%0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17507 %T Toward Earlier Diagnosis Using Combined eHealth Tools in Rheumatology: The Joint Pain Assessment Scoring Tool (JPAST) Project %A Knitza,Johannes %A Knevel,Rachel %A Raza,Karim %A Bruce,Tor %A Eimer,Ekaterina %A Gehring,Isabel %A Mathsson-Alm,Linda %A Poorafshar,Maryam %A Hueber,Axel J %A Schett,Georg %A Johannesson,Martina %A Catrina,Anca %A Klareskog,Lars %A , %+ Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, Erlangen, 91054, Germany, 49 91318532093, johannes.knitza@uk-erlangen.de %K rheumatology %K eHealth %K mHealth %K symptom-checkers %K apps %D 2020 %7 15.5.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Outcomes of patients with inflammatory rheumatic diseases have significantly improved over the last three decades, mainly due to therapeutic innovations, more timely treatment, and a recognition of the need to monitor response to treatment and to titrate treatments accordingly. Diagnostic delay remains a major challenge for all stakeholders. The combination of electronic health (eHealth) and serologic and genetic markers holds great promise to improve the current management of patients with inflammatory rheumatic diseases by speeding up access to appropriate care. The Joint Pain Assessment Scoring Tool (JPAST) project, funded by the European Union (EU) European Institute of Innovation and Technology (EIT) Health program, is a unique European project aiming to enable and accelerate personalized precision medicine for early treatment in rheumatology, ultimately also enabling prevention. The aim of the project is to facilitate these goals while at the same time, reducing cost for society and patients. %M 32348258 %R 10.2196/17507 %U https://mhealth.jmir.org/2020/5/e17507 %U https://doi.org/10.2196/17507 %U http://www.ncbi.nlm.nih.gov/pubmed/32348258 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e14375 %T Understanding and Preventing Health Concerns About Emerging Mobile Health Technologies %A Materia,Frank T %A Faasse,Kate %A Smyth,Joshua M %+ The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, United States, 1 814 863 8402, Smyth@psu.edu %K mHealth %K technology %K nocebo effect %K implementation science %K medically unexplained symptoms %D 2020 %7 25.5.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X New technologies and innovations have often improved population well-being and societal function; however, these are also often initially accompanied by worry and fear. In some cases, such worries can impede, or even prevent entirely, the adoption of the technology. Mobile health (mHealth), a discipline broadly focused on employing ambulatory technologies to improve the affordability, reach, and effectiveness of health promotion and clinical intervention approaches, offers new innovations and opportunities. Despite emerging evidence supporting mHealth efficacy (eg, for improving health outcomes), some individuals have concerns about mHealth technology that may impede scalability, efficacy, and, ultimately, the public health benefits of mHealth. We present a review and conceptual framework to examine these issues, focusing on three overarching themes: biophysiological, psychological, and societal concerns. There are features of mHealth that lead to worries about the potential negative effects on an individual’s health (eg, due to exposure to electromagnetic or radio waves), despite evidence supporting the safety of these technologies. When present, such beliefs can lead to worry that gives rise to the experience of unpleasant and concerning physical symptoms—the nocebo effect. This may represent an important implementational barrier because of apprehension toward beneficial mHealth products (or features thereof, such as wireless charging, wearable or implantable sensors, etc) and may also have broader ramifications (eg, leading to economic, governmental, and legislative actions). In addition to reviewing evidence on these points, we provide a broad three-step model of implementation research in mHealth that focuses on understanding and preventing health concerns to facilitate the safe and effective scalability of mHealth (and that may be generalizable and applied to similar technologies): (1) evaluating and better discerning public perceptions and misperceptions (and how these may differ between populations), (2) developing theory-based public health communication strategies regarding the safety of mHealth, and (3) disseminating this messaging using evidence-based methods. Collectively, these steps converge on reviewing evidence regarding the potential role of worry and nocebo in mHealth and providing a model for understanding and changing attitudes and preventing unfounded negative perceptions related to mHealth technology. %M 32449688 %R 10.2196/14375 %U http://mhealth.jmir.org/2020/5/e14375/ %U https://doi.org/10.2196/14375 %U http://www.ncbi.nlm.nih.gov/pubmed/32449688 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e18092 %T Smart Shirts for Monitoring Physiological Parameters: Scoping Review %A Khundaqji,Hamzeh %A Hing,Wayne %A Furness,James %A Climstein,Mike %+ Faculty of Health Sciences & Medicine, Bond University, 2 Promethean Way, Gold Coast, 4226, Australia, 61 0431443642, hamzeh.khundaqji@student.bond.edu.au %K wearable electronic devices %K biomedical technology %K telemedicine %K fitness trackers %K sports %K exercise %K physiology %K clinical decision making %K vital signs %D 2020 %7 27.5.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The recent trends of technological innovation and widescale digitization as potential solutions to challenges in health care, sports, and emergency service operations have led to the conception of smart textile technology. In health care, these smart textile systems present the potential to aid preventative medicine and early diagnosis through continuous, noninvasive tracking of physical and mental health while promoting proactive involvement of patients in their medical management. In areas such as sports and emergency response, the potential to provide comprehensive and simultaneous physiological insights across multiple body systems is promising. However, it is currently unclear what type of evidence exists surrounding the use of smart textiles for the monitoring of physiological outcome measures across different settings. Objective: This scoping review aimed to systematically survey the existing body of scientific literature surrounding smart textiles in their most prevalent form, the smart shirt, for monitoring physiological outcome measures. Methods: A total of 5 electronic bibliographic databases were systematically searched (Ovid Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Scopus, Cumulative Index to Nursing and Allied Health Literature, and SPORTDiscus). Publications from the inception of the database to June 24, 2019 were reviewed. Nonindexed literature relevant to this review was also systematically searched. The results were then collated, summarized, and reported. Results: Following the removal of duplicates, 7871 citations were identified. On the basis of title and abstract screening, 7632 citations were excluded, whereas 239 were retrieved and assessed for eligibility. Of these, 101 citations were included in the final analysis. Included studies were categorized into four themes: (1) prototype design, (2) validation, (3) observational, and (4) reviews. Among the 101 analyzed studies, prototype design was the most prevalent theme (50/101, 49.5%), followed by validation (29/101, 28.7%), observational studies (21/101, 20.8%), and reviews (1/101, 0.1%). Presented prototype designs ranged from those capable of monitoring one physiological metric to those capable of monitoring several simultaneously. In 29 validation studies, 16 distinct smart shirts were validated against reference technology under various conditions and work rates, including rest, submaximal exercise, and maximal exercise. The identified observational studies used smart shirts in clinical, healthy, and occupational populations for aims such as early diagnosis and stress detection. One scoping review was identified, investigating the use of smart shirts for electrocardiograph signal monitoring in cardiac patients. Conclusions: Although smart shirts have been found to be valid and reliable in the monitoring of specific physiological metrics, results were variable for others, demonstrating the need for further systematic validation. Analysis of the results has also demonstrated gaps in knowledge, such as a considerable lag of validation and observational studies in comparison with prototype design and limited investigation using smart shirts in pediatric, elite sports, and emergency service populations. %M 32348279 %R 10.2196/18092 %U http://mhealth.jmir.org/2020/5/e18092/ %U https://doi.org/10.2196/18092 %U http://www.ncbi.nlm.nih.gov/pubmed/32348279 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17320 %T A Mobile Technology for Collecting Patient-Reported Physical Activity and Distress Outcomes: Cross-Sectional Cohort Study %A Jung,Miyeon %A Lee,SaeByul %A Kim,Jisun %A Kim,HeeJeong %A Ko,BeomSeok %A Son,Byung Ho %A Ahn,Sei-Hyun %A Park,Yu Rang %A Cho,Daegon %A Chung,Haekwon %A Park,Hye Jin %A Lee,Minsun %A Lee,Jong Won %A Chung,Seockhoon %A Chung,Il Yong %+ Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, , Republic of Korea, 82 2 3010 3998, doorkeeper1@gmail.com %K telemedicine %K breast neoplasms %K mobile apps %K quality of life %K validation %K patient-reported outcome measures (PROMs) %K questionnaire %D 2020 %7 4.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Electronic patient-reported outcome (PROs) provides a fast and reliable assessment of a patient’s health-related quality of life. Nevertheless, using PRO in the traditional paper format is not practical for clinical practice due to the limitations associated with data analysis and management. A questionnaire app was developed to address the need for a practical way to group and use distress and physical activity assessment tools. Objective: The purpose of this study was to assess the level of agreement between electronic (mobile) and paper-and-pencil questionnaire responses. Methods: We validated the app version of the distress thermometer (DT), International Physical Activity Questionnaire (IPAQ), and Patient Health Questionnaire–9 (PHQ-9). A total of 102 participants answered the paper and app versions of the DT and IPAQ, and 96 people completed the PHQ-9. The study outcomes were the correlation of the data between the paper-and-pencil and app versions. Results: A total of 106 consecutive breast cancer patients were enrolled and analyzed for validation of paper and electronic (app) versions. The Spearman correlation values of paper and app surveys for patients who responded to the DT questionnaire within 7 days, within 3 days, and on the same day were .415 (P<.001), .437 (P<.001), and .603 (P<.001), respectively. Similarly, the paper and app survey correlation values of the IPAQ total physical activity metabolic equivalent of task (MET; Q2-6) were .291 (P=.003), .324 (P=.005), and .427 (P=.01), respectively. The correlation of the sum of the Patient Health Questionnaire–9 (Q1-9) according to the time interval between the paper-based questionnaire and the app-based questionnaire was .469 for 14 days (P<.001), .574 for 7 days (P<.001), .593 for 3 days (P<.001), and .512 for the same day (P=.03). These were all statistically significant. Similarly, the correlation of the PHQ (Q10) value according to the time interval between the paper-based questionnaire and the app-based questionnaire was .283 for 14 days (P=.005), .409 for 7 days (P=.001), .415 for 3 days (P=.009), and .736 for the same day (P=.001). These were all statistically significant. In the overall trend, the shorter the interval between the paper-and-pencil questionnaire and the app-based questionnaire, the higher the correlation value. Conclusions: The app version of the distress and physical activity questionnaires has shown validity and a high level of association with the paper-based DT, IPAQ (Q2-6), and PHQ-9. The app-based questionnaires were not inferior to their respective paper versions and confirm the feasibility for their use in clinical practice. The high correlation between paper and mobile app data allows the use of new mobile apps to benefit the overall health care system. Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966 %M 32364508 %R 10.2196/17320 %U https://mhealth.jmir.org/2020/5/e17320 %U https://doi.org/10.2196/17320 %U http://www.ncbi.nlm.nih.gov/pubmed/32364508 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17219 %T A Mobile Health App for the Collection of Functional Outcomes After Inpatient Stroke Rehabilitation: Pilot Randomized Controlled Trial %A Li,Li %A Huang,Jia %A Wu,Jingsong %A Jiang,Cai %A Chen,Shanjia %A Xie,Guanli %A Ren,Jinxin %A Tao,Jing %A Chan,Chetwyn C H %A Chen,Lidian %A Wong,Alex W K %+ Program in Occupational Therapy, Washington University School of Medicine, 600 South Taylor Avenue, MSC 8505-94-01, St. Louis, MO, United States, 1 314 286 0278, wongal@wustl.edu %K telemedicine %K cell phone %K stroke %K rehabilitation %K activities of daily living %K outcome and process assessment %K health care %D 2020 %7 13.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Monitoring the functional status of poststroke patients after they transition home is significant for rehabilitation. Mobile health (mHealth) technologies may provide an opportunity to reach and follow patients post discharge. However, the feasibility and validity of functional assessments administered by mHealth technologies are unknown. Objective: This study aimed to evaluate the feasibility, validity, and reliability of functional assessments administered through the videoconference function of a mobile phone–based app compared with administration through the telephone function in poststroke patients after rehabilitation hospitalization. Methods: A randomized controlled trial was conducted in a rehabilitation hospital in Southeast China. Participants were randomly assigned to either a videoconference follow-up (n=60) or a telephone follow-up (n=60) group. We measured the functional status of participants in each group at 2-week and 3-month follow-up periods. Half the participants in each group were followed by face-to-face home visit assessments as the gold standard. Validity was assessed by comparing any score differences between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Reliability was assessed by computing agreements between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Feasibility was evaluated by the levels of completion, satisfaction, comfort, and confidence in the 2 groups. Results: Scores obtained from the videoconference follow-up were similar to those of the home visit assessment. However, most scores collected from telephone administration were higher than those of the home visit assessment. The agreement between videoconference follow-up and home visit assessments was higher than that between telephone follow-up and home visit assessments at all follow-up periods. In the telephone follow-up group, completion rates were 95% and 82% at 2-week and 3-month follow-up points, respectively. In the videoconference follow-up group, completion rates were 95% and 80% at 2-week and 3-month follow-up points, respectively. There were no differences in the completion rates between the 2 groups at all follow-up periods (X21=1.6, P=.21 for 2-week follow-up; X21=1.9, P=.17 for 3-month follow-up). Patients in the videoconference follow-up group perceived higher confidence than those in the telephone follow-up group at both 2-week and 3-month follow-up periods (X23=6.7, P=.04 for 2-week follow-up; X23=8.0, P=.04 for 3-month follow-up). The videoconference follow-up group demonstrated higher satisfaction than the telephone follow-up group at 3-month follow-up (X23=13.9; P=.03). Conclusions: The videoconference follow-up assessment of functional status demonstrates higher validity and reliability, as well as higher confidence and satisfaction perceived by patients, than the telephone assessment. The videoconference assessment provides an efficient means of assessing functional outcomes of patients after hospital discharge. This method provides a novel solution for clinical trials requiring longitudinal assessments. Trial Registration: chictr.org.cn: ChiCTR1900027626; http://www.chictr.org.cn/edit.aspx?pid=44831&htm=4. %M 32401221 %R 10.2196/17219 %U https://mhealth.jmir.org/2020/5/e17219 %U https://doi.org/10.2196/17219 %U http://www.ncbi.nlm.nih.gov/pubmed/32401221 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16043 %T Human-Centered Design Strategies for Device Selection in mHealth Programs: Development of a Novel Framework and Case Study %A Polhemus,Ashley Marie %A Novák,Jan %A Ferrao,Jose %A Simblett,Sara %A Radaelli,Marta %A Locatelli,Patrick %A Matcham,Faith %A Kerz,Maximilian %A Weyer,Janice %A Burke,Patrick %A Huang,Vincy %A Dockendorf,Marissa Fallon %A Temesi,Gergely %A Wykes,Til %A Comi,Giancarlo %A Myin-Germeys,Inez %A Folarin,Amos %A Dobson,Richard %A Manyakov,Nikolay V %A Narayan,Vaibhav A %A Hotopf,Matthew %+ Merck Research Labs Information Technology, Merck Sharpe & Dohme, Svornosti 3321/2, Prague, 150 00, Czech Republic, 420 44 634 48 15, ashley.polhemus@merck.com %K human-centric design %K design thinking %K patient centricity %K device selection %K technology selection %K remote patient monitoring %K remote measurement technologies %D 2020 %7 7.