TY - JOUR AU - Sandborg, Johanna AU - Henriksson, Pontus AU - Larsen, Erica AU - Lindqvist, Anna-Karin AU - Rutberg, Stina AU - Söderström, Emmie AU - Maddison, Ralph AU - Löf, Marie PY - 2021/3/5 TI - Participants? Engagement and Satisfaction With a Smartphone App Intended to Support Healthy Weight Gain, Diet, and Physical Activity During Pregnancy: Qualitative Study Within the HealthyMoms Trial JO - JMIR Mhealth Uhealth SP - e26159 VL - 9 IS - 3 KW - pregnancy KW - gestational weight gain KW - mHealth KW - telemedicine KW - digital health KW - mobile health KW - eHealth KW - smartphone intervention KW - mobile application KW - smartphone application KW - engagement KW - physical activity KW - exercise KW - nutrition KW - diet KW - qualitative KW - thematic analysis N2 - Background: Excessive gestational weight gain (GWG) is common and associated with negative health outcomes for both mother and child. Mobile health?delivered lifestyle interventions offer the potential to mitigate excessive GWG. The effectiveness of a smartphone app (HealthyMoms) was recently evaluated in a randomized controlled trial. To explore the users? experiences of using the app, a qualitative study within the HealthyMoms trial was performed. Objective: This qualitative study explored participants? engagement and satisfaction with the 6-month usage of the HealthyMoms app. Methods: A total of 19 women (mean age: 31.7, SD 4.4 years; mean BMI: 24.6, SD 3.4 kg/m2; university degree attainment: 13/19, 68%; primiparous: 11/19, 58%) who received the HealthyMoms app in a randomized controlled trial completed semistructured exit interviews. The interviews were audiorecorded and fully transcribed, coded, and analyzed using thematic analysis with an inductive approach. Results: Thematic analysis revealed a main theme and 2 subthemes. The main theme, ?One could suit many: a multifunctional tool to strengthen women?s health during pregnancy,? and the 2 subthemes, ?Factors within and beyond the app influence app engagement? and ?Trust, knowledge, and awareness: aspects that can motivate healthy habits,? illustrated that a trustworthy and appreciated health and pregnancy app that is easy to use can inspire a healthy lifestyle during pregnancy. The first subtheme discussed how factors within the app (eg, regular updates and feedback) were perceived to motivate both healthy habits and app engagement. Additionally, factors beyond the app were described to both motivate (eg, interest, motivation, and curiosity) and limit (eg, pregnancy-related complications, lack of time) app engagement. The second subtheme reflected important aspects, such as high trustworthiness of the app, increased knowledge, and awareness from using the app, which motivated participants to improve or maintain healthy habits during pregnancy. Conclusions: The HealthyMoms app was considered a valuable and trustworthy tool to mitigate excessive GWG, with useful features and relevant information to initiate and maintain healthy habits during pregnancy. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 UR - https://mhealth.jmir.org/2021/3/e26159 UR - http://dx.doi.org/10.2196/26159 UR - http://www.ncbi.nlm.nih.gov/pubmed/33666554 ID - info:doi/10.2196/26159 ER - TY - JOUR AU - Byonanebye, Mirembe Dathan AU - Nabaggala, S. Maria AU - Naggirinya, Bwanika Agnes AU - Lamorde, Mohammed AU - Oseku, Elizabeth AU - King, Rachel AU - Owarwo, Noela AU - Laker, Eva AU - Orama, Richard AU - Castelnuovo, Barbara AU - Kiragga, Agnes AU - Parkes-Ratanshi, Rosalind PY - 2021/2/11 TI - An Interactive Voice Response Software to Improve the Quality of Life of People Living With HIV in Uganda: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e22229 VL - 9 IS - 2 KW - mHealth KW - HIV KW - quality of life KW - interactive voice response KW - mobile health KW - digital health N2 - Background: Following the successful scale-up of antiretroviral therapy (ART), the focus is now on ensuring good quality of life (QoL) and sustained viral suppression in people living with HIV. The access to mobile technology in the most burdened countries is increasing rapidly, and therefore, mobile health (mHealth) technologies could be leveraged to improve QoL in people living with HIV. However, data on the impact of mHealth tools on the QoL in people living with HIV are limited to the evaluation of SMS text messaging; these are infeasible in high-illiteracy settings. Objective: The primary and secondary outcomes were to determine the impact of interactive voice response (IVR) technology on