TY - JOUR AU - Bashi, Nazli AU - Fatehi, Farhad AU - Fallah, Mina AU - Walters, Darren AU - Karunanithi, Mohanraj PY - DA - 2018/10/19 TI - Self-Management Education Through mHealth: Review of Strategies and Structures JO - JMIR Mhealth Uhealth SP - e10771 VL - 6 IS - 10 KW - health education KW - mHealth KW - mobile apps KW - mobile phone KW - patient education KW - self-management education AB - Background: Despite the plethora of evidence on mHealth interventions for patient education, there is a lack of information regarding their structures and delivery strategies. Objective: This review aimed to investigate the structures and strategies of patient education programs delivered through smartphone apps for people with diverse conditions and illnesses. We also examined the aim of educational interventions in terms of health promotion, disease prevention, and illness management. Methods: We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and PsycINFO for peer-reviewed papers that reported patient educational interventions using mobile apps and published from 2006 to 2016. We explored various determinants of educational interventions, including the content, mode of delivery, interactivity with health care providers, theoretical basis, duration, and follow-up. The reporting quality of studies was evaluated according to the mHealth evidence and reporting assessment criteria. Results: In this study, 15 papers met the inclusion criteria and were reviewed. The studies mainly focused on the use of mHealth educational interventions for chronic disease management, and the main format for delivering interventions was text. Of the 15 studies, 6 were randomized controlled trials (RCTs), which have shown statistically significant effects on patients? health outcomes, including patients? engagement level, hemoglobin A1c, weight loss, and depression. Although the results of RCTs were mostly positive, we were unable to identify any specific effective structure and strategy for mHealth educational interventions owing to the poor reporting quality and heterogeneity of the interventions. Conclusions: Evidence on mHealth interventions for patient education published in peer-reviewed journals demonstrates that current reporting on essential mHealth criteria is insufficient for assessing, understanding, and replicating mHealth interventions. There is a lack of theory or conceptual framework for the development of mHealth interventions for patient education. Therefore, further research is required to determine the optimal structure, strategies, and delivery methods of mHealth educational interventions. UR - https://mhealth.jmir.org/2018/10/e10771/ DO - 10.2196/10771 UR - http://www.ncbi.nlm.nih.gov/pubmed/30341042 ID - info:doi/10.2196/10771 ER - TY - JOUR AU - Nguyen, D. Amy AU - Frensham, J. Lauren AU - Wong, XC Michael AU - Meslin, MM Sylvain AU - Martin, Paige AU - Lau, YS Annie AU - Baysari, T. Melissa AU - Day, O. Richard PY - DA - 2018/10/15 TI - mHealth App Patient Testing and Review of Educational Materials Designed for Self-Management of Gout Patients: Descriptive Qualitative Studies JO - JMIR Mhealth Uhealth SP - e182 VL - 6 IS - 10 KW - mobile apps KW - gout KW - self-management KW - chronic disease KW - uric acid AB - Background: Gout is a form of chronic arthritis caused by elevated serum uric acid (SUA) and culminates in painful gout attacks. Although effective uric acid-lowering therapies exist, adherence is low. This is partly due to the lack of support for patients to self-manage their disease. Mobile health apps have been used in the self-management of chronic conditions. However, not all are developed with patients, limiting their effectiveness. Objective: The objective of our study was to collect feedback from gout patients to design an effective gout self-management app. Methods: Two descriptive qualitative studies were conducted. In Study 1, researchers developed a short educational video and written materials about gout management, designed to be embedded into an app; 6 interviews and 1 focus group were held with gout patients to gather feedback on these materials. Usability testing in Study 2 involved additional gout patients using a pilot version of Healthy.me Gout, a gout self-management app, for 2 weeks. Following the trial, patients participated in an interview about their experiences using the app. Results: Patients viewed the gout educational material positively, appreciating the combined use of video, text, and images. Patients were receptive to using a mobile app to self-manage their gout. Feedback about Healthy.me Gout was generally positive with patients reporting that the tracking and diary features were most useful. Patients also provided suggestions for improving the app and educational materials. Conclusions: These studies involved patients in the development of a gout self-management app. Patients provided insight to improve the app?s presentation and usability and general lessons on useful features for chronic disease apps. Gout patients enjoyed tracking their SUA concentrations and gout attack triggers. These capabilities can be translated into self-management apps for chronic diseases that require monitoring of pathological values, medication adherence, or symptoms. Future health app design should integrate patient input and be developed iteratively to address concerns identified by patients. UR - http://mhealth.jmir.org/2018/10/e182/ DO - 10.2196/mhealth.9811 UR - http://www.ncbi.nlm.nih.gov/pubmed/30322835 ID - info:doi/10.2196/mhealth.9811 ER - TY - JOUR AU - AlJaberi, Hana PY - DA - 2018/10/10 TI - Developing Culturally Sensitive mHealth Apps for Caribbean Immigrant Women to Use During Pregnancy: Focus Group Study JO - JMIR Hum Factors SP - e29 VL - 5 IS - 4 KW - mHealth KW - human computer interaction KW - prenatal health KW - Caribbean KW - immigrant women KW - mobile phone AB - Background: A valuable addition to the mobile health (mHealth) space is an exploration of the context of minorities in developed countries. The transition period postmigration, culture, and socioeconomic uniqueness of migratory groups can shed light on the problems with existing prenatal mHealth apps. Objective: The objectives of this study were to (1) use the theoretical concept of pregnancy ecology to understand the emotional, physical, information, and social challenges affecting low-income Caribbean immigrant women?s prenatal well-being practices and (2) develop a deep understanding of challenges worthy of consideration in mHealth design for these women. Methods: This qualitative interpretive approach using analytical induction presents the findings of 3 focus group sessions with 12 Caribbean immigrant women living in South Florida in the United States. The study took place from April to September 2015. Results: The participants revealed problematic tiers and support needs within the pregnancy ecology including emotional stressors caused by family separation, physical challenges, information gaps, and longing for social support. Conclusions: mHealth interventions for low-income Caribbean immigrant women must be designed beyond the conventional way of focusing on the events surrounding the unborn child. It can be tailored to the needs of the expecting mother. Pregnancy information should be customized on the basis of the variability of lifestyle, cultural practices, socioeconomic status, and social ties while still being able to deliver appropriate guidelines and clear cultural misconceptions. UR - http://humanfactors.jmir.org/2018/4/e29/ DO - 10.2196/humanfactors.9787 UR - http://www.ncbi.nlm.nih.gov/pubmed/30305256 ID - info:doi/10.2196/humanfactors.9787 ER - TY - JOUR AU - Bernier, Angelina AU - Fedele, David AU - Guo, Yi AU - Chavez, Sarah AU - Smith, D. Megan AU - Warnick, Jennifer AU - Lieberman, Leora AU - Modave, François PY - DA - 2018/06/06 TI - New-Onset Diabetes Educator to Educate Children and Their Caregivers About Diabetes at the Time of Diagnosis: Usability Study JO - JMIR Diabetes SP - e10 VL - 3 IS - 2 KW - mHealth KW - information technology KW - diabetes education KW - pediatrics AB - Background: Diabetes self-management education is essential at the time of diagnosis. We developed the New-Onset Diabetes Educator (NODE), an animation-based educational web application for type 1 diabetes mellitus patients. Objective: Our hypothesis is that NODE is a feasible, effective and user-friendly intervention in improving diabetes self-management education delivery to child/caregiver-dyads at the time of diagnosis. Methods: We used a pragmatic parallel randomized trial design. Dyads were recruited within 48 hours of diagnosis and randomized into a NODE-enhanced diabetes self-management education or a standard diabetes self-management education group. Dyads randomized in the NODE group received the intervention on an iPad before receiving the standard diabetes self-management education with a nurse educator. The Diabetes Knowledge Test 2 assessed disease-specific knowledge pre- and postintervention in both groups, and was compared using t tests. Usability of the NODE mobile health intervention was assessed in the NODE group. Results: We recruited 16 dyads (mean child age 10.75, SD 3.44). Mean Diabetes Knowledge Test 2 scores were 14.25 (SD 4.17) and 18.13 (SD 2.17) pre- and postintervention in the NODE group, and 15.50 (SD 2.67) and 17.38 (SD 2.26) in the standard diabetes self-management education group. The effect size was medium (?=0.56). Usability ratings of NODE were excellent. Conclusions: NODE is a feasible mobile health strategy for type 1 diabetes education. It has the potential to be an effective and scalable tool to enhance diabetes self-management education at time of diagnosis, and consequently, could lead to improved long-term clinical outcomes for patients living with the disease. UR - http://diabetes.jmir.org/2018/2/e10/ DO - 10.2196/diabetes.9202 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291069 ID - info:doi/10.2196/diabetes.9202 ER - TY - JOUR AU - Athilingam, Ponrathi AU - Jenkins, Bradlee PY - DA - 2018/05/02 TI - Mobile Phone Apps to Support Heart Failure Self-Care Management: Integrative Review JO - JMIR Cardio SP - e10057 VL - 2 IS - 1 KW - heart failure KW - self-care management KW - mobile health AB - Background: With an explosive growth in mobile health, an estimated 500 million patients are potentially using mHealth apps for supporting health and self-care of chronic diseases. Therefore, this review focused on mHealth apps for use among patients with heart failure. Objective: The aim of this integrative review was to identify and assess the functionalities of mHealth apps that provided usability and efficacy data and apps that are commercially available without supporting data, all of which are to support heart failure self-care management and thus impact heart failure outcomes. Methods: A search of published, peer-reviewed literature was conducted for studies of technology-based interventions that used mHealth apps specific for heart failure. The initial database search yielded 8597 citations. After filters for English language and heart failure, the final 