie %A Wilmer,M Taylor %A Torous,John %A Björgvinsson,Thröstur %+ McLean Hospital/Harvard Medical School, 115 Mill St, Mailbox 113, Belmont, MA, 02478, United States, 1 16178553557, CBEARD@MCLEAN.HARVARD.EDU %K mobile health %K smartphone %K social media %K serious mental illness %D 2019 %7 7.6.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite high rates of smartphone ownership in psychiatric populations, there are very little data available characterizing smartphone use in individuals with mental illness. In particular, few studies have examined the interest and use of smartphones to support mental health. Objective: This study aimed to (1) characterize general smartphone app and social media usage in an acute transdiagnostic psychiatric sample with high smartphone ownership, (2) characterize current engagement and interest in the use of smartphone apps to support mental health, and (3) test demographic and clinical predictors of smartphone use. Methods: The survey was completed by all patients attending an adult partial hospital program, with no exclusion criteria. The primary outcomes were frequency of use of general and mental health smartphone apps (smartphone use survey) and the frequency of social media use and phone-checking behavior (mobile technology engagement scale). Results: Overall, 322 patients (aged mean 33.49, SD 13.87 years; 57% female) reported that their most frequently used app functions were texting, email, and social media. Younger individuals reported more frequent use across most types of apps. Baseline depression and anxiety symptoms were not associated with the frequency of app use. Participants reported health care, calendar, and texting apps as most supportive of their mental health and social media apps as most negatively affecting their mental health. Most patients reported an interest in (73.9% [238/322]) and willingness to use (81.3% [262/322]) a smartphone app to monitor their mental health condition. Less than half (44%) of the patients currently had a mental health app downloaded on their smartphone, with mindfulness and meditation apps being the most common type. Conclusions: The high interest in and willingness to use mental health apps, paired with the only moderate current reported usage, indicate a potential unmet treatment opportunity in psychiatric populations. There is potential to optimize non-mental health–specific apps to better support the needs of those with mental illness and to design a new wave of mental health apps that match the needs of these populations as well as the way they use smartphones in daily life. %M 31199338 %R 10.2196/13364 %U https://mhealth.jmir.org/2019/6/e13364/ %U https://doi.org/10.2196/13364 %U http://www.ncbi.nlm.nih.gov/pubmed/31199338 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13679 %T Who is Tracking Health on Mobile Devices: Behavioral Logfile Analysis in Hong Kong %A Guan,Lu %A Peng,Tai-Quan %A Zhu,Jonathan JH %+ Department of Communication, Michigan State University, 404 Wilson Road, East Lansing, MI, 48824, United States, 1 5173550221, winsonpeng@gmail.com %K mobile apps %K mHealth %K circadian rhythm %D 2019 %7 23.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health apps on mobile devices provide an unprecedented opportunity for ordinary people to develop social connections revolving around health issues. With increasing penetration of mobile devices and well-recorded behavioral data on such devices, it is desirable to employ digital traces on mobile devices rather than self-reported measures to capture the behavioral patterns underlying the use of mobile health (mHealth) apps in a more direct and valid way. Objective: The objectives of this study were to (1) assess the demographic predictors of the adoption of mHealth apps; (2) investigate the temporal pattern underlying the use of mHealth apps; and (3) explore the impacts of demographic variables, temporal features, and app genres on the use of mHealth apps. Methods: Logfile data of mobile devices were collected from a representative panel of about 2500 users in Hong Kong. Users’ mHealth app activities were analyzed. We first conducted a binary logistic regression analysis to uncover demographic predictors of users’ adoption status. Then we utilized a multilevel negative binomial regression to examine the impacts of demographic characteristics, temporal features, and app genres on mHealth app use. Results: It was found that 27.5% of mobile device users in Hong Kong adopt at least one genre of mHealth app. Adopters of mHealth apps tend to be female and better educated. However, demographic characteristics did not showcase the predictive powers on the use of mHealth apps, except for the gender effect (Bfemale vs Bmale=–0.18; P=.006). The use of mHealth apps demonstrates a significant temporal pattern, which is found to be moderately active during daytime and intensifying at weekends and at night. Such temporal patterns in mHealth apps use are moderated by individuals’ demographic characteristics. Finally, demographic characteristics were also found to condition the use of different genres of mHealth apps. Conclusions: Our findings suggest the importance of dynamic perspective in understanding users’ mHealth app activities. mHealth app developers should consider more the demographic differences in temporal patterns of mHealth apps in the development of mHealth apps. Furthermore, our research also contributes to the promotion of mHealth apps by emphasizing the differences of usage needs for various groups of users. %M 31120429 %R 10.2196/13679 %U http://mhealth.jmir.org/2019/5/e13679/ %U https://doi.org/10.2196/13679 %U http://www.ncbi.nlm.nih.gov/pubmed/31120429 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11687 %T Mobile Health for Tuberculosis Management in South India: Is Video-Based Directly Observed Treatment an Acceptable Alternative? %A Kumar,Anil A %A De Costa,Ayesha %A Das,Arundathi %A Srinivasa,GA %A D'Souza,George %A Rodrigues,Rashmi %+ Department of Community Health, St John's Medical College, St John's National Academy of Health Sciences, Koramangala 4th Block, Bangalore, 560034, India, 91 9845389538, rashmijr@gmail.com %K medical informatics %K tuberculosis %K mHealth %K adherence %K mobile phone %K reminder %K SMS %K voice call %K DOT %K vDOT %K video DOT %D 2019 %7 03.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the availability of low-cost mobile devices and the ease of internet access, mobile health (mHealth) is digitally revolutionizing the health sector even in resource-constrained settings. It is however necessary to assess end-user perceptions before deploying potential interventions. Objective: This study aimed to assess the mobile phone usage patterns and the acceptability of mobile phone support during care and treatment in patients with tuberculosis (TB) in South India. Methods: This exploratory study was conducted at an urban private tertiary care teaching hospital and nearby public primary-level health care facilities in Bangalore, South India. We recruited 185 patients with TB through consecutive sampling. Subsequent to written informed consent, participants responded to an interviewer-administered pretested questionnaire. The questionnaire included questions on demographics, phone usage patterns, and the benefits of using of mobile phone technology to improve health outcomes and treatment adherence. Frequency, mean, median, and SD or interquartile range were used to describe the data. Bivariate associations were assessed between demographics, clinical details, phone usage, and mHealth communication preferences using the chi-square test and odds ratios. Associations with a P value ≤.20 were included in a logistic regression model. A P value of <.05 was considered significant. Results: Of the 185 participants, 151 (81.6%) used a mobile phone, and half of them owned a smartphone. The primary use of the mobile phone was to communicate over voice calls (147/151, 97.4%). The short message service (SMS) text messaging feature was used by only 66/151 (43.7%) mobile phone users. A total of 87 of the 151 mobile phone users (57.6%) knew how to use the camera. Only 41/151 (27.2%) mobile phone users had used their mobile phones to communicate with their health care providers. Although receiving medication reminders via mobile phones was acceptable to all participants, 2 participants considered repeated reminders as an intrusion of their privacy. A majority of the participants (137/185, 74.1%) preferred health communications via voice calls. Of the total participants, 123/185 (66.5%) requested reminders to be sent only at specific times during the day, 22/185 (11.9%) suggested reminders should synchronize with their prescribed medication schedule, whereas 40/185 (21.6%) did not have any time preferences. English literacy was associated with a preference for SMS in comparison with voice calls. Most participants (142/185, 76.8%) preferred video-based directly observed treatment when compared with in-person directly observed treatment. Conclusions: Although mobile phones for supporting health and treatment adherence were acceptable to patients with TB, mHealth interventions should consider language, mode of communication, and preferred timing for communication to improve uptake. %M 30942696 %R 10.2196/11687 %U http://mhealth.jmir.org/2019/4/e11687/ %U https://doi.org/10.2196/11687 %U http://www.ncbi.nlm.nih.gov/pubmed/30942696 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12179 %T Associations of Health App Use and Perceived Effectiveness in People With Cardiovascular Diseases and Diabetes: Population-Based Survey %A Ernsting,Clemens %A Stühmann,Lena Mareike %A Dombrowski,Stephan U %A Voigt-Antons,Jan-Niklas %A Kuhlmey,Adelheid %A Gellert,Paul %+ Charité - Universitätsmedizin Berlin, Institute of Medical Sociology, Charitéplatz 1, Berlin,, Germany, 49 30450529215, paul.gellert@charite.de %K mHealth %K eHealth %K smartphone %K telemedicine %K health literacy %K chronic disease %K comorbidity %K multimorbidity %D 2019 %7 28.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps can help to change health-related behaviors and manage chronic conditions in patients with cardiovascular diseases (CVDs) and diabetes mellitus, but a certain level of health literacy and electronic health (eHealth) literacy may be needed. Objective: The aim of this study was to identify factors associated with mobile health app use in individuals with CVD or diabetes and detect relations with the perceived effectiveness of health apps among app users. Methods: The study used population-based Web-based survey (N=1500) among Germans, aged 35 years and older, with CVD, diabetes, or both. A total of 3 subgroups were examined: (1) Individuals with CVD (n=1325), (2) Individuals with diabetes (n=681), and (3) Individuals with CVD and diabetes (n=524). Sociodemographics, health behaviors, CVD, diabetes, health and eHealth literacy, characteristics of health app use, and characteristics of apps themselves were assessed by questionnaires. Linear and logistic regression models were applied. Results: Overall, patterns of factors associated with health app use were comparable in individuals with CVD or diabetes or both. Across subgroups, about every fourth patient reported using apps for health-related purposes, with physical activity and weight loss being the most prominent target behaviors. Health app users were younger, more likely to be female (except in those with CVD and diabetes combined), better educated, and reported more physical activity. App users had higher eHealth literacy than nonusers. Those users who perceived the app to have a greater effectiveness on their health behaviors tended to be more health and eHealth literate and rated the app to use more behavior change techniques (BCTs). Conclusions: There are health- and literacy-related disparities in the access to health app use among patients with CVD, diabetes, or both, which are relevant to specific health care professionals such as endocrinologists, dieticians, cardiologists, or general practitioners. Apps containing more BCTs had a higher perceived effect on people’s health, and app developers should take the complexity of needs into account. Furthermore, eHealth literacy appears to be a requirement to use health apps successfully, which should be considered in health education strategies to improve health in patients with CVD and diabetes. %M 30920383 %R 10.2196/12179 %U http://mhealth.jmir.org/2019/3/e12179/ %U https://doi.org/10.2196/12179 %U http://www.ncbi.nlm.nih.gov/pubmed/30920383 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12171 %T Temporal Stability of Smartphone Use Data: Determining Fundamental Time Unit and Independent Cycle %A Pan,Yuan-Chien %A Lin,Hsiao-Han %A Chiu,Yu-Chuan %A Lin,Sheng-Hsuan %A Lin,Yu-Hsuan %+ National Health Research Institutes, Institute of Population Health Sciences, 35 Keyan Road, Zhunan, Miaoli County, Miaoli County, 35053, Taiwan, 886 37246166 ext 36383, yuhsuanlin@nhri.org.tw %K temporal stability %K smartphone use %K smartphone addiction %K smartphone %K mobile phone %D 2019 %7 26.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Assessing human behaviors via smartphone for monitoring the pattern of daily behaviors has become a crucial issue in this century. Thus, a more accurate and structured methodology is needed for smartphone use research. Objective: The study aimed to investigate the duration of data collection needed to establish a reliable pattern of use, how long a smartphone use cycle could perpetuate by assessing maximum time intervals between 2 smartphone periods, and to validate smartphone use and use/nonuse reciprocity parameters. Methods: Using the Know Addiction database, we selected 33 participants and passively recorded their smartphone usage patterns for at least 8 weeks. We generated 4 parameters on the basis of smartphone use episodes, including total use frequency, total use duration, proactive use frequency, and proactive use duration. A total of 3 additional parameters (root mean square of successive differences, Control Index, and Similarity Index) were calculated to reflect impaired control and compulsive use. Results: Our findings included (1) proactive use duration correlated with subjective smartphone addiction scores, (2) a 2-week period of data collection is required to infer a 2-month period of smartphone use, and (3) smartphone use cycles with a time gap of 4 weeks between them are highly likely independent cycles. Conclusions: This study validated temporal stability for smartphone use patterns recorded by a mobile app. The results may provide researchers an opportunity to investigate human behaviors with more structured methods. %M 30912751 %R 10.2196/12171 %U http://mhealth.jmir.org/2019/3/e12171/ %U https://doi.org/10.2196/12171 %U http://www.ncbi.nlm.nih.gov/pubmed/30912751 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11516 %T Sensor-Based Passive Remote Monitoring and Discordant Values: Qualitative Study of the Experiences of Low-Income Immigrant Elders in the United States %A Berridge,Clara %A Chan,Keith T %A Choi,Youngjun %+ University of Washington, 4101 15th Ave NE, Seattle, WA, 98105, United States, 1 206 685 2180, clarawb@uw.edu %K immigrants %K ubiquitous sensing %K acculturation %K passive monitoring %K independent living %K family caregiving %K culturally appropriate technology %D 2019 %7 25.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Remote monitoring technologies are positioned to mitigate the problem of a dwindling care workforce and disparities in access to care for the growing older immigrant population in the United States. To achieve these ends, designers and providers need to understand how these supports can be best provided in the context of various sociocultural environments that shape older adults’ expectations and care relationships, yet few studies have examined how the same remote monitoring technologies may produce different effects and uses depending on what population is using them in a particular context. Objective: This study aimed to examine the experiences and insights of low-income, immigrant senior residents, family contacts, and staff of housing that offered a sensor-based passive monitoring system designed to track changes in movement around the home and trigger alerts for caregivers. The senior housing organization had been offering the QuietCare sensor system to its residents for 6 years at the time of the study. We are interested in adoption and discontinuation decisions and use over time, rather than projected acceptance. Our research question is how do cultural differences influence use and experiences with this remote monitoring technology? The study does not draw generalizable conclusions about how cultural groups interact with a given technology, but rather, it examines how values are made visible in elder care technology interactions. Methods: A total of 41 participants (residents, family, and staff) from 6 large senior housing independent living apartment buildings were interviewed. Interviews were conducted in English and Korean with these participants who collectively had immigrated to the United States from 10 countries. Results: The reactions of immigrant older adults to the passive monitoring system reveal that this tool offered to them was often mismatched with their values, needs, and expectations. Asian elders accepted the intervention social workers offered largely to appease them, but unlike their US-born counterparts, they adopted reluctantly without hope that it would ameliorate their situation. Asian immigrants discontinued use at the highest rate of all residents, and intergenerational family cultural conflict contributed to this termination. Social workers reported that none of the large population of Russian-speaking residents agreed to use QuietCare. Bilingual and bicultural social workers played significant roles as cultural navigators in the promotion of QuietCare to residents. Conclusions: This research into the interactions of culturally diverse people with the same monitoring technology reveals the significant role that social values and context play in shaping how people and families interact with and experience elder care interventions. If technology-based care services are to reach their full potential, it will be important to identify the ways in which cultural values produce different uses and responses to technologies intended to help older adults live independently. %M 30907741 %R 10.2196/11516 %U http://mhealth.jmir.org/2019/3/e11516/ %U https://doi.org/10.2196/11516 %U http://www.ncbi.nlm.nih.gov/pubmed/30907741 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 1 %P e12350 %T Understanding Determinants of Health Care Professionals’ Perspectives on Mobile Health Continuance and Performance %A Hsiao,Ju-Ling %A Chen,Rai-Fu %+ Department of Information Management, Chia-Nan University of Pharmacy and Science, No 60, Sec 1, Erren Rd, Rende Dist, Tainan City, 71710, Taiwan, 886 6 2664911 ext 5308, rafuchen@gmail.com %K delivery of health care %K mobile health %K health information management %K health care quality, access, and evaluation %D 2019 %7 18.03.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: With the widespread use of mobile technologies, mobile information systems have become crucial tools in health care operations. Although the appropriate use of mobile health (mHealth) may result in major advances in expanding health care coverage (increasing decision-making speeds, managing chronic conditions, and providing suitable health care in emergencies), previous studies have argued that current mHealth research does not adequately evaluate mHealth interventions, and it does not provide sufficient evidence regarding the effects on health. Objective: The aim of this study was to facilitate the widespread use of mHealth systems; an accurate evaluation of the systems from the users’ perspective is essential after the implementation and use of the system in daily health care practices. This study extends the expectation-confirmation model by using characteristics of individuals, technology, and tasks to identify critical factors affecting mHealth continuance and performance from the perspective of health care professionals (HCPs). Methods: A questionnaire survey was used to collect data from HCPs who were experienced in using mHealth systems of a Taiwanese teaching hospital. In total, 282 questionnaires were distributed, and 201 complete and valid questionnaires were returned, thus indicating a valid response rate of 71.3% (201/282). The collected data were analyzed using WarpPLS version 5.0 (ScriptWarp Systems). Results: The results revealed that mHealth continuance (R2=0.522) was mainly affected by perceived usefulness, technology maturity, individual habits, task mobility, and user satisfaction, whereas individual performance (R2=0.492) was affected by mHealth continuance. In addition, user satisfaction (R2=0.548) was affected by confirmation and perceived usefulness of mHealth, whereas perceived usefulness (R2=0.521) was affected by confirmation. This implied that confirmation played a key role in affecting perceived usefulness and user satisfaction. Furthermore, the results showed that mHealth continuance positively affected individual performance. Conclusions: The identified critical factors influencing mHealth continuance and performance can be used as a useful assessment tool by hospitals that have implemented mHealth systems to facilitate the use and infusion of the systems. Furthermore, the results can help health care institutions that intend to introduce or develop mHealth applications to identify critical issues and effectively allocate limited resources to mHealth systems. %M 30882353 %R 10.2196/12350 %U http://medinform.jmir.org/2019/1/e12350/ %U https://doi.org/10.2196/12350 %U http://www.ncbi.nlm.nih.gov/pubmed/30882353 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e12692 %T Use of Weight-Management Mobile Phone Apps in Saudi Arabia: A Web-Based Survey %A Aljuraiban,Ghadeer S %+ Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Turki Alawwal, Riyadh, 145111, Saudi Arabia, 966 14651122, galjuraiban@ksu.edu.sa %K lifestyle %K mobile app %K weight loss %K mobile phone %D 2019 %7 22.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In recent years, the use of mobile phone weight-management apps has increased significantly. Weight-management apps have been found effective in promoting health and managing weight. However, data on user perception and on barriers to app usage are scarce. Objective: This study aimed to investigate the use of weight-management apps and barriers to use as well as reasons for discontinuing use in a sample of mobile phone users in Saudi Arabia. Methods: Mobile phone users aged 18 years and above from the general public in Saudi Arabia completed a Web-based survey. The survey included questions on weight-management app usage patterns, user perceptions concerning weight management, efficacy of weight-management apps, and reasons for discontinuing use. Participants were classified into normal weight (body mass index [BMI]: 18.5 to 24.9 kg/m2) and overweight or obese (BMI: ≥25.0 kg/m2). Results: The survey included 1191 participants; 513 of them used weight-management apps. More overweight or obese respondents used these apps compared with normal weight respondents (319/513, 62.2% vs 194/513, 37.8%, respectively). App features that overweight or obese users were most interested in were mainly the possibility to be monitored by a specialist and barcode identification of calorie content, whereas normal weight users mostly preferred availability of nutrition information of food items. Reasons for discontinuing use among overweight or obese respondents were mainly that monitoring by a specialist was not offered (80/236, 33.9%) and the app was not in the local language (48/236, 20.3%). Among normal weight users, the main reason for noncontinuance was the app language (45/144, 31.3%) and difficulty of use (30/144, 20.8%). Conclusions: To better address the needs of both normal weight and overweight or obese adults, improved app designs that offer monitoring by a specialist are needed. Developers may consider ways of overcoming barriers to use, such as language, by developing local language apps, which can improve the efficacy of such apps and help spread their use. %M 30794205 %R 10.2196/12692 %U http://mhealth.jmir.org/2019/2/e12692/ %U https://doi.org/10.2196/12692 %U http://www.ncbi.nlm.nih.gov/pubmed/30794205 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 2 %P e12255 %T Use of Mobile and Computer Devices to Support Recovery in People With Serious Mental Illness: Survey Study %A Noel,Valerie A %A Acquilano,Stephanie C %A Carpenter-Song,Elizabeth %A Drake,Robert E %+ Westat, Inc, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, United States, 1 603 287 4719, valerienoel@westat.com %K app %K mental health %K mHealth %K mobile phone %K serious mental illness %D 2019 %7 20.02.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health recovery refers to an individual’s experience of gaining a sense of personal control, striving towards one’s life goals, and meeting one’s needs. Although people with serious mental illness own and use electronic devices for general purposes, knowledge of their current use and interest in future use for supporting mental health recovery remains limited. Objective: This study aimed to identify smartphone, tablet, and computer apps that mental health service recipients use and want to use to support their recovery. Methods: In this pilot study, we surveyed a convenience sample of 63 mental health service recipients with serious mental illness. The survey assessed current use and interest in mobile and computer devices to support recovery. Results: Listening to music (60%), accessing the internet (59%), calling (59%), and texting (54%) people were the top functions currently used by participants on their device to support their recovery. Participants expressed interest in learning how to use apps for anxiety/stress management (45%), mood management (45%), monitoring mental health symptoms (43%), cognitive behavioral therapy (40%), sleep (38%), and dialectical behavior therapy (38%) to support their recovery. Conclusions: Mental health service recipients currently use general functions such as listening to music and calling friends to support recovery. Nevertheless, they reported interest in trying more specific illness-management apps. %M 30785401 %R 10.2196/12255 %U http://mental.jmir.org/2019/2/e12255/ %U https://doi.org/10.2196/12255 %U http://www.ncbi.nlm.nih.gov/pubmed/30785401 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11644 %T The MomConnect Nurses and Midwives Support Platform (NurseConnect): A Qualitative Process Evaluation %A Fischer,Alex Emilio %A Sebidi,Jane %A Barron,Peter %A Lalla-Edward,Samanta Tresha %+ Wits Reproductive Health and HIV Institute, University of Witwatersrand, Hillbrow Health Precinct, 22 Esselen Street, HIllbrow, Johannesburg, 2001, South Africa, 27 073 776 2705, afischer@wrhi.ac.za %K evaluation %K mHealth %K mobile phone %K MomConnect %K NurseConnect %K South Africa %D 2019 %7 13.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Over the past decade, mobile health has steadily increased in low-income and middle-income countries. However, few platforms have been able to sustainably scale up like the MomConnect program in South Africa. NurseConnect was created as a capacity building component of MomConnect, aimed at supporting nurses and midwives in maternal and child health. The National Department of Health has committed to expanding NurseConnect to all nurses across the country, and an evaluation of the current user experience was conducted to inform a successful scale up. Objective: This study aims to evaluate the perception and use of NurseConnect by nurses and midwives to produce feedback that can be used to optimize the user experience as the platform continues to scale up. Methods: We conducted focus group discussions and in-depth interviews with 110 nurses and midwives from 18 randomly selected health care facilities across South Africa. Questions focused on mobile phone use, access to medical information and their experience with NurseConnect registration, as well as the content and different platforms. Results: All participants had mobile phones and communication through calls and messaging was the main use in both personal and work settings. Of 110 participants, 108 (98.2%) had data-enabled phones, and the internet, Google, and apps (South African National Department of Health Guidelines, iTriage, Drugs.com) were commonly used, especially to find information in the work setting. Of 110 participants, 62 (56.4%) were registered NurseConnect users and liked the message content, especially listeriosis and motivational messages, which created behavioral change in some instances. The mobisite and helpdesk, however, were underutilized because of a lack of information surrounding these platforms. Some participants did not trust medical information from websites and had more confidence in apps, while others associated a “helpdesk” with a call-in service, not a messaging one. Many of the unregistered participants had not heard of NurseConnect, and some cited data and time constraints as barriers to both registration and uptake. Conclusions: Mobile and smartphone penetration was very high, and participants often used their phone to find medical information. The NurseConnect messages were well-liked by all registered participants; however, the mobisite and helpdesk were underutilized owing to a lack of information and training around these platforms. Enhanced marketing and training initiatives that optimize existing social networks, as well as the provision of data and Wi-Fi, should be explored to ensure that registration improves, and that users are active across all platforms. %M 30758298 %R 10.2196/11644 %U http://mhealth.jmir.org/2019/2/e11644/ %U https://doi.org/10.2196/11644 %U http://www.ncbi.nlm.nih.gov/pubmed/30758298 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e12658 %T Use, Perspectives, and Attitudes Regarding Diabetes Management Mobile Apps Among Diabetes Patients and Diabetologists in China: National Web-Based Survey %A Zhang,Yiyu %A Li,Xia %A Luo,Shuoming %A Liu,Chaoyuan %A Xie,Yuting %A Guo,Jia %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 %K mobile applications %K surveys and questionnaires %D 2019 %7 08.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The diabetes disease burden in China is heavy, and mobile apps have a great potential for diabetes management. However, there is a lack of investigation of diabetes app use among Chinese diabetes patients and diabetologists. The perspectives and attitudes of diabetes patients and diabetologists regarding diabetes apps are also unclear. Objective: Our objectives were to investigate diabetes patients’ and diabetologists’ use, attitudes, and perspectives, as well as patients’ needs, with respect to diabetes apps to provide information regarding the optimal design of diabetes apps and the best strategies to promote their use. Methods: Diabetes patients and diabetologists across China were surveyed on the WeChat (Tencent Corp) network using Sojump (Changsha ran Xing InfoTech Ltd) from January 23, 2018, to July 30, 2018. In total, 2 survey links were initially sent to doctors from 46 Latent Autoimmune Diabetes of Adults Study collaborative hospitals in China in 25 major cities and were spread on their WeChat contacts network. We also published the patient survey link on 3 WeChat public accounts and requested diabetes patients to fill out questionnaires. A multivariate regression analysis was used to identify associations of demographic and basic disease information with app usage among adult patients. Results: Overall, 1276 individuals from 30 provincial regions responded to the patient survey; among them, the overall app awareness rate was 29.94% (382/1276) and usage was 15.44% (197/1276). The usage was higher among patients with type 1 diabetes (T1DM) than among patients with type 2 diabetes (T2DM; 108/473, 22.8% vs 79/733, 10.8%; P<.001). The multivariate regression analysis showed that diabetes type, age, education, family income, and location were associated with app use in adult patients (P<.05). The need for and selection of diabetes apps differed slightly between patients with T1DM and patients with T2DM. The reasons why patients discontinued the use of an app included limited time (59/197, 29.9%), complicated operations (50/197, 25.4%), ineffectiveness for glycemic control (48/197, 24.4%), and cost (38/197, 19.3%). Of the 608 responders to the diabetologist survey, 40.5% (246/608) recommended diabetes apps to patients and 25.2% (153/608) used diabetes apps to manage patients. The greatest obstacles to the diabetologists’ use of apps to manage diabetes patients include limited time (280/608, 46.1%), legal issues (129/608, 21.2%), patients’ distrust (108/608, 17.8%), and billing issues (66/608, 10.9%). Conclusions: The awareness and use of diabetes apps in Chinese people with diabetes and the proportion of diabetologists using diabetes apps to manage patients are low. Designing apps targeting different patient needs and conducting high-quality randomized controlled trials will improve the effectiveness of the apps, provide evidence for patients to choose suitable apps, and be conducive to the promotion of app use. %M 30735147 %R 10.2196/12658 %U http://mhealth.jmir.org/2019/2/e12658/ %U https://doi.org/10.2196/12658 %U http://www.ncbi.nlm.nih.gov/pubmed/30735147 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11898 %T Physical Activity Surveillance Through Smartphone Apps and Wearable Trackers: Examining the UK Potential for Nationally Representative Sampling %A Strain,Tessa %A Wijndaele,Katrien %A Brage,Søren %+ MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Addenbrookes Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom, 44 1223 330315, tessa.strain@mrc-epid.cam.ac.uk %K adult %K exercise %K fitness trackers %K health surveys %K smartphone %K surveys and questionnaires %K United Kingdom %K mobile phone %D 2019 %7 29.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones and wearable activity trackers present opportunities for large-scale physical activity (PA) surveillance that overcome some limitations of questionnaires or researcher-administered devices. However, it remains unknown whether current users of such technologies are representative of the UK population. Objective: The objective of this study was to investigate potential sociodemographic biases in individuals using, or with the potential to use, smartphone apps or wearable activity trackers for PA surveillance in the United Kingdom. Methods: We used data of adults (aged ≥16 years) from two nationally representative surveys. Using the UK-wide 2018 Ofcom Technology Tracker (unweighted N=3688), we derived mutually adjusted odds ratios (ORs; 95% CI) of personal use or household ownership of a smartwatch or fitness tracker and personal use of a smartphone by age, sex, social grade, activity- or work-limiting disability, urban or rural, and home nation. Using the 2016 Health Survey for England (unweighted N=4539), we derived mutually adjusted ORs of the use of wearable trackers or websites or smartphone apps for weight management. The explanatory variables were age, sex, PA, deprivation, and body mass index (BMI). Furthermore, we stratified these analyses by BMI, as these questions were asked in the context of weight management. Results: Smartphone use was the most prevalent of all technology outcomes, with 79.01% (weighted 2085/2639) of the Technology Tracker sample responding affirmatively. All other outcomes were <30% prevalent. Age ≥65 years was the strongest inverse correlate of all outcomes (eg, OR 0.03, 95% CI 0.02-0.05 for smartphone use compared with those aged 16-44 years). In addition, lower social grade and activity- or work-limiting disability were inversely associated with all Technology Tracker outcomes. Physical inactivity and male sex were inversely associated with both outcomes assessed in the Health Survey for England; higher levels of deprivation were only inversely associated with websites or phone apps used for weight management. The conclusions did not differ meaningfully in the BMI-stratified analyses, except for deprivation that showed stronger inverse associations with website or phone app use in the obese. Conclusions: The sole use of PA data from wearable trackers or smartphone apps for UK national surveillance is premature, as those using these technologies are more active, younger, and more affluent than those who do not. %M 30694198 %R 10.2196/11898 %U http://mhealth.jmir.org/2019/1/e11898/ %U https://doi.org/10.2196/11898 %U http://www.ncbi.nlm.nih.gov/pubmed/30694198 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10242 %T Use of Health Apps and Wearable Devices: Survey Among Italian Associations for Patient Advocacy %A Mosconi,Paola %A Radrezza,Silvia %A Lettieri,Emanuele %A Santoro,Eugenio %+ Laboratory of Medical Informatics, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 19, Via Giuseppe la Masa, Milan, 20156, Italy, 39 02 39014 ext 562, eugenio.santoro@marionegri.it %K health apps %K mobile phone %K Web-based survey %K patients’ health care advocacy associations %K wearable devices %D 2019 %7 15.