Medical Outcomes Study HIV QoL scores and viral suppression at 12 months, respectively. Methods: Within the Call for Life study, ART-experienced and ART-naïve people living with HIV commencing ART were randomized (1:1 ratio) to the control (no IVR support) or intervention arm (daily adherence and pre-appointment reminders, health information tips, and option to report symptoms). The software evaluated was Call for Life Uganda, an IVR technology that is based on the Mobile Technology for Community Health open-source software. Eligibility criteria for participation included access to a phone, fluency in local languages, and provision of consent. The differences in differences (DIDs) were computed, adjusting for baseline HIV RNA and CD4. Results: Overall, 600 participants (413 female, 68.8%) were enrolled and followed-up for 12 months. In the intervention arm of 300 participants, 298 (99.3%) opted for IVR and 2 (0.7%) chose SMS text messaging as the mode of receiving reminders and health tips. At 12 months, there was no overall difference in the QoL between the intervention and control arms (DID=0.0; P=.99) or HIV RNA (DID=0.01; P=.94). At 12 months, 124 of the 256 (48.4%) active participants had picked up at least 50% of the calls. In the active intervention participants, high users (received >75% of reminders) had overall higher QoL compared to low users (received <25% of reminders) (92.2 versus 87.8, P=.02). Similarly, high users also had higher QoL scores in the mental health domain (93.1 versus 86.8, P=.008) and better appointment keeping. Similarly, participants with moderate use (51%-75%) had better viral suppression at 12 months (80/94, 85% versus 11/19, 58%, P=.006). Conclusions: Overall, there was high uptake and acceptability of the IVR tool. While we found no overall difference in the QoL and viral suppression between study arms, people living with HIV with higher usage of the tool showed greater improvements in QoL, viral suppression, and appointment keeping. With the declining resources available to HIV programs and the increasing number of people living with HIV accessing ART, IVR technology could be used to support patient care. The tool may be helpful in situations where physical consultations are infeasible, including the current COVID epidemic. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 UR - https://mhealth.jmir.org/2021/2/e22229 UR - http://dx.doi.org/10.2196/22229 UR - http://www.ncbi.nlm.nih.gov/pubmed/33570497 ID - info:doi/10.2196/22229 ER - TY - JOUR AU - Liu, Guihua AU - Wang, Shuo AU - Liao, Jinhua AU - Ou, Ping AU - Huang, Longsheng AU - Xie, Namei AU - He, Yingshuang AU - Lin, Jinling AU - He, Hong-Gu AU - Hu, Rongfang PY - 2021/2/10 TI - The Efficacy of WeChat-Based Parenting Training on the Psychological Well-being of Mothers With Children With Autism During the COVID-19 Pandemic: Quasi-Experimental Study JO - JMIR Ment Health SP - e23917 VL - 8 IS - 2 KW - coronavirus disease 2019 KW - autism spectrum disorder KW - parenting training KW - psychological well-being KW - social media KW - WeChat KW - COVID-19 KW - autism KW - parenting KW - mental health KW - well-being KW - anxiety KW - depression KW - stress N2 - Background: During the COVID-19 pandemic, special education schools for children in most areas of China were closed between the end of January and the beginning of June in 2020. The sudden interruption in schooling and the pandemic itself caused parents to be anxious and even to panic. Mobile-based parenting skills education has been demonstrated to be an effective method for improving the psychological well-being of mothers with children with autism. However, whether it can improve the psychological states of mothers in the context of the COVID-19 pandemic is a subject that should be urgently investigated. Objective: The aim of this study is to evaluate the efficacy of WeChat-based parenting training on anxiety, depression, parenting stress, and hope in mothers with children with autism, as well as the feasibility of the program during the COVID-19 pandemic. Methods: This was a quasi-experimental trial. A total of 125 mothers with preschool children with autism were recruited in January 2020. The participants were assigned to the control group (n=60), in which they received routine care, or the intervention group (n=65), in which they received the 12-week WeChat-based parenting training plus routine care, according to their preferences. Anxiety, depression, parenting stress, hope, satisfaction, and adherence to the intervention