%0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14512 %T Back to the Future: Achieving Health Equity Through Health Informatics and Digital Health %A Brewer,LaPrincess C %A Fortuna,Karen L %A Jones,Clarence %A Walker,Robert %A Hayes,Sharonne N %A Patten,Christi A %A Cooper,Lisa A %+ Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, United States, 1 5072661376, brewer.laprincess@mayo.edu %K health informatics %K digital health %K mobile health %K eHealth %K community-based participatory research %K health equity %D 2020 %7 14.1.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The rapid proliferation of health informatics and digital health innovations has revolutionized clinical and research practices. There is no doubt that these fields will continue to have accelerated growth and a substantial impact on population health. However, there are legitimate concerns about how these promising technological advances can lead to unintended consequences such as perpetuating health and health care disparities for underresourced populations. To mitigate this potential pitfall, it is imperative for the health informatics and digital health scientific communities to understand the challenges faced by disadvantaged groups, including racial and ethnic minorities, which hinder their achievement of ideal health. This paper presents illustrative exemplars as case studies of contextually tailored, sociotechnical mobile health interventions designed with community members to address health inequities using community-engaged research approaches. We strongly encourage researchers and innovators to integrate community engagement into the development of data-driven, modernized solutions for every sector of society to truly achieve health equity for all. %M 31934874 %R 10.2196/14512 %U https://mhealth.jmir.org/2020/1/e14512 %U https://doi.org/10.2196/14512 %U http://www.ncbi.nlm.nih.gov/pubmed/31934874 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e16060 %T Elements of Social Convoy Theory in Mobile Health for Palliative Care: Scoping Review %A Portz,Jennifer D %A Elsbernd,Kira %A Plys,Evan %A Ford,Kelsey Lynett %A Zhang,Xuhong %A Gore,M Odette %A Moore,Susan L %A Zhou,Shuo %A Bull,Sheana %+ General Internal Medicine, School of Medicine, University of Colorado, 13055 E 17th, F802, Aurora, CO, 80045, United States, 1 3037248856, jennifer.portz@cuanschutz.edu %K mHealth %K palliative care %K caregivers %K mobile apps %D 2020 %7 6.1.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) provides a unique modality for improving access to and awareness of palliative care among patients, families, and caregivers from diverse backgrounds. Some mHealth palliative care apps exist, both commercially available and established by academic researchers. However, the elements of family support and family caregiving tools offered by these early apps is unknown. Objective: The objective of this scoping review was to use social convoy theory to describe the inclusion and functionality of family, social relationships, and caregivers in palliative care mobile apps. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines, a systematic search of palliative care mHealth included (1) research-based mobile apps identified from academic searches published between January 1, 2010, and March 31, 2019 and (2) commercially available apps for app stores in April 2019. Two reviewers independently assessed abstracts, app titles, and descriptions against the inclusion and exclusion criteria. Abstracted data covered app name, research team or developer, palliative care element, target audience, and features for family support and caregiving functionality as defined by social convoy theory. Results: Overall, 10 articles describing 9 individual research-based apps and 22 commercially available apps were identified. Commercially available apps were most commonly designed for both patients and social convoys, whereas the majority of research apps were designed for patient use only. Conclusions: Results suggest there is an emerging presence of apps for patients and social convoys receiving palliative care; however, there are many needs for developers and researchers to address in the future. Although palliative care mHealth is a growing field, additional research is needed for apps that embrace a team approach to information sharing, target family- and caregiver-specific issues, promote access to palliative care, and are comprehensive of palliative needs. %M 31904581 %R 10.2196/16060 %U https://mhealth.jmir.org/2020/1/e16060 %U https://doi.org/10.2196/16060 %U http://www.ncbi.nlm.nih.gov/pubmed/31904581 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e13756 %T The Mobile-Based 6-Minute Walk Test: Usability Study and Algorithm Development and Validation %A Salvi,Dario %A Poffley,Emma %A Orchard,Elizabeth %A Tarassenko,Lionel %+ Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, United Kingdom, 44 1865617679, dario.salvi@eng.ox.ac.uk %K cardiology %K exercise test %K pulmonary hypertension %K mobile apps %K digital signal processing %K global positioning system %D 2020 %7 3.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The 6-min walk test (6MWT) is a convenient method for assessing functional capacity in patients with cardiopulmonary conditions. It is usually performed in the context of a hospital clinic and thus requires the involvement of hospital staff and facilities, with their associated costs. Objective: This study aimed to develop a mobile phone–based system that allows patients to perform the 6MWT in the community. Methods: We developed 2 algorithms to compute the distance walked during a 6MWT using sensors embedded in a mobile phone. One algorithm makes use of the global positioning system to track the location of the phone when outdoors and hence computes the distance travelled. The other algorithm is meant to be used indoors and exploits the inertial sensors built into the phone to detect U-turns when patients walk back and forth along a corridor of fixed length. We included these algorithms in a mobile phone app, integrated with wireless pulse oximeters and a back-end server. We performed Bland-Altman analysis of the difference between the distances estimated by the phone and by a reference trundle wheel on 49 indoor tests and 30 outdoor tests, with 11 different mobile phones (both Apple iOS and Google Android operating systems). We also assessed usability aspects related to the app in a discussion group with patients and clinicians using a technology acceptance model to guide discussion. Results: The mean difference between the mobile phone-estimated distances and the reference values was −2.013 m (SD 7.84 m) for the indoor algorithm and −0.80 m (SD 18.56 m) for the outdoor algorithm. The absolute maximum difference was, in both cases, below the clinically significant threshold. A total of 2 pulmonary hypertension patients, 1 cardiologist, 2 physiologists, and 1 nurse took part in the discussion group, where issues arising from the use of the 6MWT in hospital were identified. The app was demonstrated to be usable, and the 2 patients were keen to use it in the long term. Conclusions: The system described in this paper allows patients to perform the 6MWT at a place of their convenience. In addition, the use of pulse oximetry allows more information to be generated about the patient’s health status and, possibly, be more relevant to the real-life impact of their condition. Preliminary assessment has shown that the developed 6MWT app is highly accurate and well accepted by its users. Further tests are needed to assess its clinical value. %M 31899457 %R 10.2196/13756 %U https://mhealth.jmir.org/2020/1/e13756 %U https://doi.org/10.2196/13756 %U http://www.ncbi.nlm.nih.gov/pubmed/31899457 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14800 %T Spatiotemporal Analysis of Men Who Have Sex With Men in Mainland China: Social App Capture-Recapture Method %A Hu,Maogui %A Xu,Chengdong %A Wang,Jinfeng %+ State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, A11, Datun road, Beijing, China, 86 10 64888965, wangjf@lreis.ac.cn %K HIV risk %K men who have sex with men %K MSM distribution %K migration %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In China, the cases of newly diagnosed HIV/AIDS in men who have sex with men (MSM) have increased more than tenfold since 2006. However, the MSM population size, geographical distribution, and migration patterns are largely unknown. Objective: Our aim is to estimate the number, spatial distribution, and migration of MSM populations in mainland China using big data from social networking. Methods: We collected 85 days of data on online users of a social networking MSM app in mainland China. Daily online MSM users and their migration across the country were investigated during a holiday period and a nonholiday period. Using the capture-mark-recapture model, we designed an experiment consisting of two independent samples to estimate the total provincial MSM population. Results: The estimate of MSM in mainland China was 8,288,536 (95% CI 8,274,931-8,302,141), accounting for 1.732% (95% CI 1.729%-1.734%) of adult men aged 18 to 64 years. The average daily number of MSM social networking online across mainland China was 1,198,682 during the nonholiday period. The five provinces (including municipalities) with the highest average number of daily online MSM numbers were Guangdong (n=141,712), Jiangsu (n=90,710), Zhejiang (n=72,212), Shandong (n=68,065), and Beijing (n=66,057). The proportion of daily online MSM among adult men in different cities varied from 0.04% to 0.96%, with a mean of 0.20% (SD 0.14%). Three migrating centers—Guangdong, Beijing, and the Yangtze River Delta (Shanghai-Zhejiang-Jiangsu)—accounted for 57.23% of MSM migrants in the county. Conclusions: The percentage of MSM among adult men in mainland China is at the middle level compared with other Asia and Pacific countries. However, the number of MSM is very large, and the distribution is uneven. Both MSM distribution and migration are highly affected by socioeconomic status. %M 32012086 %R 10.2196/14800 %U https://mhealth.jmir.org/2020/1/e14800 %U https://doi.org/10.2196/14800 %U http://www.ncbi.nlm.nih.gov/pubmed/32012086 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14368 %T Engagement and Participant Experiences With Consumer Smartwatches for Health Research: Longitudinal, Observational Feasibility Study %A Beukenhorst,Anna L %A Howells,Kelly %A Cook,Louise %A McBeth,John %A O'Neill,Terence W %A Parkes,Matthew J %A Sanders,Caroline %A Sergeant,Jamie C %A Weihrich,Katy S %A Dixon,William G %+ Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, M139PL, United Kingdom, 44 161 275 5788, anna.beuk@manchester.ac.uk %K medical informatics computing %K mHealth %K patient-reported outcomes %K musculoskeletal diseases %K mobile phone %K smartwatch/wearable %K self-tracking %D 2020 %7 29.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearables provide opportunities for frequent health data collection and symptom monitoring. The feasibility of using consumer cellular smartwatches to provide information both on symptoms and contemporary sensor data has not yet been investigated. Objective: This study aimed to investigate the feasibility and acceptability of using cellular smartwatches to capture multiple patient-reported outcomes per day alongside continuous physical activity data over a 3-month period in people living with knee osteoarthritis (OA). Methods: For the KOALAP (Knee OsteoArthritis: Linking Activity and Pain) study, a novel cellular smartwatch app for health data collection was developed. Participants (age ≥50 years; self-diagnosed knee OA) received a smartwatch (Huawei Watch 2) with the KOALAP app. When worn, the watch collected sensor data and prompted participants to self-report outcomes multiple times per day. Participants were invited for a baseline and follow-up interview to discuss their motivations and experiences. Engagement with the watch was measured using daily watch wear time and the percentage completion of watch questions. Interview transcripts were analyzed using grounded thematic analysis. Results: A total of 26 people participated in the study. Good use and engagement were observed over 3 months: most participants wore the watch on 75% (68/90) of days or more, for a median of 11 hours. The number of active participants declined over the study duration, especially in the final week. Among participants who remained active, neither watch time nor question completion percentage declined over time. Participants were mainly motivated to learn about their symptoms and enjoyed the self-tracking aspects of the watch. Barriers to full engagement were battery life limitations, technical problems, and unfulfilled expectations of the watch. Participants reported that they would have liked to report symptoms more than 4 or 5 times per day. Conclusions: This study shows that capture of patient-reported outcomes multiple times per day with linked sensor data from a smartwatch is feasible over at least a 3-month period. International Registered Report Identifier (IRRID): RR2-10.2196/10238 %M 32012078 %R 10.2196/14368 %U https://mhealth.jmir.org/2020/1/e14368 %U https://doi.org/10.2196/14368 %U http://www.ncbi.nlm.nih.gov/pubmed/32012078 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15060 %T Making Self-Management Mobile Health Apps Accessible to People With Disabilities: Qualitative Single-Subject Study %A Zhou,Leming %A Saptono,Andi %A Setiawan,I Made Agus %A Parmanto,Bambang %+ Department of Health Information Management, University of Pittsburgh, 6021 Forbes Tower, 3600 Forbes Ave at Meyran Ave, Pittsburgh, PA, 15260, United States, 1 412 383 6653, Leming.Zhou@pitt.edu %K mobile app %K self-management %K accessibility %K personalization %D 2020 %7 3.