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technological tools such as Web-based social networks, telemedicine, apps, or wearable devices are becoming more widespread in health care like elsewhere. Although patients are the main users, for example, to monitor symptoms and clinical parameters or to communicate with the doctor, their perspective is seldom analyzed, and to the best of our knowledge, no one has focused on the patients’ health care advocacy associations’ point of view. Objective: The objective of this study was to assess patients’ health care advocacy associations’ opinions about the use, usefulness, obstacles, negative aspects, and impact of health apps and wearable devices through a Web-based survey. Methods: We conducted a Web-based survey through SurveyMonkey over nearly 3 months. Participants were contacted via an email explaining the aims of the survey and providing a link to complete the Web-based questionnaire. All the 20 items were mandatory, and the anonymized data were collected automatically into a database. Only fully completed questionnaires were considered for analysis. Results: We contacted 1998 patients’ health care advocacy associations; a total of 258 questionnaires were received back (response rate 12.91%), and 227 of the received questionnaires were fully completed (completion rate 88.0%). Informative apps, hospital apps for viewing medical reports or booking visits, and those for monitoring physical activity are the most used. They are considered especially useful to improve patients’ engagement and compliance with treatment. Wearable devices to check physical activity and glycemia are the most widespread considering, again, their benefits in increasing patients’ involvement and treatment compliance. For health apps and wearable devices, the main obstacles to their use are personal and technical reasons; the risk of overmedicalization is considered the most negative aspect of their constant use, while privacy and confidentiality of data are not rated a limitation. No statistical difference was found on stratifying the answers by responders’ technological level (P=.30), age (P=.10), and the composition of the association’s advisory board (P=.15). Conclusions: According to responders, health apps and wearable devices are sufficiently known and used and are considered potential supports for greater involvement in health management. However, there are still obstacles to their adoption, and the developers need to work to make them more accessible and more useful. The involvement of patients and their associations in planning services and products based on these technologies (as well as others) would be desirable to overcome these barriers and boost awareness about privacy and the confidentiality of data. %M 30664455 %R 10.2196/10242 %U http://mhealth.jmir.org/2019/1/e10242/ %U https://doi.org/10.2196/10242 %U http://www.ncbi.nlm.nih.gov/pubmed/30664455 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e12228 %T Mobile Phone Ownership, Health Apps, and Tablet Use in US Adults With a Self-Reported History of Hypertension: Cross-Sectional Study %A Langford,Aisha T %A Solid,Craig A %A Scott,Ebony %A Lad,Meeki %A Maayan,Eli %A Williams,Stephen K %A Seixas,Azizi A %+ Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU School of Medicine, 227 E 30th Street #645, New York, NY, 10016, United States, 1 646 501 2914, aisha.langford@nyulangone.org %K smartphone %K text messaging %K health communication %K ownership %K goals %K cell phone %K telemedicine %K hypertension %K tablets %K chronic disease %D 2019 %7 14.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone and tablet ownership have increased in the United States over the last decade, contributing to the growing use of mobile health (mHealth) interventions to help patients manage chronic health conditions like diabetes. However, few studies have characterized mobile device ownership and the presence of health-related apps on mobile devices in people with a self-reported history of hypertension. Objective: This study aimed to describe the prevalence of smartphone, tablet, and basic mobile phone ownership and the presence of health apps by sociodemographic factors and self-reported hypertension status (ie, history) in a nationally representative sample of US adults, and to describe whether mobile devices are associated with health goal achievement, medical decision making, and patient-provider communication. Methods: Data from 3285 respondents from the 2017 Health Information National Trends Survey were analyzed. Participants were asked if they owned a smartphone, tablet, or basic mobile phone and if they had health apps on a smartphone or tablet. Participants were also asked if their smartphones or tablets helped them achieve a health-related goal like losing weight, make a decision about how to treat an illness, or talk with their health care providers. Chi-square analyses were conducted to test for differences in mobile device ownership, health app presence, and app helpfulness by patient characteristics. Results: Approximately 1460 (37.6% weighted prevalence) participants reported a history of hypertension. Tablet and smartphone ownership were lower in participants with a history of hypertension than in those without a history of hypertension (55% vs 66%, P=.001, and 86% vs 68%, P<.001, respectively). Participants with a history of hypertension were more likely to own a basic mobile phone only as compared to those without a history of hypertension (16% vs 9%, P<.001). Among those with a history of hypertension exclusively, basic mobile phone, smartphone, and tablet ownership were associated with age and education, but not race or sex. Older adults were more likely to report having a basic mobile phone only, whereas those with higher education were more likely to report owning a tablet or smartphone. Compared to those without a history of hypertension, participants with a history of hypertension were less likely to have health-related apps on their smartphones or tablets (45% vs 30%, P<.001) and report that mobile devices helped them achieve a health-related goal (72% vs 63%, P=.01). Conclusions: Despite the increasing use of smartphones, tablets, and health-related apps, these tools are used less among people with a self-reported history of hypertension. To reach the widest cross-section of patients, a mix of novel mHealth interventions and traditional health communication strategies (eg, print, web based, and in person) are needed to support the diverse needs of people with a history of hypertension. %M 31344667 %R 10.2196/12228 %U http://mhealth.jmir.org/2019/1/e12228/ %U https://doi.org/10.2196/12228 %U http://www.ncbi.nlm.nih.gov/pubmed/31344667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e11977 %T Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study %A Apolinário-Hagen,Jennifer %A Menzel,Mireille %A Hennemann,Severin %A Salewski,Christel %+ Department of Health Psychology, Faculty of Psychology, University of Hagen, Universitätsstraße 33, Hagen, 58097, Germany, 49 2331 987 ext 2272, jennifer.apolinario-hagen@fernuni-hagen.de %K multiple sclerosis %K eHealth %K mHealth, acceptability of health care %K patient preference %D 2018 %7 12.12.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Mobile health (mHealth) apps might have the potential to promote self-management of people with multiple sclerosis (MS) in everyday life. However, the uptake of MS apps remains poor, and little is known about the facilitators and barriers for their efficient utilization, such as technology acceptance. Objective: The aim of this study was to examine the acceptance of mHealth apps for disease management in the sense of behavioral intentions to use and explore determinants of utilization among people with MS based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Methods: Participants for this Web-based cross-sectional study were recruited throughout Germany with the support of regional MS associations and self-help groups. To identify determinants of intention to use MS apps, a measure based on the UTAUT was adapted with 4 key determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) and extended by Intolerance of Uncertainty (IU) and electronic health literacy. Potential influencing effects of both MS and computer self-efficacy (C-SE) as mediators and fatigue as a moderator were analyzed using Hayes’s PROCESS macro (SPSS version 3.0) for IBM SPSS version 24.0. Results: A total of 98 participants (mean age 47.03 years, SD 10.17; 66/98, 67% female) with moderate fatigue levels completed the survey. Although most participants (91/98, 92%) were daily smartphone users, almost two-thirds (62/98, 63%) reported no experience with MS apps. Overall, the acceptance was moderate on average (mean 3.11, SD 1.31, minimum=1 and maximum=5), with lower scores among persons with no experience (P=.04) and higher scores among current users (P<.001). In multiple regression analysis (R2=63% variance explained), performance expectancy (beta=.41) and social influence (beta=.33) were identified as significant predictors of acceptance (all P<.001). C-SE was confirmed as a partial mediator in the relationship between IU and acceptance (indirect effect: B=−.095, 95% CI −0.227 to −0.01). Furthermore, a moderated mediation by C-SE was shown in the relationship between IU and behavioral intentions to use MS apps for low (95% CI −0.42 to −0.01) and moderate levels (95% CI −0.27 to −0.01) of fatigue. Conclusions: Overall, this exploratory pilot study indicates for the first time that positive expectations about the helpfulness for self-management purposes and social support might be important factors to be considered for improving the acceptance of MS apps among smartphone users with MS. However, given some inconsistent findings, especially regarding the role of effort expectancy and IU and self-efficacy, the conceptual model needs replication with a larger sample of people with MS, varying more in fatigue levels, and a longitudinal assessment of the actual usage of MS apps predicted by acceptance in the sense of behavioral intentions to use. %M 30684408 %R 10.2196/11977 %U http://formative.jmir.org/2018/2/e11977/ %U https://doi.org/10.2196/11977 %U http://www.ncbi.nlm.nih.gov/pubmed/30684408 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e10049 %T Mobile Phone, Computer, and Internet Use Among Older Homeless Adults: Results from the HOPE HOME Cohort Study %A Raven,Maria C %A Kaplan,Lauren M %A Rosenberg,Marina %A Tieu,Lina %A Guzman,David %A Kushel,Margot %+ Department of Emergency Medicine, School of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143 0209, United States, 1 917 499 5608, maria.raven@ucsf.edu %K homelessness %K internet %K cell phone %K smartphone %K aged and middle aged %D 2018 %7 10.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. Access to mobile phones and the internet could help lower the barriers to social support, social services, and medical care; however, little is known about access to and use of these by older homeless adults. Objective: This study aimed to describe the access to and use of mobile phones, computers, and internet among a cohort of 350 homeless adults over the age of 50 years. Methods: We recruited 350 participants who were homeless and older than 50 years in Oakland, California. We interviewed participants at 6-month intervals about their health status, residential history, social support, substance use, depressive symptomology, and activities of daily living (ADLs) using validated tools. We performed clinical assessments of cognitive function. During the 6-month follow-up interview, study staff administered questions about internet and mobile technology use. We assessed participants’ comfort with and use of multiple functions associated with these technologies. Results: Of the 343 participants alive at the 6-month follow-up, 87.5% (300/343) completed the mobile phone and internet questionnaire. The median age of participants was 57.5 years (interquartile range 54-61). Of these, 74.7% (224/300) were male, and 81.0% (243/300) were black. Approximately one-fourth (24.3%, 73/300) of the participants had cognitive impairment and slightly over one-third (33.6%, 100/300) had impairments in executive function. Most (72.3%, 217/300) participants currently owned or had access to a mobile phone. Of those, most had feature phones, rather than smartphones (89, 32.1%), and did not hold annual contracts (261, 94.2%). Just over half (164, 55%) had ever accessed the internet. Participants used phones and internet to communicate with medical personnel (179, 64.6%), search for housing and employment (85, 30.7%), and to contact their families (228, 82.3%). Those who regained housing were significantly more likely to have mobile phone access (adjusted odds ratio [AOR] 3.81, 95% CI 1.77-8.21). Those with ADL (AOR 0.53, 95% CI 0.31-0.92) and executive function impairment (AOR 0.49; 95% CI 0.28-0.86) were significantly less likely to have mobile phones. Moderate to high risk amphetamine use was associated with reduced access to mobile phones (AOR 0.27, 95% CI 0.10-0.72). Conclusions: Older homeless adults could benefit from portable internet and phone access. However, participants had a lower prevalence of smartphone and internet access than adults aged over 65 years in the general public or low-income adults. Participants faced barriers to mobile phone and internet use, including financial barriers and functional and cognitive impairments. Expanding access to these basic technologies could result in improved outcomes. %M 30530464 %R 10.2196/10049 %U http://mhealth.jmir.org/2018/12/e10049/ %U https://doi.org/10.2196/10049 %U http://www.ncbi.nlm.nih.gov/pubmed/30530464 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e194 %T What Drives Young Vietnamese to Use Mobile Health Innovations? Implications for Health Communication and Behavioral Interventions %A Tran,Bach Xuan %A Zhang,Melvyn WB %A Le,Huong Thi %A Nguyen,Hinh Duc %A Nguyen,Long Hoang %A Nguyen,Quyen Le Thi %A Tran,Tho Dinh %A Latkin,Carl A %A Ho,Roger CM %+ Institute for Preventive Medicine and Public Health, Hanoi Medical University, 1 Ton That Tung, Hanoi,, Viet Nam, 84 982228662, bach.ipmph@gmail.com %K youth %K adolescent %K Vietnam %K mHealth %K mobile phone %K app %D 2018 %7 30.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone use in Vietnam has become increasingly popular in recent years, with youth (people aged 15-24 years) being one of the groups with the heaviest use. Health-related apps on mobile phones (mobile health [mHealth] apps) appear to be a feasible approach for disease and health management, especially for self-management. However, there has been a scarcity of research on mobile phone usage for health care among youth and adolescents. Objective: This study aims to identify the patterns of usage of mobile phone apps and the preferences for functionalities of mobile phone-based health-related apps among Vietnamese youth. Methods: An online cross-sectional study was conducted in Vietnam in August to October 2015. Web-based respondent-driven sampling technique was adopted to recruit participants. The online questionnaire was developed and distributed using Google Forms. Chi square and Mann-Whitney tests were used to investigate the difference in attitude and preference for mobile phone apps between the two genders. Results: Among 356 youths (age from 15 to 25 years) sampled, low prevalence was found of using mHealth apps such as beauty counseling (6.5%, 23/356), nutrition counseling (7.9%, 28/356), disease prevention (9.8%, 35/356), and disease treatment (7.6%, 27/356). The majority of users found the app(s) they used to be useful (72.7%, 48/356) and reported satisfaction with these apps (61.9%, 39/356). No significant differences were found between the genders in their perception of the usefulness of apps and their satisfaction with mobile health apps. Most of the participants (68.2%, 238/356) preferred apps which are conceptualized and designed to run on a mobile phone compared to Web-based apps, and 50% (176/356) preferred visual materials. Approximately 53.9% (188/356) reported that it was integral for the mobile phone apps to have a sharing/social network functionality. Participants with a higher perceived stress score and EuroQol-5 Dimensions (EQ-5D) index were significantly less likely to use mHealth apps. Conclusions: This study found a low proportion using mHealth-related mobile phone apps, but a high level of receptiveness and satisfaction among Vietnamese youth. Acceptance level and preferences toward mHealth apps as well as specifically preferred functionalities discovered in this study are essential not only in conceptualizing and developing appropriate mobile phone interventions targeting youth and adolescents, but also in the application of technically advanced solutions in disease prevention and health management. %M 30251704 %R 10.2196/mhealth.6490 %U http://mhealth.jmir.org/2018/11/e194/ %U https://doi.org/10.2196/mhealth.6490 %U http://www.ncbi.nlm.nih.gov/pubmed/30251704 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11508 %T The Association Between the Use of Antenatal Care Smartphone Apps in Pregnant Women and Antenatal Depression: Cross-Sectional Study %A Mo,Yushi %A Gong,Wenjie %A Wang,Joyce %A Sheng,Xiaoqi %A Xu,Dong R %+ XiangYa School of Public Health, Central South University, 238 Shangmayuanling Lane, Xiangya Road, KaiFu District, Changsha,, China, 86 13607445252, gongwenjie@csu.edu.cn %K antenatal care %K antenatal depression %K app %K mobile phone %D 2018 %7 29.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Antenatal care smartphone apps are increasingly used by pregnant women, but studies on their use and impact are scarce. Objective: This study investigates the use of antenatal care apps in pregnant women and explores the association between the use of these apps and antenatal depression. Methods: This study used a convenient sample of pregnant women recruited from Hunan Provincial Maternal and Child Health Hospital in November 2015. The participants were surveyed for their demographic characteristics, use of antenatal care apps, and antenatal depression. Factors that influenced antenatal pregnancy were analyzed using logistic regression. Results: Of the 1304 pregnant women, 71.31% (930/1304) used antenatal care apps. Higher usage of apps was associated with urban residency, nonmigrant status, first pregnancy, planned pregnancy, having no previous children, and opportunity to communicate with peer pregnant women. The cutoff score of the Edinburgh Postnatal Depression Scale was 10, and 46.11% (601/1304) of the pregnant women had depression. Logistic regression showed that depression was associated with the availability of disease-screening functions in the apps (odds ratio (OR) 1.78, 95% CI 1.03-3.06) and spending 30 minutes or more using the app (OR 2.05, 95% CI 1.19-3.52). Using apps with social media features was a protective factor for antenatal depression (OR 0.33, 95% CI 0.12-0.89). Conclusions: The prevalence of the use of prenatal care apps in pregnant women is high. The functions and time spent on these apps are associated with the incidence of antenatal depression. %M 30497996 %R 10.2196/11508 %U http://mhealth.jmir.org/2018/11/e11508/ %U https://doi.org/10.2196/11508 %U http://www.ncbi.nlm.nih.gov/pubmed/30497996 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e11715 %T Mental Health Mobile Phone App Usage, Concerns, and Benefits Among Psychiatric Outpatients: Comparative Survey Study %A Torous,John %A Wisniewski,Hannah %A Liu,Gang %A Keshavan,Matcheri %+ Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA,, United States, 1 617 667 6700, jtorous@bidmc.harvard.edu %K smartphone %K digital health %K mobile phone %K mental health %K schizophrenia %K depression %K psychiatry %K apps %D 2018 %7 16.11.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the popularity of mental health apps, it is unknown if they are actually used by those with mental illness. This study assessed whether differences in clinic setting may influence the use of mental health apps and which factors influence patient perception of apps. Objective: The objective of this study was to gain an understanding of how individuals with mental illness use their mobile phones by exploring their access to mobile phones and their use of mental health apps. Methods: A single time point survey study was conducted over a 2-week period in February 2018 at two nearby outpatient psychiatry clinics: one serving largely mood and anxiety disorder patients with private insurance staffed by both faculty and residents and the other serving largely psychotic disorder patients in a state Department of Mental Health (DMH) setting. A total of 25 patients at the state DMH clinic also consented for a single time point observation of apps currently installed on their personal mobile phone. Results: A total of 113 patients at the private insurance clinic and 73 at the state DMH clinic completed the survey. Those in the private insurance clinic were more likely to download a mental health app compared to the state DMH clinic, but actual rates of reported current app usage were comparable at each clinic, approximately 10%. Verifying current apps on patients’ mobile phones at the state DMH clinic confirmed that approximately 10% had mental health apps installed. Patients at both clinics were most concerned about privacy of mental health apps, although those at the state DMH clinic viewed cost savings as the greatest benefit while those at the private clinic reported time as the greatest benefit. Conclusions: High interest in mental health apps does not automatically translate into high use. Our results of low but similar rates of mental health app use at diverse clinics suggests DMH patients with largely psychotic disorders are as interested and engaged with apps as those in a private insurance clinic treating largely mood and anxiety disorders. Results from our study also highlight the importance of understanding how actual patients are using apps instead of relying on internet-based samples, which often yield higher results due to their likelihood of being selected. %M 30446484 %R 10.2196/11715 %U http://mental.jmir.org/2018/4/e11715/ %U https://doi.org/10.2196/11715 %U http://www.ncbi.nlm.nih.gov/pubmed/30446484 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10945 %T Barriers and Opportunities for Using Wearable Devices to Increase Physical Activity Among Veterans: Pilot Study %A Kim,Rebecca H %A Patel,Mitesh S %+ Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA,, United States, 1 2678720364, rebecca.kim@uphs.upenn.edu %K veterans %K wearable devices %K connected health device %K physical activity %K mobile phone %D 2018 %7 06.11.2018 %9 Short Paper %J JMIR Formativ Res %G English %X Background: Few studies have examined the use of wearable devices among the veteran population. Objective: The objective of this study was to evaluate veterans’ perceptions of and experiences with wearable devices and identify the potential barriers and opportunities to using such devices to increase physical activity levels in this population. Methods: Veterans able to ambulate with or without assistance completed surveys about their mobile technology use and physical activity levels. They were then given the option of using a wearable device to monitor their activity levels. Follow-up telephone interviews were conducted after 2 months. Results: A total of 16 veterans were enrolled in this study, and all of them agreed to take home and use the wearable device to monitor their activity levels. At follow-up, 91% (10/11) veterans were still using the device daily. Veterans identified both opportunities and barriers for incorporating these devices into interventions to increase physical activity. Conclusions: Veterans engaged in using wearable devices at high rates. %M 30684414 %R 10.2196/10945 %U http://formative.jmir.org/2018/2/e10945/ %U https://doi.org/10.2196/10945 %U http://www.ncbi.nlm.nih.gov/pubmed/30684414 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10916 %T Supportive Care in Radiotherapy Based on a Mobile App: Prospective Multicenter Survey %A El Shafie,Rami A %A Weber,Dorothea %A Bougatf,Nina %A Sprave,Tanja %A Oetzel,Dieter %A Huber,Peter E %A Debus,Jürgen %A Nicolay,Nils H %+ Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str 3, Freiburg, 79106, Germany, 49 761 270 95200, n.nicolay@dkfz.de %K mHealth %K radiotherapy %K mobile app %K quality of life %K surveillance %K patient-reported outcome %K acceptance %K smartphone %K mobile phone %D 2018 %7 30.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Consumer electronics and Web-enabled mobile devices are playing an increasing role in patient care, and their use in the oncologic sector opens up promising possibilities in the fields of supportive cancer care and systematic patient follow-up. Objective: The objective of our study was to assess the acceptance and possible benefits of a mobile app–based concept for supportive care of cancer patients undergoing radiotherapy. Methods: In total, 975 patients presenting for radiotherapy due to breast or prostate cancer were screened; of them, 200 owned a smartphone and consented to participate in the survey. Patients were requested to complete a questionnaire at 2 time points: prior to the initiation (T0) and after the completion (T1) of radiotherapy. The questionnaire included questions about the habits of smartphone usage, technical knowledge and abilities of the participants, readiness to use a mobile app within the context of radiotherapy, possible features of the mobile app, and general attitude toward the different aspects of oncologic treatments. For quantitative analysis, sum scores were calculated for all areas of interest, and results were correlated with patient characteristics. Additionally, answers were quantitatively compared between time points T0 and T1. Results: Median patient age was 57 (range 27-78) years. Of the 200 participants, 131 (66.2%) reported having the ability to use their smartphones with minimal to no help and 75.8% (150/200) had not used their smartphones in a medical context before. However, 73.3% (146/200) and 83.4% (166/200) of patients showed a strong interest in using a mobile app for supportive care during radiotherapy and as part of the clinical follow-up, respectively. Patients most commonly requested functionalities regarding appointment scheduling in the clinic (176/200, 88.0%) and the collection of patient-reported outcome data regarding their illness, therapy, and general well-being (130/200, 65.0%). Age was identified as the most influential factor regarding patient attitude, with patients aged <55 years being significantly more inclined toward and versed in smartphone use (P<.001). The acceptance of mobile apps was significantly higher in patients exhibiting a Karnofsky performance index <80% (P=.01). Support in the context of therapy-related side effects was judged most important by patients with poor clinical performance (P=.006). The overall acceptance of mobile apps in the context of radiotherapy surveillance was high at a median item sum score of 71.4/100 and was not significantly influenced by tumor stage, age, gender, treatment setting, or previous radiotherapies. Conclusions: The acceptance of mobile apps for the surveillance and follow-up of cancer patients undergoing radiotherapy is high; this high acceptance level will serve as a basis for future clinical trials investigating the clinical benefits of mobile app–based treatment support. Introduction of mobile apps into the clinical routine should be considered as an opportunity to improve and intensify supportive treatment for cancer patients. %M 30166275 %R 10.2196/10916 %U http://mhealth.jmir.org/2018/8/e10916/ %U https://doi.org/10.2196/10916 %U http://www.ncbi.nlm.nih.gov/pubmed/30166275 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e56 %T Patient Willingness to Consent to Mobile Phone Data Collection for Mental Health Apps: Structured Questionnaire %A Di Matteo,Daniel %A Fine,Alexa %A Fotinos,Kathryn %A Rose,Jonathan %A Katzman,Martin %+ 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,, Canada, 1 416 978 6992, dandm@ece.utoronto.ca %K passive sensing %K mobile phone sensing %K psychiatric assessment %K mood and anxiety disorders %K digital privacy %K mobile apps %K mobile phone %K consent %D 2018 %7 29.08.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: It has become possible to use data from a patient’s mobile phone as an adjunct or alternative to the traditional self-report and interview methods of symptom assessment in psychiatry. Mobile data–based assessment is possible because of the large amounts of diverse information available from a modern mobile phone, including geolocation, screen activity, physical motion, and communication activity. This data may offer much more fine-grained insight into mental state than traditional methods, and so we are motivated to pursue research in this direction. However, passive data retrieval could be an unwelcome invasion of privacy, and some may not consent to such observation. It is therefore important to measure patients’ willingness to consent to such observation if this approach is to be considered for general use. Objective: The aim of this study was to measure the ownership rates of mobile phones within the patient population, measure the patient population’s willingness to have their mobile phone used as an experimental assessment tool for their mental health disorder, and, finally, to determine how likely patients would be to provide consent for each individual source of mobile phone–collectible data across the variety of potential data sources. Methods: New patients referred to a tertiary care mood and anxiety disorder clinic from August 2016 to October 2017 completed a survey designed to measure their mobile phone ownership, use, and willingness to install a mental health monitoring app and provide relevant data through the app. Results: Of the 82 respondents, 70 (85%) reported owning an internet-connected mobile phone. When asked about installing a hypothetical mobile phone app to assess their mental health disorder, 41% (33/80) responded with complete willingness to install with another 43% (34/80) indicating potential willingness to install such an app. Willingness to give permissions for specific types of data varied by data source, with respondents least willing to consent to audio recording and analysis (19% [15/80] willing respondents, 31% [25/80] potentially willing) and most willing to consent to observation of the mobile phone screen being on or off (46% [36/79] willing respondents and 23% [18/79] potentially willing). Conclusions: The patients surveyed had a high incidence of ownership of internet-connected mobile phones, which suggests some plausibility for the general approach of mental health state inference through mobile phone data. Patients were also relatively willing to consent to data collection from sources that were less personal but expressed less willingness for the most personal communication and location data. %M 30158102 %R 10.2196/mental.9539 %U http://mental.jmir.org/2018/3/e56/ %U https://doi.org/10.2196/mental.9539 %U http://www.ncbi.nlm.nih.gov/pubmed/30158102 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e172 %T What Predicts Patients’ Adoption Intention Toward mHealth Services in China: Empirical Study %A Deng,Zhaohua %A Hong,Ziying %A Ren,Cong %A Zhang,Wei %A Xiang,Fei %+ School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 13016442007, xiangfei@hust.edu.cn %K mHealth service %K perceived risk %K trust %K TAM %K Chinese patients %K mobile phone %D 2018 %7 29.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the increasing concerns about the health of individuals in China and the development of information technology, mHealth enables patients to access health information and interact with doctors anytime and anywhere. Examining patients’ willingness to use mHealth is considered critical because its success depends on the adoption of patients. Objective: The objective of our study was to explore the determinants of mHealth service adoption among Chinese patients using an extended technology acceptance model (TAM) with trust and perceived risks. Methods: We conducted a questionnaire-based survey in 3 large hospitals in China and analyzed the data using structural equation modeling. Results: The results corroborated that the proposed model fits well. Trust, perceived usefulness, and perceived ease of use positively correlated with mHealth service adoption. Privacy and performance risks negatively correlated with the patients’ trust and adoption intention toward mHealth services. In addition, patients’ age and chronic diseases can help predict their trust level and adoption intention toward mHealth, respectively. Conclusions: We concluded that the TAM generally works in the context of mHealth adoption, although its significance has declined. In addition to technical factors, trust and perceived risks are critical for explaining mHealth service adoption among Chinese patients. %M 30158101 %R 10.2196/mhealth.9316 %U http://mhealth.jmir.org/2018/8/e172/ %U https://doi.org/10.2196/mhealth.9316 %U http://www.ncbi.nlm.nih.gov/pubmed/30158101 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10748 %T Veterans’ Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences %A Connolly,Samantha L %A Miller,Christopher J %A Koenig,Christopher J %A Zamora,Kara A %A Wright,Patricia B %A Stanley,Regina L %A Pyne,Jeffrey M %+ Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S Huntington Avenue, Building 9 Room 208F, Boston, MA, 02130, United States, 1 857 364 5987, Samantha.connolly@va.gov %K smartphone apps %K mobile phone %K mhealth %K mental health %K qualitative analysis %K rurality %K age %K veterans %K depression %K anxiety disorders %K posttraumatic stress disorder %K PTSD %K alcohol abuse %D 2018 %7 22.