%0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15301 %T Mind the App: Considerations for the Future of Mobile Health in Canada %A Zawati,Ma'n H %A Lang,Michael %+ Centre of Genomics and Policy, McGill University, 740, Avenue Dr Penfield, Suite 5203, Montreal, QC, H3A 0G1, Canada, 1 5146686599, man.zawati@mcgill.ca %K smartphone %K mobile phone %K regulation %K patients %K physicians %D 2019 %7 4.11.2019 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Over the past decade, smartphone technology has become increasingly sophisticated and ubiquitous. Modern smartphones, now owned by more than three quarters of Canadians and 94% of millennials, perform an array of functions that are potentially useful in the health care context, such as tracking fitness data, enabling health record sharing, and providing user-friendly platforms for disease management. Approximately half of smartphone users have downloaded at least one health app, and clinicians are increasingly using them in their practice. However, despite widespread use, there is little evidence that supports their safety and efficacy. Few apps have been independently evaluated and many lack basic patient protections such as privacy policies. In this context, the demand for the regulation of mobile health apps has increased. Against this backdrop, regulators, including Health Canada, have begun to propose regulating the use of smartphones in health care. In this viewpoint, we respond to Health Canada’s recent proposal to regulate smartphone use in Canada according to a risk-based model. We argue that although Health Canada’s recent proposed approach is promising, it may require complementary regulation and oversight. %M 31682580 %R 10.2196/15301 %U https://mhealth.jmir.org/2019/11/e15301 %U https://doi.org/10.2196/15301 %U http://www.ncbi.nlm.nih.gov/pubmed/31682580 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15122 %T Examining Mobile Technologies to Support Older Adults With Dementia Through the Lens of Personhood and Human Needs: Scoping Review %A Koo,Bon Mi %A Vizer,Lisa M %+ SSK Research Center for Mental Health and Communal Society, Kwangwoon University, Chambit 604, 20 Gwangun-ro, Nowon-gu, Seoul, 01897, Republic of Korea, 82 2 940 5430, bmkmon@gmail.com %K dementia %K Alzheimer disease %K mobile health %K consumer health informatics %K personhood %K systematic review %K smartphone %K mobile phone %K tablet computers %D 2019 %7 11.11.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: With the world’s rapidly growing older adult population, there is an increase in the number of people living with dementia. This growth leads to a strain on their caregivers and our health care system and to an increased attention on mitigating strain by using mobile technology to sustain the independence of people with dementia. However, less attention is given to whether these technologies meet the stated and unstated needs of people with dementia. Objective: The aim of this study was to provide an overview of the current research on mobile technologies for people with dementia, considering the current research through the lens of personhood and human needs, and to identify any gaps that represent research opportunities. Methods: We performed a systematic search in Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), and the Cochrane Central Register of Controlled Trials (CENTRAL) in October 2018. We screened 5560 articles and identified 24 that met our inclusion and exclusion criteria. We then performed thematic analysis to organize the articles by the types of support mobile technologies provide and mapped those types of support to human needs to identify the gaps in support. Results: Articles described research on mobile technologies that support people with dementia to (1) perform daily activities, (2) maintain social interaction, (3) aid memory, (4) engage in leisure activities, (5) track location, and (6) monitor health. At least one type of support mapped to each human need, with most supporting lower-level needs such as physiological and safety needs. Little attention seems to be paid to personhood. Conclusions: Mobile technologies that support daily activities, relationships, memory, leisure activities, health, and safety can partially compensate for decreased function owing to dementia, but the human needs of people with dementia are often not adequately considered. Most technologies support basic physiological and safety needs, whereas many pay little attention to higher-level needs such as self-esteem and agency. Important research opportunities include using person-centered methods to develop technology to meet higher-level needs and to preserve personhood by incorporating human and psychological needs of people with dementia along with ethical considerations. %M 31710305 %R 10.2196/15122 %U https://mhealth.jmir.org/2019/11/e15122 %U https://doi.org/10.2196/15122 %U http://www.ncbi.nlm.nih.gov/pubmed/31710305 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13604 %T Iterative Adaptation of a Mobile Nutrition Video-Based Intervention Across Countries Using Human-Centered Design: Qualitative Study %A Isler,Jasmin %A Sawadogo,N Hélène %A Harling,Guy %A Bärnighausen,Till %A Adam,Maya %A Kagoné,Moubassira %A Sié,Ali %A Greuel,Merlin %A McMahon,Shannon A %+ Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany, 49 06221 565344, mcmahon@uni-heidelberg.de %K mHealth %K Burkina Faso %K mothers %K Community Health Workers %K pregnancy %K diet %K dgital health %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso. Objective: The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings. Methods: Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors. Results: We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video’s protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted. Conclusions: Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions. %M 31710302 %R 10.2196/13604 %U http://mhealth.jmir.org/2019/11/e13604/ %U https://doi.org/10.2196/13604 %U http://www.ncbi.nlm.nih.gov/pubmed/31710302 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 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 %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e16325 %T Making Sense of Negative Findings from Mobile Attention Bias Modification Interventions for Individuals with Addictive Disorders: Quantitative Feasibility Study %A Zhang,Melvyn %A Ying,Jiangbo %A Amron,Syidda B %A Mahreen,Zaakira %A Song,Guo %A Fung,Daniel SS %A Smith,Helen E %+ National Addictions Management Service, Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 63802504, melvynzhangweibin@gmail.com %K attention bias %K cognitive bias %K psychiatry %D 2019 %7 12.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in experimental psychology have led to a better understanding of unconscious, automatic processes that result in individuals relapsing into their substance-using habits. While some reviews have demonstrated the effectiveness of bias retraining of these unconscious biases, there have been other reviews that have highlighted that bias retraining is not always effective. Other studies have revealed there was no baseline biases among some participants. An examination of mobile bias retraining interventions has also revealed mixed results, with some reporting effectiveness and others null findings. A recent feasibility and acceptability study, done by the authors, revealed that 53% of participants have had no baseline biases and 21% of those with positive baseline biases did not have a positive change in magnitude following intervention. Objective: The aim of this paper was to explore potential variables (demographic and clinical) that could account for the negative baseline biases in the prior feasibility and acceptability study, and to discuss some of the factors that could account for the absence of baseline biases. We also explored potential reasons for why there was no reduction in the magnitude of attentional biases among individuals with baseline biases. Methods: Participants who were in the rehabilitation phase of their treatment were invited to participate. During the study they had to complete a set of baseline questionnaires, and on each day that they were on the ward they had to complete an attention bias assessment and modification task and rate their cravings using a visual analogue scale. Attention bias was deemed to be present if individuals had a positive score. Results: In our study, 53% (16/30) of individuals did not present with baseline attentional biases, and among those with positive baseline biases a total of 21% (3/14) of participants did not have a reduction in the overall magnitude of attentional biases. Chi-square analyses undertaken to compare the demographic characteristics of participants with and without baseline biases did not reveal any significant findings. However, with respect to clinical characteristics, those who had positive baseline biases had experimented with more substances. Conclusions: Our study is one of the first to have explored negative findings in attention bias modification interventions for individuals with addictive disorders. We postulate that several factors could account for the absence of baseline biases and there being no changes following bias retraining. Future research ought to take into consideration these factors. %M 31714248 %R 10.2196/16325 %U http://mhealth.jmir.org/2019/11/e16325/ %U https://doi.org/10.2196/16325 %U http://www.ncbi.nlm.nih.gov/pubmed/31714248 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14452 %T Development of a Deep Learning Model for Dynamic Forecasting of Blood Glucose Level for Type 2 Diabetes Mellitus: Secondary Analysis of a Randomized Controlled Trial %A Faruqui,Syed Hasib Akhter %A Du,Yan %A Meka,Rajitha %A Alaeddini,Adel %A Li,Chengdong %A Shirinkam,Sara %A Wang,Jing %+ Center on Smart and Connected Health Technologies, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, United States, 1 210 450 8561, wangj1@uthscsa.edu %K type 2 diabetes %K long short-term memory (LSTM)-based recurrent neural networks (RNNs) %K glucose level prediction %K mobile health lifestyle data %D 2019 %7 1.