TY - JOUR AU - McNeil, Carrie AU - Divi, Nomita AU - Bargeron IV, Thomas Charles AU - Capobianco Dondona, Andrea AU - Ernst, C. Kacey AU - Gupta, S. Angela AU - Fasominu, Olukayode AU - Keatts, Lucy AU - Kelly, Terra AU - Leal Neto, B. Onicio AU - Lwin, O. May AU - Makhasi, Mvuyo AU - Mutagahywa, Beda Eric AU - Montecino-Latorre, Diego AU - Olson, Sarah AU - Pandit, S. Pranav AU - Paolotti, Daniela AU - Parker, C. Matt AU - Samad, Haiman Muhammad AU - Sewalk, Kara AU - Sheldenkar, Anita AU - Srikitjakarn, Lertrak AU - Suy Lan, Channé AU - Wilkes, Michael AU - Yano, Terdsak AU - Smolinski, Mark PY - 2025/3/26 TI - Data Parameters From Participatory Surveillance Systems in Human, Animal, and Environmental Health From Around the Globe: Descriptive Analysis JO - JMIR Public Health Surveill SP - e55356 VL - 11 KW - participatory surveillance KW - One Health KW - citizen science KW - community-based surveillance KW - digital disease detection KW - environmental health KW - wildlife health KW - livestock health KW - human health KW - data standards N2 - Background: Emerging pathogens and zoonotic spillover highlight the need for One Health surveillance to detect outbreaks as early as possible. Participatory surveillance empowers communities to collect data at the source on the health of animals, people, and the environment. Technological advances increase the use and scope of these systems. This initiative sought to collate information from active participatory surveillance systems to better understand parameters collected across the One Health spectrum. Objective: This study aims to develop a compendium of One Health data parameters by examining participatory surveillance systems active in 2023. The expected outcomes of the compendium were to pinpoint specific parameters related to human, animal, and environmental health collected globally by participatory surveillance systems and to detail how each parameter is collected. The compendium was designed to help understand which parameters are currently collected and serve as a reference for future systems and for data standardization initiatives. Methods: Contacts associated with the 60 systems identified through the One Health Participatory Surveillance System Map were invited by email to provide specific data parameters, methodologies used for data collection, and parameter-specific considerations. Information was received from 38 (63%) active systems. Data were compiled into a searchable spreadsheet-based compendium organized into 5 sections: general, livestock, wildlife, environmental, and human parameters. An advisory group comprising experts in One Health participatory surveillance reviewed the collected parameters, refined the compendium structure, and contributed to the descriptive analysis. Results: A comprehensive compendium of data parameters from a diverse array of single-sector and multisector participatory surveillance systems was collated and reviewed. The compendium includes parameters from 38 systems used in Africa (n=3, 8%), Asia (n=9, 24%), Europe (n=12, 32%), Australia (n=3, 8%), and the Americas (n=12, 32%). Almost one-third of the systems (n=11, 29%) collect data across multiple sectors. Many (n=17, 45%) focus solely on human health. Variations in data collection techniques were observed for commonly used parameters, such as demographics and clinical signs or symptoms. Most human health systems collected parameters from a cohort of users tracking their own health over time, whereas many wildlife and environmental systems incorporated event-based parameters. Conclusions: Several participatory surveillance systems have already adopted a One Health approach, enhancing traditional surveillance by identifying shared health threats among animals, people, and the environment. The compendium reveals substantial variation in how parameters are collected, underscoring the need for further work in system interoperability and data standards to allow for timely data sharing across systems during outbreaks. Parameters collated from across the One Health spectrum represent a valuable resource for informing the development of future systems and identifying opportunities to expand existing systems for multisector surveillance. UR - https://publichealth.jmir.org/2025/1/e55356 UR - http://dx.doi.org/10.2196/55356 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55356 ER - TY - JOUR AU - Rubio, Claudio AU - Besoain, Felipe PY - 2025/1/15 TI - Pervasive Games for Sexual Health Promotion: Scoping Literature Review JO - JMIR Serious Games SP - e58912 VL - 13 KW - serious games KW - promotion KW - ubiquitous technologies KW - healthy behaviors KW - HIV KW - sexually transmitted infection KW - STI KW - scoping review KW - mobile phone N2 - Background: Serious games play a fundamental role in promoting safe sexual behaviors. This medium has great potential for promoting healthy behaviors that prevent potential risk factors, such as sexually transmitted infections, and promote adherence to sexual health treatments, such as antiretroviral therapy. The ubiquity of mobile devices enhances access to such tools, increasing the effectiveness of video games as agents of change. Objective: In this scoping review, we aimed to (1) identify the extent to which pervasive games have been used in the field of sexual health, (2) determine the theories used in the design and evaluation of pervasive games for sexual health, (3) identify the methods used to evaluate pervasive games for sexual health, and (4) explore the reported benefits of using pervasive games for sexual health. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology, we conducted a comprehensive literature search in the Web of Science, Scopus, IEEE Xplore, and ACM databases for articles published between January 1, 2000, and August 4, 2024. Included articles were published in English between 2000 and 2024 and involved the design, implementation, or evaluation of a ubiquitous video game focused on promoting safe sexual behaviors, with qualitative and/or quantitative results based on theory-based techniques and ubiquitous technologies. Review articles, conference papers, or books without available data or quantitative or qualitative results were excluded. Results: We screened 521 of 612 articles (85.1%) after removing duplicates. After the title and abstract review, 51 (9.8%) articles were assessed for eligibility, and 30 (5.8%) articles meeting the criteria were studied and evaluated in depth. The results suggested that the use of pervasive video games has a positive impact on promoting safe sexual behaviors. This is enhanced by the effectiveness of theory-based techniques and the use of mobile technologies as developmental factors that drive the gaming experience. The results indicated that this domain is a growing field that should not be ignored. Conclusions: The literature showed that pervasive video games have been effective in promoting safe sexual behaviors. Substantial growth has been seen in scientific community interest in researching this domain; nevertheless, there is still much to work on. In this context, we advocate for the standardization of design, implementation, and experimentation as essential phases in creating video game experiences. These 3 fundamental aspects are critical in the development of video game?based studies to ensure the reproducibility of experiments. UR - https://games.jmir.org/2025/1/e58912 UR - http://dx.doi.org/10.2196/58912 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58912 ER - TY - JOUR AU - Choi, Ki Seul AU - Marshall, Jaclyn AU - Sexton Topper, Patrina AU - Pregnall, Andrew AU - Bauermeister, José PY - 2025/1/9 TI - Impact of a Virtual Care Navigation Service on Member-Reported Outcomes Among Lesbian, Gay, Bisexual, Transgender, and Queer Populations: Case Study JO - JMIR Form Res SP - e64137 VL - 9 KW - health care navigation KW - LGBTQ+ KW - lesbian KW - gay KW - bisexual KW - transgender KW - queer KW - access to care KW - care avoidance KW - identity-affirming care KW - minority KW - stress KW - stigma KW - health outcomes N2 - Background: While the significance of care navigation in facilitating access to health care within the lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) communities has been acknowledged, there is limited research examining how care navigation influences an individual?s ability to understand and access the care they need in real-world settings. By analyzing private sector data, we can bridge the gap between theoretical research findings and practical applications, ultimately informing both business strategies and public policy with evidence grounded in real-world efficacy. Objective: The objective of this study was to evaluate the impact of specialized virtual care navigation services on LGBTQ+ individuals? ability to comprehend and access necessary care within a national cohort of commercially insured members. Methods: This case study is based on the experience of commercially insured members, aged 18 or older, who used the LGBTQ+ Health Care Navigation (LGBTQ+ Navigation) service by Included Health between January 26 and July 31, 2023. Care coordinators assisted members by connecting them with vetted identity-affirming in-network providers, helping them navigate and understand their LGBTQ+ health benefits, and providing education and advocacy for clinical and nonclinical needs. We examined the impact of navigation on 5 member-reported outcomes. In addition to reporting the proportion who agreed or strongly agreed, we calculated an impact score that averaged assigned numerical values to all 5 question responses (1=strongly disagree to 5=strongly agree) for each respondent. We used ANOVA with Tukey post hoc tests and t tests to explore the relationships between the impact score and member characteristics, including optional self-reported demographics. Results: Out of 4703 LGBTQ+ Navigation cases, 7.53% (n=354) had member-reported outcomes. A large majority of LGBTQ+ members agreed or strongly agreed that care navigation resulted in less stress (315/354, 89%), less care avoidance (305/354, 86.2%), higher confidence in finding an identity-affirming provider (327/354, 92.4%), improved ability to comprehend health care information (312/354, 88.1%), and improved ability to engage with providers (308/354, 87%). The average impact score was 4.44 (SD 0.69), with statistically significant differences by gender identity (P=.003), race (P=.01), ethnicity (P=.008), and pronouns (P=.02). The scores were highest for members with multiple gender identities (mean 4.56, SD 0.37), and members who did not provide their race, ethnicity, or their pronouns (mean 4.55, SD 0.64). Impact scores were lowest for transgender members (mean 4.11, SD 0.95). Conclusions: The LGBTQ+ Navigation service, by enhancing members? comprehension and use of necessary care, demonstrates potential public health utility and value. Continuous evaluation of navigation services can serve as a supplementary tool for employers seeking to promote health equity and improve belonging among employees. This is particularly important as discrimination and stigma against LGBTQ+ communities persist in the United States. Therefore, scalable and system-level changes that use navigation services are essential to reach a larger proportion of the LGBTQ+ population. UR - https://formative.jmir.org/2025/1/e64137 UR - http://dx.doi.org/10.2196/64137 ID - info:doi/10.2196/64137 ER - TY - JOUR AU - Ceugniez, Maxime AU - Devanne, Hervé AU - Hermand, Eric PY - 2025/1/8 TI - Reliability and Accuracy of the Fitbit Charge 4 Photoplethysmography Heart Rate Sensor in Ecological Conditions: Validation Study JO - JMIR Mhealth Uhealth SP - e54871 VL - 13 KW - photoplethysmography KW - physical activity KW - ecological conditions KW - accuracy KW - reliability KW - Fitbit Charge 4 KW - Fitbit KW - exercise KW - ecological KW - wrist-worn device KW - device KW - sensor KW - wearables KW - usefulness KW - variability KW - sensitivity KW - heart rate KW - heart rate sensor N2 - Background: Wrist-worn photoplethysmography (PPG) sensors allow for continuous heart rate (HR) measurement without the inconveniences of wearing a chest belt. Although green light PPG technology reduces HR measurement motion artifacts, only a limited number of studies have investigated the reliability and accuracy of wearables in non?laboratory-controlled conditions with actual specific and various physical activity movements. Objective: The purpose of this study was to (1) assess the reliability and accuracy of the PPG-based HR sensor of the Fitbit Charge 4 (FC4) in ecological conditions and (2) quantify the potential variability caused by the nature of activities. Methods: We collected HR data from participants who performed badminton, tennis, orienteering running, running, cycling, and soccer while simultaneously wearing the FC4 and the Polar H10 chest belt (criterion sensor). Skin tone was assessed with the Fitzpatrick Skin Scale. Once data from the FC4 and criterion data were synchronized, accuracy and reliability analyses were performed, using intraclass correlation coefficients (ICCs), Lin concordance correlation coefficients (CCCs), mean absolute percentage errors (MAPEs), and Bland-Altman tests. A linear univariate model was also used to evaluate the effect of skin tone on bias. All analyses were stratified by activity and pooled activity types (racket sports and running sports). Results: A total of 77.5 hours of HR recordings from 26 participants (age: mean 21.1, SD 5.8 years) were analyzed. The highest reliability was found for running sports, with ICCs and CCCs of 0.90 and 0.99 for running and 0.80 and 0.93 for orienteering running, respectively, whereas the ICCs and CCCs were 0.37 and 0.78, 0.42 and 0.88, 0.65 and 0.97, and 0.49 and 0.81 for badminton, tennis, cycling, and soccer, respectively. We found the highest accuracy for running (bias: 0.1 beats per minute [bpm]; MAPE 1.2%, SD 4.6%) and the lowest for badminton (bias: ?16.5 bpm; MAPE 16.2%, SD 14.4%) and soccer (bias: ?16.5 bpm; MAPE 17.5%, SD 20.8%). Limit of agreement (LOA) width and artifact rate followed the same trend. No effect of skin tone was observed on bias. Conclusions: LOA width, bias, and MAPE results found for racket sports and soccer suggest a high sensitivity to motion artifacts for activities that involve ?sharp? and random arm movements. In this study, we did not measure arm motion, which limits our results. However, whereas individuals might benefit from using the FC4 for casual training in aerobic sports, we cannot recommend the use of the FC4 for specific purposes requiring high reliability and accuracy, such as research purposes. UR - https://mhealth.jmir.org/2025/1/e54871 UR - http://dx.doi.org/10.2196/54871 ID - info:doi/10.2196/54871 ER - TY - JOUR AU - Jin, Hengjiang AU - Qu, Ying PY - 2025/1/6 TI - Association Between Intergenerational Support, Technology Perception and Trust, and Intention to Seek Medical Care on the Internet Among Chinese Older Adults: Cross-Sectional Questionnaire Study JO - J Med Internet Res SP - e65065 VL - 27 KW - intergenerational support KW - older adults KW - internet medical intentions KW - perceived technology KW - trust N2 - Background: Avoiding technological innovation does not simplify life. In fact, using internet-based medical services can enhance the quality of life for older adults. In the context of an aging population and the growing integration of information technology, the demand for internet-based medical services among older adults is gaining increased attention. While scholars have highlighted the important role of intergenerational support in promoting digital inclusion for older adults, research on the relationship between intergenerational support and older adults? intentions to seek online care remains limited. Objective: This study aims (1) to explore the association between intergenerational support, online medical information, and older adults? intention to seek medical care online, and (2) to examine the mediating role of technology perception and trust, as well as the moderating role of eHealth literacy. Methods: A cross-sectional survey was conducted in China, collecting 958 valid responses from older adults aged 60 years and above. A vast majority of participants were between the ages of 60 and 75 years (771/958, 80.5%). Of the 958 participants, 559 (58.4%) resided in rural areas, while 399 (41.6%) lived in urban areas. The survey included questions on intergenerational support, perceived usefulness, perceived ease of use, trust, online medical information, eHealth literacy, and the intention to seek medical care online. Structural equation modeling and linear regression analysis were applied to explore the relationship between intergenerational support and the intention to seek medical care on the internet. Results: Intergenerational support was positively associated with perceived ease of use (?=.292, P<.001), perceived usefulness (?=.437, P<.001), trust (?=.322, P<.001), and the intention to seek medical care online (?=.354, P<.001). Online medical information also positively affected the intention to seek medical care online among older adults (?=.109, P<.001). Perceived ease of use (?=.029, 95% CI 0.009-0.054), perceived usefulness (?=.089, 95% CI 0.050-0.130), and trust (?=.063, 95% CI 0.036-0.099) partially mediated the association between intergenerational support and the intention to seek medical care online. Further analysis found that perceived ease of use, perceived usefulness, and trust played a chain mediating role between intergenerational support and the intention to seek medical care online (?=.015, 95% CI 0.008-0.027; ?=.022, 95% CI 0.012-0.036). Additionally, eHealth literacy played a moderating role in the relationship between intergenerational support and perceived ease of use (?=.177, P<.001), perceived usefulness (?=.073, P<.05), trust (?=.090, P<.01), and the intention to seek medical care online (?=.124, P<.001). Conclusions: An integrated model of health communication effects was constructed and validated, providing empirical support for the intention to seek medical care online and for the impact of health communication. This model also helps promote the role of technology in empowering the lives of seniors. UR - https://www.jmir.org/2025/1/e65065 UR - http://dx.doi.org/10.2196/65065 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65065 ER - TY - JOUR AU - Chan, Andrew AU - Cai, Joanne AU - Qian, Linna AU - Coutts, Brendan AU - Phan, Steven AU - Gregson, Geoff AU - Lipsett, Michael AU - Ríos Rincón, M. Adriana PY - 2024/12/2 TI - In-Home Positioning for Remote Home Health Monitoring in Older Adults: Systematic Review JO - JMIR Aging SP - e57320 VL - 7 KW - gerontology KW - geriatrics KW - older adult KW - elderly KW - aging KW - aging-in-place KW - localization KW - ambient sensor KW - wearable sensor KW - acceptability KW - home monitor KW - health monitor KW - technology KW - digital health KW - e-health KW - telehealth KW - clinical studies KW - cognitive impairment KW - neuro KW - cognition N2 - Background: With the growing proportion of Canadians aged >65 years, smart home and health monitoring technologies may help older adults manage chronic disease and support aging in place. Localization technologies have been used to support the management of frailty and dementia by detecting activities in the home. Objective: This systematic review aims to summarize the clinical evidence for in-home localization technologies, review the acceptability of monitoring, and summarize the range of technologies being used for in-home localization. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was followed. MEDLINE, Embase, CINAHL, and Scopus were searched with 2 reviewers performing screening, extractions, and quality assessments. Results: A total of 1935 articles were found, with 36 technology-focused articles and 10 articles that reported on patient outcomes being included. From moderate- to high-quality studies, 2 studies reported mixed results on identifying mild cognitive dementia or frailty, while 4 studies reported mixed results on the acceptability of localization technology. Technologies included ambient sensors; Bluetooth- or Wi-Fi?received signal strength; localizer tags using radio frequency identification, ultra-wideband, Zigbee, or GPS; and inertial measurement units with localizer tags. Conclusions: The clinical utility of localization remains mixed, with in-home sensors not being able to differentiate between older adults with healthy cognition and older adults with mild cognitive impairment. However, frailty was detectable using in-home sensors. Acceptability is moderately positive, particularly with ambient sensors. Localization technologies can achieve room detection accuracies up to 92% and linear accuracies of up to 5-20 cm that may be promising for future clinical applications. Trial Registration: PROSPERO CRD42022339845; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339845 UR - https://aging.jmir.org/2024/1/e57320 UR - http://dx.doi.org/10.2196/57320 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57320 ER - TY - JOUR AU - Turley, Kate AU - Rafferty, Joseph AU - Bond, Raymond AU - Mulvenna, Maurice AU - Ryan, Assumpta AU - Crawford, Lloyd PY - 2024/11/29 TI - Evaluating the Impact of a Daylight-Simulating Luminaire on Mood, Agitation, Rest-Activity Patterns, and Social Well-Being Parameters in a Care Home for People With Dementia: Cohort Study JO - JMIR Mhealth Uhealth SP - e56951 VL - 12 KW - digital health KW - dementia KW - dynamic lighting KW - sensors KW - circadian rhythm KW - daylight KW - wellbeing KW - mood KW - agitation KW - sleep KW - social wellbeing KW - care home KW - older adults KW - elderly KW - cardiac KW - psychological KW - monitoring N2 - Background: Living with a diagnosis of dementia can involve managing certain behavioral and psychological symptoms. Alongside cognitive decline, this cohort expresses a suppression in melatonin production which can negatively influence their alignment of sleep or wake timings with the 24 hour day and night cycle. As a result, their circadian rhythms become disrupted. Since daylight has the capacity to stimulate the circadian rhythm and humans spend approximately 90% of their time indoors, research has shifted toward the use of indoor lighting to achieve this same effect. This type of lighting is programmed in a daylight-simulating manner; mimicking the spectral changes of the sun throughout the day. As such, this paper focuses on the use of a dynamic lighting and sensing technology used to support the circadian rhythm, behavioral and psychological symptoms, and well-being of people living with dementia. Objective: This study aimed to understand how dynamic lighting, as opposed to static lighting, may impact the well-being of those who are living with dementia. Methods: An ethically approved trial was conducted within a care home for people with dementia. Data were collected in both quantitative and qualitative formats using environmentally deployed radar sensing technology and the validated QUALIDEM (Quality of Life for People With Dementia) well-being scale, respectively. An initial 4 weeks of static baseline lighting was used before switching out for 12 weeks of dynamic lighting. Metrics were collected for 11 participants on mood, social interactions, agitation, sense of feeling, and sleep and rest-activity over a period of 16 weeks. Results: Dynamic lighting showed significant improvement with a moderate effect size in well-being parameters including positive affect (P=.03), social isolation (P=.048), and feeling at home (P=.047) after 5?10 weeks of dynamic lighting exposure. The results also highlight statistically significant improvements in rest-activity?related parameters of interdaily stability (P<.001), intradaily variation (P<.001), and relative amplitude (P=.03) from baseline to weeks 5?10, with the effect propagating for interdaily stability at weeks 10?16 as well (P<.001). Nonsignificant improvements are also noted for sleep metrics with a small effect size; however, the affect in agitation does not reflect this improvement. Conclusions: Dynamic lighting has the potential to support well-being in dementia, with seemingly stronger influence in earlier weeks where the dynamic lighting initially follows the static lighting contrast, before proceeding to aggregate as marginal gains over time. Future longitudinal studies are recommended to assess the additional impact that varying daylight availability throughout the year may have on the measured parameters. UR - https://mhealth.jmir.org/2024/1/e56951 UR - http://dx.doi.org/10.2196/56951 ID - info:doi/10.2196/56951 ER - TY - JOUR AU - Huang, J. Emily AU - Chen, Yuexin AU - Clark, J. Clancy PY - 2024/11/6 TI - Using a Quality-Controlled Dataset From ViSi Mobile Monitoring for Analyzing Posture Patterns of Hospitalized Patients: Retrospective Observational Study JO - JMIR Mhealth Uhealth SP - e54735 VL - 12 KW - posture monitoring KW - ViSi mobile KW - wearable device KW - inpatient KW - quality control KW - observational study KW - monitoring data KW - inpatient monitoring KW - wearables KW - posture N2 - Background: ViSi Mobile has the capability of monitoring a patient?s posture continuously during hospitalization. Analysis of ViSi telemetry data enables researchers and health care providers to quantify an individual patient?s movement and investigate collective patterns of many patients. However, erroneous values can exist in routinely collected ViSi telemetry data. Data must be scrutinized to remove erroneous records before statistical analysis. Objective: The objectives of this study were to (1) develop a data cleaning procedure for a 1-year inpatient ViSi posture dataset, (2) consolidate posture codes into categories, (3) derive concise summary statistics from the continuous monitoring data, and (4) study types of patient posture habits using summary statistics of posture duration and transition frequency. Methods: This study examined the 2019 inpatient ViSi posture records from Atrium Health Wake Forest Baptist Medical Center. First, 2 types of errors, record overlap and time inconsistency, were identified. An automated procedure was designed to search all records for these errors. A data cleaning procedure removed erroneous records. Second, data preprocessing was conducted. Each patient?s categorical time series was simplified by consolidating the 185 ViSi codes into 5 categories (Lying, Reclined, Upright, Unknown, User-defined). A majority vote process was applied to remove bursts of short duration. Third, statistical analysis was conducted. For each patient, summary statistics were generated to measure average time duration of each posture and rate of posture transitions during the whole day and separately during daytime and nighttime. A k-means clustering analysis was performed to divide the patients into subgroups objectively. Results: The analysis used a sample of 690 patients, with a median of 3 days of extensive ViSi monitoring per patient. The median of posture durations was 10.2 hours/day for Lying, 8.0 hours/day for Reclined, and 2.5 hours/day for Upright. Lying had similar percentages of patients in low and high durations. Reclined showed a decrease in patients for higher durations. Upright had its peak at 0?2 hours, with a decrease for higher durations. Scatter plots showed that patients could be divided into several subgroups with different posture habits. This was reinforced by the k-means analysis, which identified an active subgroup and two sedentary ones with different resting styles. Conclusions: Using a 1-year ViSi dataset from routine inpatient monitoring, we derived summary statistics of posture duration and posture transitions for each patient and analyzed the summary statistics to identify patterns in the patient population. This analysis revealed several types of patient posture habits. Before analysis, we also developed methodology to clean and preprocess routinely collected inpatient ViSi monitoring data, which is a major contribution of this study. The procedure developed for data cleaning and preprocessing can have broad application to other monitoring systems used in hospitals. UR - https://mhealth.jmir.org/2024/1/e54735 UR - http://dx.doi.org/10.2196/54735 ID - info:doi/10.2196/54735 ER - TY - JOUR AU - Riad, Rachid AU - Denais, Martin AU - de Gennes, Marc AU - Lesage, Adrien AU - Oustric, Vincent AU - Cao, Nga Xuan AU - Mouchabac, Stéphane AU - Bourla, Alexis PY - 2024/10/31 TI - Automated Speech Analysis for Risk Detection of Depression, Anxiety, Insomnia, and Fatigue: Algorithm Development and Validation Study JO - J Med Internet Res SP - e58572 VL - 26 KW - speech analysis KW - voice detection KW - voice analysis KW - speech biomarkers KW - speech-based systems KW - computer-aided diagnosis KW - mental health symptom detection KW - machine learning KW - mental health KW - fatigue KW - anxiety KW - depression N2 - Background: While speech analysis holds promise for mental health assessment, research often focuses on single symptoms, despite symptom co-occurrences and interactions. In addition, predictive models in mental health do not properly assess the limitations of speech-based systems, such as uncertainty, or fairness for a safe clinical deployment. Objective: We investigated the predictive potential of mobile-collected speech data for detecting and estimating depression, anxiety, fatigue, and insomnia, focusing on other factors than mere accuracy, in the general population. Methods: We included 865 healthy adults and recorded their answers regarding their perceived mental and sleep states. We asked how they felt and if they had slept well lately. Clinically validated questionnaires measuring depression, anxiety, insomnia, and fatigue severity were also used. We developed a novel speech and machine learning pipeline involving voice activity detection, feature extraction, and model training. We automatically modeled speech with pretrained deep learning models that were pretrained on a large, open, and free database, and we selected the best one on the validation set. Based on the best speech modeling approach, clinical threshold detection, individual score prediction, model uncertainty estimation, and performance fairness across demographics (age, sex, and education) were evaluated. We used a train-validation-test split for all evaluations: to develop our models, select the best ones, and assess the generalizability of held-out data. Results: The best model was Whisper M with a max pooling and oversampling method. Our methods achieved good detection performance for all symptoms, depression (Patient Health Questionnaire-9: area under the curve [AUC]=0.76; F1-score=0.49 and Beck Depression Inventory: AUC=0.78; F1-score=0.65), anxiety (Generalized Anxiety Disorder 7-item scale: AUC=0.77; F1-score=0.50), insomnia (Athens Insomnia Scale: AUC=0.73; F1-score=0.62), and fatigue (Multidimensional Fatigue Inventory total score: AUC=0.68; F1-score=0.88). The system performed well when it needed to abstain from making predictions, as demonstrated by low abstention rates in depression detection with the Beck Depression Inventory and fatigue, with risk-coverage AUCs below 0.4. Individual symptom scores were accurately predicted (correlations were all significant with Pearson strengths between 0.31 and 0.49). Fairness analysis revealed that models were consistent for sex (average disparity ratio [DR] 0.86, SD 0.13), to a lesser extent for education level (average DR 0.47, SD 0.30), and worse for age groups (average DR 0.33, SD 0.30). Conclusions: This study demonstrates the potential of speech-based systems for multifaceted mental health assessment in the general population, not only for detecting clinical thresholds but also for estimating their severity. Addressing fairness and incorporating uncertainty estimation with selective classification are key contributions that can enhance the clinical utility and responsible implementation of such systems. UR - https://www.jmir.org/2024/1/e58572 UR - http://dx.doi.org/10.2196/58572 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58572 ER - TY - JOUR AU - Kallio, Johanna AU - Kinnula, Atte AU - Mäkelä, Satu-Marja AU - Järvinen, Sari AU - Räsänen, Pauli AU - Hosio, Simo AU - Bordallo López, Miguel PY - 2024/10/31 TI - Lessons From 3 Longitudinal Sensor-Based Human Behavior Assessment Field Studies and an Approach to Support Stakeholder Management: Content Analysis JO - J Med Internet Res SP - e50461 VL - 26 KW - field trial KW - behavioral research KW - sensor data KW - machine learning KW - pervasive technology KW - stakeholder engagement KW - qualitative coding KW - mobile phone N2 - Background: Pervasive technologies are used to investigate various phenomena outside the laboratory setting, providing valuable insights into real-world human behavior and interaction with the environment. However, conducting longitudinal field trials in natural settings remains challenging due to factors such as low recruitment success and high dropout rates due to participation burden or data quality issues with wireless sensing in changing environments. Objective: This study gathers insights and lessons from 3 real-world longitudinal field studies assessing human behavior and derives factors that impacted their research success. We aim to categorize challenges, observe how they were managed, and offer recommendations for designing and conducting studies involving human participants and pervasive technology in natural settings. Methods: We developed a qualitative coding framework to categorize and address the unique challenges encountered in real-life studies related to influential factor identification, stakeholder management, data harvesting and management, and analysis and interpretation. We applied inductive reasoning to identify issues and related mitigation actions in 3 separate field studies carried out between 2018 and 2022. These 3 field studies relied on gathering annotated sensor data. The topics involved stress and environmental assessment in an office and a school, collecting self-reports and wrist device and environmental sensor data from 27 participants for 3.5 to 7 months; work activity recognition at a construction site, collecting observations and wearable sensor data from 15 participants for 3 months; and stress recognition in location-independent knowledge work, collecting self-reports and computer use data from 57 participants for 2 to 5 months. Our key extension for the coding framework used a stakeholder identification method to identify the type and role of the involved stakeholder groups, evaluating the nature and degree of their involvement and influence on the field trial success. Results: Our analysis identifies 17 key lessons related to planning, implementing, and managing a longitudinal, sensor-based field study on human behavior. The findings highlight the importance of recognizing different stakeholder groups, including those not directly involved but whose areas of responsibility are impacted by the study and therefore have the power to influence it. In general, customizing communication strategies to engage stakeholders on their terms and addressing their concerns and expectations is essential, while planning for dropouts, offering incentives for participants, conducting field tests to identify problems, and using tools for quality assurance are relevant for successful outcomes. Conclusions: Our findings suggest that field trial implementation should include additional effort to clarify the expectations of stakeholders and to communicate with them throughout the process. Our framework provides a structured approach that can be adopted by other researchers in the field, facilitating robust and comparable studies across different contexts. Constantly managing the possible challenges will lead to better success in longitudinal field trials and developing future technology-based solutions. UR - https://www.jmir.org/2024/1/e50461 UR - http://dx.doi.org/10.2196/50461 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50461 ER - TY - JOUR AU - Favara, Giuliana AU - Barchitta, Martina AU - Maugeri, Andrea AU - Magnano San Lio, Roberta AU - Agodi, Antonella PY - 2024/10/30 TI - Sensors for Smoking Detection in Epidemiological Research: Scoping Review JO - JMIR Mhealth Uhealth SP - e52383 VL - 12 KW - smoking KW - tobacco smoke KW - smoke exposure KW - cigarette smoking KW - wearable sensor KW - public health N2 - Background: The use of wearable sensors is being explored as a challenging way to accurately identify smoking behaviors by measuring physiological and environmental factors in real-life settings. Although they hold potential benefits for aiding smoking cessation, no single wearable device currently achieves high accuracy in detecting smoking events. Furthermore, it is crucial to emphasize that this area of study is dynamic and requires ongoing updates. Objective: This scoping review aims to map the scientific literature for identifying the main sensors developed or used for tobacco smoke detection, with a specific focus on wearable sensors, as well as describe their key features and categorize them by type. Methods: According to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, an electronic search was conducted on the PubMed, MEDLINE, and Web of Science databases, using the following keywords: (?biosensors? OR ?biosensor? OR ?sensors? OR ?sensor? OR ?wearable?) AND (?smoking? OR ?smoke?). Results: Among a total of 37 studies included in this scoping review published between 2012 and March 2024, 16 described sensors based on wearable bands, 15 described multisensory systems, and 6 described other strategies to detect tobacco smoke exposure. Included studies provided details about the design or application of wearable sensors based on an elastic band to detect different aspects of tobacco smoke exposure (eg, arm, wrist, and finger movements, and lighting events). Some studies proposed a system composed of different sensor modalities (eg, Personal Automatic Cigarette Tracker [PACT], PACT 2.0, and AutoSense). Conclusions: Our scoping review has revealed both the obstacles and opportunities linked to wearable devices, offering valuable insights for future research initiatives. Tackling the recognized challenges and delving into potential avenues for enhancement could elevate wearable devices into even more effective tools for aiding smoking cessation. In this context, continuous research is essential to fine-tune and optimize these devices, guaranteeing their practicality and reliability in real-world applications. UR - https://mhealth.jmir.org/2024/1/e52383 UR - http://dx.doi.org/10.2196/52383 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52383 ER - TY - JOUR AU - Valdés-Aragonés, Myriam AU - Pérez-Rodríguez, Rodrigo AU - Carnicero, Antonio José AU - Moreno-Sánchez, A. Pedro AU - Oviedo-Briones, Myriam AU - Villalba-Mora, Elena AU - Abizanda-Soler, Pedro AU - Rodríguez-Mañas, Leocadio PY - 2024/10/22 TI - Effects of Monitoring Frailty Through a Mobile/Web-Based Application and a Sensor Kit to Prevent Functional Decline in Frail and Prefrail Older Adults: FACET (Frailty Care and Well Function) Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e58312 VL - 26 KW - frailty KW - functional status KW - older adults KW - new technologies KW - sensor KW - monitoring system KW - information and communication technologies KW - mobile app KW - sensor kit KW - sensors KW - technological ecosystem KW - clinical intervention N2 - Background: Frailty represents a state of susceptibility to stressors and constitutes a dynamic process. Untreated, this state can progress to disability. Hence, timely detection of alterations in patients? frailty status is imperative to institute prompt clinical interventions and impede frailty progression. With this aim, the FACET (Frailty Care and Well Function) technological ecosystem was developed to provide clinically gathered data from the home to a medical team for early intervention. Objective: The aim of this study was to assess whether the FACET technological ecosystem prevents frailty progression and improves frailty status, according to the frailty phenotype criteria and Frailty Trait Scale-5 items (FTS-5) at 3 and 6 months of follow-up. Methods: This randomized clinical trial involved 90 older adults aged ?70 years meeting 2 or more Fried frailty phenotype criteria, having 4 or more comorbidities, and having supervision at home. This study was conducted between August 2018 and June 2019 at the geriatrics outpatient clinics in Getafe University Hospital and Albacete University Hospital. Participants were randomized into a control group receiving standard treatment and the intervention group receiving standard treatment along with the FACET home monitoring system. The system monitored functional tests at home (gait speed, chair stand test, frailty status, and weight). Outcomes were assessed using multivariate linear regression models for continuous response and multivariate logistic models for dichotomous response. P values less than .05 were considered statistically significant. Results: The mean age of the participants was 82.33 years, with 28% (25/90) being males. Participants allocated to the intervention group showed a 74% reduction in the risk of deterioration in the FTS-5 score (P=.04) and 92% lower likelihood of worsening by 1 point according to Fried frailty phenotype criteria compared to the control group (P=.02) at 6 months of follow-up. Frailty status, when assessed through FTS-5, improved in the intervention group at 3 months (P=.004) and 6 months (P=.047), while when the frailty phenotype criteria were used, benefits were shown at 3 months of follow-up (P=.03) but not at 6 months. Conclusions: The FACET technological ecosystem helps in the early identification of changes in the functional status of prefrail and frail older adults, facilitating prompt clinical interventions, thereby improving health outcomes in terms of frailty and functional status and potentially preventing disability and dependency. Trial Registration: ClinicalTrials.gov NCT03707145; https://clinicaltrials.gov/study/NCT03707145 UR - https://www.jmir.org/2024/1/e58312 UR - http://dx.doi.org/10.2196/58312 UR - http://www.ncbi.nlm.nih.gov/pubmed/39436684 ID - info:doi/10.2196/58312 ER - TY - JOUR AU - Wen, Ming-Huan AU - Chen, Po-Yin AU - Lin, Shirling AU - Lien, Ching-Wen AU - Tu, Sheng-Hsiang AU - Chueh, Ching-Yi AU - Wu, Ying-Fang AU - Tan Cheng Kian, Kelvin AU - Hsu, Yeh-Liang AU - Bai, Dorothy PY - 2024/10/3 TI - Enhancing Patient Safety Through an Integrated Internet of Things Patient Care System: Large Quasi-Experimental Study on Fall Prevention JO - J Med Internet Res SP - e58380 VL - 26 KW - patient safety KW - falls KW - fall prevention KW - fall risk KW - sensors KW - Internet of Things KW - bed-exit alert KW - motion-sensing mattress system KW - care quality KW - quality improvement KW - ubiquitous health KW - mHealth N2 - Background: The challenge of preventing in-patient falls remains one of the most critical concerns in health care. Objective: This study aims to investigate the effect of an integrated Internet of Things (IoT) smart patient care system on fall prevention. Methods: A quasi-experimental study design is used. The smart patient care system is an integrated IoT system combining a motion-sensing mattress for bed-exit detection, specifying different types of patient calls, integrating a health care staff scheduling system, and allowing health care staff to receive and respond to alarms via mobile devices. Unadjusted and adjusted logistic regression models were used to investigate the relationship between the use of the IoT system and bedside falls compared with a traditional patient care system. Results: In total, 1300 patients were recruited from a medical center in Taiwan. The IoT patient care system detected an average of 13.5 potential falls per day without any false alarms, whereas the traditional system issued about 11 bed-exit alarms daily, with approximately 4 being false, effectively identifying 7 potential falls. The bedside fall incidence during hospitalization was 1.2% (n=8) in the traditional patient care system ward and 0.1% (n=1) in the smart ward. We found that the likelihood of bedside falls in wards with the IoT system was reduced by 88% (odds ratio 0.12, 95% CI 0.01-0.97; P=.047). Conclusions: The integrated IoT smart patient care system might prevent falls by assisting health care staff with efficient and resilient responses to bed-exit detection. Future product development and research are recommended to introduce IoT into patient care systems combining bed-exit alerts to prevent inpatient falls and address challenges in patient safety. UR - https://www.jmir.org/2024/1/e58380 UR - http://dx.doi.org/10.2196/58380 UR - http://www.ncbi.nlm.nih.gov/pubmed/39361417 ID - info:doi/10.2196/58380 ER - TY - JOUR AU - van den Beuken, F. Wisse M. AU - van Schuppen, Hans AU - Demirtas, Derya AU - van Halm, P. Vokko AU - van der Geest, Patrick AU - Loer, A. Stephan AU - Schwarte, A. Lothar AU - Schober, Patrick PY - 2024/7/25 TI - Investigating Users? Attitudes Toward Automated Smartwatch Cardiac Arrest Detection: Cross-Sectional Survey Study JO - JMIR Hum Factors SP - e57574 VL - 11 KW - out-of-hospital cardiac arrest KW - wearables KW - wearable KW - digital health KW - smartwatch KW - automated cardiac arrest detection KW - emergency medicine KW - emergency KW - cardiology KW - heart KW - cardiac KW - cross sectional KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - adoption KW - willingness KW - intent KW - intention N2 - Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality in the developed world. Timely detection of cardiac arrest and prompt activation of emergency medical services (EMS) are essential, yet challenging. Automated cardiac arrest detection using sensor signals from smartwatches has the potential to shorten the interval between cardiac arrest and activation of EMS, thereby increasing the likelihood of survival. Objective: This cross-sectional survey study aims to investigate users? perspectives on aspects of continuous monitoring such as privacy and data protection, as well as other implications, and to collect insights into their attitudes toward the technology. Methods: We conducted a cross-sectional web-based survey in the Netherlands among 2 groups of potential users of automated cardiac arrest technology: consumers who already own a smartwatch and patients at risk of cardiac arrest. Surveys primarily consisted of closed-ended questions with some additional open-ended questions to provide supplementary insight. The quantitative data were analyzed descriptively, and a content analysis of the open-ended questions was conducted. Results: In the consumer group (n=1005), 90.2% (n=906; 95% CI 88.1%-91.9%) of participants expressed an interest in the technology, and 89% (n=1196; 95% CI 87.3%-90.7%) of the patient group (n=1344) showed interest. More than 75% (consumer group: n= 756; patient group: n=1004) of the participants in both groups indicated they were willing to use the technology. The main concerns raised by participants regarding the technology included privacy, data protection, reliability, and accessibility. Conclusions: The vast majority of potential users expressed a strong interest in and positive attitude toward automated cardiac arrest detection using smartwatch technology. However, a number of concerns were identified, which should be addressed in the development and implementation process to optimize