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans’ attitudes regarding the use of these innovations are largely unknown, particularly among rural and aging populations who may benefit from increased access to care. Objective: The objective of our study was to examine veterans’ attitudes toward smartphone apps and to assess whether openness toward this technology varies by age or rurality. Methods: We conducted semistructured qualitative interviews with 66 veterans from rural and urban areas in Maine, Arkansas, and California. Eligible veterans aged 18 to 70 years had screened positive for postraumatic stress disorder (PTSD), alcohol use disorder, or major depressive disorder, but a history of mental health service utilization was not required. Interviews were digitally recorded, professionally transcribed, and coded by a research team using an established codebook. We then conducted a thematic analysis of segments pertaining to smartphone use, informed by existing theories of technology adoption. Results: Interviews revealed a marked division regarding openness to mental health smartphone apps, such that veterans either expressed strongly positive or negative views about their usage, with few participants sharing ambivalent or neutral opinions. Differences emerged between rural and urban veterans’ attitudes, with rural veterans tending to oppose app usage, describe smartphones as hard to navigate, and cite barriers such as financial limitations and connectivity issues, more so than urban populations. Moreover, rural veterans more often described smartphones as being opposed to their values. Differences did not emerge between younger and older (≥50) veterans regarding beliefs that apps could be effective or compatible with their culture and identity. However, compared with younger veterans, older veterans more often reported not owning a smartphone and described this technology as being difficult to use. Conclusions: Openness toward the use of smartphone apps in mental health treatment may vary based on rurality, and further exploration of the barriers cited by rural veterans is needed to improve access to care. In addition, findings indicate that older patients may be more open to integrating technology into their mental health care than providers might assume, although such patients may have more trouble navigating these devices and may benefit from simplified app designs or smartphone training. Given the strong opinions expressed either for or against smartphone apps, our findings suggest that apps may not be an ideal adjunctive treatment for all patients, but it is important to identify those who are open to and may greatly benefit from this technology. %M 30135050 %R 10.2196/10748 %U http://mhealth.jmir.org/2018/8/e10748/ %U https://doi.org/10.2196/10748 %U http://www.ncbi.nlm.nih.gov/pubmed/30135050 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e248 %T Information and Communication Technologies Interest, Access, and Use: Cross-Sectional Survey of a Community Sample of Urban, Predominantly Black Women %A Jabour,Sarah M %A Page,Alexis %A Hall,Seventy F %A Rodriguez,Lycinda %A Shields,Wendy C %A Alvanzo,Anika AH %+ Division of General Internal Medicine, School of Medicine, Johns Hopkins University, 1830 East Monument, Room 8069, Baltimore, MD, 21287, United States, 1 4105500094, aalvanz1@jhmi.edu %K women %K internet communication technology %K urban %K alcohol %K stress %K smartphones %D 2018 %7 14.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Information and communication technologies (ICT) offer the potential for delivering health care interventions to low socioeconomic populations who often face barriers in accessing health care. However, most studies on ICT for health education and interventions have been conducted in clinical settings. Objective: The aim of this study was to examine access to and use of mobile phones and computers, as well as interest in, using ICT for receipt of behavioral health information among a community sample of urban, predominately black, women with low socioeconomic status. Methods: Participants (N=220) were recruited from hair salons and social service centers and completed audio-computer assisted self-interviews. Results: The majority of the participants (212/220, 96.3%) reported use of a cell phone at least weekly, of which 89.1% (189/212) used smartphones and 62.3% (137/220) reported computer use at least weekly. Of the women included in the study, 51.9% (107/206) reported using a cell phone and 39.4% (74/188) reported using a computer to access health and/or safety information at least weekly. Approximately half of the women expressed an interest in receiving information about stress management (51%-56%) or alcohol and health (45%-46%) via ICT. Smartphone ownership was associated with younger age (odds ratio [OR] 0.92, 95% CI 0.87-0.97) and employment (OR 5.12, 95% CI 1.05-24.95). Accessing health and safety information weekly by phone was associated with younger age (OR 0.96, 95% CI 0.94-0.99) and inversely associated with higher income (OR 0.42, 95% CI 0.20-0.92). Conclusions: Our findings suggest that ICT use, particularly smartphone use, is pervasive among predominantly black women with low socioeconomic status in urban, nonclinical settings. These results show that ICT is a promising modality for delivering health information to this population. Further exploration of the acceptability, feasibility, and effectiveness of using ICT to disseminate behavioral health education and intervention is warranted. %M 30108036 %R 10.2196/jmir.9962 %U http://www.jmir.org/2018/8/e248/ %U https://doi.org/10.2196/jmir.9962 %U http://www.ncbi.nlm.nih.gov/pubmed/30108036 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 7 %P e162 %T Identifying Barriers and Facilitators of 13 mHealth Projects in North America and Africa: Protocol for a 5-Year Implementation Science Study %A Tilahun,Binyam %A Smillie,Kirsten %A Bardosh,Kevin Louis %A Murray,Melanie %A Fitzgerald,Mark %A Cook,Victoria %A Poureslami,Iraj %A Forrest,Jamie %A Lester,Richard %+ Division of Infectious Disease, Faculty of Medicine, University of British Columbia, 10th Avenue West, Vancouver, BC, V5Z0C1, Canada, 1 604 875 4588, tilahunb@mail.ubc.ca %K mobile health %K mHealth %K text messaging %K digital health %K implementation science %K Africa %K North America %D 2018 %7 03.07.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although many mHealth interventions have shown efficacy in research, few have been effectively implemented and sustained in real-world health system settings. Despite this programmatic gap, there is limited conclusive evidence identifying the factors that affect the implementation and successful integration of mHealth into a health system. Objective: The aim of this study is to examine the individual, organizational, and external level factors associated with the effective implementation of WelTel, an mHealth intervention designed to support outpatient medication adherence and engagement in care in Africa and North America. Methods: We will adopt the Consolidated Framework for Implementation Research (CFIR) constructs for evaluation of mHealth implementation including a scoring and monitoring system. We will apply the adapted tool to identify facilitators and barriers to implementation of the WelTel mHealth intervention in order to determine how the technology platform is perceived, diffused, adapted, and used by different mHealth project teams and health system actors in Africa and North America. We will use a mixed-methods approach to quantitatively test whether the factors identified in the CFIR framework are associated with the successful uptake of the mHealth intervention toward implementation goals. We will triangulate these data through interviews and focus group discussion with project stakeholders, exploring factors associated with successful implementation and sustainment of these interventions. Results: The development of the customized CFIR is finalized and currently is in pilot testing. The initial results of the use of the tool in those 13 implementations will be available in 2019. Continuous conference and peer- reviewed publications will be published in the coming years. Conclusions: The results of this study will provide an in-depth understanding of individual, organizational, and external level factors that influence the successful implementation of mHealth in different health systems and geographic contexts over time. Via the tool’s unique scoring system connected to qualitative descriptors, these data will inform the most critical implementation targets and contribute to the tailoring of strategies that will assist the health system in overcoming barriers to implementation, and ultimately, improve treatment adherence and engagement in care. Registered Report Identifier: RR1-10.2196/9633 %M 29970360 %R 10.2196/resprot.9633 %U http://www.researchprotocols.org/2018/7/e162/ %U https://doi.org/10.2196/resprot.9633 %U http://www.ncbi.nlm.nih.gov/pubmed/29970360 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e13 %T Mobile Technology Utilization Among Patients From Diverse Cultural and Linguistic Backgrounds Attending Cardiac Rehabilitation in Australia: Descriptive, Case-Matched Comparative Study %A Zhang,Ling %A Ding,Ding %A Neubeck,Lis %A Gallagher,Patrick %A Paull,Glenn %A Gao,Yan %A Gallagher,Robyn %+ Sydney Nursing School, University of Sydney, 2W10, Level 2, Building D17, Charles Perkins Centre, University of Sydney, Sydney, 2006, Australia, 61 2 86271398, lzha4590@uni.sydney.edu.au %K cultural and linguistic diverse %K cardiac rehabilitation %K technology %K mobile technology %K information technology %D 2018 %7 26.06.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Barriers to attending cardiac rehabilitation (CR), including cultural and linguistic differences, may be addressed by recent technological developments. However, the feasibility of using these approaches in culturally and linguistically diverse patients is yet to be determined. Objective: This study aims to assess the use of mobile technologies and features, as well as confidence in utilization across patients speaking different languages at home (ie, English, Mandarin Chinese, and a language other than English and Mandarin [other]) and are both eligible and physically suitable for CR. In addition, the study aims to determine the sociodemographic correlates of the mobile technology/feature use, including language spoken at home in the three groups mentioned above. Methods: This is a descriptive, case matched, comparative study. Age and gender-matched patients speaking English, Mandarin and other languages (n=30/group) eligible for CR were surveyed for their mobile technology and mobile feature use. Results: ‘Participants had a mean age of 66.7 years (SD 13, n=90, range 46-95), with 53.3% (48/90) male. The majority (82/90, 91.1%) used at least one technology device, with 87.8% (79/90) using mobile devices, the most common being smartphones (57/90, 63.3%), tablets (28/90, 31.1%), and text/voice-only phones (24/90, 26.7%). More English-speaking participants used computers than Mandarin or “other” language speaking participants (P=.003 and .02) and were more confident in doing so compared to Mandarin-speaking participants (P=.003). More Mandarin-speaking participants used smartphones compared with “other” language speaking participants (P=.03). Most commonly used mobile features were voice calls (77/82, 93.9%), text message (54/82, 65.9%), the internet (39/82, 47.6%), email (36/82, 43.9%), and videoconferencing (Skype or FaceTime [WeChat or QQ] 35/82, 42.7%). Less Mandarin-speaking participants used emails (P=.001) and social media (P=.007) than English-speaking participants. Speaking Mandarin was independently associated with using smartphone, emails, and accessing the web-based medication information (OR 7.238, 95% CI 1.262-41.522; P=.03, OR 0.089, 95% CI 0.016-0.490; P=.006 and OR 0.191, 95% CI 0.037-0.984; P=.05). Conclusions: This study reveals a high usage of mobile technology among CR patients and provides further insights into differences in the technology use across CALD patients in Australia. The findings of this study may inform the design and implementation of future technology-based CR. %M 31758767 %R 10.2196/cardio.9424 %U http://cardio.jmir.org/2018/1/e13/ %U https://doi.org/10.2196/cardio.9424 %U http://www.ncbi.nlm.nih.gov/pubmed/31758767 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e128 %T mHealth Technology Use and Implications in Historically Underserved and Minority Populations in the United States: Systematic Literature Review %A Anderson-Lewis,Charkarra %A Darville,Gabrielle %A Mercado,Rebeccah Eve %A Howell,Savannah %A Di Maggio,Samantha %+ Department of Public Health, University of Southern Mississippi, 118 College Drive, Hattiesburg, MS, 39406, United States, 1 601 266 5794, charkarra.andersonlewis@usm.edu %K mHealth %K mobile health %K digital health %K smartphone %K text messaging %K minority %K ethnic group %K health disparity %K underserved population %D 2018 %7 18.06.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The proportion of people in the United States who are members of at least two ethnic groups is projected to increase to 10% by the year 2050. This makes addressing health disparities and health inequities in minority populations increasingly more difficult. Minority populations, including those who classify themselves as African American and Hispanic, are using mobile phones to access health information via the internet more frequently than those who classify themselves as white, providing unique opportunities for those in public health and health education to reach these traditionally underserved populations using mobile health (mHealth) interventions. Objective: The objective of this review was to assess studies conducted in the United States that have used mHealth tools and strategies to develop and implement interventions in underserved populations. This review also examines the ways in which mHealth strategies are being employed in public health interventions to these priority population groups, as mobile phone capabilities include text messaging, mobile apps, internet access, emails, video streaming, social media, instant messaging, and more. Methods: A systematic literature review was conducted using key search phrases, the matrix method, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart diagram to identify key studies conducted between the years of 2009-2016 in the United States. These studies were reviewed for their use of mHealth interventions in historically underserved and minority populations. Results: A total of 16,270 articles were initially identified using key search phrases in three databases. Titles were reviewed and articles not meeting criteria were excluded, leaving 156 articles for further review. After additional review for relevance and inclusion criteria, 16 articles were qualified and analyzed. Conclusions: mHealth is a promising area of development for public health and health education. While successful research has been done using text messaging (short message service, SMS) and other mHealth strategies, there is a need for more research using mobile phones and tablet applications. This literature review demonstrates mHealth technology has the ability to increase prevention and health education in health disparate communities and concludes that more specified research is needed. %M 29914860 %R 10.2196/mhealth.8383 %U http://mhealth.jmir.org/2018/6/e128/ %U https://doi.org/10.2196/mhealth.8383 %U http://www.ncbi.nlm.nih.gov/pubmed/29914860 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e10316 %T Characterizing Geosocial-Networking App Use Among Young Black Men Who Have Sex With Men: A Multi-City Cross-Sectional Survey in the Southern United States %A Duncan,Dustin T %A Park,Su Hyun %A Hambrick,H Rhodes %A Dangerfield II,Derek T %A Goedel,William C %A Brewer,Russell %A Mgbako,Ofole %A Lindsey,Joseph %A Regan,Seann D %A Hickson,DeMarc A %+ Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 621, New York, NY, 10016, United States, 1 646 501 2674, dustin.duncan@nyumc.org %K HIV prevention %K black MSM %K dating apps %K homosexuality %K male %K men who have sex with men %K mobile apps %K mobile phones %D 2018 %7 14.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Understanding where and how young black men who have sex with men (YBMSM) in the southern United States meet their sexual partners is germane to understanding the underlying factors contributing to the ongoing HIV transmission in this community. Men who have sex with men (MSM) commonly use geosocial networking apps to meet sexual partners. However, there is a lack of literature exploring geosocial networking app use in this particular population. Objective: Our aim was to examine the characteristics, preferences, and behaviors of a geographically diverse sample of geosocial networking app-using YBMSM in the southern United States. Methods: Data were collected from a sample of 75 YBMSM across three cities (Gulfport, Mississippi; Jackson, Mississippi; and New Orleans, Louisiana). Multiple aspects of geosocial networking app use were assessed, including overall app use, age of participant at first app use, specific apps used, reasons for app use, photos presented on apps, logon times and duration, number of messages sent and received, and characteristics of and behaviors with partners met on apps. Survey measures of app-met partner and sexual behavior characteristics assessed at midpoint (Day 7) and completion visits (Day 14) were compared using McNemar’s test or Wilcoxon signed-rank test. In addition, we assessed activity spaces derived from GPS devices that participants wore for 2 weeks. Results: Of the 70 participants who responded to the overall app-use item, almost three-quarters (53/70, 76%) had ever used geosocial networking apps. Jack’d was the most commonly used geosocial networking app (37/53, 70%), followed by Adam4Adam (22/53, 42%), and Grindr (19/53, 36%). The mean and median number of apps used were 4.3 (SD 2.7) and 4.0 (range 0-13), respectively. Most app-using participants displayed their face on the profile picture (35/52, 67%), whereas fewer displayed their bare legs (2/52, 4%) or bare buttocks (or ass; 2/52, 4%). The mean age at the initiation of app use was 20.1 years (SD 2.78) ranging from 13-26 years. Two-thirds (35/53, 66%) of the sample reported using the apps to “kill time” when bored. A minority (9/53, 17%) reported using the apps to meet people to have sex/hook up with. The vast majority of participants reported meeting black partners for sex. Over two-thirds (36/53, 68%) reported that the HIV status of their app-met partners was negative, and 26% (14/53) reported that they did not know their partner’s HIV status. There was a significant difference in GPS activity spaces between app using YBMSM compared to nonapp using YBMSM (2719.54 km2 vs 1855.68 km2, P=.011). Conclusions: Use of geosocial networking apps to meet sexual partners among our sample of YBMSM in the southern United States was common, with a diverse range of app use behaviors being reported. Further research should characterize the association between geosocial networking app use and engagement in sexual behaviors that increase risk for HIV acquisition and transmission. In addition, geosocial networking apps present a promising platform for HIV prevention interventions targeting YBMSM who use these apps. %M 29903702 %R 10.2196/10316 %U http://mhealth.jmir.org/2018/6/e10316/ %U https://doi.org/10.2196/10316 %U http://www.ncbi.nlm.nih.gov/pubmed/29903702 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10141 %T Discovery of and Interest in Health Apps Among Those With Mental Health Needs: Survey and Focus Group Study %A Schueller,Stephen M %A Neary,Martha %A O'Loughlin,Kristen %A Adkins,Elizabeth C %+ Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, CBITs, Chicago, IL, 60614, United States, 1 312 503 1232, schueller@northwestern.edu %K mHealth %K mental health %K mobile apps %K consumer preference %K focus groups %D 2018 %7 11.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: A large number of health apps are available directly to consumers through app marketplaces. Little information is known, however, about how consumers search for these apps and which factors influence their uptake, adoption, and long-term use. Objective: The aim of this study was to understand what people look for when they search for health apps and the aspects and features of those apps that consumers find appealing. Methods: Participants were recruited from Northwestern University’s Center for Behavioral Intervention Technologies’ research registry of individuals with mental health needs. Most participants (n=811) completed a survey asking about their use and interest in health and mental health apps. Local participants were also invited to participate in focus groups. A total of 7 focus groups were conducted with 30 participants that collected more detailed information about their use and interest in health and mental health apps. Results: Survey participants commonly found health apps through social media (45.1%, 366/811), personal searches (42.7%, 346/811), or word of mouth (36.9%, 299/811), as opposed to professional sources such as medical providers (24.6%, 200/811). From the focus groups, common themes related to uptake and use of health apps included the importance of personal use before adoption, specific features that users found desirable, and trusted sources either developing or promoting the apps. Conclusions: As the number of mental health and health apps continue to increase, it is imperative to better understand the factors that impact people’s adoption and use of such technologies. Our findings indicated that a number of factors—ease of use, aesthetics, and individual experience—drove adoption and use and highlighted areas of focus for app developers and disseminators. %M 29891468 %R 10.2196/10141 %U http://www.jmir.org/2018/6/e10141/ %U https://doi.org/10.2196/10141 %U http://www.ncbi.nlm.nih.gov/pubmed/29891468 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e173 %T Spatial Distribution of Partner-Seeking Men Who Have Sex With Men Using Geosocial Networking Apps: Epidemiologic Study %A Algarin,Angel B %A Ward,Patrick J %A Christian,W Jay %A Rudolph,Abby E %A Holloway,Ian W %A Young,April M %+ Department of Epidemiology, University of Kentucky, 111 Washington Avenue, Lexington, KY,, United States, 1 859 218 2090, april.young@uky.edu %K men who have sex with men %K public health %K mobile phone %K social environment %K HIV %K sexually transmitted diseases %D 2018 %7 31.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Geosocial networking apps have made sexual partner-seeking easier for men who have sex with men, raising both challenges and opportunities for human immunodeficiency virus and sexually transmitted infection prevention and research. Most studies on men who have sex with men geosocial networking app use have been conducted in large urban areas, despite research indicating similar patterns of online- and app-based sex-seeking among men who have sex with men in rural and midsize cities. Objective: The goal of our research was to examine the spatial distribution of geosocial networking app usage and characterize areas with increasing numbers of partner-seeking men who have sex with men in a midsize city in the South. Methods: Data collection points (n=62) were spaced in 2-mile increments along 9 routes (112 miles) covering the county encompassing the city. At each point, staff logged into 3 different geosocial networking apps to record the number of geosocial networking app users within a 1-mile radius. Data were collected separately during weekday daytime (9:00 AM to 4:00 PM) and weekend nighttime (8:00 PM to 12:00 AM) hours. Empirical Bayesian kriging was used to create a raster estimating the number of app users throughout the county. Raster values were summarized for each of the county's 208 Census block groups and used as the outcome measure (ie, geosocial networking app usage). Negative binomial regression and Wilcoxon signed rank sum tests were used to examine Census block group variables (eg, median income, median age) associated with geosocial networking app usage and temporal differences in app usage, respectively. Results: The number of geosocial networking app users within a 1-mile radius of the data collection points ranged from 0 to 36 during weekday daytime hours and 0 to 39 during weekend nighttime hours. In adjusted analyses, Census block group median income and percent Hispanic ethnicity were negatively associated with geosocial networking app usage for all 3 geosocial networking apps during weekday daytime and weekend nighttime hours. Population density and the presence of businesses were positively associated with geosocial networking app usage for all 3 geosocial networking apps during both times. Conclusions: In this midsize city, geosocial networking app usage was highest in areas that were more population-dense, were lower income, and had more businesses. This research is an example of how geosocial networking apps’ geospatial capabilities can be used to better understand patterns of virtual partner-seeking among men who have sex with men. %R 10.2196/jmir.9919 %U http://www.jmir.org/2018/5/e173/ %U https://doi.org/10.2196/jmir.9919 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e126 %T The Use of Mobile Health Applications to Improve Patient Experience: Cross-Sectional Study in Chinese Public Hospitals %A Lu,Chuntao %A Hu,Yinhuan %A Xie,Jinzhu %A Fu,Qiang %A Leigh,Isabella %A Governor,Samuel %A Wang,Guanping %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan,, China, 86 13554285879, hyh288@hotmail.com %K mobile applications %K technology %K outpatients %K patient satisfaction %K surveys and questionnaire %D 2018 %7 23.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The proliferation of mobile health apps has greatly changed the way society accesses the health care industry. However, despite the widespread use of mobile health apps by patients in China, there has been little research that evaluates the effect of mobile health apps on patient experience during hospital visits. Objective: The purpose of our study was to examine whether the use of mobile health apps improves patient experience and to find out the difference in patient experience between users and nonusers and the characteristics associated with the users of these apps. Methods: We used the Chinese Outpatient Experience Questionnaire to survey patient experience. A sample of 300 outpatients was randomly selected from 3 comprehensive public hospitals (3 tertiary hospitals) in Hubei province, China. Each hospital randomly selected 50 respondents from mobile health app users and 50 from nonusers. A chi-square test was employed to compare the different categorical characteristics between mobile health app users and nonusers. A t test was used to test the significance in continuous variables between user scores and nonuser scores. Multiple linear regression was conducted to determine whether the use of mobile health apps during hospital visits was associated with patient experience. Results: The users and nonusers differed in age (χ22=12.2, P=.002), education (χ23=9.3, P=.03), living place (χ21=7.7, P=.006), and the need for specialists (χ24=11.0, P=.03). Compared with nonusers, mobile health app users in China were younger, better educated, living in urban areas, and had higher demands for specialists. In addition, mobile health app users gave significantly higher scores than nonusers in total patient experience scores (t298=3.919, P<.001), the 18 items and the 5 dimensions of physician-patient communication (t298=2.93, P=.004), health information (t298=3.556, P<.001), medical service fees (t298=3.991, P<.001), short-term outcome (t298=4.533, P<.001), and general satisfaction (t298=4.304, P<.001). Multiple linear regression results showed that the use of mobile health apps during hospital visits influenced patient experience (t289=3.143, P=.002). After controlling for other factors, it was shown that the use of mobile health apps increased the outpatient experience scores by 17.7%. Additional results from the study found that the self-rated health status (t289=3.746, P<.001) and monthly income of patients (t289=2.416, P=.02) influenced the patient experience as well. Conclusions: The use of mobile health apps could improve patient experience, especially with regard to accessing health information, making physician-patient communication more convenient, ensuring transparency in medical charge, and ameliorating short-term outcomes. All of these may contribute to positive health outcomes. Therefore, we should encourage the adoption of mobile health apps in health care settings so as to improve patient experience. %M 29792290 %R 10.2196/mhealth.9145 %U http://mhealth.jmir.org/2018/5/e126/ %U https://doi.org/10.2196/mhealth.9145 %U http://www.ncbi.nlm.nih.gov/pubmed/29792290 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e125 %T Acceptability of an mHealth App Intervention for Persons With Type 2 Diabetes and its Associations With Initial Self-Management: Randomized Controlled Trial %A Torbjørnsen,Astrid %A Småstuen,Milada Cvancarova %A Jenum,Anne Karen %A Årsand,Eirik %A Ribu,Lis %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4 St. Olavs plass, Oslo, 0130, Norway, 47 92633075, astrid.torbjornsen@oslomet.no %K diabetes mellitus, type 2 %K patient acceptance of health care %K acceptability of health care %K self-care %K mobile apps %K smartphone %K telemedicine %K regression analysis %K factor analysis %K statistical %D 2018 %7 21.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health interventions are increasingly used in health care. The level of acceptability may indicate whether and how such digital solutions will be used. Objective: This study aimed to explore associations between the level of acceptability of a mobile diabetes app and initial ability of self-management for patients with type 2 diabetes. Methods: Participants with type 2 diabetes were recruited from primary health care settings to a 3-armed randomized controlled trial in the Norwegian study in the RENEWING HEALTH project. At the 1-year follow-up, 75 out of 101 participants from the intervention groups completed an acceptability questionnaire (The Service User Technology Acceptability Questionnaire). In the randomized controlled trial, the 2 intervention groups (n=101 in total) received a mobile phone with a diabetes diary app, and one of the groups received additional health counseling given by telephone calls from a diabetes specialist nurse (n=50). At baseline, we collected clinical variables from medical records, whereas demographic data and self-management (The Health Education Impact Questionnaire) measures were self-reported. Log data from the use of the app by self-monitoring were registered continuously. Associations between initial ability to self-manage at baseline and acceptability of the diabetes diary app after 1 year were analyzed using linear regression. Results: We found statistically significant associations between 5 of the 8 self-management domains and perceived benefit, one of the acceptability factors. However, when adjusting for age, gender, and frequency of use, only 1 domain, skill and technique acquisition, remained independently associated with perceived benefit. Frequency of use of the app was the factor that revealed the strongest association with the acceptability domain perceived benefit. Conclusions: Our findings indicate that persons with diabetes may accept the app, despite its perceived benefit being associated with only one of the 8 domains of their initial level of self-management. Trial Registration: ClinicalTrials.gov NCT01315756; https://clinicaltrials.gov/show/NCT01315756 (Archived by WebCite at http://www.webcitation.org/6z46qPhWl) %M 29784635 %R 10.2196/mhealth.8824 %U http://mhealth.jmir.org/2018/5/e125/ %U https://doi.org/10.2196/mhealth.8824 %U http://www.ncbi.nlm.nih.gov/pubmed/29784635 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e103 %T Prevalence, Demographic Correlates, and Perceived Impacts of Mobile Health App Use Amongst Chinese Adults: Cross-Sectional Survey Study %A Xie,Zhenzhen %A Nacioglu,Ahmet %A Or,Calvin %+ Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Room 8-7, 8/F, Haking Wong Building, Pokfulam, Hong Kong, Hong Kong,, China (Hong Kong), 852 2859 2587, klor@hku.hk %K mHealth %K mobile health apps %K prevalence %K demographic correlates %K health behavior %D 2018 %7 26.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps have changed the way people obtain health information and services and advance their understanding and management of their health. Although many health apps are available, little is known about the prevalence of their use for different purposes, whether such use is associated with demographic characteristics, and the impacts of their use on health knowledge and management. Objective: The main objectives of this study were to examine the prevalence, extent, and demographic correlates of health app use and the perceived impacts of health app use on increased health knowledge and improved health condition management. Methods: We conducted a cross-sectional questionnaire survey of 633 Chinese adults randomly drawn from the general population in Hong Kong. Results: Of the 633 participants, 612 (96.7%) reported using mobile devices. Of them, 235 (38.4%) reported using multiple types of health apps. The most-used type of health app was about healthy living information (197/612, 32.2%), followed by measuring/recording vital signs (80/612, 13.1%), health and medical reminders (64/612, 10.5%), recovery and rehabilitation information (42/612, 6.9%), diagnosis assistance (28/612, 4.6%), emergency services (16/612, 2.6%), telehealth (11/612, 1.8%), and “other” (19/612, 3.1%). Multivariate logistic regression analysis found that health app users were more likely to be women (odds ratio [OR] 1.68, 95% CI 1.14-2.48, P=.01) of a higher self-rated social class (OR 3.66, 95% CI 1.11-12.11, P=.03). Participants who worked in education/culture/academia (OR 2.31, 95% CI 1.16-4.59, P=.02) or disciplinary forces (OR 5.07, 95% CI 1.25-20.62, P=.02) were more likely to believe that using health apps could increase their health knowledge; participants working in education/culture/academia were also more likely to believe that using health apps could improve the effectiveness of health condition management (OR 2.18, 95% CI 1.10-4.34, P=.03). Conclusions: Effort should be made to promote health app use, especially to demographic groups that are currently less likely to use health apps (eg, males, individuals from lower social classes). From the public health perspective, guidelines could be developed to help individuals identify quality health apps that meet their needs. Moreover, app developers could improve the usability of health apps to promote health app use. %M 29699971 %R 10.2196/mhealth.9002 %U http://mhealth.jmir.org/2018/4/e103/ %U https://doi.org/10.2196/mhealth.9002 %U http://www.ncbi.nlm.nih.gov/pubmed/29699971 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e101 %T Digital Inequalities in the Use of Self-Tracking Diet and Fitness Apps: Interview Study on the Influence of Social, Economic, and Cultural Factors %A Régnier,Faustine %A Chauvel,Louis %+ Institut National de la Recherche Agronomique, Alimentation et Sciences Sociales Unité de Recherche 1303, University of Paris Saclay, 65 Boulevard de Brandebourg, Ivry sur Seine Cedex, 94205, France, 33 149596914, faustine.regnier@inra.fr %K diet %K digital divide %K fitness trackers %K France %K healthy diet %K physical activity %K social networking %K social participation %K weight loss %D 2018 %7 20.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital devices are driving economic and social transformations, but assessing the uses, perceptions, and impact of these new technologies on diet and physical activity remains a major societal challenge. Objective: We aimed to determine under which social, economic, and cultural conditions individuals in France were more likely to be actively invested in the use of self-tracking diet and fitness apps for better health behaviors. Methods: Existing users of 3 diet and fitness self-tracking apps (Weight Watchers, MyFitnessPal, and sport apps) were recruited from 3 regions of France. We interviewed 79 individuals (Weight Watchers, n=37; MyFitnessPal, n=20; sport apps, n=22). In-depth semistructured interviews were conducted with each participant, using open-ended questions about their use of diet and fitness apps. A triangulation of methods (content, textual, and quantitative analyses) was performed. Results: We found 3 clusters of interviewees who differed by social background and curative goal linked to use under constraint versus preventive goal linked to chosen use, and intensity of their self-quantification efforts and participation in social networks. Interviewees used the apps for a diversity of uses, including measurement, tracking, quantification, and participation in digital communities. A digital divide was highlighted, comprising a major social gap. Social conditions for appropriation of self-tracking devices included sociodemographic factors, life course stages, and cross-cutting factors of heterogeneity. Conclusions: Individuals from affluent or intermediate social milieus were most likely to use the apps and to participate in the associated online social networks. These interviewees also demonstrated a preventive approach to a healthy lifestyle. Individuals from lower milieus were more reluctant to use digital devices relating to diet and physical activity or to participate in self-quantification. The results of the study have major implications for public health: the digital self-quantification device is intrinsically less important than the way the individual uses it, in terms of adoption of successful health behaviors. %M 29678807 %R 10.2196/mhealth.9189 %U http://mhealth.jmir.org/2018/4/e101/ %U https://doi.org/10.2196/mhealth.9189 %U http://www.ncbi.nlm.nih.gov/pubmed/29678807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e128 %T Characterization of Patient Interest in Provider-Based Consumer Health Information Technology: Survey Study %A Featherall,Joseph %A Lapin,Brittany %A Chaitoff,Alexander %A Havele,Sonia A %A Thompson,Nicolas %A Katzan,Irene %+ Neurological Institute Center for Outcomes Research & Evaluation, Cleveland Clinic, Mail Code S80, 9500 Euclid Avenue, Cleveland, OH, 44195, United States, 1 216 636 5860, katzani@ccf.org %K consumer health informatics %K medical informatics %K self efficacy %K self-management %K telemedicine %K patient-centered care %D 2018 %7 19.