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Over the past decade, a large number of mobile health (mHealth) apps have been created to help individuals to better manage their own health. However, very few of these mHealth apps were specifically designed for people with disabilities, and only a few of them have been assessed for accessibility for people with disabilities. As a result, people with disabilities have difficulties using many of these mHealth apps. Objective: The objective of this study was to identify an approach that can be generally applied to improve the accessibility of mHealth apps. Methods: We recruited 5 study participants with a primary diagnosis of cerebral palsy or spinal cord injury. All the participants had fine motor impairment or lack of dexterity, and hence, they had difficulties using some mHealth apps. These 5 study participants were first asked to use multiple modules in the client app of a novel mHealth system (iMHere 2.0), during which their performance was observed. Interviews were conducted post use to collect study participants’ desired accessibility features. These accessibility features were then implemented into the iMHere 2.0 client app as customizable options. The 5 participants were asked to use the same modules in the app again, and their performance was compared with that in the first round. A brief interview and a questionnaire were then performed at the end of the study to collect the 5 participants’ comments and impression of the iMHere 2.0 app in general and of the customizable accessibility features. Results: Study results indicate that the study participants on their first use of the iMHere 2.0 client app experienced various levels of difficulty consistent with the severity of their lack of dexterity. Their performance was improved after their desired accessibility features were added into the app, and they liked the customizable accessibility features. These participants also expressed an interest in using this mHealth system for their health self-management tasks. Conclusions: The accessibility features identified in this study improved the accessibility of the mHealth app for people with dexterity issues. Our approach for improving mHealth app accessibility may also be applied to other mHealth apps to make those apps accessible to people with disabilities. %M 31899453 %R 10.2196/15060 %U https://mhealth.jmir.org/2020/1/e15060 %U https://doi.org/10.2196/15060 %U http://www.ncbi.nlm.nih.gov/pubmed/31899453 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14036 %T An Ototoxicity Grading System Within a Mobile App (OtoCalc) for a Resource-Limited Setting to Guide Grading and Management of Drug-Induced Hearing Loss in Patients With Drug-Resistant Tuberculosis: Prospective, Cross-Sectional Case Series %A Hollander,Cara %A Joubert,Karin %A Schellack,Natalie %+ School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa, 0208, South Africa, 27 828158878, carahollander6@gmail.com %K drug-resistant tuberculosis %K ototoxicity %K grading system %K eHealth %K OtoCalc %D 2020 %7 14.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tuberculosis (TB) affects millions of people worldwide and is treated with medication including aminoglycosides and polypeptides. Individuals respond differently to medications as a result of their genetic inheritance. These differences in genetic inheritance can result in the underdosing or overdosing of medication, which may affect the efficacy or, in the case of aminoglycosides and polypeptides used in the treatment of all forms of TB, result in ototoxicity. When ototoxicity is detected, physicians should adjust dosages to minimize further ototoxicity and hearing loss; however, there are no suitable grading systems to define significant hearing loss. Objective: The aim of this study was to develop a standardized grading system by making use of an electronic health (eHealth) platform to ensure that a user-friendly method was available to interpret hearing test results, calculate significant hearing loss, and provide recommendations with regard to dosage adjustments and management. It further aimed to establish the sensitivity of the newly developed grading scale. Methods: This grading system was developed in South Africa based on data that were obtained from an audiology and pharmacokinetic study on patients with drug-resistant TB (DR-TB) at two DR-TB units at state-run hospitals. This feasibility study employed a prospective, cross-sectional, exploratory, descriptive case series research design, with a total of 22 participants. Participants underwent audiological and pharmacological assessments at baseline and every 2 weeks for the first 3 months of treatment. Various professionals (8 in total) were subsequently involved in the development of the eHealth system, including a software engineer, four audiologists, a pharmacist, a medical doctor, and a nurse. The app underwent 14 modifications that involved aspects of data storage, ease of usability, grades, and the risk factor checklist. Results: An ototoxicity grading system within a mobile app for use by doctors, nurses, and audiologists was developed for patients with DR-TB. The purpose of this user-friendly ototoxicity calculator, OtoCalc, is to (1) assist health professionals in assessing patients for ototoxicity, (2) establish the clinical significance of ototoxicity by calculating the grade of hearing loss, (3) monitor the progression of hearing loss, and (4) enable systematic referral and management of patients according to their needs. Conclusions: This newly developed system is more sensitive than the existing grading methods for determining ototoxicity in patients with DR-TB. This app needs to be trialed in a larger sample to establish data security, ease of use, and suitability within this population. %M 31934875 %R 10.2196/14036 %U https://mhealth.jmir.org/2020/1/e14036 %U https://doi.org/10.2196/14036 %U http://www.ncbi.nlm.nih.gov/pubmed/31934875 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12859 %T A Smartphone App Designed to Empower Patients to Contribute Toward Safer Surgical Care: Community-Based Evaluation Using a Participatory Approach %A Russ,Stephanie %A Latif,Zahira %A Hazell,Ahmarah Leah %A Ogunmuyiwa,Helen %A Tapper,Josephine %A Wachuku-King,Sylvia %A Sevdalis,Nick %A Ocloo,Josephine %+ King's College London, Institution of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom, 44 207 848 0683, stephanie.russ@kcl.ac.uk %K patient safety %K surgery %K smartphone %K mobile phone %K patient empowerment %D 2020 %7 20.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: MySurgery is a smartphone app designed to increase patient and carer involvement in behaviors that contribute toward safety in surgical care. Objective: This study presents a pilot evaluation of MySurgery in which we evaluated surgical patients’ perceptions of the app in terms of its content, usability, and potential impacts on communication and safety. Methods: A participatory action research (PAR) approach was used to formulate a research steering group consisting of 5 public representatives and 4 researchers with equal decision-making input. Surgical patients were recruited from the community using multiple approaches, including Web based (eg, social media, recruitment websites, and charitable or voluntary organizations) and face to face (via community centers). Participants referred to MySurgery before, during, and after their surgery and provided feedback via an embedded questionnaire and using reflective notes. Results: A diverse mix of 42 patients took part with good representation from 2 “seldom heard” groups: those with a disability and those from a black, Asian, or minority ethnic group. Most were very supportive of MySurgery, particularly those with previous experience of surgery and those who felt comfortable to be involved in conversations and decisions around their care. The app showed particular potential to empower patients to become involved in their care conversations and safety-related behaviors. Perceptions did not differ according to age, ethnicity, or length of hospital stay. Suggestions for improving the app included how to make it more accessible to certain groups, for example, those with a disability. Conclusions: MySurgery is a novel technology-driven approach for empowering patients to play a role in improving surgical safety that seems feasible for use within the United Kingdom’s National Health Service. Adopting a PAR approach and the use of a diversity strategy considerably enhanced the research process in terms of gaining diverse participant recruitment and patient and public involvement. Further testing with stakeholder groups will follow. %M 31958067 %R 10.2196/12859 %U https://mhealth.jmir.org/2020/1/e12859 %U https://doi.org/10.2196/12859 %U http://www.ncbi.nlm.nih.gov/pubmed/31958067 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15593 %T Testing Consultation Recordings in a Clinical Setting With the SecondEars Smartphone App: Mixed Methods Implementation Study %A Hyatt,Amelia %A Lipson-Smith,Ruby %A Morkunas,Bryce %A Krishnasamy,Meinir %A Jefford,Michael %A Baxter,Kathryn %A Gough,Karla %A Murphy,Declan %A Drosdowsky,Allison %A Phipps-Nelson,Jo %A White,Fiona %A White,Alan %A Serong,Lesley %A McDonald,Geraldine %A Milne,Donna %+ Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, 3068, Australia, 61 385597837, amelia.hyatt@petermac.org %K mHealth %K cancer %K mobile apps %K implementation %K pilot %K consultation audio recording %D 2020 %7 21.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care systems are increasingly looking to mobile device technologies (mobile health) to improve patient experience and health outcomes. SecondEars is a smartphone app designed to allow patients to audio-record medical consultations to improve recall, understanding, and health care self-management. Novel health interventions such as SecondEars often fail to be implemented post pilot-testing owing to inadequate user experience (UX) assessment, a key component of a comprehensive implementation strategy. Objective: This study aimed to pilot the SecondEars app within an active clinical setting to identify factors necessary for optimal implementation. Objectives were to (1) investigate patient UX and acceptability, utility, and satisfaction with the SecondEars app, and (2) understand health professional perspectives on issues, solutions, and strategies for effective implementation of SecondEars. Methods: A mixed methods implementation study was employed. Patients were invited to test the app to record consultations with participating oncology health professionals. Follow-up interviews were conducted with all participating patients (or carers) and health professionals, regarding uptake and extent of app use. Responses to the Mobile App Rating Scale (MARS) were also collected. Interviews were analyzed using interpretive descriptive methodology; all quantitative data were analyzed descriptively. Results: A total of 24 patients used SecondEars to record consultations with 10 multidisciplinary health professionals. In all, 22 of these patients used SecondEars to listen to all or part of the recording, either alone or with family. All 100% of patient participants reported in the MARS that they would use SecondEars again and recommend it to others. A total of 3 themes were identified from the patient interviews relating to the UX of SecondEars: empowerment, facilitating support in cancer care, and usability. Further, 5 themes were identified from the health professional interviews relating to implementation of SecondEars: changing hospital culture, mitigating medico-legal concerns, improving patient care, communication, and practical implementation solutions. Conclusions: Data collected during pilot testing regarding recording use, UX, and health professional and patient perspectives will be important for designing an effective implementation strategy for SecondEars. Those testing the app found it useful and felt that it could facilitate the benefits of consultation recordings, along with providing patient empowerment and support. Potential issues regarding implementation were discussed, and solutions were generated. Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12618000730202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373915&isClinicalTrial=False %M 31961333 %R 10.2196/15593 %U https://mhealth.jmir.org/2020/1/e15593 %U https://doi.org/10.2196/15593 %U http://www.ncbi.nlm.nih.gov/pubmed/31961333 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e17055 %T Benefits of Mobile Apps for Cancer Pain Management: Systematic Review %A Zheng,Caiyun %A Chen,Xu %A Weng,Lizhu %A Guo,Ling %A Xu,Haiting %A Lin,Meimei %A Xue,Yan %A Lin,Xiuqin %A Yang,Aiqin %A Yu,Lili %A Xue,Zenggui %A Yang,Jing %+ Department of Pharmacy, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou, 350001, China, 86 0591 86218372, wlz0965@fjmu.edu.cn %K mobile apps %K cancer pain %K meta-analysis %K instant messaging %D 2020 %7 23.1.