acceptance and effectiveness of the technology. UR - https://humanfactors.jmir.org/2024/1/e57574 UR - http://dx.doi.org/10.2196/57574 ID - info:doi/10.2196/57574 ER - TY - JOUR AU - Glenn, Jordan AU - Sarmadi, Parmoon AU - Cristman, Paul AU - Kim, Gabrielle AU - Lin, Ting-Hsuan AU - Kashyap, Vikram PY - 2024/5/27 TI - Using the TrueLoo Smart Device to Record Toileting Sessions in Older Adults: Retrospective Validation and Acceptance Study JO - JMIR Aging SP - e50856 VL - 7 KW - activities of daily living KW - toileting habits KW - bowel movements KW - elder care KW - smart toileting KW - monitoring technology N2 - Background: Because of the relationship between independent living and activities of daily living, care teams spend significant time managing assisted living residents? toileting problems. Recently, the TrueLoo was developed as a connected toilet seat to automatically log and monitor toileting sessions. Objective: This study aimed to demonstrate the validity of the TrueLoo to (1) record and identify toileting sessions with regard to stool and urine events; (2) compare the results with the person-reported, standard-of-care methods; and (3) establish metrics of user acceptability and ease of use in a assisted living facility population. Methods: We used two phases: (1) initial development of the TrueLoo algorithms to accurately identify urine and stool events and (2) evaluation of the algorithms against person-reported, standard-of-care methods commonly used in assisted living facilities. Phase 2 analyzed data over a 3-day period from 52 devices. Participants? age ranged from 63 to 101 (mean 84, SD 9.35) years. Acceptability and ease-of-use data were also collected. Results: Regarding the development of the TrueLoo algorithm for urine assessment, sensitivity and specificity of 96% and 85% were observed when evaluating a gold-standard labeled data set, respectively (F1-score=0.95). For stool, sensitivity and specificity of 90% and 79% were observed, respectively (F1-score=0.85). Regarding the TrueLoo algorithm in assisted living settings, classification performance statistics for urine assessment revealed sensitivity and specificity of 84% and 94%, respectively (F1-score=0.90), and for stool, 92% and 98%, respectively (F1-score=0.91). Throughout the study, 46 person-reported instances of urine were documented, compared with 630 recorded by the TrueLoo. For stool events, 116 person-reported events were reported, compared with 153 by the TrueLoo. This indicates that person-reported events were captured 7% (46/630) of the time for urine and 76% (116/153) of the time for stool. Overall, 45% (32/71) of participants said that the new toilet seat was better than their previous one, 84% (60/71) reported that using the TrueLoo was easy, and 99% (69/71) said that they believed the system could help aging adults. Over 98% (69/71) of participants reported that they would find alerts related to their health valuable and would be willing to share this information with their doctor. When asked about sharing information with caregivers, 66% (46/71) reported that they would prefer the TrueLoo to send information and alerts to their caregiver, as opposed to the participant having to personally communicate those details. Conclusions: The TrueLoo accurately recorded toileting sessions compared with standard-of-care methods, successfully establishing metrics of user acceptability and ease of use in assisted living populations. While additional validation studies are warranted, data presented in this paper support the use of the TrueLoo in assisted living settings as a model of event monitoring during toileting. UR - https://aging.jmir.org/2024/1/e50856 UR - http://dx.doi.org/10.2196/50856 UR - http://www.ncbi.nlm.nih.gov/pubmed/38801659 ID - info:doi/10.2196/50856 ER - TY - JOUR AU - Nakajima, Yuki AU - Kitayama, Asami AU - Ohta, Yuji AU - Motooka, Nobuhisa AU - Kuno-Mizumura, Mayumi AU - Miyachi, Motohiko AU - Tanaka, Shigeho AU - Ishikawa-Takata, Kazuko AU - Tripette, Julien PY - 2024/4/25 TI - Objective Assessment of Physical Activity at Home Using a Novel Floor-Vibration Monitoring System: Validation and Comparison With Wearable Activity Trackers and Indirect Calorimetry Measurements JO - JMIR Form Res SP - e51874 VL - 8 KW - smart home system KW - physical behavior KW - physical activity KW - activity tracker KW - floor vibration KW - housework-related activity KW - home-based activity KW - mobile phone N2 - Background: The self-monitoring of physical activity is an effective strategy for promoting active lifestyles. However, accurately assessing physical activity remains challenging in certain situations. This study evaluates a novel floor-vibration monitoring system to quantify housework-related physical activity. Objective: This study aims to assess the validity of step-count and physical behavior intensity predictions of a novel floor-vibration monitoring system in comparison with the actual number of steps and indirect calorimetry measurements. The accuracy of the predictions is also compared with that of research-grade devices (ActiGraph GT9X). Methods: The Ocha-House, located in Tokyo, serves as an independent experimental facility equipped with high-sensitivity accelerometers installed on the floor to monitor vibrations. Dedicated data processing software was developed to analyze floor-vibration signals and calculate 3 quantitative indices: floor-vibration quantity, step count, and moving distance. In total, 10 participants performed 4 different housework-related activities, wearing ActiGraph GT9X monitors on both the waist and wrist for 6 minutes each. Concurrently, floor-vibration data were collected, and the energy expenditure was measured using the Douglas bag method to determine the actual intensity of activities. Results: Significant correlations (P<.001) were found between the quantity of floor vibrations, the estimated step count, the estimated moving distance, and the actual activity intensities. The step-count parameter extracted from the floor-vibration signal emerged as the most robust predictor (r2=0.82; P<.001). Multiple regression models incorporating several floor-vibration?extracted parameters showed a strong association with actual activity intensities (r2=0.88; P<.001). Both the step-count and intensity predictions made by the floor-vibration monitoring system exhibited greater accuracy than those of the ActiGraph monitor. Conclusions: Floor-vibration monitoring systems seem able to produce valid quantitative assessments of physical activity for selected housework-related activities. In the future, connected smart home systems that integrate this type of technology could be used to perform continuous and accurate evaluations of physical behaviors throughout the day. UR - https://formative.jmir.org/2024/1/e51874 UR - http://dx.doi.org/10.2196/51874 UR - http://www.ncbi.nlm.nih.gov/pubmed/38662415 ID - info:doi/10.2196/51874 ER - TY - JOUR AU - Cheng, Weibin AU - Cao, Xiaowen AU - Lian, Wanmin AU - Tian, Junzhang PY - 2024/1/30 TI - An Introduction to Smart Home Ward?Based Hospital-at-Home Care in China JO - JMIR Mhealth Uhealth SP - e44422 VL - 12 KW - smart home ward KW - telemonitoring KW - telemedicine KW - home care KW - hospital at home KW - healthcare delivery KW - implementation KW - smart ward KW - medical monitoring KW - medical care KW - rehabilitation KW - health care UR - https://mhealth.jmir.org/2024/1/e44422 UR - http://dx.doi.org/10.2196/44422 ID - info:doi/10.2196/44422 ER - TY - JOUR AU - Esmaeilzadeh, Pouyan PY - 2023/12/1 TI - Older Adults? Perceptions About Using Intelligent Toilet Seats Beyond Traditional Care: Web-Based Interview Survey JO - JMIR Mhealth Uhealth SP - e46430 VL - 11 KW - older adults KW - age tech KW - intelligent toilet seat KW - survey interview KW - qualitative study KW - mobile phone N2 - Background: In contemporary society, age tech (age technology) represents a significant advancement in health care aimed at enhancing patient engagement, ensuring sustained independence, and promoting quality of life for older people. One innovative form of age tech is the intelligent toilet seat, which is designed to collect, analyze, and provide insights based on toileting logs and excreta data. Understanding how older people perceive and interact with such technology can offer invaluable insights to researchers, technology developers, and vendors. Objective: This study examined older adults? perspectives regarding the use of intelligent toilet seats. Through a qualitative methodology, this research aims to unearth the nuances of older people?s opinions, shedding light on their preferences, concerns, and potential barriers to adoption. Methods: Data were collected using a web-based interview survey distributed on Amazon Mechanical Turk. The analyzed data set comprised 174 US-based individuals aged ?65 years who voluntarily participated in this study. The qualitative data were carefully analyzed using NVivo (Lumivero) based on detailed content analysis, ensuring that emerging themes were coded and classified based on the conceptual similarities in the respondents? narratives. Results: The analysis revealed 5 dominant themes encompassing the opinions of aging adults. The perceived benefits and advantages of using the intelligent toilet seat were grouped into 3 primary themes: health-related benefits including the potential for early disease detection, continuous health monitoring, and seamless connection to health care insights. Technology-related advantages include the noninvasive nature of smart toilet seats and leveraging unique and innovative data collection and analysis technology. Use-related benefits include ease of use, potential for multiple users, and cost reduction owing to the reduced need for frequent clinical visits. Conversely, the concerns and perceived risks were classified into 2 significant themes: psychological concerns, which included concerns about embarrassment and aging-related stereotypes, and the potential emotional impact of constant health monitoring. Technical performance risks include concerns centered on privacy and security, device reliability, data accuracy, potential malfunctions, and the implications of false positives or negatives. Conclusions: The decision of older adults to incorporate intelligent toilet seats into their daily lives depends on myriad factors. Although the potential health and technological benefits are evident, valid concerns that need to be addressed remain. To foster widespread adoption, it is imperative to enhance the advantages while simultaneously addressing and mitigating the identified risks. This balanced approach will pave the way for a more holistic integration of smart health care devices into the routines of the older population, ensuring that they reap the full benefits of age tech advancements. UR - https://mhealth.jmir.org/2023/1/e46430 UR - http://dx.doi.org/10.2196/46430 UR - http://www.ncbi.nlm.nih.gov/pubmed/38039065 ID - info:doi/10.2196/46430 ER - TY - JOUR AU - Koch, Mara AU - Matzke, Ina AU - Huhn, Sophie AU - Sié, Ali AU - Boudo, Valentin AU - Compaoré, Guillaume AU - Maggioni, Anna Martina AU - Bunker, Aditi AU - Bärnighausen, Till AU - Dambach, Peter AU - Barteit, Sandra PY - 2023/11/8 TI - Assessing the Effect of Extreme Weather on Population Health Using Consumer-Grade Wearables in Rural Burkina Faso: Observational Panel Study JO - JMIR Mhealth Uhealth SP - e46980 VL - 11 KW - wearable KW - consumer-grade wearable KW - sleep KW - activity KW - heart rate KW - climate change KW - heat KW - rain KW - weather KW - sub-Saharan Africa KW - global health KW - public health KW - mobile phone N2 - Background: Extreme weather, including heat and extreme rainfall, is projected to increase owing to climate change, which can have adverse impacts on human health. In particular, rural populations in sub-Saharan Africa are at risk because of a high burden of climate-sensitive diseases and low adaptive capacities. However, there is a lack of data on the regions that are anticipated to be most exposed to climate change. Improved public health surveillance is essential for better decision-making and health prioritization and to identify risk groups and suitable adaptation measures. Digital technologies such as consumer-grade wearable devices (wearables) may generate objective measurements to guide data-driven decision-making. Objective: The main objective of this observational study was to examine the impact of weather exposure on population health in rural Burkina Faso using wearables. Specifically, this study aimed to assess the relationship between individual daily activity (steps), sleep duration, and heart rate (HR), as estimated by wearables, and exposure to heat and heavy rainfall. Methods: Overall, 143 participants from the Nouna health and demographic surveillance system in Burkina Faso wore the Withings Pulse HR wearable 24/7 for 11 months. We collected continuous weather data using 5 weather stations throughout the study region. The heat index and wet-bulb globe temperature (WBGT) were calculated as measures of heat. We used linear mixed-effects models to quantify the relationship between exposure to heat and rainfall and the wearable parameters. Participants kept activity journals and completed a questionnaire on their perception of and adaptation to heat and other weather exposure. Results: Sleep duration decreased significantly (P<.001) with higher heat exposure, with approximately 15 minutes shorter sleep duration during heat stress nights with a heat index value of ?25 °C. Many participants (55/137, 40.1%) reported that heat affected them the most at night. During the day, most participants (133/137, 97.1%) engaged in outdoor physical work such as farming, housework, or fetching water. During the rainy season, when WBGT was highest, daily activity was highest and increased when the daily maximum WBGT surpassed 30 °C during the rainiest month. In the hottest month, daily activity decreased per degree increase in WBGT for values >30 °C. Nighttime HR showed no significant correlation with heat exposure. Daytime HR data were insufficient for analysis. We found no negative health impact associated with heavy rainfall. With increasing rainfall, sleep duration increased, average nightly HR decreased, and activity decreased. Conclusions: During the study period, participants were frequently exposed to heat and heavy rainfall. Heat was particularly associated with impaired sleep and daily activity. Essential tasks such as harvesting, fetching water, and caring for livestock expose this population to weather that likely has an adverse impact on their health. Further research is essential to guide interventions safeguarding vulnerable communities. UR - https://mhealth.jmir.org/2023/1/e46980 UR - http://dx.doi.org/10.2196/46980 UR - http://www.ncbi.nlm.nih.gov/pubmed/37938879 ID - info:doi/10.2196/46980 ER - TY - JOUR AU - Watase, Teruhisa AU - Omiya, Yasuhiro AU - Tokuno, Shinichi PY - 2023/11/6 TI - Severity Classification Using Dynamic Time Warping?Based Voice Biomarkers for Patients With COVID-19: Feasibility Cross-Sectional Study JO - JMIR Biomed Eng SP - e50924 VL - 8 KW - voice biomarker KW - dynamic time warping KW - COVID-19 KW - smartphone KW - severity classification KW - biomarker KW - feasibility study KW - illness KW - monitoring KW - respiratory disease KW - accuracy KW - logistic model KW - tool KW - model N2 - Background: In Japan, individuals with mild COVID-19 illness previously required to be monitored in designated areas and were hospitalized only if their condition worsened to moderate illness or worse. Daily monitoring using a pulse oximeter was a crucial indicator for hospitalization. However, a drastic increase in the number of patients resulted in a shortage of pulse oximeters for monitoring. Therefore, an alternative and cost-effective method for monitoring patients with mild illness was required. Previous studies have shown that voice biomarkers for Parkinson disease or Alzheimer disease are useful for classifying or monitoring symptoms; thus, we tried to adapt voice biomarkers for classifying the severity of COVID-19 using a dynamic time warping (DTW) algorithm where voice wavelets can be treated as 2D features; the differences between wavelet features are calculated as scores. Objective: This feasibility study aimed to test whether DTW-based indices can generate voice biomarkers for a binary classification model using COVID-19 patients? voices to distinguish moderate illness from mild illness at a significant level. Methods: We conducted a cross-sectional study using voice samples of COVID-19 patients. Three kinds of long vowels were processed into 10-cycle waveforms with standardized power and time axes. The DTW-based indices were generated by all pairs of waveforms and tested with the Mann-Whitney U test (?<.01) and verified with a linear discrimination analysis and confusion matrix to determine which indices were better for binary classification of disease severity. A binary classification model was generated based on a generalized linear model (GLM) using the most promising indices as predictors. The receiver operating characteristic curve/area under the curve (ROC/AUC) validated the model performance, and the confusion matrix calculated the model accuracy. Results: Participants in this study (n=295) were infected with COVID-19 between June 2021 and March 2022, were aged 20 years or older, and recuperated in Kanagawa prefecture. Voice samples (n=110) were selected from the participants? attribution matrix based on age group, sex, time of infection, and whether they had mild illness (n=61) or moderate illness (n=49). The DTW-based variance indices were found to be significant (P<.001, except for 1 of 6 indices), with a balanced accuracy in the range between 79% and 88.6% for the /a/, /e/, and /u/ vowel sounds. The GLM achieved a high balance accuracy of 86.3% (for /a/), 80.2% (for /e/), and 88% (for /u/) and ROC/AUC of 94.8% (95% CI 90.6%-94.8%) for /a/, 86.5% (95% CI 79.8%-86.5%) for /e/, and 95.6% (95% CI 92.1%-95.6%) for /u/. Conclusions: The proposed model can be a voice biomarker for an alternative and cost-effective method of monitoring the progress of COVID-19 patients in care. UR - https://biomedeng.jmir.org/2023/1/e50924 UR - http://dx.doi.org/10.2196/50924 UR - http://www.ncbi.nlm.nih.gov/pubmed/37982072 ID - info:doi/10.2196/50924 ER - TY - JOUR AU - Oreskovic, Jessica AU - Kaufman, Jaycee AU - Thommandram, Anirudh AU - Fossat, Yan PY - 2023/10/24 TI - A Radar-Based Opioid Overdose Detection Device for Public Restrooms: Design, Development, and Evaluation Study JO - JMIR Biomed Eng SP - e51754 VL - 8 KW - 60 GHz radar KW - opioid overdose KW - overdose detection KW - overdose prevention KW - respiratory depression N2 - Background: The opioid epidemic is a growing crisis worldwide. While many interventions have been put in place to try to protect people from opioid overdoses, they typically rely on the person to take initiative in protecting themselves, requiring forethought, preparation, and action. Respiratory depression or arrest is the mechanism by which opioid overdoses become fatal, but it can be reversed with the timely administration of naloxone. Objective: In this study, we described the development and validation of an opioid overdose detection radar (ODR), specifically designed for use in public restroom stalls. In-laboratory testing was conducted to validate the noncontact, privacy-preserving device against a respiration belt and to determine the accuracy and reliability of the device. Methods: We used an ODR system with a high-frequency pulsed coherent radar sensor and a Raspberry Pi (Raspberry Pi Ltd), combining advanced technology with a compact and cost-effective setup to monitor respiration and detect opioid overdoses. To determine the optimal position for the ODR within the confined space of a restroom stall, iterative testing was conducted, considering the radar?s bounded capture area and the limitations imposed by the stall?s dimensions and layout. By adjusting the orientation of the ODR, we were able to identify the most effective placement where the device reliably tracked respiration in a number of expected positions. Experiments used a mock restroom stall setup that adhered to building code regulations, creating a controlled environment while maintaining the authenticity of a public restroom stall. By simulating different body positions commonly associated with opioid overdoses, the ODR?s ability to accurately track respiration in various scenarios was assessed. To determine the accuracy of the ODR, testing was performed using a respiration belt as a reference. The radar measurements were compared with those obtained from the belt in experiments where participants were seated upright and slumped over. Results: The results demonstrated favorable agreement between the radar and belt measurements, with an overall mean error in respiration cycle duration of 0.0072 (SD 0.54) seconds for all recorded respiration cycles (N=204). During the simulated overdose experiments where participants were slumped over, the ODR successfully tracked respiration with a mean period difference of 0.0091 (SD 0.62) seconds compared with the reference data. Conclusions: The findings suggest that the ODR has the potential to detect significant deviations in respiration patterns that may indicate an opioid overdose event. The success of the ODR in these experiments indicates the device should be further developed and implemented to enhance safety and emergency response measures in public restrooms. However, additional validation is required for unhealthy opioid-influenced respiratory patterns to guarantee the ODR?s effectiveness in real-world overdose situations. UR - https://biomedeng.jmir.org/2023/1/e51754 UR - http://dx.doi.org/10.2196/51754 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875668 ID - info:doi/10.2196/51754 ER - TY - JOUR AU - Randall, Natasha AU - Kamino, Waki AU - Joshi, Swapna AU - Chen, Wei-Chu AU - Hsu, Long-Jing AU - Tsui, M. Katherine AU - ?abanovi?, Selma PY - 2023/10/4 TI - Understanding the Connection Among Ikigai, Well-Being, and Home Robot Acceptance in Japanese Older Adults: Mixed Methods Study JO - JMIR Aging SP - e45442 VL - 6 KW - ikigai KW - meaning in life KW - purpose KW - well-being KW - eudaimonic KW - hedonic KW - happiness KW - home robots KW - social robots KW - human-robot interaction KW - Japan N2 - Background: Ikigai (meaning or purpose in life) is a concept understood by most older adults in Japan. The term has also garnered international attention, with recent academic attempts to map it to concepts in the Western well-being literature. In addition, efforts to use social and home robots to increase well-being have grown; however, they have mostly focused on hedonic well-being (eg, increasing happiness and decreasing loneliness) rather than eudaimonic well-being (eg, fostering meaning or purpose in life). Objective: First, we explored how Japanese older adults experience ikigai and relate these to concepts in the Western well-being literature. Second, we investigated how a home robot meant to promote ikigai is perceived by older adults. Methods: We used a mixed methods research design?including 20 interviews with older adults, a survey of 50 older adults, and 10 interviews with family caregivers. For interviews, we asked questions about older adults? sources of ikigai, happiness, and social support, along with their perception of the robot (QT). For surveys, a number of well-being scales were used, including 2 ikigai scales?ikigai-9 and K-1?and 6 Patient-Reported Outcomes Measurement Information System scales, measuring meaning and purpose, positive affect, satisfaction with participation in social roles, satisfaction with participation in discretionary social activities, companionship, and emotional support. Questions related to the perception and desired adoption of the robot and older adults? health status were also included. Results: Our results suggest that health is older adults? most common source of ikigai. Additionally, although self-rated health correlated moderately with ikigai and other well-being measures, reported physical limitation did not. As opposed to social roles (work and family), we found that ikigai is more strongly related to satisfaction with discretionary social activities (leisure, hobbies, and friends) for older adults. Moreover, we found that older adults? sources of ikigai included the eudaimonic aspects of vitality, positive relations with others, contribution, accomplishment, purpose, and personal growth, with the first 3 being most common, and the hedonic aspects of positive affect, life satisfaction, and lack of negative affect, with the first 2 being most common. However, the concept of ikigai was most related to eudaimonic well-being, specifically meaning in life, along the dimension of significance. Finally, we found that Japanese older adults have high expectations of a home robot for well-being, mentioning that it should support them in a multitude of ways before they would likely adopt it. However, we report that those with the highest levels of meaning, and satisfaction with their leisure life and friendships, may be most likely to adopt it. Conclusions: We outline several ways to improve the robot to increase its acceptance, such as improving its voice, adding functional features, and designing it to support multiple aspects of well-being. UR - https://aging.jmir.org/2023/1/e45442 UR - http://dx.doi.org/10.2196/45442 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792460 ID - info:doi/10.2196/45442 ER - TY - JOUR AU - Shaikh, Yahya AU - Gibbons, Christopher Michael PY - 2023/9/21 TI - Pathophysiologic Basis of Connected Health Systems JO - J Med Internet Res SP - e42405 VL - 25 KW - smart health KW - connected health KW - systematic methodology KW - pathophysiology KW - architecting connected health systems KW - design KW - community KW - clinic KW - environment KW - system KW - technology KW - digital therapeutic KW - therapeutic systems UR - https://www.jmir.org/2023/1/e42405 UR - http://dx.doi.org/10.2196/42405 UR - http://www.ncbi.nlm.nih.gov/pubmed/37733435 ID - info:doi/10.2196/42405 ER - TY - JOUR AU - Marini, Christina AU - Cruz, Jocelyn AU - Payano, Leydi AU - Flores, Patino Ronaldo AU - Arena, Gina-Maria AU - Mandal, Soumik AU - Leven, Eric AU - Mann, Devin AU - Schoenthaler, Antoinette PY - 2023/9/19 TI - Opening the Black Box of an mHealth Patient-Reported Outcome Tool for Diabetes Self-Management: Interview Study Among Patients With Type 2 Diabetes JO - JMIR Form Res SP - e47811 VL - 7 KW - mobile health KW - mHealth KW - patient-reported outcomes KW - diabetes KW - qualitative KW - patient engagement N2 - Background: Mobile health (mHealth) tools are used to collect data on patient-reported outcomes (PROs) and facilitate the assessment of patients? self-management behaviors outside the clinic environment. Despite the high availability of mHealth diabetes tools, there is a lack of understanding regarding the underlying reasons why these mHealth PRO tools succeed or fail in terms of changing patients? self-management behaviors. Objective: This study aims to identify the factors that drive engagement with an mHealth PRO tool and facilitate patients? adoption of self-management behaviors, as well as elicit suggestions for improvement. Methods: This qualitative study was conducted within the context of a randomized controlled trial designed to evaluate the efficacy of an mHealth PRO tool (known as i-Matter) versus usual care regarding reduction in glycated hemoglobin (HbA1c) levels and adherence to self-management behaviors at 12 months among patients with uncontrolled type 2 diabetes. Patients randomized to i-Matter participated in semistructured interviews about their experiences at the 3-, 6-, 9-, and 12-month study visits. A qualitative analysis of the interviews was conducted by 2 experienced qualitative researchers using conventional qualitative content analysis. Results: The sample comprised 71 patients, of whom 67 (94%) completed at least one interview (n=48, 72% female patients; n=25, 37% identified as African American or Black; mean age 56.65 [SD 9.79] years). We identified 4 overarching themes and 6 subthemes. Theme 1 showed that the patients? reasons for engagement with i-Matter were multifactorial. Patients were driven by internal motivating factors that bolstered their engagement and helped them feel accountable for their diabetes (subtheme 1) and external motivating factors that helped to serve as reminders to be consistent with their self-management behaviors (subtheme 2). Theme 2 revealed that the use of i-Matter changed patients? attitudes toward their disease and their health behaviors in 2 ways: patients developed more positive attitudes about their condition and their ability to effectively self-manage it (subtheme 3), and they also developed a better awareness of their current behaviors, which motivated them to adopt healthier lifestyle behaviors (subtheme 4). Theme 3 showed that patients felt more committed to their health as a result of using i-Matter. Theme 4 highlighted the limitations of i-Matter, which included its technical design (subtheme 5) and the need for more resources to support the PRO data collected and shared through the tool (subtheme 6). Conclusions: This study isolated internal and external factors that prompted patients to change their views about their diabetes, become more engaged with the intervention and their health, and adopt healthy behaviors. These behavioral mechanisms provide important insights to drive future development of mHealth interventions that could lead to sustained behavior change. UR - https://formative.jmir.org/2023/1/e47811 UR - http://dx.doi.org/10.2196/47811 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725427 ID - info:doi/10.2196/47811 ER - TY - JOUR AU - Kim, Hyunsoo AU - Jang, Jin Seong AU - Lee, Dong Hee AU - Ko, Hoon Jae AU - Lim, Young Jee PY - 2023/8/7 TI - Smart Floor Mats for a Health Monitoring System Based on Textile Pressure Sensing: Development and Usability Study JO - JMIR Form Res SP - e47325 VL - 7 KW - analysis KW - auto-mapping KW - monitoring KW - healthcare KW - health-monitoring KW - online KW - piezo-resistance sensor KW - pressure mat KW - real-time KW - sensing mats KW - smart home technology KW - smart home KW - spatial map KW - technology KW - textile N2 - Background: The rise in single-person households has resulted in social problems like loneliness and isolation, commonly known as ?death by loneliness.? Various factors contribute to this increase, including a desire for independent living and communication challenges within families due to societal changes. Older individuals living alone are particularly susceptible to loneliness and isolation due to limited family communication and a lack of social activities. Addressing these issues is crucial, and proactive solutions are needed. It is important to explore diverse measures to tackle the challenges of single-person households and prevent deaths due to loneliness in our society. Objective: Non?face-to-face health care service systems have gained widespread interest owing to the rapid development of smart home technology. Particularly, a health monitoring system must be developed to manage patients? health status and send alerts for dangerous situations based on their activity. Therefore, in this study, we present a novel health monitoring system based on the auto-mapping method, which uses real-time position sensing mats. Methods: The smart floor mats are operated as piezo-resistive devices, which are composed of a carbon nanotube?based conductive textile, electrodes, main processor circuit, and a mat. The developed smart floor system acquires real-time position information using a multiconnection method between the modules based on the auto-mapping algorithm, which automatically creates a spatial map. The auto-mapping algorithm allows the user to freely set various activity areas through floor mapping. Then, the monitoring system was evaluated in a room with an area of 41.3 m2, which is embedded with the manufactured floor mats and monitoring application. Results: This monitoring system automatically acquires information on the total number, location, and direction of the mats and creates a spatial map. The position sensing mats can be easily configured with a simple structure by using a carbon nanotube?based piezo-resistive textile. The mats detect the activity in real time and record location information since they are connected through auto-mapping technology. Conclusions: This system allows for the analysis of patients? behavior patterns and the management of health care on the web by providing important basic information for activity patterns in the monitoring system. The proposed smart floor system can serve as the foundation for smart home applications in the future, which include health care, intelligent automation, and home security, owing to its advantages of low cost, large area, and high reliability. UR - https://formative.jmir.org/2023/1/e47325 UR - http://dx.doi.org/10.2196/47325 UR - http://www.ncbi.nlm.nih.gov/pubmed/37548993 ID - info:doi/10.2196/47325 ER - TY - JOUR AU - Ghorayeb, Abir AU - Comber, Rob AU - Gooberman-Hill, Rachael PY - 2023/6/16 TI - Development of a Smart Home Interface With Older Adults: Multi-Method Co-Design Study JO - JMIR Aging SP - e44439 VL - 6 KW - data visualization KW - digital health KW - smart homes KW - older people KW - technology acceptance KW - qualitative research KW - mobile phone N2 - Background: Smart home technologies have the potential to support aging in place; however, older people?s perceptions of the value of smart homes may be influenced by their access to the information gathered by the technology. This information is needed to support their informed decision-making. Limited research has been conducted on how best to design visualizations of smart home data in keeping with the needs and wishes of older people. Objective: We aimed to investigate the design options that impact the usefulness of smart home systems, older people?s information needs, their perceptions of data visualization, and the ways they would like information displayed to them. Methods: We used a qualitative approach to empower the participants as co-designers. Data collection comprised a sequence of methods such as interviews, observation, focus groups, scenario design, probes, and design workshops. Each phase informed the next. Overall, 13 older adults (n=8, 62% female and n=5, 38% male; aged 65-89 years) consented to participate. A thematic approach was used to analyze the data set, and participants were actively involved in designing the in-home interface, which enabled them to better conceptualize their needs. Results: The information collected was clustered into 5 themes: enabling home, health, and self-monitoring; enabling opportunities for social inclusion and engagement; enhancing cognitive abilities; customizability of the display; and promoting inclusion in recreation and leisure activities. These themes informed 5 design sessions in which participants co-designed visual metaphors for the themes based on their own experiences in an age-inclusive manner. Together, the participants produced a user-friendly prototype, which they chose to call My Buddy. They found it useful to receive social and cognitive triggers, as well as recommendations for special diets or activities based on their mood, health, and social status. Conclusions: Smart home data visualization is much more than a nice-to-have option. Visualization is a must-have feature because it deepens the understanding of the information collected and means that technology provides information of value and relevance to older people. This may improve the acceptability and perceived utility of in-home technology. By understanding what older people want to know from smart home technology and considering how to visualize data in ways that work for them, we can provide an appropriate in-home interface. Such an interface would suggest ways or opportunities to connect and socialize; stimulate contact with close friends or family members; maintain awareness of health and well-being; provide support in decision-making, cognitive tasks, and daily life activities; and monitor health status. Older adults are the best co-designers for the development of visual metaphors that resonate with their own experiences. Our findings promote the development of technologies that foreground and reflect the information needs of older people and engage them as designers of the display. UR - https://aging.jmir.org/2023/1/e44439 UR - http://dx.doi.org/10.2196/44439 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327037 ID - info:doi/10.2196/44439 ER - TY - JOUR AU - Morita, P. Plinio AU - Sahu, Sundar Kirti AU - Oetomo, Arlene PY - 2023/4/13 TI - Health Monitoring Using Smart Home Technologies: Scoping Review JO - JMIR Mhealth Uhealth SP - e37347 VL - 11 KW - monitor KW - smart home KW - ambient assisted living KW - active assisted living KW - AAL KW - assisted living KW - review KW - internet of things KW - aging KW - gerontology KW - elder KW - older adult KW - older people KW - geriatric KW - digital health KW - eHealth KW - smart technology KW - older population KW - independent living KW - big data KW - machine learning KW - algorithm KW - deep learning N2 - Background: The Internet of Things (IoT) has become integrated into everyday life, with devices becoming permanent fixtures in many homes. As countries face increasing pressure on their health care systems, smart home technologies have the potential to support population health through continuous behavioral monitoring. Objective: This scoping review aims to provide insight into this evolving field of research by surveying the current technologies and applications for in-home health monitoring. Methods: Peer-reviewed papers from 2008 to 2021 related to smart home technologies for health care were extracted from 4 databases (PubMed, Scopus, ScienceDirect, and CINAHL); 49 papers met the inclusion criteria and were analyzed. Results: Most of the studies were from Europe and North America. The largest proportion of the studies were proof of concept or pilot studies. Approximately 78% (38/49) of the studies used real human participants, most of whom were older females. Demographic data were often missing. Nearly 60% (29/49) of the studies reported on the health status of the participants. Results were primarily reported in engineering and technology journals. Almost 62% (30/49) of the studies used passive infrared sensors to report on motion detection where data were primarily binary. There were numerous data analysis, management, and machine learning techniques employed. The primary challenges reported by authors were differentiating between multiple participants in a single space, technology interoperability, and data security and privacy. Conclusions: This scoping review synthesizes the current state of research on smart home technologies for health care. We were able to identify multiple trends and knowledge gaps?in particular, the lack of collaboration across disciplines. Technological development dominates over the human-centric part of the equation. During the preparation of this scoping review, we noted that the health care research papers lacked a concrete definition of a smart home, and based on the available evidence and the identified gaps, we propose a new definition for a smart home for health care. Smart home technology is growing rapidly, and interdisciplinary approaches will be needed to ensure integration into the health sector. UR - https://mhealth.jmir.org/2023/1/e37347 UR - http://dx.doi.org/10.2196/37347 UR - http://www.ncbi.nlm.nih.gov/pubmed/37052984 ID - info:doi/10.2196/37347 ER - TY - JOUR AU - Wang, H. Rosalie AU - Tannou, Thomas AU - Bier, Nathalie AU - Couture, Mélanie AU - Aubry, Régis PY - 2023/3/9 TI - Proactive and Ongoing Analysis and Management of Ethical Concerns in the Development, Evaluation, and Implementation of Smart Homes for Older Adults With Frailty JO - JMIR Aging SP - e41322 VL - 6 KW - ethics KW - older adults KW - frailty KW - smart home KW - assistive technology KW - aging in place KW - ethical concerns KW - implementation KW - bioethics KW - technology ethics KW - autonomy KW - privacy KW - security KW - informed consent KW - support ecosystem UR - https://aging.jmir.org/2023/1/e41322 UR - http://dx.doi.org/10.2196/41322 UR - http://www.ncbi.nlm.nih.gov/pubmed/36892912 ID - info:doi/10.2196/41322 ER - TY - JOUR AU - Kim, Chan Joo AU - Saguna, Saguna AU - Åhlund, Christer PY - 2023/3/8 TI - Acceptability of a Health Care App With 3 User Interfaces for Older Adults and Their Caregivers: Design and Evaluation Study JO - JMIR Hum Factors SP - e42145 VL - 10 KW - Internet of Things KW - health monitoring KW - older adults KW - augmented reality KW - user experience KW - independent living KW - design study KW - mobile phone N2 - Background: The older population needs solutions for independent living and reducing the burden on caregivers while maintaining the quality and dignity of life. Objective: The aim of this study was to design, develop, and evaluate an older adult health care app that supports trained caregivers (ie, formal caregivers) and relatives (ie, informal caregivers). We aimed to identify the factors that affect user acceptance of interfaces depending on the user?s role. Methods: We designed and developed an app with 3 user interfaces that enable remote sensing of an older adult?s daily activities and behaviors. We conducted user evaluations (N=25) with older adults and their formal and informal caregivers to obtain an overall impression of the health care monitoring app in terms of user experience and usability. In our design study, the participants had firsthand experience with our app, followed by a questionnaire and individual interview to express their opinions on the app. Through the interview, we also identified their views on each user interface and interaction modality to identify the relationship between the user?s role and their acceptance of a particular interface. The questionnaire answers were statistically analyzed, and we coded the interview answers based on keywords related to a participant?s experience, for example, ease of use and usefulness. Results: We obtained overall positive results in the user evaluation of our app regarding key aspects such as efficiency, perspicuity, dependability, stimulation, and novelty, with an average between 1.74 (SD 1.02) and 2.18 (SD 0.93) on a scale of ?3.0 to 3.0. The overall impression of our app was favorable, and we identified that ?simple? and ?intuitive? were the main factors affecting older adults? and caregivers? preference for the user interface and interaction modality. We also identified a positive user acceptance of the use of augmented reality by 91% (10/11) of the older adults to share information with their formal and informal caregivers. Conclusions: To address the need for a study to evaluate the user experience and user acceptance by older adults as well as both formal and informal caregivers regarding the user interfaces with multimodal interaction in the context of health monitoring, we designed, developed, and conducted user evaluations with the target user groups. Our results through this design study show important implications for designing future health monitoring apps with multiple interaction modalities and intuitive user interfaces in the older adult health care domain. UR - https://humanfactors.jmir.org/2023/1/e42145 UR - http://dx.doi.org/10.2196/42145 UR - http://www.ncbi.nlm.nih.gov/pubmed/36884275 ID - info:doi/10.2196/42145 ER - TY - JOUR AU - Chan, Andrew AU - Cohen, Rachel AU - Robinson, Katherine-Marie AU - Bhardwaj, Devvrat AU - Gregson, Geoffrey AU - Jutai, W. Jeffrey AU - Millar, Jason AU - Ríos Rincón, Adriana AU - Roshan Fekr, Atena PY - 2022/11/28 TI - Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review JO - JMIR Aging SP - e40079 VL - 5 IS - 4 KW - smart homes KW - concerns KW - user-centered frameworks KW - clinical evidence KW - home health monitoring KW - gerontechnology KW - telemonitoring KW - older adults N2 - Background: Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies. Objective: This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks. Methods: A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented. Results: The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied. Conclusions: Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users. UR - https://aging.jmir.org/2022/4/e40079 UR - http://dx.doi.org/10.2196/40079 UR - http://www.ncbi.nlm.nih.gov/pubmed/36441572 ID - info:doi/10.2196/40079 ER - TY - JOUR AU - Lee, Peter AU - Kim, Heepyung AU - Zitouni, Sami M. AU - Khandoker, Ahsan AU - Jelinek, F. Herbert AU - Hadjileontiadis, Leontios AU - Lee, Uichin AU - Jeong, Yong PY - 2022/11/15 TI - Trends in Smart Helmets With Multimodal Sensing for Health and Safety: Scoping Review JO - JMIR Mhealth Uhealth SP - e40797 VL - 10 IS - 11 KW - Internet of Things KW - IoT KW - sensor technology KW - smart helmet KW - smart sensor KW - wearable device KW - mobile phone N2 - Background: As a form of the Internet of Things (IoT)?gateways, a smart helmet is one of the core devices that offers distinct functionalities. The development of smart helmets connected to IoT infrastructure helps promote connected health and safety in various fields. In this regard, we present a comprehensive analysis of smart helmet technology and its main characteristics and applications for health and safety. Objective: This paper reviews the trends in smart helmet technology and provides an overview of the current and future potential deployments of such technology, the development of smart helmets for continuous monitoring of the health status of users, and the surrounding environmental conditions. The research questions were as follows: What are the main purposes and domains of smart helmets for health and safety? How have researchers realized key features and with what types of sensors? Methods: We selected studies cited in electronic databases such as Google Scholar, Web of Science, ScienceDirect, and EBSCO on smart helmets through a keyword search from January 2010 to December 2021. In total, 1268 papers were identified (Web of Science: 87/1268, 6.86%; EBSCO: 149/1268, 11.75%; ScienceDirect: 248/1268, 19.55%; and Google Scholar: 784/1268, 61.82%), and the number of final studies included after PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study selection was 57. We also performed a self-assessment of the reviewed articles to determine the quality of the paper. The scoring was based on five criteria: test environment, prototype quality, feasibility test, sensor calibration, and versatility. Results: Smart helmet research has been considered in industry, sports, first responder, and health tracking scenarios for health and safety purposes. Among 57 studies, most studies with prototype development were industrial applications (18/57, 32%), and the 2 most frequent studies including simulation were industry (23/57, 40%) and sports (23/57, 40%) applications. From our assessment-scoring result, studies tended to focus on sensor calibration results (2.3 out of 3), while the lowest part was a feasibility test (1.6 out of 3). Further classification of the purpose of smart helmets yielded 4 major categories, including activity, physiological and environmental (hazard) risk sensing, as well as risk event alerting. Conclusions: A summary of existing smart helmet systems is presented with a review of the sensor features used in the prototyping demonstrations. Overall, we aimed to explore new possibilities by examining the latest research, sensor technologies, and application platform perspectives for smart helmets as promising wearable devices. The barriers to users, challenges in the development of smart helmets, and future opportunities for health and safety applications are also discussed. In conclusion, this paper presents the current status of smart helmet technology, main issues, and prospects for future smart helmet with the objective of making the smart helmet concept a reality. UR - https://mhealth.jmir.org/2022/11/e40797 UR - http://dx.doi.org/10.2196/40797 UR - http://www.ncbi.nlm.nih.gov/pubmed/36378505 ID - info:doi/10.2196/40797 ER - TY - JOUR AU - Kim, Changgyun AU - Jeong, Hogul AU - Park, Wonse AU - Kim, Donghyun PY - 2022/10/31 TI - Tooth-Related Disease Detection System Based on Panoramic Images and Optimization Through Automation: Development Study JO - JMIR Med Inform SP - e38640 VL - 10 IS - 10 KW - object detection KW - tooth KW - diagnosis KW - panorama KW - dentistry KW - dental health KW - oral health KW - dental caries KW - image analysis KW - artificial intelligence KW - detection model KW - machine learning KW - automation KW - diagnosis system N2 - Background: Early detection of tooth-related diseases in patients plays a key role in maintaining their dental health and preventing future complications. Since dentists are not overly attentive to tooth-related diseases that may be difficult to judge visually, many patients miss timely treatment. The 5 representative tooth-related diseases, that is, coronal caries or defect, proximal caries, cervical caries or abrasion, periapical radiolucency, and residual root can be detected on panoramic images. In this study, a web service was constructed for the detection of these diseases on panoramic images in real time, which helped shorten the treatment planning time and reduce the probability of misdiagnosis. Objective: This study designed a model to assess tooth-related diseases in panoramic images by using artificial intelligence in real time. This model can perform an auxiliary role in the diagnosis of tooth-related diseases by dentists and reduce the treatment planning time spent through telemedicine. Methods: For learning the 5 tooth-related diseases, 10,000 panoramic images were modeled: 4206 coronal caries or defects, 4478 proximal caries, 6920 cervical caries or abrasion, 8290 periapical radiolucencies, and 1446 residual roots. To learn the model, the fast region-based convolutional network (Fast R-CNN), residual neural network (ResNet), and inception models were used. Learning about the 5 tooth-related diseases completely did not provide accurate information on the diseases because of indistinct features present in the panoramic pictures. Therefore, 1 detection model was applied to each tooth-related disease, and the models for each of the diseases were integrated to increase accuracy. Results: The Fast R-CNN model showed the highest accuracy, with an accuracy of over 90%, in diagnosing the 5 tooth-related diseases. Thus, Fast R-CNN was selected as the final judgment model as it facilitated the real-time diagnosis of dental diseases that are difficult to judge visually from radiographs and images, thereby assisting the dentists in their treatment plans. Conclusions: The Fast R-CNN model showed the highest accuracy in the real-time diagnosis of dental diseases and can therefore play an auxiliary role in shortening the treatment planning time after the dentists diagnose the tooth-related disease. In addition, by updating the captured panoramic images of patients on the web service developed in this study, we are looking forward to increasing the accuracy of diagnosing these 5 tooth-related diseases. The dental diagnosis system in this study takes 2 minutes for diagnosing 5 diseases in 1 panoramic image. Therefore, this system plays an effective role in setting a dental treatment schedule. UR - https://medinform.jmir.org/2022/10/e38640 UR - http://dx.doi.org/10.2196/38640 UR - http://www.ncbi.nlm.nih.gov/pubmed/36315222 ID - info:doi/10.2196/38640 ER - TY - JOUR AU - Sauzéon, Hélène AU - Edjolo, Arlette AU - Amieva, Hélène AU - Consel, Charles AU - Pérès, Karine PY - 2022/10/26 TI - Effectiveness of an Ambient Assisted Living (HomeAssist) Platform for Supporting Aging in Place of Older Adults With Frailty: Protocol for a Quasi-Experimental Study JO - JMIR Res Protoc SP - e33351 VL - 11 IS - 10 KW - ambient assisted living technology KW - AAL KW - Internet-of-Things KW - IoT KW - aging and frailty KW - independent living KW - effectiveness study N2 - Background: Ambient assisted living (AAL) technologies are viewed as a promising way to prolong aging in place, particularly when they are designed as closely as possible to the needs of the end users. However, very few evidence-based results have been provided to support its real value, notably for frail older adults who have a high risk of autonomy loss as well as entering a nursing home. Objective: We hypothesized that the benefit from an AAL with a user-centered design is effective for aging in place for frail older adults in terms of everyday functioning (instrumental activities of daily-life scale). In addition, our secondary hypotheses are that such an AAL decreases or neutralizes the frailty process and reduces the rates of institutionalization and hospitalization and that it improves the psychosocial health of participants and their caregivers when compared with the control condition. We also assume that a large proportion of equipped participants will have a satisfactory experience and will accept a subscription to an internet connection to prolong their participation. Methods: HomeAssist (HA) is an AAL platform offering a large set of apps for 3 main age-related need domains (activities of daily-living, safety, and social participation), relying on a basic set of entities (sensors, actuators, tablets, etc). The HA intervention involves monitoring based on assistive services to support activities related to independent living at home. The study design is quasi-experimental with a duration of 12 months, optionally extensible to 24 months. Follow-up assessments occurred at 0, 12, and 24 months. The primary outcome measures are related to everyday functioning. Secondary outcome measures include indices of frailty, cognitive functioning, and psychosocial health of the participants and their caregivers. Every 6 months, user experience and attitudes toward HA are also collected from equipped participants. Concomitantly, data on HA use will be collected. All measures of the study will be tested based on an intention-to-treat approach using a 2-tailed level of significance set at ?