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Consumer health information technology can improve patient engagement in their health care and assist in navigating the complexities of health care delivery. However, the consumer health information technology offerings of health systems are often driven by provider rather than patient perspectives and inadequately address patient needs, thus limiting their adoption by patients. Consideration given to patients as stakeholders in the development of such technologies may improve adoption, efficacy, and consumer health information technology resource allocation. Objective: The aims of this paper were to measure patient interest in different health system consumer health information technology apps and determine the influence of patient characteristics on consumer health information technology interest. Methods: Patients seen at the Cleveland Clinic Neurological Institute were electronically surveyed on their interest in using different consumer health information technology apps. A self-efficacy scale, Patient Health Questionnaire-9 depression screen, and EuroQol 5 dimensions health-related quality of life scale were also completed by patients. Logistic regression was used to determine the influence of patient characteristics on interest in consumer health information technology in the categories of self-management, education, and communication. Results: The majority of 3852 patient respondents had an interest in all technology categories assessed in the survey. The highest interest was in apps that allow patients to ask questions of providers (3476/3852, 90.24%) and to schedule appointments (3211/3839, 83.64%). Patient interest in consumer health information technology was significantly associated with greater depression symptoms, worse quality of life, greater health self-efficacy, and smartphone ownership (P<.001 for all listed). Conclusions: Patients should be viewed as active stakeholders in consumer health information technology development and their perspectives should consistently guide development efforts. Health systems should consider focusing on consumer health information technologies that assist patients in scheduling appointments and asking questions of providers. Patients with depression should also be considered for targeted consumer health information technology implementation. Health self-efficacy is a valid predictor of consumer health information technology interest and may play a role in the utilization of consumer health information technologies. Health systems, broadly, should put forth greater effort to understand the needs and interests of patients in the consumer health information technology development process. Consumer health information technology design and implementation may be improved by understanding which technologies patients want. %M 29674312 %R 10.2196/jmir.7766 %U http://www.jmir.org/2018/4/e128/ %U https://doi.org/10.2196/jmir.7766 %U http://www.ncbi.nlm.nih.gov/pubmed/29674312 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e118 %T Identification of Users for a Smoking Cessation Mobile App: Quantitative Study %A Chevalking,SK Leon %A Ben Allouch,Somaya %A Brusse-Keizer,Marjolein %A Postel,Marloes G %A Pieterse,Marcel E %+ Research Group Technology, Health & Care, Saxion University of Applied Sciences, MH Tromplaan 28, 7513 AB, Enschede, 70.000 PO Box, Netherlands, 31 612292901, s.benallouch@saxion.nl %K mobile applications %K telemedicine %K mHealth %K eHealth %K tobacco %K smoking cessation %K health informatics %D 2018 %7 09.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of mobile apps that support smoking cessation is growing, indicating the potential of the mobile phone as a means to support cessation. Knowledge about the potential end users for cessation apps results in suggestions to target potential user groups in a dissemination strategy, leading to a possible increase in the satisfaction and adherence of cessation apps. Objective: This study aimed to characterize potential end users for a specific mobile health (mHealth) smoking cessation app. Methods: A quantitative study was conducted among 955 Dutch smokers and ex-smokers. The respondents were primarily recruited from addiction care facilities and hospitals through Web-based media via websites and forums. The respondents were surveyed on their demographics, smoking behavior, and personal innovativeness. The intention to use and the attitude toward a cessation app were determined on a 5-point Likert scale. To study the association between the characteristics and intention to use and attitude, univariate and multivariate ordinal logistic regression analyses were performed. Results: The multivariate ordinal logistic regression showed that the number of previous quit attempts (odds ratio [OR] 4.1, 95% CI 2.4-7.0, and OR 3.5, 95% CI 2.0-5.9) and the score on the Fagerstrom Test of Nicotine Dependence (OR 0.8, 95% CI 0.8-0.9, and OR 0.8, 95% CI 0.8-0.9) positively correlates with the intention to use a cessation app and the attitude toward cessation apps, respectively. Personal innovativeness also positively correlates with the intention to use (OR 0.3, 95% CI 0.2-0.4) and the attitude towards (OR 0.2, 95% CI 0.1-0.4) a cessation app. No associations between demographics and the intention to use or the attitude toward using a cessation app were observed. Conclusions: This study is among the first to show that demographic characteristics such as age and level of education are not associated with the intention to use and the attitude toward using a cessation app when characteristics related specifically to the app, such as nicotine dependency and the number of quit attempts, are present in a multivariate regression model. This study shows that the use of mHealth apps depends on characteristics related to the content of the app rather than general user characteristics. %M 29631988 %R 10.2196/jmir.7606 %U http://www.jmir.org/2018/4/e118/ %U https://doi.org/10.2196/jmir.7606 %U http://www.ncbi.nlm.nih.gov/pubmed/29631988 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e65 %T Exploring Digital Health Use and Opinions of University Students: Field Survey Study %A Montagni,Ilaria %A Cariou,Tanguy %A Feuillet,Tiphaine %A Langlois,Emmanuel %A Tzourio,Christophe %+ Team HEALTHY, Bordeaux Population Health Research Center (Unité Mixte de Recherche 1219), University of Bordeaux / Institut National de la Santé et de la Recherche Médicale, 146 rue Léo Saignat 33076 Bordeaux, France, Bordeaux, 33076, France, 33 642193363, ilaria.montagni@u-bordeaux.fr %K eHealth %K mHealth %K students %K mobile application %K surveys %K Internet %D 2018 %7 15.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During university, students face some potentially serious health risks, and their lifestyle can have a direct effect on health and health behaviors later in life. Concurrently, university students are digital natives having easy access to the internet and new technologies. Digital health interventions offer promising new opportunities for health promotion, disease prevention, and care in this specific population. The description of the current use of and opinions on digital health among university students can inform future digital health strategies and interventions within university settings. Objective: The aim of this exploratory study was to report on university students’ use and opinions regarding information and communication technologies for health and well-being, taking into account sociodemographic and self-rated general and mental health correlates. Methods: This field survey was conducted from March to April 2017. An informed consent form and a paper questionnaire were given to students aged 18 to 24 years in 4 university campuses in Bordeaux, France. The survey was formulated in 3 sections: (1) sociodemographic characteristics and self-rated general and mental health, (2) information about the use of digital health, and (3) opinions about digital health. Data were analyzed using descriptive statistics and tests of independence. Results: A total of 59.8% (303/507 females) students completed the questionnaire. Concerning digital health use, 34.9% (174/498) had at least 1 health app mostly for physical activity (49.4%, 86/174) and general health monitoring (41.4%, 72/174,), but only 3.9% (20/507) of students had a wearable device. Almost all (94.8%, 450/476) had searched for Web-based health-related information at least once in the last 12 months. The most sought health-related topics were nutrition (68.1%, 324/476); pain and illnesses (64.5%, 307/476); and stress, anxiety, or depression (51.1%, 243/476). Although Wikipedia (79.7%, 357/448) and general health websites (349/448, 77.9%) were the most consulted sources, students considered institutional or official websites as the most credible sources (309/335, 92.2%). There were significant differences in digital health use by gender, field, and year of study. No statistically significant association was found between digital health use and self-rated general and mental health status. Concerning opinions on digital health, although 94.1% (475/505) of students estimated that today’s digital health cannot replace traditional health services and medical consultations, 44.6% (207/464) of students declared that this could be possible in the future, provided that digital health interventions are promoted by institutional or official entities. Conclusions: University students are largely using the internet for health information seeking, but using less mobile health apps and very few wearable devices. Our data suggest that digital health has the potential for improving health and well-being at the university, especially if digital health interventions take into account students’ profiles, interests, and needs. %M 29549071 %R 10.2196/mhealth.9131 %U http://mhealth.jmir.org/2018/3/e65/ %U https://doi.org/10.2196/mhealth.9131 %U http://www.ncbi.nlm.nih.gov/pubmed/29549071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e84 %T Technology and Social Media Use Among Patients Enrolled in Outpatient Addiction Treatment Programs: Cross-Sectional Survey Study %A Ashford,Robert D %A Lynch,Kevin %A Curtis,Brenda %+ Addictions, Department of Psychiatry, University of Pennsylvania, 3440 Market Street, Suite 370, Philadelphia, PA, 19104, United States, 1 817 614 4302, roberdav@upenn.edu %K digital divide %K behavioral health %K social media %K addiction %K recovery %K relapse %D 2018 %7 06.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Substance use disorder research and practice have not yet taken advantage of emerging changes in communication patterns. While internet and social media use is widespread in the general population, little is known about how these mediums are used in substance use disorder treatment. Objective: The aims of this paper were to provide data on patients' with substance use disorders mobile phone ownership rates, usage patterns on multiple digital platforms (social media, internet, computer, and mobile apps), and their interest in the use of these platforms to monitor personal recovery. Methods: We conducted a cross-sectional survey of patients in 4 intensive outpatient substance use disorder treatment facilities in Philadelphia, PA, USA. Logistic regressions were used to examine associations among variables. Results: Survey participants (N=259) were mostly male (72.9%, 188/259), African American (62.9%, 163/259), with annual incomes less than US $10,000 (62.5%, 161/259), and averaged 39 (SD 12.24) years of age. The vast majority of participants (93.8%, 243/259) owned a mobile phone and about 64.1% (166/259) owned a mobile phone with app capabilities, of which 85.1% (207/243) accessed the internet mainly through their mobile phone. There were no significant differences in age, gender, ethnicity, or socio-economic status by computer usage, internet usage, number of times participants changed their phone, type of mobile phone contract, or whether participants had unlimited calling plans. The sample was grouped into 3 age groups (Millennials, Generation Xers, and Baby Boomers). The rates of having a social media account differed across these 3 age groups with significant differences between Baby Boomers and both Generation Xers and Millennials (P<.001 in each case). Among participants with a social media account (73.6%, 190/259), most (76.1%, 144/190) reported using it daily and nearly all (98.2%, 186/190) used Facebook. Nearly half of participants (47.4%, 90/190) reported viewing content on social media that triggered substance cravings and an equal percentage reported being exposed to recovery information on social media. There was a significant difference in rates of reporting viewing recovery information on social media across the 3 age groups with Baby Boomers reporting higher rates than Millennials (P<.001). The majority of respondents (70.1%, 181/259) said they would prefer to use a relapse prevention app on their phone or receive SMS (short message service) relapse prevention text messages (72.3%, 186/259), and nearly half (49.1%, 127/259) expressed an interest in receiving support by allowing social media accounts to be monitored as a relapse prevention technique. Conclusions: To our knowledge, this is the first and largest study examining the online behavior and preferences regarding technology-based substance use disorder treatment interventions in a population of patients enrolled in community outpatient treatment programs. Patients were generally receptive to using relapse prevention apps and text messaging interventions and a substantial proportion supported social media surveillance tools. However, the design of technology-based interventions remains as many participants have monthly telephone plans which may limit continuity. %M 29510968 %R 10.2196/jmir.9172 %U http://www.jmir.org/2018/3/e84/ %U https://doi.org/10.2196/jmir.9172 %U http://www.ncbi.nlm.nih.gov/pubmed/29510968 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e50 %T Reliability of Self-Reported Mobile Phone Ownership in Rural North-Central Nigeria: Cross-Sectional Study %A Menson,William Nii Ayitey %A Olawepo,John Olajide %A Bruno,Tamara %A Gbadamosi,Semiu Olatunde %A Nalda,Nannim Fazing %A Anyebe,Victor %A Ogidi,Amaka %A Onoka,Chima %A Oko,John Okpanachi %A Ezeanolue,Echezona Edozie %+ Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, Las Vegas, NV, 89154, United States, 1 443 682 5034, william.menson@unlv.edu %K reliability %K phone ownership %K resource-limited setting %K cell phone use %K rural population %K developing countries %K self report %K Nigeria %K telemedicine %D 2018 %7 01.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: mHealth practitioners seek to leverage the ubiquity of the mobile phone to increase the impact and robustness of their interventions, particularly in resource-limited settings. However, data on the reliability of self-reported mobile phone access is minimal. Objective: We sought to ascertain the reliability of self-reported ownership of and access to mobile phones among a population of rural dwellers in north-central Nigeria. Methods: We contacted participants in a community-based HIV testing program by phone to determine actual as opposed to self-reported mobile phone access. A phone script was designed to conduct these calls and descriptive analyses conducted on the findings. Results: We dialed 349 numbers: 110 (31.5%) were answered by participants who self-reported ownership of the mobile phone; 123 (35.2%) of the phone numbers did not ring at all; 28 (8.0%) rang but were not answered; and 88 (25.2%) were answered by someone other than the participant. We reached a higher proportion of male participants (68/133, 51.1%) than female participants (42/216, 19.4%; P<.001). Conclusions: Self-reported access to mobile phones in rural and low-income areas in north-central Nigeria is higher than actual access. This has implications for mHealth programming, particularly for women’s health. mHealth program implementers and researchers need to be cognizant of the low reliability of self-reported mobile phone access. These observations should therefore affect sample-size calculations and, where possible, alternative means of reaching research participants and program beneficiaries should be established. %M 29496656 %R 10.2196/mhealth.8760 %U https://mhealth.jmir.org/2018/3/e50/ %U https://doi.org/10.2196/mhealth.8760 %U http://www.ncbi.nlm.nih.gov/pubmed/29496656 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e26 %T Prevalence of Health App Use Among Older Adults in Germany: National Survey %A Rasche,Peter %A Wille,Matthias %A Bröhl,Christina %A Theis,Sabine %A Schäfer,Katharina %A Knobe,Matthias %A Mertens,Alexander %+ Department of Mechanical Engineering, Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Bergdriesch 27, Aachen, 52062, Germany, 49 2418099477, p.rasche@iaw.rwth-aachen.de %K telemedicine %K Germany %K mobile applications %K smartphone %K aged %D 2018 %7 23.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health apps are increasingly becoming an integral part of health care. Especially in older adults, the self-management of chronic diseases by health apps might become an integral part of health care services. Objective: The aim of this explorative study was to investigate the prevalence of health app use and related demographic factors, as well as health status among older adults in Germany. Methods: A nationwide postal survey was conducted. Of the 5000 individuals contacted, a total of 576 participants completed this survey. On the basis of their self-indicated assignment to one of the three predefined user groups (health app users, general app users, and nonusers of apps), participants answered various questions regarding app and health app use, including frequency of use and number of installed apps, demographic factors, and health status. Results: In total, 16.5% (95/576) used health apps, whereas 37.5% (216/576) indicated only using general apps, and 46.0% (265/576) reported using no apps at all. The number of installed health apps was most frequently reported as between 1 and 5 apps per participant, which were usually used on a weekly basis. The most frequently cited type of health apps were exercise-related ones. Individuals using health apps were found to be younger (MeanmHealth 66.6, SD 4.7) and to have a higher level of technical readiness compared with general app users and nonusers of apps (adjusted odds ratio, AOR=4.02 [95% CI 2.23-7.25] for technical readiness, and AOR=0.905 [95% CI 0.85-0.97] for age). The most frequently mentioned sources of information about apps within the group of health and general app users were family and friends. Identified barriers against the use of health apps were a lack of trust, data privacy concerns, and fear of misdiagnosis. Conclusions: Health apps are already used by older adults in Germany. The main type of apps used are exercise-related ones. Barriers to and incentives for the use of health apps and associations with health status and users’ demographics were revealed. %M 29362211 %R 10.2196/mhealth.8619 %U http://mhealth.jmir.org/2018/1/e26/ %U https://doi.org/10.2196/mhealth.8619 %U http://www.ncbi.nlm.nih.gov/pubmed/29362211 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e193 %T Connected Health Devices for Health Care in French General Medicine Practice: Cross-Sectional Study %A El Amrani,Leila %A Oude Engberink,Agnes %A Ninot,Gregory %A Hayot,Maurice %A Carbonnel,François %+ UFR Medecine site Nord, Department of General Practice, University of Montpellier, 641 Avenue du Doyen Giraud, Montpellier, 34093, France, 33 647114591, docteurlea34@gmail.com %K general practice %K physician-patient relations %K monitoring, ambulatory %K wireless technology %K medical informatics %K telemedicine %D 2017 %7 21.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The integration of Connected Health Devices (CHDs) is growing within mobile health (mHealth) and telemedicine, encouraged by institutions and industries. The idea is to improve lifestyle habits and health behaviors as a preventive goal in an aging population with fewer physicians available. However, their ill-defined place in health care does not promote their use in current medical practice. Objective: The primary objective of this study was to quantify CHDs’ use rate by general practitioners (GPs). A secondary objective was to evaluate their benefits and limitations in usual care. Methods: A cross-sectional study through an Internet-based survey was addressed to French GPs via regional medical unions and continuous education agencies, supplemented with an informative website, from March 2015 to July 2015. Surveys where either the form was insufficiently filled or the main question was left unanswered were excluded from the study. Results: A total of 1084 answers were analyzed, of which 19.46% (211/1084, 95% CI 17.1-21.8) GPs used CHDs, and 10.15% (110/1084, 95% CI 8.5-12.1) prescribed a CHD. CHD users statistically prescribed more CHDs (7.38% [80/1084] in the user group vs 2.86% [31/1084] in nonusers; P<.001) and were more likely to use them in the future. Major interests in their utilization were in patient monitoring for 84.96% (921/1084) and patient education for 75.83% (822/1084), especially for diabetes (89.67%, 972/1084) and hypertension (84.13%, 912/1084). Generated data had to be managed securely by the patient primarily for 85.79% (930/1084) of the GPs. CHDs had to not constrain GPs outside clinical consultation, nor restrain their time for 75.83% (822/1084). Additional actors in patient care were not desired for 79.98% (867/1084) of the GPs. Questions about data management issues and technical difficulties were raised. Conclusions: CHDs are little used by French GPs and even less prescribed to their patients, as only a few GPs use these tools. Their benefits as tools of patient empowerment, although expected, remain to be demonstrated in real-life setups. %M 29269336 %R 10.2196/mhealth.7427 %U http://mhealth.jmir.org/2017/12/e193/ %U https://doi.org/10.2196/mhealth.7427 %U http://www.ncbi.nlm.nih.gov/pubmed/29269336 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e33 %T Characteristics of Adults Seeking Health Care Provider Support Facilitated by Mobile Technology: Secondary Data Analysis %A Bosak,Kelly %A Park,Shin Hye %+ School of Nursing, University of Kansas Medical Center, Mailstop 4043, 3901 Rainbow Blvd., Kansas City, KS, KS, United States, 1 913 588 4000, kbosak@kumc.edu %K health technology %K health behavior %K health care provider %K cohort analysis %D 2017 %7 21.12.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health technology is rapidly evolving with the potential to transform health care. Self-management of health facilitated by mobile technology can maximize long-term health trajectories of adults. Little is known about the characteristics of adults seeking Web-based support from health care providers facilitated by mobile technology. Objective: This study aimed to examine the following: (1) the characteristics of adults who seek human support from health care providers for health concerns using mobile technology rather than from family members and friends or others with similar health conditions and (2) the use of mobile health technology among adults with chronic health conditions. Findings of this study were interpreted in the context of the Efficiency Model of Support. Methods: We first described characteristics of adults seeking Web-based support from health care providers. Using chi-square tests for categorical variables and t test for the continuous variable of age, we compared adults seeking Web-based and conventional support by demographics. The primary aim was analyzed using multivariate logistic regression to examine whether chronic health conditions and demographic factors (eg, sex, income, employment status, race, ethnicity, education, and age) were associated with seeking Web-based support from health care providers. Results: The sample included adults (N=1453), the majority of whom were female 57.60% (837/1453), white 75.02% (1090/1453), and non-Hispanic 89.13% (1295/1453). The age of the participants ranged from 18 to 92 years (mean 48.6, standard deviation [SD] 16.8). The majority 76.05% (1105/1453) of participants reported college or higher level of education. A disparity was found in access to health care providers via mobile technology based on socioeconomic status. Adults with annual income of US $30,000 to US $100,000 were 1.72 times more likely to use Web-based methods to contact a health care provider, and adults with an annual income above US $100,000 were 2.41 to 2.46 times more likely to access health care provider support on the Web, compared with those with an annual income below US $30,000. After adjusting for other demographic covariates and chronic conditions, age was not a significant factor in Web-based support seeking. Conclusions: In this study, the likelihood of seeking Web-based support increased when adults had any or multiple chronic health conditions. A higher level of income and education than the general population was found to be related to the use of mobile health technology among adults in this survey. Future study is needed to better understand the disparity in Web-based support seeking for health issues and the clinicians’ role in promoting access to and use of mobile health technology. %M 29269337 %R 10.2196/humanfactors.8246 %U http://humanfactors.jmir.org/2017/4/e33/ %U https://doi.org/10.2196/humanfactors.8246 %U http://www.ncbi.nlm.nih.gov/pubmed/29269337 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e197 %T Health App Use Among US Mobile Phone Users: Analysis of Trends by Chronic Disease Status %A Robbins,Rebecca %A Krebs,Paul %A Jagannathan,Ram %A Jean-Louis,Girardin %A Duncan,Dustin T %+ Department of Population Health, NYU School of Medicine, 227 East 30th Street, New York, NY, 10016, United States, 1 6465012634, rebecca.robbins@nyumc.org %K smartphone %K telemedicine %K chronic disease %D 2017 %7 19.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chronic illness use or perceive mobile apps. Objective: The objective of this study was to explore behaviors and perceptions about mobile phone–based apps for health among individuals with chronic conditions. Methods: Data were collected from a national cross-sectional survey of 1604 mobile phone users in the United States that assessed mHealth use, beliefs, and preferences. This study examined health app use, reason for download, and perceived efficacy by chronic condition. Results: Among participants, having between 1 and 5 apps was reported by 38.9% (314/807) of respondents without a condition and by 6.6% (24/364) of respondents with hypertension. Use of health apps was reported 2 times or more per day by 21.3% (172/807) of respondents without a condition, 2.7% (10/364) with hypertension, 13.1% (26/198) with obesity, 12.3% (20/163) with diabetes, 12.0% (32/267) with depression, and 16.6% (53/319) with high cholesterol. Results of the logistic regression did not indicate a significant difference in health app download between individuals with and without chronic conditions (P>.05). Compared with individuals with poor health, health app download was more likely among those with self-reported very good health (odds ratio [OR] 3.80, 95% CI 2.38-6.09, P<.001) and excellent health (OR 4.77, 95% CI 2.70-8.42, P<.001). Similarly, compared with individuals who report never or rarely engaging in physical activity, health app download was more likely among those who report exercise 1 day per week (OR 2.47, 95% CI 1.6-3.83, P<.001), 2 days per week (OR 4.77, 95% CI 3.27-6.94, P<.001), 3 to 4 days per week (OR 5.00, 95% CI 3.52-7.10, P<.001), and 5 to 7 days per week (OR 4.64, 95% CI 3.11-6.92, P<.001). All logistic regression results controlled for age, sex, and race or ethnicity. Conclusions: Results from this study suggest that individuals with poor self-reported health and low rates of physical activity, arguably those who stand to benefit most from health apps, were least likely to report download and use these health tools. %M 29258981 %R 10.2196/mhealth.7832 %U http://mhealth.jmir.org/2017/12/e197/ %U https://doi.org/10.2196/mhealth.7832 %U http://www.ncbi.nlm.nih.gov/pubmed/29258981 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e52 %T Use of the Internet and Mobile Phones for Self-Management of Severe Mental Health Problems: Qualitative Study of Staff Views %A Berry,Natalie %A Bucci,Sandra %A Lobban,Fiona %+ Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Room S42, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom, 44 1613060428, natalie.berry@manchester.ac.uk %K psychosis %K bipolar disorder %K mHealth %K eHealth %K clinicians %K mobile phone %K Internet %K intervention %D 2017 %7 01.11.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Researchers are currently investigating the feasibility, acceptability, and efficacy of digital health interventions for people who experience severe mental health problems such as psychosis and bipolar disorder. Although the acceptability of digital health interventions for severe mental health problems appears to be relatively high and some people report successfully using the Internet and mobile phones to manage their mental health, the attitudes of mental health care staff toward such approaches have yet to be considered. Objective: The aim of this study was to explore mental health care staff experiences of clients with severe mental health problems engaging with the Internet and mobile phones to self-manage their mental health and their views toward these behaviors. The study also sought to examine the opinions expressed by mental health care staff toward digital health interventions for severe mental health problems to identify potential facilitators and barriers to implementation. Methods: Four focus groups were conducted with 20 staff working in mental health care services in the North West of the England using a topic guide. Focus groups involved 12 staff working in secondary care psychological services (7 participants in focus group 1 and 5 participants in focus group 4), 4 staff working in a rehabilitation unit (focus group 2), and 4 staff working in a community mental health team (focus group 3). Focus groups were transcribed verbatim, and transcripts were analyzed thematically to identify key themes that emerged from the data. Results: Four overarching themes, two with associated subthemes, were identified: (1) staff have conflicting views about the pros and cons of using Web-based resources and digital health interventions to manage mental health; (2) digital health interventions could increase access to mental health support options for severe mental health problems but may perpetuate the digital divide; (3) digital health interventions’ impact on staff roles and responsibilities; and (4) digital health interventions should be used to enhance, not replace, face-to-face support. Conclusions: This study is the first, to our knowledge, to qualitatively explore the experiences and attitudes of mental health care staff toward individuals with severe mental health problems using the Internet, mobile phones, and digital health interventions to self-manage their mental health. Understanding the positive and negative experiences and views shared by staff toward both current and potential digital health intervention use has enabled the identification of several considerations for implementation. Additionally, the findings suggest mental health care staff need clear guidance and training in relation to their responsibilities in recommending reputable and secure websites, forums, and digital health interventions and in how to manage professional boundaries on the Internet. Overall, the study highlights that digital health interventions could be well received by staff working in mental health services but importantly, such management options must be presented to frontline staff as an avenue to enhance care and extend choice, rather than as a method to reduce costs. %M 29092809 %R 10.2196/mental.8311 %U http://mental.jmir.org/2017/4/e52/ %U https://doi.org/10.2196/mental.8311 %U http://www.ncbi.nlm.nih.gov/pubmed/29092809 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 11 %P e160 %T Mobile Phone Use in Psychiatry Residents in the United States: Multisite Cross-Sectional Survey Study %A Gipson,Shih %A Torous,John %A Boland,Robert %A Conrad,Erich %+ Boston Children's Hospital, Department of Psychiatry, 300 Longwood Ave, Boston, MA, 02115, United States, 1 6173556680, mariegipsonmd@gmail.com %K technology %K graduate medical education %K mobile phone %K psychiatry %D 2017 %7 01.11.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technology ownership in the general US population and medical professionals is increasing, leading to increased use in clinical settings. However, data on use of mobile technology by psychiatry residents remain unclear. Objective: In this study, our aim was to provide data on how psychiatric residents use mobile phones in their clinical education as well as barriers relating to technology use. Methods: An anonymous, multisite survey was given to psychiatry residents in 2 regions in the United States, including New Orleans and Boston, to understand their technology use. Results: All participants owned mobile phones, and 79% (54/68) used them to access patient information. The majority do not use mobile phones to implement pharmacotherapy (62%, 42/68) or psychotherapy plans (90%, 61/68). The top 3 barriers to using mobile technology in clinical care were privacy concerns (56%, 38/68), lack of clinical guidance (40%, 27/68), and lack of evidence (29%, 20/68). Conclusions: We conclude that developing a technology curriculum and engaging in research could address these barriers to using mobile phones in clinical practice. %M 29092807 %R 10.2196/mhealth.7146 %U http://mhealth.jmir.org/2017/11/e160/ %U https://doi.org/10.2196/mhealth.7146 %U http://www.ncbi.nlm.nih.gov/pubmed/29092807 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e161 %T Mobile Technology Use Across Age Groups in Patients Eligible for Cardiac Rehabilitation: Survey Study %A Gallagher,Robyn %A Roach,Kellie %A Sadler,Leonie %A Glinatsis,Helen %A Belshaw,Julie %A Kirkness,Ann %A Zhang,Ling %A Gallagher,Patrick %A Paull,Glenn %A Gao,Yan %A Partridge,Stephanie Ruth %A Parker,Helen %A Neubeck,Lis %+ Sydney Nursing School, Charles Perkins Centre, University of Sydney, Building D17 City Road, University of Sydney, Camperdown, 2006, Australia, 61 0286270279, robyn.gallagher@sydney.edu.au %K mobile phone %K cell phone %K digital divide %K cardiac rehabilitation %K cardiovascular disease %D 2017 %7 24.