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Type 2 diabetes mellitus (T2DM) is a major public health burden. Self-management of diabetes including maintaining a healthy lifestyle is essential for glycemic control and to prevent diabetes complications. Mobile-based health data can play an important role in the forecasting of blood glucose levels for lifestyle management and control of T2DM. Objective: The objective of this work was to dynamically forecast daily glucose levels in patients with T2DM based on their daily mobile health lifestyle data including diet, physical activity, weight, and glucose level from the day before. Methods: We used data from 10 T2DM patients who were overweight or obese in a behavioral lifestyle intervention using mobile tools for daily monitoring of diet, physical activity, weight, and blood glucose over 6 months. We developed a deep learning model based on long short-term memory–based recurrent neural networks to forecast the next-day glucose levels in individual patients. The neural network used several layers of computational nodes to model how mobile health data (food intake including consumed calories, fat, and carbohydrates; exercise; and weight) were progressing from one day to another from noisy data. Results: The model was validated based on a data set of 10 patients who had been monitored daily for over 6 months. The proposed deep learning model demonstrated considerable accuracy in predicting the next day glucose level based on Clark Error Grid and ±10% range of the actual values. Conclusions: Using machine learning methodologies may leverage mobile health lifestyle data to develop effective individualized prediction plans for T2DM management. However, predicting future glucose levels is challenging as glucose level is determined by multiple factors. Future study with more rigorous study design is warranted to better predict future glucose levels for T2DM management. %M 31682586 %R 10.2196/14452 %U https://mhealth.jmir.org/2019/11/e14452 %U https://doi.org/10.2196/14452 %U http://www.ncbi.nlm.nih.gov/pubmed/31682586 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13236 %T Mental Health Apps in China: Analysis and Quality Assessment %A Shang,Jie %A Wei,Shaoming %A Jin,Jianbo %A Zhang,Puhong %+ The George Institute for Global Health, Peking University Health Science Center, 18F Jinqiu Tower B, No 6 Zhichun Rd, Haidian District, Beijing, 100088, China, 86 10 8280 0577, zpuhong@georgeinstitute.org.cn %K mental health %K mental disorder %K quality assessment %K mobile health %K digital health %K innovative health %K smartphone application %D 2019 %7 7.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental disorders have been a great burden on health care systems, affecting the quality of life of millions of people worldwide. Developing countries, including China, suffer from the double burden of both the increasing mental health issues in population and the deficiency in mental health care resources. The use of mobile health technologies, especially for mobile phone apps, can be a possible solution. Objective: This review aimed to describe the features and assess the quality of mental health apps in major mobile phone app markets in China and further discuss the priorities for mental health app development. Methods: Keywords including psychology, psychological health, psychological hygiene, psychological health service(s), mental, mental health, mental hygiene, mental health service(s), depression, and anxiety were searched in Chinese in 3 Android app markets (Baidu Mobile Assistant, Tencent MyApp, and 360 Mobile Assistant) and iOS App Store independently. Mental health apps were then selected according to established criteria for in-depth analysis and quality assessment by the Mobile App Rating Scale. Results: In total, 63 of 997 mental health apps were analyzed in depth, of which 78% (49/63) were developed by commercial entities for general population, 17% (11/63) were for patients or clients of specialized psychiatric hospitals or counseling agencies, 3% (2/63) were by government or local Centers for Disease Control and Prevention for general information, and 2% (1/63) for students of a university. Major built-in features of the apps included counseling services, mental health education, and self-assessment of mental health status by validated self-rating scales. The overall quality score of the MH apps was acceptable. Conclusions: Mental health apps are emerging in the area of mobile health in China. Popular mental health apps usually provide a synthetic platform organizing resources of information, knowledge, counseling services, self-tests, and management for the general population with mental health-related inquiries. The quality of the apps was rated as acceptable on average, suggesting some space for improvement. Official guidelines and regulations are urgently required for the field in the future. %M 31697245 %R 10.2196/13236 %U https://mhealth.jmir.org/2019/11/e13236 %U https://doi.org/10.2196/13236 %U http://www.ncbi.nlm.nih.gov/pubmed/31697245 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15489 %T Mediators of Intervention Effects on Depressive Symptoms Among People Living With HIV: Secondary Analysis of a Mobile Health Randomized Controlled Trial Using Latent Growth Curve Modeling %A Zhu,Mengting %A Cai,Weiping %A Li,Linghua %A Guo,Yan %A Monroe-Wise,Aliza %A Li,Yiran %A Zeng,Chengbo %A Qiao,Jiaying %A Xu,Zhimeng %A Zhang,Hanxi %A Zeng,Yu %A Liu,Cong %+ Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhong Shan 2nd Road, Guangzhou, China, 86 1 350 150 2582, guoy8@mail.sysu.edu.cn %K mobile health %K depression %K HIV %K randomized controlled trial %K longitudinal studies %D 2019 %7 15.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although several studies have investigated the effects of mobile health (mHealth) interventions on depression among people living with HIV, few studies have explored mediators of mHealth-based interventions to improve mental health in people living with HIV. Identifying influential mediators may enhance and refine effective components of mHealth interventions to improve mental health of people living with HIV. Objective: This study aimed to examine mediating factors of the effects of a mHealth intervention, Run4Love, designed to reduce depression among people living with HIV using 4 time-point measurement data. Methods: This study used data from a randomized controlled trial of a mHealth intervention among people living with HIV with elevated depressive symptoms in Guangzhou, China. A total of 300 patients were assigned to receive either the mHealth intervention (n=150) or a waitlist control group (n=150) through computer-generated block randomization. Depressive symptoms, coping, and HIV-related stigma were measured at baseline, 3-, 6-, and 9-month follow-ups. The latent growth curve model was used to examine the effects of the intervention on depressive symptoms via potential mediators. Mediating effects were estimated using bias-corrected 95% bootstrapped CIs (BCIs) with resampling of 5000. Results: Enhanced positive coping and reduced HIV-related stigma served as effective treatment mediators in the mHealth intervention. Specially, there was a significant indirect effect of the mHealth intervention on the slope of depressive symptoms via the slope of positive coping (beta=–2.86; 95% BCI –4.78 to –0.94). The indirect effect of the mHealth intervention on the slope of depressive symptoms via the slope of HIV-related stigma was also statistically significant (beta=–1.71; 95% BCI –3.03 to –0.40). These findings indicated that enhancement of positive coping and reduction of HIV-related stigma were important mediating factors of the mHealth intervention in reducing depression among people living with HIV. Conclusions: This study revealed the underlying mediators of a mHealth intervention to reduce depression among people living with HIV using latent growth curve model and 4 time-point longitudinal measurement data. The study results underscored the importance of improving positive coping skills and mitigating HIV-related stigma in mHealth interventions to reduce depression among people living with HIV. %M 31730042 %R 10.2196/15489 %U http://mhealth.jmir.org/2019/11/e15489/ %U https://doi.org/10.2196/15489 %U http://www.ncbi.nlm.nih.gov/pubmed/31730042 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e12442 %T Assessment of a Mobile App by Adolescents and Young Adults With Cystic Fibrosis: Pilot Evaluation %A Rudolf,Isa %A Pieper,Katharina %A Nolte,Helga %A Junge,Sibylle %A Dopfer,Christian %A Sauer-Heilborn,Annette %A Ringshausen,Felix C %A Tümmler,Burkhard %A von Jan,Ute %A Albrecht,Urs-Vito %A Fuge,Jan %A Hansen,Gesine %A Dittrich,Anna-Maria %+ Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625, Germany, 49 17615329785, dittrich.anna-maria@mh-hannover.de %K mobile phone %K mobile phone app %K mHealth %K self-management %K adolescence %K cystic fibrosis %D 2019 %7 21.