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Pain ratings reported by patients with cancer continue to increase, and numerous computer and phone apps for managing cancer-related pain have been developed recently; however, whether these apps effectively alleviate patients’ pain remains unknown. Objective: This study aimed to comprehensively evaluate the role of mobile apps in the management of cancer pain. Methods: Literature on the use of apps for cancer pain management and interventions, published before August 2019, was retrieved from the following databases: MEDLINE, Embase, Cochrane, CINAHL, Scopus, and PsycINFO. The effects of apps on cancer pain were evaluated using RevMan5.3 software, and the rates of adverse drug reactions were analyzed using the R Statistical Software Package 3.5.3. Results: A total of 13 studies were selected for the analysis: 5 randomized controlled trials (RCTs), 4 before-after studies, 2 single-arm trials, 1 prospective cohort study, and 1 prospective descriptive study. The 5 RCTs reported data for 487 patients (240 patients in the intervention group and 247 patients in the control group), and the remaining studies reported data for 428 patients. We conducted a meta-analysis of the RCTs. According to the meta-analysis, apps can significantly reduce pain scores (mean difference [MD]=–0.50, 95% CI –0.94 to –0.07, I2=62%, P=.02). We then used apps that have an instant messaging module for subgroup analysis; these apps significantly reduced patients’ pain scores (MD=–0.67, 95% CI –1.06 to –0.28, I2=57%, P<.01). Patients using apps without an instant messaging module did not see a reduction in the pain score (MD=0.30, 95% CI –1.31 to 1.92, I2=70%, P=.71). Overall, patients were highly satisfied with using apps. Other outcomes, such as pain catastrophizing or quality of life, demonstrated greater improvement in patients using apps with instant messaging modules compared with patients not using an app. Conclusions: The use of apps with instant messaging modules is associated with reduced pain scores in patients with cancer-related pain, and patient acceptance of these apps is high. Apps without instant messaging modules are associated with relatively higher pain scores. The presence of an instant messaging module may be a key factor affecting the effect of an app on cancer pain. %M 32012088 %R 10.2196/17055 %U http://mhealth.jmir.org/2020/1/e17055/ %U https://doi.org/10.2196/17055 %U http://www.ncbi.nlm.nih.gov/pubmed/32012088 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15503 %T Mobile Clinical Decision Tools Among Emergency Department Clinicians: Web-Based Survey and Analytic Data for Evaluation of The Ottawa Rules App %A Quan,Amanda My Linh %A Stiell,Ian %A Perry,Jeffrey J %A Paradis,Michelle %A Brown,Erica %A Gignac,Jordan %A Wilson,Lindsay %A Wilson,Kumanan %+ The Ottawa Hospital Research Institute, Clinical Epidemiology, 1053 Carling Avenue, Box 684, Administrative Services Building, Ottawa, ON, K1Y 4E9, Canada, 1 (613) 7985555, kwilson@ohri.ca %K emergency departments %K mHealth %K clinical prediction rule %K decision aids %D 2020 %7 29.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Canadian CT Head Rule (CCHR), the Canadian Transient Ischemic Attack (TIA) Score, and the Subarachnoid Hemorrhage (SAH) Rule have all previously demonstrated the potential to significantly standardize care and improve the management of patients in emergency departments (EDs). On the basis of user feedback, we believe that the addition of these rules to the Ottawa Rules App has the potential to increase the app’s usability and user acceptability. Objective: This study aimed to evaluate the perceived usefulness, acceptability, and uptake of the enhanced Ottawa Rules App (which now includes CCHR, TIA, and SAH Rules) among ED clinicians (medical students, residents, nurses, and physicians). Methods: The enhanced Ottawa Rules App was publicly released for free on iOS and Android operating systems in November 2018. This study was conducted across 2 tertiary EDs in Ottawa, Canada. Posters, direct enrollment, snowball sampling, and emails were used for study recruitment. A 24-question Web-based survey was administered to participants via email, and this was used to determine user acceptability of the app and Technology Readiness Index (TRI) scores. In-app user analytics were collected to track user behavior, such as the number of app sessions, length of app sessions, frequency of rule use, and the date app was first opened. Results: A total of 77 ED clinicians completed the study, including 34 nurses, 12 residents, 14 physicians, and 17 medical students completing ED rotations. The median TRI score for this group was 3.38, indicating a higher than average propensity to embrace and adopt new technologies to accomplish goals in their work or daily lives. The majority of respondents agreed or strongly agreed that the app helped participants accurately carry out the clinical rules (56/77, 73%) and that they would recommend this app to their colleagues (64/77, 83%). Feedback from study participants suggested further expansion of the app—more clinical decision rules (CDRs) and different versions of the app tailored to the clinician role. Analysis and comparison of Google Analytics data and in-app data revealed similar usage behavior among study-enrolled users and all app users globally. Conclusions: This study provides evidence that using the Ottawa Rules App (version 3.0.2) to improve and guide patient care would be feasible and widely accepted. The ability to verify self-reported user data (via a Web-based survey) against server analytics data is a notable strength of this study. Participants’ continued app use and request for the addition of more CDRs warrant the further development of this app and call for additional studies to evaluate its feasibility and usability in different settings as well as assessment of clinical impact. %M 32012095 %R 10.2196/15503 %U https://mhealth.jmir.org/2020/1/e15503 %U https://doi.org/10.2196/15503 %U http://www.ncbi.nlm.nih.gov/pubmed/32012095 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14694 %T A Tablet App Supporting Self-Management for People With Dementia: Explorative Study of Adoption and Use Patterns %A Øksnebjerg,Laila %A Woods,Bob %A Ruth,Kathrine %A Lauridsen,Annette %A Kristiansen,Susanne %A Holst,Helle Dalsgaard %A Waldemar,Gunhild %+ Danish Dementia Research Centre, Department of Neurology, The Neuroscience Centre, Rigshospitalet, Section 6922, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 22253335, laila.oeksnebjerg.02@regionh.dk %K dementia %K technology %K information technology %K self-help devices %K app %K self-management %K rehabilitation %K memory %K caregivers %D 2020 %7 17.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Assistive technology (AT) is rapidly emerging within dementia care and support. One area of AT application is support of people with dementia in compensating for cognitive symptoms and thereby promoting their self-management. There is, however, little evidence for the applicability, usability, and effectiveness of AT for people with dementia, and there is a need to identify factors that can promote adoption. Objective: This study aimed to (1) evaluate the applicability and usability of an app, tailor-made for people with dementia; (2) explore factors affecting adoption; (3) explore the possible influence of caregiver involvement; and (4) contribute to process evaluation of the intervention. Methods: The ReACT (Rehabilitation in Alzheimer's disease using Cognitive support Technology) app was designed as a holistic solution to support memory and structure in daily living. Persons with dementia had access to a personal user account, and family caregivers were given a parallel login. Written and Web-based materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use patterns, including background and disease-related data, qualitative data from a survey, and log data. Adoption was defined as the use of the app over a period of ≥90 days. Results: Data from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595; P=.046; r=0.19) and caregiver activating the app (P=.02) had a significant impact on the participant adoption status. Logistic regression analysis showed that if caregivers had activated the app, the participant was five times more likely to become an adopter (odds ratio 5.1, 95% CI 1.29-19.99; P=.02). However, the overall predictive power was low, and there was a wide variation in background and disease-related characteristics among adopters. The level of experience and skills in tablet use were not significantly different between adopters and nonadopters. Adopters generally rated the app high on usefulness, satisfaction, and ease of use (rated on the USEdem questionnaire). Their scores were significantly higher compared with nonadopters (U=5.5; P=.02; r=0.64). Analysis of use patterns showed that all functionalities of the app were used among adopters. Conclusions: For participants who became adopters, the ReACT app and the methods for self-applied implementation were applicable. However, the results were also in accordance with the well-known challenges of nonadoption and nonadherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia. %M 31951217 %R 10.2196/14694 %U https://mhealth.jmir.org/2020/1/e14694 %U https://doi.org/10.2196/14694 %U http://www.ncbi.nlm.nih.gov/pubmed/31951217 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15359 %T Development of a Living Lab for a Mobile-Based Health Program for Korean-Chinese Working Women in South Korea: Mixed Methods Study %A Kim,Youlim %A Lee,Hyeonkyeong %A Lee,Mi Kyung %A Lee,Hyeyeon %A Jang,Hyoeun %+ Mo-im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 222283373, hlee39@yuhs.ac %K mHealth %K living lab %K intervention mapping %K health promotion %D 2020 %7 8.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Korean-Chinese (KC) women make up the largest group of female migrants in South Korea. To prevent and manage chronic diseases in middle-aged KC women working full time, it is necessary to develop health promotion programs that utilize an online platform because such a platform would allow individuals to participate in health promotion interventions at their convenience. Objective: This study aimed to develop a living lab for a mobile-based health (LLm Health) program focused on improving the physical activity and cultural adaptation of KC women workers. Methods: We used a mixed methods design. Living lab principles were factored into the LLm Health program, including the use of multiple methods, user engagement, multistakeholder participants, real-life settings, and cocreation. The program was developed using the 4 steps of the intervention mapping method: needs assessment, setting of objectives, identification of intervention strategies, and intervention design. Needs assessment was conducted through a literature review, focus group interviews with a total of 16 middle-aged KC women, and an online survey related to health promotion of migrant workers given to 38 stakeholders. KC middle-aged women participated in the early stages of program development and provided the idea of developing programs and mobile apps to enhance physical activity and acculturation. The mobile app developed in the program was validated with the help of 12 KC women and 4 experts, including 3 nursing professors and a professor of physical education. They were asked to rate each item based on content, interface design, and technology on a 4-point scale using a 23-item Smartphone App Evaluation Tool for Health Care. Results: The LLm Health program comprised a 24-week walking program using Fitbit devices, the mobile app, and social cognitive interventions. The mobile app contained 6 components: a step counter, an exercise timer, an online chat function, health information, level of cardiovascular risk, and health status. The cultural aspects and lifestyles of KC women were accommodated in the entire process of program development. The content validity of the mobile app was found to be 0.90 and 0.96 according to the 12 KC women and 4 experts, respectively. Conclusions: The mobile app was found to be valid and acceptable for KC women. The living lab approach was a useful strategy for developing a culturally adaptive LLm Health program for KC women workers, leading to their active participation in the overall research process, including needs assessment, program composition, and pre-evaluation. %M 31913134 %R 10.2196/15359 %U https://mhealth.jmir.org/2020/1/e15359 %U https://doi.org/10.2196/15359 %U http://www.ncbi.nlm.nih.gov/pubmed/31913134 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e13133 %T A Mobile Phone App to Improve the Mental Health of Taxi Drivers: Single-Arm Feasibility Trial %A Davidson,Sandra %A Fletcher,Susan %A Wadley,Greg %A Reavley,Nicola %A Gunn,Jane %A Wade,Darryl %+ Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, 3053, Australia, 61 3 8344 7276, sdav@unimelb.edu.au %K mental health %K eHealth %K taxi drivers %K immigrant %K help-seeking behavior %K self-help %D 2020 %7 15.