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Emerging evidence indicates mobile technology–based strategies may improve access to secondary prevention and reduce risk factors in cardiac patients. However, little is known about cardiac patients’ use of mobile technology, particularly for health reasons and whether the usage varies across patient demographics. Objective: This study aimed to describe cardiac patients’ use of mobile technology and to determine variations between age groups after adjusting for education, employment, and confidence with using mobile technology. Methods: Cardiac patients eligible for attending cardiac rehabilitation were recruited from 9 hospital and community sites across metropolitan and rural settings in New South Wales, Australia. Participants completed a survey on the use of mobile technology devices, features used, confidence with using mobile technology, willingness and interest in learning, and health-related use. Results: The sample (N=282) had a mean age of 66.5 (standard deviation [SD] 10.6) years, 71.9% (203/282) were male, and 79.0% (223/282) lived in a metropolitan area. The most common diagnoses were percutaneous coronary intervention (33.3%, 94/282) and myocardial infarction (22.7%, 64/282). The majority (91.1%, 257/282) used at least one type of technology device, 70.9% (200/282) used mobile technology (mobile phone/tablet), and 31.9% (90/282) used all types. Technology was used by 54.6% (154/282) for health purposes, most often to access information on health conditions (41.4%, 117/282) and medications (34.8%, 98/282). Age had an important independent association with the use of mobile technology after adjusting for education, employment, and confidence. The youngest group (<56 years) was over 4 times more likely to use any mobile technology than the oldest (>69 years) age group (odds ratio [OR] 4.45, 95% CI 1.46-13.55), 5 times more likely to use mobile apps (OR 5.00, 95% CI 2.01-12.44), and 3 times more likely to use technology for health-related reasons (OR 3.31, 95% CI 1.34-8.18). Compared with the older group, the middle age group (56-69 years) was more than twice as likely to use any mobile technology (OR 2.42, 95% CI 1.27-4.59) and mobile technology for health-related purposes (OR 1.92, 95% CI 1.04-3.53). Participants who had completed high school were twice as likely to use mobile technology (OR 2.62, 95% CI 1.45-4.70), mobile apps (OR 2.05, 95% CI 1.09-3.84), and mobile technology for health-related reasons (OR 5.09, 95% CI 2.89-8.95) than those who had not completed high school. Associations were also present between participants living in metropolitan areas and mobile technology use (OR 1.07, 95% CI 1.07-4.24) and employment and mobile app use (OR 2.72, 95% CI 1.44-5.140). Conclusions: Mobile technology offers an important opportunity to improve access to secondary prevention for cardiac patients, particularly when modified to suit subgroups. High levels of mobile technology use and health motivation need to be harnessed for secondary prevention. %M 29066425 %R 10.2196/mhealth.8352 %U http://mhealth.jmir.org/2017/10/e161/ %U https://doi.org/10.2196/mhealth.8352 %U http://www.ncbi.nlm.nih.gov/pubmed/29066425 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e340 %T What Clinical Information Is Valuable to Doctors Using Mobile Electronic Medical Records and When? %A Kim,Junetae %A Lee,Yura %A Lim,Sanghee %A Kim,Jeong Hoon %A Lee,Byungtae %A Lee,Jae-Ho %+ Department of Biomedical Informatics, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic Of Korea, 82 23010 3350, rufiji@gmail.com %K mobile health %K electronic medical records %K clinical information %K rounding %K timeliness %K accessibility %K smartphone %D 2017 %7 18.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been a lack of understanding on what types of specific clinical information are most valuable for doctors to access through mobile-based electronic medical records (m-EMRs) and when they access such information. Furthermore, it has not been clearly discussed why the value of such information is high. Objective: The goal of this study was to investigate the types of clinical information that are most valuable to doctors to access through an m-EMR and when such information is accessed. Methods: Since 2010, an m-EMR has been used in a tertiary hospital in Seoul, South Korea. The usage logs of the m-EMR by doctors were gathered from March to December 2015. Descriptive analyses were conducted to explore the overall usage patterns of the m-EMR. To assess the value of the clinical information provided, the usage patterns of both the m-EMR and a hospital information system (HIS) were compared on an hourly basis. The peak usage times of the m-EMR were defined as continuous intervals having normalized usage values that are greater than 0.5. The usage logs were processed as an indicator representing specific clinical information using factor analysis. Random intercept logistic regression was used to explore the type of clinical information that is frequently accessed during the peak usage times. Results: A total of 524,929 usage logs from 653 doctors (229 professors, 161 fellows, and 263 residents; mean age: 37.55 years; males: 415 [63.6%]) were analyzed. The highest average number of m-EMR usage logs (897) was by medical residents, whereas the lowest (292) was by surgical residents. The usage amount for three menus, namely inpatient list (47,096), lab results (38,508), and investigation list (25,336), accounted for 60.1% of the peak time usage. The HIS was used most frequently during regular hours (9:00 AM to 5:00 PM). The peak usage time of the m-EMR was early in the morning (6:00 AM to 10:00 AM), and the use of the m-EMR from early evening (5:00 PM) to midnight was higher than during regular business hours. Four factors representing the types of clinical information were extracted through factor analysis. Factors related to patient investigation status and patient conditions were associated with the peak usage times of the m-EMR (P<.01). Conclusions: Access to information regarding patient investigation status and patient conditions is crucial for decision making during morning activities, including ward rounds. The m-EMRs allow doctors to maintain the continuity of their clinical information regardless of the time and location constraints. Thus, m-EMRs will best evolve in a manner that enhances the accessibility of clinical information helpful to the decision-making process under such constraints. %M 29046269 %R 10.2196/jmir.8128 %U http://www.jmir.org/2017/10/e340/ %U https://doi.org/10.2196/jmir.8128 %U http://www.ncbi.nlm.nih.gov/pubmed/29046269 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e317 %T The Digital Divide and Health Disparities in China: Evidence From a National Survey and Policy Implications %A Hong,Y Alicia %A Zhou,Zi %A Fang,Ya %A Shi,Leiyu %+ School of Public Health, Xiamen University, No. 4221-117, Xiang'an South Road, Xiamen, 361102, China, 86 9794369343, yhong@sph.tamhsc.edu %K digital divide %K health disparities %K Internet %K mobile phone %K China %D 2017 %7 11.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The digital divide persists despite broad accessibility of mobile tools. The relationship between the digital divide and health disparities reflects social status in terms of access to resources and health outcomes; however, data on this relationship are limited from developing countries such as China. Objective: The aim of this study was to examine the current rates of access to mobile tools (Internet use and mobile phone ownership) among older Chinese individuals (aged ≥45 years), the predictors of access at individual and community levels, and the relationship between access to mobile tools and health outcomes. Methods: We drew cross-sectional data from a national representative survey, the China Health and Retirement Longitudinal Study (CHARLS), which focused on the older population (aged ≥45 years). We used two-level mixed logistic regression models, controlling for unobserved heterogeneity at the community and individual levels for data analysis. In addition to individual-level socioeconomic status (SES), we included community-level resources such as neighborhood amenities, health care facilities, and community organizations. Health outcomes were measured by self-reported health and absence of disability based on validated scales. Results: Among the 18,215 participants, 6.51% had used the Internet in the past month, and 83% owned a mobile phone. In the multivariate models, Internet use was strongly associated with SES, rural or urban residence, neighborhood amenities, community resources, and geographic region. Mobile phone ownership was strongly associated with SES and rural/urban residence but not so much with neighborhood amenities and community resources. Internet use was a significant predictor of self-reported health status, and mobile phone ownership was significantly associated with having disability even after controlling for potential confounders at the individual and community levels. Conclusions: This study is one of the first to examine digital divide and its relationship with health disparities in China. The data showed a significant digital divide in China, especially in the older population. Internet access is still limited to people with higher SES; however, the mobile phone has been adopted by the general population. The digital divide is associated with not only individual SES but also community resources. Future electronic health (eHealth) programs need to consider the accessibility of mobile tools and develop culturally appropriate programs for various social groups. %M 28893724 %R 10.2196/jmir.7786 %U http://www.jmir.org/2017/9/e317/ %U https://doi.org/10.2196/jmir.7786 %U http://www.ncbi.nlm.nih.gov/pubmed/28893724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e305 %T Smartphone Ownership Among US Adult Cigarette Smokers: 2014 Health Information National Trends Survey (HINTS) Data %A Heffner,Jaimee L %A Mull,Kristin E %+ Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Ave N, Mail Stop M3-B232, PO Box 19024, Seattle, WA, 98109, United States, 1 2066677314, jheffner@fredhutch.org %K mHealth %K mobile health %K tobacco %K smoking %K nicotine use disorder %D 2017 %7 31.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite increasing interest in smartphone apps as a platform for delivery of tobacco cessation interventions, no previous studies have evaluated the prevalence and characteristics of smokers who can access smartphone-delivered interventions. Objective: To guide treatment development in this new platform and to evaluate disparities in access to smartphone-delivered interventions, we examined associations of smartphone ownership with demographics, tobacco use and thoughts about quitting, other health behaviors, physical and mental health, health care access, and Internet and technology utilization using a nationally representative sample of US adult smokers. Methods: Data were from the National Cancer Institute’s 2014 Health Information National Trends Survey 4 (HINTS 4), Cycle 4. This mailed survey targeted noninstitutionalized individuals aged 18 years or older using two-stage stratified random sampling. For this analysis, we restricted the sample to current smokers with complete data on smartphone ownership (n=479). Results: Nearly two-thirds (weighted percent=63.8%, 248/479) of smokers reported owning a smartphone. Those who were younger (P<.001), employed (P=.002), never married (P=.002), and had higher education (P=.002) and income (P<.001) had the highest rates of ownership. Smartphone owners did not differ from nonowners on frequency of smoking, recent quit attempts, or future plans to quit smoking, although they reported greater belief in the benefits of quitting (P=.04). Despite being equally likely to be overweight or obese, smartphone owners reported greater fruit and vegetable consumption (P=.03) and were more likely to report past-year efforts to increase exercise (P=.001) and to lose weight (P=.02). No differences in health care access and utilization were found. Smartphone owners reported better physical and mental health in several domains and higher access to and utilization of technology and the Internet, including for health reasons. Conclusions: Smartphone ownership among smokers mirrors many trends in the general population, including the overall rate of ownership and the association with younger age and higher socioeconomic status. Apps for smoking cessation could potentially capitalize on smartphone owners’ efforts at multiple health behavior changes and interest in communicating with health care providers via technology. These data also highlight the importance of accessible treatment options for smokers without smartphones in order to reach smokers with the highest physical and mental health burden and prevent worsening of tobacco-related health disparities as interventions move to digital platforms. %M 28860108 %R 10.2196/jmir.7953 %U https://www.jmir.org/2017/8/e305/ %U https://doi.org/10.2196/jmir.7953 %U http://www.ncbi.nlm.nih.gov/pubmed/28860108 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e96 %T Patterns of User Engagement With the Mobile App, Manage My Pain: Results of a Data Mining Investigation %A Rahman,Quazi Abidur %A Janmohamed,Tahir %A Pirbaglou,Meysam %A Ritvo,Paul %A Heffernan,Jane M %A Clarke,Hance %A Katz,Joel %+ ManagingLife, Inc., Unit 4, 850 Richmond St W, Toronto, ON, M6J 1C9, Canada, 1 416 910 3760, tahir@managinglife.com %K chronic pain %K mhealth %K opioid use %K data mining %K cluster analysis %K Manage My Pain %K pain management %K pain app %D 2017 %7 12.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pain is one of the most prevalent health-related concerns and is among the top 3 most common reasons for seeking medical help. Scientific publications of data collected from pain tracking and monitoring apps are important to help consumers and healthcare professionals select the right app for their use. Objective: The main objectives of this paper were to (1) discover user engagement patterns of the pain management app, Manage My Pain, using data mining methods; and (2) identify the association between several attributes characterizing individual users and their levels of engagement. Methods: User engagement was defined by 2 key features of the app: longevity (number of days between the first and last pain record) and number of records. Users were divided into 5 user engagement clusters employing the k-means clustering algorithm. Each cluster was characterized by 6 attributes: gender, age, number of pain conditions, number of medications, pain severity, and opioid use. Z tests and chi-square tests were used for analyzing categorical attributes. Effects of gender and cluster on numerical attributes were analyzed using 2-way analysis of variances (ANOVAs) followed up by pairwise comparisons using Tukey honest significant difference (HSD). Results: The clustering process produced 5 clusters representing different levels of user engagement. The proportion of males and females was significantly different in 4 of the 5 clusters (all P ≤.03). The proportion of males was higher than females in users with relatively high longevity. Mean ages of users in 2 clusters with high longevity were higher than users from other 3 clusters (all P <.001). Overall, males were significantly older than females (P <.001). Across clusters, females reported more pain conditions than males (all P <.001). Users from highly engaged clusters reported taking more medication than less engaged users (all P <.001). Females reported taking a greater number of medications than males (P =.04). In 4 of 5 clusters, the percentage of males taking an opioid was significantly greater (all P ≤.05) than that of females. The proportion of males with mild pain was significantly higher than that of females in 3 clusters (all P ≤.008). Conclusions: Although most users of the app reported being female, male users were more likely to be highly engaged in the app. Users in the most engaged clusters self-reported a higher number of pain conditions, a higher number of current medications, and a higher incidence of opioid usage. The high engagement by males in these clusters does not appear to be driven by pain severity which may, in part, be the case for females. Use of a mobile pain app may be relatively more attractive to highly-engaged males than highly-engaged females, and to those with relatively more complex chronic pain problems. %M 28701291 %R 10.2196/mhealth.7871 %U http://mhealth.jmir.org/2017/7/e96/ %U https://doi.org/10.2196/mhealth.7871 %U http://www.ncbi.nlm.nih.gov/pubmed/28701291 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e85 %T Use of and Beliefs About Mobile Phone Apps for Diabetes Self-Management: Surveys of People in a Hospital Diabetes Clinic and Diabetes Health Professionals in New Zealand %A Boyle,Leah %A Grainger,Rebecca %A Hall,Rosemary M %A Krebs,Jeremy D %+ Department of Medicine, University of Otago Wellington, Department of Medicine, 23A Mein St, PO Box 7343, Wellington, 6242, New Zealand, 64 43855541, Jeremy.Krebs@ccdhb.org.nz %K mHealth, mobile applications %K telemedicine %K diabetes mellitus %D 2017 %7 30.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People with diabetes mellitus (DM) are using mobile phone apps to support self-management. The numerous apps available to assist with diabetes management have a variety of functions. Some functions, like insulin dose calculators, have significant potential for harm. Objectives: The study aimed to establish (1) whether people with DM in Wellington, New Zealand, use apps for DM self-management and evaluate desirable features of apps and (2) whether health professionals (HPs) in New Zealand treating people with DM recommend apps to patients, the features HPs regard as important, and their confidence with recommending apps. Methods: A survey of patients seen at a hospital diabetes clinic over 12 months (N=539) assessed current app use and desirable features. A second survey of HPs attending a diabetes conference (n=286) assessed their confidence with app recommendations and perceived usefulness. Results: Of the 189 responders (35.0% response rate) to the patient survey, 19.6% (37/189) had used a diabetes app. App users were younger and in comparison to other forms of diabetes mellitus, users prominently had type 1 DM. The most favored feature of the app users was a glucose diary (87%, 32/37), and an insulin calculator was the most desirable function for a future app (46%, 17/37). In non-app users, the most desirable feature for a future app was a glucose diary (64.4%, 98/152). Of the 115 responders (40.2% response rate) to the HPs survey, 60.1% (68/113) had recommended a diabetes app. Diaries for blood glucose levels and carbohydrate counting were considered the most useful app features and the features HPs felt most confident to recommend. HPs were least confident in recommending insulin calculation apps. Conclusions: The use of apps to record blood glucose was the most favored function in apps used by people with diabetes, with interest in insulin dose calculating function. HPs do not feel confident in recommending insulin dose calculators. There is an urgent need for an app assessment process to give confidence in the quality and safety of diabetes management apps to people with diabetes (potential app users) and HPs (potential app prescribers). %M 28666975 %R 10.2196/mhealth.7263 %U http://mhealth.jmir.org/2017/6/e85/ %U https://doi.org/10.2196/mhealth.7263 %U http://www.ncbi.nlm.nih.gov/pubmed/28666975 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e89 %T Assessing User Engagement of an mHealth Intervention: Development and Implementation of the Growing Healthy App Engagement Index %A Taki,Sarah %A Lymer,Sharyn %A Russell,Catherine Georgina %A Campbell,Karen %A Laws,Rachel %A Ong,Kok-Leong %A Elliott,Rosalind %A Denney-Wilson,Elizabeth %+ University of Technology Sydney, Bldg 10, 8th Fl, 235 Jones St, Ultimo NSW, Sydney, 2007, Australia, 61 0424393630, sarah.b.taki@student.uts.edu.au %K mHealth %K social medium %K infant obesity %K infant development %K children %K infants %K practitioners %K primary healthcare %D 2017 %7 29.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Childhood obesity is an ongoing problem in developed countries that needs targeted prevention in the youngest age groups. Children in socioeconomically disadvantaged families are most at risk. Mobile health (mHealth) interventions offer a potential route to target these families because of its relatively low cost and high reach. The Growing healthy program was developed to provide evidence-based information on infant feeding from birth to 9 months via app or website. Understanding user engagement with these media is vital to developing successful interventions. Engagement is a complex, multifactorial concept that needs to move beyond simple metrics. Objective: The aim of our study was to describe the development of an engagement index (EI) to monitor participant interaction with the Growing healthy app. The index included a number of subindices and cut-points to categorize engagement. Methods: The Growing program was a feasibility study in which 300 mother-infant dyads were provided with an app which included 3 push notifications that was sent each week. Growing healthy participants completed surveys at 3 time points: baseline (T1) (infant age ≤3 months), infant aged 6 months (T2), and infant aged 9 months (T3). In addition, app usage data were captured from the app. The EI was adapted from the Web Analytics Demystified visitor EI. Our EI included 5 subindices: (1) click depth, (2) loyalty, (3) interaction, (4) recency, and (5) feedback. The overall EI summarized the subindices from date of registration through to 39 weeks (9 months) from the infant’s date of birth. Basic descriptive data analysis was performed on the metrics and components of the EI as well as the final EI score. Group comparisons used t tests, analysis of variance (ANOVA), Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests as appropriate. Consideration of independent variables associated with the EI score were modeled using linear regression models. Results: The overall EI mean score was 30.0% (SD 11.5%) with a range of 1.8% - 57.6%. The cut-points used for high engagement were scores greater than 37.1% and for poor engagement were scores less than 21.1%. Significant explanatory variables of the EI score included: parity (P=.005), system type including “app only” users or “both” app and email users (P<.001), recruitment method (P=.02), and baby age at recruitment (P=.005). Conclusions: The EI provided a comprehensive understanding of participant behavior with the app over the 9-month period of the Growing healthy program. The use of the EI in this study demonstrates that rich and useful data can be collected and used to inform assessments of the strengths and weaknesses of the app and in turn inform future interventions. %M 28663164 %R 10.2196/mhealth.7236 %U http://mhealth.jmir.org/2017/6/e89/ %U https://doi.org/10.2196/mhealth.7236 %U http://www.ncbi.nlm.nih.gov/pubmed/28663164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e196 %T Social Media Use and Access to Digital Technology in US Young Adults in 2016 %A Villanti,Andrea C %A Johnson,Amanda L %A Ilakkuvan,Vinu %A Jacobs,Megan A %A Graham,Amanda L %A Rath,Jessica M %+ Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth floor, Washington, DC, 20001, United States, 1 202 454 5751, avillanti@truthinitiative.org %K social media %K technology %K young adults %D 2017 %7 07.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2015, 90% of US young adults with Internet access used social media. Digital and social media are highly prevalent modalities through which young adults explore identity formation, and by extension, learn and transmit norms about health and risk behaviors during this developmental life stage. Objective: The purpose of this study was to provide updated estimates of social media use from 2014 to 2016 and correlates of social media use and access to digital technology in data collected from a national sample of US young adults in 2016. Methods: Young adult participants aged 18-24 years in Wave 7 (October 2014, N=1259) and Wave 9 (February 2016, N=989) of the Truth Initiative Young Adult Cohort Study were asked about use frequency for 11 social media sites and access to digital devices, in addition to sociodemographic characteristics. Regular use was defined as using a given social media site at least weekly. Weighted analyses estimated the prevalence of use of each social media site, overlap between regular use of specific sites, and correlates of using a greater number of social media sites regularly. Bivariate analyses identified sociodemographic correlates of access to specific digital devices. Results: In 2014, 89.42% (weighted n, 1126/1298) of young adults reported regular use of at least one social media site. This increased to 97.5% (weighted n, 965/989) of young adults in 2016. Among regular users of social media sites in 2016, the top five sites were Tumblr (85.5%), Vine (84.7%), Snapchat (81.7%), Instagram (80.7%), and LinkedIn (78.9%). Respondents reported regularly using an average of 7.6 social media sites, with 85% using 6 or more sites regularly. Overall, 87% of young adults reported access or use of a smartphone with Internet access, 74% a desktop or laptop computer with Internet access, 41% a tablet with Internet access, 29% a smart TV or video game console with Internet access, 11% a cell phone without Internet access, and 3% none of these. Access to all digital devices with Internet was lower in those reporting a lower subjective financial situation; there were also significant differences in access to specific digital devices with Internet by race, ethnicity, and education. Conclusions: The high mean number of social media sites used regularly and the substantial overlap in use of multiple social media sites reflect the rapidly changing social media environment. Mobile devices are a primary channel for social media, and our study highlights disparities in access to digital technologies with Internet access among US young adults by race/ethnicity, education, and subjective financial status. Findings from this study may guide the development and implementation of future health interventions for young adults delivered via the Internet or social media sites. %M 28592394 %R 10.2196/jmir.7303 %U http://www.jmir.org/2017/6/e196/ %U https://doi.org/10.2196/jmir.7303 %U http://www.ncbi.nlm.nih.gov/pubmed/28592394 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e77 %T Health App Possession Among Smartphone or Tablet Owners in Hong Kong: Population-Based Survey %A Shen,Chen %A Wang,Man Ping %A Chu,Joanna TW %A Wan,Alice %A Viswanath,Kasisomayajula %A Chan,Sophia Siu Chee %A Lam,Tai Hing %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong,, China (Hong Kong), 852 3917 6636, mpwang@hku.hk %K apps %K smartphone %K Chinese %D 2017 %7 05.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health apps are increasingly used with important implications for health. Hong Kong is one of the most technologically advanced and connected cities—smartphone ownership and Internet access rates are among the highest in the world. Objective: We investigated the prevalence of health app possession and related sociodemographic factors and health behaviors among smartphone or tablet owners in Hong Kong. Methods: A territory-wide population-based dual (landline and mobile) telephone survey was conducted in 2016. Respondents were asked whether they had health-related apps on their smartphones or tablets and what functions were available on the apps (eg, tracking physical activity and logging health records). Logistic regression was used to calculate the adjusted odds ratio (aOR) and 95% CI of health app possession for different demographic characteristics, socioeconomic position (education, employment, and income), health behaviors (smoking, alcohol, and physical activity) and health (body mass index and chronic diseases). Results: Of the 4129 smartphone or tablet owners (81.28%, 4129/5080 respondents), 995 (24.10%) had a health app. Tracking physical activity (67.0% of 995) and logging health records (43.0% of 995) were the most common functions of the health apps. Overall, younger age, higher education, and household income were associated with having health apps (all P<.001). Compared with physical inactivity, engaging in moderate physical activity ≥1 day/week was associated with having health apps (aOR 1.45 [95% CI 1.20-1.75] for 1-3 days/week, and aOR 1.32 [95% CI 1.07-1.62] for ≥4 days/week). Having a history of chronic diseases was associated with having health apps (aOR 1.36 [95% CI 1.11-1.68]). Conclusions: We have shown a lower prevalence of use of information and communication technologies (ICTs) in respondents with lower education and income in the most developed Chinese city. This could be seen as a confirmation of the “Inverse information law,” which suggests that those most in need have less use of services and hence receive less benefits from advancements in medicine and health related ICTs. %M 28583905 %R 10.2196/mhealth.7628 %U http://mhealth.jmir.org/2017/6/e77/ %U https://doi.org/10.2196/mhealth.7628 %U http://www.ncbi.nlm.nih.gov/pubmed/28583905 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e70 %T Uptake of an Incentive-Based mHealth App: Process Evaluation of the Carrot Rewards App %A Mitchell,Marc %A White,Lauren %A Oh,Paul %A Alter,David %A Leahey,Tricia %A Kwan,Matthew %A Faulkner,Guy %+ University Health Network, 347 Rumsey Road, Toronto, ON,, Canada, 1 416 660 7881, mmitc26@uwo.ca %K financial incentives %K mHealth %K behavioral economics %K public health %D 2017 %7 30.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Behavioral economics has stimulated renewed interest in financial health incentives worldwide. The Carrot Rewards app was developed as part of a public-private partnership to reward Canadians with loyalty points (eg, movies and groceries) for downloading the app, referring friends, and completing an average of 1 to 2 educational health quizzes per week (“micro-learning”), with long-term objectives of increasing health knowledge and encouraging healthy behaviors. Objective: The main objective of this study was to evaluate uptake of a loyalty points-based mHealth app during the exclusive 3-month launch period in British Columbia (BC), Canada. The secondary aims were to describe the health and sociodemographic characteristics of users, as well as participation levels (eg, proportion of quizzes completed and friends referred). Methods: The app was promoted via loyalty program email campaigns (1.64 million emails). Number of downloads and registrations (users enter age, gender, and valid BC postal code to register) were collected. Additional sociodemographics were inferred by linking postal codes with census data at the local health area (LHA) level. Health risk assessments were also deployed. Participation levels were collected over 3 months and descriptive data were presented. Results: In 3 months, 67,464 individuals downloaded the app; in its first week, Carrot Rewards was the most downloaded health app in Canada. Among valid users (n=57,885; at least one quiz completed), the majority were female (62.96%; 36,446/57,885) and aged 18 to 34 years (54.34%; 31,459/57,885). More than half of the users (52.40%; 30,332/57,885) resided in LHAs where the median personal income was below the provincial average (Can $28,765). Furthermore, 64.42% (37,291/57,885) of users lived in metropolitan (ie, urban) LHAs, compared with 56.17% of the general BC population. The most prevalent risk factors were “not” meeting physical activity guidelines (72.70%; 31,765/43,692) and “not” getting the flu shot last year (67.69%; 30,286/44,739). Regarding participation, 60.05% (34,761/57,885) of users were classified as “very high” engagers (>75% quiz completion rate). Conclusions: Early results suggest that loyalty points may promote mHealth app uptake. The app was downloaded by younger females especially, and BC residents from higher and lower income regions were equally represented. Loyalty points appear to have driven participation throughout the inaugural 3-month period (ie, quiz completion). %M 28559224 %R 10.2196/mhealth.7323 %U http://mhealth.jmir.org/2017/5/e70/ %U https://doi.org/10.2196/mhealth.7323 %U http://www.ncbi.nlm.nih.gov/pubmed/28559224 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e63 %T North American Public Opinion Survey on the Acceptability of Crowdsourcing Basic Life Support for Out-of-Hospital Cardiac Arrest With the PulsePoint Mobile Phone App %A Dainty,Katie N %A Vaid,Haris %A Brooks,Steven C %+ Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada, 1 6474482485, daintyk@smh.ca %K sudden cardiac death %K surveys and questionnaires %K cardiopulmonary resuscitation %K PulsePoint %K North America %D 2017 %7 17.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The PulsePoint Respond app is a novel system that can be implemented in emergency dispatch centers to crowdsource basic life support (BLS) for patients with cardiac arrest and facilitate bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator use while first responders are en route. Objective: The aim of this study was to conduct a North American survey to evaluate the public perception of the above-mentioned strategy, including acceptability and willingness to respond to alerts. Methods: We designed a Web-based survey administered by IPSOS Reid, an established external polling vendor. Sampling was designed to ensure broad representation using recent census statistics. Results: A total of 2415 survey responses were analyzed (1106 from Canada and 1309 from the United States). It was found that 98.37% (1088/1106) of Canadians and 96% (1259/1309) of Americans had no objections to PulsePoint being implemented in their community; 84.27% (932/1106) of Canadians and 55.61% (728/1309) of Americans said they would download the app to become a potential responder to cardiac arrest, respectively. Among Canadians, those who said they were likely to download PulsePoint were also more likely to have ever had CPR training (OR 1.7, 95% CI 1.2-2.4; P=.002); however, this was not true of American respondents (OR 1.0, 95% CI 0.79-1.3; P=.88). When asked to imagine themselves as a cardiac arrest victim, 95.39% (1055/1106) of Canadians and 92.44% (1210/1309) of Americans had no objections to receiving crowdsourced help in a public setting; 88.79% (982/1106) of Canadians and 84.87% (1111/1309) of Americans also had no objections to receiving help in a private setting, respectively. The most common concern identified with respect to PulsePoint implementation was a responder’s lack of ability, training, or access to proper equipment in a public setting. Conclusions: The North American public finds the concept of crowdsourcing BLS for out-of-hospital cardiac arrest to be acceptable. It demonstrates willingness to respond to PulsePoint CPR notifications and to accept help from others alerted by the app if they themselves suffered a cardiac arrest. %M 28526668 %R 10.2196/mhealth.6926 %U http://mhealth.jmir.org/2017/5/e63/ %U https://doi.org/10.2196/mhealth.6926 %U http://www.ncbi.nlm.nih.gov/pubmed/28526668 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e61 %T Ownership and Use of Commercial Physical Activity Trackers Among Finnish Adolescents: Cross-Sectional Study %A Ng,Kwok %A Tynjälä,Jorma %A Kokko,Sami %+ Research Centre for Health Promotion, Faculty of Sport and Health Sciences, University of Jyvaskyla, PO Box 35 (L), Jyväskylä, 40014, Finland, 358 451499919, kwok.ng@jyu.fi %K social determinants of health %K mobile phone %K health promotion %K disabled children %K physical activity %K adolescent %D 2017 %7 04.