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cystic fibrosis (CF) continues to be the most common life-limiting chronic pulmonary disease in adolescents and young adults. Treatment of CF demands a high treatment time investment to slow the progression of lung function decline, the most important contributor to morbidity and mortality. Adherence is challenging in CF due to the high treatment burden and the lack of immediate health consequences in case of nonadherence. Lung function decline is particularly pronounced in the transition phase between 12 and 24 years of age. The improvement of self-management and self-responsibility and independence from parents and desire for normalcy are conflicting aspects for many adolescents with CF, which influence adherence to the time-consuming pulmonary therapy. Mobile health (mHealth) care apps could help to support self-management and independence and thereby reconcile seemingly conflicting goals to improve adherence, quality of life, and ultimately CF life expectancy. Objective: This study aimed to (1) assess user behavior and satisfaction among adolescents and young adults with CF over an observation period of three months using an mHealth app; (2) identify areas of improvement for this mHealth app; and (3) compare overall and disease-specific satisfaction, lung function, and anthropometry before and after using the mHealth app. Methods: A total of 27 adolescents and young adults with CF (age range 12-24 years, mean age 16 years, SD 3 years; 14 females, 11 males) used a free mHealth app for three months of whom 25 provided questionnaire data for analysis at the end of the study. Data collection was carried out using questionnaires on usage characteristics and life satisfaction, and standardized assessment of lung function and anthropometry. Results: The use of the reminder function for medication declined from 70% (15/21) of the participants at week 4 to 65% (13/20) at week 8 of the observation period. At the end of the study, only 17% (4/23) of the participants wanted to continue using the app. Nevertheless, 56% (14/25) of participants saw the mobile app as a support for everyday life. Potential improvements targeting hedonistic qualities were identified to improve mHealth app adherence. Comparisons of satisfaction with different life aspects hinted at improvements or stabilization for the subitem respiration and the subitem lack of handicap by CF, suggesting that app use might stabilize certain CF-specific aspects of the weighted satisfaction with life. Lung function and anthropometry were not affected consistently. Conclusions: Most of the patients did not want to continue using the app after the study period. Only a few CF-specific aspects of weighted life satisfaction were possibly stabilized by the mHealth app; clinical parameters were not affected. Adaptation of the functions to adolescent-specific needs could improve the long-term use and thus positively affect the disease course. %M 31750841 %R 10.2196/12442 %U https://mhealth.jmir.org/2019/11/e12442 %U https://doi.org/10.2196/12442 %U http://www.ncbi.nlm.nih.gov/pubmed/31750841 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14946 %T Mood Monitoring Over One Year for People With Chronic Obstructive Pulmonary Disease Using a Mobile Health System: Retrospective Analysis of a Randomized Controlled Trial %A Whelan,Maxine E %A Velardo,Carmelo %A Rutter,Heather %A Tarassenko,Lionel %A Farmer,Andrew J %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 7435330992, maxine.whelan@phc.ox.ac.uk %K pulmonary disease, chronic obstructive %K self-management %K telemedicine %K computers %K handheld %K anxiety %K depression %D 2019 %7 22.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Comorbid anxiety and depression can add to the complexity of managing treatment for people living with chronic obstructive pulmonary disease (COPD). Monitoring mood has the potential to identify individuals who might benefit from additional support and treatment. Objective: We used data from the sElf-management anD support proGrammE (EDGE) trial to examine: (1) the extent to which the mood-monitoring components of a mobile health system for patients with COPD were used by participants; (2) the levels of anxiety and depression symptoms among study participants; (3) the extent to which videos providing advice about coping with low mood were viewed; and (4) the characteristics of participants with differing levels of mood and utilization of mood monitoring. Methods: A total of 107 men and women with a clinical diagnosis of COPD, aged ≥40 years old, were recruited to the intervention arm of the EDGE trial. Participants were invited to complete the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 test every four weeks using a tablet computer. Mood disturbance based on these measures was defined as a score ≥5 on either scale. Participants reporting a mood disturbance were automatically directed (signposted) to a stress or mood management video. Study outcomes included measures of health status, respiratory quality of life, and symptoms of anxiety and depression. Results: Overall, 94 (87.9%) participants completed the 12-month study. A total of 80 participants entered at least one response each month for at least ten months. On average, 16 participants (range 8-38 participants) entered ≥2 responses each month. Of all the participants, 47 (50%) gave responses indicating a mood disturbance. Participants with a mood disturbance score for both scales (n=47) compared with those without (n=20) had lower health status (P=.008), lower quality of life (P=.009), and greater anxiety (P<.001) and increased depression symptoms (P<.001). Videos were viewed by 64 (68%) people over 12 months. Of the 220 viewing visualizations, 70 (34.7%) began after being signposted. Participants signposted to the stress management video (100%; IQR 23.3-100%) watched a greater proportion of it compared to those not signposted (38.4%; IQR 16.0-68.1%; P=.03), whereas duration of viewing was not significantly different for the mood management video. Conclusions: Monitoring of anxiety and depression symptoms for people with COPD is feasible. More than half of trial participants reported scores indicating a mood disturbance during the study. Signposting participants to an advisory video when reporting increased symptoms of a mood disturbance resulted in a longer view-time for the stress management video. The opportunity to elicit measures of mood regularly as part of a health monitoring system could contribute to better care for people with COPD. %M 31755872 %R 10.2196/14946 %U http://mhealth.jmir.org/2019/11/e14946/ %U https://doi.org/10.2196/14946 %U http://www.ncbi.nlm.nih.gov/pubmed/31755872 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14730 %T Mobile Health Apps for Self-Management of Rheumatic and Musculoskeletal Diseases: Systematic Literature Review %A Najm,Aurélie %A Gossec,Laure %A Weill,Catherine %A Benoist,David %A Berenbaum,Francis %A Nikiphorou,Elena %+ Department of Rheumatology, Nantes University Hospital, 1, place Alexis Ricordeau, Nantes, 44000, France, 33 633444793, aurelie.najm@gmail.com %K mobile health %K self-management %K arthritis %K telemedicine %K musculoskeletal diseases %D 2019 %7 26.11.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Although the increasing availability of mobile health (mHealth) apps may enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health, there is a general lack of evidence on ways to ensure appropriate development and evaluation of apps. Objective: This study aimed to obtain an overview on existing mHealth apps for self-management in patients with RMDs, focusing on content and development methods. Methods: A search was performed up to December 2017 across 5 databases. For each publication relevant to an app for RMDs, information on the disease, purpose, content, and development strategies was extracted and qualitatively assessed. Results: Of 562 abstracts, 32 were included in the analysis. Of these 32 abstracts, 11 (34%) referred to an app linked to a connected device. Most of the apps targeted rheumatoid arthritis (11/32, 34%). The top three aspects addressed by the apps were pain (23/32, 71%), fatigue (15/32, 47%), and physical activity (15/32, 47%). The development process of the apps was described in 84% (27/32) of the articles and was of low to moderate quality in most of the cases. Despite most of the articles having been published within the past two years, only 5 apps were still commercially available at the time of our search. Moreover, only very few studies showed improvement of RMD outcome measures. Conclusions: The development process of most apps was of low or moderate quality in many studies. Owing to the increasing RMD patients’ willingness to use mHealth apps for self-management, optimal standards and quality assurance of new apps are mandatory. %M 31769758 %R 10.2196/14730 %U https://mhealth.jmir.org/2019/11/e14730 %U https://doi.org/10.2196/14730 %U http://www.ncbi.nlm.nih.gov/pubmed/31769758 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e12298 %T Effects of a Smartphone-Based Approach-Avoidance Intervention on Chocolate Craving and Consumption: Randomized Controlled Trial %A Meule,Adrian %A Richard,Anna %A Dinic,Radomir %A Blechert,Jens %+ Schoen Clinic Roseneck, Am Roseneck 6, Prien am Chiemsee, 83209, Germany, 49 8051 68 100 174, ameule@med.lmu.de %K food %K chocolate %K craving %K smartphone %K mobile phone %K mhealth %K digital health %K eating behavior %D 2019 %7 1.