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing use of remote measurement technologies (RMT) such as wearables or biosensors in health care programs, challenges associated with selecting and implementing these technologies persist. Many health care programs that use RMT rely on commercially available, “off-the-shelf” devices to collect patient data. However, validation of these devices is sparse, the technology landscape is constantly changing, relative benefits between device options are often unclear, and research on patient and health care provider preferences is often lacking. Objective: To address these common challenges, we propose a novel device selection framework extrapolated from human-centered design principles, which are commonly used in de novo digital health product design. We then present a case study in which we used the framework to identify, test, select, and implement off-the-shelf devices for the Remote Assessment of Disease and Relapse-Central Nervous System (RADAR-CNS) consortium, a research program using RMT to study central nervous system disease progression. Methods: The RADAR-CNS device selection framework describes a human-centered approach to device selection for mobile health programs. The framework guides study designers through stakeholder engagement, technology landscaping, rapid proof of concept testing, and creative problem solving to develop device selection criteria and a robust implementation strategy. It also describes a method for considering compromises when tensions between stakeholder needs occur. Results: The framework successfully guided device selection for the RADAR-CNS study on relapse in multiple sclerosis. In the initial stage, we engaged a multidisciplinary team of patients, health care professionals, researchers, and technologists to identify our primary device-related goals. We desired regular home-based measurements of gait, balance, fatigue, heart rate, and sleep over the course of the study. However, devices and measurement methods had to be user friendly, secure, and able to produce high quality data. In the second stage, we iteratively refined our strategy and selected devices based on technological and regulatory constraints, user feedback, and research goals. At several points, we used this method to devise compromises that addressed conflicting stakeholder needs. We then implemented a feedback mechanism into the study to gather lessons about devices to improve future versions of the RADAR-CNS program. Conclusions: The RADAR device selection framework provides a structured yet flexible approach to device selection for health care programs and can be used to systematically approach complex decisions that require teams to consider patient experiences alongside scientific priorities and logistical, technical, or regulatory constraints. %M 32379055 %R 10.2196/16043 %U https://mhealth.jmir.org/2020/5/e16043 %U https://doi.org/10.2196/16043 %U http://www.ncbi.nlm.nih.gov/pubmed/32379055 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16828 %T Midwives’ Attitudes Toward and Experience With a Tablet Intervention to Promote Safety Behaviors for Pregnant Women Reporting Intimate Partner Violence: Qualitative Study %A Garnweidner-Holme,Lisa %A Henriksen,Lena %A Flaathen,Eva Marie %A Klette Bøhler,Tone %A Lukasse,Mirjam %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PB 4 St. Olavs plass, Oslo, 0130, Norway, 47 48091956, lgarnwei@oslomet.no %K intimate partner violence %K mHealth %K attitudes %K midwives %K prenatal care %D 2020 %7 20.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Violence against women is considered a global health problem, and intimate partner violence (IPV) around the time of childbirth can have severe consequences for mother and child. Prenatal care is considered a window of opportunity to address IPV and ask women about exposure to violence since women are in regular contact with health care providers. Mobile health (mHealth) interventions might overcome the barriers to talking about IPV face-to-face. Objective: Our objective was to explore midwives’ attitudes toward a tablet intervention consisting of information about IPV and safety behaviors as well as their experiences with recruiting pregnant women of different ethnic backgrounds in a randomized controlled trial (RCT). Methods: Individual interviews were conducted with 9 midwives who recruited participants for an RCT to test a video to promote safety behaviors delivered on a tablet during prenatal care. Analysis was guided by thematic analysis. Results: Midwives perceived the tablet intervention as an appropriate supplement during prenatal care to provide information about IPV and promote safety behaviors. They participated in the RCT primarily to obtain more knowledge regarding how to communicate about IPV. The intervention was perceived as an anonymous door-opener to talk about IPV and a good solution to ensure that every woman gets the same information. However, the content of the intervention had to be trustworthy and align with the information the midwives provide to women. Given the sensitivity of IPV, midwives outlined the importance of following the intervention with face-to-face communication. Midwives reported technical problems and a high demand on their time as the main challenges to recruiting women. They experienced challenges recruiting women of different ethnic backgrounds due to linguistic barriers and the women’s skepticism about scientific research. Conclusions: The tablet intervention might help midwives communicate about IPV. Although the video was considered as an anonymous door-opener to talk about IPV, midwives outlined the importance of following the intervention with face-to-face communication. The scarcity of midwives’ time during consultations has to be considered when implementing the intervention. Further research is needed to overcome barriers that limit inclusion of women from different ethnic backgrounds. Trial Registration: ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277 %M 32432553 %R 10.2196/16828 %U http://mhealth.jmir.org/2020/5/e16828/ %U https://doi.org/10.2196/16828 %U http://www.ncbi.nlm.nih.gov/pubmed/32432553 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e14453 %T A Mobile Phone–Based Gait Assessment App for the Elderly: Development and Evaluation %A Zhong,Runting %A Rau,Pei-Luen Patrick %+ Department of Industrial Engineering, Tsinghua University, Shunde Building, 5th Floor, Beijing, 100084, China, 86 62776664, rpl@mail.tsinghua.edu.cn %K aged %K gait %K mHealth %K telemedicine %K falls prevention %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gait disorders are common among older adults. With an increase in the use of technology among older adults, a mobile phone app provides a solution for older adults to self-monitor their gait quality in daily life. Objective: This study aimed to develop a gait-monitoring mobile phone app (Pocket Gait) and evaluate its acceptability and usability among potential older users. Methods: The app was developed to allow older adults to track their gait quality, including step frequency, acceleration root mean square (RMS), step regularity, step symmetry, and step variability. We recruited a total of 148 community-dwelling older adults aged 60 years and older from two cities in China: Beijing and Chongqing. They walked in three ways (single task, dual task, and fast walking) using a smartphone with the gait-monitoring app installed and completed an acceptability and usability survey after the walk test. User acceptability was measured by a questionnaire including four quantitative measures: perceived ease of use, perceived usefulness, ease of learning, and intention to use. Usability was measured using the System Usability Scale (SUS). Interviews were conducted with participants to collect open-ended feedback questions. Results: Task type had a significant effect on all gait parameters, namely, step frequency, RMS, step variability, step regularity, and step symmetry (all P values <.001). Age had a significant effect on step frequency (P=.01), and region had a significant effect on step regularity (P=.04). The acceptability of the gait-monitoring app was positive among older adults. Participants identified the usability of the system with an overall score of 59.7 (SD 10.7) out of 100. Older adults from Beijing scored significantly higher SUS compared with older adults from Chongqing (P<.001). The age of older adults was significantly associated with their SUS score (P=.048). Older adults identified improvements such as a larger font size, inclusion of reference values for gait parameters, and inclusion of heart rate and blood pressure monitoring. Conclusions: This mobile phone app is a health management tool for older adults to self-manage their gait quality and prevent adverse outcomes. In the future, it will be important to take factors such as age and region into consideration while designing a mobile phone–based gait assessment app. The feedback of the participants would help to design more elderly-friendly products. %M 32473005 %R 10.2196/14453 %U https://mhealth.jmir.org/2020/5/e14453 %U https://doi.org/10.2196/14453 %U http://www.ncbi.nlm.nih.gov/pubmed/32473005 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15015 %T A Lower Leg Physical Activity Intervention for Individuals With Chronic Venous Leg Ulcers: Randomized Controlled Trial %A Kelechi,Teresa J %A Prentice,Margaret A %A Mueller,Martina %A Madisetti,Mohan %A Vertegel,Alexey %+ College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, Charleston, SC, 29425, United States, 1 843 792 4602, kelechtj@musc.edu %K leg ulcer %K physical activity %K exercise %K mHealth %K adherence %K randomized controlled trial %K feasibility %D 2020 %7 15.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Individuals with venous leg ulcers (VLUs) suffer disproportionately with multiple chronic conditions, are often physically deconditioned, and demonstrate high levels of physical inactivity. Objective: The primary objective of this randomized controlled trial was to establish the feasibility of a mobile health (mHealth) physical activity exercise app for individuals with VLUs to improve lower leg function. Methods: In a 6-week study, adults with VLUs were recruited from 2 wound centers in South Carolina, United States, and enrolled if they were aged 18 years or older with impaired functional mobility and an ankle-brachial index between 0.8 and 1.3. Participants were randomized 1:1 to receive evidence-based, phased, nonexertive physical conditioning activities for lower leg function (FOOTFIT) or FOOTFIT+ with an added patient-provider communication feature. The mHealth Conditioning Activities for Lower Leg Function app also provided automated educational and motivational messages and user reports. Foot movement on the VLU-affected leg was tracked by a Bluetooth-enabled triaxial accelerometer. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to assess the feasibility of reach, adherence, acceptability, implementation, and maintenance. Results: A total of 24 patients were recruited, enrolled, and randomized in the study. Most patients reported difficulty following the protocol for exercising and using the accelerometer and mobile phone and did not use the provider contact feature. However, all patients were adherent to the 6-week exercise program more than 85% of the time for duration, whereas 33% (8/24) of patients adhered more than 85% for the frequency of performing the exercises. Across the three exercise levels, adherence did not differ between the two groups. Confidence limits around the difference in proportions ranged from −0.4 to 0.7. Providers in FOOTFIT+ were inconsistent in checking participant progress reports because of lack of time from competing work commitments. The technology became outdated quickly, making maintenance problematic. Participants said they would continue to exercise their foot and legs and liked being able to follow along with the demonstrations of each level of exercise provided through the app. Conclusions: The findings of this study suggest that despite initial interest in using the app, several components of the program as originally designed had limited acceptability and feasibility. Future refinements should include the use of more modern technology including smaller wearable accelerometers, mobile phones or tablets with larger screens, an app designed with larger graphics, automated reporting for providers, and more engaging user features. Trial Registration: ClinicalTrials.gov NTC02632695; https://clinicaltrials.gov/ct2/show/NCT02632695 %M 32412419 %R 10.2196/15015 %U https://mhealth.jmir.org/2020/5/e15015 %U https://doi.org/10.2196/15015 %U http://www.ncbi.nlm.nih.gov/pubmed/32412419 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15818 %T Selecting Evidence-Based Content for Inclusion in Self-Management Apps for Pressure Injuries in Individuals With Spinal Cord Injury: Participatory Design Study %A Fiordelli,Maddalena %A Zanini,Claudia %A Amann,Julia %A Scheel-Sailer,Anke %A Brach,Mirjam %A Stucki,Gerold %A Rubinelli,Sara %+ Institute of Communication and Health, Faculty of Communication Science, Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 58 666 47 57, maddalena.fiordelli@usi.ch %K mHealth %K paraplegia %K tetraplegia %K pressure ulcers %K consensus meeting %K community engagement %K recommendations %D 2020 %7 20.