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps for monitoring and promoting physical activity (PA) are extremely popular among adults. Devices, such as heart rate monitors or sports watches (HRMs/SWs) that work with these apps are at sufficiently low costs to be available through the commercial markets. Studies have reported an increase in PA levels among adults with devices; however, it is unknown whether the phenomena are similar during early adolescence. At a time when adolescents start to develop their own sense of independence and build friendship, the ease of smartphone availability in developed countries needs to be investigated in important health promoting behaviors such as PA. Objective: The objective of this study was to investigate the ownership and usage of PA trackers (apps and HRM/SW) among adolescents in a national representative sample and to examine the association between use of devices and PA levels. Methods: The Finnish school-aged physical activity (SPA) study consisted of 4575 adolescents, aged 11-, 13-, and 15-years, who took part in a web-based questionnaire during school time about PA behaviors between April and May 2016. Binary logistic regression analyses were used to test the associations between moderate to vigorous physical activity (MVPA) and devices, after controlling for gender, age, disability, and family affluence. Results: PA tracking devices have been categorized into two types, which are accessible to adolescents: (1) apps and (2) HRM/SW. Half the adolescents (2351/4467; 52.63%) own apps for monitoring PA, yet 16.12% (720/4467) report using apps. Fewer adolescents (782/4413; 17.72%) own HRM/SW and 9.25% (408/4413) use HRM/SW. In this study, users of HRM/SW were 2.09 times (95% CI 1.64-2.67), whereas users of apps were 1.4 times (95% CI 1.15-1.74) more likely to meet PA recommendations of daily MVPA for at least 60 min compared with adolescents without HRM/SW or without apps. Conclusions: To our knowledge, this is the first study that describes the situation in Finland with adolescents using PA trackers and its association with PA levels. Implications of the use of apps and HRM/SW by adolescents are discussed. %M 28473304 %R 10.2196/mhealth.6940 %U http://mhealth.jmir.org/2017/5/e61/ %U https://doi.org/10.2196/mhealth.6940 %U http://www.ncbi.nlm.nih.gov/pubmed/28473304 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e58 %T Use of Fitness and Nutrition Apps: Associations With Body Mass Index, Snacking, and Drinking Habits in Adolescents %A De Cock,Nathalie %A Vangeel,Jolien %A Lachat,Carl %A Beullens,Kathleen %A Vervoort,Leentje %A Goossens,Lien %A Maes,Lea %A Deforche,Benedicte %A De Henauw,Stefaan %A Braet,Caroline %A Eggermont,Steven %A Kolsteren,Patrick %A Van Camp,John %A Van Lippevelde,Wendy %+ Food Chemistry and Human Nutrition, Department of Food safety and Food quality, University of Ghent, Coupure links 653, Gent, 9000, Belgium, 32 9 264 58 67, nathalieL.decock@ugent.be %K mhealth %K adolescents %K snacks %K beverages %K body mass index %D 2017 %7 25.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Efforts to improve snacking and drinking habits are needed to promote a healthy body mass index (BMI) in adolescents. Although commercial fitness and nutrition mobile phone apps are widely used, little is known regarding their potential to improve health behaviors, especially in adolescents. In addition, evidence on the mechanisms through which such fitness and nutrition apps influence behavior is lacking. Objectives: This study assessed whether the use of commercial fitness or nutrition apps was associated with a lower BMI and healthier snacking and drinking habits in adolescents. Additionally, it explored if perceived behavioral control to eat healthy; attitudes to eat healthy for the good taste of healthy foods, for overall health or for appearance; social norm on healthy eating and social support to eat healthy mediated the associations between the frequency of use of fitness or nutrition apps and BMI, the healthy snack, and beverage ratio. Methods: Cross-sectional self-reported data on snack and beverage consumption, healthy eating determinants, and fitness and nutrition app use of adolescents (N=889; mean age 14.7 years, SD 0.8; 54.8% [481/878] boys; 18.1% [145/803] overweight) were collected in a representative sample of 20 schools in Flanders, Belgium. Height and weight were measured by the researchers. The healthy snack ratio and the healthy beverage ratio were calculated as follows: gram healthy snacks or beverages/(gram healthy snacks or beverages+gram unhealthy snacks or beverages)×100. Multilevel regression and structural equation modeling were used to analyze the proposed associations and to explore multiple mediation. Results: A total of 27.6% (245/889) of the adolescents used fitness, nutrition apps or both. Frequency of using nutrition apps was positively associated with a higher healthy beverage ratio (b=2.96 [1.11], P=.008) and a higher body mass index z-scores (zBMI; b=0.13 [0.05], P=.008. A significant interaction was found between the frequency of using nutrition and for the zBMI (b=−0.03 [0.02], P=.04) and the healthy snack ratio (b=−0.84 [0.37], P=.03). Attitude to eat healthy for appearance mediated both the fitness app use frequency-zBMI (a × b=0.02 [0.01], P=.02) and the nutrition app use frequency-zBMI (a × b=0.04 [0.01], P=.001) associations. No mediation was observed for the associations between the frequency of use of fitness or nutrition apps and the healthy snack or beverage ratio. Conclusions: Commercial fitness and nutrition apps show some association with healthier eating behaviors and BMI in adolescents. However, effective behavior change techniques should be included to affect key determinants of healthy eating. %M 28442455 %R 10.2196/mhealth.6005 %U http://mhealth.jmir.org/2017/4/e58/ %U https://doi.org/10.2196/mhealth.6005 %U http://www.ncbi.nlm.nih.gov/pubmed/28442455 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e125 %T Who Uses Mobile Phone Health Apps and Does Use Matter? A Secondary Data Analytics Approach %A Carroll,Jennifer K %A Moorhead,Anne %A Bond,Raymond %A LeBlanc,William G %A Petrella,Robert J %A Fiscella,Kevin %+ Department of Family Medicine, University of Colorado, Mail Stop F496, 12631 E. 17th Ave, Aurora, CO, 80045, United States, 1 303 724 9232, jennifer.2.carroll@ucdenver.edu %K smartphone %K cell phone %K Internet %K mobile applications %K health promotion %K health behavior %D 2017 %7 19.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone use and the adoption of healthy lifestyle software apps (“health apps”) are rapidly proliferating. There is limited information on the users of health apps in terms of their social demographic and health characteristics, intentions to change, and actual health behaviors. Objective: The objectives of our study were to (1) to describe the sociodemographic characteristics associated with health app use in a recent US nationally representative sample; (2) to assess the attitudinal and behavioral predictors of the use of health apps for health promotion; and (3) to examine the association between the use of health-related apps and meeting the recommended guidelines for fruit and vegetable intake and physical activity. Methods: Data on users of mobile devices and health apps were analyzed from the National Cancer Institute’s 2015 Health Information National Trends Survey (HINTS), which was designed to provide nationally representative estimates for health information in the United States and is publicly available on the Internet. We used multivariable logistic regression models to assess sociodemographic predictors of mobile device and health app use and examine the associations between app use, intentions to change behavior, and actual behavioral change for fruit and vegetable consumption, physical activity, and weight loss. Results: From the 3677 total HINTS respondents, older individuals (45-64 years, odds ratio, OR 0.56, 95% CI 0.47-68; 65+ years, OR 0.19, 95% CI 0.14-0.24), males (OR 0.80, 95% CI 0.66-0.94), and having degree (OR 2.83, 95% CI 2.18-3.70) or less than high school education (OR 0.43, 95% CI 0.24-0.72) were all significantly associated with a reduced likelihood of having adopted health apps. Similarly, both age and education were significant variables for predicting whether a person had adopted a mobile device, especially if that person was a college graduate (OR 3.30). Individuals with apps were significantly more likely to report intentions to improve fruit (63.8% with apps vs 58.5% without apps, P=.01) and vegetable (74.9% vs 64.3%, P<.01) consumption, physical activity (83.0% vs 65.4%, P<.01), and weight loss (83.4% vs 71.8%, P<.01). Individuals with apps were also more likely to meet recommendations for physical activity compared with those without a device or health apps (56.2% with apps vs 47.8% without apps, P<.01). Conclusions: The main users of health apps were individuals who were younger, had more education, reported excellent health, and had a higher income. Although differences persist for gender, age, and educational attainment, many individual sociodemographic factors are becoming less potent in influencing engagement with mobile devices and health app use. App use was associated with intentions to change diet and physical activity and meeting physical activity recommendations. %M 28428170 %R 10.2196/jmir.5604 %U http://www.jmir.org/2017/4/e125/ %U https://doi.org/10.2196/jmir.5604 %U http://www.ncbi.nlm.nih.gov/pubmed/28428170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e101 %T Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey %A Ernsting,Clemens %A Dombrowski,Stephan U %A Oedekoven,Monika %A O´Sullivan,Julie L %A Kanzler,Melanie %A Kuhlmey,Adelheid %A Gellert,Paul %+ Institute of Medical Sociology, Charité - Universitätsmedizin Berlin, Chariteplatz 1, Berlin,, Germany, 49 30450529215, clemens.ernsting@charite.de %K telemedicine %K eHealth %K mHealth %K smartphone %K mobile apps %K health promotion %K chronic disease %K health literacy %K quality of life %D 2017 %7 05.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions. Objective: The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors. Methods: A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied. Results: It was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctor’s advice. Conclusions: Although there were many smartphone and health app users, a substantial proportion of the population was not engaged. Findings suggest age-related, socioeconomic-related, literacy-related, and health-related disparities in the use of mobile technologies. Health app use may reflect a user’s motivation to change or maintain health behaviors. App developers and researchers should take account of the needs of older people, people with low health literacy, and chronic conditions. %M 28381394 %R 10.2196/jmir.6838 %U http://www.jmir.org/2017/4/e101/ %U https://doi.org/10.2196/jmir.6838 %U http://www.ncbi.nlm.nih.gov/pubmed/28381394 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 1 %P e3 %T Using eHealth Technologies: Interests, Preferences, and Concerns of Older Adults %A Ware,Patrick %A Bartlett,Susan J %A Paré,Guy %A Symeonidis,Iphigenia %A Tannenbaum,Cara %A Bartlett,Gillian %A Poissant,Lise %A Ahmed,Sara %+ School of Physical and Occupational Therapy, McGill University, 3654 prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 398 4400 ext 00531, sara.ahmed@mcgill.ca %K Internet %K telemedicine %K self care %K chronic disease %D 2017 %7 23.03.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: The Internet and eHealth technologies represent new opportunities for managing health. Age, sex, socioeconomic status, and current technology use are some of the known factors that influence individuals’ uptake of eHealth; however, relatively little is known about facilitators and barriers to eHealth uptake specific to older adults, particularly as they relate to their experiences in accessing health care. Objective: The aim of our study was to explore the interests, preferences, and concerns of older adults in using the Internet and eHealth technologies for managing their health in relation to their experiences with the current health care system. Methods: Two focus groups (n=15) were conducted with adults aged 50+ years. Pragmatic thematic analysis using an inductive approach was conducted to identify the interests, preferences, and concerns of using the Internet and eHealth technologies. Results: Five themes emerged that include (1) Difficulty in identifying credible and relevant sources of information on the Web; (2) Ownership, access, and responsibility for medical information; (3) Peer communication and support; (4) Opportunities to enhance health care interactions; and (5) Privacy concerns. These findings support the potential value older adults perceive in eHealth technologies, particularly in their ability to provide access to personal health information and facilitate communication between providers and peers living with similar conditions. However, in order to foster acceptance, these technologies will need to provide personal and general health information that is secure, readily accessible, and easily understood. Conclusions: Older adults have diverse needs and preferences that, in part, are driven by their experiences and frustrations with the health care system. Results can help inform the design and implementation of technologies to address gaps in care and access to health information for older adults with chronic conditions who may benefit the most from this approach. %M 28336506 %R 10.2196/ijmr.4447 %U http://www.i-jmr.org/2017/1/e3/ %U https://doi.org/10.2196/ijmr.4447 %U http://www.ncbi.nlm.nih.gov/pubmed/28336506 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e24 %T Accuracy and Adoption of Wearable Technology Used by Active Citizens: A Marathon Event Field Study %A Pobiruchin,Monika %A Suleder,Julian %A Zowalla,Richard %A Wiesner,Martin %+ GECKO Institute for Medicine, Informatics & Economics, Heilbronn University, Max-Planck-Str 39, Heilbronn, 74081, Germany, 49 7131 504 633, monika.pobiruchin@hs-heilbronn.de %K athlete %K wearables %K mobile phones %K physical activity %K activity monitoring %D 2017 %7 28.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Today, runners use wearable technology such as global positioning system (GPS)–enabled sport watches to track and optimize their training activities, for example, when participating in a road race event. For this purpose, an increasing amount of low-priced, consumer-oriented wearable devices are available. However, the variety of such devices is overwhelming. It is unclear which devices are used by active, healthy citizens and whether they can provide accurate tracking results in a diverse study population. No published literature has yet assessed the dissemination of wearable technology in such a cohort and related influencing factors. Objective: The aim of this study was 2-fold: (1) to determine the adoption of wearable technology by runners, especially “smart” devices and (2) to investigate on the accuracy of tracked distances as recorded by such devices. Methods: A pre-race survey was applied to assess which wearable technology was predominantly used by runners of different age, sex, and fitness level. A post-race survey was conducted to determine the accuracy of the devices that tracked the running course. Logistic regression analysis was used to investigate whether age, sex, fitness level, or track distance were influencing factors. Recorded distances of different device categories were tested with a 2-sample t test against each other. Results: A total of 898 pre-race and 262 post-race surveys were completed. Most of the participants (approximately 75%) used wearable technology for training optimization and distance recording. Females (P=.02) and runners in higher age groups (50-59 years: P=.03; 60-69 years: P<.001; 70-79 year: P=.004) were less likely to use wearables. The mean of the track distances recorded by mobile phones with combined app (mean absolute error, MAE=0.35 km) and GPS-enabled sport watches (MAE=0.12 km) was significantly different (P=.002) for the half-marathon event. Conclusions: A great variety of vendors (n=36) and devices (n=156) were identified. Under real-world conditions, GPS-enabled devices, especially sport watches and mobile phones, were found to be accurate in terms of recorded course distances. %M 28246070 %R 10.2196/mhealth.6395 %U http://mhealth.jmir.org/2017/2/e24/ %U https://doi.org/10.2196/mhealth.6395 %U http://www.ncbi.nlm.nih.gov/pubmed/28246070 %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 e19 %T Support for Sustainable Use of Personal Health Records: Understanding the Needs of Users as a First Step Towards Patient-Driven Mobile Health %A Jung,Se Young %A Lee,Keehyuck %A Hwang,Hee %A Yoo,Sooyoung %A Baek,Hyun Young %A Kim,Jeehyoung %+ Department of Pediatrics, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam, 13620, Republic Of Korea, 82 317877284, neuroandy@snubh.org %K electronic health record %K medical informatics %K personal health record %K hospital information systems %D 2017 %7 23.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The tethering of a personal health record (PHR) to an electronic medical record (EMR) may serve as a catalyst in accelerating the distribution of integrated PHRs. Creating shared health records for patients and their health care professionals using self-administered functions of EMR-tethered PHRs is crucial to support sustainable use of the system. Objective: This study assesses the factors related to active use of a self-administered function (Health Notes) in an EMR-tethered PHR (Health4U) in a tertiary academic hospital. Methods: This research is a cross-sectional study conducted in a tertiary academic hospital in South Korea. The enrollees included adults aged 19 years and older with experience accessing Health4U in the 13-month period after June 2013. The primary outcome was the adoption of Health Notes in accordance with the number of chronic diseases. Socio-demographic variables were included as confounding factors. Results: Subjects 71 years of age and older were less likely to become active users of Health Notes than those 30 years and younger. Moreover, compared with men, women had 44% and 40% lower tendencies to become Health Notes users and active users, respectively. Those who accessed the desktop page and/or mobile page had higher tendencies to become users of Health Notes. We found a consistent increase in the odds ratio as the number of chronic diseases increased in the active users. When considering specific diseases, patients who had cancer or chronic kidney disease had higher tendencies to become users of Health Notes. Conclusions: Patients with a greater number of chronic diseases tended to use PHR more actively, and used the self-administered function. Women and the elderly may have lower tendencies to actively use PHR. Therefore, items specific to the health of each demographic—women, the elderly, and those with chronic diseases—should be carefully considered to support sustainable use of PHRs. %M 28232300 %R 10.2196/mhealth.6021 %U http://mhealth.jmir.org/2017/2/e19/ %U https://doi.org/10.2196/mhealth.6021 %U http://www.ncbi.nlm.nih.gov/pubmed/28232300 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 1 %P e5 %T Assessing Mobile Phone Access and Perceptions for Texting-Based mHealth Interventions Among Expectant Mothers and Child Caregivers in Remote Regions of Northern Kenya: A Survey-Based Descriptive Study %A Kazi,Abdul Momin %A Carmichael,Jason-Louis %A Hapanna,Galgallo Waqo %A Wangoo,Patrick Gikaria %A Karanja,Sarah %A Wanyama,Denis %A Muhula,Samuel Opondo %A Kyomuhangi,Lennie Bazira %A Loolpapit,Mores %A Wangalwa,Gilbert Bwire %A Kinagwi,Koki %A Lester,Richard Todd %+ Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver General Hospital site, Department of Medicine, 10th Floor, Gordon and Leslie Diamond Health Care Centre, room #10127 – 2775, Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 4111 ext 63140, mominkazi@gmail.com %K mobile health %K text messaging %K prenatal care %K immunization %K Kenya %D 2017 %7 30.01.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With a dramatic increase in mobile phone use in low- and middle-income countries, mobile health (mHealth) has great potential to connect health care services directly to participants enrolled and improve engagement of care. Rural and remote global settings may pose both significant challenges and opportunities. Objective: The objective of our study was to understand the demographics, phone usage and ownership characteristics, and feasibility among patients in rural and remote areas of Kenya of having text messaging (short messaging service, SMS)-based mHealth intervention for improvements in antenatal care attendance and routine immunization among children in Northern Kenya. Methods: A survey-based descriptive study was conducted between October 2014 and February 2015 at 8 health facilities in Northern Kenya as part of a program to scale up an mHealth service in rural and remote regions. The study was conducted at 6 government health facilities in Isiolo, Marsabit, and Samburu counties in remote and northern arid lands (NAL). Two less remote health facilities in Laikipia and Meru counties in more populated central highlands were included as comparison sites. Results: A total of 284 participants were surveyed; 63.4% (180/284) were from NAL clinics, whereas 36.6% (104/284) were from adjacent central highland clinics. In the NAL, almost half (48.8%, 88/180) reported no formal education and 24.4% (44/180) self-identified as nomads. The majority of participants from both regions had access to mobile phone: 99.0% (103/104) of participants from central highlands and 82.1% (147/180) of participants from NAL. Among those who had access to a phone, there were significant differences in network challenges and technology literacy between the 2 regions. However, there was no significant difference in the proportion of participants from NAL and central highlands who indicated that they would like to receive a weekly SMS text message from their health care provider (90.0% vs 95.0%; P=.52). Overall, 92.0% (230/250) of participants who had access to a telephone said that they would like to receive a weekly SMS text message from their health care provider. Most phone users already spent the equivalent of 626 SMS text messages on mobile credit for personal use. Conclusions: Despite the remoteness of northern Kenya’s NAL, the results indicate that the majority of pregnant women or care givers attending the maternal, newborn, and child health clinics have access to mobile phone and would like to receive text messages from their health care provider. mHealth programs, if designed appropriately for these settings, may be an innovative way for engaging women in care for improved maternal and newborn child health outcomes in order to achieve sustainable development goals. %M 28137702 %R 10.2196/publichealth.5386 %U http://publichealth.jmir.org/2017/1/e5/ %U https://doi.org/10.2196/publichealth.5386 %U http://www.ncbi.nlm.nih.gov/pubmed/28137702 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e134 %T The Mobile Phone Affinity Scale: Enhancement and Refinement %A Bock,Beth C %A Lantini,Ryan %A Thind,Herpreet %A Walaska,Kristen %A Rosen,Rochelle K %A Fava,Joseph L %A Barnett,Nancy P %A Scott-Sheldon,Lori AJ %+ Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, United States, 1 401 793 8020, Bbock@lifespan.org %K mobile phone %K psychometrics %K assessment %K measure %D 2016 %7 15.12.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Existing instruments that assess individuals’ relationships with mobile phones tend to focus on negative constructs such as addiction or dependence, and appear to assume that high mobile phone use reflects pathology. Mobile phones can be beneficial for health behavior change, disease management, work productivity, and social connections, so there is a need for an instrument that provides a more balanced assessment of the various aspects of individuals’ relationships with mobile phones. Objective: The purpose of this research was to develop, revise, and validate the Mobile Phone Affinity Scale, a multi-scale instrument designed to assess key factors associated with mobile phone use. Methods: Participants (N=1058, mean age 33) were recruited from Amazon Mechanical Turk between March and April of 2016 to complete a survey that assessed participants’ mobile phone attitudes and use, anxious and depressive symptoms, and resilience. Results: Confirmatory factor analysis supported a 6-factor model. The final measure consisted of 24 items, with 4 items on each of 6 factors: Connectedness, Productivity, Empowerment, Anxious Attachment, Addiction, and Continuous Use. The subscales demonstrated strong internal consistency (Cronbach alpha range=0.76-0.88, mean 0.83), and high item factor loadings (range=0.57-0.87, mean 0.75). Tests for validity further demonstrated support for the individual subscales. Conclusions: Mobile phone affinity may have an important impact in the development and effectiveness of mobile health interventions, and continued research is needed to assess its predictive ability in health behavior change interventions delivered via mobile phones. %M 27979792 %R 10.2196/mhealth.6705 %U http://mhealth.jmir.org/2016/4/e134/ %U https://doi.org/10.2196/mhealth.6705 %U http://www.ncbi.nlm.nih.gov/pubmed/27979792 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e292 %T Self-Monitoring Utilization Patterns Among Individuals in an Incentivized Program for Healthy Behaviors %A Kim,Ju Young %A Wineinger,Nathan E %A Taitel,Michael %A Radin,Jennifer M %A Akinbosoye,Osayi %A Jiang,Jenny %A Nikzad,Nima %A Orr,Gregory %A Topol,Eric %A Steinhubl,Steve %+ Department of Digital Health, Scripps Translational Science Institute, 3344 North Torrey Pines Court, Suite 300, La Jolla, CA, 92037, United States, 1 858 554 5757, steinhub@scripps.edu %K health behavior %K mobile health %K mobile apps %K reward %K self blood pressure monitoring %K blood glucose self-monitoring %D 2016 %7 17.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The advent of digital technology has enabled individuals to track meaningful biometric data about themselves. This novel capability has spurred nontraditional health care organizations to develop systems that aid users in managing their health. One of the most prolific systems is Walgreens Balance Rewards for healthy choices (BRhc) program, an incentivized, Web-based self-monitoring program. Objective: This study was performed to evaluate health data self-tracking characteristics of individuals enrolled in the Walgreens’ BRhc program, including the impact of manual versus automatic data entries through a supported device or apps. Methods: We obtained activity tracking data from a total of 455,341 BRhc users during 2014. Upon identifying users with sufficient follow-up data, we explored temporal trends in user participation. Results: Thirty-four percent of users quit participating after a single entry of an activity. Among users who tracked at least two activities on different dates, the median length of participating was 8 weeks, with an average of 5.8 activities entered per week. Furthermore, users who participated for at least twenty weeks (28.3% of users; 33,078/116,621) consistently entered 8 to 9 activities per week. The majority of users (77%; 243,774/315,744) recorded activities through manual data entry alone. However, individuals who entered activities automatically through supported devices or apps participated roughly four times longer than their manual activity-entering counterparts (average 20 and 5 weeks, respectively; P<.001). Conclusions: This study provides insights into the utilization patterns of individuals participating in an incentivized, Web-based self-monitoring program. Our results suggest automated health tracking could significantly improve long-term health engagement. %M 27856407 %R 10.2196/jmir.6371 %U http://www.jmir.org/2016/11/e292/ %U https://doi.org/10.2196/jmir.6371 %U http://www.ncbi.nlm.nih.gov/pubmed/27856407 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e35 %T Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study %A Rai,Minnie %A Vigod,Simone N %A Hensel,Jennifer M %+ Department of Psychiatry, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S1B2, Canada, 1 416 323 6400, jennifer.hensel@wchospital.ca %K e-communication %K mental health %K technology %K barriers %K social media %D 2016 %7 01.08.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom. Objective: To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns. Methods: We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication. Results: Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91% (62/68), and 59% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns including privacy and loss of in-person contact. Conclusions: A high burden of barriers to attending office-based care paired with a high interest in e-communication supports the integration of e-communication within our outpatient services. There may be early adopters to target: those with identified barriers to office-based care and who are active on social media. There is also a need for caution and preservation of existing services for those who choose not to, or cannot, access e-services. %M 27480108 %R 10.2196/mental.6068 %U http://mental.jmir.org/2016/3/e35/ %U https://doi.org/10.2196/mental.6068 %U http://www.ncbi.nlm.nih.gov/pubmed/27480108 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e90 %T Usage and Dose Response of a Mobile Acceptance and Commitment Therapy App: Secondary Analysis of the Intervention Arm of a Randomized Controlled Trial %A Mattila,Elina %A Lappalainen,Raimo %A Välkkynen,Pasi %A Sairanen,Essi %A Lappalainen,Päivi %A Karhunen,Leila %A Peuhkuri,Katri %A Korpela,Riitta %A Kolehmainen,Marjukka %A Ermes,Miikka %+ VTT Technical Research Centre of Finland Ltd, Tekniikankatu 1, Tampere, 33720, Finland, 358 207223384, elina.m.mattila@vtt.fi %K mobile apps %K Acceptance and Commitment Therapy %K retrospective study %K adherence %D 2016 %7 28.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps offer a promising medium to deliver psychological interventions. A mobile app based on Acceptance and Commitment Therapy (ACT) was developed and studied in a randomized controlled trial (RCT). Objective: To study usage metrics of a mobile ACT intervention and dose-response relationship between usage and improvement in psychological flexibility. Methods: An RCT was conducted to investigate the effectiveness of different lifestyle interventions for overweight people with psychological stress. This paper presents a secondary analysis of the group that received an 8-week mobile ACT intervention. Most of the analyzed 74 participants were female (n=64, 86%). Their median age was 49.6 (interquartile range, IQR 45.4-55.3) years and their mean level of psychological flexibility, measured with the Acceptance and Action Questionnaire II, was 20.4 (95% confidence interval 18.3-22.5). Several usage metrics describing the intensity of use, usage of content, and ways of use were calculated. Linear regression analyses were performed to study the dose-response relationship between usage and the change in psychological flexibility and to identify the usage metrics with strongest association with improvement. Binary logistic regression analyses were further used to assess the role of usage metrics between those who showed improvement in psychological flexibility and those who did not. In addition, associations between usage and baseline participant characteristics were studied. Results: The median number of usage sessions was 21 (IQR 11.8-35), the number of usage days was 15 (IQR 9.0-24), and the number of usage weeks was 7.0 (IQR 4.0-8.0). The participants used the mobile app for a median duration of 4.7 (IQR 3.2-7.2) hours and performed a median of 63 (IQR 46-98) exercises. There was a dose-response relationship between usage and the change in psychological flexibility. The strongest associations with psychological flexibility (results adjusted with gender, age, and baseline psychological variables) were found for lower usage of Self as context related exercises (B=0.22, P=.001) and higher intensity of use, described by the number of usage sessions (B=−0.10, P=.01), usage days (B=−0.17, P=.008), and usage weeks (B=−0.73, P=.02), the number of exercises performed (B=−0.02, P=.03), and the total duration of use (B=−0.30, P=.04). Also, higher usage of Acceptance related exercises (B=−0.18, P=.04) was associated with improvement. Active usage was associated with female gender, older age, and not owning a smart mobile phone before the study. Conclusions: The results indicated that active usage of a mobile ACT intervention was associated with improved psychological flexibility. Usage metrics describing intensity of use as well as two metrics related to the usage of content were found to be most strongly associated with improvement. Trial Registration: ClinicalTrials.gov NCT01738256; https://clinicaltrials.gov/ct2/show/NCT01738256 (Archived by WebCite at http://www.webcitation.org/6iTePjPLL) %M 27468653 %R 10.2196/mhealth.5241 %U http://mhealth.jmir.org/2016/3/e90/ %U https://doi.org/10.2196/mhealth.5241 %U http://www.ncbi.nlm.nih.gov/pubmed/27468653 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e89 %T Variations in the Use of mHealth Tools: The VA Mobile Health Study %A Frisbee,Kathleen L %+ Connected Health, Office of Informatics and Analytics, Veterans Health Administration, Department of Veteran Affairs, 810 Vermont Ave (102PD), Washington, DC, 20420, United States, 1 202 461 5840, Kathleen.Frisbee@va.gov %K caregivers %K telemedicine %K stress (psychological) %K veterans health %D 2016 %7 19.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) technologies exhibit promise for offering patients and their caregivers point-of-need tools for health self-management. This research study involved the dissemination of iPads containing a suite of mHealth apps to family caregivers of veterans who receive care from the Veterans Affairs (VA) Health Administration and have serious physical or mental injuries. Objective: The goal of the study was to identify factors and characteristics of veterans and their family caregivers that predict the use of mHealth apps. Methods: Veteran/family caregiver dyads (N=882) enrolled in VA’s Comprehensive Assistance for Family Caregivers program were recruited to participate in an mHealth pilot program. Veterans and caregivers who participated and received an iPad agreed to have their use of the apps monitored and were asked to complete a survey assessing Caregiver Preparedness, Caregiver Traits, and Caregiver Zarit Burden Inventory baseline surveys. Results: Of the 882 dyads, 94.9% (837/882) of caregivers were women and 95.7% (844/882) of veteran recipients were men. Mean caregiver age was 40 (SD 10.2) years and mean veteran age was 39 (SD 9.15) years, and 39.8% (351/882) lived in rural locations. Most (89%, 788/882) of the caregivers were spouses. Overall, the most frequently used app was Summary of Care, followed by RX Refill, then Journal, Care4Caregivers, VA Pain Coach, and last, VA PTSD Coach. App use was significantly predicted by the caregiver being a spouse, increased caregiver computer skills, a rural living location, lower levels of caregiver preparedness, veteran mental health diagnosis (other than posttraumatic stress disorder), and veteran age. Conclusions: This mHealth Family Caregiver pilot project effectively establishes the VA’s first patient-facing mHealth apps that are integrated within the VA data system. Use varied considerably, and apps that were most used were those that assisted them in their caregiving responsibilities. %M 27436165 %R 10.2196/mhealth.3726 %U http://mhealth.jmir.org/2016/3/e89/ %U https://doi.org/10.2196/mhealth.3726 %U http://www.ncbi.nlm.nih.gov/pubmed/27436165 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e54 %T Mobile Phone Use and its Association With Sitting Time and Meeting Physical Activity Recommendations in a Mexican American Cohort %A Chrisman,Matthew %A Chow,Wong-Ho %A Daniel,Carrie R %A Wu,Xifeng %A Zhao,Hua %+ The University of Texas MD Anderson Cancer Center, Department of Epidemiology, 1155 Pressler St., Unit 1340, Houston, TX, 77030, United States, 1 713 792 0496, mchrisman@mdanderson.org %K mobile phone %K physical activity %K Mexican Americans %K sedentary lifestyle %D 2016 %7 16.