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Repeatedly pushing high-calorie food stimuli away based on joystick movements has been found to reduce approach biases toward these stimuli. Some studies also found that such avoidance training reduced consumption of high-calorie foods. Objective: This study aimed to test effects of a smartphone-based approach-avoidance intervention on chocolate craving and consumption, to make such interventions suitable for daily use. Methods: Within a 10-day period, regular chocolate eaters (n=105, 86% female) performed five sessions during which they continuously avoided (ie, swiped upward) chocolate stimuli (experimental group, n=35), performed five sessions during which they approached and avoided chocolate stimuli equally often (placebo control group, n=35), or did not perform any training sessions (inactive control group, n=35). Training effects were measured during laboratory sessions before and after the intervention period and further continuously through daily ecological momentary assessment. Results: Self-reported chocolate craving and consumption as well as body fat mass significantly decreased from pre- to postmeasurement across all groups. Ecological momentary assessment reports evidenced no differences in chocolate craving and consumption between intervention days and rest days as a function of the group. Conclusions: A smartphone-based approach-avoidance training did not affect eating-related and anthropometric measures over and above measurement-based changes in this study. Future controlled studies need to examine whether other techniques of modifying food approach tendencies show an add-on benefit over conventional, monitoring-based intervention effects. Trial Registration: AsPredicted 8203; https://aspredicted.org/pt9df.pdf. %M 31682584 %R 10.2196/12298 %U https://mhealth.jmir.org/2019/11/e12298 %U https://doi.org/10.2196/12298 %U http://www.ncbi.nlm.nih.gov/pubmed/31682584 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e11158 %T A Mobile-Based Comprehensive Weight Reduction Program for the Workplace (Health-On): Development and Pilot Study %A Han,Min Kyu %A Cho,Belong %A Kwon,Hyuktae %A Son,Ki Young %A Lee,Hyejin %A Lee,Joo Kyung %A Park,Jinho %+ Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 0865, kkolzzi0@gmail.com %K weight loss programs %K smartphone %K mobile phone %K workplaces %K obesity %K obesity management %D 2019 %7 4.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a growing interest in mobile technology for obesity management. Despite the known effectiveness of workplace-based weight loss programs, there are few studies on mobile phone–delivered interventions. Objective: This study aimed to develop and verify an integrated and personalized mobile technology–based weight control program, named Health-On, optimized for workplaces. Methods: A weight reduction algorithm was developed for calorie prescription, continuous monitoring, periodic feedback and reevaluation, goal resetting, and offline intervention with behavior-changing strategies. A total of 30 obese volunteers (body mass index ≥25 kg/m2) participated in the 12-week Health-On pilot program. The primary outcome was weight reduction, and secondary outcomes were improved anthropometric measures, metabolic profiles, and fat computed tomography measures, all assessed pre- and postintervention. Results: Health-On incorporated proprietary algorithms and several strategies intended to maximize adherence, using compatible online and offline interventions. The mean weight of 30 participants decreased by 5.8%, and median weight also decreased from 81.3 kg (interquartile range [IQR] 77.1-87.8) before intervention to 76.6 kg (IQR 70.8-79.5) after the 12-week intervention period (P<.001). The metabolic profiles and fat measures (blood pressure, glycosylated hemoglobin, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, alanine aminotransferase, and visceral and subcutaneous adipose tissue; P<.05) also improved significantly. Conclusions: In this single-group evaluation of 30 participants before and after the Health-On program, body weight decreased and metabolic profiles and fat measures improved. Follow-up studies are needed to assess effectiveness and long-term adherence. %M 31682576 %R 10.2196/11158 %U https://mhealth.jmir.org/2019/11/e11158 %U https://doi.org/10.2196/11158 %U http://www.ncbi.nlm.nih.gov/pubmed/31682576 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14641 %T Development of a Mobile Phone App for Measuring Striking Response Time in Combat Sports: Cross-Sectional Validation Study %A Coswig,Victor %A Sant' Ana,Jader %A Coelho,Maicon Nascimento %A Pereira Moro,Antonio Renato %A Diefenthaeler,Fernando %+ Universidade Federal de Santa Catarina, Departamento de Educação Física, Campus Universitário, Reitor João David Ferreira Lima, Florianopolis, 88040-900, Brazil, 55 4837219000 ext 4779, fernando.diefenthaeler@ufsc.br %K reaction time %K martial arts %K mobile apps %K software validation %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: TReaction is a mobile app developed to determine strike response time at low cost and with easy application in combat sports. However, the validity and accuracy of the response time obtained by the TReaction app has not yet been evaluated. Objective: This study aimed to test the validity and reliability of the TReaction app in measuring motor response time in combat sports. Methods: A total of two athletes performed 59 strikes to assess the response time upon visual stimulus using the TReaction app simultaneously with a high-speed camera. Accuracy of the measure was verified using a computer simulator programmed to discharge visual stimuli and obtain the response time. Pearson correlation, Student t test for dependent samples, and the Bland-Altman analysis were performed. Accuracy was verified using the intraclass correlation coefficient. Effect size (g) and the typical error of measurement (TEM) were calculated. The significance level was set at P<.05. Results: No significant difference (P=.56) was found between both systems. The methods presented a very strong correlation (r=0.993). The magnitude of differences was trivial (g<0.25), and TEM was 1.4%. These findings indicate a high accuracy between the computer screen and the mobile app measures to determine the beginning of the task and the response time. Conclusions: Our findings suggest that the TReaction app is a valid tool to evaluate the response time in combat sports athletes. %M 31710294 %R 10.2196/14641 %U http://mhealth.jmir.org/2019/11/e14641/ %U https://doi.org/10.2196/14641 %U http://www.ncbi.nlm.nih.gov/pubmed/31710294 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14458 %T Impact of a Mobile App–Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study %A Cueto,Victor %A Wang,C Jason %A Sanders,Lee Michael %+ Division of General Internal Medicine, Department of Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, H-251, Newark, NJ, 07101, United States, 1 973 972 5672, vcueto@alumni.stanford.edu %K child obesity %K mHealth %K mobile apps %K health coaching %K health behavior %K self-monitoring %K behavior change %D 2019 %7 15.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement. Objective: The aim of this study was to assess child engagement over time, with a mobile app–based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status. Methods: This was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ≥ 85th percentile or ≥ 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan. Results: A total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in –8.03 (95% CI –10.19 to –5.87) and –9.34 (95% CI –11.31 to –7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was –0.21 (95% CI –0.25 to –0.17) per additional coaching session (P<.001). Conclusions: Among overweight and obese children using a mobile app–based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status. %M 31730041 %R 10.2196/14458 %U http://mhealth.jmir.org/2019/11/e14458/ %U https://doi.org/10.2196/14458 %U http://www.ncbi.nlm.nih.gov/pubmed/31730041 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14219 %T A Baby Formula Designed for Chinese Babies: Content Analysis of Milk Formula Advertisements on Chinese Parenting Apps %A Zhao,Jing %A Li,Mu %A Freeman,Becky %+ School of Public Health, Sydney Medical School, The University of Sydney, Edward Ford Building A27, Sydney, 2006, Australia, 61 04 0650 2156, jzha5010@uni.sydney.edu.au %K infant formula %K food policy %K health promotion %K marketing %K mobile app %K parenting %K breastfeeding %K advertisement %D 2019 %7 29.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: China is the largest market for infant formula. With the increasing use of smartphones, apps have become the latest tool used to promote milk formula. Formula manufacturers and distributors both have seized the popularity of apps as an avenue for marketing. Objective: This study aimed to identify and analyze milk formula ads featured on Chinese pregnancy and parenting apps, to build the first complete picture of app-based milk formula marketing techniques being used by milk formula brand variants on these apps, and to more fully understand the ad content that potentially undermines public health messaging about infant and young child feeding. Methods: We searched for free-to-download Chinese parenting apps in the 360 App Store, the biggest Android app store in China. The final sample consisted of 353 unique formula ads from the 79 apps that met the inclusion criteria. We developed a content analysis coding tool for categorizing the marketing techniques used in ads, which included a total of 22 coding options developed across 4 categories: emotional imagery, marketing elements, claims, and advertising disclosure. Results: The 353 milk formula ads were distributed across 31 companies, 44 brands, and 79 brand variants. Overall, 15 of 31 corporations were international with the remaining 16 being Chinese owned. An image of a natural pasture was the most commonly used emotional image among the brand variants (16/79). All variants included branding elements, and 75 variants linked directly to e-shops. Special price promotions were promoted by nearly half (n=39) of all variants. A total of 5 variants included a celebrity endorsement in their advertising. A total of 25 of the 79 variants made a product quality claim. Only 14 variants made a direct advertisement disclosure. Conclusions: The purpose of marketing messages is to widen the use of formula and normalize formula as an appropriate food for all infants and young children, rather than as a specialized food for those unable to breastfeed. Policy makers should take steps to establish an appropriate regulatory framework and provide detailed monitoring and enforcement to ensure that milk formula marketing practices do not undermine breastfeeding norms and behaviors. %M 31782743 %R 10.2196/14219 %U http://mhealth.jmir.org/2019/11/e14219/ %U