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Psychological distress among taxi drivers is 5 times higher than that in the general population, and more than half of all drivers have experienced 3 or more potentially traumatic events in their lifetime. Nevertheless, help-seeking for mental health problems in this male-dominated, predominately immigrant workforce is low. Mobile technologies have the potential to increase mental health awareness, teach self-help skills, and encourage help-seeking in this hard-to-reach population. Objective: This study aimed to assess the feasibility, acceptability, and potential efficacy of Driving to Health, a mobile phone–friendly mental health website app designed for people working as taxi drivers. Methods: Drivers (n=46) were recruited from the Melbourne Airport Taxi Holding Yard to participate in a single-arm trial. Self-reported, paper-based assessments were completed at baseline and at 1 month. Feasibility was measured by completion rates, representativeness of study participants, and levels of use. Acceptability was assessed by measuring users’ perception of the quality of the app and anticipated levels of future use. The efficacy of Driving to Health to increase awareness, self-help behaviors, and intentions to seek help was assessed using the user version of the Mobile App Rating Scale (uMARS) and the General Help-Seeking Questionnaire (GHSQ). Psychological symptoms were measured using the short form of the Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed using complete case analysis. Results: In total, 42 participants comprising drivers from 10 different countries of origin, and 14 different languages, completed pre- and poststudy measures (42/46, 91% completion rate). Just under half (45%) of all users used the app more than once with an average visit of 4 min 8 seconds. Responding to the uMARS, 62% (26/42) of the participants said that they would recommend the app to many people. Nearly all (40/42, 95%) participants said that Driving to Health increased awareness of their own mental health; 86% (36/42) said that it increased their mental health knowledge; and 76% (32/42) said that it increased their self-help behaviors. Increases in help-seeking intentions on the GHSQ were not significant, and increases on all 3 scales of DASS-21 were not reliable or meaningful. Conclusions: This study suggests that Driving to Health is an acceptable and feasible electronic health intervention for a hard-to-reach population. Our findings also suggest that Driving to Health results in increases in mental health awareness, behaviors, and willingness to seek help. %M 31939743 %R 10.2196/13133 %U https://mhealth.jmir.org/2020/1/e13133 %U https://doi.org/10.2196/13133 %U http://www.ncbi.nlm.nih.gov/pubmed/31939743 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12516 %T Mobile Health Technology Interventions for Suicide Prevention: Systematic Review %A Melia,Ruth %A Francis,Kady %A Hickey,Emma %A Bogue,John %A Duggan,Jim %A O'Sullivan,Mary %A Young,Karen %+ School of Psychology, National University of Ireland Galway, Arts Millennium Building, Galway, H91 TK33, Ireland, 353 877710431, ruth.melia@hse.ie %K mHealth %K systematic review %D 2020 %7 15.1.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Digital interventions are proposed as one way by which effective treatments for self-harm and suicidal ideation may be improved and their scalability enhanced. Mobile devices offer a potentially powerful medium to deliver evidence-based interventions with greater specificity to the individual when the intervention is needed. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice. Objective: This review aimed to examine the effectiveness of currently available mobile health (mHealth) technology tools in reducing suicide-specific outcomes. Methods: The following databases were searched: Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, and relevant sources of gray literature. All published and unpublished randomized controlled trials (RCTs), pseudo-RCTs, and pre-post observational studies that evaluated the effectiveness of mHealth technology in suicide prevention delivered via mobile computing and communication technology were included. Studies were included if they measured at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, and suicidal behavior). A total of 2 review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, on July 31, 2018. Owing to the heterogeneity of outcomes found across studies, results were not amenable for pooled synthesis, and a meta-analysis was not performed. A narrative synthesis of the available research is presented here. Results: A total of 7 studies met criteria for inclusion . Four published articles that reported on the effectiveness of the following mobile phone apps were included: iBobbly, Virtual Hope Box, BlueIce, and Therapeutic Evaluative Conditioning. Results demonstrated some positive impacts for individuals at elevated risk of suicide or self-harm, including reductions in depression, psychological distress, and self-harm and increases in coping self-efficacy. None of the apps evaluated demonstrated the ability to significantly decrease suicidal ideation compared with a control condition. In addition, 3 unpublished and recently completed trials also met criteria for inclusion in the review. Conclusions: Further research is needed to evaluate the efficacy of stand-alone mHealth technology–based interventions in suicide prevention. The small number of studies reported in this review tentatively indicate that such tools may have a positive impact on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing the following 3 main methodological limitations : (1) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies; (2) ecological validity: the tendency to exclude potential participants because of the elevated suicide risk may reduce generalizability within clinical settings; and (3) app regulation and definition: the lack of a standardized classification system for mHealth intervention type points to the need for better definition of the scope of such technologies to promote safe practice. Trial Registration: PROSPERO CRD42017072899; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72899 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8635 %M 31939744 %R 10.2196/12516 %U https://mhealth.jmir.org/2020/1/e12516 %U https://doi.org/10.2196/12516 %U http://www.ncbi.nlm.nih.gov/pubmed/31939744 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e13273 %T Effect of mHealth With Offline Antiobesity Treatment in a Community-Based Weight Management Program: Cross-Sectional Study %A Kim,Youngin %A Oh,Bumjo %A Shin,Hyun-Young %+ Department of Family Medicine, Myongji Hospital, College of Medicine, Hanyang University, 697-24 Hwajung-dong, Deokyang-gu, Goyang-Si, Gyeonggi-do 10475, Republic of Korea, 82 1090501098, shydeborah@gmail.com %K obesity %K mobile apps %K mobile health %K weight loss %D 2020 %7 21.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Weight loss interventions using mobile phone apps have recently shown promising results. Objective: This study aimed to analyze the short-term weight loss effect of a mobile coaching intervention when it is integrated with a local public health care center and a regional hospital’s antiobesity clinic as a multidisciplinary model. Methods: A total of 150 overweight or obese adults signed up to complete an 8-week antiobesity intervention program with human coaching through a mobile platform. Paired t tests and multiple linear regression analysis were used to identify the intervention factors related to weight change. Results: Among the 150 participants enrolled in this study, 112 completed the 8-week weight loss intervention. Weight (baseline: mean 77.5 kg, SD 12.9; after intervention: mean 74.8 kg, SD 12.6; mean difference −2.73 kg), body mass index, waist circumference, fat mass (baseline: mean 28.3 kg, SD 6.6; after intervention: mean 25.7 kg, SD 6.3; mean difference −2.65 kg), and fat percentage all showed a statistically significant decrease, and metabolic equivalent of task (MET) showed a statistically significant increase after intervention. In multiple linear regression analysis, age (beta=.07; P=.06), △MET (beta=−.0009; P=.10), number of articles read (beta=−.01; P=.04), and frequency of weight records (beta=−.05; P=.10; R2=0.4843) were identified as significant factors of weight change. Moreover, age (beta=.06; P=.03), sex (female; beta=1.16; P=.08), △MET (beta=−.0009; P<.001), and number of articles read (beta=−.02; P<.001; R2=0.3728) were identified as significant variables of fat mass change. Conclusions: The multidisciplinary approach, combining a mobile health (mHealth) care app by health care providers, was effective for short-term weight loss. Additional studies are needed to evaluate the efficacy of mHealth care apps in obesity treatment. %M 31961335 %R 10.2196/13273 %U http://mhealth.jmir.org/2020/1/e13273/ %U https://doi.org/10.2196/13273 %U http://www.ncbi.nlm.nih.gov/pubmed/31961335 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12306 %T Feasibility and Health Benefits of an Individualized Physical Activity Intervention in Women With Metastatic Breast Cancer: Intervention Study %A Delrieu,Lidia %A Pialoux,Vincent %A Pérol,Olivia %A Morelle,Magali %A Martin,Agnès %A Friedenreich,Christine %A Febvey-Combes,Olivia %A Pérol,David %A Belladame,Elodie %A Clémençon,Michel %A Roitmann,Eva %A Dufresne,Armelle %A Bachelot,Thomas %A Heudel,Pierre Etienne %A Touillaud,Marina %A Trédan,Olivier %A Fervers,Béatrice %+ Department of Cancer and Environment, Léon Bérard Cancer Center, 28 rue Laënnec, Lyon, 69008, France, 33 0478782800, beatrice.fervers@lyon.unicancer.fr %K metastatic breast cancer %K physical activity %K activity trackers %K feasibility %K tumor progression %D 2020 %7 28.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is limited knowledge regarding the potential benefits of physical activity in patients with metastatic breast cancer. Objective: The Advanced stage Breast cancer and Lifestyle Exercise (ABLE) Trial aimed to assess the feasibility of a physical activity intervention in women with metastatic breast cancer and to explore the effects of physical activity on functional, psychological, and clinical parameters. Methods: The ABLE Trial was a single-arm, 6-month intervention study with a home-based, unsupervised, and personalized walking program using an activity tracker. At baseline and 6 months, we assessed anthropometrics, functional fitness, physical activity level, sedentary behavior, quality of life, fatigue, and tumor progression. Paired proportions were compared using the McNemar test and changes of parameters during the intervention were analyzed using the Wilcoxon signed-rank test, the Mann-Whitney test, and Spearman rank correlations. Results: Overall, 49 participants (mean age 55 years; recruitment rate 94%) were enrolled and 96% adhered to the exercise prescription (attrition rate 2%). Statistically significant improvements in the 6-minute walking distance test (+7%, P<.001) and isometric quadriceps strength (+22%, P<.001), as well as decreases in body mass index (-2.5%, P=.03) and hip circumference (-4.0%, P<.001) were observed at 6 months. Quality of life remained stable and a nonstatistically significant decrease (-16%, P=.07) in fatigue was observed. Conclusions: The high recruitment and adherence rates suggest the willingness of patients with metastatic breast cancer to participate in a physical activity program. The beneficial outcomes regarding physical fitness and anthropometry of this unsupervised physical activity program may encourage these patients to maintain a physically active lifestyle. Future randomized controlled trials with larger sample sizes are warranted. Trial Registration: ClinicalTrials.gov NCT03148886; https://clinicaltrials.gov/ct2/show/NCT03148886 %M 32012082 %R 10.2196/12306 %U https://mhealth.jmir.org/2020/1/e12306 %U https://doi.org/10.2196/12306 %U http://www.ncbi.nlm.nih.gov/pubmed/32012082 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12884 %T Engaging Users in the Behavior Change Process With Digitalized Motivational Interviewing and Gamification: Development and Feasibility Testing of the Precious App %A Nurmi,Johanna %A Knittle,Keegan %A Ginchev,Todor %A Khattak,Fida %A Helf,Christopher %A Zwickl,Patrick %A Castellano-Tejedor,Carmina %A Lusilla-Palacios,Pilar %A Costa-Requena,Jose %A Ravaja,Niklas %A Haukkala,Ari %+ Discipline of Social Psychology, Faculty of Social Sciences, University of Helsinki, Unioninkatu 37, PO Box 54, Helsinki, 00014, Finland, 358 44 504484297, johanna.nurmi@helsinki.fi %K health app %K mHealth %K human-computer interaction %K prevention %K service design %K usability design %K intrinsic motivation %K reflective processes %K spontaneous processes %K engagement %K self-determination theory %K autonomous motivation %K gamification %K physical activity %D 2020 %7 30.