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The benefits of physical activity (PA) are well-documented. Mobile phones influence PA by promoting screen-based sedentary time, providing prompts or reminders to be active, aiding in tracking and monitoring PA, or providing entertainment during PA. It is not known how mobile phone use is associated with PA and sitting time in Mexican Americans, and how mobile phone users may differ from nonusers. Objective: To determine the associations between mobile phone use, PA, and sitting time and how these behaviors differ from mobile phone nonusers in a sample of 2982 Mexican-American adults from the Mano a Mano cohort. Methods: Differences in meeting PA recommendations and sitting time between mobile phone users and nonusers were examined using chi-square and analysis of variance tests. Logistic regression was used to examine associations between mobile phone use, PA, and sitting. Results: Mobile phone users were more likely to be obese by body mass index criteria (≥30 kg/m2), younger, born in the United States and lived there longer, more educated, and sit more hours per day but more likely to meet PA recommendations than nonusers. Males (odds ratio [OR] 1.42, 95% CI 1.16-1.74), use of text messaging (OR 1.26, 95% CI 1.03-1.56), and having a higher acculturation score (OR 1.27, 95% CI 1.07-1.52) were associated with higher odds of meeting PA recommendations. Sitting more hours per day was associated with being male, obese, born in the United States, a former alcohol drinker, and having at least a high school education. Among nonusers, being born in the United States was associated with higher odds of more sitting time, and being married was associated with higher odds of meeting PA recommendations. Conclusions: Mobile phone interventions using text messages could be tailored to promote PA in less acculturated and female Mexican American mobile phone users. %M 27311831 %R 10.2196/mhealth.4926 %U http://mhealth.jmir.org/2016/2/e54/ %U https://doi.org/10.2196/mhealth.4926 %U http://www.ncbi.nlm.nih.gov/pubmed/27311831 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e154 %T Mining Health App Data to Find More and Less Successful Weight Loss Subgroups %A Serrano,Katrina J %A Yu,Mandi %A Coa,Kisha I %A Collins,Linda M %A Atienza,Audie A %+ National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, United States, 1 2402766654, katrina.serrano@nih.gov %K weight loss %K mobile health %K mobile app %K data mining %K classification %D 2016 %7 14.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: More than half of all smartphone app downloads involve weight, diet, and exercise. If successful, these lifestyle apps may have far-reaching effects for disease prevention and health cost-savings, but few researchers have analyzed data from these apps. Objective: The purposes of this study were to analyze data from a commercial health app (Lose It!) in order to identify successful weight loss subgroups via exploratory analyses and to verify the stability of the results. Methods: Cross-sectional, de-identified data from Lose It! were analyzed. This dataset (n=12,427,196) was randomly split into 24 subsamples, and this study used 3 subsamples (combined n=972,687). Classification and regression tree methods were used to explore groupings of weight loss with one subsample, with descriptive analyses to examine other group characteristics. Data mining validation methods were conducted with 2 additional subsamples. Results: In subsample 1, 14.96% of users lost 5% or more of their starting body weight. Classification and regression tree analysis identified 3 distinct subgroups: “the occasional users” had the lowest proportion (4.87%) of individuals who successfully lost weight; “the basic users” had 37.61% weight loss success; and “the power users” achieved the highest percentage of weight loss success at 72.70%. Behavioral factors delineated the subgroups, though app-related behavioral characteristics further distinguished them. Results were replicated in further analyses with separate subsamples. Conclusions: This study demonstrates that distinct subgroups can be identified in “messy” commercial app data and the identified subgroups can be replicated in independent samples. Behavioral factors and use of custom app features characterized the subgroups. Targeting and tailoring information to particular subgroups could enhance weight loss success. Future studies should replicate data mining analyses to increase methodology rigor. %M 27301853 %R 10.2196/jmir.5473 %U http://www.jmir.org/2016/6/e154/ %U https://doi.org/10.2196/jmir.5473 %U http://www.ncbi.nlm.nih.gov/pubmed/27301853 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e66 %T Experiences With a Self-Reported Mobile Phone-Based System Among Patients With Colorectal Cancer: A Qualitative Study %A Drott,Jenny %A Vilhelmsson,Maria %A Kjellgren,Karin %A Berterö,Carina %+ Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, IMH, Linköping, 581 83, Sweden, 46 013 286820, Jenny.Drott@liu.se %K cancer %K conventional content analysis %K informatics technology systems %K mHealth %K self-reported mobile phone-based system %K symptom monitoring %D 2016 %7 09.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In cancer care, mobile phone-based systems are becoming more widely used in the assessment, monitoring, and management of side effects. Objective: To explore the experiences of patients with colorectal cancer on using a mobile phone-based system for reporting neurotoxic side effects. Methods: Eleven patients were interviewed (ages 44-68 years). A semistructured interview guide was used to perform telephone interviews. The interviews were transcribed verbatim and analyzed with qualitative content analysis. Results: The patients' experiences of using a mobile phone-based system were identified and constructed as: “being involved,” “pacing oneself,” and “managing the questions.” “Being involved” refers to their individual feelings. Patients were participating in their own care by being observant of the side effects they were experiencing. They were aware that the answers they gave were monitored in real time and taken into account by health care professionals when planning further treatment. “Pacing oneself” describes how the patients can have an impact on the time and place they choose to answer the questions. Answering the questionnaire was easy, and despite the substantial number of questions, it was quickly completed. “Managing the questions” pointed out that the patients needed to be observant because of the construction of the questions. They could not routinely answer all the questions. Patients understood that side effects can vary during the cycles of treatment and need to be assessed repeatedly during treatment. Conclusions: This mobile phone-based system reinforced the patients’ feeling of involvement in their own care. The patients were comfortable with the technology and appreciated that the system was not time consuming. %M 27282257 %R 10.2196/mhealth.5426 %U http://mhealth.jmir.org/2016/2/e66/ %U https://doi.org/10.2196/mhealth.5426 %U http://www.ncbi.nlm.nih.gov/pubmed/27282257 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e64 %T The Use of Mobile Phone and Medical Apps among General Practitioners in Hangzhou City, Eastern China %A Liu,Ying %A Ren,Wen %A Qiu,Yan %A Liu,Juanjuan %A Yin,Pei %A Ren,Jingjing %+ General Practice Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, China, 86 138 1948 5898, lisarjj@126.com %K mobile phone %K app use %K general practitioner %K mobile technology %D 2016 %7 24.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile phones and mobile phone apps have expanded new forms of health professionals’ work. There are many studies on the use of mobile phone apps for different specialists. However, there are no studies on the current use of mobile phone apps among general practitioners (GPs). Objective: The objective of the study was to investigate the extent to which GPs own smartphones with apps and use them to aid their clinical activities. Methods: A questionnaire survey of GPs was undertaken in Hangzhou, Eastern China. Data probing GPs’ current use of medical apps in their clinical activities and factors influencing app use were collected and analyzed Results: 125 GPs participated in the survey. 90.4% of GPs owned a mobile phone, with 48.7% owning an iPhone and 47.8% owning an Android phone. Most mobile phone owners had 1-3 medical-related apps, with very few owning more than 4. There was no difference in number of apps between iPhone and Android owners (χ2=1.388, P=0.846). 36% of GPs reported using medical-related apps on a daily basis. The majority of doctors reported using apps to aid clinical activities less than 30 minutes per day. Conclusions: A high level of mobile phone ownership and usage among GPs was found in this study, but few people chose medical-related apps to support their clinical practice. %M 27220417 %R 10.2196/mhealth.4508 %U http://mhealth.jmir.org/2016/2/e64/ %U https://doi.org/10.2196/mhealth.4508 %U http://www.ncbi.nlm.nih.gov/pubmed/27220417 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 5 %P e114 %T Potential Reach of mHealth Versus Traditional Mass Media for Prevention of Chronic Diseases: Evidence From a Nationally Representative Survey in a Middle-Income Country in Africa %A Yepes,Maryam %A Maurer,Jürgen %A Viswanathan,Barathi %A Gedeon,Jude %A Bovet,Pascal %+ University Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne,, Switzerland, +41 21 314 7272, pascal.bovet@chuv.ch %K digital divide %K mHealth %K eHealth %K mass media %K mobile phone %K noncommunicable diseases %K short message service %K email %K internet access %K developing countries %K low- and middle-income countries %K Africa %D 2016 %7 20.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Public radio and television announcements have a long tradition in public health education. With the global rise of computer and mobile device ownership, short message service (SMS) and email-based health services (mHealth) are promising new tools for health promotion. Objective: Our objectives were to examine 1) self-reported exposure to programs related to noncommunicable diseases (NCDs) on national public television and radio during the 12 months preceding the survey (2013–2014), 2) current ownership of a mobile phone, smartphone, computer, or tablet, and use of the Internet, and 3) willingness of individuals to receive SMS or emails with information on health, with a focus on distribution of these variables across different demographic, socioeconomic status (SES), and NCD risk groups. Methods: We obtained data in a population survey of 1240 participants aged 25–64 years conducted in 2013–2014 in the Seychelles, a rapidly developing small island state in the African region. We administered a structured questionnaire and measured NCD risk factors. Univariate and multivariate analyses explored the relationships between outcomes and sociodemographic variables. Results: Of 1240 participants, 1037 (83.62%) reported exposure to NCD-related programs on public television, while a lower proportion of 740 adults (59.67%), reported exposure via public radio (P <.001). Exposure to NCD-related programs on public television was associated with older age (P <.001) and female sex (P <.001), but not with SES, while exposure to NCD-related programs on public radio was associated with older age (P <.001) and lower SES (P <.001). A total of 1156 (93.22%) owned a mobile phone and ownership was positively associated with female sex (P <.001), younger age (P <.001), and higher SES (P <.001). Only 396 adults (31.93%) owned a smartphone and 244 adults (19.67%) used their smartphone to access the Internet. A total of 1048 adults (84.51%) reported willingness to receive health-related SMS, which was positively associated with female sex (P <.001), younger age (P <.001), and higher SES (P <.001). Controlling for SES, exposure to NCD-related programs on public television or radio and willingness to receive health-related SMS were not independently associated with a person’s NCD risk. Conclusions: Broadcasting health programs through traditional mass media (national public radio and television) reached the majority of the population under study, including older adults and those in lower socioeconomic groups. With a high penetration of mobile phones and willingness to receive health-related SMS, mHealth presents an opportunity for health programs, especially when targeted SMS messages are intended for younger adults and those in higher socioeconomic groups. By contrast, due to reduced Internet access, email-based programs had a more limited reach for health promotion programs. These findings emphasize the different reach of interventions using SMS or email versus traditional mass media, according to demographic and socioeconomic categories, for health education programs in a developing country. %M 27207074 %R 10.2196/jmir.5592 %U http://www.jmir.org/2016/5/e114/ %U https://doi.org/10.2196/jmir.5592 %U http://www.ncbi.nlm.nih.gov/pubmed/27207074 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e52 %T Are Text Messages a Feasible and Acceptable Way to Reach Female Entertainment Workers in Cambodia with Health Messages? A Cross-Sectional Phone Survey %A Brody,Carinne %A Dhaliwal,Sukhmani %A Tuot,Sovannary %A Johnson,Michael %A Pal,Khuondyla %A Yi,Siyan %+ Touro University California, Public Health Program, Center for Global Health Research, 1310 Club Drive, Vallejo, CA, 94592, United States, 1 7076388533, carinne.brody@gmail.com %K mHealth %K short message service %K Cambodia %K female sex workers %K HIV %D 2016 %7 20.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Despite great achievements in reducing the prevalence of HIV, eliminating new HIV infections remains a challenge in Cambodia. Entertainment venues such as restaurants, karaoke bars, beer gardens, cafes, pubs, and massage parlors are now considered important venues for HIV prevention efforts and other health outreach interventions. Objective: The purpose of this study was to explore phone use and texting practices of female entertainment workers (FEWs) in order to determine if text messaging is a feasible and acceptable way to link FEWs to health services. Methods: This cross-sectional phone survey was conducted in May 2015 with 97 FEWs aged 18–35 years and currently working at an entertainment venue in Phnom Penh. Results: Of the 96 respondents, 51% reported sending text messages daily; of them, 47% used Khmer script and 45% used Romanized Khmer. Younger FEWs were more likely to report daily texting (P<.001). Most FEWs (98%) in this study reported feeling comfortable receiving private health messages despite the fact that 39% were sharing their phone with others. Younger FEWs were less likely to share their phone with others (P=.02). Of all of the FEWs, 47% reported owning a smartphone, and younger women were more likely to own a smartphone than were older women (P=.08). Conclusions: The findings from this study support the development of mHealth interventions targeting high-risk groups in urban areas of Cambodia. Our data suggest that mHealth interventions using texting may be a feasible way of reaching FEWs in Phnom Penh. %M 27207374 %R 10.2196/mhealth.5297 %U http://mhealth.jmir.org/2016/2/e52/ %U https://doi.org/10.2196/mhealth.5297 %U http://www.ncbi.nlm.nih.gov/pubmed/27207374 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e41 %T Assessing the Use of Mobile Health Technology by Patients: An Observational Study in Primary Care Clinics %A Ramirez,Veronica %A Johnson,Emily %A Gonzalez,Cesar %A Ramirez,Vanessa %A Rubino,Barbara %A Rossetti,Gina %+ Department of Internal Medicine, Los Angeles County + University of Southern California Medical Center, 2020 Zonal Avenue, IRD 620, Los Angeles, CA, 90033, United States, 1 323 226 7556, ramirezv@usc.edu %K Mobile health applications %K mobile health technology %K telemedicine %D 2016 %7 19.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: There is significant potential for mobile health technology to improve health outcomes for patients with chronic diseases. However, there is a need for further development of mobile health technology that would help to improve the health of lower-income communities. Objective: The study objective was to assess mobile phone and app usage among a culturally diverse patient population, and to determine whether patients would be interested in using mobile health technology to help manage their chronic diseases. Methods: An observational study was conducted with patients of the Internal Medicine resident primary care clinics of Los Angeles County and University of Southern California (LAC+USC) Medical Center. Self-reported information regarding demographics, current mobile phone usage, current mobile health app and social media usage, barriers to using mobile phones or mobile health apps, and interest in using a mobile health app was collected. Results: Ninety-one percent of patients owned a mobile phone, with 76% (169/223) of these reporting having a mobile phone with Internet capability. Fifty-seven percent of subjects used mobile apps on their mobile phones, and 32% (41/130) of these used mobile apps related to their health. Eighty-six percent (207/241) of respondents voiced interest in using a mobile app to improve their health, and 40% (88/221) stated they would use such an app daily. Patients stated they would find the mobile health app most useful for nutrition, exercise, and obtaining general information on medical conditions. Conclusions: Despite the fact that the majority of our primary care patients were of lower socioeconomic status, they utilized mobile phones with Internet and mobile app capabilities to a great extent. There was substantial interest among our patients in using mobile health technology to both manage chronic disease and improve overall health. Given that cultural, educational, and socioeconomic disparities strongly correlate with higher rates of chronic diseases such as obesity, diabetes and hypertension, access to culturally relevant mobile health tools may empower patients in these populations to improve health outcomes. %M 27095507 %R 10.2196/mhealth.4928 %U http://mhealth.jmir.org/2016/2/e41/ %U https://doi.org/10.2196/mhealth.4928 %U http://www.ncbi.nlm.nih.gov/pubmed/27095507 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e32 %T Uptake of a Consumer-Focused mHealth Application for the Assessment and Prevention of Heart Disease: The <30 Days Study %A Goyal,Shivani %A Morita,Plinio P %A Picton,Peter %A Seto,Emily %A Zbib,Ahmad %A Cafazzo,Joseph A %+ Centre for Global eHealth Innovation, Techna Institute, University Health Network, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 647 979 3309, shivani.goyal@uhn.ca %K health behavior %K lifestyle %K cardiovascular disease %K prevention %K risk reduction %K mobile apps %K mobile phone %K incentives %D 2016 %7 24.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Lifestyle behavior modification can reduce the risk of cardiovascular disease, one of the leading causes of death worldwide, by up to 80%. We hypothesized that a dynamic risk assessment and behavior change tool delivered as a mobile app, hosted by a reputable nonprofit organization, would promote uptake among community members. We also predicted that the uptake would be influenced by incentives offered for downloading the mobile app. Objective: The primary objective of our study was to evaluate the engagement levels of participants using the novel risk management app. The secondary aim was to assess the effect of incentives on the overall uptake and usage behaviors. Methods: We publicly launched the app through the iTunes App Store and collected usage data over 5 months. Aggregate information included population-level data on download rates, use, risk factors, and user demographics. We used descriptive statistics to identify usage patterns, t tests, and analysis of variance to compare group means. Correlation and regression analyses determined the relationship between usage and demographic variables. Results: We captured detailed mobile usage data from 69,952 users over a 5-month period, of whom 23,727 (33.92%) were registered during a 1-month AIR MILES promotion. Of those who completed the risk assessment, 73.92% (42,380/57,330) were female, and 59.38% (34,042/57,330) were <30 years old. While the older demographic had significantly lower uptake than the younger demographic, with only 8.97% of users aged ≥51 years old downloading the app, the older demographic completed more challenges than their younger counterparts (F8, 52,422 = 55.10, P<.001). In terms of engagement levels, 84.94% (44,537/52,431) of users completed 1–14 challenges over a 30-day period, and 10.03% (5,259/52,431) of users completed >22 challenges. On average, users in the incentives group completed slightly more challenges during the first 30 days of the intervention (mean 7.9, SD 0.13) than those in the nonincentives group (mean 6.1, SD 0.06, t28870=–12.293, P<.001, d=0.12, 95% CI –2.02 to –1.47). The regression analysis suggested that sex, age group, ethnicity, having 5 of the risk factors (all but alcohol), incentives, and the number of family histories were predictors of the number of challenges completed by a user (F14, 56,538 = 86.644, P<.001, adjusted R2 = .021). Conclusion: While the younger population downloaded the app the most, the older population demonstrated greater sustained engagement. Behavior change apps have the potential to reach a targeted population previously thought to be uninterested in or unable to use mobile apps. The development of such apps should assume that older adults will in fact engage if the behavior change elements are suitably designed, integrated into daily routines, and tailored. Incentives may be the stepping-stone that is needed to guide the general population toward preventative tools and promote sustained behavior change. %M 27012937 %R 10.2196/mhealth.4730 %U http://mhealth.jmir.org/2016/1/e32/ %U https://doi.org/10.2196/mhealth.4730 %U http://www.ncbi.nlm.nih.gov/pubmed/27012937 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e101 %T Health App Use Among US Mobile Phone Owners: A National Survey %A Krebs,Paul %A Duncan,Dustin T %+ New York University School of Medicine, Department of Population Health, 227 East 30th Street, 7th Floor, New York, NY, 10016, United States, 1 646 501 2637, Paul.Krebs@nyumc.org %K cell phones %K mobile apps %K telemedicine %D 2015 %7 04.11.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile phone health apps may now seem to be ubiquitous, yet much remains unknown with regard to their usage. Information is limited with regard to important metrics, including the percentage of the population that uses health apps, reasons for adoption/nonadoption, and reasons for noncontinuance of use. Objective: The purpose of this study was to examine health app use among mobile phone owners in the United States. Methods: We conducted a cross-sectional survey of 1604 mobile phone users throughout the United States. The 36-item survey assessed sociodemographic characteristics, history of and reasons for health app use/nonuse, perceived effectiveness of health apps, reasons for stopping use, and general health status. Results: A little over half (934/1604, 58.23%) of mobile phone users had downloaded a health-related mobile app. Fitness and nutrition were the most common categories of health apps used, with most respondents using them at least daily. Common reasons for not having downloaded apps were lack of interest, cost, and concern about apps collecting their data. Individuals more likely to use health apps tended to be younger, have higher incomes, be more educated, be Latino/Hispanic, and have a body mass index (BMI) in the obese range (all P<.05). Cost was a significant concern among respondents, with a large proportion indicating that they would not pay anything for a health app. Interestingly, among those who had downloaded health apps, trust in their accuracy and data safety was quite high, and most felt that the apps had improved their health. About half of the respondents (427/934, 45.7%) had stopped using some health apps, primarily due to high data entry burden, loss of interest, and hidden costs. Conclusions: These findings suggest that while many individuals use health apps, a substantial proportion of the population does not, and that even among those who use health apps, many stop using them. These data suggest that app developers need to better address consumer concerns, such as cost and high data entry burden, and that clinical trials are necessary to test the efficacy of health apps to broaden their appeal and adoption. %M 26537656 %R 10.2196/mhealth.4924 %U http://mhealth.jmir.org/2015/4/e101/ %U https://doi.org/10.2196/mhealth.4924 %U http://www.ncbi.nlm.nih.gov/pubmed/26537656 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e116 %T Prescription Tablets in the Digital Age: A Cross-Sectional Study Exploring Patient and Physician Attitudes Toward the Use of Tablets for Clinic-Based Personalized Health Care Information Exchange %A Patel,Vishal %A Hale,Timothy M %A Palakodeti,Sandeep %A Kvedar,Joseph C %A Jethwani,Kamal %+ Connected Health Innovation, Partners HealthCare Connected Health, 25 New Chardon Street, Suite 300, Boston, MA, 02114, United States, 1 617 643 9852, tmhale@mgh.harvard.edu %K electronic health records %K tablets %K health education %K self-management %K primary care %K physician patient relationship %K digital health %K iPad %K patient-reported outcome measures %D 2015 %7 19.10.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: To reduce the cost of health care while increasing efficiency and quality, health systems are seeking innovative means to engage and empower patients. Improved use of information technology and electronic health record (EHR) infrastructure is essential, and required for “meaningful use” as mandated by the federal government. Providing personalized health information using tablets at the point of care could enhance the clinical experience and enable efficient collection of patient reported outcome measures to guide clinical decision making. Objective: The aim of this study is to explore patient and provider attitudes and interest in a proposed clinic-based tablet system for personal health information exchange. To provide a context to understand patients’ use of tablets during their clinic visit, we also examine patients’ current activities and time spent in the waiting room, and their use of health information resources. Methods: Surveys were administered to 84 patients in the waiting room of a community health center affiliated with Massachusetts General Hospital (MGH) in Boston, MA. This survey included a vignette and illustration describing a proposed tablet-based system in which the patient, upon sign in at the clinic, receives a tablet loaded with personalized information tailored to their specific medical conditions and preferences. Patients were queried about their interest in such a system in comparison to traditional forms of patient education as well as their current health information seeking behaviors and activities and time spent in the waiting room. Interviews with five MGH-affiliated health care providers were conducted to assess their opinions regarding the proposed tablet system. Results: The majority (>60%) of patients were “very” or “extremely” interested in the proposed tablet system and thought it would improve their knowledge about their medical condition (60%), assist them in making healthy choices (57%), and help them to feel more comfortable talking with their provider (55%). Patients thought the system would be more motivating, informative, and engaging than traditional printed health education materials. The tablet system was not considered more effective than face-to-face interaction with providers, though 44% thought it would improve their relationship with their physician. Overall, 91% of respondents were willing to learn how to use a tablet and 75% reported being “very” or “extremely” confident they could use one. Four of the five providers believed that the proposed tablet system would improve clinical workflow and patient education. Patients and providers were concerned about privacy and security of data collected using the tablets. Conclusions: Both patients and providers were highly amenable to integrating tablets into the clinical experience, and tablets may be useful in improving patients’ health knowledge, the collection of patient reported outcome measures, and improved patient-provider communication. Further research into operationalizing such systems and their validation is necessary before integration into standard clinical practice. %M 26481906 %R 10.2196/resprot.3806 %U http://www.researchprotocols.org/2015/4/e116/ %U https://doi.org/10.2196/resprot.3806 %U http://www.ncbi.nlm.nih.gov/pubmed/26481906 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e89 %T Evaluation of Social Media Utilization by Latino Adolescents: Implications for Mobile Health Interventions %A Landry,Megan %A Vyas,Amita %A Turner,Monique %A Glick,Sara %A Wood,Susan %+ Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, SPH 3rd Floor, 950 New Hampshire Ave, NW, Washington, DC, 20052, United States, 1 202 994 9049, landry.mm@gmail.com %K acculturation %K Latino/a %K sex %K short message service %K social networking %D 2015 %7 29.09.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Trends in social media use, including sending/receiving short message service (SMS) and social networking, are constantly changing, yet little is known about adolescent’s utilization and behaviors. This longitudinal study examines social media utilization among Latino youths, and differences by sex and acculturation. Objectives: The purpose of this study was to examine Latino adolescents’ social media utilization and behavior over a 16-month period, and to assess whether changes in use differed by sex and acculturation. Methods: This study included 555 Latino youths aged 13-19 who completed baseline and 16-month follow-up surveys. Prevalence of social media utilization and frequency, by sex and acculturation categories, was examined using generalized estimating equations. Results: Women are more likely to use SMS, but men are significantly more likely to SMS a girl/boyfriend (P=.03). The use of Internet by men and women to research health information increased over time. Facebook use declined over time (P<.001), whereas use of YouTube (P=.03) and Instagram (P<.001) increased, especially among women and more US acculturated youths. Conclusion: Social media is ubiquitous in Latino adolescents’ lives and may be a powerful mode for public health intervention delivery. %M 26420553 %R 10.2196/mhealth.4374 %U http://mhealth.jmir.org/2015/3/e89/ %U https://doi.org/10.2196/mhealth.4374 %U http://www.ncbi.nlm.nih.gov/pubmed/26420553 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 9 %P e215 %T How Consumers and Physicians View New Medical Technology: Comparative Survey %A Boeldt,Debra L %A Wineinger,Nathan E %A Waalen,Jill %A Gollamudi,Shreya %A Grossberg,Adam %A Steinhubl,Steven R %A McCollister-Slipp,Anna %A Rogers,Marc A %A Silvers,Carey %A Topol,Eric J %+ Scripps Translational Science Institute, Scripps Health, The Scripps Research Institute, 3344 North Torrey Pines Ct, Suite 300, La Jolla, CA, 92037, United States, 1 858 554 5708, etopol@scripps.edu %K digital revolution %K healthcare %K medical technology %K physician and consumer attitudes %K electronic health record %K mobile health %D 2015 %7 14.09.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: As a result of the digital revolution coming to medicine, a number of new tools are becoming available and are starting to be introduced in clinical practice. Objective: We aim to assess health care professional and consumer attitudes toward new medical technology including smartphones, genetic testing, privacy, and patient-accessible electronic health records. Methods: We performed a survey with 1406 health care providers and 1102 consumer responders. Results: Consumers who completed the survey were more likely to prefer new technologies for a medical diagnosis (437/1102, 39.66%) compared with providers (194/1406, 13.80%; P<.001), with more providers (393/1406, 27.95%) than consumers (175/1102, 15.88%) reporting feeling uneasy about using technology for a diagnosis. Both providers and consumers supported genetic testing for various purposes, with providers (1234/1406, 87.77%) being significantly more likely than consumers (806/1102, 73.14%) to support genetic testing when planning to have a baby (P<.001). Similarly, 91.68% (1289/1406) of providers and 81.22% (895/1102) of consumers supported diagnosing problems in a fetus (P<.001). Among providers, 90.33% (1270/1406) were concerned that patients would experience anxiety after accessing health records, and 81.95% (1149/1406) felt it would lead to requests for unnecessary medical evaluations, but only 34.30% (378/1102; P<.001) and 24.59% (271/1102; P<.001) of consumers expressed the same concerns, respectively. Physicians (137/827, 16.6%) reported less concern about the use of technology for diagnosis compared to medical students (21/235, 8.9%; P=.03) and also more frequently felt that patients owned their medical record (323/827, 39.1%; and 30/235, 12.8%, respectively; P<.001). Conclusions: Consumers and health professionals differ significantly and broadly in their views of emerging medical technology, with more enthusiasm and support expressed by consumers. %M 26369254 %R 10.2196/jmir.4456 %U http://www.jmir.org/2015/9/e215/ %U https://doi.org/10.2196/jmir.4456 %U http://www.ncbi.nlm.nih.gov/pubmed/26369254 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e72 %T The Prevalence and Characteristics of Emergency Medicine Patient Use of New Media %A Post,Lori Ann %A Vaca,Federico E %A Biroscak,Brian J %A Dziura,James %A Brandt,Cynthia %A Bernstein,Steven L %A Taylor,Richard %A Jagminas,Liudvikas %A D'Onofrio,Gail %+ Yale School of Medicine, Department of Emergency Medicine, Yale University, 464 Congress Ave, Suite 260, New Haven, CT, 06519, United States, 1 203 980 7107, lori.post@yale.edu %K medical informatics %K new media %K health care services %K personal health management %K mobile phones %D 2015 %7 08.07.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Little is known about “new media” use, defined as media content created or consumed on demand on an electronic device, by patients in emergency department (ED) settings. The application of this technology has the potential to enhance health care beyond the index visit. Objective: The objectives are to determine the prevalence and characteristics of ED patients’ use of new media and to then define and identify the potential of new media to transcend health care barriers and improve the public’s health. Methods: Face-to-face, cross-sectional surveys in Spanish and English were given to 5,994 patients who were sequentially enrolled from July 12 to August 30, 2012. Data were collected from across a Southern Connecticut health care system’s 3 high-volume EDs for 24 hours a day, 7 days a week for 6 weeks. The EDs were part of an urban academic teaching hospital, an urban community hospital, and an academic affiliate hospital. Results: A total of 5,994 (89% response rate) ED patients reported identical ownership of cell phones (85%, P<.001) and smartphones (51%, P<.001) that were used for calling (99%, P<.001). The older the patient, however, the less likely it was that the patient used the phone for texting (96% vs 16%, P<.001). Income was positively associated with smartphone ownership (P<.001) and the use of health apps (P>.05) and personal health records (P<.001). Ownership of iPhones compared to Android phones were similar (44% vs 45%, P<.05). Race and ethnicity played a significant role in texting and smartphone ownership, with Hispanics reporting the highest rates of 79% and 56%, respectively, followed by black non-Hispanics at 77% and 54%, respectively, and white non-Hispanics at 65% and 42%, respectively (P<.05). Conclusions: There is a critical mass of ED patients who use new media. Older persons are less comfortable texting and using smartphone apps. Income status has a positive relationship with smartphone ownership and use of smartphone apps. Regardless of income, however, texting and ownership of smartphones was highest for Latinos and black non-Latinos. These findings have implications for expanding health care beyond the ED visit through the use of cell phones, smartphones, texting, the Internet, and health care apps to improve the health of the public. %M 26156096 %R 10.2196/mhealth.4438 %U http://mhealth.jmir.org/2015/3/e72/ %U https://doi.org/10.2196/mhealth.4438 %U http://www.ncbi.nlm.nih.gov/pubmed/26156096 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e164 %T Prevalence and Frequency of mHealth and eHealth Use Among US and UK Smokers and Differences by Motivation to Quit %A Borrelli,Belinda %A Bartlett,Yvonne Kiera %A Tooley,Erin %A Armitage,Christopher J %A Wearden,Alison %+ Boston University, Henry M Goldman School of Dental Medicine, 560 Harrison Ave, 3rd floor, Boston, MA, 02118, United States, 1 617 414 1116, belindab@bu.edu %K smoking cessation %K eHealth %K mHealth %K health behavior %K motivation %K text messaging %D 2015 %7 4.7.