were measured at three timepoints: baseline (T0), postintervention (T1), and a 20-week follow-up (T2). Results: In total, 109 mothers completed the T1 assessment and 104 mothers completed the T2 assessment. The results of the linear mixed model analysis showed statistically significant group × time interaction effects for the intervention on anxiety (F=14.219, P<.001), depression (F=26.563, P<.001), parenting stress (F=68.572, P<.001), and hope (F=197.608, P<.001). Of all mothers in the intervention group, 90.4% (48.8/54) reported that they were extremely satisfied with the WeChat-based parenting training. In total, 40.0% (26/65) logged their progress in home training each week and 61.5% (40/65) logged their progress more than 80% of the time for all 20 weeks. Conclusions: The WeChat-based parenting training is acceptable and appears to be an effective approach for reducing anxiety, depression, and parenting stress, as well as increasing hope in mothers with children with autism during the global COVID-19 pandemic. Future studies with rigorous designs and longer follow-up periods are needed to further detect the effectiveness of the WeChat-based parenting training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031772; http://www.chictr.org.cn/showproj.aspx?proj=52165 UR - https://mental.jmir.org/2021/2/e23917 UR - http://dx.doi.org/10.2196/23917 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481751 ID - info:doi/10.2196/23917 ER - TY - JOUR AU - Willems, J. Stijn AU - Coppieters, W. Michel AU - Pronk, Yvette AU - Diks, F. Miranda J. AU - van der Heijden, P. Klaas W. A. AU - Rooker, Servan AU - Scholten-Peeters, M. Gwendolyne G. PY - 2021/2/8 TI - A Clinical Journey Mobile Health App for Perioperative Patients: Cross-sectional Study JO - JMIR Hum Factors SP - e20694 VL - 8 IS - 1 KW - eHealth KW - mHealth KW - applications KW - musculoskeletal KW - user-friendliness KW - rehabilitation KW - usability KW - patient education KW - technology KW - disability KW - feasibility KW - adherence N2 - Background: Mobile eHealth apps are important tools in personal health care management. The Patient Journey app was developed to inform patients with musculoskeletal disorders during their perioperative period. The app contains timely information, video exercises, and functional tasks. Although the Patient Journey app and other health apps are widely used, little research is available on how patients appreciate these apps. Objective: The primary aim of this study was to evaluate the user-friendliness of the Patient Journey app in terms of its usability and the attitudes of users toward the app. The secondary aim was to evaluate positive and negative user experiences. Methods: A web-based questionnaire was sent to 2114 patients scheduled for surgery for a musculoskeletal disorder. Primary outcomes were usability (measured with the System Usability Scale) and user attitudes regarding the Patient Journey app (assessed with the second part of the eHealth Impact Questionnaire). The secondary outcomes were evaluated with multiple choice questions and open-ended questions, which were analyzed via inductive thematic content analyses. Results: Of the 940 patients who responded, 526 used the Patient Journey app. The usability of the app was high (System Usability Scale: median 85.0, IQR 72.5-92.5), and users had a positive attitude toward the Information and Presentation provided via the app (eHealth Impact Questionnaire: median 78.0, IQR 68.8-84.4). The app did not adequately improve the users? confidence in discussing health with others (eHealth Impact Questionnaire: median 63.9, IQR 50.0-75.0) or motivation to manage health (eHealth Impact Questionnaire: median 61.1, IQR 55.6-72.2). Three core themes emerged regarding positive and negative user experiences: (1) content and information, (2) expectations and experiences, and (3) technical performance. Users experienced timely information and instructions positively and found that the app prepared and guided them optimally through the perioperative period. Negative user experiences were overly optimistic information, scarcely presented information about pain (medication), lack of reference data, insufficient information regarding clinical course deviations and complications, and lack of interaction with clinicians. Conclusions: The Patient Journey app is a usable, informative, and presentable tool to inform patients with musculoskeletal disorders during their perioperative period. The qualitative analyses identified aspects that can further