=.05, concerning our primary and secondary efficacy outcomes. Results: Descriptive analyses were conducted to characterize the recruited equipped participants compared with the others (excluded and refusals) on the data available at the eligibility visit, to describe the characteristics of the recruited sample at baseline, as well as those of the dropouts. Finally, recruitment at 12 months included equipped participants (n=73), matched with control participants (n=474, from pre-existing cohorts). The results of this study will be disseminated through scientific publications and conferences. This will provide a solid basis for the creation of a start-up to market the technology. Conclusions: This trial will inform the real-life efficacy of HA in prolonging aging in place for frail older adults and yield an informed analysis of AAL use and adoption in frail older individuals. International Registered Report Identifier (IRRID): DERR1-10.2196/33351 UR - https://www.researchprotocols.org/2022/10/e33351 UR - http://dx.doi.org/10.2196/33351 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287595 ID - info:doi/10.2196/33351 ER - TY - JOUR AU - Bijlani, Nivedita AU - Nilforooshan, Ramin AU - Kouchaki, Samaneh PY - 2022/9/19 TI - An Unsupervised Data-Driven Anomaly Detection Approach for Adverse Health Conditions in People Living With Dementia: Cohort Study JO - JMIR Aging SP - e38211 VL - 5 IS - 3 KW - contextual matrix profile KW - multidimensional anomaly detection KW - outlier detection KW - sensor-based remote health monitoring KW - dementia KW - unsupervised learning N2 - Background: Sensor-based remote health monitoring can be used for the timely detection of health deterioration in people living with dementia with minimal impact on their day-to-day living. Anomaly detection approaches have been widely applied in various domains, including remote health monitoring. However, current approaches are challenged by noisy, multivariate data and low generalizability. Objective: This study aims to develop an online, lightweight unsupervised learning?based approach to detect anomalies representing adverse health conditions using activity changes in people living with dementia. We demonstrated its effectiveness over state-of-the-art methods on a real-world data set of 9363 days collected from 15 participant households by the UK Dementia Research Institute between August 2019 and July 2021. Our approach was applied to household movement data to detect urinary tract infections (UTIs) and hospitalizations. Methods: We propose and evaluate a solution based on Contextual Matrix Profile (CMP), an exact, ultrafast distance-based anomaly detection algorithm. Using daily aggregated household movement data collected via passive infrared sensors, we generated CMPs for location-wise sensor counts, duration, and change in hourly movement patterns for each patient. We computed a normalized anomaly score in 2 ways: by combining univariate CMPs and by developing a multidimensional CMP. The performance of our method was evaluated relative to Angle-Based Outlier Detection, Copula-Based Outlier Detection, and Lightweight Online Detector of Anomalies. We used the multidimensional CMP to discover and present the important features associated with adverse health conditions in people living with dementia. Results: The multidimensional CMP yielded, on average, 84.3% recall with 32.1 alerts, or a 5.1% alert rate, offering the best balance of recall and relative precision compared with Copula-Based and Angle-Based Outlier Detection and Lightweight Online Detector of Anomalies when evaluated for UTI and hospitalization. Midnight to 6 AM bathroom activity was shown to be the most important cross-patient digital biomarker of anomalies indicative of UTI, contributing approximately 30% to the anomaly score. We also demonstrated how CMP-based anomaly scoring can be used for a cross-patient view of anomaly patterns. Conclusions: To the best of our knowledge, this is the first real-world study to adapt the CMP to continuous anomaly detection in a health care scenario. The CMP inherits the speed, accuracy, and simplicity of the Matrix Profile, providing configurability, the ability to denoise and detect patterns, and explainability to clinical practitioners. We addressed the need for anomaly scoring in multivariate time series health care data by developing the multidimensional CMP. With high sensitivity, a low alert rate, better overall performance than state-of-the-art methods, and the ability to discover digital biomarkers of anomalies, the CMP is a clinically meaningful unsupervised anomaly detection technique extensible to multimodal data for dementia and other health care scenarios. UR - https://aging.jmir.org/2022/3/e38211 UR - http://dx.doi.org/10.2196/38211 UR - http://www.ncbi.nlm.nih.gov/pubmed/36121687 ID - info:doi/10.2196/38211 ER - TY - JOUR AU - Kim, Daejin AU - Bian, Hongyi AU - Chang, K. Carl AU - Dong, Liang AU - Margrett, Jennifer PY - 2022/9/1 TI - In-Home Monitoring Technology for Aging in Place: Scoping Review JO - Interact J Med Res SP - e39005 VL - 11 IS - 2 KW - in-home monitoring KW - aging in place KW - ambient assisted living KW - home modification KW - monitoring KW - aging KW - technology KW - intervention KW - older adult KW - wellness KW - independence KW - monitor KW - research KW - sensor KW - activity KW - behavior KW - cognitive KW - sleep N2 - Background: For successful aging-in-place strategy development, in-home monitoring technology is necessary as a new home modification strategy. Monitoring an older adult?s daily physical activity at home can positively impact their health and well-being by providing valuable information about functional, cognitive, and social health status. However, it is questionable how these in-home monitoring technologies have changed the traditional residential environment. A comprehensive review of existing research findings should be utilized to characterize recent relative technologies and to inform design considerations. Objective: The main purpose of this study was to classify recent smart home technologies that monitor older adults? health and to architecturally describe these technologies as they are used in older adults? homes. Methods: The scoping review method was employed to identify key characteristics of in-home monitoring technologies for older adults. In June 2021, four databases, including Web of Science, IEEE Xplore, ACM Digital Library, and Scopus, were searched for peer-reviewed articles pertaining to smart home technologies used to monitor older adults? health in their homes. We used two search strings to retrieve articles: types of technology and types of users. For the title, abstract, and full-text screening, the inclusion criteria were original and peer-reviewed research written in English, and research on monitoring, detecting, recognizing, analyzing, or tracking human physical, emotional, and social behavior. The exclusion criteria included theoretical, conceptual, or review papers; studies on wearable systems; and qualitative research. Results: This scoping review identified 30 studies published between June 2016 and 2021 providing overviews of in-home monitoring technologies, including (1) features of smart home technologies and (2) sensor locations and sensor data. First, we found six functions of in-home monitoring technology among the reviewed papers: daily activities, abnormal behaviors, cognitive impairment, falls, indoor person positioning, and sleep quality. Most of the research (n=27 articles) focused on functional monitoring and analysis, such as activities of daily living, instrumental activities of daily living, or falls among older adults; a few studies (n=3) covered social interaction monitoring. Second, this scoping review also found 16 types of sensor technologies. The most common data types encountered were passive infrared motion sensors (n=21) and contact sensors (n=19), which were used to monitor human behaviors such as bodily presence and time spent on activities. Specific locations for each sensor were also identified. Conclusions: This wide-ranging synthesis demonstrates that in-home monitoring technologies within older adults? homes play an essential role in aging in place, in that the technology monitors older adults? daily activities and identifies various health-related issues. This research provides a key summarization of in-home monitoring technologies that can be applied in senior housing for successful aging in place. These findings will be significant when developing home modification strategies or new senior housing. UR - https://www.i-jmr.org/2022/2/e39005 UR - http://dx.doi.org/10.2196/39005 UR - http://www.ncbi.nlm.nih.gov/pubmed/36048502 ID - info:doi/10.2196/39005 ER - TY - JOUR AU - Nyenhuis, Sharmilee AU - Cramer, Emily AU - Grande, Matthew AU - Huntington-Moskos, Luz AU - Krueger, Kathryn AU - Bimbi, Olivia AU - Polivka, Barbara AU - Eldeirawi, Kamal PY - 2022/8/2 TI - Utilizing Real-time Technology to Assess the Impact of Home Environmental Exposures on Asthma Symptoms: Protocol for an Observational Pilot Study JO - JMIR Res Protoc SP - e39887 VL - 11 IS - 8 KW - asthma KW - home environment KW - ecologic momentary assessment KW - air quality KW - spirometry N2 - Background: It is estimated that over 60% of adults with asthma have uncontrolled symptoms, representing a substantial health and economic impact. The effects of the home environment and exposure to volatile organic compounds (VOCs) and fine particulate matter (PM2.5) on adults with asthma remain unknown. In addition, methods currently used to assess the home environment do not capture real-time data on potentially modifiable environmental exposures or their effect on asthma symptoms. Objective: The aims of this study are to (1) determine the feasibility and usability of ecological momentary assessment (EMA) to assess self-report residential environmental exposures and asthma symptoms, home monitoring of objective environmental exposures (total VOCs and PM2.5), and lung function in terms of forced expiratory volume in 1 second (FEV1%); (2) assess the frequency and level of residential environmental exposures (eg, disinfectants/cleaners, secondhand smoke) via self-reported data and home monitoring objective measures; (3) assess the level of asthma control as indicated by self-reported asthma symptoms and lung function; and (4) explore associations of self-reported and objective measures of residential environmental exposures with self-reported and objective measures of asthma control. Methods: We will recruit 50 adults with asthma who have completed our online Global COVID-19 Asthma Study, indicated willingness to be contacted for future studies, reported high use of disinfectant/cleaning products, and have asthma that is not well controlled. Participants will receive an indoor air quality monitor and a home spirometer to measure VOCs, PM2.5, and FEV1%, respectively. EMA data will be collected using a personal smartphone and EMA software platform. Participants will be sent scheduled and random EMA notifications to assess asthma symptoms, environmental exposures, lung function, and mitigation strategies. After the 14-day data collection period, participants will respond to survey items related to acceptability, appropriateness, and feasibility. Results: This study was funded in March 2021. We pilot tested our procedures and began recruitment in April 2022. The anticipated completion of the study is 2023. Conclusions: Findings from this feasibility study will support a powered study to address the impact of home environmental exposures on asthma symptoms and develop tailored, home-based asthma interventions that are responsive to the changing home environment and home routines. Trial Registration: ClinicalTrials.gov NCT05224076; https://clinicaltrials.gov/ct2/show/NCT05224076 International Registered Report Identifier (IRRID): DERR1-10.2196/39887 UR - https://www.researchprotocols.org/2022/8/e39887 UR - http://dx.doi.org/10.2196/39887 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916686 ID - info:doi/10.2196/39887 ER - TY - JOUR AU - Jones, Chelsea AU - Smith-MacDonald, Lorraine AU - Brown, G. Matthew R. AU - VanDehy, Jacob AU - Grunnet-Jepsen, Rasmus AU - Ordek, P. Vrajeshri AU - Kruger, Sarah AU - Ayres Gerhart, Anne AU - van Veelen, Nancy AU - Nijdam, J. Mirjam AU - Burback, Lisa AU - Cao, Bo AU - Roy, J. Michael AU - Sessoms, Pinata AU - Vermetten, Eric AU - Brémault-Phillips, Suzette PY - 2022/7/12 TI - The Redesign and Validation of Multimodal Motion-Assisted Memory Desensitization and Reconsolidation Hardware and Software: Mixed Methods, Modified Delphi?Based Validation Study JO - JMIR Hum Factors SP - e33682 VL - 9 IS - 3 KW - multimodal motion-assisted memory desensitization and reconsolidation KW - 3MDR KW - participants KW - therapists KW - patients KW - military KW - virtual reality KW - mobile phone N2 - Background: In recent years, the delivery of evidence-based therapies targeting posttraumatic stress disorder (PTSD) has been the focus of the Departments of Defense in countries such as Canada, the Netherlands, and the United States. More than 66% of military members continue to experience symptoms of PTSD that significantly impact their daily functioning and quality of life after completing evidence-based treatments. Innovative, engaging, and effective treatments for PTSD are needed. Multimodal motion-assisted memory desensitization and reconsolidation (3MDR) is an exposure-based, virtual reality?supported therapy used to treat military members and veterans with treatment-resistant PTSD. Given the demonstrated efficacy of 3MDR in recently published randomized control trials, there is both an interest in and a need to adapt the intervention to other populations affected by trauma and to improve accessibility to the treatment. Objective: We aimed to further innovate, develop, and validate new and existing hardware and software components of 3MDR to enhance its mobility, accessibility, feasibility, and applicability to other populations affected by trauma, including public safety personnel (PSP), via international collaboration. Methods: This study used a modified Delphi expert consultation method and mixed methods quasi-experimental validation with the purpose of software validation among PSP (first responders, health care providers) participants (N=35). A team of international experts from the Netherlands, the United States, and Canada met on the web on a weekly basis since September 2020 to discuss the adoption of 3MDR in real-world contexts, hardware and software development, and software validation. The evolution of 3MDR hardware and software was undertaken followed by a mixed methods software validation study with triangulation of results to inform the further development of 3MDR. Results: This study resulted in the identification, description, and evolution of hardware and software components and the development of new 3MDR software. Within the software validation, PSP participants widely acknowledged that the newly developed 3MDR software would be applicable and feasible for PSP affected by trauma within their professions. The key themes that emerged from the thematic analysis among the PSP included the desire for occupationally tailored environments, individually tailored immersion, and the applicability of 3MDR beyond military populations. Conclusions: Within the modified Delphi consultation and software validation study, support for 3MDR as an intervention was communicated. PSP participants perceived that 3MDR was relevant for populations affected by trauma beyond military members and veterans. The resulting hardware and software evolution addressed the recommendations and themes that arose from PSP participants. 3MDR is a novel, structured, exposure-based, virtual reality?supported therapy that is currently used to treat military members and veterans with PTSD. Going forward, it is necessary to innovate and adapt 3MDR, as well as other trauma interventions, to increase effectiveness, accessibility, cost-effectiveness, and efficacy among other populations affected by trauma. UR - https://humanfactors.jmir.org/2022/3/e33682 UR - http://dx.doi.org/10.2196/33682 UR - http://www.ncbi.nlm.nih.gov/pubmed/35819834 ID - info:doi/10.2196/33682 ER - TY - JOUR AU - Morgan, Catherine AU - Tonkin, L. Emma AU - Craddock, Ian AU - Whone, L. Alan PY - 2022/7/7 TI - Acceptability of an In-home Multimodal Sensor Platform for Parkinson Disease: Nonrandomized Qualitative Study JO - JMIR Hum Factors SP - e36370 VL - 9 IS - 3 KW - sensor KW - Parkinson disease KW - wearables KW - cameras KW - acceptability KW - smart home KW - behavior change KW - multimodal home-based KW - qualitative N2 - Background: Parkinson disease (PD) symptoms are complex, gradually progressive, and fluctuate hour by hour. Home-based technological sensors are being investigated to measure symptoms and track disease progression. A smart home sensor platform, with cameras and wearable devices, could be a useful tool to use to get a fuller picture of what someone?s symptoms are like. High-resolution video can capture the ground truth of symptoms and activities. There is a paucity of information about the acceptability of such sensors in PD. Objective: The primary objective of our study was to explore the acceptability of living with a multimodal sensor platform in a naturalistic setting in PD. Two subobjectives are to identify any suggested limitations and to explore the sensors? impact on participant behaviors. Methods: A qualitative study was conducted with an inductive approach using semistructured interviews with a cohort of PD and control participants who lived freely for several days in a home-like environment while continuously being sensed. Results: This study of 24 participants (12 with PD) found that it is broadly acceptable to use multimodal sensors including wrist-worn wearables, cameras, and other ambient sensors passively in free-living in PD. The sensor that was found to be the least acceptable was the wearable device. Suggested limitations on the platform for home deployment included camera-free time and space. Behavior changes were noted by the study participants, which may have related to being passively sensed. Recording high-resolution video in the home setting for limited periods of time was felt to be acceptable to all participants. Conclusions: The results broaden the knowledge of what types of sensors are acceptable for use in research in PD and what potential limitations on these sensors should be considered in future work. The participants? reported behavior change in this study should inform future similar research design to take this factor into account. Collaborative research study design, involving people living with PD at every stage, is important to ensure that the technology is acceptable and that the data outcomes produced are ecologically valid and accurate. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-041303 UR - https://humanfactors.jmir.org/2022/3/e36370 UR - http://dx.doi.org/10.2196/36370 UR - http://www.ncbi.nlm.nih.gov/pubmed/35797101 ID - info:doi/10.2196/36370 ER - TY - JOUR AU - Cao, Yuanyuan AU - Erdt, Mojisola AU - Robert, Caroline AU - Naharudin, Binte Nurhazimah AU - Lee, Qi Shan AU - Theng, Yin-Leng PY - 2022/6/24 TI - Decision-making Factors Toward the Adoption of Smart Home Sensors by Older Adults in Singapore: Mixed Methods Study JO - JMIR Aging SP - e34239 VL - 5 IS - 2 KW - aging in place KW - health care systems and management KW - telehealth KW - assistive technology KW - assisted living facilities N2 - Background: An increasing aging population has become a pressing problem in many countries. Smart systems and intelligent technologies support aging in place, thereby alleviating the strain on health care systems. Objective: This study aims to identify decision-making factors involved in the adoption of smart home sensors (SHS) by older adults in Singapore. Methods: The study involved 3 phases: as an intervention, SHS were installed in older adults? homes (N=42) for 4 to 5 weeks; in-depth semistructured interviews were conducted with 18 older adults, 2 center managers, 1 family caregiver, and 1 volunteer to understand the factors involved in the decision-making process toward adoption of SHS; and follow-up feedback was collected from 42 older adult participants to understand the reasons for adopting or not adopting SHS. Results: Of the 42 participants, 31 (74%) adopted SHS after the intervention, whereas 11 (26%) did not adopt SHS. The reasons for not adopting SHS ranged from privacy concerns to a lack of family support. Some participants did not fully understand SHS functionality and did not perceive the benefits of using SHS. From the interviews, we found that the decision-making process toward the adoption of SHS technology involved intrinsic factors, such as understanding the technology and perceiving its usefulness and benefits, and more extrinsic factors, such as considering affordability and care support from the community. Conclusions: We found that training and a strong support ecosystem could empower older adults in their decision to adopt technology. We advise the consideration of human values and involvement of older adults in the design process to build user-centric assistive technology. UR - https://aging.jmir.org/2022/2/e34239 UR - http://dx.doi.org/10.2196/34239 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749213 ID - info:doi/10.2196/34239 ER - TY - JOUR AU - Mullick, Tahsin AU - Radovic, Ana AU - Shaaban, Sam AU - Doryab, Afsaneh PY - 2022/6/24 TI - Predicting Depression in Adolescents Using Mobile and Wearable Sensors: Multimodal Machine Learning?Based Exploratory Study JO - JMIR Form Res SP - e35807 VL - 6 IS - 6 KW - adolescent KW - depression KW - uHealth KW - machine learning KW - mobile phone N2 - Background: Depression levels in adolescents have trended upward over the past several years. According to a 2020 survey by the National Survey on Drug Use and Health, 4.1 million US adolescents have experienced at least one major depressive episode. This number constitutes approximately 16% of adolescents aged 12 to 17 years. However, only 32.3% of adolescents received some form of specialized or nonspecialized treatment. Identifying worsening symptoms earlier using mobile and wearable sensors may lead to earlier intervention. Most studies on predicting depression using sensor-based data are geared toward the adult population. Very few studies look into predicting depression in adolescents. Objective: The aim of our work was to study passively sensed data from adolescents with depression and investigate the predictive capabilities of 2 machine learning approaches to predict depression scores and change in depression levels in adolescents. This work also provided an in-depth analysis of sensor features that serve as key indicators of change in depressive symptoms and the effect of variation of data samples on model accuracy levels. Methods: This study included 55 adolescents with symptoms of depression aged 12 to 17 years. Each participant was passively monitored through smartphone sensors and Fitbit wearable devices for 24 weeks. Passive sensors collected call, conversation, location, and heart rate information daily. Following data preprocessing, 67% (37/55) of the participants in the aggregated data set were analyzed. Weekly Patient Health Questionnaire-9 surveys answered by participants served as the ground truth. We applied regression-based approaches to predict the Patient Health Questionnaire-9 depression score and change in depression severity. These approaches were consolidated using universal and personalized modeling strategies. The universal strategies consisted of Leave One Participant Out and Leave Week X Out. The personalized strategy models were based on Accumulated Weeks and Leave One Week One User Instance Out. Linear and nonlinear machine learning algorithms were trained to model the data. Results: We observed that personalized approaches performed better on adolescent depression prediction compared with universal approaches. The best models were able to predict depression score and weekly change in depression level with root mean squared errors of 2.83 and 3.21, respectively, following the Accumulated Weeks personalized modeling strategy. Our feature importance investigation showed that the contribution of screen-, call-, and location-based features influenced optimal models and were predictive of adolescent depression. Conclusions: This study provides insight into the feasibility of using passively sensed data for predicting adolescent depression. We demonstrated prediction capabilities in terms of depression score and change in depression level. The prediction results revealed that personalized models performed better on adolescents than universal approaches. Feature importance provided a better understanding of depression and sensor data. Our findings can help in the development of advanced adolescent depression predictions. UR - https://formative.jmir.org/2022/6/e35807 UR - http://dx.doi.org/10.2196/35807 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749157 ID - info:doi/10.2196/35807 ER - TY - JOUR AU - Ramezani, Ramin AU - Zhang, Wenhao AU - Roberts, Pamela AU - Shen, John AU - Elashoff, David AU - Xie, Zhuoer AU - Stanton, Annette AU - Eslami, Michelle AU - Wenger, S. Neil AU - Trent, Jacqueline AU - Petruse, Antonia AU - Weldon, Amelia AU - Ascencio, Andy AU - Sarrafzadeh, Majid AU - Naeim, Arash PY - 2022/5/23 TI - Physical Activity Behavior of Patients at a Skilled Nursing Facility: Longitudinal Cohort Study JO - JMIR Mhealth Uhealth SP - e23887 VL - 10 IS - 5 KW - physical medicine and rehabilitation KW - geriatrics KW - remote sensing technology KW - physical activity KW - frailty KW - health care delivery models KW - wearable sensors KW - indoor localization KW - Bluetooth low energy beacons KW - smartwatches N2 - Background: On-body wearable sensors have been used to predict adverse outcomes such as hospitalizations or fall, thereby enabling clinicians to develop better intervention guidelines and personalized models of care to prevent harmful outcomes. In our previous work, we introduced a generic remote patient monitoring framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and the extraction of indoor localization using Bluetooth low energy beacons, in concert. Using the same framework, this paper addresses the longitudinal analyses of a group of patients in a skilled nursing facility. We try to investigate if the metrics derived from a remote patient monitoring system comprised of physical activity and indoor localization sensors, as well as their association with therapist assessments, provide additional insight into the recovery process of patients receiving rehabilitation. Objective: The aim of this paper is twofold: (1) to observe longitudinal changes of sensor-based physical activity and indoor localization features of patients receiving rehabilitation at a skilled nursing facility and (2) to investigate if the sensor-based longitudinal changes can complement patients? changes captured by therapist assessments over the course of rehabilitation in the skilled nursing facility. Methods: From June 2016 to November 2017, patients were recruited after admission to a subacute rehabilitation center in Los Angeles, CA. Longitudinal cohort study of patients at a skilled nursing facility was followed over the course of 21 days. At the time of discharge from the skilled nursing facility, the patients were either readmitted to the hospital for continued care or discharged to a community setting.A longitudinal study of the physical therapy, occupational therapy, and sensor-based data assessments was performed. A generalized linear mixed model was used to find associations between functional measures with sensor-based features. Occupational therapy and physical therapy assessments were performed at the time of admission and once a week during the skilled nursing facility admission. Results: Of the 110 individuals in the analytic sample with mean age of 79.4 (SD 5.9) years, 79 (72%) were female and 31 (28%) were male participants. The energy intensity of an individual while in the therapy area was positively associated with transfer activities (?=.22; SE 0.08; P=.02). Sitting energy intensity showed positive association with transfer activities (?=.16; SE 0.07; P=.02). Lying down energy intensity was negatively associated with hygiene activities (?=?.27; SE 0.14; P=.04). The interaction of sitting energy intensity with time (?=?.13; SE 0.06; P=.04) was associated with toileting activities. Conclusions: This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features, a subset of which can provide crucial information to the story line of daily and longitudinal activity patterns of patients receiving rehabilitation at a skilled nursing facility. The findings suggest that detecting physical activity changes within locations may offer some insight into better characterizing patients? progress or decline. UR - https://mhealth.jmir.org/2022/5/e23887 UR - http://dx.doi.org/10.2196/23887 UR - http://www.ncbi.nlm.nih.gov/pubmed/35604762 ID - info:doi/10.2196/23887 ER - TY - JOUR AU - Oetomo, Arlene AU - Jalali, Niloofar AU - Costa, Paro Paula Dornhofer AU - Morita, Pelegrini Plinio PY - 2022/5/12 TI - Indoor Temperatures in the 2018 Heat Wave in Quebec, Canada: Exploratory Study Using Ecobee Smart Thermostats JO - JMIR Form Res SP - e34104 VL - 6 IS - 5 KW - Internet of Things KW - IoT KW - heat waves KW - public health KW - smart home technology KW - smart thermostats KW - indoor temperature KW - air conditioning KW - heat alert response systems KW - thermostat KW - unsafe temperatures KW - uHealth N2 - Background: Climate change, driven by human activity, is rapidly changing our environment and posing an increased risk to human health. Local governments must adapt their cities and prepare for increased periods of extreme heat and ensure that marginalized populations do not suffer detrimental health outcomes. Heat warnings traditionally rely on outdoor temperature data which may not reflect indoor temperatures experienced by individuals. Smart thermostats could be a novel and highly scalable data source for heat wave monitoring. Objective: The objective of this study was to explore whether smart thermostats can be used to measure indoor temperature during a heat wave and identify houses experiencing indoor temperatures above 26°C. Methods: We used secondary data?indoor temperature data recorded by ecobee smart thermostats during the Quebec heat waves of 2018 that claimed 66 lives, outdoor temperature data from Environment Canada weather stations, and indoor temperature data from 768 Quebec households. We performed descriptive statistical analyses to compare indoor temperatures differences between air conditioned and non?air conditioned houses in Montreal, Gatineau, and surrounding areas from June 1 to August 31, 2018. Results: There were significant differences in indoor temperature between houses with and without air conditioning on both heat wave and non?heat wave days (P<.001). Households without air conditioning consistently recorded daily temperatures above common indoor temperature standards. High indoor temperatures persisted for an average of 4 hours per day in non?air conditioned houses. Conclusions: Our findings were consistent with current literature on building warming and heat retention during heat waves, which contribute to increased risk of heat-related illnesses. Indoor temperatures can be captured continuously using smart thermostats across a large population. When integrated with local heat health action plans, these data could be used to strengthen existing heat alert response systems and enhance emergency medical service responses. UR - https://formative.jmir.org/2022/5/e34104 UR - http://dx.doi.org/10.2196/34104 UR - http://www.ncbi.nlm.nih.gov/pubmed/35550317 ID - info:doi/10.2196/34104 ER - TY - JOUR AU - Read, A. Emily AU - Gagnon, A. Danie AU - Donelle, Lorie AU - Ledoux, Kathleen AU - Warner, Grace AU - Hiebert, Brad AU - Sharma, Ridhi PY - 2022/5/11 TI - Stakeholder Perspectives on In-home Passive Remote Monitoring to Support Aging in Place in the Province of New Brunswick, Canada: Rapid Qualitative Investigation JO - JMIR Aging SP - e31486 VL - 5 IS - 2 KW - aging in place KW - home care KW - older adults KW - passive remote monitoring N2 - Background: The province of New Brunswick (NB) has one of the oldest populations in Canada, providing an opportunity to develop and test innovative strategies to address the unique health challenges faced by older adults. Passive remote monitoring technology has the potential to support independent living among older adults. Limited research has examined the benefits of and barriers to the adoption of this technology among community-dwelling older adults. Objective: This study aimed to explore perceptions of in-home passive remote monitoring technology designed to support aging in place from the perspective of older adults, their family or friend caregivers, social workers, and government decision-makers in the province of NB, Canada. Methods: Between October 2018 and March 2020, a rapid qualitative investigation of 28 one-on-one interviews was conducted in person or via telephone. Participants included 2 home support services clients and 11 family or friend caregivers who had used passive remote monitoring technology in their homes; 8 social workers who had worked as case managers for home support services clients; and 7 individuals who were key government decision-makers in the adoption, policy development, and use of the technology in the province of NB. The interviews focused on the following topics: decision to adopt the passive remote monitoring system, barriers to adopting the passive remote monitoring system, benefits of the passive remote monitoring system, impact on client health outcomes, and privacy concerns. The interviews were audio recorded, transcribed, and analyzed by a team of 6 researchers. Data analysis was conducted using a rapid assessment process approach that included matrix analysis. Results: Participants reported that the use of the remote monitoring system allowed older adults to live at home longer and provided caregiver relief. Stakeholders were invested in meeting the home support (home care) needs of older adults. However, when it came to the use of remote monitoring, there was a lack of consensus about which clients it was well-suited for and the role that social workers should play in informing clients and caregivers about the service (role ambiguity, gatekeeping, and perceived conflicts of interest). Conclusions: Our findings highlight many benefits and challenges of the adoption of passive remote monitoring for clients, their family or friend caregivers, and public provincial health and social services systems. Passive remote monitoring is a valuable tool that can provide support to older adults and their family or friend caregivers when it is a good fit with client needs. Further work is needed in NB to increase public and social workers? awareness of the service and its benefits. UR - https://aging.jmir.org/2022/2/e31486 UR - http://dx.doi.org/10.2196/31486 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544304 ID - info:doi/10.2196/31486 ER - TY - JOUR AU - McCloud, Rachel AU - Perez, Carly AU - Bekalu, Awoke Mesfin AU - Viswanath, K. PY - 2022/5/9 TI - Using Smart Speaker Technology for Health and Well-being in an Older Adult Population: Pre-Post Feasibility Study JO - JMIR Aging SP - e33498 VL - 5 IS - 2 KW - technology KW - older adults KW - communication inequalities KW - digital health KW - elderly population KW - smart technology KW - smart speaker KW - well-being KW - health technology KW - mobile phone N2 - Background: Although smart speaker technology is poised to help improve the health and well-being of older adults by offering services such as music, medication reminders, and connection to others, more research is needed to determine how older adults from lower socioeconomic position (SEP) accept and use this technology. Objective: This study aimed to investigate the feasibility of using smart speakers to improve the health and well-being of low-SEP older adults. Methods: A total of 39 adults aged between 65 and 85 years who lived in a subsidized housing community were recruited to participate in a 3-month study. The participants had a smart speaker at their home and were given a brief orientation on its use. Over the course of the study, participants were given weekly check-in calls to help assist with any problems and newsletters with tips on how to use the speaker. Participants received a pretest and posttest to gauge comfort with technology, well-being, and perceptions and use of the speaker. The study staff also maintained detailed process notes of interactions with the participants over the course of the study, including a log of all issues reported. Results: At the end of the study period, 38% (15/39) of the participants indicated using the speaker daily, and 38% (15/39) of the participants reported using it several times per week. In addition, 72% (28/39) of the participants indicated that they wanted to continue using the speaker after the end of the study. Most participants (24/39, 62%) indicated that the speaker was useful, and approximately half of the participants felt that the speaker gave them another voice to talk to (19/39, 49%) and connected them with the outside world (18/39, 46%). Although common uses were using the speaker for weather, music, and news, fewer participants reported using it for health-related questions. Despite the initial challenges participants experienced with framing questions to the speaker, additional explanations by the study staff addressed these issues in the early weeks of the study. Conclusions: The results of this study indicate that there is promise for smart speaker technology for low-SEP older adults, particularly to connect them to music, news, and reminders. Future studies will need to provide more upfront training on query formation as well as develop and promote more specific options for older adults, particularly in the area of health and well-being. UR - https://aging.jmir.org/2022/2/e33498 UR - http://dx.doi.org/10.2196/33498 UR - http://www.ncbi.nlm.nih.gov/pubmed/35532979 ID - info:doi/10.2196/33498 ER - TY - JOUR AU - Timon, M. Claire AU - Heffernan, Emma AU - Kilcullen, M. Sophia AU - Lee, Hyowon AU - Hopper, Louise AU - Quinn, Joe AU - McDonald, David AU - Gallagher, Pamela AU - Smeaton, F. Alan AU - Moran, Kieran AU - Hussey, Pamela AU - Murphy, Catriona PY - 2022/5/5 TI - Development of an Internet of Things Technology Platform (the NEX System) to Support Older Adults to Live Independently: Protocol for a Development and Usability Study JO - JMIR Res Protoc SP - e35277 VL - 11 IS - 5 KW - independent living KW - older adults KW - Internet of Things KW - wearable electronic devices KW - activities of daily living KW - mobile phone N2 - Background: In a rapidly aging population, new and efficient ways of providing health and social support to older adults are required that not only preserve independence but also maintain quality of life and safety. Objective: The NEX project aims to develop an integrated Internet of Things system coupled with artificial intelligence to offer unobtrusive health and wellness monitoring to support older adults living independently in their home environment. The primary objective of this study is to develop and evaluate the technical performance and user acceptability of the NEX system. The secondary objective is to apply machine learning algorithms to the data collected via the NEX system to identify and eventually predict changes in the routines of older adults in their own home environment. Methods: The NEX project commenced in December 2019 and is expected to be completed by August 2022. Mixed methods research (web-based surveys and focus groups) was conducted with 426 participants, including older adults (aged ?60 years), family caregivers, health care professionals, and home care workers, to inform the development of the NEX system (phase 1). The primary outcome will be evaluated in 2 successive trials (the Friendly trial [phase 2] and the Action Research Cycle trial [phase 3]). The secondary objective will be explored in the Action Research Cycle trial (phase 3). For the Friendly trial, 7 older adult participants aged ?60 years and living alone in their own homes for a 10-week period were enrolled. A total of 30 older adult participants aged ?60 years and living alone in their own homes will be recruited for a 