https://doi.org/10.2196/14219 %U http://www.ncbi.nlm.nih.gov/pubmed/31782743 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14247 %T An Interactive Parent-Targeted Text Messaging Intervention to Improve Oral Health in Children Attending Urban Pediatric Clinics: Feasibility Randomized Controlled Trial %A Borrelli,Belinda %A Henshaw,Michelle %A Endrighi,Romano %A Adams,William G %A Heeren,Timothy %A Rosen,Rochelle K %A Bock,Beth %A Werntz,Scott %+ Center for Behavioral Science Research, Boston University Henry M Goldman School of Dental Medicine, 560 Harrison Ave, 3rd floor, Boston, MA, 02118, United States, 1 617 358 3358, belindab@bu.edu %K oral health %K mHealth %K text message %K dental caries %K health behavior %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective preventive treatments for dental decay exist, but caries experience among preschoolers has not changed, with marked disparities in untreated decay. Despite near-universal use of SMS text messaging, there are no studies using text messages to improve the oral health of vulnerable children. Objective: This randomized controlled feasibility trial aimed to test the effects of oral health text messages (OHT) versus a control (child wellness text messages or CWT). OHT was hypothesized to outperform CWT on improving pediatric oral health behaviors and parent attitudes. Methods: Parents with a child aged <7 years were recruited at urban clinics during pediatric appointments (79% [41/52] below poverty line; 66% [36/55] black) and randomized to OHT (text messages on brushing, dental visits, bottle and sippy cups, healthy eating and sugary beverages, and fluoride) or CWT (text messages on reading, safety, physical activity and development, secondhand smoke, and stress) groups. Automated text messages based on Social Cognitive Theory were sent twice each day for 8-weeks. Groups were equivalent on the basis of the number of text messages sent, personalization, interactivity, and opportunity to earn electronic badges and unlock animated characters. Assessments were conducted at baseline and 8 weeks later. Data were analyzed with linear mixed–effects models. Results: A total of 55 participants were randomized (28 OHT and 27 CWT). Only one participant dropped out during the text message program and 47 (24 OHT and 23 CWT) completed follow up surveys. Response rates exceeded 68.78% (1040/1512) and overall program satisfaction was high (OHT mean 6.3; CWT mean 6.2; 1-7 scale range). Of the OHT group participants, 84% (21/25) would recommend the program to others. Overall program likeability scores were high (OHT mean 5.90; CWT mean 6.0; 1-7 scale range). Participants reported high perceived impact of the OHT program on brushing their child’s teeth, motivation to address their child's oral health, and knowledge of their child's oral health needs (mean 4.7, 4.6, and 4.6, respectively; 1-5 scale range). At follow up, compared with CWT, OHT group participants were more likely to brush their children’s teeth twice per day (odds ratio [OR] 1.37, 95% CI 0.28-6.50) and demonstrated improved attitudes regarding the use of fluoride (OR 3.82, 95% CI 0.9-16.8) and toward getting regular dental checkups for their child (OR 4.68, 95% CI 0.24-91.4). There were modest, but not significant, changes in motivation (F1,53=0.60; P=.45) and self–efficacy (F1,53=0.24; P=.63) to engage in oral health behaviors, favoring OHT (d=0.28 and d=0.16 for motivation and self–efficacy, respectively). Conclusions: The OHT program demonstrated feasibility was well utilized and appealing to the target population and showed promise for efficacy. %M 31710306 %R 10.2196/14247 %U https://mhealth.jmir.org/2019/11/e14247 %U https://doi.org/10.2196/14247 %U http://www.ncbi.nlm.nih.gov/pubmed/31710306 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15771 %T Impact of Social Determinants of Health and Demographics on Refill Requests by Medicare Patients Using a Conversational Artificial Intelligence Text Messaging Solution: Cross-Sectional Study %A Brar Prayaga,Rena %A Agrawal,Ridhika %A Nguyen,Benjamin %A Jeong,Erwin W %A Noble,Harmony K %A Paster,Andrew %A Prayaga,Ram S %+ mPulse Mobile, Inc, 16530 Ventura Blvd, Suite 500, Encino, CA, 91436, United States, 1 888 678 5735, rena@mpulsemobile.com %K text messaging %K SMS %K refill adherence %K medication adherence %K Medicare patients %K conversational AI %K social determinants of health %K predictive modeling %K machine learning %K health disparities %D 2019 %7 18.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonadherence among patients with chronic disease continues to be a significant concern, and the use of text message refill reminders has been effective in improving adherence. However, questions remain about how differences in patient characteristics and demographics might influence the likelihood of refill using this channel. Objective: The aim of this study was to evaluate the efficacy of an SMS-based refill reminder solution using conversational artificial intelligence (AI; an automated system that mimics human conversations) with a large Medicare patient population and to explore the association and impact of patient demographics (age, gender, race/ethnicity, language) and social determinants of health on successful engagement with the solution to improve refill adherence. Methods: The study targeted 99,217 patients with chronic disease, median age of 71 years, for medication refill using the mPulse Mobile interactive SMS text messaging solution from December 2016 to February 2019. All patients were partially adherent or nonadherent Medicare Part D members of Kaiser Permanente, Southern California, a large integrated health plan. Patients received SMS reminders in English or Spanish and used simple numeric or text responses to validate their identity, view their medication, and complete a refill request. The refill requests were processed by Kaiser Permanente pharmacists and support staff, and refills were picked up at the pharmacy or mailed to patients. Descriptive statistics and predictive analytics were used to examine the patient population and their refill behavior. Qualitative text analysis was used to evaluate quality of conversational AI. Results: Over the course of the study, 273,356 refill reminders requests were sent to 99,217 patients, resulting in 47,552 refill requests (17.40%). This was consistent with earlier pilot study findings. Of those who requested a refill, 54.81% (26,062/47,552) did so within 2 hours of the reminder. There was a strong inverse relationship (r10=−0.93) between social determinants of health and refill requests. Spanish speakers (5149/48,156, 10.69%) had significantly lower refill request rates compared with English speakers (42,389/225,060, 18.83%; X21 [n=273,216]=1829.2; P<.001). There were also significantly different rates of refill requests by age band (X26 [n=268,793]=1460.3; P<.001), with younger patients requesting refills at a higher rate. Finally, the vast majority (284,598/307,484, 92.23%) of patient responses were handled using conversational AI. Conclusions: Multiple factors impacted refill request rates, including a strong association between social determinants of health and refill rates. The findings suggest that higher refill requests are linked to language, race/ethnicity, age, and social determinants of health, and that English speakers, whites, those younger than 75 years, and those with lower social determinants of health barriers are significantly more likely to request a refill via SMS. A neural network–based predictive model with an accuracy level of 78% was used to identify patients who might benefit from additional outreach to narrow identified gaps based on demographic and socioeconomic factors. %M 31738170 %R 10.2196/15771 %U http://mhealth.jmir.org/2019/11/e15771/ %U https://doi.org/10.2196/15771 %U http://www.ncbi.nlm.nih.gov/pubmed/31738170 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15664 %T Development of MyTeen Text Messaging Program to Support Parents of Adolescents: Qualitative Study %A Chu,Joanna Ting Wai %A Wadham,Angela %A Jiang,Yannan %A Whittaker,Robyn %A Stasiak,Karolina %A Shepherd,Matthew %A Bullen,Christopher %+ National Institute for Health Innovation, University of Auckland, 261 Morrin Road, Glen Innes, Auckland, 1072, New Zealand, 64 3737599, jt.chu@auckland.ac.nz %K programs %K mHealth %K adolescents %K parents %K text messaging %D 2019 %7 20.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents play an important role in the lives of adolescents, and supporting and addressing the needs of families continue to be the focus of many researchers and policy makers. Mobile health interventions have great potential for supporting parents at a population level because of their broad reach and convenience. However, limited evidence exists for such interventions for parents of adolescents. This study reports on the formative work conducted with parents and/or primary caregivers to identify their needs and preferences for the development of MyTeen—an SMS text messaging program on promoting parental competence and mental health literacy for parents of adolescents (aged 10-15 years). Objective: The aim of this qualitative study was to explore parents and/or primary caregivers’ perspectives around youth well-being, parenting, and parenting support and their input on the development of MyTeen SMS text messaging parenting intervention. Methods: A total of 5 focus groups (n=45) were conducted with parents or primary caregivers of adolescents aged 10 to 15 years between October and December 2017 in New Zealand. A semistructured interview guideline and prompts were used. Data were audiotaped, transcribed, and analyzed using inductive thematic analysis. Results: Participants were concerned about youth mental health (ie, stigma and increasing demand on adolescents), and a number of parenting challenges (ie, social expectations, time, impact of technology, changes in family communication pattern, and recognizing and talking about mental health issues) were noted. Importantly, participants reported the lack of services and support available for families, and many were not aware of services for parents themselves. A number of recommendations were given on the style, content, and frequency of developing the text messaging program. Conclusions: Findings from this qualitative work informed the development of MyTeen, an SMS text messaging program designed to increase parental competence and improve mental health literacy for parents of adolescents. %M 31746767 %R 10.2196/15664 %U http://mhealth.jmir.org/2019/11/e15664/ %U https://doi.org/10.2196/15664 %U http://www.ncbi.nlm.nih.gov/pubmed/31746767 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14380 %T An Interactive Mobile Phone App (SMART 5-A-DAY) for Increasing Knowledge of and Adherence to Fruit and Vegetable Recommendations: Development and Pilot Randomized Controlled Trial %A Appleton,Katherine Marie %A Passmore,David %A Burn,Isobel %A Pidgeon,Hanna %A Nation,Philippa %A Boobyer,Charlotte %A Jiang,Nan %+ Bournemouth University, Poole House, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 01202965985, k.appleton@bournemouth.ac.uk %K fruit %K vegetables %K diet therapy %K knowledge %K questionnaires %K portion sizes %D 2019 %7 20.