improve the user experiences of the app. UR - http://humanfactors.jmir.org/2021/1/e20694/ UR - http://dx.doi.org/10.2196/20694 UR - http://www.ncbi.nlm.nih.gov/pubmed/33555262 ID - info:doi/10.2196/20694 ER - TY - JOUR AU - Logie, Carmen AU - Okumu, Moses AU - Hakiza, Robert AU - Kibuuka Musoke, Daniel AU - Berry, Isha AU - Mwima, Simon AU - Kyambadde, Peter AU - Kiera, Mimy Uwase AU - Loutet, Miranda AU - Neema, Stella AU - Newby, Katie AU - McNamee, Clara AU - Baral, D. Stefan AU - Lester, Richard AU - Musinguzi, Joshua AU - Mbuagbaw, Lawrence PY - 2021/2/2 TI - Mobile Health?Supported HIV Self-Testing Strategy Among Urban Refugee and Displaced Youth in Kampala, Uganda: Protocol for a Cluster Randomized Trial (Tushirikiane, Supporting Each Other) JO - JMIR Res Protoc SP - e26192 VL - 10 IS - 2 KW - adolescents and youth KW - implementation research KW - HIV testing KW - mobile health KW - refugee KW - Uganda N2 - Background: HIV is the leading cause of mortality among youth in sub-Saharan Africa. Uganda hosts over 1.43 million refugees, and more than 83,000 live in Kampala, largely in informal settlements. There is limited information about HIV testing uptake and preferences among urban refugee and displaced youth. HIV self-testing is a promising method for increasing testing uptake. Further, mobile health (mHealth) interventions have been effective in increasing HIV testing uptake and could be particularly useful among youth. Objective: This study aims to evaluate the feasibility and effectiveness of two HIV self-testing implementation strategies (HIV self-testing intervention alone and HIV self-testing combined with an mHealth intervention) in comparison with the HIV testing standard of care in terms of HIV testing outcomes among refugee/displaced youth aged 16 to 24 years in Kampala, Uganda. Methods: A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomization will be performed with a 1:1:1 method. Approximately 450 adolescents (150 per cluster) will be enrolled and followed for 12 months. Data will be collected at the following three time points: baseline enrollment, 8 months after enrollment, and 12 months after enrollment. Primary outcomes (HIV testing frequency, HIV status knowledge, linkage to confirmatory testing, and linkage to HIV care) and secondary outcomes (depression, condom use efficacy, consistent condom use, sexual relationship power, HIV stigma, and adolescent sexual and reproductive health stigma) will be evaluated. Results: The study has been conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (June 14, 2019), Mildmay Uganda (November 11, 2019), and the Uganda National Council for Science and Technology (August 3, 2020). The Tushirikiane trial launched in February 2020, recruiting a total of 452 participants. Data collection was paused for 8 months due to COVID-19. Data collection for wave 2 resumed in November 2020, and as of December 10, 2020, a total of 295 participants have been followed-up. The third, and final, wave of data collection will be conducted between February and March 2021. Conclusions: This study will contribute to the knowledge of differentiated HIV testing implementation strategies for urban refugee and displaced youth living in informal settlements. We will share the findings in peer-reviewed manuscripts and conference presentations. Trial Registration: ClinicalTrials.gov NCT04504097; https://clinicaltrials.gov/ct2/show/NCT04504097. International Registered Report Identifier (IRRID): DERR1-10.2196/26192 UR - https://www.researchprotocols.org/2021/2/e26192 UR - http://dx.doi.org/10.2196/26192 UR - http://www.ncbi.nlm.nih.gov/pubmed/33528378 ID - info:doi/10.2196/26192 ER - TY - JOUR AU - Kabukye, K. Johnblack AU - Ilozumba, Onaedo AU - Broerse, W. Jacqueline E. AU - de Keizer, Nicolette AU - Cornet, Ronald PY - 2021/1/26 TI - Implementation of an Interactive Voice Response System for Cancer Awareness in Uganda: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e22061 VL - 9 IS - 1 KW - telemedicine KW - medical oncology KW - health promotion KW - low-and-middle-income countries KW - participatory research KW - mobile phone N2 - Background: Cancer awareness is crucial for cancer care and prevention. However, cancer awareness in Uganda is low, and access to cancer information is limited. Objective: This study aims to (1) understand the cancer awareness situation in Uganda (perceptions, beliefs, information needs, and challenges to accessing cancer information) and opinions about interactive voice response (IVR) systems; (2) develop