487 abstracts was reviewed. After removing duplicates, a total of 18 articles that tested usability and efficacy of mobile apps for heart failure self-management were included for review. Google Play and Apple App Store were searched with specified criteria to identify mHealth apps for heart failure. A total of 26 commercially available apps specific for heart failure were identified and rated using the validated Mobile Application Rating Scale. Results: The review included studies with low-quality design and sample sizes ranging from 7 to 165 with a total sample size of 847 participants from all 18 studies. Nine studies assessed usability of the newly developed mobile health system. Six of the studies included are randomized controlled trials, and 4 studies are pilot randomized controlled trials with sample sizes of fewer than 40. There were inconsistencies in the self-care components tested, increasing bias. Thus, risk of bias was assessed using the Cochrane Collaboration?s tool for risk of selection, performance, detection, attrition, and reporting biases. Most studies included in this review are underpowered and had high risk of bias across all categories. Three studies failed to provide enough information to allow for a complete assessment of bias, and thus had unknown or unclear risk of bias. This review on the commercially available apps demonstrated many incomplete apps, many apps with bugs, and several apps with low quality. Conclusions: The heterogeneity of study design, sample size, intervention components, and outcomes measured precluded the performance of a systematic review or meta-analysis, thus introducing bias of this review. Although the heart failure?related outcomes reported in this review vary, they demonstrated trends toward making an impact and offer a potentially cost-effective solution with 24/7 access to symptom monitoring as a point of care solution, promoting patient engagement in their own home care. UR - http://cardio.jmir.org/2018/1/e10057/ DO - 10.2196/10057 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/10057 ER - TY - JOUR AU - AlJaberi, Hana PY - DA - 2018/04/13 TI - Social Interaction Needs and Entertainment Approaches to Pregnancy Well-Being in mHealth Technology Design for Low-Income Transmigrant Women: Qualitative Codesign Study JO - JMIR Mhealth Uhealth SP - e61 VL - 6 IS - 4 KW - mHealth KW - mobile health KW - participatory design KW - pregnancy KW - Caribbean KW - immigrant women AB - Background: Low-income Caribbean transmigrant women face unique health challenges during pregnancy that set forth multidimensional implications for the design of mobile health (mHealth). Acknowledgment of the unique health needs of low-income Caribbean immigrant women in the United States and what that entails regarding technology design remains rarely examined in the literature of mHealth technologies. Objective: The goal of this study was to reveal the needs and gaps in mHealth interventions for pregnant immigrant women not yet realized in this field. These understandings reveal design opportunities for mHealth. Methods: The use of the qualitative participatory action research approach of codesign workshops in this study resulted in design solutions by the participants after reflecting on their earlier focus group discussions. The highlights are not the resulting designs per se but rather the inferences derived from the researcher reflecting on these designs. Results: The designs exposed two themes relevant to this paper. First, the participants desired the inclusion and rebuilding of social and organizational relationships in mHealth. The resulting designs formulate an understanding of the women?s health-related social support needs and how technology can facilitate them. Second, the participants wanted entertainment with an element of social participation incorporated in mHealth pregnancy management interventions. This brings attention to the role entertainment can add to the impact mHealth can deliver for pregnancy well-being. Conclusions: The study concluded with an examination of social and entertainment design implications that reveal pregnant immigrant women?s virtual health-related sharing habits, choice of sharing interaction scenarios during pregnancy (eg, local, long distance, one-way, two-way, and many-many), and choice of sharing media (eg, text, voice, and video). Additionally, the study revealed exclusions to social sharing capabilities in health technologies for these women. UR - http://mhealth.jmir.org/2018/4/e61/ DO - 10.2196/mhealth.7708 UR - http://www.ncbi.nlm.nih.gov/pubmed/29653919 ID - info:doi/10.2196/mhealth.7708 ER - TY - JOUR AU - Fadda, Marta AU - Galimberti, Elisa AU - Fiordelli, Maddalena AU - Schulz, Johannes Peter PY - DA - 2018/03/07 TI - Evaluation of a Mobile Phone?Based Intervention to Increase Parents? Knowledge About the Measles-Mumps-Rubella Vaccination and Their Psychological Empowerment: Mixed-Method Approach JO - JMIR Mhealth Uhealth SP - e59 VL - 6 IS - 3 KW - qualitative research KW - measles-mumps-rubella vaccine KW - surveys and questionnaires KW - mobile applications KW - knowledge KW - patient participation AB - Background: There is mixed evidence on the effectiveness of vaccination-related interventions. A major limitation of most intervention studies is that they do not apply randomized controlled trials (RCTs), the method that, over the last 2 decades, has increasingly been considered as the only method to provide proof of the effectiveness of an intervention and, consequently, as the most important instrument in deciding whether to adopt an intervention or not. This study, however, holds that methods other than RCTs also can produce meaningful results. Objective: The aim of this study was to evaluate 2 mobile phone?based interventions aimed at increasing parents? knowledge of the measles-mumps-rubella (MMR) vaccination (through elements of gamification) and their psychological empowerment (through the use of narratives), respectively. The 2 interventions were part of an RCT. Methods: We conducted 2 studies with the RCT participants: a Web-based survey aimed at assessing their rating of the tool regarding a number of qualities such as usability and usefulness (N=140), and qualitative telephonic interviews to explore participants? experiences with the app (N=60). Results: The results of the survey showed that participants receiving the knowledge intervention (alone or together with the empowerment intervention) liked the app significantly better compared with the group that only received the empowerment intervention (F2,137=15.335; P<.001). Parents who were exposed to the empowerment intervention complained that they did not receive useful information but were only invited to make an informed, autonomous MMR vaccination decision. Conclusions: The results suggest that efforts to empower patients should always be accompanied by the provision of factual information. Using a narrative format that promotes parents? identification can be an appropriate strategy, but it should be employed together with the presentation of more points of views and notions regarding, for instance, the risks and benefits of the vaccination at the same time. Trial Registration: International Standard Randomized Controlled Trial Number 30768813; http://www.isrctn.com/ ISRCTN30768813 (Archived by WebCite at http://www.webcitation.org/6xOQSJ3w8) UR - http://mhealth.jmir.org/2018/3/e59/ DO - 10.2196/mhealth.8263 UR - http://www.ncbi.nlm.nih.gov/pubmed/29514772 ID - info:doi/10.2196/mhealth.8263 ER - TY - JOUR AU - Magnani, W. Jared AU - Schlusser, L. Courtney AU - Kimani, Everlyne AU - Rollman, L. Bruce AU - Paasche-Orlow, K. Michael AU - Bickmore, W. Timothy PY - DA - 2017/12/12 TI - The Atrial Fibrillation Health Literacy Information Technology System: Pilot Assessment JO - JMIR Cardio SP - e7 VL - 1 IS - 2 KW - atrial fibrillation KW - mHealth KW - health-related quality of life KW - medication adherence AB - Background: Atrial fibrillation (AF) is a highly prevalent heart rhythm condition that has significant associated morbidity and requires chronic treatment. Mobile health (mHealth) technologies have the potential to enhance multiple aspects of AF care, including education, monitoring of symptoms, and encouraging and tracking medication adherence. We have previously implemented and tested relational agents to improve outcomes in chronic disease and sought to develop a smartphone-based relational agent for improving patient-centered outcomes in AF. Objective: The objective of this study was to pilot a smartphone-based relational agent as preparation for a randomized clinical trial, the Atrial Fibrillation Health Literacy Information Technology Trial (AF-LITT). Methods: We developed the relational agent for use by a smartphone consistent with our prior approaches. We programmed the relational agent as a computer-animated agent to simulate a face-to-face conversation and to serve as a health counselor or coach specific to AF. Relational agent?s dialogue content, informed by a review of literature, focused on patient-centered domains and qualitative interviews with patients with AF, encompassed AF education, common symptoms, adherence challenges, and patient activation. We established that the content was accessible to individuals with limited health or computer literacy. Relational agent content coordinated with use of the smartphone AliveCor Kardia heart rate and rhythm monitor. Participants (N=31) were recruited as a convenience cohort from ambulatory clinical sites and instructed to use the relational agent and Kardia for 30 days. We collected demographic, social, and clinical characteristics and conducted baseline and 30-day assessments of health-related quality of life (HRQoL) with the Atrial Fibrillation Effect on Quality of life (AFEQT) measure; self-reported medication adherence with the Morisky 8-item Medication Adherence Scale (MMAS-8); and patient activation with the Patient Activation Measure (PAM). Results: Participants (mean age 68 [SD 11]; 39% [12/31] women) used the relational agent for an average 17.8 (SD 10.0) days. The mean number of independent log-ins was 19.6 (SD 10.7), with a median of 20 times over 30 days. The mean number of Kardia uses was 26.5 (SD 5.9), and participants using Kardia were in AF for 14.3 (SD 11.0) days. AFEQT scores improved significantly from 64.5 (SD 22.9) at baseline to 76.3 (SD 19.4) units at 30 days (P<.01). We observed marginal but statistically significant improvement in self-reported medication adherence (baseline: 7.3 [SD 0.9], 30 days: 7.7 [SD 0.5]; P=.01). Assessments of acceptability identified that most of the participants found the relational agent useful, informative, and trustworthy. Conclusions: We piloted a 30-day smartphone-based intervention that combined a relational agent with dedicated content for AF alongside Kardia heart rate and rhythm monitoring. Pilot participants had favorable improvements in HRQoL and self-reported medication adherence, as well as positive responses to the intervention. These data will guide a larger, enhanced randomized trial implementing the smartphone relational agent