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most adults do not engage in sufficient physical activity to maintain good health. Smartphone apps are increasingly used to support physical activity but typically focus on tracking behaviors with no support for the complex process of behavior change. Tracking features do not engage all users, and apps could better reach their targets by engaging users in reflecting their reasons, capabilities, and opportunities to change. Motivational interviewing supports this active engagement in self-reflection and self-regulation by fostering psychological needs proposed by the self-determination theory (ie, autonomy, competence, and relatedness). However, it is unknown whether digitalized motivational interviewing in a smartphone app engages users in this process. Objective: This study aimed to describe the theory- and evidence-based development of the Precious app and to examine how digitalized motivational interviewing using a smartphone app engages users in the behavior change process. Specifically, we aimed to determine if use of the Precious app elicits change talk in participants and how they perceive autonomy support in the app. Methods: A multidisciplinary team built the Precious app to support engagement in the behavior change process. The Precious app targets reflective processes with motivational interviewing and spontaneous processes with gamified tools, and builds on the principles of self-determination theory and control theory by using 7 relational techniques and 12 behavior change techniques. The feasibility of the app was tested among 12 adults, who were asked to interact with the prototype and think aloud. Semistructured interviews allowed participants to extend their statements. Participants’ interactions with the app were video recorded, transcribed, and analyzed with deductive thematic analysis to identify the theoretical themes related to autonomy support and change talk. Results: Participants valued the autonomy supportive features in the Precious app (eg, freedom to pursue personally relevant goals and receive tailored feedback). We identified the following five themes based on the theory-based theme autonomy support: valuing the chance to choose, concern about lack of autonomy, expecting controlling features, autonomous goals, and autonomy supportive feedback. The motivational interviewing features actively engaged participants in reflecting their outcome goals and reasons for activity, producing several types of change talk and very little sustain talk. The types of change talk identified were desire, need, reasons, ability, commitment, and taking steps toward change. Conclusions: The Precious app takes a unique approach to engage users in the behavior change process by targeting both reflective and spontaneous processes. It allows motivational interviewing in a mobile form, supports psychological needs with relational techniques, and targets intrinsic motivation with gamified elements. The motivational interviewing approach shows promise, but the impact of its interactive features and tailored feedback needs to be studied over time. The Precious app is undergoing testing in a series of n-of-1 randomized controlled trials. %M 32003750 %R 10.2196/12884 %U https://mhealth.jmir.org/2020/1/e12884 %U https://doi.org/10.2196/12884 %U http://www.ncbi.nlm.nih.gov/pubmed/32003750 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e16838 %T Digital HIV Care Navigation for Young People Living With HIV in San Francisco, California: Feasibility and Acceptability Study %A Trujillo,Dillon %A Turner,Caitlin %A Le,Victory %A Wilson,Erin C %A Arayasirikul,Sean %+ Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, 5th Floor, San Francisco, CA, 94102, United States, 1 415 554 9000, sean.arayasirikul@gmail.com %K HIV/AIDS %K digital HIV care navigation %K young people living with HIV %K mHealth %D 2020 %7 10.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: HIV continues to be a public health challenge adversely affecting youth and young adults, as they are the fastest-growing group of new HIV infections in the United States and the group with the poorest health outcomes among those living with HIV. HIV prevention science has turned to mobile health as a novel approach to reach and engage young people living with HIV (YPLWH) experiencing barriers to HIV care. Objective: This study aimed to assess the feasibility and acceptability of a text message–based HIV care navigation intervention for YPLWH in San Francisco. Health eNavigation is a 6-month text message–based HIV care navigation where YPLWH are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. Digital HIV care navigation included delivery of the following through SMS text messaging: (1) HIV care navigation, (2) health promotion and education, (3) motivational interviewing, and (4) social support. Methods: We evaluated the feasibility and acceptability of a text message–based HIV care navigation intervention among YPLWH. We assessed feasibility using quantitative data for the overall sample (N=120) to describe participant text messaging activity during the intervention. Acceptability was assessed through semistructured, in-depth interviews with a subsample of 16 participants 12 months after enrollment. Interviews were audio-recorded, transcribed, and analyzed using grounded theory. Results: Overall, the text message–based HIV care navigation intervention was feasible and acceptable. The majority of participants exhibited medium or high levels of engagement (50/120 [41.7%] and 26/120 [21.7%], respectively). Of the majority of participants who were newly diagnosed with HIV, 63% (24/38) had medium to high engagement. Similarly, among those who were not newly diagnosed, 63% (52/82) had medium to high engagement. The majority of participants found that the intervention added value to their lives and improved their engagement in HIV care, medication adherence, and viral suppression. Conclusions: Text message–based HIV care navigation is a potentially powerful tool that may help bridge the gaps for linkage and retention and improve overall engagement in HIV care for many YPLWH. Our results indicate that participation in text message–based HIV care navigation is both feasible and acceptable across pervasive structural barriers that would otherwise hinder intervention engagement. %M 31922489 %R 10.2196/16838 %U http://mhealth.jmir.org/2020/1/e16838/ %U https://doi.org/10.2196/16838 %U http://www.ncbi.nlm.nih.gov/pubmed/31922489 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14939 %T A Mobile App for Longterm Monitoring of Narcolepsy Symptoms: Design, Development, and Evaluation %A Quaedackers,Laury %A De Wit,Jan %A Pillen,Sigrid %A Van Gilst,Merel %A Batalas,Nikolaos %A Lammers,Gert Jan %A Markopoulos,Panos %A Overeem,Sebastiaan %+ Center for Sleep Medicine, Kempenhaeghe, Sterkselseweg 65, Heeze, 5591 VE, Netherlands, 31 40 2279490, quaedackersl@kempenhaeghe.nl %K outcome measure %K hypersomnia %K patient-related outcome measure %K PROM %K mHealth %K symptom monitoring %D 2020 %7 7.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Narcolepsy is a chronic sleep disorder with a broad variety of symptoms. Although narcolepsy is primarily characterized by excessive daytime sleepiness and cataplexy (loss of muscle control triggered by emotions), patients may suffer from hypnagogic hallucinations, sleep paralysis, and fragmented night sleep. However, the spectrum of narcolepsy also includes symptoms not related to sleep, such as cognitive or psychiatric problems. Symptoms vary greatly among patients and day-to-day variance can be considerable. Available narcolepsy questionnaires do not cover the whole symptom spectrum and may not capture symptom variability. Therefore, there is a clinical need for tools to monitor narcolepsy symptoms over time to evaluate their burden and the effect of treatment. Objective: This study aimed to describe the design, development, implementation, and evaluation of the Narcolepsy Monitor, a companion app for long-term symptom monitoring in narcolepsy patients. Methods: After several iterations during which content, interaction design, data management, and security were critically evaluated, a complete version of the app was built. The Narcolepsy Monitor allows patients to report a broad spectrum of experienced symptoms and rate their severity based on the level of burden that each symptom imposes. The app emphasizes the reporting of changes in relative severity of the symptoms. A total of 7 patients with narcolepsy were recruited and asked to use the app for 30 days. Evaluation was done by using in-depth interviews and user experience questionnaire. Results: We designed and developed a final version of the Narcolepsy Monitor after which user evaluation took place. Patients used the app on an average of 45.3 (SD 19.2) days. The app was opened on 35% of those days. Daytime sleepiness was the most dynamic symptom, with a mean number of changes of 5.5 (SD 3.7) per month, in contrast to feelings of anxiety or panic, which was only moved 0.3 (SD 0.7) times per month. Mean symptom scores were highest for daytime sleepiness (1.8 [SD 1.0]), followed by lack of energy (1.6 [SD 1.4]) and often awake at night (1.5 [SD 1.0]). The personal in-depth interviews revealed 3 major themes: (1) reasons to use, (2) usability, and (3) features. Overall, patients appreciated the concept of ranking symptoms on subjective burden and found the app easy to use. Conclusions: The Narcolepsy Monitor appears to be a helpful tool to gain more insight into the individual burden of narcolepsy symptoms over time and may serve as a patient-reported outcome measure for this debilitating disorder. %M 31909723 %R 10.2196/14939 %U https://mhealth.jmir.org/2020/1/e14939 %U https://doi.org/10.2196/14939 %U http://www.ncbi.nlm.nih.gov/pubmed/31909723 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12424 %T Considerations for Improved Mobile Health Evaluation: Retrospective Qualitative Investigation %A Dick,Samantha %A O'Connor,Yvonne %A Thompson,Matthew J %A O'Donoghue,John %A Hardy,Victoria %A Wu,Tsung-Shu Joseph %A O'Sullivan,Timothy %A Chirambo,Griphin Baxter %A Heavin,Ciara %+ Health Information Systems Research Centre, Cork University Business School, University College Cork, Cork, Ireland, 353 21 420 5576, samantha.dick@ucc.ie %K telemedicine %K mHealth %K research design %K developing countries %D 2020 %7 22.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone use and, consequently, mobile health (mHealth) interventions have seen an exponential increase in the last decade. There is an excess of 318,000 health-related apps available free of cost for consumers to download. However, many of these interventions are not evaluated and are lacking appropriate regulations. Randomized controlled trials are often considered the gold standard study design in determining the effectiveness of interventions, but recent literature has identified limitations in the methodology when used to evaluate mHealth. Objective: The objective of this study was to investigate the system developers’ experiences of evaluating mHealth interventions in the context of a developing country. Methods: We employed a qualitative exploratory approach, conducting semistructured interviews with multidisciplinary members of an mHealth project consortium. A conventional content analysis approach was used to allow codes and themes to be identified directly from the data. Results: The findings from this study identified the system developers’ perceptions of mHealth evaluation, providing an insight into the requirements of an effective mHealth evaluation. This study identified social and technical factors which should be taken into account when evaluating an mHealth intervention. Conclusions: Contextual issues represented one of the most recurrent challenges of mHealth evaluation in the context of a developing country, highlighting the importance of a mixed method evaluation. There is a myriad of social, technical, and regulatory variables, which may impact the effectiveness of an mHealth intervention. Failure to account for these variables in an evaluation may limit the ability of the intervention to achieve long-term implementation and scale. %M 32012085 %R 10.2196/12424 %U https://mhealth.jmir.org/2020/1/e12424 %U https://doi.org/10.2196/12424 %U http://www.ncbi.nlm.nih.gov/pubmed/32012085 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14082 %T Use of Evidence-Based Best Practices and Behavior Change Techniques in Breast Cancer Apps: Systematic Analysis %A Kalke,Kerstin %A Ginossar,Tamar %A Bentley,Joshua M %A Carver,Hannah %A Shah,Sayyed Fawad Ali %A Kinney,Anita Y %+ Department of Communication Studies, Northwestern University, 633 Clark St, Evanston, IL, 60208, United States, 1 5054489363, kerstinkalke2023@u.northwestern.edu %K mHealth %K breast cancer %K mobile apps %K health behavior %K health apps %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Theoretically designed mobile health (mHealth) breast cancer interventions are essential for achieving positive behavior change. In the case of breast cancer, they can improve the health outcomes of millions of women by increasing prevention and care efforts. However, little is known about the theoretical underpinnings of breast cancer apps available to the general public. Objective: Given that theories may strengthen mHealth interventions, this study aimed to identify breast cancer apps designed to support behavior change, to assess the extent to which they address content along the cancer care continuum and contain behavior change techniques, and to assess the degree to which star rating is related to theory-based design. Methods: Using a criteria-based screening process, we searched 2 major app stores for breast cancer apps designed to promote behavior change. Apps were coded for content along the cancer care continuum and analyzed for behavior change techniques. The Mann-Whitney U test was used to examine the relationship between star ratings and the use of behavior change techniques