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Fruit and vegetable consumption is important for health, but many individuals fail to consume adequate amounts for health benefits. Although many individuals are aware of current fruit and vegetable consumption recommendations, research suggests that adherence to these is hampered by low knowledge of the details of these recommendations. Objective: This paper reports the development and details of a pilot randomized controlled test of a novel interactive mobile phone app for addressing low knowledge of the UK 5-a-day fruit and vegetable recommendations. Methods: Requirements for the app were first defined by researchers and potential end users and prioritized using the MoSCoW (Must have, Should have, Could have, Won’t have) method. Second, a prototype mobile phone app was developed using an agile approach. Third, the prototype app was tested in a randomized controlled pilot trial for impacts on knowledge and intake of fruit and vegetables. Volunteers were randomized to either receive (n=50) or not receive the app (n=44) for 2 or 4 weeks, and fruit and vegetable knowledge, intake, and behavior were assessed at the beginning of the study and after 1 and 2 weeks or after 2 and 4 weeks, respectively. App usage and qualitative feedback were also investigated. All findings then informed the development of a final app. Results: Low knowledge of consumption recommendations centered around portion sizes and the need for variety, and an interactive mobile phone app was considered a suitable tool for improving this knowledge in a practical manner that would be available both at time of consumption and outside of these times. The pilot test revealed improved behavior after 2 weeks compared with baseline in volunteers who received the app, but improvements in knowledge on fruit and vegetable recommendations were found in both groups, and no improvements in fruit and vegetable intakes were found in formal measures. Patterns of app usage and qualitative feedback also suggested a number of modifications. The resultant final app incorporates several behavior change techniques (goal-setting, self-monitoring, and personalized feedback) as well as aiming to improve knowledge. Conclusions: A novel interactive mobile phone app was successfully developed based on requirements, and when tested in a pilot randomized controlled trial, this app was found to have some impacts on fruit and vegetable outcomes. Although benefits from the app were small, impacts will likely increase as a result of recent modifications. The final SMART 5-A-DAY app is available in the Google Play Store and now needs testing in the target population. Trial Registration: ClinicalTrials.gov NCT02779491; https://www.clinicaltrials.gov/ct2/show/NCT02779491 %M 31746766 %R 10.2196/14380 %U http://mhealth.jmir.org/2019/11/e14380/ %U https://doi.org/10.2196/14380 %U http://www.ncbi.nlm.nih.gov/pubmed/31746766 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13173 %T Evaluation of Heart Failure Apps to Promote Self-Care: Systematic App Search %A Wali,Sahr %A Demers,Catherine %A Shah,Hiba %A Wali,Huda %A Lim,Delphine %A Naik,Nirav %A Ghany,Ahmad %A Vispute,Ayushi %A Wali,Maya %A Keshavjee,Karim %+ Department of Medicine, McMaster University, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada, 1 905 525 9140 ext 73324, demers@hhsc.ca %K mHealth %K heart failure %K self-care %K mobile phone %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heart failure (HF) is a chronic disease that affects over 1% of Canadians and at least 26 million people worldwide. With the continued rise in disease prevalence and an aging population, HF-related costs are expected to create a significant economic burden. Many mobile health (mHealth) apps have been developed to help support patients’ self-care in the home setting, but it is unclear if they are suited to the needs or capabilities of older adults. Objective: This study aimed to identify HF apps and evaluate whether they met the criteria for optimal HF self-care. Methods: We conducted a systematic search of all apps available exclusively for HF self-care across Google Play and the App Store. We then evaluated the apps according to a list of 25 major functions pivotal to promoting HF self-care for older adults. Results: A total of 74 apps for HF self-care were identified, but only 21 apps were listed as being both HF and self-care specific. None of the apps had all 25 of the listed features for an adequate HF self-care app, and only 41% (31/74) apps had the key weight management feature present. HF Storylines received the highest functionality score (18/25, 72%). Conclusions: Our findings suggest that currently available apps are not adequate for use by older adults with HF. This highlights the need for mHealth apps to refine their development process so that user needs and capabilities are identified during the design stage to ensure the usability of the app. %M 31710298 %R 10.2196/13173 %U https://mhealth.jmir.org/2019/11/e13173 %U https://doi.org/10.2196/13173 %U http://www.ncbi.nlm.nih.gov/pubmed/31710298 %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 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 e15940 %T Improving Medication Information Presentation Through Interactive Visualization in Mobile Apps: Human Factors Design %A Roosan,Don %A Li,Yan %A Law,Anandi %A Truong,Huy %A Karim,Mazharul %A Chok,Jay %A Roosan,Moom %+ Western University of Health Sciences, College of Pharmacy, 309 E 2nd St, Pomona, CA, , United States, 1 909 469 8778, droosan@westernu.edu %K visual perception %K adverse drug event %K human factors design %K mobile health %D 2019 %7 25.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the detailed patient package inserts (PPIs) with prescription drugs that communicate crucial information about safety, there is a critical gap between patient understanding and the knowledge presented. As a result, patients may suffer from adverse events. We propose using human factors design methodologies such as hierarchical task analysis (HTA) and interactive visualization to bridge this gap. We hypothesize that an innovative mobile app employing human factors design with an interactive visualization can deliver PPI information aligned with patients’ information processing heuristics. Such an app may help patients gain an improved overall knowledge of medications. Objective: The objective of this study was to explore the feasibility of designing an interactive visualization-based mobile app using an HTA approach through a mobile prototype. Methods: Two pharmacists constructed the HTA for the drug risperidone. Later, the specific requirements of the design were translated using infographics. We transferred the wireframes of the prototype into an interactive user interface. Finally, a usability evaluation of the mobile health app was conducted. Results: A mobile app prototype using HTA and infographics was successfully created. We reiterated the design based on the specific recommendations from the usability evaluations. Conclusions: Using HTA methodology, we successfully created a mobile prototype for delivering PPI on the drug risperidone to patients. The hierarchical goals and subgoals were translated into a mobile prototype. %M 31763991 %R 10.2196/15940 %U http://mhealth.jmir.org/2019/11/e15940/ %U https://doi.org/10.2196/15940 %U http://www.ncbi.nlm.nih.gov/pubmed/31763991 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15313 %T The Use of Smartphone-Based Triage to Reduce the Rate of Outpatient Error Registration: Cross-Sectional Study %A Xie,Wanhua %A Cao,Xiaojun %A Dong,Hongwei %A Liu,Yu %+ Outpatient Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No 9 Jinhui Road, Tianhe District, Guangzhou, 510623, China, 86 13725370379, xiewanhua1@126.com %K smartphone %K triage %K outpatients %K personal satisfaction %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In many clinics, patients now have the option to make Web-based appointments but doing so according to their own judgment may lead to wrong registration and delayed medical services. We hypothesized that smartphone-based triage in outpatient services is superior to Web-based self-appointment registration guided by the medical staff. Objective: This study aimed to investigate smartphone-based triage in outpatient services compared with Web-based self-appointment registration and to provide a reference for improving outpatient care under appointment registration. Methods: The following parameters in Guangzhou Women and Children’s