and the Kardia monitor system. UR - http://cardio.jmir.org/2017/2/e7/ DO - 10.2196/cardio.8543 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/cardio.8543 ER - TY - JOUR AU - Mirk, M. Sean AU - Wegrzyn, Marie Nicole PY - DA - 2017/07/19 TI - Apps for Health-Related Education in Pharmacy Practice: Needs Assessment Survey Among Patients Within a Large Metropolitan Area JO - JMIR Res Protoc SP - e133 VL - 6 IS - 7 KW - patient education KW - mHealth KW - health information management KW - user-centered design AB - Background: Patient education resources are crucial to the effectiveness of prescribed pharmacotherapy. However, user interest and patient preference for these materials is lacking. Regardless of the field, nearly every article on designing mHealth apps references the lack of end-user involvement as a key flaw to sustainable design. The traditional paper-based methods of patient education are difficult to tailor to a patient?s specific needs and learning styles, but a customizable app might be beneficial. Objective: Regarding a mobile app for patient education, the objectives of the study were to (1) quantify patient interest, (2) determine desirable features, and (3) determine if a relationship exists between patient variables and interest in an iPad app for patient education. Methods: A paper-based questionnaire was developed and administered to consenting patients receiving care within three sites: two suburban outpatient sites where ambulatory care services are provided and one urban hospital site where ambulatory care transition services are provided. Results: A total of 121 surveys were completed. Most respondents were female (64/120, 53.3%), between 50 and 70 years of age, white/Caucasian (94/120, 78.3%), owned at least one technology device, and knew what an iPad was. Diabetes was the most common disease state (43/120, 35.8%), followed by heart failure (27/120, 22.5%), history of venous thromboembolism (VTE) (21/120, 17.5%), and asthma/chronic obstructive pulmonary disease (17/120, 14.2%). Overall interest in a mobile health app for patient education was 63.7% (72/113). Interest increased to 68.4% (78/114) if a health care provider recommended it. Respondents with one chronic health condition were more likely to be interested in an app compared to those with two or more. Respondents with a history of VTE were mostly likely to be interested in using an app on their own accord, while respondents with diabetes were mostly likely to be interested if their health care provider recommended it. Conclusions: This preliminary needs assessment identified that patients are interested in using mHealth apps for health-related education in pharmacy practice, particularly if their health care provider recommends it. UR - http://www.researchprotocols.org/2017/7/e133/ DO - 10.2196/resprot.5886 UR - http://www.ncbi.nlm.nih.gov/pubmed/28724511 ID - info:doi/10.2196/resprot.5886 ER - TY - JOUR AU - Wilkinson, L. Jessica AU - Strickling, Kate AU - Payne, E. Hannah AU - Jensen, C. Kayla AU - West, H. Joshua PY - DA - 2016/12/08 TI - Evaluation of Diet-Related Infographics on Pinterest for Use of Behavior Change Theories: A Content Analysis JO - JMIR Mhealth Uhealth SP - e133 VL - 4 IS - 4 KW - behavioral health KW - content analysis KW - nutrition KW - social media KW - Internet KW - healthy eating KW - theory AB - Background: There is increasing interest in Pinterest as a method of disseminating health information. However, it is unclear whether the health information promoted on Pinterest is evidence-based or incorporates behavior change theory. Objectives: The objective of the study was to determine the presence of health behavior theory (HBT) constructs in pins found on Pinterest and assess the relationship between various pin characteristics and the likelihood of inclusion of HBT. Methods: A content analysis was conducted on pins collected from Pinterest identified with the search terms ?nutrition infographic? and ?healthy eating infographic.? The coding rubric included HBT constructs, pin characteristics, and visual communication tools. Each HBT construct was coded as present or not present (yes=1, no=0). A total theory score was calculated by summing the values for each of the 9 constructs (range 0-9). Adjusted regression analysis was used to identify factors associated with the inclusion of health behavior change theory in pins (P<.05). Results: The mean total theory score was 2.03 (SD 1.2). Perceived benefits were present most often (170/236, 72%), followed by behavioral capability (123/238, 51.7%) and perceived severity (79/236, 33.5%). The construct that appeared the least was self-regulation/self-control (2/237, 0.8%). Pin characteristics associated with the inclusion of HBT included a large amount of text (P=.01), photographs of real people (P=.001), cartoon pictures of food (P=.01), and the presence of references (P=.001). The number of repins (P=.04), likes (P=.01), and comments (P=.01) were positively associated with the inclusion of HBT. Conclusions: These findings suggest that current Pinterest infographics targeting healthy eating contain few HBT elements. Health professionals and organizations should create and disseminate infographics that contain more elements of HBT to better influence healthy eating behavior. This may be accomplished by creating pins that use both text and images of people and food in order to portray elements of HBT and convey nutritional information. UR - http://mhealth.jmir.org/2016/4/e133/ DO - 10.2196/mhealth.6367 UR - http://www.ncbi.nlm.nih.gov/pubmed/27932316 ID - info:doi/10.2196/mhealth.6367 ER - TY - JOUR AU - Panatto, Donatella AU - Domnich, Alexander AU - Gasparini, Roberto AU - Bonanni, Paolo AU - Icardi, Giancarlo AU - Amicizia, Daniela AU - Arata, Lucia AU - Carozzo, Stefano AU - Signori, Alessio AU - Bechini, Angela AU - Boccalini, Sara PY - DA - 2016/12/02 TI - An eHealth Project on Invasive Pneumococcal Disease: Comprehensive Evaluation of a Promotional Campaign JO - J Med Internet Res SP - e316 VL - 18 IS - 12 KW - invasive pneumococcal disease KW - pneumococcus KW - eHealth KW - mHealth KW - mobile app AB - Background: The recently launched Pneumo Rischio eHealth project, which consists of an app, a website, and social networking activity, is aimed at increasing public awareness of invasive pneumococcal disease (IPD). The launch of this project was prompted by the inadequate awareness of IPD among both laypeople and health care workers, the heavy socioeconomic burden of IPD, and the far from optimal vaccination coverage in Italy, despite the availability of safe and effective vaccines. Objective: The objectives of our study were to analyze trends in Pneumo Rischio usage before and after a promotional campaign, to characterize its end users, and to assess its user-rated quality. Methods: At 7 months after launching Pneumo Rischio, we established a 4-month marketing campaign to promote the project. This intervention used various approaches and channels, including both traditional and digital marketing strategies. To highlight usage trends, we used different techniques of time series analysis and modeling, including a modified Mann-Kendall test, change-point detection, and segmented negative binomial regression of interrupted time series. Users were characterized in terms of demographics and IPD risk categories. Customer-rated quality was evaluated by means of a standardized tool in a sample of app users. Results: Over 1 year, the app was accessed by 9295 users and the website was accessed by 143,993 users, while the project?s Facebook page had 1216 fans. The promotional intervention was highly effective in increasing the daily number of users. In particular, the Mann-Kendall trend test revealed a significant (P ?.01) increasing trend in both app and website users, while change-point detection analysis showed that the first significant change corresponded to the start of the promotional campaign. Regression analysis showed a significant immediate effect of the intervention, with a mean increase in daily numbers of users of 1562% (95% CI 456%-4870%) for the app and 620% (95% CI 176%-1777%) for the website. Similarly, the postintervention daily trend in the number of users was positive, with a relative increase of 0.9% (95% CI 0.0%-1.8%) for the app and 1.4% (95% CI 0.7%-2.1%) for the website. Demographics differed between app and website users and Facebook fans. A total of 69.15% (10,793/15,608) of users could be defined as being at risk of IPD, while 4729 users expressed intentions to ask their doctor for further information on IPD. The mean app quality score assigned by end users was approximately 79.5% (397/500). Conclusions: Despite its specific topic, Pneumo Rischio was accessed by a considerable number of users, who ranked it as a high-quality project. In order to reach their target populations, however, such projects should be promoted. UR - http://www.jmir.org/2016/12/e316/ DO - 10.2196/jmir.6205 UR - http://www.ncbi.nlm.nih.gov/pubmed/27913372 ID - info:doi/10.2196/jmir.6205 ER - TY - JOUR AU - Rickard, Nikki AU - Arjmand, Hussain-Abdulah AU - Bakker, David AU - Seabrook, Elizabeth PY - DA - 2016/11/23 TI - Development of a Mobile Phone App to Support Self-Monitoring of Emotional Well-Being: A Mental Health Digital Innovation JO - JMIR Ment Health SP - e49 VL - 3 IS - 4 KW - eHealth KW - emotions KW - mental health KW - mobile phone KW - feedback AB - Background: Emotional well-being is a primary component of mental health and well-being. Monitoring changes in emotional state daily over extended periods is, however, difficult using traditional methodologies. Providing mental health support is also challenging when approximately only 1 in 2 people with mental health issues seek professional help. Mobile phone technology offers a sustainable means of enhancing self-management of emotional well-being. Objective: This paper aims to describe the development of a mobile phone tool designed to monitor emotional changes in a natural everyday context and in real time. Methods: This evidence-informed mobile phone app monitors emotional mental health and well-being, and it provides links to mental health organization websites and resources. The app obtains data via self-report psychological questionnaires, experience sampling methodology (ESM), and automated behavioral data collection. Results: Feedback from 11 individuals (age range 16-52 years; 4 males, 7 females), who tested the app over 30 days, confirmed via survey and focus group methods that the app was functional and usable. Conclusions: Recommendations for future researchers and developers of mental health apps to be used for research are also presented. The methodology described in this paper offers a powerful tool for a range of potential mental health research studies and provides a valuable standard against which development of future mental health apps should be considered. UR - http://mental.jmir.org/2016/4/e49/ DO - 10.2196/mental.6202 UR - http://www.ncbi.nlm.nih.gov/pubmed/27881358 ID - info:doi/10.2196/mental.6202 ER - TY - JOUR AU - Chen, Elizabeth AU - Mangone, Rose Emily PY - DA - 