10-week data collection period (phase 3). Results: Phase 1 of the project (n=426) was completed in December 2020, and phase 2 (n=7 participants for a 10-week pilot study) was completed in September 2021. The expected completion date for the third project phase (30 participants for the 10-week usability study) is June 2022. Conclusions: The NEX project has considered the specific everyday needs of older adults and other stakeholders, which have contributed to the design of the integrated system. The innovation of the NEX system lies in the use of Internet of Things technologies and artificial intelligence to identify and predict changes in the routines of older adults. The findings of this project will contribute to the eHealth research agenda, focusing on the improvement of health care provision and patient support in home and community environments. International Registered Report Identifier (IRRID): DERR1-10.2196/35277 UR - https://www.researchprotocols.org/2022/5/e35277 UR - http://dx.doi.org/10.2196/35277 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511224 ID - info:doi/10.2196/35277 ER - TY - JOUR AU - Forchuk, Cheryl AU - Serrato, Jonathan AU - Lizotte, Daniel AU - Mann, Rupinder AU - Taylor, Gavin AU - Husni, Sara PY - 2022/4/29 TI - Developing a Smart Home Technology Innovation for People With Physical and Mental Health Problems: Considerations and Recommendations JO - JMIR Mhealth Uhealth SP - e25116 VL - 10 IS - 4 KW - smart home KW - smart technology KW - mental health KW - physical health, eHealth KW - comorbidity KW - innovation KW - communication KW - connection KW - uHealth KW - ubiquitous health KW - digital health UR - https://mhealth.jmir.org/2022/4/e25116 UR - http://dx.doi.org/10.2196/25116 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486422 ID - info:doi/10.2196/25116 ER - TY - JOUR AU - Qirtas, Muhammad Malik AU - Zafeiridi, Evi AU - Pesch, Dirk AU - White, Bantry Eleanor PY - 2022/4/12 TI - Loneliness and Social Isolation Detection Using Passive Sensing Techniques: Scoping Review JO - JMIR Mhealth Uhealth SP - e34638 VL - 10 IS - 4 KW - passive sensing KW - loneliness KW - social isolation KW - smartphone KW - sensors KW - wearables KW - monitoring KW - scoping review KW - eHealth KW - mHealth KW - mobile phone N2 - Background: Loneliness and social isolation are associated with multiple health problems, including depression, functional impairment, and death. Mobile sensing using smartphones and wearable devices, such as fitness trackers or smartwatches, as well as ambient sensors, can be used to acquire data remotely on individuals and their daily routines and behaviors in real time. This has opened new possibilities for the early detection of health and social problems, including loneliness and social isolation. Objective: This scoping review aimed to identify and synthesize recent scientific studies that used passive sensing techniques, such as the use of in-home ambient sensors, smartphones, and wearable device sensors, to collect data on device users? daily routines and behaviors to detect loneliness or social isolation. This review also aimed to examine various aspects of these studies, especially target populations, privacy, and validation issues. Methods: A scoping review was undertaken, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Studies on the topic under investigation were identified through 6 databases (IEEE Xplore, Scopus, ACM, PubMed, Web of Science, and Embase). The identified studies were screened for the type of passive sensing detection methods for loneliness and social isolation, targeted population, reliability of the detection systems, challenges, and limitations of these detection systems. Results: After conducting the initial search, a total of 40,071 papers were identified. After screening for inclusion and exclusion criteria, 29 (0.07%) studies were included in this scoping review. Most studies (20/29, 69%) used smartphone and wearable technology to detect loneliness or social isolation, and 72% (21/29) of the studies used a validated reference standard to assess the accuracy of passively collected data for detecting loneliness or social isolation. Conclusions: Despite the growing use of passive sensing technologies for detecting loneliness and social isolation, some substantial gaps still remain in this domain. A population heterogeneity issue exists among several studies, indicating that different demographic characteristics, such as age and differences in participants? behaviors, can affect loneliness and social isolation. In addition, despite extensive personal data collection, relatively few studies have addressed privacy and ethical issues. This review provides uncertain evidence regarding the use of passive sensing to detect loneliness and social isolation. Future research is needed using robust study designs, measures, and examinations of privacy and ethical concerns. UR - https://mhealth.jmir.org/2022/4/e34638 UR - http://dx.doi.org/10.2196/34638 UR - http://www.ncbi.nlm.nih.gov/pubmed/35412465 ID - info:doi/10.2196/34638 ER - TY - JOUR AU - Khetrapal, Pramit AU - Stafford, Ronnie AU - Ó Scanaill, Pádraig AU - Kocadag, Huriye AU - Timinis, Constantinos AU - Chang, L. Angela H. AU - Hadjivasiliou, Adamos AU - Liu, Yansong AU - Gibbs, Olivia AU - Pickford, Eleanor AU - Walker, David AU - Baker, Hilary AU - Duncan, Jacqueline AU - Tan, Melanie AU - Williams, Norman AU - Catto, James AU - Drobnjak, Ivana AU - Kelly, John PY - 2022/4/6 TI - Measuring Patient Compliance With Remote Monitoring Following Discharge From Hospital After Major Surgery (DREAMPath): Protocol for a Prospective Observational Study JO - JMIR Res Protoc SP - e30638 VL - 11 IS - 4 KW - digital health KW - telemonitoring KW - remote monitoring KW - telehealth KW - surgery KW - hospital KW - compliance KW - patient monitoring KW - wearable technology KW - smart devices N2 - Background: The incidence of major surgery is on the rise globally, and more than 20% of patients are readmitted to hospital following discharge from hospital. During their hospital stay, patients are monitored for early detection of clinical deterioration, which includes regularly measuring physiological parameters such as blood pressure, heart rate, respiratory rate, temperature, and pulse oximetry. This monitoring ceases upon hospital discharge, as patients are deemed clinically stable. Monitoring after discharge is relevant to detect adverse events occurring in the home setting and can be made possible through the development of digital technologies and mobile networks. Smartwatches and other technological devices allow patients to self-measure physiological parameters in the home setting, and Bluetooth connectivity can facilitate the automatic collection and transfer of this data to a secure server with minimal input from the patient. Objective: This paper presents the protocol for the DREAMPath (Domiciliary Recovery After Medicalization Pathway) study, which aims to measure compliance with a multidevice remote monitoring kit after discharge from hospital following major surgery. Methods: DREAMPath is a single-center, prospective, observational, cohort study, comprising 30 patients undergoing major intracavity surgery. The primary outcome is to assess patient compliance with wearable and interactive smart technology in the first 30 days following discharge from hospital after major surgery. Secondary outcomes will explore the relation between unplanned health care events and physiological data collected in the study, as well as to explore a similar relationship with daily patient-reported outcome measures (Quality of Recovery?15 score). Secondary outcomes will be analyzed using appropriate regression methods. Cardiopulmonary exercise testing data will also be collected to assess correlations with wearable device data. Results: Recruitment was halted due to COVID-19 restrictions and will progress once research staff are back from redeployment. We expect that the study will be completed in the first quarter of 2022. Conclusions: Digital health solutions have been recently made possible due to technological advances, but urgency in rollout has been expedited due to COVID-19. The DREAMPath study will inform readers about the feasibility of remote monitoring for a patient group that is at an increased risk of acute deterioration. Trial Registration: ISRCTN Registry ISRCTN62293620; https://www.isrctn.com/ISRCTN62293620 International Registered Report Identifier (IRRID): DERR1-10.2196/30638 UR - https://www.researchprotocols.org/2022/4/e30638 UR - http://dx.doi.org/10.2196/30638 UR - http://www.ncbi.nlm.nih.gov/pubmed/35383570 ID - info:doi/10.2196/30638 ER - TY - JOUR AU - Jalali, Niloofar AU - Sahu, Sundar Kirti AU - Oetomo, Arlene AU - Morita, Pelegrini Plinio PY - 2022/4/1 TI - Usability of Smart Home Thermostat to Evaluate the Impact of Weekdays and Seasons on Sleep Patterns and Indoor Stay: Observational Study JO - JMIR Mhealth Uhealth SP - e28811 VL - 10 IS - 4 KW - public health KW - Internet of Things (IoT) KW - big data KW - sleep monitoring KW - health monitoring KW - mobile phone N2 - Background: Sleep behavior and time spent at home are important determinants of human health. Research on sleep patterns has traditionally relied on self-reported data. Not only does this methodology suffer from bias but the population-level data collection is also time-consuming. Advances in smart home technology and the Internet of Things have the potential to overcome these challenges in behavioral monitoring. Objective: The objective of this study is to demonstrate the use of smart home thermostat data to evaluate household sleep patterns and the time spent at home and how these behaviors are influenced by different weekdays and seasonal variations. Methods: From the 2018 ecobee Donate your Data data set, 481 North American households were selected based on having at least 300 days of data available, equipped with ?6 sensors, and having a maximum of 4 occupants. Daily sleep cycles were identified based on sensor activation and used to quantify sleep time, wake-up time, sleep duration, and time spent at home. Each household?s record was divided into different subsets based on seasonal, weekday, and seasonal weekday scales. Results: Our results demonstrate that sleep parameters (sleep time, wake-up time, and sleep duration) were significantly influenced by the weekdays. The sleep time on Fridays and Saturdays is greater than that on Mondays, Wednesdays, and Thursdays (n=450; P<.001; odds ratio [OR] 1.8, 95% CI 1.5-3). There is significant sleep duration difference between Fridays and Saturdays and the rest of the week (n=450; P<.001; OR 1.8, 95% CI 1.4-2). Consequently, the wake-up time is significantly changing between weekends and weekdays (n=450; P<.001; OR 5.6, 95% CI 4.3-6.3). The results also indicate that households spent more time at home on Sundays than on the other weekdays (n=445; P<.001; OR 2.06, 95% CI 1.64-2.5). Although no significant association is found between sleep parameters and seasonal variation, the time spent at home in the winter is significantly greater than that in summer (n=455; P<.001; OR 1.6, 95% CI 1.3-2.3). These results are in accordance with existing literature. Conclusions: This is the first study to use smart home thermostat data to monitor sleep parameters and time spent at home and their dependence on weekday, seasonal, and seasonal weekday variations at the population level. These results provide evidence of the potential of using Internet of Things data to help public health officials understand variations in sleep indicators caused by global events (eg, pandemics and climate change). UR - https://mhealth.jmir.org/2022/4/e28811 UR - http://dx.doi.org/10.2196/28811 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363147 ID - info:doi/10.2196/28811 ER - TY - JOUR AU - Cristiano, Alessia AU - Musteata, Stela AU - De Silvestri, Sara AU - Bellandi, Valerio AU - Ceravolo, Paolo AU - Cesari, Matteo AU - Azzolino, Domenico AU - Sanna, Alberto AU - Trojaniello, Diana PY - 2022/2/28 TI - Older Adults? and Clinicians? Perspectives on a Smart Health Platform for the Aging Population: Design and Evaluation Study JO - JMIR Aging SP - e29623 VL - 5 IS - 1 KW - smart health KW - remote monitoring KW - requirement elicitation KW - older population KW - age-related chronic conditions KW - healthy aging KW - Internet of Things KW - mobile phone N2 - Background: Over recent years, interest in the development of smart health technologies aimed at supporting independent living for older populations has increased. The integration of innovative technologies, such as the Internet of Things, wearable technologies, artificial intelligence, and ambient-assisted living applications, represents a valuable solution for this scope. Designing such an integrated system requires addressing several aspects (eg, equipment selection, data management, analytics, costs, and users? needs) and involving different areas of expertise (eg, medical science, service design, biomedical and computer engineering). Objective: The objective of this study is 2-fold; we aimed to design the functionalities of a smart health platform addressing 5 chronic conditions prevalent in the older population (ie, hearing loss, cardiovascular diseases, cognitive impairments, mental health problems, and balance disorders) by considering both older adults? and clinicians? perspectives and to evaluate the identified smart health platform functionalities with a small group of older adults. Methods: Overall, 24 older adults (aged >65 years) and 118 clinicians were interviewed through focus group activities and web-based questionnaires to elicit the smart health platform requirements. Considering the elicited requirements, the main functionalities of smart health platform were designed. Then, a focus group involving 6 older adults was conducted to evaluate the proposed solution in terms of usefulness, credibility, desirability, and learnability. Results: Eight main functionalities were identified and assessed?cognitive training and hearing training (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 6/6, 100%; learnability: 6/6, 100%), monitoring of physiological parameters (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 6/6, 100%; learnability: 5/6, 83%), physical training (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 5/6, 83%; learnability: 2/6, 33%), psychoeducational intervention (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 4/6, 67%; learnability: 2/6, 33%), mood monitoring (usefulness: 4/6, 67%; credibility: 4/6, 67%; desirability: 3/6, 50%; learnability: 5/6, 50%), diet plan (usefulness: 5/6, 83%; credibility: 4/6, 67%; desirability: 1/6, 17%; learnability: 2/6, 33%), and environment monitoring and adjustment (usefulness: 1/6, 17%; credibility: 1/6, 17%; desirability: 0/6, 0%; learnability: 0/6, 0%). Most of them were highly appreciated by older participants, with the only exception being environment monitoring and adjustment. The results showed that the proposed functionalities met the needs and expectations of users (eg, improved self-management of patients? disease and enhanced patient safety). However, some aspects need to be addressed (eg, technical and privacy issues). Conclusions: The presented smart health platform functionalities seem to be able to meet older adults? needs and desires to enhance their self-awareness and self-management of their medical condition, encourage healthy and independent living, and provide evidence-based support for clinicians? decision-making. Further research with a larger and more heterogeneous pool of stakeholders in terms of demographics and clinical conditions is needed to assess system acceptability and overall user experience in free-living conditions. UR - https://aging.jmir.org/2022/1/e29623 UR - http://dx.doi.org/10.2196/29623 UR - http://www.ncbi.nlm.nih.gov/pubmed/35225818 ID - info:doi/10.2196/29623 ER - TY - JOUR AU - Sunshine, Jacob PY - 2022/2/21 TI - Smart Speakers: The Next Frontier in mHealth JO - JMIR Mhealth Uhealth SP - e28686 VL - 10 IS - 2 KW - digital health KW - mobile health KW - machine learning KW - smart speaker KW - smartphone UR - https://mhealth.jmir.org/2022/2/e28686 UR - http://dx.doi.org/10.2196/28686 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188467 ID - info:doi/10.2196/28686 ER - TY - JOUR AU - Santos, Mauro AU - Vollam, Sarah AU - Pimentel, AF Marco AU - Areia, Carlos AU - Young, Louise AU - Roman, Cristian AU - Ede, Jody AU - Piper, Philippa AU - King, Elizabeth AU - Harford, Mirae AU - Shah, Akshay AU - Gustafson, Owen AU - Tarassenko, Lionel AU - Watkinson, Peter PY - 2022/2/15 TI - The Use of Wearable Pulse Oximeters in the Prompt Detection of Hypoxemia and During Movement: Diagnostic Accuracy Study JO - J Med Internet Res SP - e28890 VL - 24 IS - 2 KW - diagnostic accuracy KW - hypoxia KW - hypoxemia KW - wearable pulse oximeter KW - continuous monitoring KW - mHealth KW - wearable technology KW - patient monitoring KW - deterioration KW - blood oxygen KW - hospital N2 - Background: Commercially available wearable (ambulatory) pulse oximeters have been recommended as a method for managing patients at risk of physiological deterioration, such as active patients with COVID-19 disease receiving care in hospital isolation rooms; however, their reliability in usual hospital settings is not known. Objective: We report the performance of wearable pulse oximeters in a simulated clinical setting when challenged by motion and low levels of arterial blood oxygen saturation (SaO2). Methods: The performance of 1 wrist-worn (Wavelet) and 3 finger-worn (CheckMe O2+, AP-20, and WristOx2 3150) wearable, wireless transmission?mode pulse oximeters was evaluated. For this, 7 motion tasks were performed: at rest, sit-to-stand, tapping, rubbing, drinking, turning pages, and using a tablet. Hypoxia exposure followed, in which inspired gases were adjusted to achieve decreasing SaO2 levels at 100%, 95%, 90%, 87%, 85%, 83%, and 80%. Peripheral oxygen saturation (SpO2) estimates were compared with simultaneous SaO2 samples to calculate the root-mean-square error (RMSE). The area under the receiver operating characteristic curve was used to analyze the detection of hypoxemia (ie, SaO2<90%). Results: SpO2 estimates matching 215 SaO2 samples in both study phases, from 33 participants, were analyzed. Tapping, rubbing, turning pages, and using a tablet degraded SpO2 estimation (RMSE>4% for at least 1 device). All finger-worn pulse oximeters detected hypoxemia, with an overall sensitivity of ?0.87 and specificity of ?0.80, comparable to that of the Philips MX450 pulse oximeter. Conclusions: The SpO2 accuracy of wearable finger-worn pulse oximeters was within that required by the International Organization for Standardization guidelines. Performance was degraded by motion, but all pulse oximeters could detect hypoxemia. Our findings support the use of wearable, wireless transmission?mode pulse oximeters to detect the onset of clinical deterioration in hospital settings. Trial Registration: ISRCTN Registry 61535692; http://www.isrctn.com/ISRCTN61535692 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-034404 UR - https://www.jmir.org/2022/2/e28890 UR - http://dx.doi.org/10.2196/28890 UR - http://www.ncbi.nlm.nih.gov/pubmed/35166690 ID - info:doi/10.2196/28890 ER - TY - JOUR AU - Corman, Peterson Benjamin Harris AU - Rajupet, Sritha AU - Ye, Fan AU - Schoenfeld, Randi Elinor PY - 2022/1/26 TI - The Role of Unobtrusive Home-Based Continuous Sensing in the Management of Postacute Sequelae of SARS CoV-2 JO - J Med Internet Res SP - e32713 VL - 24 IS - 1 KW - SARS CoV-2 KW - COVID-19 KW - post-acute sequelae of SARS CoV-2 (PASC) KW - post-COVID KW - long COVID KW - continuous sensing KW - passive monitoring KW - wearable sensors KW - contactless sensors KW - vital sign monitoring UR - https://www.jmir.org/2022/1/e32713 UR - http://dx.doi.org/10.2196/32713 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932496 ID - info:doi/10.2196/32713 ER - TY - JOUR AU - Germini, Federico AU - Noronha, Noella AU - Borg Debono, Victoria AU - Abraham Philip, Binu AU - Pete, Drashti AU - Navarro, Tamara AU - Keepanasseril, Arun AU - Parpia, Sameer AU - de Wit, Kerstin AU - Iorio, Alfonso PY - 2022/1/21 TI - Accuracy and Acceptability of Wrist-Wearable Activity-Tracking Devices: Systematic Review of the Literature JO - J Med Internet Res SP - e30791 VL - 24 IS - 1 KW - diagnosis KW - measurement KW - wrist-wearable devices KW - mobile phone N2 - Background: Numerous wrist-wearable devices to measure physical activity are currently available, but there is a need to unify the evidence on how they compare in terms of acceptability and accuracy. Objective: The aim of this study is to perform a systematic review of the literature to assess the accuracy and acceptability (willingness to use the device for the task it is designed to support) of wrist-wearable activity trackers. Methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and SPORTDiscus for studies measuring physical activity in the general population using wrist-wearable activity trackers. We screened articles for inclusion and, for the included studies, reported data on the studies? setting and population, outcome measured, and risk of bias. Results: A total of 65 articles were included in our review. Accuracy was assessed for 14 different outcomes, which can be classified in the following categories: count of specific activities (including step counts), time spent being active, intensity of physical activity (including energy expenditure), heart rate, distance, and speed. Substantial clinical heterogeneity did not allow us to perform a meta-analysis of the results. The outcomes assessed most frequently were step counts, heart rate, and energy expenditure. For step counts, the Fitbit Charge (or the Fitbit Charge HR) had a mean absolute percentage error (MAPE) <25% across 20 studies. For heart rate, the Apple Watch had a MAPE <10% in 2 studies. For energy expenditure, the MAPE was >30% for all the brands, showing poor accuracy across devices. Acceptability was most frequently measured through data availability and wearing time. Data availability was ?75% for the Fitbit Charge HR, Fitbit Flex 2, and Garmin Vivofit. The wearing time was 89% for both the GENEActiv and Nike FuelBand. Conclusions: The Fitbit Charge and Fitbit Charge HR were consistently shown to have a good accuracy for step counts and the Apple Watch for measuring heart rate. None of the tested devices proved to be accurate in measuring energy expenditure. Efforts should be made to reduce the heterogeneity among studies. UR - https://www.jmir.org/2022/1/e30791 UR - http://dx.doi.org/10.2196/30791 UR - http://www.ncbi.nlm.nih.gov/pubmed/35060915 ID - info:doi/10.2196/30791 ER - TY - JOUR AU - Krukowski, Rebecca AU - Johnson, Brandi AU - Kim, Hyeonju AU - Sen, Saunak AU - Homsi, Riad PY - 2021/12/24 TI - A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial JO - JMIR Form Res SP - e30578 VL - 5 IS - 12 KW - pregnancy KW - weight KW - physical activity KW - self-weighing N2 - Background: Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach. Objective: The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals. Methods: We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2×2×2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine?s GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation. Results: Participants were enrolled at, on average, 9.6 (SD 1.8) weeks? gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62%) were Black or African American, 30 (77%) were not married, and 29 (74%) had an annual household income of less than US $50,000. Of the 39 participants, 35 (90%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not. Conclusions: A financial incentive?based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive?based interventions for healthy GWG behaviors. Trial Registration: ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194 UR - https://formative.jmir.org/2021/12/e30578 UR - http://dx.doi.org/10.2196/30578 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951594 ID - info:doi/10.2196/30578 ER - TY - JOUR AU - Edwards, J. Katie AU - Jones, B. Ray AU - Shenton, Deborah AU - Page, Toni AU - Maramba, Inocencio AU - Warren, Alison AU - Fraser, Fiona AU - Kri?aj, Tanja AU - Coombe, Tristan AU - Cowls, Hazel AU - Chatterjee, Arunangsu PY - 2021/12/20 TI - The Use of Smart Speakers in Care Home Residents: Implementation Study JO - J Med Internet Res SP - e26767 VL - 23 IS - 12 KW - voice-activated technology KW - smart speaker KW - care home KW - technology-enabled care KW - older people KW - learning disability KW - digital technology KW - consumer device KW - smart device N2 - Background: The use of smart speakers to improve well-being had been trialed in social care by others; however, we were not aware of their implementation in most care homes across a region in the Southwest of the United Kingdom. For the widespread adoption of new technology, it must be locally demonstrable and become normalized. Objective: The aim of this study was to install smart speakers in care homes in a rural and coastal region and to explore if and how the devices were being used, the barriers to their implementation, and their potential benefits. Methods: Email, workshops, drop-in sessions, phone, and cold calling was used to contact all 230 care homes, offering a free smart speaker and some advisory support. Care homes accepting the devices were asked to complete a feedback diary. Nonresponse rate for diary completion was high and was thus supplemented with a telephone survey. Results: Over the course of 7 months, we installed 156 devices in 92 care homes for older people, 50 devices for people with physical or mental health needs, and 8 for others. The devices were used mainly for music but also for poetry, recipes, light controls, jokes, and video calls. Care home managers reported the benefits for the residents, including enhanced engagement with home activities, enjoyment, calming effects, and the acquisition of new skills. Implementation problems included internet connectivity, staff capacity, and skills. Conclusions: Affordable consumer devices such as smart speakers should be installed in all care homes to benefit residents. Voice-activated technologies are easy to use and promote interaction. This study indicates that implementation in care homes was possible and that smart speakers had multifaceted benefits for residents and staff. Most care homes in this region now use smart speakers for their residents, thereby normalizing this practice. UR - https://www.jmir.org/2021/12/e26767 UR - http://dx.doi.org/10.2196/26767 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932010 ID - info:doi/10.2196/26767 ER - TY - JOUR AU - Kennedy, Mari-Rose AU - Huxtable, Richard AU - Birchley, Giles AU - Ives, Jonathan AU - Craddock, Ian PY - 2021/11/26 TI - ?A Question of Trust? and ?a Leap of Faith??Study Participants? Perspectives on Consent, Privacy, and Trust in Smart Home Research: Qualitative Study JO - JMIR Mhealth Uhealth SP - e25227 VL - 9 IS - 11 KW - smart homes KW - assistive technology KW - research ethics KW - informed consent KW - privacy KW - anonymization KW - trust N2 - Background: Ubiquitous, smart technology has the potential to assist humans in numerous ways, including with health and social care. COVID-19 has notably hastened the move to remotely delivering many health services. A variety of stakeholders are involved in the process of developing technology. Where stakeholders are research participants, this poses practical and ethical challenges, particularly if the research is conducted in people?s homes. Researchers must observe prima facie ethical obligations linked to participants? interests in having their autonomy and privacy respected. Objective: This study aims to explore the ethical considerations around consent, privacy, anonymization, and data sharing with participants involved in SPHERE (Sensor Platform for Healthcare in a Residential Environment), a project for developing smart technology for monitoring health behaviors at home. Participants? unique insights from being part of this unusual experiment offer valuable perspectives on how to properly approach informed consent for similar smart home research in the future. Methods: Semistructured qualitative interviews were conducted with 7 households (16 individual participants) recruited from SPHERE. Purposive sampling was used to invite participants from a range of household types and ages. Interviews were conducted in participants? homes or on-site at the University of Bristol. Interviews were digitally recorded, transcribed verbatim, and analyzed using an inductive thematic approach. Results: Four themes were identified?motivation for participating; transparency, understanding, and consent; privacy, anonymity, and data use; and trust in research. Motivations to participate in SPHERE stemmed from an altruistic desire to support research directed toward the public good. Participants were satisfied with the consent process despite reporting some difficulties?recalling and understanding the information received, the timing and amount of information provision, and sometimes finding the information to be abstract. Participants were satisfied that privacy was assured and judged that the goals of the research compensated for threats to privacy. Participants trusted SPHERE. The factors that were relevant to developing and maintaining this trust were the trustworthiness of the research team, the provision of necessary information, participants? control over their participation, and positive prior experiences of research involvement. Conclusions: This study offers valuable insights into the perspectives of participants in smart home research on important ethical considerations around consent and privacy. The findings may have practical implications for future research regarding the types of information researchers should convey, the extent to which anonymity can be assured, and the long-term duty of care owed to the participants who place trust in researchers not only on the basis of this information but also because of their institutional affiliation. This study highlights important ethical implications. Although autonomy matters, trust appears to matter the most. Therefore, researchers should be alert to the need to foster and maintain trust, particularly as failing to do so might have deleterious effects on future research. UR - https://mhealth.jmir.org/2021/11/e25227 UR - http://dx.doi.org/10.2196/25227 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842551 ID - info:doi/10.2196/25227 ER - TY - JOUR AU - Wang, Chaofan AU - Jiang, Weiwei AU - Yang, Kangning AU - Yu, Difeng AU - Newn, Joshua AU - Sarsenbayeva, Zhanna AU - Goncalves, Jorge AU - Kostakos, Vassilis PY - 2021/11/24 TI - Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology JO - J Med Internet Res SP - e27880 VL - 23 IS - 11 KW - hand hygiene KW - hand hygiene compliance KW - hand hygiene quality KW - electronic monitoring systems KW - systematic review KW - mobile phone N2 - Background: Hand hygiene is one of the most effective ways of preventing health care?associated infections and reducing their transmission. Owing to recent advances in sensing technologies, electronic hand hygiene monitoring systems have been integrated into the daily routines of health care workers to measure their hand hygiene compliance and quality. Objective: This review aims to summarize the latest technologies adopted in electronic hand hygiene monitoring systems and discuss the capabilities and limitations of these systems. Methods: A systematic search of PubMed, ACM Digital Library, and IEEE Xplore Digital Library was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were initially screened and assessed independently by the 2 authors, and disagreements between them were further summarized and resolved by discussion with the senior author. Results: In total, 1035 publications were retrieved by the search queries; of the 1035 papers, 89 (8.60%) fulfilled the eligibility criteria and were retained for review. In summary, 73 studies used electronic monitoring systems to monitor hand hygiene compliance, including application-assisted direct observation (5/73, 7%), camera-assisted observation (10/73, 14%), sensor-assisted observation (29/73, 40%), and real-time locating system (32/73, 44%). A total of 21 studies evaluated hand hygiene quality, consisting of compliance with the World Health Organization 6-step hand hygiene techniques (14/21, 67%) and surface coverage or illumination reduction of fluorescent substances (7/21, 33%). Conclusions: Electronic hand hygiene monitoring systems face issues of accuracy, data integration, privacy and confidentiality, usability, associated costs, and infrastructure improvements. Moreover, this review found that standardized measurement tools to evaluate system performance are lacking; thus, future research is needed to establish standardized metrics to measure system performance differences among electronic hand hygiene monitoring systems. Furthermore, with sensing technologies and algorithms continually advancing, more research is needed on their implementation to improve system performance and address other hand hygiene?related issues. UR - https://www.jmir.org/2021/11/e27880 UR - http://dx.doi.org/10.2196/27880 UR - http://www.ncbi.nlm.nih.gov/pubmed/34821565 ID - info:doi/10.2196/27880 ER - TY - JOUR AU - Bhimaraju, Hari AU - Nag, Nitish AU - Pandey, Vaibhav AU - Jain, Ramesh PY - 2021/11/23 TI - Understanding ?Atmosome?, the Personal Atmospheric Exposome: Comprehensive Approach JO - JMIR Biomed Eng SP - e28920 VL - 6 IS - 4 KW - exposome KW - exposomics KW - personal health KW - indoor air quality KW - health state estimation KW - health informatics KW - public health policy KW - epidemiology KW - embedded systems KW - internet of things N2 - Background: Modern environmental health research extensively focuses on outdoor air pollutants and their effects on public health. However, research on monitoring and enhancing individual indoor air quality is lacking. The field of exposomics encompasses the totality of human environmental exposures and its effects on health. A subset of this exposome deals with atmospheric exposure, termed the ?atmosome.? The atmosome plays a pivotal role in health and has significant effects on DNA, metabolism, skin integrity, and lung health. Objective: The aim of this work is to develop a low-cost, comprehensive measurement system for collecting and analyzing atmosomic factors. The research explores the significance of the atmosome in personalized and preventive care for public health. Methods: An internet of things microcontroller-based system is introduced and demonstrated. The system collects real-time indoor air quality data and posts it to the cloud for immediate access. Results: The experimental results yield air quality measurements with an accuracy of 90% when compared with precalibrated commercial devices and demonstrate a direct correlation between lifestyle and air quality. Conclusions: Quantifying the individual atmosome is a monumental step in advancing personalized health, medical research, and epidemiological research. The 2 main goals in this work are to present the atmosome as a measurable concept and to demonstrate how to implement it using low-cost electronics. By enabling atmosome measurements at a communal scale, this work also opens up potential new directions for public health research. Researchers will now have the data to model the impact of indoor air pollutants on the health of individuals, communities, and specific demographics, leading to novel approaches for predicting and preventing diseases. UR - https://biomedeng.jmir.org/2021/4/e28920 UR - http://dx.doi.org/10.2196/28920 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/28920 ER - TY - JOUR AU - Lancioni, E. Giulio AU - Singh, N. Nirbhay AU - O'Reilly, F. Mark AU - Sigafoos, Jeff AU - Alberti, Gloria AU - Chiariello, Valeria AU - Campodonico, Francesca AU - Desideri, Lorenzo PY - 2021/11/17 TI - Technology-Aided Spatial Cues, Instructions, and Preferred Stimulation for Supporting People With Intellectual and Visual Disabilities in Their Occupational Engagement and Mobility: Usability Study JO - JMIR Rehabil Assist Technol SP - e33481 VL - 8 IS - 4 KW - technology KW - smartphone KW - motion sensors KW - intellectual disability KW - visual impairments KW - occupational engagement KW - mobility KW - mobile phone N2 - Background: Persons with severe or profound intellectual disability and visual impairment tend to be passive and sedentary, and technology-aided intervention may be required to improve their condition without excessive demands on staff time. Objective: This study aims to extend the assessment of technology-aided interventions for supporting functional occupational engagement and mobility in 7 people with intellectual disability and visual impairment and to use a technology system that is simpler and less expensive than those previously used. Methods: The technology system involved a Samsung Galaxy A10, 4 Philips Hue indoor motion sensors, and 4 mini speakers. Within each session, the participants were to collect 18 objects (ie, one at a time) from 3 different areas (stations) located within a large room, bring each of the objects to a central desk, and put away each of those objects there. For each object, the participants received verbal (spatial) cues for guiding them to the area where the object was to be collected, a verbal instruction (ie, request) to take an object, verbal (spatial) cues for guiding them to the central desk, a verbal instruction to put away the object collected, and praise and preferred stimulation. Results: During baseline, the frequency of responses completed correctly (objects collected and put away independently) was 0 or near 0. During the intervention phase (ie, with the support of the technology setup), the frequency increased for all participants, reaching a mean of almost 18 (out of 18 response opportunities) for 6 participants and about 13 for the remaining participant. The mean session duration ranged from 12 to 30 minutes. Conclusions: A program, such as the one used in this study, can be useful in promoting occupational engagement and mobility in persons with intellectual disability and visual impairment. UR - https://rehab.jmir.org/2021/4/e33481 UR - http://dx.doi.org/10.2196/33481 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787588 ID - info:doi/10.2196/33481 ER - TY - JOUR AU - Oladele, Ayo Daniel AU - Markus, Didam Elisha AU - Abu-Mahfouz, M. Adnan PY - 2021/11/15 TI - Adaptability of Assistive Mobility Devices and the Role of the Internet of Medical Things: Comprehensive Review JO - JMIR Rehabil Assist Technol SP - e29610 VL - 8 IS - 4 KW - internet of medical things framework KW - internet of things KW - adaptability KW - multisensor fusion KW - mobility aids KW - user system interface KW - assistive mobility devices KW - mobile phone N2 - Background: With the projected upsurge in the percentage of people with some form of disability, there has been a significant increase in the need for assistive mobility devices. However, for mobility aids to be effective, such devices should be adapted to the user?s needs. This can be achieved by improving the confidence of the acquired information (interaction between the user, the environment, and the device) following design specifications. Therefore, there is a need for literature review on the adaptability of assistive mobility devices. Objective: In this study, we aim to review the adaptability of assistive mobility devices and the role of the internet of medical things in terms of the acquired information for assistive mobility devices. We review internet-enabled assistive mobility technologies and non?internet of things (IoT) assistive mobility devices. These technologies will provide awareness of the status of adaptive mobility technology and serve as a source and reference regarding information to health care professionals and researchers. Methods: We performed a literature review search on the following databases of academic references and journals: Google Scholar, ScienceDirect, Institute of Electrical and Electronics Engineers, Springer, and websites of assistive mobility and foundations presenting studies on assistive mobility found through a generic Google search (including the World Health Organization website). The following keywords were used: assistive mobility OR assistive robots, assistive mobility devices, internet-enabled assistive mobility technologies, IoT Framework OR IoT Architecture AND for Healthcare, assisted navigation OR autonomous navigation, mobility AND aids OR devices, adaptability of assistive technology, adaptive mobility devices, pattern recognition, autonomous navigational systems, human-robot interfaces, motor rehabilitation devices, perception, and ambient assisted living. Results: We identified 13,286 results (excluding titles that were not relevant to this study). Then, through a narrative review, we selected 189 potential studies (189/13,286, 1.42%) from the existing literature on the adaptability of assistive mobility devices and IoT frameworks for assistive mobility and conducted a critical analysis. Of the 189 potential studies, 82 (43.4%) were selected for analysis after meeting the inclusion criteria. On the basis of the type of technologies presented in the reviewed articles, we proposed a categorization of the adaptability of smart assistive mobility devices in terms of their interaction with the user (user system interface), perception techniques, and communication and sensing frameworks. Conclusions: We discussed notable limitations of the reviewed literature studies. The findings revealed that an improvement in the adaptation of assistive mobility systems would require a reduction in training time and avoidance of cognitive overload. Furthermore, sensor fusion and classification accuracy are critical for achieving real-world testing requirements. Finally, the trade-off between cost and performance should be considered in the commercialization of these devices. UR - https://rehab.jmir.org/2021/4/e29610 UR - http://dx.doi.org/10.2196/29610 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779786 ID - info:doi/10.2196/29610 ER - TY - JOUR AU - Moczygemba, R. Leticia AU - Thurman, Whitney AU - Tormey, Kyler AU - Hudzik, Anthony AU - Welton-Arndt, Lauren AU - Kim, Elizabeth PY - 2021/11/3 TI - GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study JO - JMIR Mhealth Uhealth SP - e25553 VL - 9 IS - 11 KW - GPS KW - mHealth KW - care coordination KW - people experiencing homelessness KW - homelessness KW - emergency department KW - health outcomes KW - health care costs KW - mobile phone N2 - Background: People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased use, poor health outcomes, and high health care costs. Most people experiencing homelessness have a mobile phone of some type, which makes mobile health (mHealth) interventions a feasible way to connect a person experiencing homelessness with providers. Objective: This study aims to investigate the accuracy, acceptability, and preliminary outcomes of a GPS-enabled mHealth (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness are in the ED or hospital. Methods: This study was a pre-post design with baseline and 4-month postenrollment assessments. People experiencing homelessness, taking at least 2 medications for chronic conditions, scoring at least 10 on the Patient Health Questionnaire-9, and having at least 2 ED or hospital visits in the previous 6 months were eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily email to assess medication adherence. GPS alerts were compared with ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t tests compared scores on the Patient Health Questionnaire-9, Medical Outcomes Study Social Support Survey, and Adherence Starts with Knowledge-12 adherence survey at baseline and exit. Semistructured exit interviews examined the perceptions and benefits of the intervention. Results: In total, 30 participants were enrolled; the mean age was 44.1 (SD 9.7) years. Most participants were male (20/30, 67%), White (17/30, 57%), and not working (19/30, 63%). Only 19% (3/16) of the ED or hospital visit alerts aligned with HIE data, mainly because of patients not having the smartphone with them during the visit, the smartphone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (mean 16.9, SD 5.8) and exit (mean 12.7, SD 8.2; t19=2.9; P=.009) and a significant difference in adherence barriers between baseline (mean 2.4, SD 1.4) and exit (mean 1.5, SD 1.5; t17=2.47; P=.03). Participants agreed that the app was easy to use (mean 4.4/5, SD 1.0, with 5=strongly agree), and the email helped them remember to take their medications (mean 4.6/5, SD 0.6). Qualitative data indicated that unlimited smartphone access allowed participants to meet social needs and maintain contact with case managers, health care providers, family, and friends. Conclusions: mHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; however, unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination. UR - https://mhealth.jmir.org/2021/11/e25553 UR - http://dx.doi.org/10.2196/25553 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730550 ID - info:doi/10.2196/25553 ER - TY - JOUR AU - Bastoni, Sofia AU - Wrede, Christian AU - da Silva, Cristina Marcia AU - Sanderman, Robbert AU - Gaggioli, Andrea AU - Braakman-Jansen, Annemarie AU - van Gemert-Pijnen, Lisette PY - 2021/10/8 TI - Factors Influencing Implementation of eHealth Technologies to Support Informal Dementia Care: Umbrella Review JO - JMIR Aging SP - e30841 VL - 4 IS - 4 KW - eHealth KW - assistive technologies KW - dementia KW - informal care KW - home care KW - implementation N2 - Background: The worldwide increase in community-dwelling people with dementia underscores the need for innovative eHealth technologies that aim to provide support to both patients and their informal caregivers in the home setting. However, sustainable implementation of eHealth technologies within this target group can be difficult. Objective: The goal of this study was to gain a thorough understanding of why it is often difficult to implement eHealth technologies in practice, even though numerous technologies are designed to support people with dementia and their informal caregivers at home. In particular, our study aimed to (1) provide an overview of technologies that have been used and studied in the context of informal dementia care and (2) explore factors influencing the implementation of these technologies. Methods: Following an umbrella review design, five different databases were searched (PubMed, PsycINFO, Medline, Scopus, and Cochrane) for (systematic) reviews. Among 2205 reviews retrieved, 21 were included in our analysis based on our screening and selection procedure. A combination of deductive and inductive thematic analyses was performed, using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework for organizing the findings. Results: We identified technologies designed to be used ?by informal caregivers,? ?by people with dementia,? and ?with people with dementia.? Within those groups, most of the represented technologies included, respectively: (i) devices for in-home monitoring of lifestyle, health, and safety; (ii) technologies for supporting memory, orientation, and day structure; and (iii) technologies to facilitate communication between the informal