in apps with star ratings compared to those without ratings. Results: The search resulted in a total of 302 apps, of which 133 were identified as containing breast cancer content. Only 9.9% (30/302) of apps supported behavior change and were further analyzed. These apps were disproportionally focused on behaviors to enhance early detection, whereas only a few apps supported care management, treatment, and posttreatment behaviors. Regarding theories, 63% (19/30) of apps customized content to users, 70% (21/30) established a health-behavior link, and 80% (24/30) provided behavior change instructions. Of the 30 apps, 15 (50%) prompted intention formation whereas less than half of the apps included goal setting (9/30, 30%) and goal reviewing (7/30, 23%). Most apps did not provide information on peer behavior (7/30, 23%) or allow for social comparison (6/30, 20%). None of the apps mobilized social norms. Only half of the apps (15/30, 50%) were user rated. The results of the Mann-Whitney U test showed that apps with star ratings contained significantly more behavior change techniques (median 6.00) than apps without ratings. The analysis of behavior change techniques used in apps revealed their shortcomings in the use of goal setting and social influence features. Conclusions: Our findings indicate that commercially available breast cancer apps have not yet fully realized their potential to promote behavior change, with only a minority of apps focusing on behavior change, and even fewer including theoretical design to support behavior change along the cancer care continuum. These shortcomings are likely limiting the effectiveness of apps and their ability to improve public health. More attention needs to be paid to the involvement of professionals in app development and adherence to theories and best practices in app design to support individuals along the cancer care continuum. %M 32012084 %R 10.2196/14082 %U https://mhealth.jmir.org/2020/1/e14082 %U https://doi.org/10.2196/14082 %U http://www.ncbi.nlm.nih.gov/pubmed/32012084 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e16247 %T Mobile Health Projects in a High-Complexity Reference Hospital: Case Study %A Grau-Corral,Inmaculada %A Jansà,Margarida %A Gascon,Pau %A Lozano-Rubí,Raimundo %A Pantoja,Percy Efrain %A Roca,Daria %A Aragunde Miguens,Valentín %A Hidalgo-Mazzei,Diego %A Escarrabill,Joan %+ Hospital Clinic de Barcelona, Villarroel 170, Barcelona, 08036, Spain, 34 692241233, Imma.grau.corral@gmail.com %K mobile health %K observational study %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The widespread adoption of mobile and wearable devices and apps makes it essential to assess their possible impact on the management of health and diseases. Health care providers (HCPs) find themselves faced with a new situation in their setting with the proliferation of mobile health (mHealth) intervention tests. Few studies have addressed the development of mHealth and the methodologies to manage these apps in a tertiary hospital. Objective: The aim of this study was to evaluate the mHealth projects implemented in the Hospital Clínic of Barcelona to increase awareness of the context in which they are used and to develop policies for the development of good practice in mHealth innovation. Methods: A prospective, descriptive cross-sectional study was conducted in a highly specialized university hospital with 850 beds for adults and a reference population of 520,000 inhabitants. A specific questionnaire was developed based on the Mobile Health 5 Dimensions European (MOHE 5D-EU) theoretical model to find mHealth projects. Apps, telemedicine, and wearable devices were included in the systematic search. For that purpose, a vertical (top-down) email-based snowball process was conducted. Data were collected from February to December 2018 by conducting personal interviews with HCPs using a structured questionnaire. Results: During the study period, 45 interviews were conducted; 35 mHealth initiatives were found, with 25 targeted to patients and 10 to health professionals. Most mHealth initiatives (34/35, 97%) were related to the software field (apps and telemedicine initiatives), and one was related to wearable devices. Among the projects, 68% (24/35) were classified as medical devices or developments at the edge (developments susceptible to limitations depending on the intended use). In relation to data protection, 27 initiatives managing personal data (27/35, 77%) considered data protection legislation. Only 9% (3/35) of the initiatives had foreseen the use of interconnectivity standards. Most of the initiatives were funded by grants (14/35, 40%), sponsorships (5/35, 14%), or the hospital itself (5/35, 14%). In terms of clinical management, most projects were developed in the field of research, followed by professional tools, clinical information, and therapeutic education. Only 6 projects were involved with health care; all were led by either the industry or small and medium enterprises. Conclusions: This study helped create the design of a map of the mHealth projects conducted in our hospital that showed the stages of development of the different ongoing projects. This will allow monitoring of mHealth projects and construction of tools to reinforce areas with detected deficiencies. Our theoretical approach using a modified MOHE 5D-EU model was found to be useful for analyzing the characteristics of mHealth projects. %M 32012092 %R 10.2196/16247 %U http://mhealth.jmir.org/2020/1/e16247/ %U https://doi.org/10.2196/16247 %U http://www.ncbi.nlm.nih.gov/pubmed/32012092 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14557 %T The Florida Mobile Health Adherence Project for People Living With HIV (FL-mAPP): Longitudinal Assessment of Feasibility, Acceptability, and Clinical Outcomes %A Escobar-Viera,César %A Zhou,Zhi %A Morano,Jamie P %A Lucero,Robert %A Lieb,Spencer %A McIntosh,Sean %A Clauson,Kevin A %A Cook,Robert L %+ Center for Research on Media, Technology, and Health, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, United States, 1 412 692 4297, escobar-viera@pitt.edu %K mHealth %K HIV %K ART adherence %K feasibility %K acceptability %D 2020 %7 8.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: For people living with HIV (PLWH), antiretroviral therapy (ART) adherence is crucial to attain better health outcomes. Although research has leveraged consumer health information technologies to enhance ART adherence, no study has evaluated feasibility and clinical outcomes associated with the usage of a commercially available, regularly updated mobile health (mHealth) app for improving ART adherence among PLWH. Objective: This study aimed to assess the feasibility, acceptability, and clinical outcomes of Care4Today, an existing, free, biprogrammatic mHealth app for improving ART adherence among PLWH. Methods: The Florida mHealth Application Adherence Project (FL-mAPP) was a 90-day longitudinal pilot study conducted in 3 public HIV clinics in Florida, United States. After obtaining informed consent, 132 participants completed a survey and then were given the option to try an existing mHealth app to help with ART adherence. Of these, 33.3% (44/132) declined, 31.1% (41/132) agreed but never used the app, and 35.6% (47/132) used the app. All were asked to complete follow-up surveys at 30 days and 90 days after enrollment. Usage data were used to assess feasibility. Clinical outcomes of self-reported ART adherence and chart-obtained HIV viral load and CD4+ T-cell counts were compared among those who used the platform (users) versus those who did not (nonusers). Participants and HIV care providers also provided responses to open-ended questions about what they liked and did not like about the app; comments were analyzed using thematic analysis. Results: Of 132 participants, 47 (35.6%) and 85 (64.4%) were categorized as users and nonusers, respectively. Among users, a Kaplan-Meier plot showed that 25 persons (53%) continued using the app after the 90-day follow-up. At 30-day follow-up, 13 (81.3%) of those who used the mHealth app reported ≥95% ART adherence, compared with 17 (58.6%) nonusers (P=.12). Overall, 39 (82%) users liked or somewhat liked using the platform. Participants’ favorite features were medication reminders, ability to create custom reminders, and adherence reports. Conclusions: This longitudinal study found that a commercially available medication adherence mHealth app was a feasible and acceptable intervention to improve ART adherence among PLWH and engaged in clinical care across 3 public HIV clinics in the state of Florida. Overall, participants liked the Care4Today app and thought the medication reminders were their favorite feature. Generally, self-reports of ART adherence were better among users than nonusers, both at 30- and 90-day follow-ups. Further clinical research needs to address user fatigue for improving app usage. %M 31913127 %R 10.2196/14557 %U https://mhealth.jmir.org/2020/1/e14557 %U https://doi.org/10.2196/14557 %U http://www.ncbi.nlm.nih.gov/pubmed/31913127 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15146 %T Usability and Utility of a Mobile App to Improve Medication Adherence Among Ambulatory Care Patients in Malaysia: Qualitative Study %A Chew,Sara %A Lai,Pauline Siew Mei %A Ng,Chirk Jenn %+ Department of Primary Care Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, 50603, Malaysia, 60 379493920, plai@ummc.edu.my %K medication adherence app %K usability testing %K utility testing %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To date, several medication adherence apps have been developed. However, the existing apps have been developed without involving relevant stakeholders and were not subjected to mobile health app guidelines. In addition, the usability and utility of these apps have not been tested with end users. Objective: This study aimed to describe the usability and utility testing of a newly developed medication adherence app—Med Assist—among ambulatory care patients in Malaysia. Methods: The Med Assist app was developed based on the Theory of Planned Behavior and the Nielson usability model. Beta testing was conducted from March to May 2016 at a primary care clinic in Kuala Lumpur. Ambulatory care patients who scored ≥40% on the electronic health literacy scale, were aged ≥21 years, and were taking two or more long-term medications were recruited. Two rounds of in-depth interviews were conducted with each participant. The first interview, which was conducted upon participant recruitment, was to assess the usability of Med Assist. Participants were asked to download Med Assist on their phone and perform two tasks (register themselves on Med Assist and enter at least one medication). Participants were encouraged to “concurrently think aloud” when using Med Assist, while nonverbal cues were observed and recorded. The participants were then invited for a second interview (conducted ≥7 days after the first interview) to assess the utility of Med Assist after using the app for 1 week. This was done using “retrospective probing” based on a topic guide developed for utilities that could improve medication adherence. Results: Usability and utility testing was performed for the Med Assist app (version P4). A total of 13 participants were recruited (6 men, 7 women) for beta testing. Three themes emerged from the usability testing, while three themes emerged from the utility testing. From the usability testing, participants found Med Assist easy to use and user friendly, as they were able to complete the tasks given to them. However, the details required when adding a new medication were found to be confusing despite displaying information in a hierarchical order. Participants who were caregivers as well as patients found the multiple-user support and pill buddy utility useful. This suggests that Med Assist may improve the medication adherence of patients on multiple long-term medications. Conclusions: The usability and utility testing of Med Assist with end users made the app more patient centered in ambulatory care. From the usability testing, the overall design and layout of Med Assist were simple and user friendly enough for participants to navigate through the app and add a new medication. From the participants’ perspectives, Med Assist was a useful and reliable tool with the potential to improve medication adherence. In addition, utilities such as multiple user support and a medication refill reminder encouraged improved medication management. %M 32003748 %R 10.2196/15146 %U http://mhealth.jmir.org/2020/1/e15146/ %U https://doi.org/10.2196/15146 %U http://www.ncbi.nlm.nih.gov/pubmed/32003748 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12113 %T Effect of 5-Minute Movies Shown via a Mobile Phone App on Risk Factors and Mortality After Stroke in a Low- to Middle-Income Country: Randomized Controlled Trial for the Stroke Caregiver Dyad Education Intervention (Movies4Stroke) %A Kamal,Ayeesha %A Khoja,Adeel %A Usmani,Bushra %A Magsi,Shahvaiz %A Malani,Aresha %A Peera,Zahra %A Sattar,Saadia %A Ahmed Akram,Masood %A Shahnawaz,Sumaira %A Zulfiqar,Maryam %A Muqeet,Abdul %A Zaidi,Fabiha %A Sayani,Saleem %A Artani,Azmina %A Azam,Iqbal %A Saleem,Sarah %+ Aga Khan University, Stroke Services and Research, Faculty Office Building, First Floor, Department of Medicine,, Stadium Road Campus, Karachi, 74800, Pakistan, 92 2134930051 ext 4559, ayeesha.kamal@aku.edu %K stroke %K mobile health %K noncommunicable diseases %K adherence %D 2020 %7 28.