2016/11/10 TI - A Systematic Review of Apps using Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) JO - JMIR Mhealth Uhealth SP - e122 VL - 4 IS - 4 KW - mHealth KW - eHealth KW - smartphone KW - mobile phone KW - app KW - teen KW - adolescent KW - young adult KW - systematic review KW - unintended pregnancy KW - family planning KW - pregnancy prevention KW - contraception AB - Background: Adolescents in the United States and globally represent a high-risk population for unintended pregnancy, which leads to high social, economic, and health costs. Access to smartphone apps is rapidly increasing among youth, but little is known about the strategies that apps employ to prevent pregnancy among adolescents and young adults. Further, there are no guidelines on best practices for adolescent and young adult pregnancy prevention through mobile apps. Objective: This review developed a preliminary evaluation framework for the assessment of mobile apps for adolescent and young adult pregnancy prevention and used this framework to assess available apps in the Apple App Store and Google Play that targeted adolescents and young adults with family planning and pregnancy prevention support. Methods: We developed an assessment rubric called Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) for data extraction using evidence-based and promising best practices from the literature. mCAPP comprises 4 domains: (1) app characteristics, (2) user interface features, (3) adolescent pregnancy prevention best practices, and (4) general sexual and reproductive health (SRH) features. For inclusion in the review, apps that advertised pregnancy prevention services and explicitly mentioned youth, were in English, and were free were systematically identified in the Apple App Store and Google Play in 2015. Screening, data extraction, and 4 interrater reliability checks were conducted by 2 reviewers. Each app was assessed for 92 facets of the mCAPP checklist. Results: Our search returned 4043 app descriptions in the Apple App Store (462) and Google Play (3581). After screening for inclusion criteria, 22 unique apps were included in our analysis. Included apps targeted teens in primarily developed countries, and the most common user interface features were clinic and health service locators. While app strengths included provision of SRH education, description of modern contraceptives, and some use of evidence-based adolescent best practices, gaps remain in the implementation of the majority of adolescent best practices and user interface features. Of the 8 best practices for teen pregnancy prevention operationalized through mCAPP, the most commonly implemented best practice was the provision of information on how to use contraceptives to prevent pregnancy (15/22), followed by provision of accurate information on pregnancy risk of sexual behaviors (13/22); information on SRH communication, negotiation, or refusal skills (10/22); and the use of persuasive language around contraceptive use (9/22). Conclusions: The quality and scope of apps for adolescent pregnancy prevention varies, indicating that developers and researchers may need a supportive framework. mCAPP can help researchers and developers consider mobile-relevant evidence-based best practices for adolescent SRH as they develop teen pregnancy prevention apps. Given the novelty of the mobile approach, further research is needed on the impact of mCAPP criteria via mobile channels on adolescent health knowledge, behaviors, and outcomes. UR - http://mhealth.jmir.org/2016/4/e122/ DO - 10.2196/mhealth.6611 UR - http://www.ncbi.nlm.nih.gov/pubmed/27833070 ID - info:doi/10.2196/mhealth.6611 ER - TY - JOUR AU - Donaire-Gonzalez, David AU - Valentín, Antònia AU - de Nazelle, Audrey AU - Ambros, Albert AU - Carrasco-Turigas, Glòria AU - Seto, Edmund AU - Jerrett, Michael AU - Nieuwenhuijsen, J. Mark PY - DA - 2016/11/10 TI - Benefits of Mobile Phone Technology for Personal Environmental Monitoring JO - JMIR Mhealth Uhealth SP - e126 VL - 4 IS - 4 KW - smartphone KW - cell phones KW - mobile applications KW - monitoring, ambulatory KW - spatio-temporal analysis KW - automatic data processing KW - travel KW - environmental exposure AB - Background: Tracking individuals in environmental epidemiological studies using novel mobile phone technologies can provide valuable information on geolocation and physical activity, which will improve our understanding of environmental exposures. Objective: The objective of this study was to assess the performance of one of the least expensive mobile phones on the market to track people's travel-activity pattern. Methods: Adults living and working in Barcelona (72/162 bicycle commuters) carried simultaneously a mobile phone and a Global Positioning System (GPS) tracker and filled in a travel-activity diary (TAD) for 1 week (N=162). The CalFit app for mobile phones was used to log participants? geographical location and physical activity. The geographical location data were assigned to different microenvironments (home, work or school, in transit, others) with a newly developed spatiotemporal map-matching algorithm. The tracking performance of the mobile phones was compared with that of the GPS trackers using chi-square test and Kruskal-Wallis rank sum test. The minute agreement across all microenvironments between the TAD and the algorithm was compared using the Gwet agreement coefficient (AC1). Results: The mobile phone acquired locations for 905 (29.2%) more trips reported in travel diaries than the GPS tracker (P<.001) and had a median accuracy of 25 m. Subjects spent on average 57.9%, 19.9%, 9.0%, and 13.2% of time at home, work, in transit, and other places, respectively, according to the TAD and 57.5%, 18.8%, 11.6%, and 12.1%, respectively, according to the map-matching algorithm. The overall minute agreement between both methods was high (AC1 .811, 95% CI .810-.812). Conclusions: The use of mobile phones running the CalFit app provides better information on which microenvironments people spend their time in than previous approaches based only on GPS trackers. The improvements of mobile phone technology in microenvironment determination are because the mobile phones are faster at identifying first locations and capable of getting location in challenging environments thanks to the combination of assisted-GPS technology and network positioning systems. Moreover, collecting location information from mobile phones, which are already carried by individuals, allows monitoring more people with a cheaper and less burdensome method than deploying GPS trackers. UR - http://mhealth.jmir.org/2016/4/e126/ DO - 10.2196/mhealth.5771 UR - http://www.ncbi.nlm.nih.gov/pubmed/27833069 ID - info:doi/10.2196/mhealth.5771 ER - TY - JOUR AU - Gomez Quiñonez, Stefanie AU - Walthouwer, Louis Michel Jean AU - Schulz, Nadine Daniela AU - de Vries, Hein PY - DA - 2016/11/09 TI - mHealth or eHealth? Efficacy, Use, and Appreciation of a Web-Based Computer-Tailored Physical Activity Intervention for Dutch Adults: A Randomized Controlled Trial JO - J Med Internet Res SP - e278 VL - 18 IS - 11 KW - mHealth KW - eHealth KW - Web-based intervention KW - computer-tailored intervention KW - physical activity AB - Background: Until a few years ago, Web-based computer-tailored interventions were almost exclusively delivered via computer (eHealth). However, nowadays, interventions delivered via mobile phones (mHealth) are an interesting alternative for health promotion, as they may more easily reach people 24/7. Objective: The first aim of this study was to compare the efficacy of an mHealth and an eHealth version of a Web-based computer-tailored physical activity intervention with a control group. The second aim was to assess potential differences in use and appreciation between the 2 versions. Methods: We collected data among 373 Dutch adults at 5 points in time (baseline, after 1 week, after 2 weeks, after 3 weeks, and after 6 months). We recruited participants from a Dutch online research panel and randomly assigned them to 1 of 3 conditions: eHealth (n=138), mHealth (n=108), or control condition (n=127). All participants were asked to complete questionnaires at the 5 points in time. Participants in the eHealth and mHealth group received fully automated tailored feedback messages about their current level of physical activity. Furthermore, they received personal feedback aimed at increasing their amount of physical activity when needed. We used analysis of variance and linear regression analyses to examine differences between the 2 study groups and the control group with regard to efficacy, use, and appreciation. Results: Participants receiving feedback messages (eHealth and mHealth together) were significantly more physically active after 6 months than participants in the control group (B=8.48, df=2, P=.03, Cohen d=0.27). We found a small effect size favoring the eHealth condition over the control group (B=6.13, df=2, P=.09, Cohen d=0.21). The eHealth condition had lower dropout rates (117/138, 84.8%) than the mHealth condition (81/108, 75.0%) and the control group (91/127, 71.7%). Furthermore, in terms of usability and appreciation, the eHealth condition outperformed the mHealth condition with regard to participants receiving (t182=3.07, P=.002) and reading the feedback messages (t181=2.34, P=.02), as well as the clarity of the messages (t181=1.99, P=.049). Conclusions: We tested 2 Web-based computer-tailored physical activity intervention versions (mHealth and eHealth) against a control condition with regard to efficacy, use, usability, and appreciation. The overall effect was mainly caused by the more effective eHealth intervention. The mHealth app was rated inferior to the eHealth version with regard to usability and appreciation. More research is needed to assess how both methods can complement each other. Trial Registration: Netherlands Trial Register: NTR4503; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4503 (Archived by WebCite at http://www.webcitation.org/6lEi1x40s) UR - http://www.jmir.org/2016/11/e278/ DO - 10.2196/jmir.6171 UR - http://www.ncbi.nlm.nih.gov/pubmed/27829576 ID - info:doi/10.2196/jmir.6171 ER - TY - JOUR AU - Huang, Tzu-Yen Evelyn AU - Williams, Henrietta AU - Hocking, S. Jane AU - Lim, SC Megan PY - DA - 2016/11/08 TI - Safe Sex Messages Within Dating and Entertainment Smartphone Apps: A Review JO - JMIR Mhealth Uhealth SP - e124 VL - 4 IS - 4 KW - mobile apps KW - sexual health KW - STDs KW - sexually transmitted diseases KW - mobile health KW - mHealth AB - Background: Smartphone apps provide a new platform for entertainment, information distribution, and health promotion activities, as well as for dating and casual sexual encounters. Previous research has shown high acceptability of sexual health interventions via smartphone apps; however, sexual health promotion apps were infrequently downloaded and underused. Integrating sexual health promotion into established apps might be a more effective method. Objective: The objective of our study was to critically review popular sex-related apps and dating apps, in order to ascertain whether they contain any