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technological solutions, particularly mobile health (mHealth), have been shown to be potentially viable approaches for sustaining individuals’ self-management of chronic health conditions. Theory-based interventions are more successful, as evidence-based information is an essential prerequisite for appropriate self-management. However, several reviews have shown that many existing mobile apps fail to be either theoretically grounded or based on evidence. Although some authors have attempted to address these two issues by focusing on the design and development processes of apps, concrete efforts to systematically select evidence-based content are scant. Objective: The objective of this study was to present a procedure for the participatory identification of evidence-based content to ground the development of a self-management app. Methods: To illustrate the procedure, we focused on the prevention and management of pressure injuries (PIs) in individuals with spinal cord injury (SCI). The procedure involves the following three steps: (1) identification of existing evidence through review and synthesis of existing recommendations on the prevention and self-management of PIs in SCI; (2) a consensus meeting with experts from the field of SCI and individuals with SCI to select the recommendations that are relevant and applicable to community-dwelling individuals in their daily lives; and (3) consolidation of the results of the study. Results: In this case study, at the end of the three-step procedure, the content for an mHealth intervention was selected in the form of 98 recommendations. Conclusions: This study describes a procedure for the participatory identification and selection of disease-specific evidence and professional best practices to inform self-management interventions. This procedure might be especially useful in cases of complex chronic health conditions, as every recommendation in these cases needs to be evaluated and considered in light of all other self-management requirements. Hence, the agreement of experts and affected individuals is essential to ensure the selection of evidence-based content that is considered to be relevant and applicable. %M 32432559 %R 10.2196/15818 %U http://mhealth.jmir.org/2020/5/e15818/ %U https://doi.org/10.2196/15818 %U http://www.ncbi.nlm.nih.gov/pubmed/32432559 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16207 %T Peer-to-Peer Social Media as an Effective Prevention Strategy: Quasi-Experimental Evaluation %A Evans,William %A Andrade,Elizabeth %A Pratt,Michaela %A Mottern,Alexandra %A Chavez,Sergio %A Calzetta-Raymond,Anthony %A Gu,Jiayan %+ Milken Institute School of Public Health, George Washington University, Washington, DC, United States, 1 2023519546, wdevans@gwu.edu %K social media %K substance use %K prevention %K marijuana %K opioids %K adolescent health %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Substance use by adolescents remains to be at unacceptably high levels, and there is evidence that teens’ social norms are becoming more favorable toward recreational use and perceived safety of substances such as marijuana and prescription opioids. Social media offer a low-cost, potentially high-impact approach to disseminate prevention messages. Objective: Living the Example (LTE) is a program that trains adolescent youth ambassadors to develop and disseminate prevention messages within their own social media networks and through in-school activities. This study aimed to evaluate the effects of exposure to LTE-based social media on students in the youth ambassadors’ networks. Methods: The George Washington (GW) University designed and implemented a quasi-experimental evaluation of the LTE program in 3 Maryland high schools. Before program launch, a sample of 826 students (wave 1) at the 3 schools, drawn from a census of freshmen enrolled in a class attended by all students at the grade level, completed a survey. A total of 584 students were surveyed at the wave 2 program midpoint and 542 at the wave 3 endpoint. The survey contained questions on drug use–related attitudes, beliefs, intentions, and behaviors, all based on validated measures. We evaluated the effects of LTE on the intended next 30-day drug use, and controlling for LTE self-reported exposure, age, and gender from waves 2 and 3 was appended into a single dataset. We first conducted ordinal logistic regressions for each drug use intention in wave 3 (ie, sell or distribute illegal drugs, smoke cigarettes, drink beer/wine/hard liquor when parents do not know about it, use marijuana, use lysergic acid diethylamide, cocaine, amphetamines or other illegal drugs, use heroin, use synthetic drugs, and use any prescription pills without a prescription) to examine the association between LTE exposure and drug use intentions. We included an interaction term for the study wave to examine intervention effects. Results: We found a significant positive effect of LTE exposure on all 8 measured drug use intentions: sell/distribute illegal drugs; smoke cigarettes; drink beer, wine, or liquor when my parents do not know about it; use marijuana; use cocaine, amphetamines, or other illegal drug; use heroin; use synthetic drugs; use any prescription pills without a prescription (all P<.05; odds ratios ranging from 2.12 to 3.71). We also found that boys were more likely than girls to exhibit reduced drug use intentions. We also found reductions in 30-day intentions between the second and third survey waves for all 8 measured drug use variables. Conclusions: Overall, the results are consistent with and indicate a stronger LTE effect in this study compared with a previous pilot study. LTE appears to offer a protective effect, with exposure to program messages leading to reduced/improved drug use intentions. %M 32374270 %R 10.2196/16207 %U https://mhealth.jmir.org/2020/5/e16207 %U https://doi.org/10.2196/16207 %U http://www.ncbi.nlm.nih.gov/pubmed/32374270 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15888 %T A Sexual Health Promotion App for Transgender Women (Trans Women Connected): Development and Usability Study %A Sun,Christina J %A Anderson,Kirsten M %A Kuhn,Tamara %A Mayer,Liat %A Klein,Charles H %+ School of Public Health, Oregon Health & Science University-Portland State University, 506 SW Mill St., Suite 450, SCH, Portland, OR, 97201, United States, 1 503 725 8858, chrsun@pdx.edu %K transgender persons %K HIV %K sexual health %K minority health %K health care disparities %K health status disparities %D 2020 %7 12.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women. Objective: This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app. Methods: We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions. Results: Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer–friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively. Conclusions: This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway. %M 32396131 %R 10.2196/15888 %U https://mhealth.jmir.org/2020/5/e15888 %U https://doi.org/10.2196/15888 %U http://www.ncbi.nlm.nih.gov/pubmed/32396131 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17270 %T Efficacy of the Ascure Smoking Cessation Program: Retrospective Study %A Kato,Ayaka %A Tanigawa,Tomoyuki %A Satake,Kohta %A Nomura,Akihiro %+ Innovative Clinical Research Center, Kanazawa University, 13-1 Takara-machi, Kanazawa, Kanazawa, Ishikawa, 920-8641, Japan, 81 76 265 2049, anomura@med.kanazawa-u.ac.jp %K smoking cessation %K nicotine dependence %K telecare %K telemedicine %K mHealth %K digital therapeutics %K mobile phone %K smoking cessation program %K online counseling %D 2020 %7 14.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking cessation helps extend a healthy life span and reduces medical expenses. However, the standard 12-week smoking cessation program in Japan has several notable problems. First, only 30% of participants complete this program. Second, participants may choose not to participate unless they have a strong motivation to quit smoking, such as health problems. Third, the program does not provide enough support during the period between clinical visits and after 12 weeks. Objective: This study examined the efficacy of the 24-week ascure program to address the problems of accessibility and continuous support. The program combines online mentoring, over-the-counter pharmacotherapy, and a smartphone app. Methods: Using a retrospective study design, we investigated data for 177 adult smokers who were enrolled in the ascure smoking cessation program between August 2017 and August 2018. The primary outcomes were continuous abstinence rates (CARs) during weeks 9-12 and weeks 21-24. To confirm smoking status, we performed salivary cotinine testing at weeks 12 and 24. We also evaluated the program adherence rate. Finally, we performed exploratory analysis to determine the factors associated with continuous abstinence at weeks 21-24 to provide insights for assisting with long-term continuous abstinence. Results: The CARs of all participants for weeks 9-12 and weeks 21-24 were 48.6% (95% CI 41.2-56.0) and 47.5% (95% CI 40.0-54.8), respectively. Program adherence rates were relatively high throughout (72% at week 12 and 60% at week 24). In the analysis of the factors related to the CAR at weeks 21-24, the number of entries in the app’s digital diary and number of educational videos watched during the first 12 weeks were significant factors. Conclusions: The ascure program achieved favorable CARs, and participants showed high adherence. Proactive usage of the smartphone app may help contribute to smoking cessation success in the long-term. %M 32406856 %R 10.2196/17270 %U https://mhealth.jmir.org/2020/5/e17270 %U https://doi.org/10.2196/17270 %U http://www.ncbi.nlm.nih.gov/pubmed/32406856 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17371 %T Use of Apps to Promote Childhood Vaccination: Systematic Review %A de Cock,Caroline %A van Velthoven,Michelle %A Milne-Ives,Madison %A Mooney,Mary %A Meinert,Edward %+ Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Children's Hospital, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K vaccination %K vaccination coverage %K mobile apps %K infant %K childhood vaccination %K immunization %K smartphone technology %K mobile phone %D 2020 %7 18.5.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Vaccination is a critical step in reducing child mortality; however, vaccination rates have declined in many countries in recent years. This decrease has been associated with an increase in the outbreak of vaccine-preventable diseases. The potential for leveraging mobile platforms to promote vaccination coverage has been investigated in the development of numerous mobile apps. Although many are available for public use, there is little robust evaluation of these apps. Objective: This systematic review aimed to assess the effectiveness of apps supporting childhood vaccinations in improving vaccination uptake, knowledge, and decision making as well as the usability and user perceptions of these apps. Methods: PubMed, Excerpta Medica Database (EMBASE), Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Education Resources Information Center (ERIC) databases were systematically searched for studies published between 2008 and 2019 that evaluated childhood vaccination apps. Two authors screened and selected studies according to the inclusion and exclusion criteria. Data were extracted and analyzed, and the studies were assessed for risk of bias. Results: A total of 28 studies evaluating 25 apps met the inclusion criteria and were included in this analysis. Overall, 9 studies assessed vaccination uptake, of which 4 reported significant benefits (P<.001 or P=.03) of the implementation of the app. Similarly, 4 studies indicated a significant (P≤.054) impact on knowledge and on vaccination decision making. Patient perceptions, usability, and acceptability were generally positive. The quality of the included studies was found to be moderate to poor, with many aspects of the methodology being unclear. Conclusions: There is little evidence to support the use of childhood vaccination apps to improve vaccination uptake, knowledge, or decision making. Further research is required to understand the dichotomous effects of vaccination-related information provision and the evaluation of these apps in larger, more robust studies. The methodology of studies must be reported more comprehensively to accurately assess the effectiveness of childhood vaccination apps and the risk of bias of studies. International Registered Report Identifier (IRRID): RR2-10.2196/16929 %M 32421684 %R 10.2196/17371 %U https://mhealth.jmir.org/2020/5/e17371 %U https://doi.org/10.2196/17371 %U http://www.ncbi.nlm.nih.gov/pubmed/32421684 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15085 %T Use of the Healthy Lifestyle Coaching Chatbot App to Promote Stair-Climbing Habits Among Office Workers: Exploratory Randomized Controlled Trial %A Piao,Meihua %A Ryu,Hyeongju %A Lee,Hyeongsuk %A Kim,Jeongeun %+ College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, 03080, Republic of Korea, 82 2 740 8803, rnyoo@snu.ac.kr %K exercise %K habits %K reward %K health behavior %K healthy lifestyle %D 2020 %7 19.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Lack of time for exercise is common among office workers given their busy lives. Because of occupational restrictions and difficulty in taking time off, it is necessary to suggest effective ways for workers to exercise regularly. Sustaining lifestyle habits that increase nonexercise activity in daily life can solve the issue of lack of exercise time. Healthy Lifestyle Coaching Chatbot is a messenger app based on the habit formation model that can be used as a tool to provide a health behavior intervention that emphasizes the importance of sustainability and involvement. Objective: This study aimed to assess the efficacy of the Healthy Lifestyle Coaching Chatbot intervention presented via a messenger app aimed at stair-climbing habit formation for office workers. Methods: From February 1, 2018, to April 30, 2018, a total of 106 people participated in the trial after online recruitment. Participants were randomly assigned to the intervention group (n=57) or the control group (n=49). The intervention group received cues and intrinsic and extrinsic rewards for the entire 12 weeks. However, the control group did not receive intrinsic rewards for the first 4 weeks and only received all rewards as in the intervention group from the fifth to twelfth week. The Self-Report Habit Index (SRHI) of participants was evaluated every week, and the level of physical activity was measured at the beginning and end of the trial. SPSS Statistics version 21 (IBM Corp) was used for statistical analysis. Results: After 4 weeks of intervention without providing the intrinsic rewards in the control group, the change in SRHI scores was 13.54 (SD 14.99) in the intervention group and 6.42 (SD 9.42) in the control group, indicating a significant difference between the groups (P=.04). When all rewards were given to both groups, from the fifth to twelfth week, the change in SRHI scores of the intervention and control groups was comparable at 12.08 (SD 10.87) and 15.88 (SD 13.29), respectively (P=.21). However, the level of physical activity showed a significant difference between the groups after 12 weeks of intervention (P=.045). Conclusions: This study provides evidence that intrinsic rewards are important to enhance the sustainability and effectiveness of an intervention. The Healthy Lifestyle Coaching Chatbot program can be a cost-effective method for healthy habit formation. Trial Registration: Clinical Research Information Service KCT0004009; https://tinyurl.com/w4oo7md %M 32427114 %R 10.2196/15085 %U https://mhealth.jmir.org/2020/5/e15085 %U https://doi.org/10.2196/15085 %U http://www.ncbi.nlm.nih.gov/pubmed/32427114 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15112 %T A Pedometer-Guided Physical Activity Intervention for Obese Pregnant Women (the Fit MUM Study): Randomized Feasibility Study %A Darvall,Jai N %A Wang,Andrew %A Nazeem,Mohamed Nusry %A Harrison,Cheryce L %A Clarke,Lauren %A Mendoza,Chennelle %A Parker,Anna %A Harrap,Benjamin %A Teale,Glyn %A Story,David %A Hessian,Elizabeth %+ Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, 3050, Australia, 61 393427000, jai.darvall@mh.org.au %K gestational weight gain %K pregnancy %K maternal obesity %K lifestyle intervention %K pedometer %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity in pregnancy is a growing problem worldwide, with excessive gestational weight gain (GWG) occurring in the majority of pregnancies. This significantly increases risks to both mother and child. A major contributor to both prepregnancy obesity and excessive GWG is physical inactivity; however, past interventions targeting maternal weight gain and activity levels during the antenatal period have been ineffective in women who are already overweight. Pedometer-guided activity may offer a novel solution for increasing activity levels in this population. Objective: This initial feasibility randomized controlled trial aimed to test a pedometer-based intervention to increase activity and reduce excessive GWG in pregnant women. Methods: We supplied 30 pregnant women with obesity a Fitbit Zip pedometer and randomized them into 1 of 3 groups: control (pedometer only), app (pedometer synced to patients’ personal smartphone, with self-monitoring of activity), or app-coach (addition of a health coach–delivered behavioral change program). Feasibility outcomes included participant compliance with wearing pedometers (days with missing pedometer data), data syncing, and data integrity. Activity outcomes (step counts and active minutes) were analyzed using linear mixed models and generalized estimating equations. Results: A total of 30 participants were recruited within a 10-week period, with a dropout rate of 10% (3/30; 2 withdrawals and 1 stillbirth); 27 participants thus completed the study. Mean BMI in all groups was ≥35 kg/m2. Mean (SD) percentage of missing data days were 23.4% (20.6%), 39.5% (32.4%), and 21.1% (16.0%) in control, app group, and app-coach group patients, respectively. Estimated mean baseline activity levels were 14.5 active min/day and 5455 steps/day, with no significant differences found in activity levels between groups, with mean daily step counts in all groups remaining in the sedentary (5000 steps/day) or low activity (5000-7499 steps/day) categories for the entire study duration. There was a mean decrease of 7.8 steps/day for each increase in gestation day over the study period (95% CI 2.91 to 12.69, P=.002). Conclusions: Activity data syncing with a personal smartphone is feasible in a cohort of pregnant women with obesity. However, our results do not support a future definitive study in its present form. Recruitment and retention rates were adequate, as was activity data syncing to participants’ smartphones. A follow-up interventional trial seeking to reduce GWG and improve activity in this population must focus on improving compliance with activity data recording and behavioral interventions delivered. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12617000038392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370884 %M 32348280 %R 10.2196/15112 %U http://mhealth.jmir.org/2020/5/e15112/ %U https://doi.org/10.2196/15112 %U http://www.ncbi.nlm.nih.gov/pubmed/32348280 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16937 %T Assessment of the Efficacy of a Mobile Phone–Delivered Just-in-Time Planning Intervention to Reduce Alcohol Use in Adolescents: Randomized Controlled Crossover Trial %A Haug,Severin %A Paz Castro,Raquel %A Scholz,Urte %A Kowatsch,Tobias %A Schaub,Michael Patrick %A Radtke,Theda %+ Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, Zurich, 8005, Switzerland, 41 444481174, severin.haug@isgf.uzh.ch %K alcohol %K adolescents %K planning intervention %K just-in-time intervention %K crossover trial %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Interventions to reduce alcohol use typically include several elements, such as information on the risks of alcohol consumption, planning for sensible drinking, and training of protective behavioral strategies. However, the effectiveness of these individual intervention elements within comprehensive programs has not been addressed so far, but it could provide valuable insights for the development of future interventions. Just-in-time interventions provided via mobile devices are intended to help people make healthy decisions in the moment and thus could influence health behavior. Objective: The aim of this study was to test the proximal effects of a mobile phone–delivered, just-in-time planning intervention to reduce alcohol use in adolescents who reported recent binge drinking. The efficacy of this individual intervention element was tested within a comprehensive intervention program to reduce problem drinking in adolescents. Methods: The study had an AB/BA crossover design, in which participants were randomly allocated to (1) a group receiving the planning intervention (A) in period 1 and assessment only (B) in period 2 or (2) a group receiving assessment only (B) in period 1 and the planning intervention (A) in period 2. The planning intervention included a text message to choose one of two predetermined if-then plans to practice sensible drinking with friends or when going out and a prompt to visualize the chosen plan. There was a washout period of at least 1 week between period 1 and period 2. Results: Out of 633 program participants who recently binge drank, 136 (21.5%) were receptive in both periods of time and provided data on the proximal outcome, which was the number of alcoholic drinks consumed with friends or when going out. After the planning intervention, the number of alcoholic drinks consumed was approximately one standard drink lower compared with the finding without the intervention (P=.01). Conclusions: A mobile phone–delivered, just-in-time, if-then planning intervention to practice sensible drinking with friends or when going out is effective in reducing alcohol consumption among adolescents who report recent binge drinking. Based on the relatively low percentage of participants with self-reported receptivity for the planning intervention, measures to increase the population impact of similar planning interventions should be implemented and tested in future trials. Trial Registration: ISRCTN Registry ISRCTN52150713; http://www.isrctn.com/ISRCTN52150713 %M 32452818 %R 10.2196/16937 %U http://mhealth.jmir.org/2020/5/e16937/ %U https://doi.org/10.2196/16937 %U http://www.ncbi.nlm.nih.gov/pubmed/32452818 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16999 %T Effect of an mHealth Intervention Using a Pedometer App With Full In-Person Counseling on Body Composition of Overweight Adults: Randomized Controlled Weight Loss Trial %A Hernández-Reyes,Alberto %A Cámara-Martos,Fernando %A Molina-Luque,Rafael %A Moreno-Rojas,Rafael %+ Universidad de Córdoba, Darwin Building, Annex, Campus de Rabanales, Córdoba, 14014, Spain, 34 687376563, z52heloa@uco.es %K pedometer %K physical activity %K exercise prescription %K diet %K health behavior %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In clinical practice, it is difficult to convey the benefits of sustained physical activity to adult patients with excess weight or obesity. For this purpose, a goal-setting walking prescription may be an effective strategy. Objective: This study aimed to determine the efficacy of the intervention of a pedometer app in setting a goal to reach 10,000 steps per day in adults. Methods: Overweight adults (n=98; mean body mass index 32.53 [SD 4.92] kg/m2) were randomized to one of two conditions (control or intervention). Both groups downloaded a pedometer app that recorded their daily step counts and were given a daily walking goal of 10,000 steps. Subjects participated in a 24-week in-person behavioral weight control program and were asked to monitor their daily levels using the pedometer app. Baseline data were recorded and followed up weekly. Only the intervention group had structured information delivery, a personalized physical activity prescription, and follow-up on number of steps per day. Results: The results show that regardless of sex or age, prescribing walking increased the number of steps per day by 4806 step on average (standardized β coefficient=–0.813, SE=427.586, t=–11.242, P<.001). Conclusions: These results could have implications for improving self-monitoring in overweight adults during periods of weight loss. Health professionals should analyze the implementation of tools that permit them to prescribe, follow up, and encourage the achievement of a goal of physical activity in overweight or obese patients. Trial Registration: ClinicalTrials.gov NCT03845478; https://clinicaltrials.gov/ct2/show/NCT03845478 %M 32348263 %R 10.2196/16999 %U http://mhealth.jmir.org/2020/5/e16999/ %U https://doi.org/10.2196/16999 %U http://www.ncbi.nlm.nih.gov/pubmed/32348263 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15502 %T Preparing African American Men to Make Informed Prostate Cancer Screening Decisions: Development and Pilot Testing of an Interactive Online Decision Aid %A Allen,Jennifer Dacey %A Reich,Amanda %A Cuevas,Adolfo G %A Ladin,Keren %+ Department of Community Health, Tufts University, 574 Boston Ave, Suite 208, Medford, MA, 02421, United States, 1 617 627 3233, jennifer.allen@tufts.edu %K decision support techniques %K prostate neoplasms %K early detection of cancer %K decision making (shared) %K men’s health %K minority health %D 2020 %7 5.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: African American men are at a higher risk of developing and dying from prostate cancer compared to white men. The serum prostate-specific antigen (PSA) screening test has a high risk of false-positive results and overdiagnosis; therefore, it is not routinely recommended. Rather, men are encouraged to make individualized decisions with their medical providers, after being fully informed about its potential benefits, limitations, and risks. Objective: This study aimed to describe the development and pilot testing of an interactive Web-based decision aid (DA; Prostate Cancer Screening Preparation [PCSPrep]) for African American men, designed to promote informed decision making for prostate cancer screening. Methods: Four focus groups (n=33) were conducted to assess men’s reactions to DAs developed in prior studies and gather information to modify the content and format. The pilot test employed a pre-posttest evaluation design. A convenience sample of 41 men aged 45-70 years with no history of prostate cancer was recruited from community settings. Participants completed online surveys before and after using PCSPrep that assessed prostate cancer screening knowledge, decision self-efficacy, decisional conflict, and preparation for decision making. Results: Use of PCSPrep was associated with a significant increase in prostate cancer knowledge (49% vs 62% correct responses; P<.001), and men also experienced less decisional conflict (24 vs 15 on a scale of 0-100; P=.008). No changes in self-efficacy about decision making or screening preferences were observed. Most men (81%) reported that using PCSPrep prepared them to make informed decisions in partnership with their provider. Conclusions: PCSPrep was an acceptable DA that improved men’s knowledge, reduced decisional conflict, and promoted the perception of being prepared for shared decision making. Further research is needed to test the DA in a larger randomized trial. %M 32369032 %R 10.2196/15502 %U https://mhealth.jmir.org/2020/5/e15502 %U https://doi.org/10.2196/15502 %U http://www.ncbi.nlm.nih.gov/pubmed/32369032 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15849 %T Effectiveness of Text Message Interventions for Weight Management in Adolescents: Systematic Review %A Partridge,Stephanie Ruth %A Raeside,Rebecca %A Singleton,Anna %A Hyun,Karice %A Redfern,Julie %+ The University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Department of General Practice, Acacia House, Westmead Hospital, Sydney, 2145, Australia, 61 288908187, stephanie.partridge@sydney.edu.au %K adolescent %K text message %K obesity %K overweight %K prevention %K mHealth %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The incidence of obesity among adolescents is increasing. Text messages are a primary communication form for adolescents and potentially a scalable strategy for delivering population health interventions. Objective: This study aimed to determine the effectiveness of text message interventions in reducing BMI in adolescents and describe characteristics that are common to effective interventions. Methods: This systematic review included randomized controlled trials of text message lifestyle interventions involving adolescents aged 10 to 19 years with outcomes focused on obesity prevention or management. Primary outcome was objective or self-report change in BMI. Results: In total, 4362 records were identified, and 215 full-text articles were assessed for eligibility. A total of 8 unique studies were identified, including 767 participants, mean age 14.3 (SD 0.9) years, BMI 29.7 (SD 1.6) kg/m2 and 53.1% (407/767) female (31/101, 30.7%-172/172, 100.0%). All interventions were multicomponent. The median active intervention period was 4.5 months. During the active and extended intervention phases, text messages accounted for >50% (8 studies) and >85% (3 studies) of contact points, respectively. Text messages were heterogeneous, with a median of 1.5 text messages sent per week (range: 1-21). A total of 4 studies utilized two-way text message communication with health professionals Of the 8 studies, 7 demonstrated reductions in BMI or BMI z-score in the intervention group compared with the control at the end of the final follow-up. The effect was only statistically significant in 1 study at 6 months. Over 6 months, reductions in BMI (kg/m2) ranged from 1.3% to 4.5% and BMI z-score ranged from 4.2% to 28.1%. Overall quality of the studies was low. Conclusions: Further research is required to elucidate the effectiveness and potential impact of text message interventions on weight and weight-related behaviors in adolescents. %M 32348264 %R 10.2196/15849 %U http://mhealth.jmir.org/2020/5/e15849/ %U https://doi.org/10.2196/15849 %U http://www.ncbi.nlm.nih.gov/pubmed/32348264 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16747 %T An App for Detecting Bullying of Nurses Using Convolutional Neural Networks and Web-Based Computerized Adaptive Testing: Development and Usability Study %A Ma,Shu-Ching %A Chou,Willy %A Chien,Tsair-Wei %A Chow,Julie Chi %A Yeh,Yu-Tsen %A Chou,Po-Hsin %A Lee,Huan-Fang %+ Department of Nursing, College of Medicine, National Cheng Kung University, No 988, Chung Hwa Road, Yung Kung District, Tainan 710, Taiwan, Tainan, 710, Taiwan, 886 +8862812811, Eamonn0330@gmail.com %K nurse bullying %K NAQ-R assessment %K receiver operating characteristic curve %K convolutional neural network %K computerized adaptive testing %D 2020 %7 20.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Workplace bullying has been measured in many studies to investigate its effects on mental health issues. However, none have used web-based computerized adaptive testing (CAT) with bully classifications and convolutional neural networks (CNN) for reporting the extent of individual bullying in the workplace. Objective: This study aims to build a model using CNN to develop an app for automatic detection and classification of nurse bullying-levels, incorporated with online Rasch computerized adaptive testing, to help assess nurse bullying at an earlier stage. Methods: We recruited 960 nurses working in a Taiwan Ch-Mei hospital group to fill out the 22-item Negative Acts Questionnaire-Revised (NAQ-R) in August 2012. The k-mean and the CNN were used as unsupervised and supervised learnings, respectively, for: (1) dividing nurses into three classes (n=918, 29, and 13 with suspicious mild, moderate, and severe extent of being bullied, respectively); and (2) building a bully prediction model to estimate 69 different parameters. Finally, data were separated into training and testing sets in a proportion of 70:30, where the former was used to predict the latter. We calculated the sensitivity, specificity, and receiver operating characteristic curve (area under the curve [AUC]), along with the accuracy across studies for comparison. An app predicting the respondent bullying-level was developed, involving the model’s 69 estimated parameters and the online Rasch CAT module as a website assessment. Results: We observed that: (1) the 22-item model yields higher accuracy rates for three categories, with an accuracy of 94% for the total 960 cases, and accuracies of 99% (AUC 0.99; 95% CI 0.99-1.00) and 83% (AUC 0.94; 95% CI 0.82-0.99) for the lower and upper groups (cutoff points at 49 and 66 points) based on the 947 cases and 42 cases, respectively; and (2) the 700-case training set, with 95% accuracy, predicts the 260-case testing set reaching an accuracy of 97. Thus, a NAQ-R app for nurses that predicts bullying-level was successfully developed and demonstrated in this study. Conclusions: The 22-item CNN model, combined with the Rasch online CAT, is recommended for improving the accuracy of the nurse NAQ-R assessment. An app developed for helping nurses self-assess workplace bullying at an early stage is required for application in the future. %M 32432557 %R 10.2196/16747 %U https://mhealth.jmir.org/2020/5/e16747 %U https://doi.org/10.2196/16747 %U http://www.ncbi.nlm.nih.gov/pubmed/32432557 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15096 %T A Mobile Phone–Based Sexual and Reproductive Health Intervention for Female Sex Workers in Kenya: Development and Qualitative Study %A Ampt,Frances H %A L'Engle,Kelly %A Lim,Megan S C %A Plourde,Kate F %A Mangone,Emily %A Mukanya,Collins Mudogo %A Gichangi,Peter %A Manguro,Griffins %A Hellard,Margaret %A Stoové,Mark %A Chersich,Matthew F %A Jaoko,Walter %A Agius,Paul A %A Temmerman,Marleen %A Wangari,Winnie %A Luchters,Stanley %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 2 9282 2111, frances.ampt@burnet.edu.au %K sex work %K mobile health (mHealth) %K unintended pregnancy %K qualitative research %D 2020 %7 29.