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pakistan is the sixth most populous nation in the world and has an estimated 4 million stroke survivors. Most survivors are taken care of by community-based caregivers, and there are no inpatient rehabilitation facilities. Objective: The objective of this study was to evaluate the effectiveness and safety of locally designed 5-min movies rolled out in order of relevance that are thematically delivered in a 3-month program to deliver poststroke education to stroke survivor and caregiver dyads returning to the community. Methods: This study was a randomized controlled, outcome assessor–blinded, parallel group, single-center superiority trial in which participants (stroke survivor-caregiver dyads) with first-ever stroke (both ischemic and hemorrhagic) incidence were randomized within 48 hours of their stroke into either the video-based education intervention group or the control group. The video-based education intervention group had health education delivered through short videos that were shown to the participants and their caregivers at the time of admission, before discharge, and the first and third months of follow-up after discharge. The control group had standardized care including predischarge education and counseling according to defined protocols. All participants enrolled in the video education intervention and control groups were followed for 12 months after discharge for outcome assessment in the outpatient stroke clinics. The primary outcome measures were the proportion of participants achieving control of blood pressure, blood sugar, and blood cholesterol in the video intervention versus the control group. Several predefined secondary outcomes were included in this study, of which we report the mortality and functional disability in this paper. Analysis was by performed using the intention-to-treat principle. Results: A total of 310 stroke survivors and their caregiver dyads (participant dyads) were recruited over a duration of 6 months. In total, 155 participant dyads were randomized into the intervention and control groups, each. The primary outcome of control of three major risk factors revealed that at 12 months, there was a greater percentage of participants with a systolic BP<125 mm Hg (18/54, 33% vs 11/52, 21%; P=.16), diastolic BP<85 mm Hg (44/54, 81% vs 37/52, 71%; P=.21), HbA1c level<7% (36/55, 65% vs 30/40, 75%; P=.32), and low-density lipoprotein level<100 mg/dL (36/51, 70% vs 30/45, 67%; P=.68) in the intervention group than in the control group. The secondary outcome reported is the mortality among the stroke survivors because the number of stroke-related complications was higher in the control group than in the intervention group (13/155, 8.4% vs 2/155, 1.3%), and this difference was statistically significant (P<.001). Conclusions: The Movies4Stroke trial failed to achieve its primary specified outcome. However, secondary outcomes that directly related to survival skills of stroke survivors demonstrated the effectiveness of the video-based intervention on improving stroke-related mortality and survival without disability. Trial Registration: ClinicalTrials.gov NCT02202330; https://www.clinicaltrials.gov/ct2/show/NCT02202330 %M 32012080 %R 10.2196/12113 %U http://mhealth.jmir.org/2020/1/e12113/ %U https://doi.org/10.2196/12113 %U http://www.ncbi.nlm.nih.gov/pubmed/32012080 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14213 %T A Gig mHealth Economy Framework: Scoping Review of Internet Publications %A Alanezi,Fahad %A Alanzi,Turki %+ Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, 2835 King Faisal Road, Dammam, Saudi Arabia, 966 133331211, talanzi@iau.edu.sa %K gig economy %K gigs %K mHealth %K sharing economy %K gig mHealth %D 2020 %7 15.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The gig economy (characterized by short-term contracts rather than being a full-time employee in an organization) is one of the most recent and important tendencies that have expanded through the global economic market thanks to advances in internet and communication technologies. Similarly, mobile health (mHealth) technologies have also evolved rapidly with the development of the internet and mobile apps, attracting attention globally for their health care benefits. Objective: This study aimed to propose an integration of mHealth within the framework of the gig economy that leads to a new dimension of health care services and the proposal of a new term: gig mHealth. Methods: A review and systematic search of articles, books, and opinions that allowed for answering the research questions were executed through the internet. In this sense, the concept of the gig economy and examples, advantages and disadvantages, were reviewed. Similarly, the general characteristics of mHealth technologies were revised. In addition, the role of technology in supporting the development of the gig economy and mHealth technologies and the interactions between them were investigated. Results: The findings suggested that the gig economy is characterized by its flexibility in working hours, on-demand work, free agents, freelancing, freedom in the choice of work, and independent contracts. In addition, an analysis of an mHealth system indicated that it was composed of patients, specialists, nurses, and database administrators. In this system, patients and specialists or nurses are connected to cloud services for the transmission of data and medical information through a mobile app. Here, the administrators update the database and app features, among other technical tasks. Conversely, a general structure of an integrated gig mHealth system was developed. In this structure, the mHealth care services and the mHealth care activities were incorporated into a gig economy model. In addition, a practical example of an integrated view of a gig economy app in mHealth that illustrates the interaction between the patients (consumers) and providers (partners) of mHealth care services, mHealth care activities, health care professionals, and individual contractors was presented. The consumers and providers were interconnected with the health care company, brand, or firm through digital means using a mobile app or Windows platforms. Conclusions: The analysis carried out in this study suggested the possibility of integrating mHealth within the framework of the gig economy enhancing health care service delivery and the management of health care activities. The following 4 major areas of apps proposed in the mHealth framework that can catalyze the operations using the features of the gig economy were sharing/renting medical and diagnostic equipment and resources, on-demand appointments/self-health management, on-demand health care services, and assigning health care activities/gigs to individual contractors. This integration leads to a new dimension for health care services and the proposal of a new term: gig mHealth. %M 31939745 %R 10.2196/14213 %U https://mhealth.jmir.org/2020/1/e14213 %U https://doi.org/10.2196/14213 %U http://www.ncbi.nlm.nih.gov/pubmed/31939745 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e13244 %T Applicability of the User Engagement Scale to Mobile Health: A Survey-Based Quantitative Study %A Holdener,Marianne %A Gut,Alain %A Angerer,Alfred %+ Winterthur Institute of Health Economics, School of Management and Law, Zurich University of Applied Sciences, Gertrudstrasse 15, Winterthur, 8401, Switzerland, 41 798145158, marianneholdener@bluemail.ch %K mobile health %K mhealth %K mobile apps %K user engagement %K measurement %K user engagement scale %K chatbot %D 2020 %7 3.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has recently been exponential growth in the development and use of health apps on mobile phones. As with most mobile apps, however, the majority of users abandon them quickly and after minimal use. One of the most critical factors for the success of a health app is how to support users’ commitment to their health. Despite increased interest from researchers in mobile health, few studies have examined the measurement of user engagement with health apps. Objective: User engagement is a multidimensional, complex phenomenon. The aim of this study was to understand the concept of user engagement and, in particular, to demonstrate the applicability of a user engagement scale (UES) to mobile health apps. Methods: To determine the measurability of user engagement in a mobile health context, a UES was employed, which is a psychometric tool to measure user engagement with a digital system. This was adapted to Ada, developed by Ada Health, an artificial intelligence–powered personalized health guide that helps people understand their health. A principal component analysis (PCA) with varimax rotation was conducted on 30 items. In addition, sum scores as means of each subscale were calculated. Results: Survey data from 73 Ada users were analyzed. PCA was determined to be suitable, as verified by the sampling adequacy of Kaiser-Meyer-Olkin=0.858, a significant Bartlett test of sphericity (χ2300=1127.1; P<.001), and communalities mostly within the 0.7 range. Although 5 items had to be removed because of low factor loadings, the results of the remaining 25 items revealed 4 attributes: perceived usability, aesthetic appeal, reward, and focused attention. Ada users showed the highest engagement level with perceived usability, with a value of 294, followed by aesthetic appeal, reward, and focused attention. Conclusions: Although the UES was deployed in German and adapted to another digital domain, PCA yielded consistent subscales and a 4-factor structure. This indicates that user engagement with health apps can be assessed with the German version of the UES. These results can benefit related mobile health app engagement research and may be of importance to marketers and app developers. %M 31899454 %R 10.2196/13244 %U https://mhealth.jmir.org/2020/1/e13244 %U https://doi.org/10.2196/13244 %U http://www.ncbi.nlm.nih.gov/pubmed/31899454 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15329 %T Quality Assurance of Health Wearables Data: Participatory Workshop on Barriers, Solutions, and Expectations %A Abdolkhani,Robab %A Gray,Kathleen %A Borda,Ann %A DeSouza,Ruth %+ Health and Biomedical Informatics Centre, The University of Melbourne, Level 13, 305 Grattan St, Melbourne, Victoria, 3000, Australia, 61 390358703, rabdolkhani@student.unimelb.edu.au %K remote sensing technology %K data quality assurance %K patient-generated health data %K wearable devices %K participatory research %D 2020 %7 22.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The ubiquity of health wearables and the consequent production of patient-generated health data (PGHD) are rapidly escalating. However, the utilization of PGHD in routine clinical practices is still low because of data quality issues. There is no agreed approach to PGHD quality assurance; therefore, realizing the promise of PGHD requires in-depth discussion among diverse stakeholders to identify the data quality assurance challenges they face and understand their needs for PGHD quality assurance. Objective: This paper reports findings from a workshop aimed to explore stakeholders’ data quality challenges, identify their needs and expectations, and offer practical solutions. Methods: A qualitative multi-stakeholder workshop was conducted as a half-day event on the campus of an Australian University located in a major health care precinct, namely the Melbourne Parkville Precinct. The 18 participants had experience of PGHD use in clinical care, including people who identified as health care consumers, clinical care providers, wearables suppliers, and health information specialists. Data collection was done by facilitators capturing written notes of the proceedings as attendees engaged in participatory design activities in written and oral formats, using a range of whole-group and small-group interactive methods. The collected data were analyzed thematically, using deductive and inductive coding. Results: The participants’ discussions revealed a range of technical, behavioral, operational, and organizational challenges surrounding PGHD, from the time when data are collected by patients to the time data are used by health care providers for clinical decision making. PGHD stakeholders found consensus on training and engagement needs, continuous collaboration among stakeholders, and development of technical and policy standards to assure PGHD quality. Conclusions: Assuring PGHD quality is a complex process that requires the contribution of all PGHD stakeholders. The variety and depth of inputs in our workshop highlighted the importance of co-designing guidance for PGHD quality guidance. %M 32012090 %R 10.2196/15329 %U https://mhealth.jmir.org/2020/1/e15329 %U https://doi.org/10.2196/15329 %U http://www.ncbi.nlm.nih.gov/pubmed/32012090 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15663 %T Factors Related to User Ratings and User Downloads of Mobile Apps for Maternal and Infant Health: Cross-Sectional Study %A Biviji,Rizwana %A Vest,Joshua R %A Dixon,Brian E %A Cullen,Theresa %A Harle,Christopher A %+ Science of Healthcare Delivery, College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, AZ, 85004, United States, 1 