Medical Center were analyzed: wrong registration rate, the degree of patient satisfaction, outpatient visits 6 months before and after smartphone-based triage, queries after smartphone-based triage, number of successful registrations, inquiry content, and top 10 recommended diseases and top 10 recommended departments after queries. Results: Smartphone-based triage showed significant effects on average daily queries, which accounted for 16.15% (1956/12,112) to 29.46% (3643/12,366) of daily outpatient visits. The average daily successful registration after queries accounted for 56.14% (1101/1961) to 60.92% (1437/2359) of daily queries and 9.33% (1130/12,112) to 16.83% (2081/12,366) of daily outpatient visits. The wrong registration rate after smartphone-based triage was reduced from 0.68% (12,810/1,895,829) to 0.12% (2379/2,017,921) (P<.001), and the degree of patient satisfaction was improved. Monthly outpatient visits were increased by 0.98% (3192/325,710) to 13.09% (42,939/328,032) compared with the same period the preceding year (P=.02). Conclusions: Smartphone-based triage significantly reduces the wrong registration rate caused by patient Web-based appointment registration and improves the degree of patient satisfaction. Thus, it is worth promoting. %M 31710300 %R 10.2196/15313 %U http://mhealth.jmir.org/2019/11/e15313/ %U https://doi.org/10.2196/15313 %U http://www.ncbi.nlm.nih.gov/pubmed/31710300 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e16442 %T Quality Awareness and Its Influence on the Evaluation of App Meta-Information by Physicians: Validation Study %A Albrecht,Urs-Vito %A Framke,Theodor %A von Jan,Ute %+ Peter L Reichertz Institute for Medical Informatics, Hannover Medical School, Carl-Neuberg-Str 1, Hannover, 30625, Germany, 49 511532 ext 3508, albrecht.urs-vito@mh-hannover.de %K mobile health %K evaluation studies %K mobile apps %K quality principles %K usage decisions %D 2019 %7 18.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Meta-information provided about health apps on app stores is often the only readily available source of quality-related information before installation. Objective: The purpose of this study was to assess whether physicians deem a predefined set of quality principles as relevant for health apps; whether they are able to identify corresponding information in a given sample of app descriptions; and whether, and how, this facilitates their informed usage decisions. Methods: All members of the German Society for Internal Medicine were invited by email to participate in an anonymous online survey over a 6-week period. Participants were randomly assigned one app description focusing on cardiology or pulmonology. In the survey, participants were asked three times about whether the assigned description sufficed for a usage decision: they were asked (1) after giving an appraisal of the relevance of nine predefined app quality principles, (2) after determining whether the descriptions covered the quality principles, and (3) after they assessed the availability of detailed quality information by means of 25 additional key questions. Tests for significance of changes in their decisions between assessments 1 and 2, and between assessments 2 and 3, were conducted with the McNemar-Bowker test of symmetry. The effect size represents the discordant proportion ratio sum as a quotient of the test statistics of the Bowker test and the number of observation units. The significance level was set to alpha=.05 with a power of 1-beta=.95. Results: A total of 441 of 724 participants (60.9%) who started the survey fully completed the questionnaires and were included in the evaluation. The participants predominantly rated the specified nine quality principles as important for their decision (approximately 80%-99% of ratings). However, apart from the practicality criterion, information provided in the app descriptions was lacking for both groups (approximately 51%-92%). Reassessment of the apps led to more critical assessments among both groups. After having familiarized themselves with the nine quality principles, approximately one-third of the participants (group A: 63/220, 28.6%; group B: 62/221, 28.1%) came to more critical usage decisions in a statistically significant manner (McNemar-Bowker test, groups A and B: P<.001). After a subsequent reassessment with 25 key questions, critical appraisals further increased, although not in a statistically significant manner (McNemar-Bowker, group A: P=.13; group B: P=.05). Conclusions: Sensitizing physicians to the topic of quality principles via questions about attitudes toward established quality principles, and letting them apply these principles to app descriptions, lead to more critical appraisals of the sufficiency of the information they provided. Even working with only nine generic criteria was sufficient to bring about the majority of decision changes. This may lay the foundation for aiding physicians in their app-related decision processes, without unduly taking up their valuable time. %M 31738179 %R 10.2196/16442 %U http://mhealth.jmir.org/2019/11/e16442/ %U https://doi.org/10.2196/16442 %U http://www.ncbi.nlm.nih.gov/pubmed/31738179 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15191 %T Continuous Digital Monitoring of Walking Speed in Frail Elderly Patients: Noninterventional Validation Study and Longitudinal Clinical Trial %A Mueller,Arne %A Hoefling,Holger Alfons %A Muaremi,Amir %A Praestgaard,Jens %A Walsh,Lorcan C %A Bunte,Ola %A Huber,Roland Martin %A Fürmetz,Julian %A Keppler,Alexander Martin %A Schieker,Matthias %A Böcker,Wolfgang %A Roubenoff,Ronenn %A Brachat,Sophie %A Rooks,Daniel S %A Clay,Ieuan %+ Novartis Institutes for BioMedical Research, Campus St Johan, Basel, Switzerland, 41 61 324 1111, ieuan.clay@novartis.com %K gait %K walking speed %K mobility limitation %K accelerometry %K clinical trials %K frailty %K wearable electronic devices %K algorithms %K open source data %K data collection %K dataset %D 2019 %7 27.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital technologies and advanced analytics have drastically improved our ability to capture and interpret health-relevant data from patients. However, only limited data and results have been published that demonstrate accuracy in target indications, real-world feasibility, or the validity and value of these novel approaches. Objective: This study aimed to establish accuracy, feasibility, and validity of continuous digital monitoring of walking speed in frail, elderly patients with sarcopenia and to create an open source repository of raw, derived, and reference data as a resource for the community. Methods: Data described here were collected as a part of 2 clinical studies: an independent, noninterventional validation study and a phase 2b interventional clinical trial in older adults with sarcopenia. In both studies, participants were monitored by using a waist-worn inertial sensor. The cross-sectional, independent validation study collected data at a single site from 26 naturally slow-walking elderly subjects during a parcours course through the clinic, designed to simulate a real-world environment. In the phase 2b interventional clinical trial, 217 patients with sarcopenia were recruited across 32 sites globally, where patients were monitored over 25 weeks, both during and between visits. Results: We have demonstrated that our approach can capture in-clinic gait speed in frail slow-walking adults with a residual standard error of 0.08 m per second in the independent validation study and 0.08, 0.09, and 0.07 m per second for the 4 m walk test (4mWT), 6-min walk test (6MWT), and 400 m walk test (400mWT) standard gait speed assessments, respectively, in the interventional clinical trial. We demonstrated the feasibility of our approach by capturing 9668 patient-days of real-world data from 192 patients and 32 sites, as part of the interventional clinical trial. We derived inferred contextual information describing the length of a given walking bout and uncovered positive associations between the short 4mWT gait speed assessment and gait speed in bouts between 5 and 20 steps (correlation of 0.23) and longer 6MWT and 400mWT assessments with bouts of 80 to 640 steps (correlations of 0.48 and 0.59, respectively). Conclusions: This study showed, for the first time, accurate capture of real-world gait speed in slow-walking older adults with sarcopenia. We demonstrated the feasibility of long-term digital monitoring of mobility in geriatric populations, establishing that sufficient data can be collected to allow robust monitoring of gait behaviors outside the clinic, even in the absence of feedback or incentives. Using inferred context, we demonstrated the ecological validity of in-clinic gait assessments, describing positive associations between in-clinic performance and real-world walking behavior. We make all data available as an open source resource for the community, providing a basis for further study of the relationship between standardized physical performance assessment and real-world behavior and independence. %M 31774406 %R 10.2196/15191 %U http://mhealth.jmir.org/2019/11/e15191/ %U https://doi.org/10.2196/15191 %U http://www.ncbi.nlm.nih.gov/pubmed/31774406 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13858 %T Parental Perspectives of a Wearable Activity Tracker for Children Younger Than 13 Years: Acceptability and Usability Study %A Mackintosh,Kelly A %A Chappel,Stephanie E %A Salmon,Jo %A Timperio,Anna %A Ball,Kylie %A Brown,Helen %A Macfarlane,Susie %A Ridgers,Nicola D %+ Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia, 61 3 9244 6718, nicky.ridgers@deakin.edu.au %K mobile applications %K physical activity %K child %K monitoring, ambulatory %K wearable electronic devices %D 2019 %7 4.