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women’s Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. Objective: This paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants’ responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability. Methods: The research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach. Results: The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information. Conclusions: Our results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs’ lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change. %M 32469326 %R 10.2196/15096 %U https://mhealth.jmir.org/2020/5/e15096 %U https://doi.org/10.2196/15096 %U http://www.ncbi.nlm.nih.gov/pubmed/32469326 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17085 %T Analysis of Secure Apps for Daily Clinical Use by German Orthopedic Surgeons: Searching for the "Needle in a Haystack" %A Dittrich,Florian %A Beck,Sascha %A Harren,Anna Katharina %A Reinecke,Felix %A Serong,Sebastian %A Jung,Jochen %A Back,David Alexander %A Wolf,Milan %A Landgraeber,Stefan %+ Department for Orthopaedics and Orthopaedics Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstr. 100, Homburg, Germany, 49 68411624520, florian.dittrich@uks.eu %K smartphone %K mHealth %K app %K orthopedics %K app store %K screening %D 2020 %7 7.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It is undeniable that appropriate smartphone apps offer enormous opportunities for dealing with future challenges in orthopedic surgery and public health, in general. However, it is still unclear how the apps currently available in the two major app stores can be used in daily clinical routine by German orthopedic surgeons. Objective: This study aimed to gain evidence regarding the quantity and quality of apps available in the two major app stores and their suitability for use by orthopedic surgeons in Germany. Methods: We conducted a systematic, keyword-based app store screening to obtain evidence concerning the quantity and quality of commercially available apps. Apps that met the inclusion criteria were evaluated using the app synopsis–checklist for users and the German Mobile App Rating Scale for secure use, trustworthiness, and quality. Results: The investigation revealed serious shortcomings regarding legal and medical aspects. Furthermore, most apps turned out to be useless and unsuitable for the clinical field of application (4242/4249, 99.84%). Finally, 7 trustworthy and high-quality apps (7/4249, 0.16%) offering secure usage in the daily clinical routine of orthopedists were identified. These apps mainly focused on education (5/7). None of them were CE (Conformité Européenne) certified. Moreover, there are no studies providing evidence that these apps have any positive use whatsoever. Conclusions: The data obtained in our study suggest that the number of trustworthy and high-quality apps on offer is extremely low. Nowadays, finding appropriate apps in the fast-moving, complex, dynamic, and rudimentarily controlled app stores is most challenging. Promising approaches, for example, systematic app store screenings, app-rating developments, reviews or app libraries, and the creation of consistent standards have been established. However, further efforts are necessary to ensure that these innovative mobile health apps not only provide the correct information but are also safe to use in daily clinical practice. %M 32379054 %R 10.2196/17085 %U https://mhealth.jmir.org/2020/5/e17085 %U https://doi.org/10.2196/17085 %U http://www.ncbi.nlm.nih.gov/pubmed/32379054 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17798 %T Android and iPhone Mobile Apps for Psychosocial Wellness and Stress Management: Systematic Search in App Stores and Literature Review %A Lau,Nancy %A O'Daffer,Alison %A Colt,Susannah %A Yi-Frazier,Joyce P %A Palermo,Tonya M %A McCauley,Elizabeth %A Rosenberg,Abby R %+ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1900 Ninth Ave, JMB 10-C, Seattle, WA, 98101, United States, 1 2068840569, nancy.lau@seattlechildrens.org %K mHealth %K mobile health %K mental health %D 2020 %7 22.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In an oversaturated market of publicly available mobile apps for psychosocial self-care and stress management, health care providers, patients, and consumers interested in mental health–related apps may wonder which, if any, are efficacious. Readily available metrics for consumers include user popularity and media buzz rather than scientific evidence. Objective: This systematic review aimed to (1) examine the breadth of therapeutic contents and features of psychosocial wellness and stress management apps available to self-help seekers for public download and (2) determine which of these apps have original research support. Methods: First, we conducted a systematic review of publicly available apps on the iPhone App Store (Apple Inc) and Android Google Play (Google LLC) platforms using conventional self-help-seeking search terms related to wellness and stress. The results were limited to English-language apps available for free download. In total, 2 reviewers independently evaluated all apps and discussed the findings to reach 100% consensus regarding inclusion. Second, a literature review was conducted on the included apps to identify supporting studies with original data collection. Results: We screened 3287 apps and found 1009 psychosocial wellness and stress management apps. Content varied widely. The most common evidence-based strategy was mindfulness-meditation, followed by positive psychology and goal setting. Most apps were intended to be used as self-help interventions, with only 1.09% (11/1009) involving an electronic therapist and 1.88% (19/1009) designed as a supplement to in-person psychotherapy. Only 4.66% (47/1009) of apps targeted individuals with psychological disorders, and less than 1% of apps (6/1009, 0.59%) targeted individuals with other chronic illnesses. Approximately 2% (21/1009, 2.08%) were supported by original research publications, with a total of 25 efficacy studies and 10 feasibility studies. The Headspace mindfulness app had the most evidence, including 8 efficacy studies. Most other scientifically backed apps were supported by a single feasibility or efficacy study. Conclusions: Only 2.08% (21/1009) of publicly available psychosocial wellness and stress management mobile apps discoverable to self-help seekers have published, peer-reviewed evidence of feasibility and/or efficacy. Clinicians and investigators may use these findings to help patients and families navigate the volume of emerging digital health interventions for stress management and wellness. %M 32357125 %R 10.2196/17798 %U http://mhealth.jmir.org/2020/5/e17798/ %U https://doi.org/10.2196/17798 %U http://www.ncbi.nlm.nih.gov/pubmed/32357125 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17300 %T Content and Quality of Infant Feeding Smartphone Apps: Five-Year Update on a Systematic Search and Evaluation %A Cheng,Heilok %A Tutt,Alison %A Llewellyn,Catherine %A Size,Donna %A Jones,Jennifer %A Taki,Sarah %A Rossiter,Chris %A Denney-Wilson,Elizabeth %+ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, 2050, Australia, 61 1800793864, jessica.cheng@sydney.edu.au %K breast feeding %K bottle feeding %K infant food %K readability %K consumer health information %K breastfeeding %K mobile apps %K smartphones %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents use apps to access information on child health, but there are no standards for providing evidence-based advice, support, and information. Well-developed apps that promote appropriate infant feeding and play can support healthy growth and development. A 2015 systematic assessment of smartphone apps in Australia about infant feeding and play found that most apps had minimal information, with poor readability and app quality. Objective: This study aimed to systematically evaluate the information and quality of smartphone apps providing information on breastfeeding, formula feeding, introducing solids, or infant play for consumers. Methods: The Google Play store and Apple App Store were searched for free and paid Android and iPhone Operating System (iOS) apps using keywords for infant feeding, breastfeeding, formula feeding, and tummy time. The apps were evaluated between September 2018 and January 2019 for information content based on Australian guidelines, app quality using the 5-point Mobile App Rating Scale, readability, and suitability of health information. Results: A total of 2196 unique apps were found and screened. Overall, 47 apps were evaluated, totaling 59 evaluations for apps across both the Android and iOS platforms. In all, 11 apps had affiliations to universities and health services as app developers, writers, or editors. Furthermore, 33 apps were commercially developed. The information contained within the apps was poor: 64% (38/59) of the evaluations found no or low coverage of information found in the Australian guidelines on infant feeding and activity, and 53% (31/59) of the evaluations found incomplete or incorrect information with regard to the depth of information provided. Subjective app assessment by health care practitioners on whether they would use, purchase, or recommend the app ranged from poor to acceptable (median 2.50). Objective assessment of the apps’ engagement, functionality, aesthetics, and information was scored as acceptable (median 3.63). The median readability score for the apps was at the American Grade 8 reading level. The suitability of health information was rated superior or adequate for content, reading demand, layout, and interaction with the readers. Conclusions: The quality of smartphone apps on infant feeding and activity was moderate based on the objective measurements of engagement, functionality, aesthetics, and information from a reliable source. The overall quality of information on infant feeding and activity was poor, indicated by low coverage of topics and incomplete or partially complete information. The key areas for improvement involved providing evidence-based information consistent with the Australian National Health and Medical Research Council’s Infant Feeding Guidelines. Apps supported and developed by health care professionals with adequate health service funding can ensure that parents are provided with credible and reliable resources. %M 32459187 %R 10.2196/17300 %U http://mhealth.jmir.org/2020/5/e17300/ %U https://doi.org/10.2196/17300 %U http://www.ncbi.nlm.nih.gov/pubmed/32459187 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17458 %T Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses %A Lecomte,Tania %A Potvin,Stéphane %A Corbière,Marc %A Guay,Stéphane %A Samson,Crystal %A Cloutier,Briana %A Francoeur,Audrey %A Pennou,Antoine %A Khazaal,Yasser %+ Department of Psychology, University of Montreal, 90 rue Vincent d'Indy, Bur C-358, CP 6128, Succ Centre-Ville, Montreal, QC, H3C 3J7, Canada, 1 343 6274, tania.lecomte@umontreal.ca %K apps %K mental health %K depression %K anxiety %K review %K meta %D 2020 %7 29.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health apps have great potential to help people needing support to cope with distress or specific symptoms. In fact, there is an exponential increase in the number of mental health apps available on the internet, with less than 5% being actually studied. Objective: This study aimed to assess the quality of the available evidence regarding the use of mental health apps and to summarize the results obtained so far. Methods: Systematic reviews and meta-analyses were searched, specifically for mobile apps on mental health issues or symptoms, and rated using the Grading of Recommendations Assessment, Development and Evaluation system. Results: A total of 7 meta-analyses were carefully reviewed and rated. Although some meta-analyses looked at any mental health issue and analyzed the data together, these studies were of poorer quality and did not offer strong empirical support for the apps. Studies focusing specifically on anxiety symptoms or depressive symptoms were of moderate to high quality and generally had small to medium effect sizes. Similarly, the effects of apps on stress and quality of life tended to offer small to medium effects and were of moderate to high quality. Studies looking at stand-alone apps had smaller effect sizes but better empirical quality than studies looking at apps with guidance. The studies that included follow-ups mostly found a sustained impact of the app at an 11-week follow-up. Conclusions: This meta-review revealed that apps for anxiety and depression hold great promise with clear clinical advantages, either as stand-alone self-management or as adjunctive treatments. More meta-analyses and more quality studies are needed to recommend apps for other mental health issues or for specific populations. %M 32348289 %R 10.2196/17458 %U https://mhealth.jmir.org/2020/5/e17458 %U https://doi.org/10.2196/17458 %U http://www.ncbi.nlm.nih.gov/pubmed/32348289 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e18400 %T Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development %A Fedele,David A %A Cushing,Christopher C %A Koskela-Staples,Natalie %A Patton,Susana R %A McQuaid,Elizabeth L %A Smyth,Joshua M %A Prabhakaran,Sreekala %A Gierer,Selina %A Nezu,Arthur M %+ Department of Clinical & Health Psychology, University of Florida, 101 S Newell Dr, Rm 3151, PO Box 100165, Gainesville, FL, 32610, United States, 1 3522945765, dfedele@phhp.ufl.edu %K asthma %K mobile health %K adherence %K adolescence %K self-regulation %K problem-solving %K adolescent %K youth %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents’ difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents’ objectively measured ICS adherence data indicate suboptimal rates of medication use. Objective: The current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content. Methods: We developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17–year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development. Results: Consistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow). Conclusions: ReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT’s emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process. %M 32374273 %R 10.2196/18400 %U https://mhealth.jmir.org/2020/5/e18400 %U https://doi.org/10.2196/18400 %U http://www.ncbi.nlm.nih.gov/pubmed/32374273 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e18597 %T Efficacy and Impact of Digital HIV Care Navigation in Young People Living With HIV in San Francisco, California: Prospective Study %A Arayasirikul,Sean %A Turner,Caitlin %A Trujillo,Dillon %A Le,Victory %A Wilson,Erin C %+ San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, San Francisco, CA, , 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 8.