6024963300, Rizwana.Biviji@asu.edu %K mHealth %K mobile apps %K pregnancy %K parturition %K infant care %K smartphones %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps related to maternal and infant health (MIH) are prevalent and frequently used. Some of these apps are extremely popular and have been downloaded over 5 million times. However, the understanding of user behavior and user adoption of these apps based on consumer preferences for different app features and categories is limited. Objective: This study aimed to examine the relationship between MIH app characteristics and users’ perceived satisfaction and intent to use. Methods: The associations between app characteristics, ratings, and downloads were assessed in a sample of MIH apps designed to provide health education or decision-making support to pregnant women or parents and caregivers of infants. Multivariable linear regression was used to assess the relationship between app characteristics and user ratings, and ordinal logistic regression was used to assess the relationship between app characteristics and user downloads. Results: The analyses of user ratings and downloads included 421 and 213 apps, respectively. The average user rating was 3.79 out of 5. Compared with the Apple App Store, the Google Play Store was associated with high user ratings (beta=.33; P=.005). Apps with higher standardized user ratings (beta=.80; P<.001), in-app purchases (beta=1.12; P=.002), and in-app advertisements (beta=.64; P=.02) were more frequently downloaded. Having a health care organization developer as part of the development team was neither associated with user ratings (beta=−.20; P=.06) nor downloads (beta=−.14; P=.63). Conclusions: A majority of MIH apps are developed by non–health care organizations, which could raise concern about the accuracy and trustworthiness of in-app information. These findings could benefit app developers in designing better apps and could help inform marketing and development strategies. Further work is needed to evaluate the clinical accuracy of information provided within the apps. %M 32012107 %R 10.2196/15663 %U http://mhealth.jmir.org/2020/1/e15663/ %U https://doi.org/10.2196/15663 %U http://www.ncbi.nlm.nih.gov/pubmed/32012107 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12651 %T Perspectives of People Who Are Overweight and Obese on Using Wearable Technology for Weight Management: Systematic Review %A Hu,Ruiqi %A van Velthoven,Michelle Helena %A Meinert,Edward %+ Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Level 2, Children's Hospital, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K wearable electronic devices %K wearable technology %K wearable device %K mobile health %K digital technology %K weight loss %K wearable %K activity tracker %K obesity %K overweight %D 2020 %7 13.1.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Obesity is a large contributor to preventable chronic diseases and health care costs. The efficacy of wearable devices for weight management has been researched; however, there is limited knowledge on how these devices are perceived by users. Objective: This study aimed to review user perspectives on wearable technology for weight management in people who are overweight and obese. Methods: We searched the online databases Pubmed, Scopus, Embase, and the Cochrane library for literature published from 2008 onward. We included all types of studies using a wearable device for delivering weight-loss interventions in adults who are overweight or obese, and qualitative data were collected about participants' perspectives on the device. We performed a quality assessment using criteria relevant to different study types. The Cochrane risk of bias tool was used for randomized controlled trials. The Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) was used for nonrandomized studies. The Oxman and Guyatt Criteria were used for systematic reviews. We used the critical appraisal checklist for qualitative studies. Data were extracted into a data extraction sheet and thematically analyzed. Results: We included 19 studies: 5 randomized controlled trials, 6 nonrandomized studies, 5 qualitative studies, and 3 reviews. Mixed perceptions existed for different constructs of wearable technologies, which reflects the differences in the suitability of wearable technology interventions for different individuals in different contexts. This also indicates that interventions were not often tailored to participants' motivations. In addition, very few wearable technology interventions included a thorough qualitative analysis of the participants' view on important features of the intervention that made it successful. Conclusions: This study highlights the importance of determining the type of intervention most suitable for an individual before the intervention is used. Our findings could help participants find a suitable intervention that is most effective for them. Further research needs to develop a user-centered tool for obtaining comprehensive user feedback. Trial Registration: PROSPERO CRD42018096932; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=96932 %M 31929104 %R 10.2196/12651 %U https://mhealth.jmir.org/2020/1/e12651 %U https://doi.org/10.2196/12651 %U http://www.ncbi.nlm.nih.gov/pubmed/31929104 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e16409 %T Activity Tracker–Based Metrics as Digital Markers of Cardiometabolic Health in Working Adults: Cross-Sectional Study %A Rykov,Yuri %A Thach,Thuan-Quoc %A Dunleavy,Gerard %A Roberts,Adam Charles %A Christopoulos,George %A Soh,Chee-Kiong %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, CSB, 18th Floor, 11 Mandalay Rd, Singapore, 308232, Singapore, 65 87660342, yuri.rykov@ntu.edu.sg %K mobile health %K metabolic cardiovascular syndrome %K fitness trackers %K wearable electronic devices %K Fitbit %K steps %K heart rate %K physical activity %K circadian rhythms %K sedentary behavior %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Greater adoption of wearable devices with multiple sensors may enhance personalized health monitoring, facilitate early detection of some diseases, and further scale up population health screening. However, few studies have explored the utility of data from wearable fitness trackers in cardiovascular and metabolic disease risk prediction. Objective: This study aimed to investigate the associations between a range of activity metrics derived from a wearable consumer-grade fitness tracker and major modifiable biomarkers of cardiometabolic disease in a working-age population. Methods: This was a cross-sectional study of 83 working adults. Participants wore Fitbit Charge 2 for 21 consecutive days and went through a health assessment, including fasting blood tests. The following clinical biomarkers were collected: BMI, waist circumference, waist-to-hip ratio, blood pressure, triglycerides (TGs), high-density lipoprotein (HDL) and low-density lipoprotein cholesterol, and blood glucose. We used a range of wearable-derived metrics based on steps, heart rate (HR), and energy expenditure, including measures of stability of circadian activity rhythms, sedentary time, and time spent at various intensities of physical activity. Spearman rank correlation was used for preliminary analysis. Multiple linear regression adjusted for potential confounders was used to determine the extent to which each metric of activity was associated with continuous clinical biomarkers. In addition, pairwise multiple regression was used to investigate the significance and mutual dependence of activity metrics when two or more of them had significant association with the same outcome from the previous step of the analysis. Results: The participants were predominantly middle aged (mean age 44.3 years, SD 12), Chinese (62/83, 75%), and male (64/83, 77%). Blood biomarkers of cardiometabolic disease (HDL cholesterol and TGs) were significantly associated with steps-based activity metrics independent of age, gender, ethnicity, education, and shift work, whereas body composition biomarkers (BMI, waist circumference, and waist-to-hip ratio) were significantly associated with energy expenditure–based and HR-based metrics when adjusted for the same confounders. Steps-based interdaily stability of circadian activity rhythm was strongly associated with HDL (beta=5.4 per 10% change; 95% CI 1.8 to 9.0; P=.005) and TG (beta=−27.7 per 10% change; 95% CI −48.4 to −7.0; P=.01). Average daily steps were negatively associated with TG (beta=−6.8 per 1000 steps; 95% CI −13.0 to −0.6; P=.04). The difference between average HR and resting HR was significantly associated with BMI (beta=−.5; 95% CI −1.0 to −0.1; P=.01) and waist circumference (beta=−1.3; 95% CI −2.4 to −0.2; P=.03). Conclusions: Wearable consumer-grade fitness trackers can provide acceptably accurate and meaningful information, which might be used in the risk prediction of cardiometabolic disease. Our results showed the beneficial effects of stable daily patterns of locomotor activity for cardiometabolic health. Study findings should be further replicated with larger population studies. %M 32012098 %R 10.2196/16409 %U http://mhealth.jmir.org/2020/1/e16409/ %U https://doi.org/10.2196/16409 %U http://www.ncbi.nlm.nih.gov/pubmed/32012098 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e17666 %T Correction: 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 %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X %M 32012112 %R 10.2196/17666 %U http://mhealth.jmir.org/2020/1/e17666/ %U https://doi.org/10.2196/17666 %U http://www.ncbi.nlm.nih.gov/pubmed/32012112 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e13191 %T Why We Eat What We Eat: Assessing Dispositional and In-the-Moment Eating Motives by Using Ecological Momentary Assessment %A Wahl,Deborah Ronja %A Villinger,Karoline %A Blumenschein,Michael %A König,Laura Maria %A Ziesemer,Katrin %A Sproesser,Gudrun %A Schupp,Harald Thomas %A Renner,Britta %+ Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, PO Box 47, Konstanz, 78457, Germany, 49 7531 88 3977, deborah.wahl@uni-konstanz.de %K mHealth %K eating %K motivation %K mobile app %K EMA %K in-the-moment %K disposition %K trait %K state %D 2020 %7 7.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Why do we eat? Our motives for eating are diverse, ranging from hunger and liking to social norms and affect regulation. Although eating motives can vary from eating event to eating event, which implies substantial moment-to-moment differences, current ways of measuring eating motives rely on single timepoint questionnaires that assess eating motives as situation-stable dispositions (traits). However, mobile technologies including smartphones allow eating events and motives to be captured in real time and real life, thus capturing experienced eating motives in-the-moment (states). Objective: This study aimed to examine differences between why people think they eat (trait motives) and why they eat in the moment of consumption (state motives) by comparing a dispositional (trait) and an in-the-moment (state) assessment of eating motives. Methods: A total of 15 basic eating motives included in The Eating Motivation Survey (ie, liking, habit, need and hunger, health, convenience, pleasure, traditional eating, natural concerns, sociability, price, visual appeal, weight control, affect regulation, social norms, and social image) were assessed in 35 participants using 2 methodological approaches: (1) a single timepoint dispositional assessment and (2) a smartphone-based ecological momentary assessment (EMA) across 8 days (N=888 meals) capturing eating motives in the moment of eating. Similarities between dispositional and in-the-moment eating motive profiles were assessed according to 4 different indices of profile similarity, that is, overall fit, shape, scatter, and elevation. Moreover, a visualized person × motive data matrix was created to visualize and analyze between- and within-person differences in trait and state eating motives. Results: Similarity analyses yielded a good overall fit between the trait and state eating motive profiles across participants, indicated by a double-entry intraclass correlation of 0.52 (P<.001). However, although trait and state motives revealed a comparable rank order (r=0.65; P<.001), trait motives overestimated 12 of 15 state motives (P<.001; d=1.97). Specifically, the participants assumed that 6 motives (need and hunger, price, habit, sociability, traditional eating, and natural concerns) are more essential for eating than they actually were in the moment (d>0.8). Furthermore, the visualized person × motive data matrix revealed substantial interindividual differences in intraindividual motive profiles. Conclusions: For a comprehensive understanding of why we eat what we eat, dispositional assessments need to be extended by in-the-moment assessments of eating motives. Smartphone-based EMAs reveal considerable intra- and interindividual differences in eating motives, which are not captured by single timepoint dispositional assessments. Targeting these differences between why people think they eat what they eat and why they actually eat in the moment may hold great promise for tailored mobile health interventions facilitating behavior changes. %M 31909719 %R 10.2196/13191 %U https://mhealth.jmir.org/2020/1/e13191 %U https://doi.org/10.2196/13191 %U http://www.ncbi.nlm.nih.gov/pubmed/31909719