sexual health content. Methods: Part 1: In January 2015, we used the term ?sexual? to search for free apps in the Apple iTunes store and Android Google Play store, and categorized the sexual health content of the 137 apps identified. Part 2: We used the term ?dating? to search for free geosocial-networking apps in the Apple iTunes and Android Google Play stores. The apps were downloaded to test functionality and to determine whether they included sexual health content. Results: Part 1: Of the 137 apps identified, 15 (11.0%) had sexual health content and 15 (11.0%) contained messages about sexual assault or violence. The majority of the apps did not contain any sexual health content. Part 2: We reviewed 60 dating apps: 44 (73%) targeting heterosexual users, 9 (15%) targeting men who have sex with men (MSM), 3 (5%) targeting lesbian women, and 4 (7%) for group dating. Only 9 dating apps contained sexual health content, of which 7 targeted MSM. Conclusions: The majority of sex-related apps and dating apps contained no sexual health content that could educate users about and remind them of their sexual risks. Sexual health practitioners and public health departments will need to work with app developers to promote sexual health within existing popular apps. For those apps that already contain sexual health messages, further study to investigate the effectiveness of the content is needed. UR - http://mhealth.jmir.org/2016/4/e124/ DO - 10.2196/mhealth.5760 UR - http://www.ncbi.nlm.nih.gov/pubmed/27826133 ID - info:doi/10.2196/mhealth.5760 ER - TY - JOUR AU - Laws, A. Rachel AU - Litterbach, V. Eloise-Kate AU - Denney-Wilson, A. Elizabeth AU - Russell, G. Catherine AU - Taki, Sarah AU - Ong, Kok-Leong AU - Elliott, M. Rosalind AU - Lymer, J. Sharyn AU - Campbell, J. Karen PY - DA - 2016/09/15 TI - A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program JO - J Med Internet Res SP - e248 VL - 18 IS - 9 KW - recruitment KW - mHealth KW - parents KW - social media KW - obesity prevention KW - infant feeding KW - children KW - infants KW - practitioners KW - primary health care AB - Background: Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs. Objective: The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention. Methods: The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ?18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants? baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews. Results: A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD $14) and highest for practice nurse recruitment (AUD $586). Just over half of the intervention group (50.3%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3%, 22/300 over 18 weeks). No significant differences were observed in participant sociodemographic characteristics between recruitment methods, with the exception that practitioner/face-to-face recruitment resulted in a higher proportion of first-time parents (68% versus 48%, P=.002). Less than half of the practitioners surveyed reported referring to the program often or most of the time. Key barriers to practitioner referral included lack of time, difficulty remembering to refer, staff changes, lack of parental engagement, and practitioner difficulty in accessing the app. Conclusions: Online recruitment using parenting-related Facebook pages was the most cost effective and timely method of recruitment to an mHealth intervention targeting parents of young infants. Consideration needs to be given to addressing practitioner barriers to referral, to further explore if this can be a viable method of recruitment. UR - http://www.jmir.org/2016/9/e248/ DO - 10.2196/jmir.5691 UR - http://www.ncbi.nlm.nih.gov/pubmed/27634633 ID - info:doi/10.2196/jmir.5691 ER - TY - JOUR AU - Lyles, R. Courtney AU - Altschuler, Andrea AU - Chawla, Neetu AU - Kowalski, Christine AU - McQuillan, Deanna AU - Bayliss, Elizabeth AU - Heisler, Michele AU - Grant, W. Richard PY - DA - 2016/09/14 TI - User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits JO - JMIR Mhealth Uhealth SP - e108 VL - 4 IS - 3 KW - primary health care KW - chronic disease KW - computers, handheld KW - mobile applications KW - medical informatics KW - health communication AB - Background: Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits. Objective: Our aim was to employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization. Methods: We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care providers, followed by three design sessions with a 12-patient group. We audiorecorded and transcribed all discussions and categorized major themes. In addition, we met with 15 key health communication, education, and technology leaders within our health system to further review the design and plan for broader implementation of the tool. In this paper, we present the significant changes made to the tablet tool at each phase of this design work. Results: Patient feedback emphasized the need to make the tablet tool accessible for patients who lacked technical proficiency and to reduce the quantity and complexity of text presentation. Both patients and their providers identified specific content choices based on their personal experiences (eg, the ability to raise private or sensitive concerns) and recommended targeting new patients. Stakeholder groups provided essential input on the need to augment text with video and to create different versions of the videos to match sex and race/ethnicity of the actors with patients. Conclusions: User-centered design in collaboration with patients, providers, and key health stakeholders led to marked evolution in the initial content, layout, and target audience for a tablet waiting room tool intended to assist complex patients with setting visit discussion priorities. UR - http://mhealth.jmir.org/2016/3/e108/ DO - 10.2196/mhealth.6187 UR - http://www.ncbi.nlm.nih.gov/pubmed/27627965 ID - info:doi/10.2196/mhealth.6187 ER - TY - JOUR AU - Frisbee, L. Kathleen PY - DA - 2016/07/19 TI - Variations in the Use of mHealth Tools: The VA Mobile Health Study JO - JMIR Mhealth Uhealth SP - e89 VL - 4 IS - 3 KW - caregivers KW - telemedicine KW - stress (psychological) KW - veterans health AB - Background: Mobile health (mHealth) technologies exhibit promise for offering patients and their caregivers point-of-need tools for health self-management. This research study involved the dissemination of iPads containing a suite of mHealth apps to family caregivers of veterans who receive care from the Veterans Affairs (VA) Health Administration and have serious physical or mental injuries. Objective: The goal of the study was to identify factors and characteristics of veterans and their family caregivers that predict the use of mHealth apps. Methods: Veteran/family caregiver dyads (N=882) enrolled in VA?s Comprehensive Assistance for Family Caregivers program were recruited to participate in an mHealth pilot program. Veterans and caregivers who participated and received an iPad agreed to have their use of the apps monitored and were asked to complete a survey assessing Caregiver Preparedness, Caregiver Traits, and Caregiver Zarit Burden Inventory baseline surveys. Results: Of the 882 dyads, 94.9% (837/882) of caregivers were women and 95.7% (844/882) of veteran recipients were men. Mean caregiver age was 40 (SD 10.2) years and mean veteran age was 39 (SD 9.15) years, and 39.8% (351/882) lived in rural locations. Most (89%, 788/882) of the caregivers were spouses. Overall, the most frequently used app was Summary of Care, followed by RX Refill, then Journal, Care4Caregivers, VA Pain Coach, and last, VA PTSD Coach. App use was significantly predicted by the caregiver being a spouse, increased caregiver computer skills, a rural living location, lower levels of caregiver preparedness, veteran mental health diagnosis (other than posttraumatic stress disorder), and veteran age. Conclusions: This mHealth Family Caregiver pilot project effectively establishes the VA?s first patient-facing mHealth apps that are integrated within the VA data system. Use varied considerably, and apps that were most used were those that assisted them in their caregiving responsibilities. UR - http://mhealth.jmir.org/2016/3/e89/ DO - 10.2196/mhealth.3726 UR - http://www.ncbi.nlm.nih.gov/pubmed/27436165 ID - info:doi/10.2196/mhealth.3726 ER - TY - JOUR AU - Micallef, Christianne AU - McLeod, Monsey AU - Castro-Sánchez, Enrique AU - Gharbi, Myriam AU - Charani, Esmita AU - Moore, SP Luke AU - Gilchrist, Mark AU - Husson, Fran AU - Costelloe, Ceire AU - Holmes, H. Alison PY - DA - 2016/07/06 TI - An Evidence-Based Antimicrobial Stewardship Smartphone App for Hospital Outpatients: Survey-based Needs Assessment Among Patients JO - JMIR Mhealth Uhealth SP - e83 VL - 4 IS - 3 KW - mobile electronic devices KW - mHealth KW - mobile health KW - antimicrobial resistance KW - patient involvement AB - Background: Current advances in modern technology have enabled the development and utilization of electronic medical software apps for both mobile and desktop computing devices. A range of apps on a large variety of clinical conditions for patients and the public are available, but very few target antimicrobials or infections. Objective: We sought to explore the use of different antimicrobial information resources with a focus on electronic platforms, including apps for portable devices, by outpatients at two large, geographically distinct National Health Service (NHS) teaching hospital trusts in England. We wanted to determine whether there is demand for an evidence-based app for patients, to garner their perceptions around infections/antimicrobial prescribing, and to describe patients? experiences of their interactions with health care professionals in relation to this topic. Methods: A cross-sectional survey design was used to investigate aspects of antimicrobial prescribing and electronic devices experienced by patients at four hospitals in London and a teaching hospital in the East of England. Results: A total of 99 surveys were completed and analyzed. A total of 82% (80/98) of respondents had recently been prescribed antimicrobials; 87% (85/98) of respondents were prescribed an antimicrobial by a hospital doctor or through their general practitioner (GP) in primary care. Respondents wanted information on the etiology (42/65, 65%) and prevention and/or management (32/65, 49%) of their infections, with the infections reported being upper and lower respiratory tract, urinary tract, oral, and skin and soft tissue infections. All patients (92/92, 100%) desired specific information on the antimicrobial prescribed. Approximately half (52/95, 55%) stated it was ?fine? for doctors to use a mobile phone/tablet computer during the consultation while 13% (12/95) did not support the idea of doctors accessing health care information in this way. Although only 30% (27/89) of respondents reported on the use of health care apps, 95% (81/85) offered information regarding aspects of antimicrobials or infections that could be provided through a tailored app for patients. Analysis of the comments revealed the following main global themes: knowledge, technology, and patient experience. Conclusions: The majority of respondents in our study wanted to have specific etiological and/or infection management advice. All required antimicrobial-related information. Also, most supported the use of electronic resources of information, including apps, by their doctors. While a minority of people currently use health apps, many feel that apps could be used to provide additional support/information related to infections and appropriate use of antimicrobials. In addition, we found that there is a need for health care professionals to engage with patients and help address common misconceptions around the generation of antimicrobial resistance. UR - http://mhealth.jmir.org/2016/3/e83/ DO - 10.2196/mhealth.5243 UR - http://www.ncbi.nlm.nih.gov/pubmed/27383743 ID - info:doi/10.2196/mhealth.5243 ER - TY - JOUR AU - White, K. Becky AU - Martin, Annegret AU - White, A. James AU - Burns, K. Sharyn AU - Maycock, R. Bruce AU - Giglia, C. Roslyn AU - Scott, A. Jane PY - DA - 2016/06/27 TI - Theory-Based Design and Development of a Socially Connected, Gamified Mobile App for Men About Breastfeeding (Milk Man) JO - JMIR Mhealth Uhealth SP - e81 VL - 4 IS - 2 KW - mHealth KW - smartphone KW - mobile phone KW - app KW - breastfeeding KW - fathers KW - gamification KW - social connectivity AB - Background: Despite evidence of the benefits of breastfeeding, <15% of Australian babies are exclusively breastfed to the recommended 6 months. The support of the father is one of the most important factors in breastfeeding success, and targeting breastfeeding interventions to the father has been a successful strategy in previous research. Mobile technology offers unique opportunities to engage and reach populations to enhance health literacy and healthy behavior. Objective: The objective of our study was to use previous research, formative evaluation, and behavior change theory to develop the first evidence-based breastfeeding app targeted at men. We designed the app to provide men with social support and information aiming to increase the support men can offer their breastfeeding partners. Methods: We used social cognitive theory to design and develop the Milk Man app through stages of formative research, testing, and iteration. We held focus groups with new and expectant fathers (n=18), as well as health professionals (n=16), and used qualitative data to inform the design and development of the app. We tested a prototype with fathers (n=4) via a think-aloud study and the completion of the Mobile Application Rating Scale (MARS). Results: Fathers and health professionals provided input through the focus groups that informed the app development. The think-aloud walkthroughs identified 6 areas of functionality and usability to be addressed, including the addition of a tutorial, increased size of text and icons, and greater personalization. Testers rated the app highly, and the average MARS score for the app was 4.3 out of 5. Conclusions: To our knowledge, Milk Man is the first breastfeeding app targeted specifically at men. The development of Milk Man followed a best practice approach, including the involvement of a multidisciplinary team and grounding in behavior change theory. It tested well with end users during development. Milk Man is currently being trialed as part of the Parent Infant Feeding Initiative (ACTRN12614000605695). UR - http://mhealth.jmir.org/2016/2/e81/ DO - 10.2196/mhealth.5652 UR - http://www.ncbi.nlm.nih.gov/pubmed/27349756 ID - info:doi/10.2196/mhealth.5652 ER - TY - JOUR AU - BinDhim, F. Nasser AU - Alanazi, M. Eman AU - Aljadhey, Hisham AU - Basyouni, H. Mada AU - Kowalski, R. Stefan AU - Pont, G. Lisa AU - Shaman, M. Ahmed AU - Trevena, Lyndal AU - Alhawassi, M. Tariq PY - DA - 2016/06/27 TI - Does a Mobile Phone Depression-Screening App Motivate Mobile Phone Users With High Depressive Symptoms to Seek a Health Care Professional?s Help? JO - J Med Internet Res SP - e156 VL - 18 IS - 6 KW - mental health KW - depression KW - mobile phone KW - public health informatics KW - patients? screening AB - Background: The objective of disease screening is to encourage high-risk subjects to seek health care diagnosis and treatment. Mobile phone apps can effectively screen mental health conditions, including depression. However, it is not known how effective such screening methods are in motivating users to discuss the obtained results of such apps with health care professionals. Does a mobile phone depression-screening app motivate users with high depressive symptoms to seek health care professional advice? This study aimed to address this question. Method: This was a single-cohort, prospective, observational study of a free mobile phone depression app developed in English and released on Apple?s App Store. Apple App Store users (aged 18 or above) in 5 countries, that is, Australia, Canada, New Zealand (NZ), the United Kingdom (UK), and the United States (US), were recruited directly via the app?s download page. The participants then completed the Patient Health Questionnaire (PHQ-9), and their depression screening score was displayed to them. If their score was 11 or above and they had never been diagnosed with depression before, they were advised to take their results to their health care professional. They were to follow up after 1 month. Results: A group of 2538 participants from the 5 countries completed PHQ-9 depression screening with the app. Of them, 322 participants were found to have high depressive symptoms and had never been diagnosed with depression, and received advice to discuss their results with health care professionals. About 74% of those completed the follow-up; approximately 38% of these self-reported consulting their health care professionals about their depression score. Only positive attitude toward depression as a real disease was associated with increased follow-up response rate (odds ratio (OR) 3.2, CI 1.38-8.29). Conclusions: A mobile phone depression-screening app motivated some users to seek a depression diagnosis. However, further study should investigate how other app users use the screening results provided by such apps. UR - http://www.jmir.org/2016/6/e156/ DO - 10.2196/jmir.5726 UR - http://www.ncbi.nlm.nih.gov/pubmed/27349441 ID - info:doi/10.2196/jmir.5726 ER - TY - JOUR AU - Arvidsson, Susann AU - Gilljam, Britt-Mari AU - Nygren, Jens AU - Ruland, Maria Cornelia AU - Nordby-Bøe, Trude AU - Svedberg, Petra PY - DA - 2016/06/24 TI - Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer JO - JMIR Mhealth Uhealth SP - e76 VL - 4 IS - 2 KW - cancer KW - children KW - communication KW - mobile app KW - participation KW - validation AB - Background: Children with cancer undergo intensive and long treatment periods that expose them and their families to a number of difficult physical, mental, and social challenges. Empowering children by actively involving them in their care can help them to cope with these challenges. It can, however, be difficult for children to be involved and talk about their illness experiences in a ?traditional? conversation with health care professionals, especially for younger children. Sisom (Norwegian acronym ?Si det som det er? or ?Tell it how it is?) is an interactive computer-based assessment and communication tool to give children (aged 6-12 years) with cancer a ?voice? in their care. Because of technological advances and widespread use of mobile devices Sisom had to be redesigned to better meet the needs of children of today. Objective: To redesign Sisom for use on mobile devices and to validate and adapt it for use in a Swedish population of children with cancer. Methods: A user-experience design was used. Content adaptation included forward-backward translation by Swedish and Norwegian translators. Healthy children (n=5), children with experiences of cancer treatment (n=5) and their parents (n=5), and pediatric nurses (n=2) were then involved in culturally adapting Sisom to the Swedish context. The iterative low- and high-fidelity evaluation was supported by a think aloud method, semistructured interviews, and drawings to capture children?s views of Sisom. The redesign and evaluation continued until no further changes or improvements were identified by the participants or the researchers. Results: Children, parents, and pediatric nurses offered many suggestions for improvements to the original version in terms of content, aesthetics, and usability of Sisom. The most significant change that emerged through user input was a modification that entailed not using problem-focused statements in the assessment items. The parents and pediatric nurses considered the revised assessment items to be general and less diagnosis specific. The evaluation of aesthetics resulted in brighter colors and more positive and exciting details in the animations. The evaluation of usability included improvements of the verbal instructions on how to navigate in Sisom 2, and also that the answers to assessment items in Sisom 2 should be saved to provide the children with the option to pause and to continue answering the remaining assessment items at a later stage. Conclusions: Overall, this paper describes the process of using user-experience design with children in order to redesign and validate an interactive assessment and communication tool and how the outcomes of this process resulted in a new version, Sisom 2. All participants confirmed the usability and qualities of using the final version. Future research should be directed toward the implementation of Sisom 2 in clinical practice and to evaluate outcomes from individual and organizational levels. UR - http://mhealth.jmir.org/2016/2/e76/ DO - 10.2196/mhealth.5715 UR - http://www.ncbi.nlm.nih.gov/pubmed/27343004 ID - info:doi/10.2196/mhealth.5715 ER - TY - JOUR AU - Puszkiewicz, Patrycja AU - Roberts, L. Anna AU - Smith, Lee AU - Wardle, Jane AU - Fisher, Abigail PY - DA - 2016/05/31 TI - Assessment of Cancer Survivors? Experiences of Using a Publicly Available Physical Activity Mobile Application JO - JMIR Cancer SP - e7 VL - 2 IS - 1 KW - cancer survivors KW - mobile applications KW - mHealth KW - physical activity KW - sleep AB - Background: Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective: This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors? attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods: The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: Of the people who responded to the study advertisement, 73% (16/22) agreed to participate and 100% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one?s lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions: All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population. UR - http://cancer.jmir.org/2016/1/e7/ DO - 10.2196/cancer.5380 UR - http://www.ncbi.nlm.nih.gov/pubmed/28410168 ID - info:doi/10.2196/cancer.5380 ER - TY - JOUR AU - Breitenstein, M. Susan AU - Fogg, Louis AU - Ocampo, V. Edith AU - Acosta, I. Diana AU - Gross, Deborah PY - DA - 2016/04/20 TI - Parent Use and Efficacy of a Self-Administered, Tablet-Based Parent Training Intervention: A Randomized Controlled Trial JO - JMIR mHealth uHealth SP - e36 VL - 4 IS - 2 KW - Internet, intervention, mobile app, mobile health, parenting, prevention AB - Background: Parent training programs are traditionally delivered in face-to-face formats and require trained facilitators and weekly parent attendance. Implementing face-to-face sessions is challenging in busy primary care settings and many barriers exist for parents to attend these sessions. Tablet-based delivery of parent training offers an alternative to face-to-face delivery to make parent training programs easier to deliver in primary care settings and more convenient and accessible to parents. We adapted the group-based Chicago Parent Program (CPP) to be delivered as a self-administered, tablet-based program called the ezParent program. Objective: The purpose of this study was to (1) assess the feasibility of the ezParent program by examining parent satisfaction with the program and the percent of modules completed, (2) test the efficacy of the ezParent program by examining the effects compared with a control condition for improving parenting and child behavior in a sample of low-income ethnic minority parents of young children recruited from a primary care setting, and (3) compare program completion and efficacy with prior studies of the group-based CPP. Methods: The study used a two-group randomized controlled trial (RCT) design with repeated measures follow up. Subjects (n=79) were randomly assigned to an intervention or attention control condition. Data collection was at baseline and 12 and 24 weeks post baseline. Parents were recruited from a large, urban, primary care pediatric clinic. ezParent module completion was calculated as the percentage of the six modules completed by the intervention group parents. Attendance in the group-based CPP was calculated as the percentage of attendance at sessions 1 through 10. Satisfaction data were summarized using item frequencies. Parent and child data were analyzed using a repeated measures analysis of variance (RM-ANOVA) with simple contrasts to determine if there were significant intervention effects on the outcome measures. Effect sizes for between group comparisons were calculated for all outcome variables and compared with CPP group based archival data. Results: ezParent module completion rate was 85.4% (34.2/40; 95% confidence interval [CI] = 78.4%-93.7%) and was significantly greater (P<.05) than face-to-face CPP group attendance (135.2/267, 50.6%) attendance of sessions; 95% CI = 46.8%-55.6%). ezParent participants reported the program as very helpful (35/40, 88.0%) and they would highly recommend the program (33/40, 82.1%) to another parent. ezParent participants showed greater improvements in parenting warmth (F1,77 = 4.82, P<.05) from time 1 to 3. No other significant differences were found. Cohen?s d effect sizes for intervention group improvements in parenting warmth, use of corporal punishment, follow through, parenting stress, and intensity of child behavior problems were comparable or greater than those of the group-based CPP. Conclusions: Data from this study indicate the feasibility and acceptability of the ezParent program in a low-income, ethnic minority population of parents and comparable effect sizes with face-to-face delivery for parents. UR - http://mhealth.jmir.org/2016/2/e36/ DO - 10.2196/mhealth.5202 UR - http://www.ncbi.nlm.nih.gov/pubmed/27098111 ID - info:doi/10.2196/mhealth.5202 ER - TY - JOUR AU - Simons, Lucy AU - Valentine, Z. Althea AU - Falconer, J. Caroline AU - Groom, Madeleine AU - Daley, David AU - Craven, P. Michael AU - Young, Zoe AU - Hall, Charlotte AU - Hollis, Chris PY - DA - 2016/03/23 TI - Developing mHealth Remote Monitoring Technology for Attention Deficit Hyperactivity Disorder: A Qualitative Study Eliciting User Priorities and Needs JO - JMIR mHealth uHealth SP - e31 VL - 4 IS - 1 KW - attention deficit hyperactivity disorder KW - mHealth KW - eMental Health KW - remote monitoring technology KW - mental health services KW - qualitative methods KW - feasibility testing KW - user requirements AB - Background: Guidelines in the United Kingdom recommend that medication titration for attention deficit hyperactivity disorder (ADHD) should be completed within 4-6 weeks and include regular reviews. However, most clinicians think that weekly clinic contact is infeasible, and audits have shown that this timeline is rarely achieved. Thus, a more effective monitoring and review system is needed; remote monitoring technology (RMT) may be one way to improve current practice. However, little is known about whether patients with ADHD, their families, and clinicians would be interested in using RMT. Objective: To explore patients?, parents?, and health care professionals? views and attitudes toward using digital technology for remote monitoring during titration for ADHD. Methods: This was a qualitative study, and data were collected through 11 focus groups with adults and young people with ADHD, parents of children with ADHD, and health care professionals (N=59). Results: All participant groups were positive about using RMT in the treatment of ADHD, but they were also aware of barriers to its use, especially around access to technology and integrating RMT into clinical care. They identified that RMT had the most potential for use in the ongoing management and support of ADHD, rather than during the distinct titration period. Participants identified features of RMT that could improve the quality of consultations and support greater self-management. Conclusions: RMT has the potential to augment support and care for ADHD, but it needs to go beyond the titration period and offer more to patients and families than monitoring through outcome measures. Developing and evaluating an mHealth app that incorporates the key features identified by end users is required. UR - http://mhealth.jmir.org/2016/1/e31/ DO - 10.2196/mhealth.5009 UR - http://www.ncbi.nlm.nih.gov/pubmed/27009498 ID - info:doi/10.2196/mhealth.5009 ER - TY - JOUR AU - Browne, H. Sara AU - Behzadi, Yashar AU - Littlewort, Gwen PY - DA - 2015/12/31 TI - Let Visuals Tell the Story: Medication Adherence in Patients with Type II Diabetes Captured by a Novel Ingestion Sensor Platform JO - JMIR mHealth uHealth SP - e108 VL - 3 IS - 4 KW - ingestion sensor platform KW - data visualization KW - time domain methods KW - medication adherence KW - patient self-management AB - Background: Chronic diseases such as diabetes require high levels of medication adherence and patient self-management for optimal health outcomes. A novel sensing platform, Digital Health Feedback System (Proteus Digital Health, Redwood City, CA), can for the first time detect medication ingestion events and physiological measures simultaneously, using an edible sensor, personal monitor patch, and paired mobile device. The Digital Health Feedback System (DHFS) generates a large amount of data. Visual analytics of this rich dataset may provide insights into longitudinal patterns of medication adherence in the natural setting and potential relationships between medication adherence and physiological measures that were previously unknown. Objective: Our aim was to use modern methods of visual analytics to represent continuous and discrete data from the DHFS, plotting multiple different data types simultaneously to evaluate the potential of the DHFS to capture longitudinal patterns of medication-taking behavior and self-management in individual patients with type II diabetes. Methods: Visualizations were generated using time domain methods of oral metformin medication adherence and physiological data obtained by the DHFS use in 5 patients with type II diabetes over 37-42 days. The DHFS captured at-home metformin adherence, heart rate, activity, and sleep/rest. A mobile glucose monitor captured glucose testing and level (mg/dl). Algorithms were developed to analyze data over varying time periods: across the entire study, daily, and weekly. Following visualization analysis, correlations between sleep/rest and medication ingestion were calculated across all subjects. Results: A total of 197 subject days, encompassing 141,840 data events were analyzed. Individual continuous patch use varied between 87-98%. On average, the cohort took 78% (SD 12) of prescribed medication and took 77% (SD 26) within the prescribed ±2-hour time window. Average activity levels per subjects ranged from 4000-12,000 steps per day. The combination of activity level and heart rate indicated different levels of cardiovascular fitness between subjects. Visualizations over the entire study captured the longitudinal pattern of missed doses (the majority of which took place in the evening), the timing of ingestions in individual subjects, and the range of medication ingestion timing, which varied from 1.5-2.4 hours (Subject 3) to 11 hours (Subject 2). Individual morning self-management patterns over the study period were obtained by combining the times of waking, metformin ingestion, and glucose measurement. Visualizations combining multiple data streams over a 24-hour period captured patterns of broad daily events: when subjects rose in the morning, tested their blood glucose, took their medications, went to bed, hours of sleep/rest, and level of activity during the day. Visualizations identified highly consistent daily patterns in Subject 3, the most adherent participant. Erratic daily patterns including sleep/rest were demonstrated in Subject 2, the least adherent subject. Correlation between sleep /rest and medication ingestion in each individual subject was evaluated. Subjects 2 and 4 showed correlation between amount of sleep/rest over a 24-hour period and medication-taking the following day (Subject 2: r=.47, P<.02; Subject 4: r=.35, P<.05). With Subject 2, sleep/rest disruptions during the night were highly correlated (r=.47, P<.009) with missing doses the following day. Conclusions: Visualizations integrating medication ingestion and physiological data from the DHFS over varying time intervals captured detailed individual longitudinal patterns of medication adherence and self-management in the natural setting. Visualizing multiple data streams simultaneously, providing a data-rich representation, revealed information that would not have been shown by plotting data streams individually. Such analyses provided data far beyond traditional adherence summary statistics and may form the foundation of future personalized predictive interventions to drive longitudinal adherence and support optimal self-management in chronic diseases such as diabetes. UR - http://mhealth.jmir.org/2015/4/e108/ DO - 10.2196/mhealth.4292 UR - http://www.ncbi.nlm.nih.gov/pubmed/26721413 ID - info:doi/10.2196/mhealth.4292 ER - TY - JOUR AU - Wark, D. John AU - Henningham, Lucy AU - Gorelik, Alexandra AU - Jayasinghe, Yasmin AU - Hartley, Stefanie AU - Garland, Marie Suzanne PY - DA - 2015/10/05 TI - Basal Temperature Measurement Using a Multi-Sensor Armband in Australian Young Women: A Comparative Observational Study JO - JMIR mHealth uHealth SP - e94 VL - 3 IS - 4 KW - basal body temperature KW - young female health initiative KW - BodyMedia SenseWear KW - ovulation KW - menstrual cycle, young