cancer awareness messages and implement them in an IVR system; and (3) evaluate user acceptance and use of the IVR system. Methods: A participatory design approach was adopted. To understand cancer awareness needs and challenges, 3 interviews and 7 focus group discussions (FGDs) were conducted with cancer health care providers, patients with cancer, caregivers and survivors, administrators, and lay citizens (n=73). On the basis of the resulting qualitative data, audio messages addressing cancer information needs were developed and implemented in an IVR system. The system and messages were tested with users (n=12) during 2 co-design workshops before final rollout. Finally, the system was evaluated over 6 months after going live, using call records and user feedback from telephone interviews with callers (n=40). Results: The cancer information needs included general topics such as what cancer is, what causes it, cancer screening and diagnosis, cancer treatment, and practical information on what to expect during cancer care. There were also myths and misconceptions that need to be addressed, such as that cancer is due to witchcraft and has no treatment. Information on COVID-19 was also sought after following the outbreak. We developed 20 audio cancer messages (approximately 2 minutes each) in English and Luganda, along with 14 IVR navigation instructions. These were implemented in an IVR system with 24/7 availability from all over Uganda via a toll-free multi-channel telephone number. The total number of calls made to the IVR system 6 months after going live was 3820. Of these, 2437 (63.8%) lasted at least 30 seconds and were made from 1230 unique telephone numbers. There were 191 voice messages and 760 calls to live agents, most of which (681/951, 71.6%) were in Luganda. Call volumes peaked following advertisement of the system and lockdowns due to COVID-19. Participants were generally familiar with IVR technology, and caller feedback was largely positive. Cited benefits included convenience, toll-free access, and detailed information. Recommendations for improvement of the system included adding live agents and marketing of the system to target users. Conclusions: IVR technology provides an acceptable and accessible method for providing cancer information to patients and the general public in Uganda. However, a need remains for health system reforms to provide additional cancer information sources and improve cancer care services in general. UR - http://mhealth.jmir.org/2021/1/e22061/ UR - http://dx.doi.org/10.2196/22061 UR - http://www.ncbi.nlm.nih.gov/pubmed/33496672 ID - info:doi/10.2196/22061 ER - TY - JOUR AU - Batch, C. Bryan AU - Spratt, E. Susan AU - Blalock, V. Dan AU - Benditz, Chad AU - Weiss, Andi AU - Dolor, J. Rowena AU - Cho, H. Alex PY - 2021/1/20 TI - General Behavioral Engagement and Changes in Clinical and Cognitive Outcomes of Patients with Type 2 Diabetes Using the Time2Focus Mobile App for Diabetes Education: Pilot Evaluation JO - J Med Internet Res SP - e17537 VL - 23 IS - 1 KW - mobile technology KW - diabetes KW - self management support KW - self efficacy KW - illness perception N2 - Background: Type 2 diabetes affects 30 million Americans, representing a significant cause of morbidity and mortality. Self-management support is an important component of chronic illness care and is a key pillar of the chronic care model. Face-to-face teaching and patient education materials suffer from being static or incompatible with mobile lifestyles. Digital apps provide a self-management support alternative that is convenient and scalable. Objective: This pilot study tested the real-world deployment of a self-guided mobile app for diabetes education (Time2Focus app; MicroMass Communications Inc, Cary, NC), which utilizes evidence-based content and gamification to deliver an interactive learning experience. Methods: Primary care providers were approached for permission to invite their patients to participate. Eligible patients were 18 to 89 years of age, had a diagnosis of type 2 diabetes, hemoglobin A1c (HbA1c) ?8% and <12% in the past 3 months, an active online patient portal account (tied to the electronic health record), and access to an iOS or Android smartphone. Interested patients were emailed a baseline survey, and once this was completed, were sent instructions for downloading the Time2Focus app. After completing all 12 levels, participants were sent a follow-up survey. The primary outcome was the change in HbA1c. Secondary outcomes included medication