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young people are disproportionately impacted by HIV infection and exhibit poor HIV care continuum outcomes. Mobile health (mHealth) interventions are promising approaches to meet the unique needs of young people living with HIV. Youth-focused interventions are needed to improve HIV care continuum outcomes. Objective: This study assessed the preliminary efficacy and impact of a digital HIV care navigation intervention among young people living with HIV in San Francisco. Health electronic navigation (eNavigation or eNav) is a 6-month, text message–based, digital HIV care navigation intervention, in which young people living with HIV are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. Methods: This study had a single-arm, prospective, pre-post design. The analysis included 120 young men who have sex with men or transwomen living with HIV aged between 18 and 34 years. We analyzed self-reported sociobehavioral information pre- and postintervention at baseline and 6 months, which was collected using computer-assisted self-interviewing surveys. We characterized the sample and built generalized estimating equation (GEE) models to assess differences in HIV care continuum outcomes at baseline and 6 months. Results: The characteristics according to the intervention completion status were not different from those of the overall sample. The mean age of the participants was 27.75 years (SD 4.07). Most participants (103/120, 85.8%) identified as men, and the sample was racially/ethnically diverse. At baseline, majority (99/120, 82.5%) of the participants had recently received primary HIV care, yet this was more likely in those who completed the intervention than in those who did not (54/60, 90% vs 45/60, 75%; χ21=4.68, P=.03). More than half of the sample reported taking antiretroviral therapy (92/120, 76.7%) and having an undetectable viral load (65/120, 54.2%). The 6-month follow-up surveys were completed by 73.3% (88/120) of participants, and these participants were not characteristically different from the overall sample at baseline. GEE models indicated that participants had increased odds of viral suppression at 6 months as compared with baseline. No relevant additive or multiplicative interactions were noted on comparing outcome effects over time according to intervention completion. Conclusions: Digital HIV care navigation fills a critical gap in public health and HIV care systems, making these systems more responsive and accountable to the needs of the most vulnerable individuals. Our intervention bridges the time between primary care visits with interactive, tailored, personalized, and peer-delivered social support; information; and motivational interviewing to scaffold behavioral change. This study is part of the next wave of system-informed mHealth intervention research that will offer potentially disruptive solutions to traditional in-person delivered interventions and improve the health of the most vulnerable individuals. International Registered Report Identifier (IRRID): RR2-10.2196/16406 %M 32383680 %R 10.2196/18597 %U https://mhealth.jmir.org/2020/5/e18597 %U https://doi.org/10.2196/18597 %U http://www.ncbi.nlm.nih.gov/pubmed/32383680 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e14884 %T Development of the InCharge Health Mobile App to Improve Adherence to Hydroxyurea in Patients With Sickle Cell Disease: User-Centered Design Approach %A Alberts,Nicole M %A Badawy,Sherif M %A Hodges,Jason %A Estepp,Jeremie H %A Nwosu,Chinonyelum %A Khan,Hamda %A Smeltzer,Matthew P %A Homayouni,Ramin %A Norell,Sarah %A Klesges,Lisa %A Porter,Jerlym S %A Hankins,Jane S %+ Department of Hematology, St Jude Children’s Research Hospital, 332 Danny Thomas Place, Mail Stop 800, Memphis, TN, 38105, United States, 1 901 595 4153, Jane.Hankins@stjude.org %K sickle cell anemia %K hydroxyurea %K hydroxycarbamide %K medication adherence %K self-management %K mobile health %K internet %D 2020 %7 8.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sickle cell disease (SCD) is an inherited blood disorder causing acute complications and chronic progressive end organ damage. SCD is associated with significant morbidity, early mortality, impaired health-related quality of life, and increased acute health care utilization. Hydroxyurea is a US Food and Drug Administration–approved medication that reduces disease complications, acute health care utilization, and costs. However, adherence to hydroxyurea is suboptimal. Mobile health (mHealth) interventions have the potential to improve hydroxyurea adherence, but few examples exist that are specific to the SCD population. Objective: This study aimed to design a mHealth intervention for individuals with SCD to improve adherence to hydroxyurea, using a user-centered design that was informed by specific barriers to hydroxyurea adherence and utilization in this population. Methods: This study consisted of 4 phases. In phase 1, individuals with SCD and health care providers participated in an optimization digital workshop. In phase 2, patients completed surveys pertaining to their interest in mHealth use, barriers and facilitators to hydroxyurea use, and health literacy. Phases 3 and 4 involved semistructured interviews and focus groups, respectively, and used the Health Belief Model (HBM) as the framework to investigate drivers of poor hydroxyurea adherence and to inform the development of an app prototype. In addition, in phase 4, we have incorporated the patients’ feedback on the preliminary app prototype and its features. Results: Barriers to hydroxyurea adherence were consistent with the literature and included forgetfulness and several specific thoughts and emotions associated with hydroxyurea use (eg, fear of side effects, depression, stigma, and hopelessness). In addition, more than half of the participants reported potentially low health literacy. Preferred patient app features included 7 key components, namely (1) medication reminders and tracker, (2) disease education, (3) communication, (4) personalization, (5) motivation, (6) support during pain episodes, and (7) social support. Utilizing a user-centered design approach, data obtained from patients and providers were translated into features within the app, mapping to components of the HBM and the specific drivers of hydroxyurea adherence and matching the literacy level of the population, resulting in the development of a novel mobile app called InCharge Health. Conclusions: The InCharge Health app is an mHealth intervention developed with substantial input from users and by mapping the HBM as the framework that guided the choice for its components. InCharge Health is a customized product for the SCD population aimed at optimizing medication adherence, with the end goal of improving quality of life and health outcomes among patients with SCD. The efficacy and implementation of the InCharge Health app as an mHealth intervention to promote hydroxyurea adherence will be tested in a future stepped-wedge multicenter trial for adolescents and adults with SCD. %M 32383683 %R 10.2196/14884 %U https://mhealth.jmir.org/2020/5/e14884 %U https://doi.org/10.2196/14884 %U http://www.ncbi.nlm.nih.gov/pubmed/32383683 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17315 %T Health System Stakeholders’ Perspective on the Role of Mobile Health and Its Adoption in the Swiss Health System: Qualitative Study %A Lingg,Myriam %A Lütschg,Verena %+ SOS Beobachter Foundation, Flurstrasse 55, Zurich, 8048, Switzerland, 41 058 269 21 21, myriam.lingg@ringier.ch %K mobile health %K mHealth %K eHealth %K telehealth %K telemedicine %K digitization %K electronic health record %K technology %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health solutions have great potential to change the way health care is delivered, including better clinical outcomes and improved processes and access to health services. However, the adoption of mobile health (mHealth) solutions for patient monitoring has been rather slow in Switzerland. The reasons are complex, and a better understanding is needed to leverage the full potential of mHealth. Objective: This study aimed to deepen the understanding of the potential relevance and influence of mHealth for the health system and health care provision, and factors influencing its adoption. The findings will be used to provide an outlook on feasible recommendations for action. Methods: We conducted a qualitative survey using a maximum variation sample of a heterogeneous group of stakeholders (N=50) in the Swiss health care system with a profound knowledge of digital health and medical devices. A semistructured interview guide including open- and closed-ended questions was used to address questions around mHealth relevance and its influence on the health system, the relevance of selected determinants for mHealth adoption, and important influencing factors. A content analysis method was applied. Results: Overall, respondents thought that mHealth would have a beneficial impact on the Swiss health system but that its adoption would evolve slowly. We derived 23 key opportunities regarding patient and patient pathway, treatment of disease, and diseases and health conditions. High consistency in answers among respondents was observed for treatment of disease. Stakeholders’ attitudes toward mHealth adoption along the relevance of 23 preselected determinants were relatively consistent. However, we obtained diverging attitudes regarding the influence of trends, enablers, and restraints in Switzerland and translated them into 26 key themes influencing mHealth adoption. Relevant trends comprise changing needs and expectations of patients, a rising need for efficient health care delivery, growing interest in improved outpatient care, and emerging technologies and progressing digitization. Important enablers include growing demand for new financing schemes and incentive concepts, rising demand for comprehensive information on and stronger body of evidence for mHealth use cases, and increasing need for easy to use alternate care approaches. Challenging restraints are rigidness of thinking and siloed actions of health system actors, complexity of changing the existing regulations and structures, little understanding of mHealth use and the role of clinicians, and risk of further polarization of the population. Conclusions: This study provides a comprehensive look at mHealth in the Swiss health system. It becomes apparent that strong governance is inevitable to foster a sustainable data strategy and to reconcile the different interests of stakeholders. The use of mHealth will add value but will not necessarily reduce the burden on the system caused by emerging societal needs and changing disease prevalence. %M 32391802 %R 10.2196/17315 %U https://mhealth.jmir.org/2020/5/e17315 %U https://doi.org/10.2196/17315 %U http://www.ncbi.nlm.nih.gov/pubmed/32391802 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16147 %T Remote Patient Monitoring Technologies for Predicting Chronic Obstructive Pulmonary Disease Exacerbations: Review and Comparison %A Fan,Kathleen G %A Mandel,Jess %A Agnihotri,Parag %A Tai-Seale,Ming %+ Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, United States, 1 650 815 5485, mtaiseale@health.ucsd.edu %K COPD %K disease exacerbation %K remote patient monitoring %K mobile health %K telehealth %K at-home monitoring %K remote monitoring system %K wearable %D 2020 %7 21.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death by disease worldwide and has a 30-day readmission rate of 22.6%. In 2015, COPD was added to the Medicare Hospital Readmission Reductions Program. Objective: The objective of this paper was to survey the current medical technologies for remote patient monitoring (RPM) tools that forecast COPD exacerbations in order to reduce COPD readmissions. Methods: We searched literature and digital health news to find commercially available RPM devices focused on predicting COPD exacerbations. These technologies were reviewed and compared according to four criteria: forecasting ability, cost, ease of use, and appearance. A rating system was developed to facilitate the evaluation process. Results: As of June 2019, a list of handheld and hands-free devices was compiled. We compared features and found substantial variations. Devices that ranked higher on all criteria tended to have a high or unlisted price. Commonly mass-marketed devices like the pulse oximeter and spirometer surprisingly fulfilled the least criteria. Conclusions: The COPD RPM technologies with most technological promise and compatibility with daily living appear to have high or unlisted prices. Consumers and providers need better access to product information to make informed decisions. %M 32348262 %R 10.2196/16147 %U http://mhealth.jmir.org/2020/5/e16147/ %U https://doi.org/10.2196/16147 %U http://www.ncbi.nlm.nih.gov/pubmed/32348262 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15111 %T Mobile Phone–Based Behavioral Interventions in Pregnancy to Promote Maternal and Fetal Health in High-Income Countries: Systematic Review %A Hussain,Tasmeen %A Smith,Patricia %A Yee,Lynn M %+ Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2145, Chicago, IL, United States, 1 312 472 4685, lynn.yee@northwestern.edu %K mHealth %K mobile health %K pregnancy %K smartphone %K text messaging %K mobile applications %K software %K chronic disease %K health behavior %D 2020 %7 28.5.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Chronic diseases have recently had an increasing effect on maternal-fetal health, especially in high-income countries. However, there remains a lack of discussion regarding health management with technological approaches, including mobile health (mHealth) interventions. Objective: This study aimed to systematically evaluate mHealth interventions used in pregnancy in high-income countries and their effects on maternal health behaviors and maternal-fetal health outcomes. Methods: This systematic review identified studies published between January 1, 2000, and November 30, 2018, in MEDLINE via PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were eligible for inclusion if they included only pregnant women in high-income countries and evaluated stand-alone mobile phone interventions intended to promote healthy maternal beliefs, behaviors, and/or maternal-fetal health outcomes. Two researchers independently reviewed and categorized aspects of full-text articles, including source, study design, intervention and control, duration, participant age, attrition rate, main outcomes, and risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was registered in PROSPERO before initiation. Results: Of the 2225 records examined, 28 studies were included and categorized into 4 themes: (1) gestational weight gain, obesity and physical activity (n=9); (2) smoking cessation (n=9); (3) influenza vaccination (n=2); and (4) general prenatal health, preventive strategies, and miscellaneous topics (n=8). Reported sample sizes ranged from 16 to 5243 with a median of 91. Most studies were performed in the United States (18/28, 64%) and were randomized controlled trials (21/28, 75%). All participants in the included studies were pregnant at the time of study initiation. Overall, 14% (4/28) of studies showed association between intervention use and improved health outcomes; all 4 studies focused on healthy gestational weight. Among those, 3 studies showed intervention use was associated with less overall gestational weight gain. These 3 studies involved interventions with text messaging or an app in combination with another communication strategy (Facebook or email). Regarding smoking cessation, influenza vaccination, and miscellaneous topics, there was some evidence of positive effects on health behaviors and beliefs, but very limited correlation with improved health outcomes. Data and interventions were heterogeneous, precluding a meta-analysis. Conclusions: In high-income countries, utilization of mobile phone–based health behavior interventions in pregnancy demonstrates some correlation with positive beliefs, behaviors, and health outcomes. More effective interventions are multimodal in terms of features and tend to focus on healthy gestational weight gain. %M 32463373 %R 10.2196/15111 %U https://mhealth.jmir.org/2020/5/e15111 %U https://doi.org/10.2196/15111 %U http://www.ncbi.nlm.nih.gov/pubmed/32463373 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15762 %T Mobile App to Improve House Officers’ Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study %A Hejjaji,Vittal %A Malik,Ali O %A Peri-Okonny,Poghni A %A Thomas,Merrill %A Tang,Yuanyuan %A Wooldridge,David %A Spertus,John A %A Chan,Paul S %+ Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, 4401 Wornall Rd, Kansas City, MO, United States, 1 2162781685, hejjajiv@umkc.edu %K cardiac arrest %K advanced cardiac life support %K mHealth %K quality improvement %K medical education %D 2020 %7 19.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. Objective: The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers’ adherence to ACLS guidelines. Methods: As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired t tests compared performance with and without the mobile app. Results: Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95% CI 0.6 to 1.6]; P<.