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is increasing availability of, and interest in, wearable activity trackers for children younger than 13 years. However, little is known about how children and parents use these activity trackers or perceive their acceptability. Objective: This study primarily aimed to ascertain parental perspectives on the acceptability and usability of wearables designed to monitor children’s physical activity levels. Secondary aims were to (1) identify practical considerations for future use in physical activity interventions and promotion initiatives; (2) determine use of different features and functions incorporated into the accompanying app; and (3) identify parents’ awareness of their child’s current physical activity levels. Methods: In total, 36 children (18 boys and 18 girls) aged 7-12 years were asked to wear a wrist-worn activity tracker (KidFit) for 4 consecutive weeks and to use the accompanying app with parental assistance and guidance. Each week, one parent from each family (n=25; 21 mothers and 4 fathers) completed a Web-based survey to record their child’s activity tracker use, app interaction, and overall experiences. At the end of the 4-week period, a subsample of 10 parents (all mothers) participated in face-to-face interviews exploring perceptions of the acceptability and usability of wearable activity trackers and accompanying apps. Quantitative and qualitative data were analyzed descriptively and thematically, respectively. Thematic data are presented using pen profiles, which were constructed from verbatim transcripts. Results: Parents reported that they and their children typically found the associated app easy to use for activity tracking, though only step or distance information was generally accessed and some difficulties interpreting the data were reported. Children were frustrated with not being able to access real-time feedback, as the features and functions were only available through the app, which was typically accessed by, or in the presence of, parents. Parents identified that children wanted additional functions including a visual display to track and self-monitor activity, access to the app for goal setting, and the option of undertaking challenges against schools or significant others. Other barriers to the use of wearable activity trackers included discomfort of wearing the monitor because of the design and the inability to wear for water- or contact-based sports. Conclusions: Most parents reported that the wearable activity tracker was easy for their child or children to use and a useful tool for tracking their children’s daily activity. However, several barriers were identified, which may impact sustained use over time; both the functionality and wearability of the activity tracker should therefore be considered. Overall, wearable activity trackers for children have the potential to be integrated into targeted physical activity promotion initiatives. %M 31682585 %R 10.2196/13858 %U https://mhealth.jmir.org/2019/11/e13858 %U https://doi.org/10.2196/13858 %U http://www.ncbi.nlm.nih.gov/pubmed/31682585 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13722 %T Opportunities and Pitfalls in Applying Emotion Recognition Software for Persons With a Visual Impairment: Simulated Real Life Conversations %A Buimer,Hendrik %A Schellens,Renske %A Kostelijk,Tjerk %A Nemri,Abdellatif %A Zhao,Yan %A Van der Geest,Thea %A Van Wezel,Richard %+ Department of Biophysics, Radboud University, Heijendaalseweg 135, Nijmegen, Netherlands, 31 24 3652428, h.buimer@donders.ru.nl %K visual impairment %K emotion recognition %K tactile %K social interaction %D 2019 %7 21.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A large part of the communication cues exchanged between persons is nonverbal. Persons with a visual impairment are often unable to perceive these cues, such as gestures or facial expression of emotions. In a previous study, we have determined that visually impaired persons can increase their ability to recognize facial expressions of emotions from validated pictures and videos by using an emotion recognition system that signals vibrotactile cues associated with one of the six basic emotions. Objective: The aim of this study was to determine whether the previously tested emotion recognition system worked equally well in realistic situations and under controlled laboratory conditions. Methods: The emotion recognition system consists of a camera mounted on spectacles, a tablet running facial emotion recognition software, and a waist belt with vibrotactile stimulators to provide haptic feedback representing Ekman’s six universal emotions. A total of 8 visually impaired persons (4 females and 4 males; mean age 46.75 years, age range 28-66 years) participated in two training sessions followed by one experimental session. During the experiment, participants engaged in two 15 minute conversations, in one of which they wore the emotion recognition system. To conclude the study, exit interviews were conducted to assess the experiences of the participants. Due to technical issues with the registration of the emotion recognition software, only 6 participants were included in the video analysis. Results: We found that participants were quickly able to learn, distinguish, and remember vibrotactile signals associated with the six emotions. A total of 4 participants felt that they were able to use the vibrotactile signals in the conversation. Moreover, 5 out of the 6 participants had no difficulties in keeping the camera focused on the conversation partner. The emotion recognition was very accurate in detecting happiness but performed unsatisfactorily in recognizing the other five universal emotions. Conclusions: The system requires some essential improvements in performance and wearability before it is ready to support visually impaired persons in their daily life interactions. Nevertheless, the participants saw potential in the system as an assistive technology, assuming their user requirements can be met. %M 31750838 %R 10.2196/13722 %U https://mhealth.jmir.org/2019/11/e13722 %U https://doi.org/10.2196/13722 %U http://www.ncbi.nlm.nih.gov/pubmed/31750838 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13765 %T Real-Time Mobile Monitoring of Drinking Episodes in Young Adult Heavy Drinkers: Development and Comparative Survey Study %A Fridberg,Daniel J %A Faria,James %A Cao,Dingcai %A King,Andrea C %+ Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S Maryland Ave, MC 3077, Chicago, IL, 60637, United States, 1 7738343598, dfridberg@bsd.uchicago.edu %K ecological momentary assessment %K young adults %K binge drinking %D 2019 %7 20.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Binge drinking, defined as consuming five or more standard alcoholic drinks for men (four for women) within a 2-hour period, is common among young adults and is associated with significant alcohol-related morbidity and mortality. To date, most research on this problem in young adults has relied upon retrospective questionnaires or costly laboratory-based procedures. Smartphone-based ecological momentary assessment (EMA) may address these limitations by allowing researchers to measure alcohol use and related consequences in real time and in drinkers’ natural environments. To date, however, relatively less research has systematically examined the utility of this approach in a sample of young adults targeting real-world heavy drinking episodes specifically. Objective: This study aimed to evaluate the feasibility, acceptability, and safety of a smartphone-based EMA method targeting binge drinking and related outcomes in heavy drinking young adults during real-world drinking occasions. Methods: Young adult binge drinkers in the smartphone group (N=83; mean 25.4 (SD 2.6) years; 58% (48/83) male; bingeing on 23.2% (6.5/28) days in the past month) completed baseline measures of alcohol use and drinking-related consequences, followed by up to two smartphone-based EMA sessions of typical drinking behavior and related outcomes in their natural environments. They also completed next-day and two-week follow-up surveys further assessing alcohol use and related consequences during the EMA sessions and two weeks after study participation, respectively. A separate demographic- and drinking-matched safety comparison group (N=25) completed the baseline and two-week follow-up surveys but did not complete EMA of real-world drinking behavior. Results: Most participants (71%, 59/83) in the smartphone group engaged in binge drinking during at least one 3-hour EMA session, consuming 7.3 (SD 3.0) standard alcoholic drinks. They completed 87.2% (507/581) system-initiated EMA prompts during the real-world drinking episode, supporting the feasibility of this approach. The procedure was acceptable, as evidenced by high participant ratings for overall satisfaction with the EMA software and study procedures and low ratings for intrusiveness of the mobile surveys. Regarding safety, participants endorsed few drinking-related consequences during or after the real-world drinking episode, with no adverse or serious adverse events reported. There were no differences between the groups in terms of changes in drinking behavior or consequences from baseline to two-week follow-up. Conclusions: This study provided preliminary support for the feasibility, acceptability, and safety of a smartphone-based EMA of real-time alcohol use and related outcomes in young adult heavy drinkers. The results suggest that young adults can use smartphones to safely monitor drinking even during very heavy drinking episodes. Smartphone-based EMA has strong potential to inform future research on the epidemiology of and intervention for alcohol use disorder by providing researchers with an efficient and inexpensive way to capture large amounts of data on real-world drinking behavior and consequences. %M 31746774 %R 10.2196/13765 %U https://mhealth.jmir.org/2019/11/e13765 %U https://doi.org/10.2196/13765 %U http://www.ncbi.nlm.nih.gov/pubmed/31746774