women AB - Background: The menstrual cycle is a key marker of health in women of reproductive age. Monitoring ovulation is useful in health studies involving young women. The upward shift in basal body temperature, which occurs shortly after ovulation and continues until the next menses, is a potentially useful marker of ovulation, which has been exploited in clinical and research settings. Objective: We investigated the utility of BodyMedia SenseWear (BMSW) in monitoring ovulation in young women by analyzing the correlation and agreement of basal temperatures measured using BMSW and a digital oral thermometer. Methods: Kappa statistics were used to determine the agreement in ovulation detection between the two devices, for each participant, under each form of analysis. Participants also completed an online questionnaire assessing the acceptability of both devices. Results: We recruited 16 participants with 15 of them providing analyzable data (11 OCP non-users, 4 OCP users). Weak to moderate correlations were observed between thermometer and BMSW temperature measurements averaged over 5 different time intervals. However, no agreement between methods was observed using Bland-Altman plots. There was a significant difference in the range of temperatures that each device recorded (thermometer: 35.3-37.2°C, BMSW: 29.7-36.7°C) with BMSW temperatures significantly lower than thermometer temperatures: mean 34.6°C (SD 1.2) versus 36.4°C (SD 0.3) respectively, P<.001. Poor agreement was observed between devices under quantitative analysis of ovulation while fair agreement was observed under visual analysis. Under both quantitative and visual analysis, there was 0% agreement for evidence of ovulation. Conclusions: This study demonstrated the importance of evaluating biomeasures collected using mobile monitoring devices by comparison with standard methods. It revealed a relatively poor correlation between BMSW and oral thermometer temperature readings and suggested that BMSW is unlikely to detect an upward shift in basal body temperature. Participant behavior suggested poor compliance in the use of BMSW for basal temperature measurement and that the basal body temperature method may not be suitable for use in unselected samples of young women. There is a need for research tools for monitoring ovulation that are simple, self-administered, and inexpensive, yet appealing to young women. UR - http://mhealth.jmir.org/2015/4/e94/ DO - 10.2196/mhealth.4263 UR - http://www.ncbi.nlm.nih.gov/pubmed/26441468 ID - info:doi/10.2196/mhealth.4263 ER - TY - JOUR AU - Sieverdes, Christopher John AU - Nemeth, S. Lynne AU - Magwood, S. Gayenell AU - Baliga, K. Prabhakar AU - Chavin, D. Kenneth AU - Brunner-Jackson, Brenda AU - Patel, K. Sachin AU - Ruggiero, J. Kenneth AU - Treiber, A. Frank PY - DA - 2015/08/10 TI - Patient-Centered mHealth Living Donor Transplant Education Program for African Americans: Development and Analysis JO - JMIR Res Protoc SP - e84 VL - 4 IS - 3 KW - kidney transplantation KW - living donors KW - mobile apps KW - qualitative research KW - telemedicine AB - Background: There is a critical need to expand the pool of available kidneys for African Americans who are on the transplant wait-list due to the disproportionally lower availability of deceased donor kidneys compared with other races/ethnic groups. Encouraging living donation is one method to fill this need. Incorporating mHealth strategies may be a way to deliver educational and supportive services to African American transplant-eligible patients and improve reach to those living in remote areas or unable to attend traditional group-session-based programs. Before program development, it is essential to perform formative research with target populations to determine acceptability and cultivate a patient-centered and culturally relevant approach to be used for program development. Objective: The objectives of this study were to investigate African American kidney transplant recipients? and kidney donors?/potential donors? attitudes and perceptions toward mobile technology and its viability in an mHealth program aimed at educating patients about the process of living kidney donation. Methods: Using frameworks from the technology acceptance model and self-determination theory, 9 focus groups (n=57) were administered to African Americans at a southeastern medical center, which included deceased/living donor kidney recipients and living donors/potential donors. After a demonstration of a tablet-based video education session and explanation of a group-based videoconferencing session, focus groups examined members? perceptions about how educational messages should be presented on topics pertaining to the process of living kidney donation and the transplantation. Questionnaires were administered on technology use and perceptions of the potential program communication platform. Transcripts were coded and themes were examined using NVivo 10 software. Results: Qualitative findings found 5 major themes common among all participants. These included the following: (1) strong support for mobile technology use; (2) different media formats were preferred; (3) willingness to engage in video chats, but face-to-face interaction sometimes preferred; (4) media needs to be user friendly; (5) high prevalence of technology access. Our results show that recipients were willing to spend more time on education than the donors group, they wanted to build conversation skills to approach others, and preferred getting information from many sources, whereas the donor group wanted to hear from other living donors. The questionnaires revealed 85% or more of the sample scored 4+ on a 5-point Likert scale, which indicates high degree of interest to use the proposed program, belief that other mHealth technologies would help with adherence to medical regimens, and doctors would make regimen adjustments quicker. In addition, high utilization of mobile technology was reported; 71.9% of the participants had a mobile phone and 43.9% had a tablet. Conclusions: Our study supports the use of an mHealth education platform for African Americans to learn about living donation. However, potential recipients and potential donors have differing needs, and therefore, programs should be tailored to each target audience. UR - http://www.researchprotocols.org/2015/3/e84/ DO - 10.2196/resprot.3715 UR - http://www.ncbi.nlm.nih.gov/pubmed/26265532 ID - info:doi/10.2196/resprot.3715 ER - TY - JOUR AU - Brand, Leah AU - Beltran, Alicia AU - Buday, Richard AU - Hughes, Sheryl AU - O'Connor, Teresia AU - Baranowski, Janice AU - Dadabhoy, R. Hafza AU - Diep, S. Cassandra AU - Baranowski, Tom PY - DA - 2015/07/24 TI - Training Vegetable Parenting Practices Through a Mobile Game: Iterative Qualitative Alpha Test JO - JMIR Serious Games SP - e6 VL - 3 IS - 2 KW - mobile games KW - games for health KW - serious games KW - pediatric nutrition KW - parenting AB - Background: Vegetable consumption protects against chronic diseases, but many young children do not eat vegetables. One quest within the mobile application Mommio was developed to train mothers of preschoolers in effective vegetable parenting practices, or ways to approach getting their child to eat and enjoy vegetables. A much earlier version of the game, then called Kiddio, was alpha tested previously, but the game has since evolved in key ways. Objective: The purpose of this research was to alpha test the first quest, substantiate earlier findings and obtain feedback on new game features to develop an effective, compelling parenting game. Methods: Mothers of preschool children (n=20) played a single quest of Mommio 2 to 4 times, immediately after which a semi-structured interview about their experience was completed. Interviews were transcribed and double coded using thematic analysis methods. Results: Mothers generally liked the game, finding it realistic and engaging. Some participants had difficulties with mechanics for moving around the 3-D environment. Tips and hints were well received, and further expansion and customization were desired. Conclusions: Earlier findings were supported, though Mommio players reported more enjoyment than Kiddio players. Continued development will include more user-friendly mechanics, customization, opportunities for environment interaction, and food parenting scenarios. UR - http://games.jmir.org/2015/2/e6/ DO - 10.2196/games.4081 UR - http://www.ncbi.nlm.nih.gov/pubmed/26208899 ID - info:doi/10.2196/games.4081 ER - TY - JOUR AU - Boyd, Dallas Andrew AU - Moores, Kaitlin AU - Shah, Vicki AU - Sadhu, Eugene AU - Shroff, Adhir AU - Groo, Vicki AU - Dickens, Carolyn AU - Field, Jerry AU - Baumann, Matthew AU - Welland, Betty AU - Gutowski, Gerry AU - Flores Jr, D. Jose AU - Zhao, Zhongsheng AU - Bahroos, Neil AU - Hynes, M. Denise AU - Wilkie, J. Diana PY - DA - 2015/07/02 TI - My Interventional Drug-Eluting Stent Educational App (MyIDEA): Patient-Centered Design Methodology JO - JMIR mHealth uHealth SP - e74 VL - 3 IS - 3 KW - drug-eluting stents KW - health informatics KW - Kolb's learning theory KW - mHealth KW - patient-centered design KW - patient education AB - Background: Patient adherence to medication regimens is critical in most chronic disease treatment plans. This study uses a patient-centered tablet app, ?My Interventional Drug-Eluting Stent Educational App (MyIDEA).? This is an educational program designed to improve patient medication adherence. Objective: Our goal is to describe the design, methodology, limitations, and results of the MyIDEA tablet app. We created a mobile technology-based patient education app to improve dual antiplatelet therapy adherence in patients who underwent a percutaneous coronary intervention and received a drug-eluting stent. Methods: Patient advisers were involved in the development process of MyIDEA from the initial wireframe to the final launch of the product. The program was restructured and redesigned based on the patient advisers? suggestions as well as those from multidisciplinary team members. To accommodate those with low health literacy, we modified the language and employed attractive color schemes to improve ease of use. We assumed that the target patient population may have little to no experience with electronic tablets, and therefore, we designed the interface to be as intuitive as possible. Results: The MyIDEA app has been successfully deployed to a low-health-literate elderly patient population in the hospital setting. A total of 6 patients have interacted with MyIDEA for an average of 17.6 minutes/session. Conclusions: Including patient advisers in the early phases of a mobile patient education development process is critical. A number of changes in text order, language, and color schemes occurred to improve ease of use. The MyIDEA program has been successfully deployed to a low-health-literate elderly patient population. Leveraging patient advisers throughout the development process helps to ensure implementation success. UR - http://mhealth.jmir.org/2015/3/e74/ DO - 10.2196/mhealth.4021 UR - http://www.ncbi.nlm.nih.gov/pubmed/26139587 ID - info:doi/10.2196/mhealth.4021 ER -