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference –0.7 [95% CI –0.3 to –1.0]; P<.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9% vs 89.0%; absolute difference 1.9% [95% CI 0.6% to 3.4%]; P=.007). Conclusions: This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown. %M 32427115 %R 10.2196/15762 %U https://mhealth.jmir.org/2020/5/e15762 %U https://doi.org/10.2196/15762 %U http://www.ncbi.nlm.nih.gov/pubmed/32427115 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16527 %T The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial %A Ngo,Victoria %A Matsumoto,Cynthia G %A Joseph,Jill G %A Bell,Janice F %A Bold,Richard J %A Davis,Andra %A Reed,Sarah C %A Kim,Katherine K %+ Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th Street, Suite 2600, Sacramento, CA, United States, 1 5107615461, kathykim@ucdavis.edu %K care coordination, continuity of patient care %K oncology %K chemotherapy %K patient-centered care %K mobile health %K technology adoption %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)—a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy. Objective: This study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy. Methods: A two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant’s life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated. Results: A total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record. Conclusions: The findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness. %M 32452814 %R 10.2196/16527 %U http://mhealth.jmir.org/2020/5/e16527/ %U https://doi.org/10.2196/16527 %U http://www.ncbi.nlm.nih.gov/pubmed/32452814 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e11567 %T The Most-Cited Authors Who Published Papers in JMIR mHealth and uHealth Using the Authorship-Weighted Scheme: Bibliometric Analysis %A Kan,Wei-Chih %A Chou,Willy %A Chien,Tsair-Wei %A Yeh,Yu-Tsen %A Chou,Po-Hsin %+ School of Medicine, National Yang-Ming University, 18F, 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan, 886 228757557, choupohsin@gmail.com %K betweenness centrality %K authorship collaboration %K Google Maps %K social network analysis %K knowledge concept map %K the author-weighted scheme %D 2020 %7 7.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many previous papers have investigated most-cited articles or most productive authors in academics, but few have studied most-cited authors. Two challenges are faced in doing so, one of which is that some different authors will have the same name in the bibliometric data, and the second is that coauthors’ contributions are different in the article byline. No study has dealt with the matter of duplicate names in bibliometric data. Although betweenness centrality (BC) is one of the most popular degrees of density in social network analysis (SNA), few have applied the BC algorithm to interpret a network’s characteristics. A quantitative scheme must be used for calculating weighted author credits and then applying the metrics in comparison. Objective: This study aimed to apply the BC algorithm to examine possible identical names in a network and report the most-cited authors for a journal related to international mobile health (mHealth) research. Methods: We obtained 676 abstracts from Medline based on the keywords “JMIR mHealth and uHealth” (Journal) on June 30, 2018. The author names, countries/areas, and author-defined keywords were recorded. The BCs were then calculated for the following: (1) the most-cited authors displayed on Google Maps; (2) the geographical distribution of countries/areas for the first author; and (3) the keywords dispersed by BC and related to article topics in comparison on citation indices. Pajek software was used to yield the BC for each entity (or node). Bibliometric indices, including h-, g-, and x-indexes, the mean of core articles on g(Ag)=sum (citations on g-core/publications on g-core), and author impact factor (AIF), were applied. Results: We found that the most-cited author was Sherif M Badawy (from the United States), who had published six articles on JMIR mHealth and uHealth with high bibliometric indices (h=3; AIF=8.47; x=4.68; Ag=5.26). We also found that the two countries with the highest BC were the United States and the United Kingdom and that the two keyword clusters of mHealth and telemedicine earned the highest indices in comparison to other counterparts. All visual representations were successfully displayed on Google Maps. Conclusions: The most cited authors were selected using the authorship-weighted scheme (AWS), and the keywords of mHealth and telemedicine were more highly cited than other counterparts. The results on Google Maps are novel and unique as knowledge concept maps for understanding the feature of a journal. The research approaches used in this study (ie, BC and AWS) can be applied to other bibliometric analyses in the future. %M 32379053 %R 10.2196/11567 %U https://mhealth.jmir.org/2020/5/e11567 %U https://doi.org/10.2196/11567 %U http://www.ncbi.nlm.nih.gov/pubmed/32379053 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e14826 %T Evaluating the Quality of Health-Related WeChat Public Accounts: Cross-Sectional Study %A Wang,Fuzhi %A Wang,Zhuoxin %A Sun,Weiwei %A Yang,Xiumu %A Bian,Zhiwei %A Shen,Lining %A Pan,Wei %A Liu,Peng %A Chen,Xingzhi %A Fu,Lianguo %A Zhang,Fan %A Luo,Dan %+ School of Health Management, Bengbu Medical College, 2600 Donghai Rd, Longzihu District, Bengbu, China, 86 13865073216, ld.bbmc@foxmail.com %K health-related WeChat Public Account %K HONcode %K suitability assessment of material %K evaluation %K social media %K mHealth %K app %K health information %K internet %D 2020 %7 8.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As representatives of health information communication platforms accessed through mobile phones and mobile terminals, health-related WeChat public accounts (HWPAs) have a large consumer base in the Chinese-speaking world. However, there is still a lack of general understanding of the status quo of HWPAs and the quality of the articles they release. Objective: The aims of this study were to assess the conformity of HWPAs to the Health on the Net Foundation Code of Conduct (HONcode) and to evaluate the suitability of articles disseminated by HWPAs. Methods: The survey was conducted from April 23 to May 5, 2019. Based on the monthly (March 1-31, 2019) WeChat Index provided by Qingbo Big Data, the top 100 HWPAs were examined to evaluate their HONcode compliance. The first four articles published by each HWPA on the survey dates were selected as samples to evaluate their suitability. All materials were assessed by three raters. The materials were assessed using the HONcode checklist and the Suitability Assessment of Materials (SAM) score sheet. Data analysis was performed with SPSS version 17.0 (SPSS Inc, Chicago, IL, USA) and Excel version 2013 (Microsoft Inc, Washington DC, USA). Results: A total of 93 HWPAs and 210 of their released articles were included in this study. For six of the eight principles, the 93 HWPAs nearly consistently did not meet the requirements of the HONcode. The HWPAs certified by Tencent Corporation (66/93, 71%) were generally slightly superior to those without such certification (27/93, 29%) in terms of compliance with HONcode principles. The mean SAM score for the 210 articles was 67.72 (SD 10.930), which indicated “adequate” suitability. There was no significant difference between the SAM scores of the articles published by certified and uncertified HWPAs (P=.07), except in the literacy requirements dimension (tdf=97=–2.418, P=.02). Conclusions: The HWPAs had low HONcode conformity. Although the suitability of health information released by HWPAs was at a moderate level, there were still problems identified, such as difficulty in tracing information sources, excessive implicit advertisements, and irregular usage of charts. In addition, the low approval requirements of HWPAs were not conducive to improvement of their service quality. %M 32383684 %R 10.2196/14826 %U https://mhealth.jmir.org/2020/5/e14826 %U https://doi.org/10.2196/14826 %U http://www.ncbi.nlm.nih.gov/pubmed/32383684 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15909 %T A Questionnaire for Assessing User Satisfaction With Mobile Health Apps: Development Using Rasch Measurement Theory %A Melin,Jeanette %A Bonn,Stephanie Erika %A Pendrill,Leslie %A Trolle Lagerros,Ylva %+ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2, Stockholm, 171 76, Sweden, 46 46 851779183, ylva.trolle@ki.se %K cell phone %K healthy lifestyle %K methods %K mobile applications %K psychometrics %K smartphone %K telemedicine %K mobile phone %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps offer great opportunities to deliver large-scale, cost-efficient digital solutions for implementing lifestyle changes. Furthermore, many mHealth apps act as medical devices. Yet, there is little research on how to assess user satisfaction with an mHealth solution. Objective: This study presents the development of the mHealth Satisfaction Questionnaire and evaluates its measurement properties. Methods: Respondents who took part in the Health Integrator Study and were randomized to use the Health Integrator smartphone app for lifestyle changes (n=112), with and without additional telephone coaching, rated their satisfaction with the app using the new 14-item mHealth Satisfaction Questionnaire. The ratings were given on a 5-point Likert scale and measurement properties were evaluated using Rasch measurement theory (RMT). Results: Optimal scoring was reached when response options 2, 3, and 4 were collapsed, giving three response categories. After omitting two items that did not fit into the scale, fit residuals were within, or close to, the recommended range of ±2.5. There was no differential item functioning between intervention group, age group, or sex. The Person Separation Index was 0.79, indicating that the scale’s ability to discriminate correctly between person leniency was acceptable for group comparisons but not for individual evaluations. The scale did not meet the criterion of unidimensionality; 16.1% (18/112) of the respondents were outside the desired range of −1.96 to 1.96. In addition, several items showed local dependency and three underlying dimensions emerged: negative experiences, positive experiences, and lifestyle consequences of using the mHealth solution. Conclusions: In times where mHealth apps and digital solutions are given more attention, the mHealth Satisfaction Questionnaire provides a new possibility to measure user satisfaction to ensure usability and improve development of new apps. Our study is one of only a few cases where RMT has been used to evaluate the usability of such an instrument. There is, though, a need for further development of the mHealth Satisfaction Questionnaire, including the addition of more items and consideration of further response options. The mHealth Satisfaction Questionnaire should also be evaluated in a larger sample and with other mHealth apps and in other contexts. Trial Registration: ClinicalTrials.gov NCT03579342; http://clinicaltrials.gov/ct2/show/NCT03579342. %M 32452817 %R 10.2196/15909 %U http://mhealth.jmir.org/2020/5/e15909/ %U https://doi.org/10.2196/15909 %U http://www.ncbi.nlm.nih.gov/pubmed/32452817 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16716 %T Wrist-Worn Wearables for Monitoring Heart Rate and Energy Expenditure While Sitting or Performing Light-to-Vigorous Physical Activity: Validation Study %A Düking,Peter %A Giessing,Laura %A Frenkel,Marie Ottilie %A Koehler,Karsten %A Holmberg,Hans-Christer %A Sperlich,Billy %+ Integrative and Experimental Exercise Science, Department of Sport Science, University of Würzburg, Judenbühlweg 11, Würzburg, 97082, Germany, 49 931 31 ext 8479, peterdueking@gmx.de %K cardiorespiratory fitness %K innovation %K smartwatch %K technology %K wearable %K digital health %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity reduces the incidences of noncommunicable diseases, obesity, and mortality, but an inactive lifestyle is becoming increasingly common. Innovative approaches to monitor and promote physical activity are warranted. While individual monitoring of physical activity aids in the design of effective interventions to enhance physical activity, a basic prerequisite is that the monitoring devices exhibit high validity. Objective: Our goal was to assess the validity of monitoring heart rate (HR) and energy expenditure (EE) while sitting or performing light-to-vigorous physical activity with 4 popular wrist-worn wearables (Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa). Methods: While wearing the 4 different wearables, 25 individuals performed 5 minutes each of sitting, walking, and running at different velocities (ie, 1.1 m/s, 1.9 m/s, 2.7 m/s, 3.6 m/s, and 4.1 m/s), as well as intermittent sprints. HR and EE were compared to common criterion measures: Polar-H7 chest belt for HR and indirect calorimetry for EE. Results: While monitoring HR at different exercise intensities, the standardized typical errors of the estimates were 0.09-0.62, 0.13-0.88, 0.62-1.24, and 0.47-1.94 for the Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, respectively. Depending on exercise intensity, the corresponding coefficients of variation were 0.9%-4.3%, 2.2%-6.7%, 2.9%-9.2%, and 4.1%-19.1%, respectively, for the 4 wearables. While monitoring EE at different exercise intensities, the standardized typical errors of the estimates were 0.34-1.84, 0.32-1.33, 0.46-4.86, and 0.41-1.65 for the Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, respectively. Depending on exercise intensity, the corresponding coefficients of variation were 13.5%-27.1%, 16.3%-28.0%, 15.9%-34.5%, and 8.0%-32.3%, respectively. Conclusions: The Apple Watch Series 4 provides the highest validity (ie, smallest error rates) when measuring HR while sitting or performing light-to-vigorous physical activity, followed by the Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, in that order. The Apple Watch Series 4 and Polar Vantage V are suitable for valid HR measurements at the intensities tested, but HR data provided by the Garmin Fenix 5 and Fitbit Versa should be interpreted with caution due to higher error rates at certain intensities. None of the 4 wrist-worn wearables should be employed to monitor EE at the intensities and durations tested. %M 32374274 %R 10.2196/16716 %U https://mhealth.jmir.org/2020/5/e16716 %U https://doi.org/10.2196/16716 %U http://www.ncbi.nlm.nih.gov/pubmed/32374274 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16674 %T Low-Cost Consumer-Based Trackers to Measure Physical Activity and Sleep Duration Among Adults in Free-Living Conditions: Validation Study %A Degroote,Laurent %A Hamerlinck,Gilles %A Poels,Karolien %A Maher,Carol %A Crombez,Geert %A De Bourdeaudhuij,Ilse %A Vandendriessche,Ann %A Curtis,Rachel G %A DeSmet,Ann %+ Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Ghent, Belgium, 32 9 264 62 99, laurent.degroote@ugent.be %K fitness trackers %K mobile phone %K accelerometry %K physical activity %K sleep %D 2020 %7 19.