adherence, self-care activities, self-reporting of physical activities, diabetes self-efficacy, illness perceptions, diabetes distress scale, and users? engagement with and rating of the app. Results: Of 1355 potentially eligible patients screened, 201 were consented. Of these 201 patients, 101 (50.2%) did not download the app. Of the 100 participants (49.8%) who downloaded the app, 16 (16.0%) completed 0 levels, 26 (26.0%) completed 1 to 4 levels, 10 (10.0%) completed 5 to 11 levels, and 48 (48.0%) completed all 12 levels of the app and the follow-up survey. Those completing one or more levels had a mean pre/post-HbA1c change of ?0.41% (compared to ?0.32% among those who completed zero levels); however, the unadjusted two-tailed t test indicated no significant difference between the two groups (P=.73). Diabetes self-efficacy showed a large and significant increase during app usage for completers (mean change 1.28, P<.001, d=.83). Severity of illness perceptions showed a small but significant decrease during app usage for completers (mean change ?0.51, P=.004, d=.43). Diabetes distress showed a small but significant decrease during app usage for completers (mean change ?0.45, P=.006, d=.41). The net promoter score was 62.5, indicating that those who completed all levels of the app rated it highly and would recommend it to others. Conclusions: Participants who engaged in all 12 levels of the Time2Focus mobile app showed an improvement in diabetes self-efficacy and a decrease in severity of illness perceptions. The decrease in HbA1c observed in app users relative to nonusers during this limited pilot study was not statistically significant. However, uptake and application of lessons learned from self-management support may be delayed. Further research is needed to address how to increase engagement through self-management support and to investigate if follow up over a longer period demonstrates a significant change in outcomes such as HbA1c. UR - http://www.jmir.org/2021/1/e17537/ UR - http://dx.doi.org/10.2196/17537 UR - http://www.ncbi.nlm.nih.gov/pubmed/33470947 ID - info:doi/10.2196/17537 ER - TY - JOUR AU - Yang, Samuel AU - Lee, Jennifer AU - Sezgin, Emre AU - Bridge, Jeffrey AU - Lin, Simon PY - 2021/1/11 TI - Clinical Advice by Voice Assistants on Postpartum Depression: Cross-Sectional Investigation Using Apple Siri, Amazon Alexa, Google Assistant, and Microsoft Cortana JO - JMIR Mhealth Uhealth SP - e24045 VL - 9 IS - 1 KW - voice assistant KW - virtual assistant KW - conversational agent KW - postpartum depression KW - mobile health KW - mental health N2 - Background: A voice assistant (VA) is inanimate audio-interfaced software augmented with artificial intelligence, capable of 2-way dialogue, and increasingly used to access health care advice. Postpartum depression (PPD) is a common perinatal mood disorder with an annual estimated cost of $14.2 billion. Only a small percentage of PPD patients seek care due to lack of screening and insufficient knowledge of the disease, and this is, therefore, a prime candidate for a VA-based digital health intervention. Objective: In order to understand the capability of VAs, our aim was to assess VA responses to PPD questions in terms of accuracy, verbal response, and clinically appropriate advice given. Methods: This cross-sectional study examined four VAs (Apple Siri, Amazon Alexa, Google Assistant, and Microsoft Cortana) installed on two mobile devices in early 2020. We posed 14 questions to each VA that were retrieved from the American College of Obstetricians and Gynecologists (ACOG) patient-focused Frequently Asked Questions (FAQ) on PPD. We scored the VA responses according to accuracy of speech recognition, presence of a verbal response, and clinically appropriate advice in accordance with ACOG FAQ, which were assessed by two board-certified physicians. Results: Accurate recognition of the query ranged from 79% to 100%. Verbal response ranged from 36% to 79%. If no verbal response was given, queries were treated like a web search between 33% and 89% of the time. Clinically appropriate advice given by VA ranged from 14% to 29%. We compared the category proportions using the Fisher exact test. No single VA statistically outperformed other VAs in the three performance categories. Additional observations showed that two VAs (Google Assistant and Microsoft Cortana) included advertisements in their responses. Conclusions: While the best performing VA gave clinically appropriate advice to 29% of the PPD questions, all four VAs taken