caregiver and person with dementia. Most of the identified factors influencing implementation related to the condition of dementia, characteristics of the technology, expected/perceived value of users, and characteristics of the informal caregiver. Considerably less information has been reported on factors related to the implementing organization and technology supplier, wider institutional and sociocultural context of policy and regulations, and continued adaptation of technology over time. Conclusions: Our study offers a comprehensive overview of eHealth technologies in the context of informal dementia care and contributes to gaining a better understanding of a broad range of factors influencing their implementation. Our results uncovered a knowledge gap regarding success factors for implementation related to the organizational and broader context and continuous adaptation over the long term. Although future research is needed, the current findings can help researchers and stakeholders in improving the development and implementation of eHealth technologies to support informal dementia care. UR - https://aging.jmir.org/2021/4/e30841 UR - http://dx.doi.org/10.2196/30841 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623314 ID - info:doi/10.2196/30841 ER - TY - JOUR AU - Tiersen, Federico AU - Batey, Philippa AU - Harrison, C. Matthew J. AU - Naar, Lenny AU - Serban, Alina-Irina AU - Daniels, C. Sarah J. AU - Calvo, A. Rafael PY - 2021/8/11 TI - Smart Home Sensing and Monitoring in Households With Dementia: User-Centered Design Approach JO - JMIR Aging SP - e27047 VL - 4 IS - 3 KW - assistive technology KW - independent living KW - internet of things KW - remote monitoring KW - dementia KW - human centered design KW - user-centered design KW - patient-centered care KW - smart home KW - digital health N2 - Background: As life expectancy grows, so do the challenges of caring for an aging population. Older adults, including people with dementia, want to live independently and feel in control of their lives for as long as possible. Assistive technologies powered by artificial intelligence and internet of things devices are being proposed to provide living environments that support the users? safety, psychological, and medical needs through remote monitoring and interventions. Objective: This study investigates the functional, psychosocial, and environmental needs of people living with dementia, their caregivers, clinicians, and health and social care service providers toward the design and implementation of smart home systems. Methods: We used an iterative user-centered design approach comprising 9 substudies. First, semistructured interviews (9 people with dementia, 9 caregivers, and 10 academic and clinical staff) and workshops (35 pairs of people with dementia and caregivers, and 12 health and social care clinicians) were conducted to define the needs of people with dementia, home caregivers, and professional stakeholders in both daily activities and technology-specific interactions. Then, the spectrum of needs identified was represented via patient?caregiver personas and discussed with stakeholders in a workshop (14 occupational therapists; 4 National Health Service pathway directors; and 6 researchers in occupational therapy, neuropsychiatry, and engineering) and 2 focus groups with managers of health care services (n=8), eliciting opportunities for innovative care technologies and public health strategies. Finally, these design opportunities were discussed in semistructured interviews with participants of a smart home trial involving environmental sensors, physiological measurement devices, smartwatches, and tablet-based chatbots and cognitive assessment puzzles (10 caregivers and 2 people with dementia). A thematic analysis revealed factors that motivate household members to use these technologies. Results: Outcomes of these activities include a qualitative and quantitative analysis of patient, caregiver, and clinician needs and the identification of challenges and opportunities for the design and implementation of remote monitoring systems in public health pathways. Conclusions: Participatory design methods supported the triangulation of stakeholder perspectives to aid the development of more patient-centered interventions and their translation to clinical practice and public health strategy. We discuss the implications and limitations of our findings, the value and the applicability of our methodology, and directions for future research. UR - https://aging.jmir.org/2021/3/e27047 UR - http://dx.doi.org/10.2196/27047 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383672 ID - info:doi/10.2196/27047 ER - TY - JOUR AU - Hui, Yan Chi AU - McKinstry, Brian AU - Fulton, Olivia AU - Buchner, Mark AU - Pinnock, Hilary PY - 2021/7/16 TI - Patients? and Clinicians? Perceived Trust in Internet-of-Things Systems to Support Asthma Self-management: Qualitative Interview Study JO - JMIR Mhealth Uhealth SP - e24127 VL - 9 IS - 7 KW - asthma KW - self-management KW - telehealth KW - internet-of-thing KW - trust N2 - Background: Asthma affects 235 million people worldwide. Supported self-management, including an action plan agreed with clinicians, improves asthma outcomes. Internet-of-things (IoT) systems with artificial intelligence (AI) can provide customized support for a range of self-management functions, but trust is vital to encourage patients? adoption of such systems. Many models for understanding trust exist, some explicitly designed for eHealth, but no studies have used these models to explore trust in the context of using IoT systems to support asthma self-management. Objective: In this study, we aim to use the McKnight model to explore the functionality, helpfulness, and reliability domains of patients? and clinicians? trust in IoT systems to deliver the 14 components of self-management support defined by the PRISMS (Practical Reviews in Self-Management Support) taxonomy. Methods: We used think-aloud techniques in semistructured interviews to explore the views of patients and clinicians. Patients were recruited from research registers and social media and purposively sampled to include a range of ages, genders, action plan ownership, asthma duration, hospital admissions, and experience with mobile apps. Clinicians (primary, secondary, and community-based) were recruited from professional networks. Interviews were transcribed verbatim, and thematic analysis was used to explore perceptions of the functionality, helpfulness, and reliability of IoT features to support components of supported self-management. Results: A total of 12 patients and 12 clinicians were interviewed. Regarding perceived functionality, most patients considered that an IoT system had functionality that could support a broad range of self-management tasks. They wanted a system to provide customized advice involving AI. With regard to perceived helpfulness, they considered that IoT systems could usefully provide integrated support for a number of recognized components of self-management support. In terms of perceived reliability, they believed they could rely on the system to log their asthma condition and provide preset action plan advice triggered by their logs. However, they were less confident that the system could operate continuously and without errors in providing advice. They were not confident that AI could generate new advice or reach diagnostic conclusions without the interpretation of their trusted clinicians. Clinicians wanted clinical evidence before trusting the system. Conclusions: IoT systems including AI were regarded as offering potentially helpful functionality in mediating the action plans developed with a trusted clinician, although our technologically adept participants were not yet ready to trust AI to generate novel advice. Research is needed to ensure that technological capability does not outstrip the trust of individuals using it. UR - https://mhealth.jmir.org/2021/7/e24127 UR - http://dx.doi.org/10.2196/24127 UR - http://www.ncbi.nlm.nih.gov/pubmed/34269684 ID - info:doi/10.2196/24127 ER - TY - JOUR AU - Vuorinen, Anna-Leena AU - Helander, Elina AU - Pietilä, Julia AU - Korhonen, Ilkka PY - 2021/6/28 TI - Frequency of Self-Weighing and Weight Change: Cohort Study With 10,000 Smart Scale Users JO - J Med Internet Res SP - e25529 VL - 23 IS - 6 KW - self-monitoring KW - self-weighing KW - weight change, weight loss, normal weight, overweight, obese, temporal weight change N2 - Background: Frequent self-weighing is associated with successful weight loss and weight maintenance during and after weight loss interventions. Less is known about self-weighing behaviors and associated weight change in free-living settings. Objective: This study aimed to investigate the association between the frequency of self-weighing and changes in body weight in a large international cohort of smart scale users. Methods: This was an observational cohort study with 10,000 randomly selected smart scale users who had used the scale for at least 1 year. Longitudinal weight measurement data were analyzed. The association between the frequency of self-weighing and weight change over the follow-up was investigated among normal weight, overweight, and obese users using Pearson?s correlation coefficient and linear models. The association between the frequency of self-weighing and temporal weight change was analyzed using linear mixed effects models. Results: The eligible sample consisted of 9768 participants (6515/9768, 66.7% men; mean age 41.5 years; mean BMI 26.8 kg/m2). Of the participants, 4003 (4003/9768, 41.0%), 3748 (3748/9768, 38.4%), and 2017 (2017/9768, 20.6%) were normal weight, overweight, and obese, respectively. During the mean follow-up time of 1085 days, the mean weight change was ?0.59 kg, and the mean percentage of days with a self-weigh was 39.98%, which equals 2.8 self-weighs per week. The percentage of self-weighing days correlated inversely with weight change, r=?0.111 (P<.001). Among normal weight, overweight, and obese individuals, the correlations were r=?0.100 (P<.001), r=?0.125 (P<.001), and r=?0.148 (P<.001), respectively. Of all participants, 72.5% (7085/9768) had at least one period of ?30 days without weight measurements. During the break, weight increased, and weight gains were more pronounced among overweight and obese individuals: 0.58 kg in the normal weight group, 0.93 kg in the overweight group, and 1.37 kg in the obese group (P<.001). Conclusions: Frequent self-weighing was associated with favorable weight loss outcomes also in an uncontrolled, free-living setting, regardless of specific weight loss interventions. The beneficial associations of regular self-weighing were more pronounced for overweight or obese individuals. UR - https://www.jmir.org/2021/6/e25529 UR - http://dx.doi.org/10.2196/25529 UR - http://www.ncbi.nlm.nih.gov/pubmed/34075879 ID - info:doi/10.2196/25529 ER - TY - JOUR AU - Rennick-Egglestone, Stefan AU - Mawson, Sue PY - 2021/6/17 TI - Homes of Stroke Survivors Are a Challenging Environment for Rehabilitation Technologies JO - JMIR Rehabil Assist Technol SP - e12029 VL - 8 IS - 2 KW - domestic rehabilitation technology KW - brain injury KW - stroke KW - research through design UR - https://rehab.jmir.org/2021/2/e12029 UR - http://dx.doi.org/10.2196/12029 UR - http://www.ncbi.nlm.nih.gov/pubmed/34137728 ID - info:doi/10.2196/12029 ER - TY - JOUR AU - Schütz, Narayan AU - Saner, Hugo AU - Botros, Angela AU - Pais, Bruno AU - Santschi, Valérie AU - Buluschek, Philipp AU - Gatica-Perez, Daniel AU - Urwyler, Prabitha AU - Müri, M. René AU - Nef, Tobias PY - 2021/6/11 TI - Contactless Sleep Monitoring for Early Detection of Health Deteriorations in Community-Dwelling Older Adults: Exploratory Study JO - JMIR Mhealth Uhealth SP - e24666 VL - 9 IS - 6 KW - sleep restlessness KW - telemonitoring KW - digital biomarkers KW - contactless sensing KW - pervasive computing KW - home-monitoring KW - older adults KW - toss and turns KW - sleep monitoring KW - body movements in bed N2 - Background: Population aging is posing multiple social and economic challenges to society. One such challenge is the social and economic burden related to increased health care expenditure caused by early institutionalizations. The use of modern pervasive computing technology makes it possible to continuously monitor the health status of community-dwelling older adults at home. Early detection of health issues through these technologies may allow for reduced treatment costs and initiation of targeted preventive measures leading to better health outcomes. Sleep is a key factor when it comes to overall health and many health issues manifest themselves with associated sleep deteriorations. Sleep quality and sleep disorders such as sleep apnea syndrome have been extensively studied using various wearable devices at home or in the setting of sleep laboratories. However, little research has been conducted evaluating the potential of contactless and continuous sleep monitoring in detecting early signs of health problems in community-dwelling older adults. Objective: In this work we aim to evaluate which contactlessly measurable sleep parameter is best suited to monitor perceived and actual health status changes in older adults. Methods: We analyzed real-world longitudinal (up to 1 year) data from 37 community-dwelling older adults including more than 6000 nights of measured sleep. Sleep parameters were recorded by a pressure sensor placed beneath the mattress, and corresponding health status information was acquired through weekly questionnaires and reports by health care personnel. A total of 20 sleep parameters were analyzed, including common sleep metrics such as sleep efficiency, sleep onset delay, and sleep stages but also vital signs in the form of heart and breathing rate as well as movements in bed. Association with self-reported health, evaluated by EuroQol visual analog scale (EQ-VAS) ratings, were quantitatively evaluated using individual linear mixed-effects models. Translation to objective, real-world health incidents was investigated through manual retrospective case-by-case analysis. Results: Using EQ-VAS rating based self-reported perceived health, we identified body movements in bed?measured by the number toss-and-turn events?as the most predictive sleep parameter (t score=?0.435, P value [adj]=<.001). Case-by-case analysis further substantiated this finding, showing that increases in number of body movements could often be explained by reported health incidents. Real world incidents included heart failure, hypertension, abdominal tumor, seasonal flu, gastrointestinal problems, and urinary tract infection. Conclusions: Our results suggest that nightly body movements in bed could potentially be a highly relevant as well as easy to interpret and derive digital biomarker to monitor a wide range of health deteriorations in older adults. As such, it could help in detecting health deteriorations early on and provide timelier, more personalized, and precise treatment options. UR - https://mhealth.jmir.org/2021/6/e24666 UR - http://dx.doi.org/10.2196/24666 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114966 ID - info:doi/10.2196/24666 ER - TY - JOUR AU - Thomas, E. Beena AU - Kumar, Vignesh J. AU - Periyasamy, Murugesan AU - Khandewale, Subhash Amit AU - Hephzibah Mercy, J. AU - Raj, Michael E. AU - Kokila, S. AU - Walgude, Shashikant Apurva AU - Gaurkhede, Rahul Gunjan AU - Kumbhar, Dattatraya Jagannath AU - Ovung, Senthanro AU - Paul, Mariyamma AU - Rajkumar, Sathyan B. AU - Subbaraman, Ramnath PY - 2021/6/10 TI - Acceptability of the Medication Event Reminder Monitor for Promoting Adherence to Multidrug-Resistant Tuberculosis Therapy in Two Indian Cities: Qualitative Study of Patients and Health Care Providers JO - J Med Internet Res SP - e23294 VL - 23 IS - 6 KW - tuberculosis KW - drug-resistant KW - medication adherence KW - mHealth KW - digital adherence technologies KW - India N2 - Background: Patients with multidrug-resistant tuberculosis (MDR-TB) face challenges adhering to medications, given that treatment is prolonged and has a high rate of adverse effects. The Medication Event Reminder Monitor (MERM) is a digital pillbox that provides pill-taking reminders and facilitates the remote monitoring of medication adherence. Objective: This study aims to assess the MERM?s acceptability to patients and health care providers (HCPs) during pilot implementation in India?s public sector MDR-TB program. Methods: From October 2017 to September 2018, we conducted qualitative interviews with patients who were undergoing MDR-TB therapy and were being monitored with the MERM and HCPs in the government program in Chennai and Mumbai. Interview transcripts were independently coded by 2 researchers and analyzed to identify the emergent themes. We organized findings by using the Unified Theory of Acceptance and Use of Technology (UTAUT), which outlines 4 constructs that predict technology acceptance?performance expectancy, effort expectancy, social influence, and facilitating conditions. Results: We interviewed 65 patients with MDR-TB and 10 HCPs. In patient interviews, greater acceptance of the MERM was related to perceptions that the audible and visual reminders improved medication adherence and that remote monitoring reduced the frequency of clinic visits (performance expectancy), that the device?s organization and labeling of medications made it easier to take them correctly (effort expectancy), that the device facilitated positive family involvement in the patient?s care (social influences), and that remote monitoring made patients feel more cared for by the health system (facilitating conditions). Lower patient acceptance was related to problems with the durability of the MERM?s cardboard construction and difficulties with portability and storage because of its large size (effort expectancy), concerns regarding stigma and the disclosure of patients? MDR-TB diagnoses (social influences), and the incorrect understanding of the MERM because of suboptimal counseling (facilitating conditions). In their interviews, HCPs reported that MERM implementation resulted in fewer in-person interactions with patients and thus allowed HCPs to dedicate more time to other tasks, which improved job satisfaction. Conclusions: Several features of the MERM support its acceptability among patients with MDR-TB and HCPs, and some barriers to patient use could be addressed by improving the design of the device. However, some barriers, such as disease-related stigma, are more difficult to modify and may limit use of the MERM among some patients with MDR-TB. Further research is needed to assess the accuracy of MERM for measuring adherence, its effectiveness for improving treatment outcomes, and patients? sustained use of the device in larger scale implementation. UR - https://www.jmir.org/2021/6/e23294 UR - http://dx.doi.org/10.2196/23294 UR - http://www.ncbi.nlm.nih.gov/pubmed/34110300 ID - info:doi/10.2196/23294 ER - TY - JOUR AU - Ho, Kendall AU - Novak Lauscher, Helen AU - Cordeiro, Jennifer AU - Hawkins, Nathaniel AU - Scheuermeyer, Frank AU - Mitton, Craig AU - Wong, Hubert AU - McGavin, Colleen AU - Ross, Dianne AU - Apantaku, Glory AU - Karim, Ehsan Mohammad AU - Bhullar, Amrit AU - Abu-Laban, Riyad AU - Nixon, Suzanne AU - Smith, Tyler PY - 2021/6/3 TI - Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre?Post Study JO - JMIR Form Res SP - e24509 VL - 5 IS - 6 KW - telemonitoring KW - heart failure KW - home health monitoring KW - technology KW - telehealth KW - emergency care KW - community care KW - emergency department KW - quality of life KW - self-efficacy N2 - Background: Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. Objective: Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. Methods: Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient?s condition. In our evaluation, the primary outcome was the combination of unscheduled emergency department revisits of discharged participants or death within 90 days. Secondary outcomes included 90-day hospital readmissions, patient quality of life (as measured by Veterans Rand 12-Item Health Survey and Kansas City Cardiomyopathy Scale), self-efficacy (as measured by European Heart Failure Self-Care Behaviour Scale 9), end-user experience, and health system cost-effectiveness including cost reduction and hospital bed capacity. In this feasibility study, we also tested the recruitment strategy, clinical protocols, evaluation framework, and data collection methods. Results: Seventy participants were enrolled into this trial. Participant engagement to monitoring was measured at 94% (N=70; ie, data submitted 56/60 days on average). Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 79% reduction of emergency department revisits post monitoring, an 87% reduction in hospital readmissions, and a 60% reduction in the median hospital length of stay (n=36). Cost of hospitalization for participants decreased by 71%, and emergency department visit costs decreased by 58% (n=30). Overall health system costs for our participants showed a 56% reduction post monitoring (n=30). HF-specific quality of life (Kansas City Cardiomyopathy Scale) scores showed a significant increase of 101% (n=35) post monitoring (P<.001). General quality of life (Veterans Rand 12-Item Health Survey) improved by 19% (n=35) on the mental component score (P<.001) and 19% (n=35) on the physical component score (P=.02). Self-efficacy improved by 6% (n=35). Interviews with participants revealed that they were satisfied overall with the monitoring program and its usability, and participants reported being more engaged, educated, and involved in their self-management. Conclusions: Results from this small-sample feasibility study suggested that our HHM intervention can be beneficial in supporting patients post discharge. Additionally, key insights from the trial allowed us to refine our methods and procedures, such as shifting our recruitment methods to in-patient wards and increasing our scope of data collection. Although these findings are promising, a more rigorous trial design is required to test the true efficacy of the intervention. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across British Columbia. Trial Registration: ClinicalTrials.gov NCT03439384; https://clinicaltrials.gov/ct2/show/NCT03439384 UR - https://formative.jmir.org/2021/6/e24509 UR - http://dx.doi.org/10.2196/24509 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081015 ID - info:doi/10.2196/24509 ER - TY - JOUR AU - Malik, Raza Ahmed AU - Boger, Jennifer PY - 2021/5/31 TI - Zero-Effort Ambient Heart Rate Monitoring Using Ballistocardiography Detected Through a Seat Cushion: Prototype Development and Preliminary Study JO - JMIR Rehabil Assist Technol SP - e25996 VL - 8 IS - 2 KW - ballistocardiography KW - heart rate KW - ambient health monitoring KW - zero-effort technology KW - continuous wavelet transform N2 - Background: Cardiovascular diseases are a leading cause of death worldwide and result in significant economic costs to health care systems. The prevalence of cardiovascular conditions that require monitoring is expected to increase as the average age of the global population continues to rise. Although an accurate cardiac assessment can be performed at medical centers, frequent visits for assessment are not feasible for most people, especially those with limited mobility. Monitoring of vital signs at home is becoming an increasingly desirable, accessible, and practical alternative. As wearable devices are not the ideal solution for everyone, it is necessary to develop parallel and complementary approaches. Objective: This research aims to develop a zero-effort, unobtrusive, cost-effective, and portable option for home-based ambient heart rate monitoring. Methods: The prototype seat cushion uses load cells to acquire a user?s ballistocardiogram (BCG). The analog signal from the load cells is amplified and filtered by a signal-conditioning circuit before being digitally recorded. A pilot study with 20 participants was conducted to analyze the prototype?s ability to capture the BCG during five real-world tasks: sitting still, watching a video on a computer screen, reading, using a computer, and having a conversation. A novel algorithm based on the continuous wavelet transform was developed to extract the heart rate by detecting the largest amplitude values (J-peaks) in the BCG signal. Results: The pilot study data showed that the BCG signals from all five tasks had sufficiently large portions to extract heart rate. The continuous wavelet transform?based algorithm for J-peak detection demonstrated an overall accuracy of 91.4% compared with electrocardiography. Excluding three outliers that had significantly noisy BCG data, the algorithm achieved 94.6% accuracy, which was aligned with that of wearable devices. Conclusions: This study suggests that BCG acquired through a seat cushion is a viable alternative to wearable technologies. The prototype seat cushion presented in this study is an example of a relatively accessible, affordable, portable, and unobtrusive zero-effort approach to achieve frequent home-based ambient heart rate monitoring. UR - https://rehab.jmir.org/2021/2/e25996 UR - http://dx.doi.org/10.2196/25996 UR - http://www.ncbi.nlm.nih.gov/pubmed/34057420 ID - info:doi/10.2196/25996 ER - TY - JOUR AU - Clarke, Holly AU - Clark, Stephen AU - Birkin, Mark AU - Iles-Smith, Heather AU - Glaser, Adam AU - Morris, A. Michelle PY - 2021/5/17 TI - Understanding Barriers to Novel Data Linkages: Topic Modeling of the Results of the LifeInfo Survey JO - J Med Internet Res SP - e24236 VL - 23 IS - 5 KW - topic modeling KW - text analysis KW - lifestyle data KW - consumer data KW - mHealth KW - loyalty card KW - fitness tracker KW - data linkage KW - data sharing KW - public attitudes KW - public opinion N2 - Background: Novel consumer and lifestyle data, such as those collected by supermarket loyalty cards or mobile phone exercise tracking apps, offer numerous benefits for researchers seeking to understand diet- and exercise-related risk factors for diseases. However, limited research has addressed public attitudes toward linking these data with individual health records for research purposes. Data linkage, combining data from multiple sources, provides the opportunity to enhance preexisting data sets to gain new insights. Objective: The aim of this study is to identify key barriers to data linkage and recommend safeguards and procedures that would encourage individuals to share such data for potential future research. Methods: The LifeInfo Survey consulted the public on their attitudes toward sharing consumer and lifestyle data for research purposes. Where barriers to data sharing existed, participants provided unstructured survey responses detailing what would make them more likely to share data for linkage with their health records in the future. The topic modeling technique latent Dirichlet allocation was used to analyze these textual responses to uncover common thematic topics within the texts. Results: Participants provided responses related to sharing their store loyalty card data (n=2338) and health and fitness app data (n=1531). Key barriers to data sharing identified through topic modeling included data safety and security, personal privacy, requirements of further information, fear of data being accessed by others, problems with data accuracy, not understanding the reason for data linkage, and not using services that produce these data. We provide recommendations for addressing these issues to establish the best practice for future researchers interested in using these data. Conclusions: This study formulates a large-scale consultation of public attitudes toward this kind of data linkage, which is an important first step in understanding and addressing barriers to participation in research using novel consumer and lifestyle data. UR - https://www.jmir.org/2021/5/e24236 UR - http://dx.doi.org/10.2196/24236 UR - http://www.ncbi.nlm.nih.gov/pubmed/33998998 ID - info:doi/10.2196/24236 ER - TY - JOUR AU - Gwon, Danbi AU - Cho, Hakyung AU - Shin, Hangsik PY - 2021/5/11 TI - Feasibility of a Waistband-Type Wireless Wearable Electrocardiogram Monitoring System Based on a Textile Electrode: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e26469 VL - 9 IS - 5 KW - electrocardiogram KW - telehealth KW - telemetry KW - telemonitoring KW - textile electrode KW - wearable system KW - smartphone KW - mobile phone N2 - Background: Electrocardiogram (ECG) monitoring in daily life is essential for effective management of cardiovascular disease, a leading cause of death. Wearable ECG measurement systems in the form of clothing have been proposed to replace Holter monitors used for clinical ECG monitoring; however, they have limitations in daily use because they compress the upper body and, in doing so, cause discomfort during wear. Objective: The purpose of this study was to develop a wireless wearable ECG monitoring system that includes a textile ECG electrode that can be applied to the lining of pants and can be used in the same way that existing lower clothing is worn, without compression to the upper body. Methods: A textile electrode with stretchable characteristics was fabricated by knitting a conductive yarn together with polyester-polyurethane fiber, which was then coated with silver compound; an ECG electrode was developed by placing it on an elastic band in a modified limb lead configuration. In addition, a system with analog-to-digital conversion, wireless communication, and a smartphone app was developed, allowing users to be able to check and store their own ECGs in real time. A signal processing algorithm was also developed to remove noise from the obtained signal and to calculate the heart rate. To evaluate the ECG and heart rate measurement performance of the developed module, a comparative evaluation with a commercial device was performed. ECGs were measured for 5 minutes each in standing, sitting, and lying positions; the mean absolute percentage errors of heart rates measured with both systems were then compared. Results: The system was developed in the form of a belt buckle with a size of 53 × 45 × 12 mm (width × height × depth) and a weight of 23 g. In a qualitative evaluation, it was confirmed that the P-QRS-T waveform was clearly observed in ECGs obtained with the wearable system. From the results of the heart rate estimation, the developed system could track changes in heart rate as calculated by a commercial ECG measuring device; in addition, the mean absolute percentage errors of heart rates were 1.80%, 2.84%, and 2.48% in the standing, sitting, and lying positions, respectively. Conclusions: The developed system was able to effectively measure ECG and calculate heart rate simply through being worn as existing clothing without upper body pressure. It is anticipated that general usability can be secured through further evaluation under more diverse conditions. UR - https://mhealth.jmir.org/2021/5/e26469 UR - http://dx.doi.org/10.2196/26469 UR - http://www.ncbi.nlm.nih.gov/pubmed/33973860 ID - info:doi/10.2196/26469 ER - TY - JOUR AU - Guay, Manon AU - Labbé, Mathieu AU - Séguin-Tremblay, Noémie AU - Auger, Claudine AU - Goyer, Geneviève AU - Veloza, Emily AU - Chevalier, Natalie AU - Polgar, Jan AU - Michaud, François PY - 2021/5/11 TI - Adapting a Person?s Home in 3D Using a Mobile App (MapIt): Participatory Design Framework Investigating the App?s Acceptability JO - JMIR Rehabil Assist Technol SP - e24669 VL - 8 IS - 2 KW - occupational therapy KW - mobile phone KW - aging KW - disability KW - telehealth KW - 3D visualization KW - universal design KW - built environment KW - camera KW - remote assessment KW - assistive technology N2 - Background: Home adaptation processes enhancing occupational engagement rely on identifying environmental barriers, generally during time-consuming home visits performed by occupational therapists (OTs). Relevance of a 3D model to the OT?s work has been attested, but a convenient and consumer-available technology to map the home environment in 3D is currently lacking. For instance, such a technology would support the exploration of home adaptations for a person with disability, with or without an OT visit. Objective: The aim of this study was to document the development and acceptability of a 3D mapping eHealth technology, optimizing its contribution to the OT?s work when conducting assessments in which home representations are essential to fit a person?s needs. Methods: A user-centered perspective, embedded in a participatory design framework where users are considered as research partners (not as just study participants), is reported. OTs, engineers, clinicians, researchers, and students, as well as the relatives of older adults contributed by providing ongoing feedback (eg, demonstrations, brainstorming, usability testing, questionnaires, prototyping). System acceptability, as per the Nielsen model, is documented by deductively integrating the data. Results: A total of 24 stakeholders contributed significantly to MapIt technology?s co-design over a span of 4 years. Fueled by the objective to enhance MapIt?s acceptability, 11 iterations lead to a mobile app to scan a room and produce its 3D model in less than 5 minutes. The app is available for smartphones and paired with computer software. Scanning, visualization, and automatic measurements are done on a smartphone equipped with a motion sensor and a camera with depth perception, and the computer software facilitates visualization, while allowing custom measurement of architectural elements directly on the 3D model. Stakeholders? perception was favorable regarding MapIt?s acceptability, testifying to its usefulness (ie, usability and utility). Residual usability issues as well as concerns about accessibility and scan rendering still need to be addressed to foster its integration to a clinical context. Conclusions: MapIt allows to scan a room quickly and simply, providing a 3D model from images taken in real-world settings and to remotely but jointly explore home adaptations to enhance a person?s occupational engagement. UR - https://rehab.jmir.org/2021/2/e24669 UR - http://dx.doi.org/10.2196/24669 UR - http://www.ncbi.nlm.nih.gov/pubmed/33973867 ID - info:doi/10.2196/24669 ER - TY - JOUR AU - Wu, Chia-Tung AU - Li, Guo-Hung AU - Huang, Chun-Ta AU - Cheng, Yu-Chieh AU - Chen, Chi-Hsien AU - Chien, Jung-Yien AU - Kuo, Ping-Hung AU - Kuo, Lu-Cheng AU - Lai, Feipei PY - 2021/5/6 TI - Acute Exacerbation of a Chronic Obstructive Pulmonary Disease Prediction System Using Wearable Device Data, Machine Learning, and Deep Learning: Development and Cohort Study JO - JMIR Mhealth Uhealth SP - e22591 VL - 9 IS - 5 KW - chronic obstructive pulmonary disease KW - clinical decision support systems KW - health risk assessment KW - wearable device N2 - Background: The World Health Organization has projected that by 2030, chronic obstructive pulmonary disease (COPD) will be the third-leading cause of mortality and the seventh-leading cause of morbidity worldwide. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with an accelerated decline in lung function, diminished quality of life, and higher mortality. Accurate early detection of acute exacerbations will enable early management and reduce mortality. Objective: The aim of this study was to develop a prediction system using lifestyle data, environmental factors, and patient symptoms for the early detection of AECOPD in the upcoming 7 days. Methods: This prospective study was performed at National Taiwan University Hospital. Patients with COPD that did not have a pacemaker and were not pregnant were invited for enrollment. Data on lifestyle, temperature, humidity, and fine particulate matter were collected using wearable devices (Fitbit Versa), a home air quality?sensing device (EDIMAX Airbox), and a smartphone app. AECOPD episodes were evaluated via standardized questionnaires. With these input features, we evaluated the prediction performance of machine learning models, including random forest, decision trees, k-nearest neighbor, linear discriminant analysis, and adaptive boosting, and a deep neural network model. Results: The continuous real-time monitoring of lifestyle and indoor environment factors was implemented by integrating home air quality?sensing devices, a smartphone app, and wearable devices. All data from 67 COPD patients were collected prospectively during a mean 4-month follow-up period, resulting in the detection of 25 AECOPD episodes. For 7-day AECOPD prediction, the proposed AECOPD predictive model achieved an accuracy of 92.1%, sensitivity of 94%, and specificity of 90.4%. Receiver operating characteristic curve analysis showed that the area under the curve of the model in predicting AECOPD was greater than 0.9. The most important variables in the model were daily steps walked, stairs climbed, and daily distance moved. Conclusions: Using wearable devices, home air quality?sensing devices, a smartphone app, and supervised prediction algorithms, we achieved excellent power to predict whether a patient would experience AECOPD within the upcoming 7 days. The AECOPD prediction system provided an effective way to collect lifestyle and environmental data, and yielded reliable predictions of future AECOPD events. Compared with previous studies, we have comprehensively improved the performance of the AECOPD prediction model by adding objective lifestyle and environmental data. This model could yield more accurate prediction results for COPD patients than using only questionnaire data. UR - https://mhealth.jmir.org/2021/5/e22591 UR - http://dx.doi.org/10.2196/22591 UR - http://www.ncbi.nlm.nih.gov/pubmed/33955840 ID - info:doi/10.2196/22591 ER - TY - JOUR AU - Frija-Masson, Justine AU - Mullaert, Jimmy AU - Vidal-Petiot, Emmanuelle AU - Pons-Kerjean, Nathalie AU - Flamant, Martin AU - d'Ortho, Marie-Pia PY - 2021/4/30 TI - Accuracy of Smart Scales on Weight and Body Composition: Observational Study JO - JMIR Mhealth Uhealth SP - e22487 VL - 9 IS - 4 KW - smart scales KW - DEXA KW - obesity N2 - Background: Smart scales are increasingly used at home by patients to monitor their body weight and body composition, but scale accuracy has not often been documented. Objective: The goal of the research was to determine the accuracy of 3 commercially available smart scales for weight and body composition compared with dual x-ray absorptiometry (DEXA) as the gold standard. Methods: We designed a cross-sectional study in consecutive patients evaluated for DEXA in a physiology unit in a tertiary hospital in France. There were no exclusion criteria except patient declining to participate. Patients were weighed with one smart scale immediately after DEXA. Three scales were compared (scale 1: Body Partner [Téfal], scale 2: DietPack [Terraillon], and scale 3: Body Cardio [Nokia Withings]). We determined absolute error between the gold standard values obtained from DEXA and the smart scales for body mass, fat mass, and lean mass. Results: The sample for analysis included 53, 52, and 48 patients for each of the 3 tested smart scales, respectively. The median absolute error for body weight was 0.3 kg (interquartile range [IQR] ?0.1, 0.7), 0 kg (IQR ?0.4, 0.3), and 0.25 kg (IQR ?0.10, 0.52), respectively. For fat mass, absolute errors were ?2.2 kg (IQR ?5.8, 1.3), ?4.4 kg (IQR ?6.6, 0), and ?3.7 kg (IQR ?8.0, 0.28), respectively. For muscular mass, absolute errors were ?2.2 kg (IQR ?5.8, 1.3), ?4.4 kg (IQR ?6.6, 0), and ?3.65 kg (IQR ?8.03, 0.28), respectively. Factors associated with fat mass measurement error were weight for scales 1 and 2 (P=.03 and P<.001, respectively), BMI for scales 1 and 2 (P=.034 and P<.001, respectively), body fat for scale 1 (P<.001), and muscular and bone mass for scale 2 (P<.001 for both). Factors associated with muscular mass error were weight and BMI for scale 1 (P<.001 and P=.004, respectively), body fat for scales 1 and 2 (P<.001 for both), and muscular and bone mass for scale 2 (P<.001 and P=.002, respectively). Conclusions: Smart scales are not accurate for body composition and should not replace DEXA in patient care. Trial Registration: ClinicalTrials.gov NCT03803098; https://clinicaltrials.gov/ct2/show/NCT03803098 UR - https://mhealth.jmir.org/2021/4/e22487 UR - http://dx.doi.org/10.2196/22487 UR - http://www.ncbi.nlm.nih.gov/pubmed/33929337 ID - info:doi/10.2196/22487 ER - TY - JOUR AU - El Fatouhi, Douae AU - Delrieu, Lidia AU - Goetzinger, Catherine AU - Malisoux, Laurent AU - Affret, Aurélie AU - Campo, David AU - Fagherazzi, Guy PY - 2021/4/15 TI - Associations of Physical Activity Level and Variability With 6-Month Weight Change Among 26,935 Users of Connected Devices: Observational Real-Life Study JO - JMIR Mhealth Uhealth SP - e25385 VL - 9 IS - 4 KW - connected devices KW - Withings KW - physical activity KW - step count KW - wearable activity trackers KW - digital health KW - free-living KW - weight loss KW - digital scale KW - mobile phone N2 - Background: Physical activity (PA) is a modifiable lifestyle factor that can be targeted to increase energy expenditure and promote weight loss. However, the amount of PA required for weight loss remains inconsistent. Wearable activity trackers constitute a valuable opportunity to obtain objective measurements of PA and study large populations in real-life settings. Objective: We aim to study the associations of initial device-assessed PA characteristics (average step counts and step count variability) and their evolution with 6-month weight change. Methods: We analyzed data from 26,935 Withings-connected device users (wearable activity trackers and digital scales). To assess the initial PA characteristics and their 6-month changes, we used data recorded during the first and sixth 30-day periods of activity tracker use. For each of these periods, we used the monthly mean of daily step values as a proxy for PA level and derived the monthly coefficient of variation (CV) of daily step values to estimate PA level variability. Associations between initial PA characteristics and 6-month weight change were assessed using multivariable linear regression analyses controlled for age, sex, blood pressure, heart rate, and the predominant season. Restricted cubic spline regression was performed to better characterize the continuous shape of the associations between PA characteristics and weight change. Secondary analyses were performed by analyzing the 6-month evolution of PA characteristics in relation to weight change. Results: Our results revealed that both a greater PA level and lower PA level variability were associated with weight loss. Compared with individuals who were initially in the sedentary category (<5000 steps/day), individuals who were low active (5000-7499 steps/day), somewhat active (7500-9999 steps/day), and active (?10,000 steps/day) had a 0.21-kg, a 0.52-kg, and a 1.17-kg greater decrease in weight, respectively (95% CI ?0.36 to ?0.06, ?0.70 to ?0.33, and ?1.42 to ?0.93, respectively). Compared with users whose PA level CV was >63%, users whose PA level CV ranged from 51% to 63%, 40% to 51%, and was ?40%, had a 0.19-kg, a 0.23-kg, and a 0.33-kg greater decrease in weight, respectively (95% CI ?0.38 to ?0.01, ?0.41 to ?0.04, and ?0.53 to ?0.13, respectively). We also observed that each 1000 steps/day increase in PA level over the 6-month follow-up was associated with a 0.26-kg (95% CI ?0.29 to ?0.23) decrease in weight. No association was found between the 6-month changes in PA level variability and weight change. Conclusions: Our results add to the current body of knowledge that health benefits can be observed below the 10,000 steps/day threshold and suggest that not only increased mean PA level but also greater regularity of the PA level may play important roles in short-term weight loss. UR - https://mhealth.jmir.org/2021/4/e25385 UR - http://dx.doi.org/10.2196/25385 UR - http://www.ncbi.nlm.nih.gov/pubmed/33856352 ID - info:doi/10.2196/25385 ER - TY - JOUR AU - Wrede, Christian AU - Braakman-Jansen, Annemarie AU - van Gemert-Pijnen, Lisette PY - 2021/4/12 TI - Requirements for Unobtrusive Monitoring to Support Home-Based Dementia Care: Qualitative Study Among Formal and Informal Caregivers JO - JMIR Aging SP - e26875 VL - 4 IS - 2 KW - in-home monitoring KW - ambient assisted living KW - assistive technologies KW - dementia KW - home care KW - informal care KW - aging in place N2 - Background: Due to a growing shortage in residential care, people with dementia will increasingly be encouraged to live at home for longer. Although people with dementia prefer extended independent living, this also puts more pressure on both their informal and formal care networks. To support (in)formal caregivers of people with dementia, there is growing interest in unobtrusive contactless in-home monitoring technologies that allow caregivers to remotely monitor the lifestyle, health, and safety of their care recipients. Despite their potential, these solutions will only be viable if they meet the expectations and needs of formal and informal caregivers of people with dementia. Objective: The objective of this study was to explore the expected benefits, barriers, needs, and requirements toward unobtrusive in-home monitoring from the perspective of formal and informal caregivers of community-dwelling people with dementia. Methods: A combination of semistructured interviews and focus groups was used to collect data among informal (n=19) and formal (n=16) caregivers of people with dementia. Both sets of participants were presented with examples of unobtrusive in-home monitoring followed by questions addressing expected benefits, barriers, and needs. Relevant in-home monitoring goals were identified using a previously developed topic list. Interviews and focus groups were transcribed and inductively analyzed. Requirements for unobtrusive in-home monitoring were elicited based on the procedure of van Velsen and Bergvall-Kåreborn. Results: Formal and informal caregivers saw unobtrusive in-home monitoring as a support tool that should particularly be used to monitor (the risk of) falls, day and night rhythm, personal hygiene, nocturnal restlessness, and eating and drinking behavior. Generally, (in)formal caregivers reported cross-checking self-care information, extended independent living, objective communication, prevention and proactive measures, emotional reassurance, and personalized and optimized care as the key benefits of unobtrusive in-home monitoring. Main concerns centered around privacy, information overload, and ethical concerns related to dehumanizing care. Furthermore, 16 requirements for unobtrusive in-home monitoring were generated that specified desired functions, how the technology should communicate with the user, which services surrounding the technology were seen as needed, and how the technology should be integrated into the existing work context. Conclusions: Despite the presence of barriers, formal and informal caregivers of people with dementia generally saw value in unobtrusive in-home monitoring, and felt that these systems could contribute to a shift from reactive to more proactive and less obtrusive care. However, the full potential of unobtrusive in-home monitoring can only unfold if relevant concerns are considered. Our requirements can inform the development of more acceptable and goal-directed in-home monitoring technologies to support home-based dementia care. UR - https://aging.jmir.org/2021/2/e26875 UR - http://dx.doi.org/10.2196/26875 UR - http://www.ncbi.nlm.nih.gov/pubmed/33843596 ID - info:doi/10.2196/26875 ER - TY - JOUR AU - Vanegas, Erik AU - Salazar, Yolocuauhtli AU - Igual, Raúl AU - Plaza, Inmaculada PY - 2021/4/9 TI - Force-Sensitive Mat for Vertical Jump Measurement to Assess Lower Limb Strength: Validity and Reliability Study JO - JMIR Mhealth Uhealth SP - e27336 VL - 9 IS - 4 KW - vertical jump KW - mHealth KW - mobile health KW - force-sensitive resistor KW - lower limb strength KW - leg strength N2 - Background: Vertical jump height is widely used in health care and sports fields to assess muscle strength and power from lower limb muscle groups. Different approaches have been proposed for vertical jump height measurement. Some commonly used approaches need no sensor at all; however, these methods tend to overestimate the height reached by the subjects. There are also novel systems using different kind of sensors like force-sensitive resistors, capacitive sensors, and inertial measurement units, among others, to achieve more accurate measurements. Objective: The objective of this study is twofold. The first objective is to validate the functioning of a developed low-cost system able to measure vertical jump height. The second objective is to assess the effects on obtained measurements when the sampling frequency of the system is modified. Methods: The system developed in this study consists of a matrix of force-sensitive resistor sensors embedded in a mat with electronics that allow a full scan of the mat. This mat detects pressure exerted on it. The system calculates the jump height by using the flight-time formula, and the result is sent through Bluetooth to any mobile device or PC. Two different experiments were performed. In the first experiment, a total of 38 volunteers participated with the objective of validating the performance of the system against a high-speed camera used as reference (120 fps). In the second experiment, a total of 15 volunteers participated. Raw data were obtained in order to assess the effects of different sampling frequencies on the performance of the system with the same reference device. Different sampling frequencies were obtained by performing offline downsampling of the raw data. In both experiments, countermovement jump and countermovement jump with arm swing techniques were performed. Results: In the first experiment an overall mean relative error (MRE) of 1.98% and a mean absolute error of 0.38 cm were obtained. Bland-Altman and correlation analyses were performed, obtaining a coefficient of determination equal to R2=.996. In the second experiment, sampling frequencies of 200 Hz, 100 Hz, and 66.6 Hz show similar performance with MRE below 3%. Slower sampling frequencies show an exponential increase in MRE. On both experiments, when dividing jump trials in different heights reached, a decrease in MRE with higher height trials suggests that the precision of the proposed system increases as height reached increases. Conclusions: In the first experiment, we concluded that results between the proposed system and the reference are systematically the same. In the second experiment, the relevance of a sufficiently high sampling frequency is emphasized, especially for jump trials whose height is below 10 cm. For trials with heights above 30 cm, MRE decreases in general for all sampling frequencies, suggesting that at higher heights reached, the impact of high sampling frequencies is lesser. UR - https://mhealth.jmir.org/2021/4/e27336 UR - http://dx.doi.org/10.2196/27336 UR - http://www.ncbi.nlm.nih.gov/pubmed/33835040 ID - info:doi/10.2196/27336 ER - TY - JOUR AU - Abrantes, Diogo AU - Teles, Soraia AU - Tavares de Sousa, Rita AU - Freitas, Alberto AU - Vieira-Marques, Pedro AU - Ferreira, Ana PY - 2021/3/1 TI - A Multipurpose Platform for Ambient Assisted Living (ActiveAdvice): Usability Study JO - JMIR Aging SP - e18164 VL - 4 IS - 1 KW - aging KW - ambient assisted living KW - elderly KW - usability testing KW - user-centered design N2 - Background: Aging of the global population is slowly paving the way for new markets for care products and services. The desire of older people to maintain their independence while remaining at home is boosting the development of ambient assisted living (AAL) solutions. Lack of user awareness of AAL solutions paired with an insufficient use of user-centered and participatory design approaches in the development of these products has hindered the uptake of these solutions by end users. Objective: This study aims to describe the usability and users? experiences within a novel platform, ActiveAdvice, aimed at offering advice and a holistic market overview of AAL products and services. Methods: Usability tests were performed on the developed platform among identified prospective end users, with 32 older adults and informal carers from 4 European countries being part of the user tests. The usability and appeal of the web interface design, information flow, and information architecture were analyzed by collecting both objective and subjective measures. These would include pretest and posttest surveys, along with a series of think-aloud tasks to be performed within the platform. Results: The outcomes suggest that the ActiveAdvice platform?s objectives and functionalities are mostly aligned with the needs and expectations of end users, who demonstrated interest in using it, stressing its purpose along with its simple and intuitive interaction. Task completion rates were high, and participants had good satisfaction rates when navigating the platform. However, the tests still advocate for an improved design at some points and better disclosure of information. Conclusions: Our findings shed light on a few peculiarities of interface design, information architecture, user needs, and preferred functionalities, which should be applied to future developments of similar platforms with related services. The AAL field could benefit from tools supporting the dissemination of available AAL solutions and how they can improve one's quality of life. These tools may benefit not only older adults but also caregivers, business owners, and governmental employees. UR - https://aging.jmir.org/2021/1/e18164 UR - http://dx.doi.org/10.2196/18164 UR - http://www.ncbi.nlm.nih.gov/pubmed/33646134 ID - info:doi/10.2196/18164 ER - TY - JOUR AU - Wild, Katherine AU - Sharma, Nicole AU - Mattek, Nora AU - Karlawish, Jason AU - Riley, Thomas AU - Kaye, Jeffrey PY - 2021/1/13 TI - Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study JO - J Med Internet Res SP - e18806 VL - 23 IS - 1 KW - technology KW - remote sensing technology KW - care transition N2 - Background: Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data. Objective: This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions. Methods: Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes. Results: During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use. Conclusions: Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use. UR - https://www.jmir.org/2021/1/e18806 UR - http://dx.doi.org/10.2196/18806 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439144 ID - info:doi/10.2196/18806 ER - TY - JOUR AU - Hunter, Inga AU - Elers, Phoebe AU - Lockhart, Caroline AU - Guesgen, Hans AU - Singh, Amardeep AU - Whiddett, Dick PY - 2020/12/2 TI - Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals JO - JMIR Mhealth Uhealth SP - e24157 VL - 8 IS - 12 KW - smart home KW - home monitoring technology KW - aging in place KW - information governance KW - information management KW - older people KW - support network KW - aging KW - elderly health N2 - Background: Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. Objective: The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people?s health and well-being. Methods: Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. Results: The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was ?access to technology and systems,? which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was ?collecting and sharing of information,? which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients? social environment. The third theme was that all respondents identified similar ?barriers to uptake?: cost and funding issues, usability of systems by older people, and information security and privacy concerns. Conclusions: The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people?s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required. UR - https://mhealth.jmir.org/2020/12/e24157 UR - http://dx.doi.org/10.2196/24157 UR - http://www.ncbi.nlm.nih.gov/pubmed/33263551 ID - info:doi/10.2196/24157 ER - TY - JOUR AU - Sahu, Sundar Kirti AU - Oetomo, Arlene AU - Morita, Pelegrini Plinio PY - 2020/11/20 TI - Enabling Remote Patient Monitoring Through the Use of Smart Thermostat Data in Canada: Exploratory Study JO - JMIR Mhealth Uhealth SP - e21016 VL - 8 IS - 11 KW - disruptive technology KW - health information systems KW - public health surveillance KW - health behavior KW - Internet of Things KW - cell phone KW - mobile phone N2 - Background: Advances in technology have made the development of remote patient monitoring possible in recent years. However, there is still room for innovation in the types of technologies that are developed, used, and implemented. The smart thermostat solutions provided in this study can expand beyond typically defined features and be used for improved holistic health monitoring purposes. Objective: The aim of this study is to validate the hypothesis that remote motion sensors could be used to quantify and track an individual?s movements around the house. On the basis of our results, the next step would be to determine if using remote motion sensors could be a novel data collection method compared with the national census-level surveys administered by governmental bodies. The results will be used to inform a more extensive implementation study of similar smart home technologies to gather data for machine learning algorithms and to build upon pattern recognition and comprehensive health monitoring. Methods: We conducted a pilot study with a sample size of 8 to validate the use of remote motion sensors to quantify movement in the house. A large database containing data from smart home thermostats was analyzed to compare the following indicators; sleep, physical activity, and sedentary behavior. These indicators were developed by the Public Health Agency of Canada and are collected through traditional survey methods. Results: The results showed a significant Spearman rank correlation coefficient of 0.8 (P<.001), which indicates a positive linear association between the total number of sensors activated and the total number of indoor steps traveled by study participants. In addition, the indicators of sleep, physical activity, and sedentary behavior were all found to be highly comparable with those attained by the Public Health Agency of Canada. Conclusions: The findings demonstrate that remote motion sensors data from a smart thermostat solution are a viable option when compared with traditional survey data collection methods for health data collection and are also a form of zero-effort technology that can be used to monitor the activity levels and nature of activity of occupants within the home. UR - https://mhealth.jmir.org/2020/11/e21016 UR - http://dx.doi.org/10.2196/21016 UR - http://www.ncbi.nlm.nih.gov/pubmed/33216001 ID - info:doi/10.2196/21016 ER - TY - JOUR AU - Jalali, Niloofar AU - Sahu, Sundar Kirti AU - Oetomo, Arlene AU - Morita, Pelegrini Plinio PY - 2020/11/13 TI - Understanding User Behavior Through the Use of Unsupervised Anomaly Detection: Proof of Concept Using Internet of Things Smart Home Thermostat Data for Improving Public Health Surveillance JO - JMIR Mhealth Uhealth SP - e21209 VL - 8 IS - 11 KW - public health KW - IoT KW - anomaly detection KW - behavioral monitoring KW - deep learning KW - variational autoencoder KW - LSTM N2 - Background: One of the main concerns of public health surveillance is to preserve the physical and mental health of older adults while supporting their independence and privacy. On the other hand, to better assist those individuals with essential health care services in the event of an emergency, their regular activities should be monitored. Internet of Things (IoT) sensors may be employed to track the sequence of activities of individuals via ambient sensors, providing real-time insights on daily activity patterns and easy access to the data through the connected ecosystem. Previous surveys to identify the regular activity patterns of older adults were deficient in the limited number of participants, short period of activity tracking, and high reliance on predefined normal activity. Objective: The objective of this study was to overcome the aforementioned challenges by performing a pilot study to evaluate the utilization of large-scale data from smart home thermostats that collect the motion status of individuals for every 5-minute interval over a long period of time. Methods: From a large-scale dataset, we selected a group of 30 households who met the inclusion criteria (having at least 8 sensors, being connected to the system for at least 355 days in 2018, and having up to 4 occupants). The indoor activity patterns were captured through motion sensors. We used the unsupervised, time-based, deep neural-network architecture long short-term memory-variational autoencoder to identify the regular activity pattern for each household on 2 time scales: annual and weekday. The results were validated using 2019 records. The area under the curve as well as loss in 2018 were compatible with the 2019 schedule. Daily abnormal behaviors were identified based on deviation from the regular activity model. Results: The utilization of this approach not only enabled us to identify the regular activity pattern for each household but also provided other insights by assessing sleep behavior using the sleep time and wake-up time. We could also compare the average time individuals spent at home for the different days of the week. From our study sample, there was a significant difference in the time individuals spent indoors during the weekend versus on weekdays. Conclusions: This approach could enhance individual health monitoring as well as public health surveillance. It provides a potentially nonobtrusive tool to assist public health officials and governments in policy development and emergency personnel in the event of an emergency by measuring indoor behavior while preserving privacy and using existing commercially available thermostat equipment. UR - http://mhealth.jmir.org/2020/11/e21209/ UR - http://dx.doi.org/10.2196/21209 UR - http://www.ncbi.nlm.nih.gov/pubmed/33185562 ID - info:doi/10.2196/21209 ER - TY - JOUR AU - Lussier, Maxime AU - Aboujaoudé, Aline AU - Couture, Mélanie AU - Moreau, Maxim AU - Laliberté, Catherine AU - Giroux, Sylvain AU - Pigot, Hélène AU - Gaboury, Sébastien AU - Bouchard, Kévin AU - Belchior, Patricia AU - Bottari, Carolina AU - Paré, Guy AU - Consel, Charles AU - Bier, Nathalie PY - 2020/11/13 TI - Using Ambient Assisted Living to Monitor Older Adults With Alzheimer Disease: Single-Case Study to Validate the Monitoring Report JO - JMIR Med Inform SP - e20215 VL - 8 IS - 11 KW - activities of daily living KW - aging KW - Alzheimer disease KW - ambient assisted living KW - health care KW - technology assessment KW - health KW - remote sensing technology N2 - Background: Many older adults choose to live independently in their homes for as long as possible, despite psychosocial and medical conditions that compromise their independence in daily living and safety. Faced with unprecedented challenges in allocating resources, home care administrators are increasingly open to using monitoring technologies known as ambient assisted living (AAL) to better support care recipients. To be effective, these technologies should be able to report clinically relevant changes to support decision making at an individual level. Objective: The aim of this study is to examine the concurrent validity of AAL monitoring reports and information gathered by care professionals using triangulation. Methods: This longitudinal single-case study spans over 490 days of monitoring a 90-year-old woman with Alzheimer disease receiving support from local health care services. A clinical nurse in charge of her health and social care was interviewed 3 times during the project. Linear mixed models for repeated measures were used to analyze each daily activity (ie, sleep, outing activities, periods of low mobility, cooking-related activities, hygiene-related activities). Significant changes observed in data from monitoring reports were compared with information gathered by the care professional to explore concurrent validity. Results: Over time, the monitoring reports showed evolving trends in the care recipient?s daily activities. Significant activity changes occurred over time regarding sleep, outings, cooking, mobility, and hygiene-related activities. Although the nurse observed some trends, the monitoring reports highlighted information that the nurse had not yet identified. Most trends detected in the monitoring reports were consistent with the clinical information gathered by the nurse. In addition, the AAL system detected changes in daily trends following an intervention specific to meal preparation. Conclusions: Overall, trends identified by AAL monitoring are consistent with clinical reports. They help answer the nurse?s questions and help the nurse develop interventions to maintain the care recipient at home. These findings suggest the vast potential of AAL technologies to support health care services and aging in place by providing valid and clinically relevant information over time regarding activities of daily living. Such data are essential when other sources yield incomplete information for decision making. UR - https://medinform.jmir.org/2020/11/e20215 UR - http://dx.doi.org/10.2196/20215 UR - http://www.ncbi.nlm.nih.gov/pubmed/33185555 ID - info:doi/10.2196/20215 ER - TY - JOUR AU - Choi, K. Yong AU - Thompson, J. Hilaire AU - Demiris, George PY - 2020/11/10 TI - Use of an Internet-of-Things Smart Home System for Healthy Aging in Older Adults in Residential Settings: Pilot Feasibility Study JO - JMIR Aging SP - e21964 VL - 3 IS - 2 KW - Internet of Things KW - smart home KW - independent living KW - aging KW - healthy aging N2 - Background: The Internet-of-Things (IoT) technologies can create smart residences that integrate technology within the home to enhance residents? safety as well as monitor their health and wellness. However, there has been little research on real-world testing of IoT smart home devices with older adults, and the feasibility and acceptance of such tools have not been systematically examined. Objective: This study aims to conduct a pilot study to investigate the feasibility of using IoT smart home devices in the actual residences of older adults to facilitate healthy aging. Methods: We conducted a 2-month feasibility study on community-dwelling older adults. Participants chose among different IoT devices to be installed and deployed within their homes. The IoT devices tested varied depending on the participant?s preference: a door and window sensor, a multipurpose sensor (motion, temperature, luminosity, and humidity), a voice-operated smart speaker, and an internet protocol (IP) video camera. Results: We recruited a total of 37 older adults for this study, with 35 (95%) successfully completing all procedures in the 2-month study. The average age of the sample was 78 (SD 9) years and primarily comprised women (29/37, 78%), those who were educated (31/37, 86%; bachelor?s degree or higher), and those affected by chronic conditions (33/37, 89%). The most widely chosen devices among the participants were multipurpose sensors and smart speakers. An IP camera was a significantly unpopular choice among participants in both phases. The participant feedback suggests that perceived privacy concerns, perceived usefulness, and curiosity to technology were strong factors when considering which device to have installed in their home. Conclusions: Overall, our deployment results revealed that the use of IoT smart home devices is feasible in actual residences of older adults. These findings may inform the follow-up assessment of IoT technologies and their impact on health-related outcomes and advance our understanding of the role of IoT home-based monitoring technologies to promote successful aging-in-place for older adults. Future trials should consider older adults? preferences for the different types of smart home devices to be installed in real-world residential settings. UR - http://aging.jmir.org/2020/2/e21964/ UR - http://dx.doi.org/10.2196/21964 UR - http://www.ncbi.nlm.nih.gov/pubmed/33170128 ID - info:doi/10.2196/21964 ER - TY - JOUR AU - Fritz, L. Roschelle AU - Wilson, Marian AU - Dermody, Gordana AU - Schmitter-Edgecombe, Maureen AU - Cook, J. Diane PY - 2020/11/6 TI - Automated Smart Home Assessment to Support Pain Management: Multiple Methods Analysis JO - J Med Internet Res SP - e23943 VL - 22 IS - 11 KW - pain KW - remote monitoring KW - sensors KW - smart homes KW - multiple methods N2 - Background: Poorly managed pain can lead to substance use disorders, depression, suicide, worsening health, and increased use of health services. Most pain assessments occur in clinical settings away from patients? natural environments. Advances in smart home technology may allow observation of pain in the home setting. Smart homes recognizing human behaviors may be useful for quantifying functional pain interference, thereby creating new ways of assessing pain and supporting people living with pain. Objective: This study aimed to determine if a smart home can detect pain-related behaviors to perform automated assessment and support intervention for persons with chronic pain. Methods: A multiple methods, secondary data analysis was conducted using historic ambient sensor data and weekly nursing assessment data from 11 independent older adults reporting pain across 1-2 years of smart home monitoring. A qualitative approach was used to interpret sensor-based data of 27 unique pain events to support clinician-guided training of a machine learning model. A periodogram was used to calculate circadian rhythm strength, and a random forest containing 100 trees was employed to train a machine learning model to recognize pain-related behaviors. The model extracted 550 behavioral markers for each sensor-based data segment. These were treated as both a binary classification problem (event, control) and a regression problem. Results: We found 13 clinically relevant behaviors, revealing 6 pain-related behavioral qualitative themes. Quantitative results were classified using a clinician-guided random forest technique that yielded a classification accuracy of 0.70, sensitivity of 0.72, specificity of 0.69, area under the receiver operating characteristic curve of 0.756, and area under the precision-recall curve of 0.777 in comparison to using standard anomaly detection techniques without clinician guidance (0.16 accuracy achieved; P<.001). The regression formulation achieved moderate correlation, with r=0.42. Conclusions: Findings of this secondary data analysis reveal that a pain-assessing smart home may recognize pain-related behaviors. Utilizing clinicians? real-world knowledge when developing pain-assessing machine learning models improves the model?s performance. A larger study focusing on pain-related behaviors is warranted to improve and test model performance. UR - http://www.jmir.org/2020/11/e23943/ UR - http://dx.doi.org/10.2196/23943 UR - http://www.ncbi.nlm.nih.gov/pubmed/33105099 ID - info:doi/10.2196/23943 ER - TY - JOUR AU - Nelson, C. Elizabeth AU - Sools, M. Anneke AU - Vollenbroek-Hutten, R. Miriam M. AU - Verhagen, Tibert AU - Noordzij, L. Matthijs PY - 2020/11/3 TI - Embodiment of Wearable Technology: Qualitative Longitudinal Study JO - JMIR Mhealth Uhealth SP - e16973 VL - 8 IS - 11 KW - wearability KW - implantable wearable KW - body extension KW - smart prosthesis KW - implantable devices KW - technology dependence KW - cognitive prosthesis KW - phenomenology KW - embodied self-discrepancy KW - technology addiction KW - longitudinal qualitative design N2 - Background: Current technology innovations, such as wearables, have caused surprising reactions and feelings of deep connection to devices. Some researchers are calling mobile and wearable technologies cognitive prostheses, which are intrinsically connected to individuals as if they are part of the body, similar to a physical prosthesis. Additionally, while several studies have been performed on the phenomenology of receiving and wearing a physical prosthesis, it is unknown whether similar subjective experiences arise with technology. Objective: In one of the first qualitative studies to track wearables in a longitudinal investigation, we explore whether a wearable can be embodied similar to a physical prosthesis. We hoped to gain insights and compare the phases of embodiment (ie, initial adjustment to the prosthesis) and the psychological responses (ie, accept the prosthesis as part of their body) between wearables and limb prostheses. This approach allowed us to find out whether this pattern was part of a cyclical (ie, period of different usage intensity) or asymptotic (ie, abandonment of the technology) pattern. Methods: We adapted a limb prosthesis methodological framework to be applied to wearables and conducted semistructured interviews over a span of several months to assess if, how, and to what extent individuals come to embody wearables similar to prosthetic devices. Twelve individuals wore fitness trackers for 9 months, during which time interviews were conducted in the following three phases: after 3 months, after 6 months, and at the end of the study after 9 months. A deductive thematic analysis based on Murray?s work was combined with an inductive approach in which new themes were discovered. Results: Overall, the individuals experienced technology embodiment similar to limb embodiment in terms of adjustment, wearability, awareness, and body extension. Furthermore, we discovered two additional themes of engagement/reengagement and comparison to another device or person. Interestingly, many participants experienced a rarely reported phenomenon in longitudinal studies where the feedback from the device was counterintuitive to their own beliefs. This created a blurring of self-perception and a dilemma of ?whom? to believe, the machine or one?s self. Conclusions: There are many similarities between the embodiment of a limb prosthesis and a wearable. The large overlap between limb and wearable embodiment would suggest that insights from physical prostheses can be applied to wearables and vice versa. This is especially interesting as we are seeing the traditionally ?dumb? body prosthesis becoming smarter and thus a natural merging of technology and body. Future longitudinal studies could focus on the dilemma people might experience of whether to believe the information of the device over their own thoughts and feelings. These studies might take into account constructs, such as technology reliance, autonomy, and levels of self-awareness. UR - https://mhealth.jmir.org/2020/11/e16973 UR - http://dx.doi.org/10.2196/16973 UR - http://www.ncbi.nlm.nih.gov/pubmed/33141093 ID - info:doi/10.2196/16973 ER - TY - JOUR AU - Evers, JW Luc AU - Raykov, P. Yordan AU - Krijthe, H. Jesse AU - Silva de Lima, Lígia Ana AU - Badawy, Reham AU - Claes, Kasper AU - Heskes, M. Tom AU - Little, A. Max AU - Meinders, J. Marjan AU - Bloem, R. Bastiaan PY - 2020/10/9 TI - Real-Life Gait Performance as a Digital Biomarker for Motor Fluctuations: The Parkinson@Home Validation Study JO - J Med Internet Res SP - e19068 VL - 22 IS - 10 KW - digital biomarkers KW - remote patient monitoring KW - wearable sensors KW - real-life gait KW - Parkinson disease KW - biomarker KW - patient monitoring KW - wearables KW - gait N2 - Background: Wearable sensors have been used successfully to characterize bradykinetic gait in patients with Parkinson disease (PD), but most studies to date have been conducted in highly controlled laboratory environments. Objective: This paper aims to assess whether sensor-based analysis of real-life gait can be used to objectively and remotely monitor motor fluctuations in PD. Methods: The Parkinson@Home validation study provides a new reference data set for the development of digital biomarkers to monitor persons with PD in daily life. Specifically, a group of 25 patients with PD with motor fluctuations and 25 age-matched controls performed unscripted daily activities in and around their homes for at least one hour while being recorded on video. Patients with PD did this twice: once after overnight withdrawal of dopaminergic medication and again 1 hour after medication intake. Participants wore sensors on both wrists and ankles, on the lower back, and in the front pants pocket, capturing movement and contextual data. Gait segments of 25 seconds were extracted from accelerometer signals based on manual video annotations. The power spectral density of each segment and device was estimated using Welch?s method, from which the total power in the 0.5- to 10-Hz band, width of the dominant frequency, and cadence were derived. The ability to discriminate between before and after medication intake and between patients with PD and controls was evaluated using leave-one-subject-out nested cross-validation. Results: From 18 patients with PD (11 men; median age 65 years) and 24 controls (13 men; median age 68 years), ?10 gait segments were available. Using logistic LASSO (least absolute shrinkage and selection operator) regression, we classified whether the unscripted gait segments occurred before or after medication intake, with mean area under the receiver operator curves (AUCs) varying between 0.70 (ankle of least affected side, 95% CI 0.60-0.81) and 0.82 (ankle of most affected side, 95% CI 0.72-0.92) across sensor locations. Combining all sensor locations did not significantly improve classification (AUC 0.84, 95% CI 0.75-0.93). Of all signal properties, the total power in the 0.5- to 10-Hz band was most responsive to dopaminergic medication. Discriminating between patients with PD and controls was generally more difficult (AUC of all sensor locations combined: 0.76, 95% CI 0.62-0.90). The video recordings revealed that the positioning of the hands during real-life gait had a substantial impact on the power spectral density of both the wrist and pants pocket sensor. Conclusions: We present a new video-referenced data set that includes unscripted activities in and around the participants? homes. Using this data set, we show the feasibility of using sensor-based analysis of real-life gait to monitor motor fluctuations with a single sensor location. Future work may assess the value of contextual sensors to control for real-world confounders. UR - https://www.jmir.org/2020/10/e19068 UR - http://dx.doi.org/10.2196/19068 UR - http://www.ncbi.nlm.nih.gov/pubmed/33034562 ID - info:doi/10.2196/19068 ER - TY - JOUR AU - Huang, Yitong AU - Benford, Steve AU - Price, Dominic AU - Patel, Roma AU - Li, Benqian AU - Ivanov, Alex AU - Blake, Holly PY - 2020/7/29 TI - Using Internet of Things to Reduce Office Workers? Sedentary Behavior: Intervention Development Applying the Behavior Change Wheel and Human-Centered Design Approach JO - JMIR Mhealth Uhealth SP - e17914 VL - 8 IS - 7 KW - sedentary behavior KW - workplace KW - just-in-time adaptive intervention KW - internet of things N2 - Background: Sedentary behavior (SB) is associated with various adverse health outcomes. The prevalence of prolonged sitting at work among office workers makes a case for SB interventions to target this setting and population. Everyday mundane objects with embedded microelectronics and ubiquitous computing represent a novel mode of delivering health behavior change interventions enabled by internet of things (IoTs). However, little is known about how to develop interventions involving IoT technologies. Objective: This paper reports the design and development of an IoT-enabled SB intervention targeting office workers. Methods: The process was guided by the behavior change wheel (BCW), a systematic framework for theory-informed and evidence-based development of behavior change interventions, complemented by the human-centered design (HCD) approach. Intervention design was shaped by findings from a diary-probed interview study (n=20), a stakeholder design workshop (n=8), and a series of theoretical mapping and collaborative technical design activities. Results: The resulting intervention named WorkMyWay targets a reduction in office workers? prolonged stationary behaviors at work and an increase in regular breaks by modifying behavioral determinants in 11 theoretical domains with 17 behavior change techniques. The delivery technology consists of a wearable activity tracker, a light-emitting diode reminder device attached to a vessel (ie, water bottle or cup), and a companion Android app connected to both devices over Bluetooth. The delivery plan consists of a 2-week baseline assessment, a 30-min face-to-face action planning session, and 6-week self-directed use of the delivery technology. Conclusions: This is the first study to demonstrate that it is possible to develop a complex IoT-enabled intervention by applying a combination of the BCW and HCD approaches. The next step is to assess the feasibility of WorkMyWay prior to testing intervention efficacy in a full-scale trial. The intervention mapping table that links individual intervention components with hypothesized mechanisms of action can serve as the basis for testing and clarifying theory-based mechanisms of action in future studies on WorkMyWay. UR - http://mhealth.jmir.org/2020/7/e17914/ UR - http://dx.doi.org/10.2196/17914 UR - http://www.ncbi.nlm.nih.gov/pubmed/32723716 ID - info:doi/10.2196/17914 ER - TY - JOUR AU - Flitcroft, Leah AU - Chen, Sun Won AU - Meyer, Denny PY - 2020/6/26 TI - The Demographic Representativeness and Health Outcomes of Digital Health Station Users: Longitudinal Study JO - J Med Internet Res SP - e14977 VL - 22 IS - 6 KW - population health KW - health behavior KW - health technology KW - eHealth KW - health status N2 - Background: Digital health stations offer an affordable and accessible platform for people to monitor their health; however, there is limited information regarding the demographic profile of users and the health benefits of this technology. Objective: This study aimed to assess the demographic representativeness of health station users, identify the factors associated with repeat utilization of stations, and determine if the health status of repeat users changed between baseline and final health check. Methods: Data from 180,442 health station users in Australia, including 8441 repeat users, were compared with 2014-2015 Australian National Health Survey (NHS) participants on key demographic and health characteristics. Binary logistic regression analyses were used to compare demographic and health characteristics of repeat and one-time users. Baseline and final health checks of repeat users were compared using McNemar tests and Wilcoxon signed rank tests. The relationship between the number of checks and final health scores was investigated using generalized linear models. Results: The demographic profile of SiSU health station users differs from that of the general population. A larger proportion of SiSU users were female (100,814/180,442, 55.87% vs 7807/15,393, 50.72%), younger (86,387/180,442, 47.88% vs 5309/15,393, 34.49% aged less than 35 years), and socioeconomically advantaged (64,388/180,442, 35.68% vs 3117/15,393, 20.25%). Compared with NHS participants, a smaller proportion of SiSU health station users were overweight or obese, were smokers, had high blood pressure (BP), or had diabetes. When data were weighted for demographic differences, only rates of high BP were found to be lower for SiSU users compared with the NHS participants (odds ratio [OR] 1.26; P<.001). Repeat users were more likely to be female (OR 1.37; P<.001), younger (OR 0.99; P<.001), and from high socioeconomic status areas?those residing in socioeconomic index for areas quintiles 4 and 5 were significantly more likely to be repeat users compared with those residing in quintile 1 (OR 1.243; P<.001 and OR 1.151; P<.001, respectively). Repeat users were more likely to have a higher BMI (OR 1.02; P<.001), high BP (OR 1.15; P<.001), and less likely to be smokers (OR 0.77; P<.001). Significant improvements in health status were observed for repeat users. Mean BMI decreased by 0.97 kg/m2 from baseline to final check (z=?14.24; P<.001), whereas the proportion of people with high BP decreased from 15.77% (1080/6848) to 12.90% (885/6860; ?21=38.2; P<.001). The proportion of smokers decreased from 11.91% (1005/8438) to 10.13% (853/8421; ?21=48.4; P<.001). Number of repeat health checks was significantly associated with smoking status (OR 0.96; P<.048) but not with higher BP (P=.14) or BMI (P=.23). Conclusions: These findings provide valuable insight into the benefits of health stations for self-monitoring and partially support previous research regarding the effect of demographics and health status on self-management of health. UR - http://www.jmir.org/2020/6/e14977/ UR - http://dx.doi.org/10.2196/14977 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589150 ID - info:doi/10.2196/14977 ER - TY - JOUR AU - Fadrique, X. Laura AU - Rahman, Dia AU - Vaillancourt, Hélène AU - Boissonneault, Paul AU - Donovska, Tania AU - Morita, P. Plinio PY - 2020/6/22 TI - Overview of Policies, Guidelines, and Standards for Active Assisted Living Data Exchange: Thematic Analysis JO - JMIR Mhealth Uhealth SP - e15923 VL - 8 IS - 6 KW - ambient assisted living KW - active assisted living KW - AAL KW - Internet of Things KW - aging well KW - aging in place KW - elderly KW - geriatrics KW - standards KW - policies KW - health care KW - ambient intelligence KW - domotics KW - ubiquitous health KW - wearable N2 - Background: A primary concern for governments and health care systems is the rapid growth of the aging population. To provide a better quality of life for the elderly, researchers have explored the use of wearables, sensors, actuators, and mobile health technologies. The term AAL can be referred to as active assisted living or ambient assisted living, with both sometimes used interchangeably. AAL technologies describes systems designed to improve the quality of life, aid in independence, and create healthier lifestyles for those who need assistance at any stage of their lives. Objective: The aim of this study was to understand the standards and policy guidelines that companies use in the creation of AAL technologies and to highlight the gap between available technologies, standards, and policies and what should be available for use. Methods: A literature review was conducted to identify critical standards and frameworks related to AAL. Interviews with 15 different stakeholders across Canada were carried out to complement this review. The results from interviews were coded using a thematic analysis and then presented in two workshops about standards, policies, and governance to identify future steps and opportunities regarding AAL. Results: Our study showed that the base technology, standards, and policies necessary for the creation of AAL technology are not the primary problem causing disparity between existing and accessible technologies; instead nontechnical issues and integration between existing technologies present the most significant issue. A total of five themes have been identified for further analysis: (1) end user and purpose; (2) accessibility; (3) interoperability; (4) data sharing; and (5) privacy and security. Conclusions: Interoperability is currently the biggest challenge for the future of data sharing related to AAL technology. Additionally, the majority of stakeholders consider privacy and security to be the main concerns related to data sharing in the AAL scope. Further research is necessary to explore each identified gap in detail. UR - https://mhealth.jmir.org/2020/6/e15923 UR - http://dx.doi.org/10.2196/15923 UR - http://www.ncbi.nlm.nih.gov/pubmed/32568090 ID - info:doi/10.2196/15923 ER - TY - JOUR AU - Seelye, Adriana AU - Leese, Isabelle Mira AU - Dorociak, Katherine AU - Bouranis, Nicole AU - Mattek, Nora AU - Sharma, Nicole AU - Beattie, Zachary AU - Riley, Thomas AU - Lee, Jonathan AU - Cosgrove, Kevin AU - Fleming, Nicole AU - Klinger, Jessica AU - Ferguson, John AU - Lamberty, John Greg AU - Kaye, Jeffrey PY - 2020/6/8 TI - Feasibility of In-Home Sensor Monitoring to Detect Mild Cognitive Impairment in Aging Military Veterans: Prospective Observational Study JO - JMIR Form Res SP - e16371 VL - 4 IS - 6 KW - aging KW - mild cognitive impairment KW - activities of daily living KW - technology N2 - Background: Aging military veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer dementia, which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signals of cognitive and daily functioning decline in older adults. Objective: This study aimed to evaluate the feasibility of a novel ecologically valid assessment approach that integrates passive in-home and mobile technologies to assess instrumental activities of daily living (IADLs) that are not well captured by clinic-based assessment methods in an aging military veteran sample. Methods: Participants included 30 community-dwelling military veterans, classified as healthy controls (mean age 72.8, SD 4.9 years; n=15) or MCI (mean age 74.3, SD 6.0 years; n=15) using the Clinical Dementia Rating Scale. Participants were in relatively good health (mean modified Cumulative Illness Rating Scale score 23.1, SD 2.9) without evidence of depression (mean Geriatrics Depression Scale score 1.3, SD 1.6) or anxiety (mean generalized anxiety disorder questionnaire 1.3, SD 1.3) on self-report measures. Participants were clinically assessed at baseline and 12 months later with health and daily function questionnaires and neuropsychological testing. Daily computer use, medication taking, and physical activity and sleep data were collected via passive computer monitoring software, an instrumented pillbox, and a fitness tracker watch in participants? environments for 12 months between clinical study visits. Results: Enrollment began in October 2018 and continued until the study groups were filled in January 2019. A total of 201 people called to participate following public posting and focused mailings. Most common exclusionary criteria included nonveteran status 11.4% (23/201), living too far from the study site 9.4% (19/201), and having exclusionary health concerns 17.9% (36/201). Five people have withdrawn from the study: 2 with unanticipated health conditions, 2 living in a vacation home for more than half of the year, and 1 who saw no direct benefit from the research study. At baseline, MCI participants had lower Montreal Cognitive Assessment (P<.001) and higher Functional Activities Questionnaire (P=.04) scores than healthy controls. Over seven months, research personnel visited participants? homes a total of 73 times for technology maintenance. Technology maintenance visits were more prevalent for MCI participants (P=.04) than healthy controls. Conclusions: Installation and longitudinal deployment of a passive in-home IADL monitoring platform with an older adult military veteran sample was feasible. Knowledge gained from this pilot study will be used to help develop acceptable and effective home-based assessment tools that can be used to passively monitor cognition and daily functioning in older adult samples. UR - https://formative.jmir.org/2020/6/e16371 UR - http://dx.doi.org/10.2196/16371 UR - http://www.ncbi.nlm.nih.gov/pubmed/32310138 ID - info:doi/10.2196/16371 ER - TY - JOUR AU - Rawtaer, Iris AU - Mahendran, Rathi AU - Kua, Heok Ee AU - Tan, Pink Hwee AU - Tan, Xian Hwee AU - Lee, Tih-Shih AU - Ng, Pin Tze PY - 2020/5/5 TI - Early Detection of Mild Cognitive Impairment With In-Home Sensors to Monitor Behavior Patterns in Community-Dwelling Senior Citizens in Singapore: Cross-Sectional Feasibility Study JO - J Med Internet Res SP - e16854 VL - 22 IS - 5 KW - dementia KW - neurocognitive disorder KW - pattern recognition, automated/methods KW - internet of things KW - early diagnosis N2 - Background: Dementia is a global epidemic and incurs substantial burden on the affected families and the health care system. A window of opportunity for intervention is the predementia stage known as mild cognitive impairment (MCI). Individuals often present to services late in the course of their disease and more needs to be done for early detection; sensor technology is a potential method for detection. Objective: The aim of this cross-sectional study was to establish the feasibility and acceptability of utilizing sensors in the homes of senior citizens to detect changes in behaviors unobtrusively. Methods: We recruited 59 community-dwelling seniors (aged >65 years who live alone) with and without MCI and observed them over the course of 2 months. The frequency of forgetfulness was monitored by tagging personal items and tracking missed doses of medication. Activities such as step count, time spent away from home, television use, sleep duration, and quality were tracked with passive infrared motion sensors, smart plugs, bed sensors, and a wearable activity band. Measures of cognition, depression, sleep, and social connectedness were also administered. Results: Of the 49 participants who completed the study, 28 had MCI and 21 had healthy cognition (HC). Frequencies of various sensor-derived behavior metrics were computed and compared between MCI and HC groups. MCI participants were less active than their HC counterparts and had more sleep interruptions per night. MCI participants had forgotten their medications more times per month compared with HC participants. The sensor system was acceptable to over 80% (40/49) of study participants, with many requesting for permanent installation of the system. Conclusions: We demonstrated that it was both feasible and acceptable to set up these sensors in the community and unobtrusively collect data. Further studies evaluating such digital biomarkers in the homes in the community are needed to improve the ecological validity of sensor technology. We need to refine the system to yield more clinically impactful information. UR - https://www.jmir.org/2020/5/e16854 UR - http://dx.doi.org/10.2196/16854 UR - http://www.ncbi.nlm.nih.gov/pubmed/32369031 ID - info:doi/10.2196/16854 ER - TY - JOUR AU - Zhou, Xiaoping AU - Zhao, Jichao AU - Liang, Xun PY - 2020/4/3 TI - Cyberphysical Human Sexual Behavior Acquisition System (SeBA): Development and Implementation Study in China JO - JMIR Mhealth Uhealth SP - e12677 VL - 8 IS - 4 KW - cyberphysical system KW - sexual behavior KW - smart sex toys KW - mobile social network N2 - Background: Sexual health is one of the principal components of human well-being. Traditional methods for observing human sexual behavior typically adopt manual intervention approaches (eg, interviews). However, the data obtained by such traditional approaches suffer from intrinsic bias and limited sample sizes. Sexual behavioral data that are more reflective of the actualsituation can be collected by equipping sex toys with sensors. Objective: To address the limitations of traditional human sexual behavior data observation methods, a