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Both mHealth and eHealth interventions for smoking cessation are rapidly being developed and tested. There are no data on use of mHealth and eHealth technologies by smokers in general or by smokers who are not motivated to quit smoking. Objective: The aims of our study were to (1) assess technology use (eg, texting, social media, Internet) among smokers in the United States and United Kingdom, (2) examine whether technology use differs between smokers who are motivated to quit and smokers who are not motivated to quit, (3) examine previous use of technology to assist with smoking cessation, and (4) examine future intentions to use technology to assist with smoking cessation. Methods: Participants were 1000 adult smokers (54.90%, 549/1000 female; mean age 43.9, SD 15.5 years; US: n=500, UK: n=500) who were recruited via online representative sampling strategies. Data were collected online and included demographics, smoking history, and frequency and patterns of technology use. Results: Among smokers in general, there was a high prevalence of mobile and smartphone ownership, sending and receiving texts, downloading and using apps, using Facebook, and visiting health-related websites. Smokers who were unmotivated to quit were significantly less likely to own a smartphone or handheld device that connects to the Internet than smokers motivated to quit. There was a significantly lower prevalence of sending text messages among US smokers unmotivated to quit (78.2%, 179/229) versus smokers motivated to quit (95.0%, 229/241), but no significant differences between the UK groups (motivated: 96.4%, 239/248; unmotivated: 94.9%, 223/235). Smokers unmotivated to quit in both countries were significantly less likely to use a handheld device to read email, play games, browse the Web, or visit health-related websites versus smokers motivated to quit. US smokers had a high prevalence of app downloads regardless of motivation to quit, but UK smokers who were motivated to quit had greater prevalence of app downloads than smokers unmotivated to quit. US smokers were significantly more likely to have a Facebook account (87.0%, 435/500) than UK smokers (76.4%, 382/500), but smokers unmotivated to quit in both countries used Facebook less frequently than smokers motivated to quit. Smokers who were unmotivated to quit were less likely to have used eHealth or mHealth platforms to help them quit smoking in the past and less likely to say that they would use them for smoking cessation in the future. Conclusions: Although smokers unmotivated to quit make less use of technology than smokers motivated to quit, there is sufficient prevalence to make it worthwhile to develop eHealth and mHealth interventions to encourage cessation. Short and low-effort communications, such as text messaging, might be better for smokers who are less motivated to quit. Multiple channels may be required to reach unmotivated smokers. %M 26149323 %R 10.2196/jmir.4420 %U http://www.jmir.org/2015/7/e164/ %U https://doi.org/10.2196/jmir.4420 %U http://www.ncbi.nlm.nih.gov/pubmed/26149323 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e163 %T Information and Communication Technology Use Among Low-Income Pregnant and Postpartum Women by Race and Ethnicity: A Cross-Sectional Study %A Chilukuri,Nymisha %A West,Meredith %A Henderson,Janice Lynn %A Lawson,Shari %A Ehsanipoor,Robert %A Costigan,Kathleen %A Polk,Sarah %A Bennett,Wendy %+ Division of General Internal Medicine, Johns Hopkins University School of Medicine, Suite 2-616, 2024 E. Monument St, Baltimore, MD, 21205, United States, 1 410 502 6081, wendy.bennett@jhmi.edu %K pregnancy %K health services accessibility %K postpartum period %K cell phones %K text messaging %K Internet %K health status disparities %K Hispanic Americans %D 2015 %7 03.07.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Pregnancy and the postpartum period provide windows of opportunity to impact perinatal and lifelong preventive health behavior for women and their families, but these opportunities are often missed. Understanding racial/ethnic differences in information and communication technology (ICT) use could inform technology-based interventions in diverse populations. Objective: The objective of the study was to evaluate differences in the use of ICT between racial and ethnic groups as well as by English language proficiency. Methods: We conducted a cross-sectional study of 246 women who were aged 18 years or older and pregnant or within 1 year of delivery. They were recruited from 4 hospital-based outpatient clinics and completed a self-administered survey. We used multivariate regression analysis to evaluate the association between race/ethnicity and ICT (mobile phone/short message service [SMS] text message, Internet, and social network) usage by race/ethnicity and perceived English language proficiency after adjusting for age, income, marital status, and insurance status. Results: In all, 28% (69/246) of participants were Latina, 40% (98/246) were African American, 23% (56/246) were white, and 9% (23/246) from other racial/ethnic groups. Of the Latinas, 84% (58/69) reported limited English language proficiency and 59% (41/69) were uninsured. More than 90% of all participants reported mobile phone use, but more than 25% (65/246) had changed phone numbers 2 or more times in the past year. Compared to white women, African American women were less likely to SMS text message (OR 0.07, 95% CI 0.01-0.63) and Latinas were less likely to use the Internet to find others with similar concerns (OR 0.23, 95% CI 0.08-0.73). Women with limited English language proficiency were less likely to use the Internet overall (OR 0.30, 95% CI 0.09-0.99) or use email (OR 0.22, 95% CI 0.08-0.63) compared to women with adequate English language proficiency. Conclusions: Mobile phones are widely available for the delivery of health interventions to low-income, racially diverse pregnant and postpartum women, but disparities in Internet use and SMS text messaging exist. Interventions or programs requiring Web-based apps may have lower uptake unless alternatives are available, such as those adapted for limited English proficiency populations. %M 26142162 %R 10.2196/jmir.3916 %U http://www.jmir.org/2015/7/e163/ %U https://doi.org/10.2196/jmir.3916 %U http://www.ncbi.nlm.nih.gov/pubmed/26142162 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 1 %P e4 %T Geosocial-Networking App Usage Patterns of Gay, Bisexual, and Other Men Who Have Sex With Men: Survey Among Users of Grindr, A Mobile Dating App %A Goedel,William C %A Duncan,Dustin T %+ School of Medicine, Department of Population Health, New York University, 227 East 30th Street, Room 628A, New York, NY, 10016, United States, 1 646 501 2715, wcg219@nyu.edu %K homosexuality %K MSM %K men who have sex with men %K male %K mobile apps %K dating apps %K mobile phones %K HIV %K AIDS prevention %D 2015 %7 08.05.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Geosocial-networking apps like Grindr have been used increasingly among men who have sex with men (MSM) to meet anonymous partners. These mobile dating apps employ global positioning system technology to facilitate connections with other users based on their current location. These new technologies have generated quicker and easier modes for men who have sex with men to meet potential partners based on attraction and physical proximity. Objective: The aim of this study is to describe geosocial-networking app use and recent sexual behaviors of MSM in the Atlanta metropolitan statistical area. Methods: Our sample was recruited from Grindr, the most commonly used of these mobile apps among MSM, using broadcast advertising. Advertisements were displayed over the course of a 72-hour period and participants were directed to a Web-based survey. Results: In total, 604 men clicked through the advertisement, and 92 users completed the survey. One-third (38.0%) of the men reported using these mobile apps to meet new sexual partners, and one-fifth (18.5%) used them to “kill time” when bored. Men reporting currently being in a relationship were less likely to report using these mobile apps to meet other MSM to date or to find a boyfriend or romantic partner, but more likely to report using these mobile apps to meet other MSM to have sex, X224=12.1, P=.016. Respondents had current accounts on 3.11 mobile apps (SD 1.84) on average, with Grindr being the most common (100%), followed by Scruff (52.5%), and Jack’d (45.7%). Most men were most active in the late night (40.2%), and on weekdays (64.1%). Each day, on average, men reported opening these mobile apps 8.38 times (SD 8.10) and spent 1.31 hours (SD 1.15) on these mobile apps. The age respondents began using these mobile apps was associated with the age at their first instance of insertive anal sex (r80=.527, P<.001) and receptive anal sex (r76=.527, P<.001). Conclusions: These findings suggest that MSM use multiple mobile apps and spend significant time on them. For these reasons, HIV prevention interventions could be delivered on these mobile apps. %M 27227127 %R 10.2196/publichealth.4353 %U http://publichealth.jmir.org/2015/1/e4/ %U https://doi.org/10.2196/publichealth.4353 %U http://www.ncbi.nlm.nih.gov/pubmed/27227127 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e25 %T Internet Use and Access Among Pregnant Women via Computer and Mobile Phone: Implications for Delivery of Perinatal Care %A Peragallo Urrutia,Rachel %A Berger,Alexander A %A Ivins,Amber A %A Beckham,A Jenna %A Thorp Jr,John M %A Nicholson,Wanda K %+ Division of Women's Primary Healthcare, Department of Obstetrics and Gynecology, University of North Carolina, CB#7570, 3031 Old Clinic Building, Chapel Hill, NC, , United States, 1 919 843 7851, wanda_nicholson@med.unc.edu %K pregnancy %K postpartum period %K Internet %K mobile phone %K health behavior %K risk reduction behavior %D 2015 %7 30.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The use of Internet-based behavioral programs may be an efficient, flexible method to enhance prenatal care and improve pregnancy outcomes. There are few data about access to, and use of, the Internet via computers and mobile phones among pregnant women. Objective: We describe pregnant women’s access to, and use of, computers, mobile phones, and computer technologies (eg, Internet, blogs, chat rooms) in a southern United States population. We describe the willingness of pregnant women to participate in Internet-supported weight-loss interventions delivered via computers or mobile phones. Methods: We conducted a cross-sectional survey among 100 pregnant women at a tertiary referral center ultrasound clinic in the southeast United States. Data were analyzed using Stata version 10 (StataCorp) and R (R Core Team 2013). Means and frequency procedures were used to describe demographic characteristics, access to computers and mobile phones, and use of specific Internet modalities. Chi-square testing was used to determine whether there were differences in technology access and Internet modality use according to age, race/ethnicity, income, or children in the home. The Fisher’s exact test was used to describe preferences to participate in Internet-based postpartum weight-loss interventions via computer versus mobile phone. Logistic regression was used to determine demographic characteristics associated with these preferences. Results: The study sample was 61.0% white, 26.0% black, 6.0% Hispanic, and 7.0% Asian with a mean age of 31.0 (SD 5.1). Most participants had access to a computer (89/100, 89.0%) or mobile phone (88/100, 88.0%) for at least 8 hours per week. Access remained high (>74%) across age groups, racial/ethnic groups, income levels, and number of children in the home. Internet/Web (94/100, 94.0%), email (90/100, 90.0%), and Facebook (50/100, 50.0%) were the most commonly used Internet technologies. Women aged less than 30 years were more likely to report use of Twitter and chat rooms compared to women 30 years of age or older. Of the participants, 82.0% (82/100) were fairly willing or very willing to participate in postpartum lifestyle intervention. Of the participants, 83.0% (83/100) were fairly willing or very willing to participate in an Internet intervention delivered via computer, while only 49.0% (49/100) were fairly willing or very willing to do so via mobile phone technology. Older women and women with children tended to be less likely to desire a mobile phone-based program. Conclusions: There is broad access and use of computer and mobile phone technology among southern US pregnant women with varied demographic characteristics. Pregnant women are willing to participate in Internet-supported perinatal interventions. Our findings can inform the development of computer- and mobile phone-based approaches for the delivery of clinical and educational interventions. %M 25835744 %R 10.2196/mhealth.3347 %U http://mhealth.jmir.org/2015/1/e25/ %U https://doi.org/10.2196/mhealth.3347 %U http://www.ncbi.nlm.nih.gov/pubmed/25835744 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e7 %T mHealth in the Wild: Using Novel Data to Examine the Reach, Use, and Impact of PTSD Coach %A Owen,Jason E %A Jaworski,Beth K %A Kuhn,Eric %A Makin-Byrd,Kerry N %A Ramsey,Kelly M %A Hoffman,Julia E %+ National Center for PTSD, Dissemination & Training Division, Department of Veterans Affairs Palo Alto Health Care System, Bldg 334, 795 Willow Rd, Menlo Park, CA, 94025, United States, 1 6504935000 ext 23478, jason.owen@va.gov %K PTSD %K trauma %K mHealth %K mental heatlh %K mobile app %K public health %K self-management %D 2015 %7 25.03.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: A majority of Americans (58%) now use smartphones, making it possible for mobile mental health apps to reach large numbers of those who are living with untreated, or under-treated, mental health symptoms. Although early trials suggest positive effects for mobile health (mHealth) interventions, little is known about the potential public health impact of mobile mental health apps. Objective: The purpose of this study was to characterize reach, use, and impact of “PTSD Coach”, a free, broadly disseminated mental health app for managing posttraumatic stress disorder (PTSD) symptoms. Methods: Using a mixed-methods approach, aggregate mobile analytics data from 153,834 downloads of PTSD Coach were analyzed in conjunction with 156 user reviews. Results: Over 60% of users engaged with PTSD Coach on multiple occasions (mean=6.3 sessions). User reviews reflected gratitude for the availability of the app and being able to use the app specifically during moments of need. PTSD Coach users reported relatively high levels of trauma symptoms (mean PTSD Checklist Score=57.2, SD=15.7). For users who chose to use a symptom management tool, distress declined significantly for both first-time users (mean=1.6 points, SD=2.6 on the 10-point distress thermometer) and return-visit users (mean=2.0, SD=2.3). Analysis of app session data identified common points of attrition, with only 80% of first-time users reaching the app’s home screen and 37% accessing one of the app’s primary content areas. Conclusions: These findings suggest that PTSD Coach has achieved substantial and sustained reach in the population, is being used as intended, and has been favorably received. PTSD Coach is a unique platform for the delivery of mobile mental health education and treatment, and continuing evaluation and improvement of the app could further strengthen its public health impact. %M 26543913 %R 10.2196/mental.3935 %U http://mental.jmir.org/2015/1/e7/ %U https://doi.org/10.2196/mental.3935 %U http://www.ncbi.nlm.nih.gov/pubmed/26543913 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e33 %T Short-Term Trajectories of Use of a Caloric-Monitoring Mobile Phone App Among Patients With Type 2 Diabetes Mellitus in a Primary Care Setting %A Goh,Glenn %A Tan,Ngiap Chuan %A Malhotra,Rahul %A Padmanabhan,Uma %A Barbier,Sylvaine %A Allen Jr,John Carson %A Østbye,Truls %+ Duke Global Health Institute, 310 Trent Drive, Durham, NC, , United States, 1 919 660 0331, truls.ostbye@duke.edu %K type 2 diabetes mellitus %K self-management %K mobile phone %K mobile apps %K longitudinal studies %D 2015 %7 03.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-management plays an important role in maintaining good control of diabetes mellitus, and mobile phone interventions have been shown to improve such self-management. The Health Promotion Board of Singapore has created a caloric-monitoring mobile health app, the “interactive Diet and Activity Tracker” (iDAT). Objective: The objective was to identify and describe short-term (8-week) trajectories of use of the iDAT app among patients with type 2 diabetes mellitus in a primary care setting in Singapore, and identify patient characteristics associated with each trajectory. Methods: A total of 84 patients with type 2 diabetes mellitus from a public primary care clinic in Singapore who had not previously used the iDAT app were enrolled. The app was demonstrated and patients’ weekly use of the app was monitored over 8 weeks. Weekly use was defined as any record in terms of food entry or exercise workout entry in that week. Information on demographics, diet and exercise motivation, diabetes self-efficacy (Diabetes Empowerment Scale-Short Form), and clinical variables (body mass index, blood pressure, and glycosylated hemoglobin/HbA1c) were collected at baseline. iDAT app use trajectories were delineated using latent-class growth modeling (LCGM). Association of patient characteristics with the trajectories was ascertained using logistic regression analysis. Results: Three iDAT app use trajectories were observed: Minimal Users (66 out of 84 patients, 78.6%, with either no iDAT use at all or use only in the first 2 weeks), Intermittent-Waning Users (10 out of 84 patients, 11.9%, with occasional weekly use mainly in the first 4 weeks), and Consistent Users (8 out of 84 patients, 9.5%, with weekly use throughout all or most of the 8 weeks). The adjusted odds ratio of being a Consistent User, relative to a Minimal User, was significantly higher for females (OR 19.55, 95% CI 1.78-215.42) and for those with higher exercise motivation scores at baseline (OR 4.89, 95% CI 1.80-13.28). The adjusted odds ratio of being an Intermittent-Waning User relative to a Minimal User was also significantly higher for those with higher exercise motivation scores at baseline (OR 1.82, 95% CI 1.00-3.32). Conclusions: This study provides insight into the nature and extent of usage of a caloric-monitoring app among patients with type 2 diabetes and managed in primary care. The application of LCGM provides a useful framework for evaluating future app use in other patient populations. %M 25648130 %R 10.2196/jmir.3938 %U http://www.jmir.org/2015/2/e33/ %U https://doi.org/10.2196/jmir.3938 %U http://www.ncbi.nlm.nih.gov/pubmed/25648130 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e7 %T Diet App Use by Sports Dietitians: A Survey in Five Countries %A Jospe,Michelle R %A Fairbairn,Kirsty A %A Green,Peter %A Perry,Tracy L %+ Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, 9054, New Zealand, 64 3 479 7948, michelle.jospe@otago.ac.nz %K nutritional requirements %K nutrition assessment %K dietary self-monitoring %K mobile apps %K questionnaire %K telemedicine %K sports nutritional sciences %D 2015 %7 22.01.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Despite the hundreds of diet apps available for use on smartphones (mobile phones), no studies have examined their use as tools for dietary assessment and tracking in sports nutrition. Objective: The aim is to examine the prevalence and perceptions of using smartphone diet apps for dietary assessment and tracking among sports dietitians. Methods: A cross-sectional online survey to examine the use and perception of diet apps was developed and distributed to sports dietitians in Australia, Canada, New Zealand, the United Kingdom, and the United States (US). Results: The overall response rate from the 1709 sports dietitians invited to participate was 10.3% (n=180). diet apps were used by 32.4% (57/176) of sports dietitians to assess and track the dietary intake of athletes. Sports dietitians from the US were more likely to use smartphone diet apps than sports dietitians from other countries (OR=5.61, 95% CI 1.84-17.08, P=.002). Sports dietitians used 28 different diet apps, with 56% (32/57) choosing MyFitnessPal. Overall, sports dietitians held a positive perception of smartphone diet apps, with the majority of respondents viewing diet apps as “better” (25/53, 47%) or “equivalent” (22/53, 41%) when compared with traditional dietary assessment methods. Conclusions: Nearly one-third of sports dietitians used mobile phone diet apps in sports nutrition practice, and viewed them as useful in helping to assess and track the dietary intake of athletes. %M 25616274 %R 10.2196/mhealth.3345 %U http://mhealth.jmir.org/2015/1/e7/ %U https://doi.org/10.2196/mhealth.3345 %U http://www.ncbi.nlm.nih.gov/pubmed/25616274 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e3 %T Non-Work-Related Use of Personal Mobile Phones by Hospital Registered Nurses %A McBride,Deborah L %A LeVasseur,Sandra A %A Li,Dongmei %+ Samuel Merritt University, 3100 Telegraph Ave, Oakland, CA, , United States, 1 510 848 1721, dmcbride@samuelmerritt.edu %K distraction %K smartphone %K cellular phone %K Internet %K nurses %K hospital %K non-work related smartphone use %D 2015 %7 13.01.2015 %9 Short Paper %J JMIR mHealth uHealth %G English %X Background: Personal mobile phones and other personal communication devices (smartphones and tablet computers) provide users with an ever-increasing number and diversity of non-work-related activities while at work. In hospitals, where the vigilance of health care workers is essential for patient care, the potential distraction of these devices could be hazardous to patients. Objective: The objective of this study was to determine the frequency of non-work-related use of personal mobile phones and other personal communication devices among hospital registered nurses. Methods: In March 2014, a previously validated 30-question survey was emailed to the 10,978 members of the Academy of Medical Surgical Nurses. There were 825 respondents who met the inclusion criteria. Results: The use of a personal mobile phone or other personal communication device while working (excluding meal times and breaks) was reported by 78.1% (644/825) of respondents. Nurses reported regularly (sometimes, often, or always) sending personal emails and text messages (38.6%, 318/825), reading news (25.7%, 212/825), checking/posting on social networking sites (20.8%, 172/825), shopping (9.6%, 79/825), and playing games (6.5%, 54/825) while working. Conclusions: This study found that hospital nurses frequently use their personal mobile phones or other personal communication devices for non-work-related activities at work. The primary activity reported was to send personal emails and text messages to family and friends. %M 25586982 %R 10.2196/mhealth.4001 %U http://mhealth.jmir.org/2015/1/e3/ %U https://doi.org/10.2196/mhealth.4001 %U http://www.ncbi.nlm.nih.gov/pubmed/25586982 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 1 %N 1 %P e5 %T Patient Smartphone Ownership and Interest in Mobile Apps to Monitor Symptoms of Mental Health Conditions: A Survey in Four Geographically Distinct Psychiatric Clinics %A Torous,John %A Chan,Steven Richard %A Yee-Marie Tan,Shih %A Behrens,Jacob %A Mathew,Ian %A Conrad,Erich J %A Hinton,Ladson %A Yellowlees,Peter %A Keshavan,Matcheri %+ Harvard Longwood Psychiatry Residency Training Program, 330 Brookline Ave, Boston, MA, 02115, United States, 1 6176674630, jtorous@bidmc.harvard.edu %K psychiatry %K mobile health %K smartphone %D 2014 %7 23.12.2014 %9 Original Paper %J JMIR Mental Health %G English %X Background: Despite growing interest in mobile mental health and utilization of smartphone technology to monitor psychiatric symptoms, there remains a lack of knowledge both regarding patient ownership of smartphones and their interest in using such to monitor their mental health. Objective: To provide data on psychiatric outpatients’ prevalence of smartphone ownership and interest in using their smartphones to run applications to monitor their mental health. Methods: We surveyed 320 psychiatric outpatients from four clinics around the United States in order to capture a geographically and socioeconomically diverse patient population. These comprised a state clinic in Massachusetts (n=108), a county clinic in California (n=56), a hybrid public and private clinic in Louisiana (n=50), and a private/university clinic in Wisconsin (n=106). Results: Smartphone ownership and interest in utilizing such to monitor mental health varied by both clinic type and age with overall ownership of 62.5% (200/320), which is slightly higher than the average United States’ rate of ownership of 58% in January 2014. Overall patient interest in utilizing smartphones to monitor symptoms was 70.6% (226/320). Conclusions: These results suggest that psychiatric outpatients are interested in using their smartphones to monitor their mental health and own the smartphones capable of running mental healthcare related mobile applications. %M 26543905 %R 10.2196/mental.4004 %U http://mental.jmir.org/2014/1/e5/ %U https://doi.org/10.2196/mental.4004 %U http://www.ncbi.nlm.nih.gov/pubmed/26543905 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e43 %T Digital Technology Ownership, Usage, and Factors Predicting Downloading Health Apps Among Caucasian, Filipino, Korean, and Latino Americans: The Digital Link to Health Survey %A Bender,Melinda S %A Choi,JiWon %A Arai,Shoshana %A Paul,Steven M %A Gonzalez,Prisila %A Fukuoka,Yoshimi %+ University of California San Francisco, Institute for Health & Aging, Department of Social and Behavioral Sciences, 3333 California St, Suite 340, Box 0646, San Francisco, CA, 94118, United States, 1 415 476 4668, Melinda.Bender@ucsf.edu %K digital technology %K mobile health apps %K mHealth %K Latinos %K Filipinos %K Koreans %K cross-sectional survey %D 2014 %7 22.10.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Interventions using mobile health (mHealth) apps have been effective in promoting healthy lifestyle behavior change and hold promise in improving health outcomes to thereby reduce health disparities among diverse racial/ethnic populations, particularly Latino and Asian American subgroups (Filipinos and Koreans) at high risk for diabetes and cardiovascular disease. Latinos and Asian Americans are avid digital technology owners and users. However, limited datasets exist regarding digital technology ownership and use, especially among specific racial/ethnic subgroups. Such information is needed to inform development of culturally tailored mHealth tools for use with lifestyle interventions promoting healthy behaviors for these at-risk racial/ethnic populations. Objective: The intent of the study was to examine (1) digital technology ownership and usage, and (2) factors predicting downloading health apps for Caucasian, Filipino, Korean, and Latino American subgroups. Methods: A cross-sectional survey conducted in August 2013 through December 2013 recruited 904 participants (Caucasians n=172, Filipinos n=250, Koreans n=234, and Latinos n=248), age >18 years, from California community events, clinics, churches, and online. English, Spanish, and Korean surveys were administered via paper or online. Descriptive statistics characterized the sociodemographics and digital technology ownership/usage of the 904 participants. Differences among groups in categorical variables were examined using chi-square statistics. Logistic regression was used to determine factors predicting downloading health apps. Results: Overall, mean age was 44 years (SD 16.1), with 64.3% (581/904) female. Only 44.7% (404/904) of all participants reported English as their primary language (Caucasian 98.3%, 169/172; Filipino 67.6%, 169/250; Korean 9.4%, 22/234, and Latino 17.7%, 44/248. Overall, mobile phone ownership was 92.8% (839/904). Compared to all groups, Koreans were more likely to own a mobile phone (82.8%, 194/234), computer (91.4%, 214/234), or tablet (55.2%, 129/234), whereas Latinos (67.5%, 167/248; 65.3%, 162/248; 24.4%, 61/248, respectively) were least likely. Internet access via mobile phones (90.5%, 818/904) was higher than computers (78.6%, 711/904). Odds of downloading health apps increased with college (OR 2.62, 95% CI 1.44-4.80) or graduate school (OR 2.93, 95% CI 1.43-6.00) compared to some high school; and family history of heart attack (OR 2.02, 95% CI 1.16-3.51). Odds of downloading health apps were reduced with: race/ethnicity, Latino (OR 0.37, 95% CI 0.20-0.69), and Korean (OR 0.52, 95% CI 0.31-0.88) compared to Caucasians; increasing age (OR 0.96, 95% CI 0.95-0.97); and completing paper surveys (OR 0.50, 95% CI 0.34-0.75). Conclusions: This survey study uniquely targeted specific racial/ethnic subgroups. Results indicated that despite a narrowing racial/ethnic “digital divide”, some disparities still exist, particularly among racial/ethnic groups with less education and whose primary language is not English. Findings will be used to inform development and evaluation of culturally tailored mHealth apps for use with interventions promoting healthy behavior change for Filipinos, Koreans, and Latinos. %M 25339246 %R 10.2196/mhealth.3710 %U http://mhealth.jmir.org/2014/4/e43/ %U https://doi.org/10.2196/mhealth.3710 %U http://www.ncbi.nlm.nih.gov/pubmed/25339246 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e4 %T Who Uses Smoking Cessation Apps? A Feasibility Study Across Three Countries via Smartphones %A BinDhim,Nasser F %A McGeechan,Kevin %A Trevena,Lyndal %+ Sydney Medical School, Department of Public Health, University of Sydney, Rm 125, Lvl 1, Edward Ford Building A27, Sydney, 2006, Australia, 61 434556298, nbin6641@uni.sydney.edu.au %K smartphone %K handheld computers %K health promotion %K tobacco and smoking %K global health %K prevention %K apps %K health Informatics %K public health %D 2014 %7 06.02.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone use is growing worldwide. While hundreds of smoking cessation apps are currently available in the app stores, there is no information about who uses them. Smartphones also offer potential as a research tool, but this has not previously been explored. Objective: This study aims to measure and compare the uptake of a smoking cessation app over one year in Australia, the United Kingdom, and the United States. It also assesses the feasibility of conducting research via an app, describing respondents’ characteristics (demographics, smoking status, and other health related app use), and examining differences across countries. Methods: This is a cross-sectional exploratory study of adults 18 years and older, passively recruited over one year in 2012, who downloaded this study app (Quit Advisor) via the two largest app stores (Apple and Android). Results: The total number of app downloads after one year was 1751, 72.98% (1278/1751) of them were Apple operation system users. Of these 1751 participants, 47.68% (835/1751) were from the United States, 29.18% (511/1751) were from the United Kingdom, and 16.68% (292/1751) were from Australia. There were 602 participants, 36.75% (602/1638) that completed a questionnaire within the app. Of these 602 participants, 58.8% (354/602) were female and the mean age was 32 years. There were no significant differences between countries in terms of age, operation system used, number of quitting attempts, and language spoken at home. However, there were significant differences between countries in terms of gender and stage of change. There were 77.2% (465/602) of the respondents that were ready to quit in the next 30 days and the majority of these had never sought professional help (eg, “Quitline”). More than half had downloaded smoking cessation apps in the past and of these, three-quarters had made quitting attempts (lasted at least 24 hours) using an app before. Respondents who had attempted to quit three times or more in the previous year were more likely to have tried smoking cessation apps (OR 3.3, 95% CI 2.1-5.2). There were 50.2% (302/602) of the respondents that had used other health related apps before. Of these, 89.4% (270/302) were using health related apps at least once a week, but 77.5% (234/302) never checked the credibility of the health app publishers before downloading. Conclusions: A smartphone app was able to reach smokers across three countries that were not seeking professional help, but were ready to quit within the next 30 days. Respondents were relatively young and almost demographically similar across all three countries. They also frequently used other health related apps, mostly without checking the credibility of their publishers. %M 25098439 %R 10.2196/mhealth.2841 %U http://mhealth.jmir.org/2014/1/e4/ %U https://doi.org/10.2196/mhealth.2841 %U http://www.ncbi.nlm.nih.gov/pubmed/25098439 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e195 %T New Media Use by Patients Who Are Homeless: The Potential of mHealth to Build Connectivity %A Post,Lori Ann %A Vaca,Federico E %A Doran,Kelly M %A Luco,Cali %A Naftilan,Matthew %A Dziura,James %A Brandt,Cynthia %A Bernstein,Steven %A Jagminas,Liudvikas %A D'Onofrio,Gail %+ Department of Emergency Medicine, Yale School of Medicine, Yale University, Suite 263, 464 Congress Ave, New Haven, CT, 06519, United States, 1 203 785 4172, lori.post@yale.edu %K homelessness %K mHealth %K connectivity %K emergency department %D 2013 %7 03.09.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients experiencing homelessness represent a disproportionate share of emergency department (ED) visits due to poor access to primary care and high levels of unmet health care needs. This is in part due to the difficulty of communicating and following up with patients who are experiencing homelessness. Objective: To determine the prevalence and types of “new media” use among ED patients who experience homelessness. Methods: This was a cross-sectional observational study with sequential enrolling of patients from three emergency departments 24/7 for 6 weeks. In total, 5788 ED patients were enrolled, of whom 249 experienced homelessness. Analyses included descriptive statistics, and unadjusted and adjusted odds ratios. Results: 70.7% (176/249) of patients experiencing homelessness own cell phones compared to 85.90% (4758/5539) of patients in stable housing (P=.001) with the former more likely to own Androids, 70% (53/76) versus 43.89% (1064/2424), and the latter more likely to have iPhones, 44.55% (1080/2424) versus 17% (13/76) (P=.001). There is no significant difference in new media use, modality, or frequency for both groups; however, there is a difference in contract plan with 50.02% (2380/4758) of stably housed patients having unlimited minutes versus 37.5% (66/176) of homeless patients. 19.78% (941/4758) of patients in stable housing have pay-as-you-go plans versus 33.0% (58/176) of homeless patients (P=.001). Patients experiencing homelessness are more likely to want health information on alcohol/substance abuse, mental health, domestic violence, pregnancy and smoking cessation. Conclusions: This study is unique in its characterization of new media ownership and use among ED patients experiencing homelessness. New media is a powerful tool to connect patients experiencing homelessness to health care. %M 24001876 %R 10.2196/jmir.2724 %U http://www.jmir.org/2013/9/e195/ %U https://doi.org/10.2196/jmir.2724 %U http://www.ncbi.nlm.nih.gov/pubmed/24001876