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable trackers for monitoring physical activity (PA) and total sleep time (TST) are increasingly popular. These devices are used not only by consumers to monitor their behavior but also by researchers to track the behavior of large samples and by health professionals to implement interventions aimed at health promotion and to remotely monitor patients. However, high costs and accuracy concerns may be barriers to widespread adoption. Objective: This study aimed to investigate the concurrent validity of 6 low-cost activity trackers for measuring steps, moderate-to-vigorous physical activity (MVPA), and TST: Geonaut On Coach, iWown i5 Plus, MyKronoz ZeFit4, Nokia GO, VeryFit 2.0, and Xiaomi MiBand 2. Methods: A free-living protocol was used in which 20 adults engaged in their usual daily activities and sleep. For 3 days and 3 nights, they simultaneously wore a low-cost tracker and a high-cost tracker (Fitbit Charge HR) on the nondominant wrist. Participants wore an ActiGraph GT3X+ accelerometer on the hip at daytime and a BodyMedia SenseWear device on the nondominant upper arm at nighttime. Validity was assessed by comparing each tracker with the ActiGraph GT3X+ and BodyMedia SenseWear using mean absolute percentage error scores, correlations, and Bland-Altman plots in IBM SPSS 24.0. Results: Large variations were shown between trackers. Low-cost trackers showed moderate-to-strong correlations (Spearman r=0.53-0.91) and low-to-good agreement (intraclass correlation coefficient [ICC]=0.51-0.90) for measuring steps. Weak-to-moderate correlations (Spearman r=0.24-0.56) and low agreement (ICC=0.18-0.56) were shown for measuring MVPA. For measuring TST, the low-cost trackers showed weak-to-strong correlations (Spearman r=0.04-0.73) and low agreement (ICC=0.05-0.52). The Bland-Altman plot revealed a variation between overcounting and undercounting for measuring steps, MVPA, and TST, depending on the used low-cost tracker. None of the trackers, including Fitbit (a high-cost tracker), showed high validity to measure MVPA. Conclusions: This study was the first to examine the concurrent validity of low-cost trackers. Validity was strongest for the measurement of steps; there was evidence of validity for measurement of sleep in some trackers, and validity for measurement of MVPA time was weak throughout all devices. Validity ranged between devices, with Xiaomi having the highest validity for measurement of steps and VeryFit performing relatively strong across both sleep and steps domains. Low-cost trackers hold promise for monitoring and measurement of movement and sleep behaviors, both for consumers and researchers. %M 32282332 %R 10.2196/16674 %U http://mhealth.jmir.org/2020/5/e16674/ %U https://doi.org/10.2196/16674 %U http://www.ncbi.nlm.nih.gov/pubmed/32282332 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17804 %T Augmented Reality–Based Rehabilitation of Gait Impairments: Case Report %A Held,Jeremia Philipp Oskar %A Yu,Kevin %A Pyles,Connor %A Veerbeek,Janne Marieke %A Bork,Felix %A Heining,Sandro-Michael %A Navab,Nassir %A Luft,Andreas Rüdiger %+ Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Frauenklinikstrasse 26, Zurich, 8091, Switzerland, 41 44 255 5645, jeremia.held@uzh.ch %K HoloLens 2 %K gait %K rehabilitation %K stroke %K augmented reality %K sensors %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gait and balance impairments are common in neurological diseases, including stroke, and negatively affect patients’ quality of life. Improving balance and gait are among the main goals of rehabilitation. Rehabilitation is mainly performed in clinics, which lack context specificity; therefore, training in the patient’s home environment is preferable. In the last decade, developed rehabilitation technologies such as virtual reality and augmented reality (AR) have enabled gait and balance training outside clinics. Here, we propose a new method for gait rehabilitation in persons who have had a stroke in which mobile AR technology and a sensor-based motion capture system are combined to provide fine-grained feedback on gait performance in real time. Objective: The aims of this study were (1) to investigate manipulation of the gait pattern of persons who have had a stroke based on virtual augmentation during overground walking compared to walking without AR performance feedback and (2) to investigate the usability of the AR system. Methods: We developed the ARISE (Augmented Reality for gait Impairments after StrokE) system, in which we combined a development version of HoloLens 2 smart glasses (Microsoft Corporation) with a sensor-based motion capture system. One patient with chronic minor gait impairment poststroke completed clinical gait assessments and an AR parkour course with patient-centered performance gait feedback. The movement kinematics during gait as well as the usability and safety of the system were evaluated. Results: The patient changed his gait pattern during AR parkour compared to the pattern observed during the clinical gait assessments. He recognized the virtual objects and ranked the usability of the ARISE system as excellent. In addition, the patient stated that the system would complement his standard gait therapy. Except for the symptom of exhilaration, no adverse events occurred. Conclusions: This project provided the first evidence of gait adaptation during overground walking based on real-time feedback through visual and auditory augmentation. The system has potential to provide gait and balance rehabilitation outside the clinic. This initial investigation of AR rehabilitation may aid the development and investigation of new gait and balance therapies. %M 32452815 %R 10.2196/17804 %U http://mhealth.jmir.org/2020/5/e17804/ %U https://doi.org/10.2196/17804 %U http://www.ncbi.nlm.nih.gov/pubmed/32452815 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e18921 %T Correction: Postvaccination Fever Response Rates in Children Derived Using the Fever Coach Mobile App: A Retrospective Observational Study %A Ahn,Sang Hyun %A Zhiang,Jooho %A Kim,Hyery %A Chang,Seyun %A Shin,Jaewon %A Kim,Myeongchan %A Lee,Yura %A Lee,Jae-Ho %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2228 2493, yurangpark@yuhs.ac %D 2020 %7 7.5.2020 %9 Corrigenda and Addenda %J JMIR Mhealth Uhealth %G English %X %M 32379698 %R 10.2196/18921 %U https://mhealth.jmir.org/2020/5/e18921 %U https://doi.org/10.2196/18921 %U http://www.ncbi.nlm.nih.gov/pubmed/32379698 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e18859 %T Correction: Using Goal-Directed Design to Create a Mobile Health App to Improve Patient Compliance With Hypertension Self-Management: Development and Deployment %A Duan,Huilong %A Wang,Zheyu %A Ji,Yumeng %A Ma,Li %A Liu,Fang %A Chi,Mingwei %A Deng,Ning %A An,Jiye %+ College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, 38 Zheda Rd, Zhouyiqing Bldg 512, Yuquan Campus, Hangzhou, China, 86 571 2295 2693, zju.dengning@gmail.com %D 2020 %7 28.5.2020 %9 Corrigenda and Addenda %J JMIR Mhealth Uhealth %G English %X %M 32463789 %R 10.2196/18859 %U https://mhealth.jmir.org/2020/5/e18859 %U https://doi.org/10.2196/18859 %U http://www.ncbi.nlm.nih.gov/pubmed/32463789 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15628 %T Mobile Health Daily Life Monitoring for Parkinson Disease: Development and Validation of Ecological Momentary Assessments %A Habets,Jeroen %A Heijmans,Margot %A Herff,Christian %A Simons,Claudia %A Leentjens,Albert FG %A Temel,Yasin %A Kuijf,Mark %A Kubben,Pieter %+ Department of Neurosurgery, School of Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, Maastricht, 6229 ER, Netherlands, 31 43 3881348, j.habets@maastrichtuniversity.nl %K ecological momentary assessment %K experience sampling method %K electronic diary %K Parkinson’s disease monitoring %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parkinson disease monitoring is currently transitioning from periodic clinical assessments to continuous daily life monitoring in free-living conditions. Traditional Parkinson disease monitoring methods lack intraday fluctuation detection. Electronic diaries (eDiaries) hold the potential to collect subjective experiences on the severity and burden of motor and nonmotor symptoms in free-living conditions. Objective: This study aimed to develop a Parkinson disease–specific eDiary based on ecological momentary assessments (EMAs) and to explore its validation. Methods: An observational cohort of 20 patients with Parkinson disease used the smartphone-based EMA eDiary for 14 consecutive days without adjusting free-living routines. The eDiary app presented an identical questionnaire consisting of questions regarding affect, context, motor and nonmotor symptoms, and motor performance 7 times daily at semirandomized moments. In addition, patients were asked to complete a morning and an evening questionnaire. Results: Mean affect correlated moderate-to-strong and moderate with motor performance (R=0.38 to 0.75; P<.001) and motor symptom (R=0.34 to 0.50; P<.001) items, respectively. The motor performance showed a weak-to-moderate negative correlation with motor symptoms (R=−0.31 to −0.48; P<.001). Mean group answers given for on-medication conditions vs wearing-off-medication conditions differed significantly (P<.05); however, not enough questionnaires were completed for the wearing-off-medication condition to reproduce these findings on individual levels. Conclusions: We presented a Parkinson disease–specific EMA eDiary. Correlations between given answers support the internal validity of the eDiary and underline EMA’s potential in free-living Parkinson disease monitoring. Careful patient selection and EMA design adjustment to this targeted population and their fluctuations are necessary to generate robust proof of EMA validation in future work. Combining clinical Parkinson disease knowledge with practical EMA experience is inevitable to design and perform studies, which will lead to the successful integration of eDiaries in free-living Parkinson disease monitoring. %M 32339999 %R 10.2196/15628 %U https://mhealth.jmir.org/2020/5/e15628 %U https://doi.org/10.2196/15628 %U http://www.ncbi.nlm.nih.gov/pubmed/32339999 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15458 %T Associations Between Parent Self-Reported and Accelerometer-Measured Physical Activity and Sedentary Time in Children: Ecological Momentary Assessment Study %A de Brito,Junia N %A Loth,Katie A %A Tate,Allan %A Berge,Jerica M %+ Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street SE, Suite 400, Minneapolis, MN, 55414, United States, 1 612 625 0931, nogue013@umn.edu %K ecological momentary assessment %K accelerometry %K mobile devices %K physical activity %K sedentary behavior %K children %D 2020 %7 19.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Retrospective self-report questionnaires are the most common method for assessing physical activity (PA) and sedentary behavior (SB) in children when the use of objective assessment methods (eg, accelerometry) is cost prohibitive. However, self-report measures have limitations (eg, recall bias). The use of real-time, mobile ecological momentary assessment (EMA) has been proposed to address these shortcomings. The study findings will provide useful information for researchers interested in using EMA surveys for measuring PA and SB in children, particularly when reported by a parent or caregiver. Objective: This study aimed to examine the associations between the parent’s EMA report of their child’s PA and SB and accelerometer-measured sedentary time (ST), light-intensity PA (LPA), and moderate-to-vigorous–intensity PA (MVPA) and to examine if these associations differed by day of week, sex, and season. Methods: A total of 140 parent-child dyads (mean child age 6.4 years, SD 0.8; n=66 girls; n=21 African American; n=24 American Indian; n=25 Hispanic/Latino; n=24 Hmong; n=22 Somali; and n=24 white) participated in this study. During an 8-day period, parents reported child PA and SB via multiple daily signal contingent EMA surveys, and children wore a hip-mounted accelerometer to objectively measure ST, LPA, and MVPA. Accelerometer data was matched to the time period occurring before parent EMA-report of child PA and SB. Generalized estimating equations with interaction-term analyses were performed to determine whether the relationship between parent-EMA report of child PA and SB and accelerometer-measured ST and LPA and MVPA outcomes differed by day of the week, sex and season. Results: The parent’s EMA report of their child’s PA and SB was strongly associated with accelerometer-measured ST, LPA, and MVPA. The parent’s EMA report of their child’s PA was stronger during the weekend than on weekdays for accelerometer-measured ST (P≤.001) and LPA (P<.001). For the parent’s EMA report of their child’s SB, strong associations were observed with accelerometer-measured ST (P<.001), LPA (P=.005), and MVPA (P=.008). The findings related to sex-interaction terms indicated that the association between the parent-reported child’s PA via EMA and the accelerometer-measured MVPA was stronger for boys than girls (P=.02). The association between the parent’s EMA report of their child’s PA and SB and accelerometer-measured ST and PA was similar across seasons in this sample (all P values >.31). Conclusions: When the use of accelerometry-based methods is not feasible and in contexts where the parent is able to spend more proximate time observing the child’s PA and SB, the parent’s EMA report might be a superior method for measuring PA and SB in young children relative to self-report, given the EMA’s strong associations with accelerometer-measured PA and ST. %M 32348283 %R 10.2196/15458 %U http://mhealth.jmir.org/2020/5/e15458/ %U https://doi.org/10.2196/15458 %U http://www.ncbi.nlm.nih.gov/pubmed/32348283 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17034 %T Mood and Stress Evaluation of Adult Patients With Moyamoya Disease in Korea: Ecological Momentary Assessment Method Using a Mobile Phone App %A Yang,Yong Sook %A Ryu,Gi Wook %A Park,Chang Gi %A Yeom,Insun %A Shim,Kyu Won %A Choi,Mona %+ Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 222283341, monachoi@yuhs.ac %K affect %K ecological momentary assessment %K mood %K Moyamoya disease %K psychological stress %D 2020 %7 25.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Moyamoya disease (MMD) is a known progressive obstructive cerebrovascular disorder. Monitoring and managing mood and stress are critical for patients with MMD, as they affect clinical outcomes. The ecological momentary assessment (EMA) method is a longitudinal study design by which multiple variable assessments can be performed over time to detect momentary fluctuations and changes in psychological dimensions such as mood and stress over time. Objective: This study aimed to identify predicting factors associated with momentary mood and stress at both the within-person and between-person levels and to examine individual fluctuation of mood over time in the short term using an EMA method combined with a mobile phone app. Methods: Participants aged older than 18 years were recruited from a tertiary hospital in Seoul, Korea, between July 2018 and January 2019. The PsyMate scale for negative affect (NA) and positive affect (PA) and the Trier Inventory for Chronic Stress Scale were uploaded on patient mobile phones. Using a mobile app, data were collected four times a day for 7 days. Pearson correlations and mixed modeling were used to predict relationships between repeatedly measured variables at both the between-person and within-person levels. Results: The mean age of the 93 participants was 40.59 (SD 10.06) years, 66 (71%) were female, and 71 (76%) were married. Participants provided 1929 responses out of a possible 2604 responses (1929/2604, 74.08%). The mean momentary NA and PA values were 2.15 (SD 1.12) and 4.70 (SD 1.31) out of 7, respectively. The momentary stress value was 2.03 (SD 0.98) out of 5. Momentary NA, PA, and stress were correlated (P<.001) and varied over time in relation to momentary variables. Common momentary variables associated with momentary mood and stress at both the within-person (level 1) and between-person (level 2) levels were identified. Momentary NA increased when being alone and being at the hospital at both levels, whereas momentary PA increased when eating or drinking, resting, being at a café, restaurant or a public place but decreased when being alone at both levels. Momentary stress increased when being at the office, at a public place, or as the time of the day went by but decreased when resting or during the weekend. Different factors affecting mood and stress at different levels were identified. Fluctuations in individual momentary mood over time at the within-person level were captured. Conclusions: The EMA method using a mobile phone app demonstrated its ability to capture changes in mood and stress in various environmental contexts in patients with MMD. The results could provide baseline information for developing interventions to manage negative mood and stress of patients with MMD based on the identified predictors affecting mood and stress at two different levels. %M 32449687 %R 10.2196/17034 %U http://mhealth.jmir.org/2020/5/e17034/ %U https://doi.org/10.2196/17034 %U http://www.ncbi.nlm.nih.gov/pubmed/32449687