novel cyberphysical system is proposed to capture natural human sexual behavior data in China at the nationwide level. Methods: A cyberphysical human sexual behavior acquisition system (SeBA) was designed and implemented. SeBA jointly utilizes state of the art information and communication technologies such as smart sex toys, smartphones, and mobile social networks. Smart sex toys enable objective collection of data on human sexual behavior, while the mobile social network provides the possibility of partnered sex in a cyberphysical manner. The objectives and function settings are discussed, and the overall framework of the system architecture is presented. Results: Operation and privacy policies are proposed and the technical solution of SeBA is described. The effectiveness of SeBA was verified based on analysis of users? human sexual behavior data collected from January 2016 to June 2017. A total of 103,424 solo sexual behaviors were recorded involving 13,047 users, and 61,007 partnered sexual behaviors from 7,140 users were observed. The proportions of males and females in the solo and partnered sex groups were fairly consistent with recent statistics on unmarried individuals in China. We also found that only a small portion of individuals provided information on at least one other attribute besides the required input of gender, such as age, height, location, job, sex preferences, purposes, and interests. Conclusions: To the best of our knowledge, this is the first study to analyze objective human sexual behavior data at the nationwide level. Although the data are restricted to China, this study can provide insight for further research on human sexual behavior based on the huge amount of data available from wireless smart sex toys worldwide. It is anticipated that findings from such objective big data analyses can help deepen our understanding of sexual behavior, as well as improve sexual health and sexual wellness. UR - https://mhealth.jmir.org/2020/4/e12677 UR - http://dx.doi.org/10.2196/12677 UR - http://www.ncbi.nlm.nih.gov/pubmed/32271153 ID - info:doi/10.2196/12677 ER - TY - JOUR AU - Besoain, Felipe AU - Perez-Navarro, Antoni AU - Jacques Aviñó, Constanza AU - Caylà, A. Joan AU - Barriga, A. Nicolas AU - Garcia de Olalla, Patricia PY - 2020/3/17 TI - Prevention of HIV and Other Sexually Transmitted Infections by Geofencing and Contextualized Messages With a Gamified App, UBESAFE: Design and Creation Study JO - JMIR Mhealth Uhealth SP - e14568 VL - 8 IS - 3 KW - human immunodeficiency virus KW - mobile apps KW - sexually transmitted infection KW - recreational games N2 - Background: Advances in the development of information and communication technologies have facilitated social and sexual interrelationships, thanks to the websites and apps created to this end. However, these resources can also encourage sexual contacts without appropriate preventive measures in relation to HIV and other sexually transmitted infections (STIs). How can users be helped to benefit from the advantages of these apps while keeping in mind those preventive measures? Objective: This study aimed to prevent STIs by helping users to remember preventive measures in the risky situations. Methods: We have used the design and creation methodology and have developed a software system. This system has two parts: an Android operating system app with emphasis on ubiquitous computing and gamification as well as a server with a webpage. First, a functional test with 5 men who have sex with men (MSM) allowed us to test the app with end users. In addition, a feasibility test with 4 MSM for a month allowed us to try the UBESAFE system with all its functionalities. Results: The main output is a system called UBESAFE that is addressed to MSM. The system has two main parts: (1) an app that sends preventive contextualized messages to users when they use a contact app or when they are near a point where sexual contacts are likely and (2) a server part that was managed by the public health agency of Barcelona (ASPB), which preserves the quality and pertinence of messages and places and offers instant help to users. To increase users? adherence, UBESAFE uses a gamified system to engage users in the creation of preventive messages. Users increased the initial pool of messages by more than 100% (34/30) and created more than 56% (9/16) of places (named hot zones). Conclusions: The system helped MSM who used it to become conscious about HIV and other STIs. The system also helped the ASPB to stay in contact with MSM and to detect behaviors that could benefit from preventive measures. All functions were performed in a nonintrusive manner because users used the app privately. Furthermore, the system has shown how important it is to make users a part of the creation process as well as to develop apps that work by themselves and thus become useful to the users. UR - http://mhealth.jmir.org/2020/3/e14568/ UR - http://dx.doi.org/10.2196/14568 UR - http://www.ncbi.nlm.nih.gov/pubmed/32181752 ID - info:doi/10.2196/14568 ER - TY - JOUR AU - L'Hommedieu, Michelle AU - L'Hommedieu, Justin AU - Begay, Cynthia AU - Schenone, Alison AU - Dimitropoulou, Lida AU - Margolin, Gayla AU - Falk, Tiago AU - Ferrara, Emilio AU - Lerman, Kristina AU - Narayanan, Shrikanth PY - 2019/12/10 TI - Lessons Learned: Recommendations For Implementing a Longitudinal Study Using Wearable and Environmental Sensors in a Health Care Organization JO - JMIR Mhealth Uhealth SP - e13305 VL - 7 IS - 12 KW - research KW - research techniques KW - Ecological Momentary Assessment KW - wearable electronic devices UR - https://mhealth.jmir.org/2019/12/e13305 UR - http://dx.doi.org/10.2196/13305 UR - http://www.ncbi.nlm.nih.gov/pubmed/31821155 ID - info:doi/10.2196/13305 ER - TY - JOUR AU - Piau, Antoine AU - Wild, Katherine AU - Mattek, Nora AU - Kaye, Jeffrey PY - 2019/08/30 TI - Current State of Digital Biomarker Technologies for Real-Life, Home-Based Monitoring of Cognitive Function for Mild Cognitive Impairment to Mild Alzheimer Disease and Implications for Clinical Care: Systematic Review JO - J Med Internet Res SP - e12785 VL - 21 IS - 8 KW - technology KW - Alzheimer disease KW - cognition disorders KW - dementia KW - older adults KW - digital biomarkers KW - digital phenotyping KW - digital health N2 - Background: Among areas that have challenged the progress of dementia care has been the assessment of change in symptoms over time. Digital biomarkers are defined as objective, quantifiable, physiological, and behavioral data that are collected and measured by means of digital devices, such as embedded environmental sensors or wearables. Digital biomarkers provide an alternative assessment approach, as they allow objective, ecologically valid, and long-term follow-up with continuous assessment. Despite the promise of a multitude of sensors and devices that can be applied, there are no agreed-upon standards for digital biomarkers, nor are there comprehensive evidence-based results for which digital biomarkers may be demonstrated to be most effective. Objective: In this review, we seek to answer the following questions: (1) What is the evidence for real-life, home-based use of technologies for early detection and follow-up of mild cognitive impairment (MCI) or dementia? And (2) What transformation might clinicians expect in their everyday practices? Methods: A systematic search was conducted in PubMed, Cochrane, and Scopus databases for papers published from inception to July 2018. We searched for studies examining the implementation of digital biomarker technologies for mild cognitive impairment or mild Alzheimer disease follow-up and detection in nonclinic, home-based settings. All studies that included the following were examined: community-dwelling older adults (aged 65 years or older); cognitively healthy participants or those presenting with cognitive decline, from subjective cognitive complaints to early Alzheimer disease; a focus on home-based evaluation for noninterventional follow-up; and remote diagnosis of cognitive deterioration. Results: An initial sample of 4811 English-language papers were retrieved. After screening and review, 26 studies were eligible for inclusion in the review. These studies ranged from 12 to 279 participants and lasted between 3 days to 3.6 years. Most common reasons for exclusion were as follows: inappropriate setting (eg, hospital setting), intervention (eg, drugs and rehabilitation), or population (eg, psychiatry and Parkinson disease). We summarized these studies into four groups, accounting for overlap and based on the proposed technological solutions, to extract relevant data: (1) data from dedicated embedded or passive sensors, (2) data from dedicated wearable sensors, (3) data from dedicated or purposive technological solutions (eg, games or surveys), and (4) data derived from use of nondedicated technological solutions (eg, computer mouse movements). Conclusions: Few publications dealt with home-based, real-life evaluations. Most technologies were far removed from everyday life experiences and were not mature enough for use under nonoptimal or uncontrolled conditions. Evidence available from embedded passive sensors represents the most relatively mature research area, suggesting that some of these solutions could be proposed to larger populations in the coming decade. The clinical and research communities would benefit from increasing attention to these technologies going forward. UR - http://www.jmir.org/2019/8/e12785/ UR - http://dx.doi.org/10.2196/12785 UR - http://www.ncbi.nlm.nih.gov/pubmed/31471958 ID - info:doi/10.2196/12785 ER - TY - JOUR AU - Crossley, Morgan Sam Graeme AU - McNarry, Anne Melitta AU - Eslambolchilar, Parisa AU - Knowles, Zoe AU - Mackintosh, Alexandra Kelly PY - 2019/5/31 TI - The Tangibility of Personalized 3D-Printed Feedback May Enhance Youths? Physical Activity Awareness, Goal Setting, and Motivation: Intervention Study JO - J Med Internet Res SP - e12067 VL - 21 IS - 6 KW - behavior change KW - health education KW - feedback KW - self-monitoring KW - accelerometry KW - schools KW - adolescent KW - child N2 - Background: In the United Kingdom, most youth fail to achieve the government guideline of 60 min of moderate to vigorous physical activity (MVPA) daily. Reasons that are frequently cited for the underachievement of this guideline include (1) a lack of awareness of personal physical activity levels (PALs) and (2) a lack of understanding of what activities and different intensities contribute to daily targets of physical activity (PA). Technological advances have enabled novel ways of representing PA data through personalized tangible three-dimensional (3D) models. Objective: The purpose of this study was to investigate the efficacy of 3D-printed models to enhance youth awareness and understanding of and motivation to engage in PA. Methods: A total of 39 primary school children (22 boys; mean age 7.9 [SD 0.3] years) and 58 secondary school adolescents (37 boys; mean age 13.8 [SD 0.3] years) participated in a 7-week fading intervention, whereby participants were given 3D-printed models of their previous week?s objectively assessed PALs at 4 time points. Following the receipt of their 3D model, each participant completed a short semistructured video interview (children, 4.5 [SD 1.2] min; adolescents, 2.2 [SD 0.6] min) to assess their PA awareness, understanding, and motivation. Data were transcribed verbatim and thematically analyzed to enable key emergent themes to be further explored and identified. Results: Analyses revealed that the 3D models enhanced the youths? awareness of and ability to recall and self-evaluate their PA behaviors. By the end of the study, the youths, irrespective of age, were able to correctly identify and relate to the government?s PA guideline represented on the models, despite their inability to articulate the government's guideline through time and intensity. Following the fourth 3D model, 72% (71/97) of the youths used the models as a goal-setting strategy, further highlighting such models as a motivational tool to promote PA. Conclusions: The results suggest that 3D-printed models of PA enhanced the youths? awareness of their PA levels and provided a motivational tool for goal setting, potentially offering a unique strategy for future PA promotion. UR - https://www.jmir.org/2019/6/e12067/ UR - http://dx.doi.org/10.2196/12067 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199322 ID - info:doi/10.2196/12067 ER - TY - JOUR AU - Thorpe, Rosemary Julia AU - Forchhammer, Hysse Birgitte AU - Maier, M. Anja PY - 2019/5/30 TI - Development of a Sensor-Based Behavioral Monitoring Solution to Support Dementia Care JO - JMIR Mhealth Uhealth SP - e12013 VL - 7 IS - 6 KW - ambulatory monitoring KW - patient-centered care KW - physical activity KW - dementia KW - wearable electronics devices KW - activity trackers KW - mHealth KW - human behavior KW - system design N2 - Background: Mobile and wearable technology presents exciting opportunities for monitoring behavior using widely available sensor data. This could support clinical research and practice aimed at improving quality of life among the growing number of people with dementia. However, it requires suitable tools for measuring behavior in a natural real-life setting that can be easily implemented by others. Objective: The objectives of this study were to develop and test a set of algorithms for measuring mobility and activity and to describe a technical setup for collecting the sensor data that these algorithms require using off-the-shelf devices. Methods: A mobility measurement module was developed to extract travel trajectories and home location from raw GPS (global positioning system) data and to use this information to calculate a set of spatial, temporal, and count-based mobility metrics. Activity measurement comprises activity bout extraction from recognized activity data and daily step counts. Location, activity, and step count data were collected using smartwatches and mobile phones, relying on open-source resources as far as possible for accessing data from device sensors. The behavioral monitoring solution was evaluated among 5 healthy subjects who simultaneously logged their movements for 1 week. Results: The evaluation showed that the behavioral monitoring solution successfully measures travel trajectories and mobility metrics from location data and extracts multimodal activity bouts during travel between locations. While step count could be used to indicate overall daily activity level, a concern was raised regarding device validity for step count measurement, which was substantially higher from the smartwatches than the mobile phones. Conclusions: This study contributes to clinical research and practice by providing a comprehensive behavioral monitoring solution for use in a real-life setting that can be replicated for a range of applications where knowledge about individual mobility and activity is relevant. UR - https://mhealth.jmir.org/2019/6/e12013/ UR - http://dx.doi.org/10.2196/12013 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199304 ID - info:doi/10.2196/12013 ER - TY - JOUR AU - Norell Pejner, Margaretha AU - Ourique de Morais, Wagner AU - Lundström, Jens AU - Laurell, Hélène AU - Skärsäter, Ingela PY - 2019/04/30 TI - A Smart Home System for Information Sharing, Health Assessments, and Medication Self-Management for Older People: Protocol for a Mixed-Methods Study JO - JMIR Res Protoc SP - e12447 VL - 8 IS - 4 KW - assessments KW - medication KW - mixed methods KW - older people KW - self-management KW - smart homes N2 - Background: Older adults often want to stay in a familiar place, such as their home, as they get older. This so-called aging in place, which may involve support from relatives or care professionals, can promote older people?s independence and well-being. The combination of aging and disease, however, can lead to complex medication regimes and difficulties for care providers in correctly assessing the older person's health. In addition, the organization of health care is fragmented, which makes it difficult for health professionals to encourage older people to participate in their own care. It is also a challenge to perform adequate health assessments and to engage in appropriate communication between health care professionals. Objective: The purpose of this paper is to describe the design for an integrated home-based system that can acquire and compile health-related evidence for guidance and information-sharing among care providers and care receivers in order to support and promote medication self-management among older people. Methods: The authors used a participatory design approach for this mixed-methods project, which was divided into four phases. Phase I, Conceptualization, consists of the conceptualization of a system to support medication self-management, objective health assessments, and communication between health care professionals. Phase II, Development of a System, consists of building and bringing together the conceptualized systems from Phase I. Phase III, Pilot Study, and Phase IV, Full-Scale Intervention, are described briefly. Results: Participants in Phase I were people who were involved in some way in the care of older adults and included older adults themselves, relatives of older adults, care professionals, and industrial partners. With input from Phase I participants, we identified two relevant concepts for promoting medication self-management, both of which related to systems that participants believed could provide guidance for the older adults themselves, relatives of older adults, and care professionals. The systems will also encourage information-sharing between care providers and care receivers. The first is the concept of the Intelligent Age-Friendly Home (IAFH), defined as an integrated residential system that evolves to sense, reason, and act in response to individuals? needs, preferences, and behaviors as these change over time. The second concept is the Medication safety, Objective assessments of health-related behaviors, and Personalized medication reminders (MedOP) system, a system that would be supported by the IAFH, and which consists of three related components: one that assesses health behaviors, another that communicates health data, and a third that promotes medication self-management. Conclusions: The participants in this project were older adults, relatives of older adults, care professionals, and our industrial partners. With input from the participants, we identified two main concepts that could comprise a system for health assessment, communication, and medication self-management: the IAFH and the MedOP system. These concepts will be tested in this study to determine whether they can facilitate and promote medication self-management among older people. International Registered Report Identifier (IRRID): DERR1-10.2196/12447 UR - http://www.researchprotocols.org/2019/4/e12447/ UR - http://dx.doi.org/10.2196/12447 UR - http://www.ncbi.nlm.nih.gov/pubmed/31038459 ID - info:doi/10.2196/12447 ER - TY - JOUR AU - Berridge, Clara AU - Chan, T. Keith AU - Choi, Youngjun PY - 2019/03/25 TI - Sensor-Based Passive Remote Monitoring and Discordant Values: Qualitative Study of the Experiences of Low-Income Immigrant Elders in the United States JO - JMIR Mhealth Uhealth SP - e11516 VL - 7 IS - 3 KW - immigrants KW - ubiquitous sensing KW - acculturation KW - passive monitoring KW - independent living KW - family caregiving KW - culturally appropriate technology N2 - Background: Remote monitoring technologies are positioned to mitigate the problem of a dwindling care workforce and disparities in access to care for the growing older immigrant population in the United States. To achieve these ends, designers and providers need to understand how these supports can be best provided in the context of various sociocultural environments that shape older adults? expectations and care relationships, yet few studies have examined how the same remote monitoring technologies may produce different effects and uses depending on what population is using them in a particular context. Objective: This study aimed to examine the experiences and insights of low-income, immigrant senior residents, family contacts, and staff of housing that offered a sensor-based passive monitoring system designed to track changes in movement around the home and trigger alerts for caregivers. The senior housing organization had been offering the QuietCare sensor system to its residents for 6 years at the time of the study. We are interested in adoption and discontinuation decisions and use over time, rather than projected acceptance. Our research question is how do cultural differences influence use and experiences with this remote monitoring technology? The study does not draw generalizable conclusions about how cultural groups interact with a given technology, but rather, it examines how values are made visible in elder care technology interactions. Methods: A total of 41 participants (residents, family, and staff) from 6 large senior housing independent living apartment buildings were interviewed. Interviews were conducted in English and Korean with these participants who collectively had immigrated to the United States from 10 countries. Results: The reactions of immigrant older adults to the passive monitoring system reveal that this tool offered to them was often mismatched with their values, needs, and expectations. Asian elders accepted the intervention social workers offered largely to appease them, but unlike their US-born counterparts, they adopted reluctantly without hope that it would ameliorate their situation. Asian immigrants discontinued use at the highest rate of all residents, and intergenerational family cultural conflict contributed to this termination. Social workers reported that none of the large population of Russian-speaking residents agreed to use QuietCare. Bilingual and bicultural social workers played significant roles as cultural navigators in the promotion of QuietCare to residents. Conclusions: This research into the interactions of culturally diverse people with the same monitoring technology reveals the significant role that social values and context play in shaping how people and families interact with and experience elder care interventions. If technology-based care services are to reach their full potential, it will be important to identify the ways in which cultural values produce different uses and responses to technologies intended to help older adults live independently. UR - http://mhealth.jmir.org/2019/3/e11516/ UR - http://dx.doi.org/10.2196/11516 UR - http://www.ncbi.nlm.nih.gov/pubmed/30907741 ID - info:doi/10.2196/11516 ER - TY - JOUR AU - Crossley, Morgan Sam Graeme AU - McNarry, Anne Melitta AU - Rosenberg, Michael AU - Knowles, R. Zoe AU - Eslambolchilar, Parisa AU - Mackintosh, Alexandra Kelly PY - 2019/02/22 TI - Understanding Youths? Ability to Interpret 3D-Printed Physical Activity Data and Identify Associated Intensity Levels: Mixed-Methods Study JO - J Med Internet Res SP - e11253 VL - 21 IS - 2 KW - 3D printing KW - education KW - adolescent KW - child KW - comprehension KW - understanding KW - mental recall N2 - Background: A significant proportion of youth in the United Kingdom fail to meet the recommended 60 minutes of moderate-to-vigorous physical activity every day. One of the major barriers encountered in achieving these physical activity recommendations is the perceived difficulty for youths to interpret physical activity intensity levels and apply them to everyday activities. Personalized physical activity feedback is an important method to educate youths about behaviors and associated outcomes. Recent advances in 3D printing have enabled novel ways of representing physical activity levels through personalized tangible feedback to enhance youths? understanding of concepts and make data more available in the everyday physical environment rather than on screen. Objective: The purpose of this research was to elicit youths? (children and adolescents) interpretations of two age-specific 3D models displaying physical activity and to assess their ability to appropriately align activities to the respective intensity. Methods: Twelve primary school children (9 boys; mean age 7.8 years; SD 0.4 years) and 12 secondary school adolescents (6 boys; mean age 14.1 years; SD 0.3 years) participated in individual semistructured interviews. Interview questions, in combination with two interactive tasks, focused on youths? ability to correctly identify physical activity intensities and interpret an age-specific 3D model. Interviews were transcribed verbatim, content was analyzed, and outcomes were represented via tables and diagrammatic pen profiles. Results: Youths, irrespective of age, demonstrated a poor ability to define moderate-intensity activities. Moreover, children and adolescents demonstrated difficulty in correctly identifying light- and vigorous-intensity activities, respectively. Although youths were able to correctly interpret different components of the age-specific 3D models, children struggled to differentiate physical activity intensities represented in the models. Conclusions: These findings support the potential use of age-specific 3D models of physical activity to enhance youths? understanding of the recommended guidelines and associated intensities. UR - http://www.jmir.org/2019/2/e11253/ UR - http://dx.doi.org/10.2196/11253 UR - http://www.ncbi.nlm.nih.gov/pubmed/30794204 ID - info:doi/10.2196/11253 ER - TY - JOUR AU - Kang, Hyo-Jin AU - Han, Jieun AU - Kwon, Hyun Gyu PY - 2019/02/08 TI - An Ecological Approach to Smart Homes for Health Care Services: Conceptual Framework of a Smart Servicescape Wheel JO - JMIR Mhealth Uhealth SP - e12425 VL - 7 IS - 2 KW - health care information management KW - system analysis, smart homes for health care services KW - ecological approach KW - conceptual framework KW - smart servicescape wheel N2 - Background: Smart homes are considered effective solutions for home health care for the elderly, as smart home technologies can reduce care costs and improve elderly residents? independence. To develop a greater understanding of smart homes for health care services (SHHSs), this study accentuated the necessity of ecological approaches with an emphasis on environmental constraints. This study was based on 2 rationales: (1) users are inclined to perceive the service quality and service experience from environments (ie, servicescape) owing to the intangibility of health care and the pervasiveness of smart home technologies, and (2) both service domains are complex adaptive systems in which diversified and undefined service experiences?not only a few intended service flows?can be generated by complex combinations of servicescape elements. Objective: This study proposed the conceptual framework of a Smart Servicescape Wheel (SSW) as an ecological approach delineating the extensive spectrum of environmental constraints in SHHSs. Methods: The SSW framework was established based on a literature review. Results: Generally divided by perceptible and imperceptible servicescapes, the SSW consists of the perceptible Physical scape (ie, hardware components, environmental cues, and human states) and Social scape (ie, service relationships and social relationships) as well as the imperceptible Datascape (ie, computing intelligence, databases, and communication networks). Following the ecological approach, each category of the SSW is subdivided and defined at the level of components or functions. Conclusions: The SSW?s strengths lie in the various application opportunities for SHHSs. In terms of service planning and development, the SSW can be utilized to (1) establish the requirements for SHHS development, (2) associate with work domain analysis by defining component layers, and (3) understand the real contexts of SHHSs for the enhanced prediction of diverse service experiences. Regarding service management, it can be applied to develop measurement items for the operation and evaluation of SHHSs. UR - http://mhealth.jmir.org/2019/2/e12425/ UR - http://dx.doi.org/10.2196/12425 UR - http://www.ncbi.nlm.nih.gov/pubmed/30735145 ID - info:doi/10.2196/12425 ER - TY - JOUR AU - Crossley, Morgan Sam Graeme AU - McNarry, Anne Melitta AU - Hudson, Joanne AU - Eslambolchilar, Parisa AU - Knowles, Zoe AU - Mackintosh, Alexandra Kelly PY - 2019/01/30 TI - Perceptions of Visualizing Physical Activity as a 3D-Printed Object: Formative Study JO - J Med Internet Res SP - e12064 VL - 21 IS - 1 KW - 3D printing KW - feedback KW - youth KW - education KW - school N2 - Background: The UK government recommends that children engage in moderate-to-vigorous physical activity for at least 60 min every day. Despite associated physiological and psychosocial benefits of physical activity, many youth fail to meet these guidelines partly due to sedentary screen-based pursuits displacing active behaviors. However, technological advances such as 3D printing have enabled innovative methods of visualizing and conceptualizing physical activity as a tangible output. Objective: The aim of this study was to elicit children?s, adolescents?, parents?, and teachers? perceptions and understanding of 3D physical activity objects to inform the design of future 3D models of physical activity. Methods: A total of 28 primary school children (aged 8.4 [SD 0.3] years; 15 boys) and 42 secondary school adolescents (aged 14.4 [SD 0.3] years; 22 boys) participated in semistructured focus groups, with individual interviews conducted with 8 teachers (2 male) and 7 parents (2 male). Questions addressed understanding of the physical activity guidelines, 3D model design, and both motivation for and potential engagement with a 3D physical activity model intervention. Pupils were asked to use Play-Doh to create and describe a model that could represent their physical activity levels (PAL). Data were transcribed verbatim and thematically analyzed, and key emergent themes were represented using pen profiles. Results: Pupils understood the concept of visualizing physical activity as a 3D object, although adolescents were able to better analyze and critique differences between low and high PAL. Both youths and adults preferred a 3D model representing a week of physical activity data when compared with other temporal representations. Furthermore, all participants highlighted that 3D models could act as a motivational tool to enhance youths? physical activity. From the Play-Doh designs, 2 key themes were identified by pupils, with preferences indicated for models of abstract representations of physical activity or bar charts depicting physical activity, respectively. Conclusions: These novel findings highlight the potential utility of 3D objects of physical activity as a mechanism to enhance children?s and adolescents? understanding of, and motivation to increase, their PAL. This study suggests that 3D printing may offer a unique strategy for promoting physical activity in these groups. UR - http://www.jmir.org/2019/1/e12064/ UR - http://dx.doi.org/10.2196/12064 UR - http://www.ncbi.nlm.nih.gov/pubmed/30698532 ID - info:doi/10.2196/12064 ER - TY - JOUR AU - Conn, J. Nicholas AU - Schwarz, Q. Karl AU - Borkholder, A. David PY - 2019/01/18 TI - In-Home Cardiovascular Monitoring System for Heart Failure: Comparative Study JO - JMIR Mhealth Uhealth SP - e12419 VL - 7 IS - 1 KW - ballistocardiogram KW - BCG KW - blood pressure KW - ECG KW - electrocardiogram KW - heart failure KW - Internet of Things KW - IoT KW - photoplethysmogram KW - PPG KW - remote monitoring KW - SpO2 KW - stroke volume N2 - Background: There is a pressing need to reduce the hospitalization rate of heart failure patients to limit rising health care costs and improve outcomes. Tracking physiologic changes to detect early deterioration in the home has the potential to reduce hospitalization rates through early intervention. However, classical approaches to in-home monitoring have had limited success, with patient adherence cited as a major barrier. This work presents a toilet seat?based cardiovascular monitoring system that has the potential to address low patient adherence as it does not require any change in habit or behavior. Objective: The objective of this work was to demonstrate that a toilet seat?based cardiovascular monitoring system with an integrated electrocardiogram, ballistocardiogram, and photoplethysmogram is capable of clinical-grade measurements of systolic and diastolic blood pressure, stroke volume, and peripheral blood oxygenation. Methods: The toilet seat?based estimates of blood pressure and peripheral blood oxygenation were compared to a hospital-grade vital signs monitor for 18 subjects over an 8-week period. The estimated stroke volume was validated on 38 normative subjects and 111 subjects undergoing a standard echocardiogram at a hospital clinic for any underlying condition, including heart failure. Results: Clinical grade accuracy was achieved for all of the seat measurements when compared to their respective gold standards. The accuracy of diastolic blood pressure and systolic blood pressure is 1.2 (SD 6.0) mm Hg (N=112) and ?2.7 (SD 6.6) mm Hg (N=89), respectively. Stroke volume has an accuracy of ?2.5 (SD 15.5) mL (N=149) compared to an echocardiogram gold standard. Peripheral blood oxygenation had an RMS error of 2.3% (N=91). Conclusions: A toilet seat?based cardiovascular monitoring system has been successfully demonstrated with blood pressure, stroke volume, and blood oxygenation accuracy consistent with gold standard measures. This system will be uniquely positioned to capture trend data in the home that has been previously unattainable. Demonstration of the clinical benefit of the technology requires additional algorithm development and future clinical trials, including those targeting a reduction in heart failure hospitalizations. UR - http://mhealth.jmir.org/2019/1/e12419/ UR - http://dx.doi.org/10.2196/12419 UR - http://www.ncbi.nlm.nih.gov/pubmed/30664492 ID - info:doi/10.2196/12419 ER - TY - JOUR AU - Yoo, Junsang AU - Soh, Yeong Ji AU - Lee, Hyoung Wan AU - Chang, Kyung Dong AU - Lee, Uk Se AU - Cha, Chul Won PY - 2018/11/22 TI - Experience of Emergency Department Patients With Using the Talking Pole Device: Prospective Interventional Descriptive Study JO - JMIR Mhealth Uhealth SP - e191 VL - 6 IS - 11 KW - emergency department KW - health information technology KW - Internet of Things KW - mobile phone KW - patient engagement N2 - Background: Patient engagement is important. However, it can be difficult in emergency departments (EDs). Objective: The aim of this study was to evaluate the satisfaction of ED patients using a patient-friendly health information technology (HIT) device, the ?Talking Pole,? and to assess the factors relevant to their satisfaction. Methods: This study was conducted in May 2017 at the ED of a tertiary hospital. The ?Talking Pole? is a smartphone-based device attached to a intravenous infusion pole with sensors. It is capable of sensing patient movement and fluid dynamics. In addition, it provides clinical information from electronic medical records to patients and serves as a wireless communication tool between patients and nurses. Patients and caregivers who entered the observation room of the ED were selected for the study. The ?Talking Pole? devices were provided to all participants, regardless of their need for an intravenous pole upon admittance to the ED. After 2 hours, each participant was given an 18-item questionnaire created for this research, measured on a 5-point Likert scale, regarding their satisfaction with ?Talking Pole.? Results: Among 52 participants recruited, 54% (28/52) were patients and the remaining were caregivers. In total, 38% (20/52) were male participants; the average age was 54.6 (SD 12.9) years, and 63% (33/52) of the participants were oncology patients and their caregivers. The overall satisfaction rate was 4.17 (SD 0.79 ) points. Spearman correlation coefficient showed a strong association of ?overall satisfaction? with ?comparison to the previous visit? (?=.73 ), ?perceived benefit? (?=.73), ?information satisfaction? (?=.70), and ?efficiency? (?=.70). Conclusions: In this study, we introduced a patient-friendly HIT device, the ?Talking Pole.? Its architecture focused on enhancing information delivery, which is regarded as a bottleneck toward achieving patient engagement in EDs. Patient and caregiver satisfaction with the ?Talking Pole? was positive in the ED environment. In particular, correlation coefficient results improved our understanding about patients? satisfaction, HIT devices, and services used in the ED. UR - http://mhealth.jmir.org/2018/11/e191/ UR - http://dx.doi.org/10.2196/mhealth.9676 UR - http://www.ncbi.nlm.nih.gov/pubmed/30467105 ID - info:doi/10.2196/mhealth.9676 ER - TY - JOUR AU - Jamwal, Rebecca AU - Callaway, Libby AU - Winkler, Di AU - Farnworth, Louise AU - Tate, Robyn PY - 2018/11/08 TI - Evaluating the Use of Smart Home Technology by People With Brain Impairment: Protocol for a Single-Case Experimental Design JO - JMIR Res Protoc SP - e10451 VL - 7 IS - 11 KW - assistive technology KW - clinical research protocol KW - disabled persons KW - housing KW - mobile phone N2 - Background: Smart home technologies are emerging as a useful component of support delivery for people with brain impairment. To promote their successful uptake and sustained use, focus on technology support services, including training, is required. Objective: The objective of this paper is to present a systematic smart home technology training approach for people with brain impairment. In addition, the paper outlines a multiple-baseline, single-case experimental design methodology to evaluate training effectiveness. Methods: Adult participants experiencing acquired brain impairment who can provide consent to participate and who live in housing where smart home technology is available will be recruited. Target behaviors will be identified in consultation with each participant based on his or her personal goals for technology use. Target behaviors may include participant knowledge of the number and type of technology functions available, frequency of smart home technology use, and number of function types used. Usage data will be gathered via log-on smart home technology servers. A smart technology digital training package will also be developed and left on a nominated device (smartphone, tablet) with each participant to use during the trial and posttrial, as desired. Measures of the target behavior will be taken throughout the baseline, intervention, and postintervention phases to provide the evidence of impact of the training on the target behaviors and ascertain whether utilization rates are sustained over time. In addition, trial results will be analyzed using structured visual analysis, supplemented with statistical analysis appropriate to single-case methodology. Results: While ascertaining the effectiveness of this training protocol, study results will offer new insights into technology-related training approaches for people with brain impairment. Preliminary data collection has been commenced at one supported housing site, with further scoping work continuing to recruit participants from additional sites. Conclusions: Evaluation evidence will assist in planning for the smart technology set-up as well as training and support services necessary to accompany the provision of new devices and systems. International Registered Report Identifier (IRRID): RR1-10.2196/10451 UR - https://www.researchprotocols.org/2018/11/e10451/ UR - http://dx.doi.org/10.2196/10451 UR - http://www.ncbi.nlm.nih.gov/pubmed/30409766 ID - info:doi/10.2196/10451 ER - TY - JOUR AU - Offermann-van Heek, Julia AU - Ziefle, Martina PY - 2018/9/24 TI - They Don?t Care About Us! Care Personnel?s Perspectives on Ambient Assisted Living Technology Usage: Scenario-Based Survey Study JO - JMIR Rehabil Assist Technol SP - e10424 VL - 5 IS - 2 KW - Ambient Assisted Living technologies KW - assistive technologies KW - care professionals KW - diverse care contexts KW - web-based survey KW - quantitative scenario-based approach KW - technology acceptance KW - user diversity N2 - Background: Demographic change represents enormous burdens for the care sectors, resulting in high proportions of (older) people in need of care and a lack of care staff. Ambient Assisted Living (AAL) technologies have the potential to support the bottlenecks in care supply but are not yet in widespread use in professional care contexts. Objective: The objective of our study was to investigate professional caregivers? AAL technology acceptance and their perception regarding specific technologies, data handling, perceived benefits, and barriers. In particular, this study focuses on the perspectives on AAL technologies differing between care professionals working in diverse care contexts to examine the extent to which the care context influences the acceptance of assistive technologies. Methods: A Web-based survey (N=170) was carried out focusing on professional caregivers including medical, geriatric, and disabled people?s caregivers. Based on a scenario, the participants were asked for their perceptions concerning specific technologies, specific types of gathered data, and potential benefits of and barriers to AAL technology usage. Results: The care context significantly impacted the evaluations of AAL technologies (F14,220=2.514; P=.002). Professional caregivers of disabled people had a significantly more critical attitude toward AAL technologies than medical and geriatric caregivers, indicated (1) by being the only caregiver group that rejected evaluations of AAL technology acceptance (F2,118=4.570; P=.01) and specific technologies (F2,118=11.727; P<.001) applied for gathering data and (2) by the comparatively lowest agreements referring to the evaluations of data types (F2,118=4.073, P=.02) that are allowed to be gathered. Conclusions: AAL technology acceptance is critical because of technology implementation reasons, especially in the care of people with disabilities. AAL technologies in care contexts have to be tailored to care professional?s needs and concerns (?care about us?). The results contribute to a broader understanding of professional caregivers? needs referring to specific data and technology configurations and enclose major differences concerning diverse care contexts. Integrating these findings into user group-tailored technology concepts and communication strategies will support a sustainable adoption of AAL systems in professional care contexts. UR - http://rehab.jmir.org/2018/2/e10424/ UR - http://dx.doi.org/10.2196/10424 UR - http://www.ncbi.nlm.nih.gov/pubmed/30249592 ID - info:doi/10.2196/10424 ER - TY - JOUR AU - Xu, Xiaowei AU - Wang, Ju AU - Hou, Li AU - Guo, Zhen AU - Li, Jiao PY - 2018/08/14 TI - A Dietary Management System Using Radio-Frequency Identification Technology to Collect Information on Chinese Food Consumption: Development and Feasibility Study JO - JMIR Mhealth Uhealth SP - e166 VL - 6 IS - 8 KW - diet records KW - RFID technology KW - radio frequency identification device KW - food consumption KW - Chinese foods N2 - Background: Dietary management is important for personal health. However, it is challenging to record quantified food information in an efficient, accurate, and sustainable manner, particularly for the consumption of Chinese food. Objective: The objective of this study was to develop a dietary management system to record information on consumption of Chinese food, which can help in assessing individuals? dietary intake and maintaining healthy eating behaviors. We proposed to use plates embedded with radio-frequency identification chips to carry Chinese foods and collect food consumption data. Methods: We obtained food composition and nutrient (eg, carbohydrate, fat, fiber) data from the Chinese Recipe Database and China Food Composition Database. To test the feasibility of the dietary management system at a population level, we applied it to collect data on 489 Chinese foods that were consumed at lunchtime across 7 weeks by 10,528 individuals. To test individual-level output, we selected an individual participant with completed 20-day dietary data for analysis. We examined the system?s nutrient calculation performance by comparing the nutrient values of 3 selected Chinese dishes calculated by our method with the results of chemical measurements. Results: We collected the dietary intake for a group of 10,528 individuals aged from 20 to 40 years having lunch in a restaurant across 7 weeks. A total of 489 Chinese dishes were identified. We analyzed a specified customer?s diet recordings and broke his or her 20 lunch diet recordings down to ingredients and then to nutrient intake. We compared the nutrient value of a given Chinese dish (eg, garlic puree cooked pork leg) calculated by our method with the results of chemical measurements. The mean absolute percentage deviation showed that our method enabled collection of dietary intake for Chinese foods. Conclusions: This preliminary study demonstrated the feasibility of radio-frequency identification?based dietary management for Chinese food consumption. In future, we will investigate factors such as preparation method, weight of food consumed, and auxiliary ingredients to improve dietary assessment accuracy. UR - http://mhealth.jmir.org/2018/8/e166/ UR - http://dx.doi.org/10.2196/mhealth.7674 UR - http://www.ncbi.nlm.nih.gov/pubmed/30108037 ID - info:doi/10.2196/mhealth.7674 ER - TY - JOUR AU - Conn, J. Nicholas AU - Schwarz, Q. Karl AU - Borkholder, A. David PY - 2018/05/28 TI - Nontraditional Electrocardiogram and Algorithms for Inconspicuous In-Home Monitoring: Comparative Study JO - JMIR Mhealth Uhealth SP - e120 VL - 6 IS - 5 KW - algorithms KW - delineation KW - ECG KW - EDB KW - electrocardiogram KW - Internet of Things KW - IoT KW - MITDB KW - signal quality KW - wearable N2 - Background: Wearable and connected in-home medical devices are typically utilized in uncontrolled environments and often measure physiologic signals at suboptimal locations. Motion artifacts and reduced signal-to-noise ratio, compared with clinical grade equipment, results in a highly variable signal quality that can change significantly from moment to moment. The use of signal quality classification algorithms and robust feature delineation algorithms designed to achieve high accuracy on poor quality physiologic signals can prove beneficial in addressing concerns associated with measurement accuracy, confidence, and clinical validity. Objective: The objective of this study was to demonstrate the successful extraction of clinical grade measures using a custom signal quality classification algorithm for the rejection of poor-quality regions and a robust QRS delineation algorithm from a nonstandard electrocardiogram (ECG) integrated into a toilet seat; a device plagued by many of the same challenges as wearable technologies and other Internet of Things?based medical devices. Methods: The present algorithms were validated using a study of 25 normative subjects and 29 heart failure (HF) subjects. Measurements captured from a toilet seat-based buttocks electrocardiogram were compared with a simultaneously captured 12-lead clinical grade ECG. The ECG lead with the highest morphological correlation to buttocks electrocardiogram was used to determine the accuracy of the heart rate (HR), heart rate variability (HRV), which used the standard deviation of the normal-to-normal (SDNN) intervals between sinus beats, QRS duration, and the corrected QT interval (QTc). These algorithms were benchmarked using the MIT-BIH Arrhythmia Database (MITDB) and European ST-T Database (EDB), which are standardized databases commonly used to test QRS detection algorithms. Results: Clinical grade accuracy was achieved for all buttocks electrocardiogram measures compared with standard Lead II. For the normative cohort, the mean was ?0.0 (SD 0.3) bpm (N=141 recordings) for HR accuracy and ?1.0 (SD 3.4) ms for HRV (N=135). The QRS duration and the QTc interval had an accuracy of ?0.5 (SD 6.6) ms (N=85) and 14.5 (SD 11.1) ms (N=85), respectively. In the HF cohort, the accuracy for HR, HRV, QRS duration, and QTc interval was 0.0 (SD 0.3) bpm (N=109), ?6.6 (SD 13.2) ms (N=99), 2.9 (SD 11.5) ms (N=59), and 11.2 (SD 19.1) ms (N=58), respectively. When tested on MITDB and EDB, the algorithms presented herein had an overall sensitivity and positive predictive value of over 99.82% (N=900,059 total beats), which is comparable to best in-class algorithms tuned specifically for use with these databases. Conclusions: The present algorithmic approach to data analysis of noisy physiologic data was successfully demonstrated using a toilet seat-based ECG remote monitoring system. This approach to the analysis of physiologic data captured from wearable and connected devices has future potential to enable new types of monitoring devices, providing new insights through daily, inconspicuous in-home monitoring. UR - http://mhealth.jmir.org/2018/5/e120/ UR - http://dx.doi.org/10.2196/mhealth.9604 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/mhealth.9604 ER - TY - JOUR AU - Wong-Parodi, Gabrielle AU - Dias, Beatrice M. AU - Taylor, Michael PY - 2018/03/08 TI - Effect of Using an Indoor Air Quality Sensor on Perceptions of and Behaviors Toward Air Pollution (Pittsburgh Empowerment Library Study): Online Survey and Interviews JO - JMIR Mhealth Uhealth SP - e48 VL - 6 IS - 3 KW - indoor air pollution KW - particulate matter KW - inhalation KW - decision aids N2 - Background: Air quality affects us all and is a rapidly growing concern in the 21st century. We spend the majority of our lives indoors and can be exposed to a number of pollutants smaller than 2.5 microns (particulate matter, PM2.5) resulting in detrimental health effects. Indoor air quality sensors have the potential to provide people with the information they need to understand their risk and take steps to reduce their exposure. One such sensor is the Speck sensor developed at the Community Robotics, Education and Technology Empowerment Lab at Carnegie Mellon University. This sensor provides users with continuous real-time and historical PM2.5 information, a Web-based platform where people can track their PM2.5 levels over time and learn about ways to reduce their exposure, and a venue (blog post) for the user community to exchange information. Little is known about how the use of such monitors affects people?s knowledge, attitudes, and behaviors with respect to indoor air pollution. Objective: The aim of this study was to assess whether using the sensor changes what people know and do about indoor air pollution. Methods: We conducted 2 studies. In the first study, we recruited 276 Pittsburgh residents online and through local branches of the Carnegie Library of Pittsburgh, where the Speck sensor was made available by the researchers in the library catalog. Participants completed a 10- to 15-min survey on air pollution knowledge (its health impact, sources, and mitigation options), perceptions of indoor air quality, confidence in mitigation, current behaviors toward air quality, and personal empowerment and creativity in the spring and summer of 2016. In our second study, we surveyed 26 Pittsburgh residents in summer 2016 who checked out the Speck sensor for 3 weeks on the same measures assessed in the first study, with additional questions about the perception and use of the sensor. Follow-up interviews were conducted with a subset of those who used the Speck sensor. Results: A series of paired t tests found participants were significantly more knowledgeable (t25=?2.61, P=.02), reported having significantly better indoor air quality (t25=?5.20, P<.001), and felt more confident about knowing how to mitigate their risk (t25=?1.87, P=.07) after using the Speck sensor than before. McNemar test showed participants tended to take more action to reduce indoor air pollution after using the sensor (?225=2.7, P=.10). Qualitative analysis suggested possible ripple effects of use, including encouraging family and friends to learn about indoor air pollution. Conclusions: Providing people with low- or no-cost portable indoor air quality monitors, with a supporting Web-based platform that offers information about how to reduce risk, can help people better express perceptions and adopt behaviors commensurate with the risks they face. Thus, thoughtfully designed and deployed personal sensing devices can help empower people to take steps to reduce their risk. UR - http://mhealth.jmir.org/2018/3/e48/ UR - http://dx.doi.org/10.2196/mhealth.8273 UR - http://www.ncbi.nlm.nih.gov/pubmed/29519779 ID - info:doi/10.2196/mhealth.8273 ER - TY - JOUR AU - Berridge, Clara PY - 2018/02/21 TI - Medicaid Becomes the First Third-Party Payer to Cover Passive Remote Monitoring for Home Care: Policy Analysis JO - J Med Internet Res SP - e66 VL - 20 IS - 2 KW - policy making KW - Medicaid KW - long-term care KW - aging KW - information technology KW - passive remote monitoring KW - sensing KW - ethics KW - technology implementation N2 - Background: Recent years have seen an influx of location-tracking, activity-monitoring sensors, and Web-cameras to remotely monitor the safety of older adults in their homes and to reduce reliance on in-person assistance. The state of research on these monitoring technologies leaves open crucial financial, social, and ethical cost-benefit questions, which have prevented widespread use. Medicaid is now the first large third-party payer in the United States to pay for these technologies, and their use is likely to increase as states transition to managed long-term services and supports (MLTSS). Objectives: This is the first study to examine how state Medicaid programs are treating passive remote monitoring technologies. This study identifies (1) which states allow location tracking, sensor systems, and cameras; (2) what policies are in place to track their use; (3) what implementation processes and program monitoring mechanisms are in place; and (4) what related insights Medicaid program stakeholders would like to learn from researchers. Methods: Interviews were conducted with 43 state, federal, and managed care organization (MCO) Medicaid program stakeholders about how these technologies are used in state waivers serving community-dwelling older adults in 15 states, and what policies are in place to regulate them. The interviews were analyzed by the research team using the framework analysis method for applied policy research. Results: Two-thirds of the states cover location tracking and activity-monitoring sensors and one-third cover cameras, but only 3 states have specific service categories that allow them to track when they are paying for any of these technologies, impeding regulation and understanding of their use at the state and federal level. Consideration of ethical and social risks is limited, and states struggle to understand which circumstances warrant use. They are further challenged by extreme resource restrictions and transitions to MLTSS by MCOs inexperienced in serving this growing ?high-need, high-cost? population. Conclusions: Decisions about Medicaid reimbursement of technologies that have the potential to dramatically alter the way older adults receive supportive services are being made without research on their use, social and ethical implications, or outcomes. At a minimum, new service categories are needed to enable oversight. Participants prioritized 3 research aims to inform practice: (1) determine cost-effectiveness; (2) identify what type of information beneficiaries want to be generated and whom they want it to be shared with; and (3) understand how to support ethical decision making for beneficiaries with cognitive impairment. These findings provide direction for future research and reveal that greater interaction between policy makers and researchers in this field is needed. UR - http://www.jmir.org/2018/2/e66/ UR - http://dx.doi.org/10.2196/jmir.9650 UR - http://www.ncbi.nlm.nih.gov/pubmed/29467120 ID - info:doi/10.2196/jmir.9650 ER - TY - JOUR AU - Paredes, Enrique Pablo AU - Hamdan, Al-Huda Nur AU - Clark, Dav AU - Cai, Carrie AU - Ju, Wendy AU - Landay, A. James PY - 2017/12/04 TI - Evaluating In-Car Movements in the Design of Mindful Commute Interventions: Exploratory Study JO - J Med Internet Res SP - e372 VL - 19 IS - 12 KW - mental health KW - stress KW - stress management KW - mindfulness KW - in-car experience KW - interventions KW - just-in-time interventions KW - autonomous vehicles KW - cars KW - driving KW - breathing KW - mindful movement N2 - Background: The daily commute could be a right moment to teach drivers to use movement or breath towards improving their mental health. Long commutes, the relevance of transitioning from home to work, and vice versa and the privacy of commuting by car make the commute an ideal scenario and time to perform mindful exercises safely. Whereas driving safety is paramount, mindful exercises might help commuters decrease their daily stress while staying alert. Increasing vehicle automation may present new opportunities but also new challenges. Objective: This study aimed to explore the design space for movement-based mindful interventions for commuters. We used qualitative analysis of simulated driving experiences in combination with simple movements to obtain key design insights. Methods: We performed a semistructured viability assessment in 2 parts. First, a think-aloud technique was used to obtain information about a driving task. Drivers (N=12) were given simple instructions to complete movements (configural or breath-based) while engaged in either simple (highway) or complex (city) simulated urban driving tasks using autonomous and manual driving modes. Then, we performed a matching exercise where participants could experience vibrotactile patterns from the back of the car seat and map them to the prior movements. Results: We report a summary of individual perceptions concerning different movements and vibrotactile patterns. Beside describing situations within a drive when it may be more likely to perform movement-based interventions, we also describe movements that may interfere with driving and those that may complement it well. Furthermore, we identify movements that could be conducive to a more relaxing commute and describe vibrotactile patterns that could guide such movements and exercises. We discuss implications for design such as the influence of driving modality on the adoption of movement, need for personal customization, the influence that social perception has on participants, and the potential role of prior awareness of mindful techniques in the adoption of new movement-based interventions. Conclusions: This exploratory study provides insights into which types of movements could be better suited to design mindful interventions to reduce stress for commuters, when to encourage such movements, and how best to guide them using noninvasive haptic stimuli embedded in the car seat. UR - http://www.jmir.org/2017/12/e372/ UR - http://dx.doi.org/10.2196/jmir.6983 UR - http://www.ncbi.nlm.nih.gov/pubmed/29203458 ID - info:doi/10.2196/jmir.6983 ER - TY - JOUR AU - Loiselle, G. Carmen AU - Ahmed, Saima PY - 2017/11/10 TI - Is Connected Health Contributing to a Healthier Population? JO - J Med Internet Res SP - e386 VL - 19 IS - 11 KW - connected health KW - mHealth KW - eHealth KW - uHealth KW - ubiquitous health UR - http://www.jmir.org/2017/11/e386/ UR - http://dx.doi.org/10.2196/jmir.8309 UR - http://www.ncbi.nlm.nih.gov/pubmed/29127077 ID - info:doi/10.2196/jmir.8309 ER - TY - JOUR AU - Fagherazzi, Guy AU - El Fatouhi, Douae AU - Bellicha, Alice AU - El Gareh, Amin AU - Affret, Aurélie AU - Dow, Courtney AU - Delrieu, Lidia AU - Vegreville, Matthieu AU - Normand, Alexis AU - Oppert, Jean-Michel AU - Severi, Gianluca PY - 2017/10/23 TI - An International Study on the Determinants of Poor Sleep Amongst 15,000 Users of Connected Devices JO - J Med Internet Res SP - e363 VL - 19 IS - 10 KW - connected devices KW - sleep KW - Withings KW - Nokia KW - determinants KW - Internet of Things KW - epidemiology KW - wearables KW - lifestyle KW - blood pressure KW - steps KW - heart rate KW - weight N2 - Background: Sleep is a modifiable lifestyle factor that can be a target for efficient intervention studies to improve the quality of life and decrease the risk or burden of some chronic conditions. Knowing the profiles of individuals with poor sleep patterns is therefore a prerequisite. Wearable devices have recently opened new areas in medical research as potential efficient tools to measure lifestyle factors such as sleep quantity and quality. Objectives: The goal of our research is to identify the determinants of poor sleep based on data from a large population of users of connected devices. Methods: We analyzed data from 15,839 individuals (13,658 males and 2181 females) considered highly connected customers having purchased and used at least 3 connected devices from the consumer electronics company Withings (now Nokia). Total and deep sleep durations as well as the ratio of deep/total sleep as a proxy of sleep quality were analyzed in association with available data on age, sex, weight, heart rate, steps, and diastolic and systolic blood pressures. Results: With respect to the deep/total sleep duration ratio used as a proxy of sleep quality, we have observed that those at risk of having a poor ratio (?0.40) were more frequently males (odds ratio [OR]female vs male=0.45, 95% CI 0.38-0.54), younger individuals (OR>60 years vs 18-30 years=0.47, 95% CI 0.35-0.63), and those with elevated heart rate (OR>78 bpm vs ?61 bpm=1.18, 95% CI 1.04-1.34) and high systolic blood pressure (OR>133 mm Hg vs ?116 mm Hg=1.22, 95% CI 1.04-1.43). A direct association with weight was observed for total sleep duration exclusively. Conclusions: Wearables can provide useful information to target individuals at risk of poor sleep. Future alert or mobile phone notification systems based on poor sleep determinants measured with wearables could be tested in intervention studies to evaluate the benefits. UR - http://www.jmir.org/2017/10/e363/ UR - http://dx.doi.org/10.2196/jmir.7930 UR - http://www.ncbi.nlm.nih.gov/pubmed/29061551 ID - info:doi/10.2196/jmir.7930 ER - TY - JOUR AU - Bayen, Eleonore AU - Jacquemot, Julien AU - Netscher, George AU - Agrawal, Pulkit AU - Tabb Noyce, Lynn AU - Bayen, Alexandre PY - 2017/10/17 TI - Reduction in Fall Rate in Dementia Managed Care Through Video Incident Review: Pilot Study JO - J Med Internet Res SP - e339 VL - 19 IS - 10 KW - video monitoring KW - video review KW - mobile app KW - deep learning KW - fall KW - Alzheimer disease KW - dementia N2 - Background: Falls of individuals with dementia are frequent, dangerous, and costly. Early detection and access to the history of a fall is crucial for efficient care and secondary prevention in cognitively impaired individuals. However, most falls remain unwitnessed events. Furthermore, understanding why and how a fall occurred is a challenge. Video capture and secure transmission of real-world falls thus stands as a promising assistive tool. Objective: The objective of this study was to analyze how continuous video monitoring and review of falls of individuals with dementia can support better quality of care. Methods: A pilot observational study (July-September 2016) was carried out in a Californian memory care facility. Falls were video-captured (24×7), thanks to 43 wall-mounted cameras (deployed in all common areas and in 10 out of 40 private bedrooms of consenting residents and families). Video review was provided to facility staff, thanks to a customized mobile device app. The outcome measures were the count of residents? falls happening in the video-covered areas, the acceptability of video recording, the analysis of video review, and video replay possibilities for care practice. Results: Over 3 months, 16 falls were video-captured. A drop in fall rate was observed in the last month of the study. Acceptability was good. Video review enabled screening for the severity of falls and fall-related injuries. Video replay enabled identifying cognitive-behavioral deficiencies and environmental circumstances contributing to the fall. This allowed for secondary prevention in high-risk multi-faller individuals and for updated facility care policies regarding a safer living environment for all residents. Conclusions: Video monitoring offers high potential to support conventional care in memory care facilities. UR - http://www.jmir.org/2017/10/e339/ UR - http://dx.doi.org/10.2196/jmir.8095 UR - http://www.ncbi.nlm.nih.gov/pubmed/29042342 ID - info:doi/10.2196/jmir.8095 ER - TY - JOUR AU - Davies, John Richard AU - Parker, Jack AU - McCullagh, Paul AU - Zheng, Huiru AU - Nugent, Chris AU - Black, David Norman AU - Mawson, Susan PY - 2016/11/08 TI - A Personalized Self-Management Rehabilitation System for Stroke Survivors: A Quantitative Gait Analysis Using a Smart Insole JO - JMIR Rehabil Assist Technol SP - e11 VL - 3 IS - 2 KW - ambulatory monitoring KW - gait KW - rehabilitation KW - self-management KW - smart insole KW - stroke N2 - Background: In the United Kingdom, stroke is the single largest cause of adult disability and results in a cost to the economy of £8.9 billion per annum. Service needs are currently not being met; therefore, initiatives that focus on patient-centered care that promote long-term self-management for chronic conditions should be at the forefront of service redesign. The use of innovative technologies and the ability to apply these effectively to promote behavior change are paramount in meeting the current challenges. Objective: Our objective was to gain a deeper insight into the impact of innovative technologies in support of home-based, self-managed rehabilitation for stroke survivors. An intervention of daily walks can assist with improving lower limb motor function, and this can be measured by using technology. This paper focuses on assessing the usage of self-management technologies on poststroke survivors while undergoing rehabilitation at home. Methods: A realist evaluation of a personalized self-management rehabilitation system was undertaken in the homes of stroke survivors (N=5) over a period of approximately two months. Context, mechanisms, and outcomes were developed and explored using theories relating to motor recovery. Participants were encouraged to self-manage their daily walking activity; this was achieved through goal setting and motivational feedback. Gait data were collected and analyzed to produce metrics such as speed, heel strikes, and symmetry. This was achieved using a ?smart insole? to facilitate measurement of walking activities in a free-living, nonrestrictive environment. Results: Initial findings indicated that 4 out of 5 participants performed better during the second half of the evaluation. Performance increase was evident through improved heel strikes on participants? affected limb. Additionally, increase in performance in relation to speed was also evident for all 5 participants. A common strategy emerged across all but one participant as symmetry performance was sacrificed in favor of improved heel strikes. This paper evaluates compliance and intensity of use. Conclusion: Our findings suggested that 4 out of the 5 participants improved their ability to heel strike on their affected limb. All participants showed improvements in their speed of gait measured in steps per minute with an average increase of 9.8% during the rehabilitation program. Performance in relation to symmetry showed an 8.5% average decline across participants, although 1 participant improved by 4%. Context, mechanism, and outcomes indicated that dual motor learning and compensatory strategies were deployed by the participants. UR - http://rehab.jmir.org/2016/2/e11/ UR - http://dx.doi.org/10.2196/rehab.5449 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582260 ID - info:doi/10.2196/rehab.5449 ER - TY - JOUR AU - Stokke, Randi PY - 2016/07/14 TI - The Personal Emergency Response System as a Technology Innovation in Primary Health Care Services: An Integrative Review JO - J Med Internet Res SP - e187 VL - 18 IS - 7 KW - home care services KW - caring practice KW - personal emergency alarm system KW - PERS KW - safety alarm KW - social alarm KW - telecare KW - review N2 - Background: Most western countries are experiencing greater pressure on community care services due to increased life expectancy and changes in policy toward prioritizing independent living. This has led to a demand for change and innovation in caring practices with an expected increased use of technology. Despite numerous attempts, it has proven surprisingly difficult to implement and adopt technological innovations. The main established technological innovation in home care services for older people is the personal emergency response system (PERS), which is widely adopted and used throughout most western countries aiming to support ?aging safely in place.? Objective: This integrative review examines how research literature describes use of the PERS focusing on the users? perspective, thus exploring how different actors experience the technology in use and how it affects the complex interactions between multiple actors in caring practices. Methods: The review presents an overview of the body of research on this well-established telecare solution, indicating what is important for different actors in regard to accepting and using this technology in community care services. An integrative review, recognized by a systematic search in major databases followed by a review process, was conducted. Results: The search resulted in 33 included studies describing different actors? experiences with the PERS in use. The overall focus was on the end users? experiences and the consequences of having and using the alarm, and how the technology changes caring practices and interactions between the actors. Conclusions: The PERS contributes to safety and independent living for users of the alarm, but there are also unforeseen consequences and possible improvements in the device and the integrated service. This rather simple and well-established telecare technology in use interacts with the actors involved, creating changes in daily living and even affecting their identities. This review argues for an approach to telecare in which the complexity of practice is accounted for and shows how the plug-and-play expectations producers tend to generate is a simplification of the reality. This calls for a recognition that place and actors matter, as does a sensitivity to technology as an integrated part of complex caring practices. UR - http://www.jmir.org/2016/7/e187/ UR - http://dx.doi.org/10.2196/jmir.5727 UR - http://www.ncbi.nlm.nih.gov/pubmed/27417422 ID - info:doi/10.2196/jmir.5727 ER - TY - JOUR AU - Koldijk, Saskia AU - Kraaij, Wessel AU - Neerincx, A. Mark PY - 2016/07/05 TI - Deriving Requirements for Pervasive Well-Being Technology From Work Stress and Intervention Theory: Framework and Case Study JO - JMIR Mhealth Uhealth SP - e79 VL - 4 IS - 3 KW - psychological stress KW - professional burn-out KW - behavioral symptoms KW - self-management KW - health technology KW - early medical intervention N2 - Background: Stress in office environments is a big concern, often leading to burn-out. New technologies are emerging, such as easily available sensors, contextual reasoning, and electronic coaching (e-coaching) apps. In the Smart Reasoning for Well-being at Home and at Work (SWELL) project, we explore the potential of using such new pervasive technologies to provide support for the self-management of well-being, with a focus on individuals' stress-coping. Ideally, these new pervasive systems should be grounded in existing work stress and intervention theory. However, there is a large diversity of theories and they hardly provide explicit directions for technology design. Objective: The aim of this paper is to present a comprehensive and concise framework that can be used to design pervasive technologies that support knowledge workers to decrease stress. Methods: Based on a literature study we identify concepts relevant to well-being at work and select different work stress models to find causes of work stress that can be addressed. From a technical perspective, we then describe how sensors can be used to infer stress and the context in which it appears, and use intervention theory to further specify interventions that can be provided by means of pervasive technology. Results: The resulting general framework relates several relevant theories: we relate ?engagement and burn-out? to ?stress?, and describe how relevant aspects can be quantified by means of sensors. We also outline underlying causes of work stress and how these can be addressed with interventions, in particular utilizing new technologies integrating behavioral change theory. Based upon this framework we were able to derive requirements for our case study, the pervasive SWELL system, and we implemented two prototypes. Small-scale user studies proved the value of the derived technology-supported interventions. Conclusions: The presented framework can be used to systematically develop theory-based technology-supported interventions to address work stress. In the area of pervasive systems for well-being, we identified the following six key research challenges and opportunities: (1) performing multi-disciplinary research, (2) interpreting personal sensor data, (3) relating measurable aspects to burn-out, (4) combining strengths of human and technology, (5) privacy, and (6) ethics. UR - http://mhealth.jmir.org/2016/3/e79/ UR - http://dx.doi.org/10.2196/mhealth.5341 UR - http://www.ncbi.nlm.nih.gov/pubmed/27380749 ID - info:doi/10.2196/mhealth.5341 ER - TY - JOUR AU - Spanakis, G. Emmanouil AU - Santana, Silvina AU - Tsiknakis, Manolis AU - Marias, Kostas AU - Sakkalis, Vangelis AU - Teixeira, António AU - Janssen, H. Joris AU - de Jong, Henri AU - Tziraki, Chariklia PY - 2016/06/24 TI - Technology-Based Innovations to Foster Personalized Healthy Lifestyles and Well-Being: A Targeted Review JO - J Med Internet Res SP - e128 VL - 18 IS - 6 KW - mHealth KW - eHealth KW - lifestyle KW - health promotion KW - health behavior KW - persuasive technologies KW - cloud computing KW - personalized health monitoring KW - interoperability KW - wellness programs N2 - Background: New community-based arrangements and novel technologies can empower individuals to be active participants in their health maintenance, enabling people to control and self-regulate their health and wellness and make better health- and lifestyle-related decisions. Mobile sensing technology and health systems responsive to individual profiles combined with cloud computing can expand innovation for new types of interoperable services that are consumer-oriented and community-based. This could fuel a paradigm shift in the way health care can be, or should be, provided and received, while lessening the burden on exhausted health and social care systems. Objective: Our goal is to identify and discuss the main scientific and engineering challenges that need to be successfully addressed in delivering state-of-the-art, ubiquitous eHealth and mHealth services, including citizen-centered wellness management services, and reposition their role and potential within a broader context of diverse sociotechnical drivers, agents, and stakeholders. Methods: We review the state-of-the-art relevant to the development and implementation of eHealth and mHealth services in critical domains. We identify and discuss scientific, engineering, and implementation-related challenges that need to be overcome to move research, development, and the market forward. Results: Several important advances have been identified in the fields of systems for personalized health monitoring, such as smartphone platforms and intelligent ubiquitous services. Sensors embedded in smartphones and clothes are making the unobtrusive recognition of physical activity, behavior, and lifestyle possible, and thus the deployment of platforms for health assistance and citizen empowerment. Similarly, significant advances are observed in the domain of infrastructure supporting services. Still, many technical problems remain to be solved, combined with no less challenging issues related to security, privacy, trust, and organizational dynamics. Conclusions: Delivering innovative ubiquitous eHealth and mHealth services, including citizen-centered wellness and lifestyle management services, goes well beyond the development of technical solutions. For the large-scale information and communication technology-supported adoption of healthier lifestyles to take place, crucial innovations are needed in the process of making and deploying usable empowering end-user services that are trusted and user-acceptable. Such innovations require multidomain, multilevel, transdisciplinary work, grounded in theory but driven by citizens? and health care professionals? needs, expectations, and capabilities and matched by business ability to bring innovation to the market. UR - http://www.jmir.org/2016/6/e128/ UR - http://dx.doi.org/10.2196/jmir.4863 UR - http://www.ncbi.nlm.nih.gov/pubmed/27342137 ID - info:doi/10.2196/jmir.4863 ER - TY - JOUR AU - Stucki, A. Reto AU - Urwyler, Prabitha AU - Rampa, Luca AU - Müri, René AU - Mosimann, P. Urs AU - Nef, Tobias PY - 2014/07/21 TI - A Web-Based Non-Intrusive Ambient System to Measure and Classify Activities of Daily Living JO - J Med Internet Res SP - e175 VL - 16 IS - 7 KW - ADL classifier KW - forward chaining inference engine KW - rule-based KW - wireless sensor system KW - dementia KW - Alzheimer KW - behavior pattern KW - activity monitoring KW - assistive technology KW - smart homes N2 - Background: The number of older adults in the global population is increasing. This demographic shift leads to an increasing prevalence of age-associated disorders, such as Alzheimer?s disease and other types of dementia. With the progression of the disease, the risk for institutional care increases, which contrasts with the desire of most patients to stay in their home environment. Despite doctors? and caregivers? awareness of the patient?s cognitive status, they are often uncertain about its consequences on activities of daily living (ADL). To provide effective care, they need to know how patients cope with ADL, in particular, the estimation of risks associated with the cognitive decline. The occurrence, performance, and duration of different ADL are important indicators of functional ability. The patient?s ability to cope with these activities is traditionally assessed with questionnaires, which has disadvantages (eg, lack of reliability and sensitivity). Several groups have proposed sensor-based systems to recognize and quantify these activities in the patient?s home. Combined with Web technology, these systems can inform caregivers about their patients in real-time (eg, via smartphone). Objective: We hypothesize that a non-intrusive system, which does not use body-mounted sensors, video-based imaging, and microphone recordings would be better suited for use in dementia patients. Since it does not require patient?s attention and compliance, such a system might be well accepted by patients. We present a passive, Web-based, non-intrusive, assistive technology system that recognizes and classifies ADL. Methods: The components of this novel assistive technology system were wireless sensors distributed in every room of the participant?s home and a central computer unit (CCU). The environmental data were acquired for 20 days (per participant) and then stored and processed on the CCU. In consultation with medical experts, eight ADL were classified. Results: In this study, 10 healthy participants (6 women, 4 men; mean age 48.8 years; SD 20.0 years; age range 28-79 years) were included. For explorative purposes, one female Alzheimer patient (Montreal Cognitive Assessment score=23, Timed Up and Go=19.8 seconds, Trail Making Test A=84.3 seconds, Trail Making Test B=146 seconds) was measured in parallel with the healthy subjects. In total, 1317 ADL were performed by the participants, 1211 ADL were classified correctly, and 106 ADL were missed. This led to an overall sensitivity of 91.27% and a specificity of 92.52%. Each subject performed an average of 134.8 ADL (SD 75). Conclusions: The non-intrusive wireless sensor system can acquire environmental data essential for the classification of activities of daily living. By analyzing retrieved data, it is possible to distinguish and assign data patterns to subjects' specific activities and to identify eight different activities in daily living. The Web-based technology allows the system to improve care and provides valuable information about the patient in real-time. UR - http://www.jmir.org/2014/7/e175/ UR - http://dx.doi.org/10.2196/jmir.3465 UR - http://www.ncbi.nlm.nih.gov/pubmed/25048461 ID - info:doi/10.2196/jmir.3465 ER - TY - JOUR AU - Wolbring, Gregor AU - Lashewicz, Bonnie PY - 2014/06/20 TI - Home Care Technology Through an Ability Expectation Lens JO - J Med Internet Res SP - e155 VL - 16 IS - 6 KW - ability expectation KW - ableism KW - home care KW - home care technology KW - health care technology KW - people with disabilities KW - sensor devices and platforms KW - social robotics KW - health information gathering KW - participatory design UR - http://www.jmir.org/2014/6/e155/ UR - http://dx.doi.org/10.2196/jmir.3135 UR - http://www.ncbi.nlm.nih.gov/pubmed/24956581 ID - info:doi/10.2196/jmir.3135 ER - TY - JOUR AU - Liddle, Jacki AU - Ireland, David AU - McBride, J. Simon AU - Brauer, G. Sandra AU - Hall, M. Leanne AU - Ding, Hang AU - Karunanithi, Mohan AU - Hodges, W. Paul AU - Theodoros, Deborah AU - Silburn, A. Peter AU - Chenery, J. Helen PY - 2014/03/12 TI - Measuring the Lifespace of People With Parkinson?s Disease Using Smartphones: Proof of Principle JO - JMIR Mhealth Uhealth SP - e13 VL - 2 IS - 1 KW - Parkinson's disease KW - community KW - telemedicine KW - mHealth N2 - Background: Lifespace is a multidimensional construct that describes the geographic area in which a person lives and conducts their activities, and reflects mobility, health, and well-being. Traditionally, it has been measured by asking older people to self-report the length and frequency of trips taken and assistance required. Global Positioning System (GPS) sensors on smartphones have been used to measure Lifespace of older people, but not with people with Parkinson?s disease (PD). Objective: The objective of this study was to investigate whether GPS data collected via smartphones could be used to indicate the Lifespace of people with PD. Methods: The dataset was supplied via the Michael J Fox Foundation Data Challenge and included 9 people with PD and 7 approximately matched controls. Participants carried smartphones with GPS sensors over two months. Data analysis compared the PD group and the control group. The impact of symptom severity on Lifespace was also investigated. Results: Visualization methods for comparing Lifespace were developed including scatterplots and heatmaps. Lifespace metrics for comparison included average daily distance, percentage of time spent at home, and number of trips into the community. There were no significant differences between the PD and the control groups on Lifespace metrics. Visual representations of Lifespace were organized based on the self-reported severity of symptoms, suggesting a trend of decreasing Lifespace with increasing PD symptoms. Conclusions: Lifespace measured by GPS-enabled smartphones may be a useful concept to measure the progression of PD and the impact of various therapies and rehabilitation programs. Directions for future use of GPS-based Lifespace are provided. UR - http://mhealth.jmir.org/2014/1/e13/ UR - http://dx.doi.org/10.2196/mhealth.2799 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100206 ID - info:doi/10.2196/mhealth.2799 ER - TY - JOUR AU - Seppälä, Antto AU - Nykänen, Pirkko AU - Ruotsalainen, Pekka PY - 2014/03/11 TI - Privacy-Related Context Information for Ubiquitous Health JO - JMIR Mhealth Uhealth SP - e12 VL - 2 IS - 1 KW - ubiquitous health KW - privacy KW - context information KW - trust KW - policy N2 - Background: Ubiquitous health has been defined as a dynamic network of interconnected systems. A system is composed of one or more information systems, their stakeholders, and the environment. These systems offer health services to individuals and thus implement ubiquitous computing. Privacy is the key challenge for ubiquitous health because of autonomous processing, rich contextual metadata, lack of predefined trust among participants, and the business objectives. Additionally, regulations and policies of stakeholders may be unknown to the individual. Context-sensitive privacy policies are needed to regulate information processing. Objective: Our goal was to analyze privacy-related context information and to define the corresponding components and their properties that support privacy management in ubiquitous health. These properties should describe the privacy issues of information processing. With components and their properties, individuals can define context-aware privacy policies and set their privacy preferences that can change in different information-processing situations. Methods: Scenarios and user stories are used to analyze typical activities in ubiquitous health to identify main actors, goals, tasks, and stakeholders. Context arises from an activity and, therefore, we can determine different situations, services, and systems to identify properties for privacy-related context information in information-processing situations. Results: Privacy-related context information components are situation, environment, individual, information technology system, service, and stakeholder. Combining our analyses and previously identified characteristics of ubiquitous health, more detailed properties for the components are defined. Properties define explicitly what context information for different components is needed to create context-aware privacy policies that can control, limit, and constrain information processing. With properties, we can define, for example, how data can be processed or how components are regulated or in what kind of environment data can be processed. Conclusions: This study added to the vision of ubiquitous health by analyzing information processing from the viewpoint of an individual?s privacy. We learned that health and wellness-related activities may happen in several environments and situations with multiple stakeholders, services, and systems. We have provided new knowledge regarding privacy-related context information and corresponding components by analyzing typical activities in ubiquitous health. With the identified components and their properties, individuals can define their personal preferences on information processing based on situational information, and privacy services can capture privacy-related context of the information-processing situation. UR - http://mhealth.jmir.org/2014/1/e12/ UR - http://dx.doi.org/10.2196/mhealth.3123 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100084 ID - info:doi/10.2196/mhealth.3123 ER - TY - JOUR AU - Sjölinder, Marie AU - Avatare Nöu, Anneli PY - 2014/03/07 TI - Indoor and Outdoor Social Alarms: Understanding Users' Perspectives JO - JMIR Mhealth Uhealth SP - e9 VL - 2 IS - 1 KW - health services for the aged KW - technology KW - man-machine systems KW - computer communication networks KW - caregivers KW - social alarm KW - security KW - safety UR - http://mhealth.jmir.org/2014/1/e9/ UR - http://dx.doi.org/10.2196/mhealth.2730 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099060 ID - info:doi/10.2196/mhealth.2730 ER - TY - JOUR AU - Ruotsalainen, Sakari Pekka AU - Blobel, Bernd AU - Seppälä, Antto AU - Nykänen, Pirkko PY - 2013/10/08 TI - Trust Information-Based Privacy Architecture for Ubiquitous Health JO - JMIR Mhealth Uhealth SP - e23 VL - 1 IS - 2 KW - ubiquitous health KW - privacy KW - computational trust KW - policy KW - context-awareness N2 - Background: Ubiquitous health is defined as a dynamic network of interconnected systems that offers health services independent of time and location to a data subject (DS). The network takes place in open and unsecure information space. It is created and managed by the DS who sets rules that regulate the way personal health information is collected and used. Compared to health care, it is impossible in ubiquitous health to assume the existence of a priori trust between the DS and service providers and to produce privacy using static security services. In ubiquitous health features, business goals and regulations systems followed often remain unknown. Furthermore, health care-specific regulations do not rule the ways health data is processed and shared. To be successful, ubiquitous health requires novel privacy architecture. Objective: The goal of this study was to develop a privacy management architecture that helps the DS to create and dynamically manage the network and to maintain information privacy. The architecture should enable the DS to dynamically define service and system-specific rules that regulate the way subject data is processed. The architecture should provide to the DS reliable trust information about systems and assist in the formulation of privacy policies. Furthermore, the architecture should give feedback upon how systems follow the policies of DS and offer protection against privacy and trust threats existing in ubiquitous environments. Methods: A sequential method that combines methodologies used in system theory, systems engineering, requirement analysis, and system design was used in the study. In the first phase, principles, trust and privacy models, and viewpoints were selected. Thereafter, functional requirements and services were developed on the basis of a careful analysis of existing research published in journals and conference proceedings. Based on principles, models, and requirements, architectural components and their interconnections were developed using system analysis. Results: The architecture mimics the way humans use trust information in decision making, and enables the DS to design system-specific privacy policies using computational trust information that is based on systems? measured features. The trust attributes that were developed describe the level systems for support awareness and transparency, and how they follow general and domain-specific regulations and laws. The monitoring component of the architecture offers dynamic feedback concerning how the system enforces the polices of DS. Conclusions: The privacy management architecture developed in this study enables the DS to dynamically manage information privacy in ubiquitous health and to define individual policies for all systems considering their trust value and corresponding attributes. The DS can also set policies for secondary use and reuse of health information. The architecture offers protection against privacy threats existing in ubiquitous environments. Although the architecture is targeted to ubiquitous health, it can easily be modified to other ubiquitous applications. UR - http://mhealth.jmir.org/2013/2/e23/ UR - http://dx.doi.org/10.2196/mhealth.2731 UR - http://www.ncbi.nlm.nih.gov/pubmed/25099213 ID - info:doi/10.2196/mhealth.2731 ER - TY - JOUR AU - Taka?, Boris AU - Català, Andreu AU - Rodríguez Martín, Daniel AU - van der Aa, Nico AU - Chen, Wei AU - Rauterberg, Matthias PY - 2013/07/15 TI - Position and Orientation Tracking in a Ubiquitous Monitoring System for Parkinson Disease Patients With Freezing of Gait Symptom JO - JMIR Mhealth Uhealth SP - e14 VL - 1 IS - 2 KW - Parkinson disease KW - Freezing of Gait KW - context-aware system KW - indoor localization KW - person orientation N2 - Background: Freezing of gait (FoG) is one of the most disturbing and least understood symptoms in Parkinson disease (PD). Although the majority of existing assistive systems assume accurate detections of FoG episodes, the detection itself is still an open problem. The specificity of FoG is its dependency on the context of a patient, such as the current location or activity. Knowing the patient's context might improve FoG detection. One of the main technical challenges that needs to be solved in order to start using contextual information for FoG detection is accurate estimation of the patient's position and orientation toward key elements of his or her indoor environment. Objective: The objectives of this paper are to (1) present the concept of the monitoring system, based on wearable and ambient sensors, which is designed to detect FoG using the spatial context of the user, (2) establish a set of requirements for the application of position and orientation tracking in FoG detection, (3) evaluate the accuracy of the position estimation for the tracking system, and (4) evaluate two different methods for human orientation estimation. Methods: We developed a prototype system to localize humans and track their orientation, as an important prerequisite for a context-based FoG monitoring system. To setup the system for experiments with real PD patients, the accuracy of the position and orientation tracking was assessed under laboratory conditions in 12 participants. To collect the data, the participants were asked to wear a smartphone, with and without known orientation around the waist, while walking over a predefined path in the marked area captured by two Kinect cameras with non-overlapping fields of view. Results: We used the root mean square error (RMSE) as the main performance measure. The vision based position tracking algorithm achieved RMSE = 0.16 m in position estimation for upright standing people. The experimental results for the proposed human orientation estimation methods demonstrated the adaptivity and robustness to changes in the smartphone attachment position, when the fusion of both vision and inertial information was used. Conclusions: The system achieves satisfactory accuracy on indoor position tracking for the use in the FoG detection application with spatial context. The combination of inertial and vision information has the potential for correct patient heading estimation even when the inertial wearable sensor device is put into an a priori unknown position. UR - http://mhealth.jmir.org/2013/2/e14/ UR - http://dx.doi.org/10.2196/mhealth.2539 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098265 ID - info:doi/10.2196/mhealth.2539 ER - TY - JOUR AU - Aztiria, Asier AU - Farhadi, Golnaz AU - Aghajan, Hamid PY - 2013/06/18 TI - User Behavior Shift Detection in Ambient Assisted Living Environments JO - JMIR Mhealth Uhealth SP - e6 VL - 1 IS - 1 KW - shift detection KW - intelligent environments KW - disease detection UR - http://mhealth.jmir.org/2013/1/e6/ UR - http://dx.doi.org/10.2196/mhealth.2536 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100679 ID - info:doi/10.2196/mhealth.2536 ER -