together achieved 64% clinically appropriate advice. All four VAs performed well in accurately recognizing a PPD query, but no VA achieved even a 30% threshold for providing clinically appropriate PPD information. Technology companies and clinical organizations should partner to improve guidance, screen patients for mental health disorders, and educate patients on potential treatment. UR - http://mhealth.jmir.org/2021/1/e24045/ UR - http://dx.doi.org/10.2196/24045 UR - http://www.ncbi.nlm.nih.gov/pubmed/33427680 ID - info:doi/10.2196/24045 ER - TY - JOUR AU - Schooley, Benjamin AU - Singh, Akanksha AU - Hikmet, Ne?et AU - Brookshire, Robert AU - Patel, Nitin PY - 2020/12/22 TI - Integrated Digital Patient Education at the Bedside for Patients with Chronic Conditions: Observational Study JO - JMIR Mhealth Uhealth SP - e22947 VL - 8 IS - 12 KW - patient education KW - patient understanding KW - blended learning KW - adherence KW - digital patient education KW - chronic condition KW - understanding KW - outcome KW - mHealth KW - education KW - digital health N2 - Background: Patient education delivered by a health care provider increases patients? understanding and adherence to medical instructions, which helps to improve patient health. Multiple challenges exist to delivering effective patient education to patients with multiple chronic conditions, including giving the necessary time, range, and types of learning materials, and assessing the level of understanding. To help overcome these challenges, it is important to study new electronic means to assist in patient education, such as the use of mobile devices, interactive media, 3-dimensional images, and multimedia educational content at the bedside. Objective: The goal of this study was to address the need for blended learning strategies combining technical and workflow integration of digital patient education systems for patients with chronic conditions within and across the regular process of care. Studies are needed to evaluate the utility and benefits of these technologies for providers and patients alike. Methods: A mixed-methods approach was employed including survey administration to 178 patients after they received digital patient education in person with a health care provider, and qualitative interviews with 16 nurse educators who used the mobile digital health education technology to deliver instruction to patients. Patient survey data were analyzed using chi-square statistical tests. Qualitative interviews were analyzed for user acceptance and perceived value themes. Results: Patients who were counseled using a blended digital health education approach reported improved understanding of educational content (P=.034) and chronic health conditions (P<.001), were more motivated to care for themselves at home (P<.001), were more likely to say that they felt capable of making health care decisions with their doctors (P<.001) and on their own (P=.001), and were more likely to report their intention to follow their doctor?s instructions (P<.001) than were patients whose education was not computer-based. Nurse educators felt that the digital education system and content enhanced their education efforts and could be easily integrated into the outpatient clinical workflow. Conclusions: Patient education for individuals with chronic conditions may be more effective than traditional formats when provided in blended digital formats supervised by a health care provider. UR - http://mhealth.jmir.org/2020/12/e22947/ UR - http://dx.doi.org/10.2196/22947 UR - http://www.ncbi.nlm.nih.gov/pubmed/33350961 ID - info:doi/10.2196/22947 ER - TY - JOUR AU - Bashi, Nazli AU - Varnfield, Marlien AU - Karunanithi, Mohanraj PY - 2020/12/18 TI - A Smartphone App for Patients With Acute Coronary Syndrome (MoTER-ACS): User-Centered Design Approach JO - JMIR Form Res SP - e17542 VL - 4 IS - 12 KW - mobile health KW - mHealth KW - mobile health apps KW - smartphone KW - mobile phone KW - self-management KW - patient education KW - cardiovascular disease KW - acute coronary syndrome N2 - Background: Postdischarge interventions are limited for patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and the need to travel from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions. Objective: The aim of this study was to develop a smartphone-based intervention for providing postdischarge support to patients with ACS. Methods: The content of Mobile Technology?Enabled Rehabilitation for Patients with ACS (MoTER-ACS) was derived from a series of small studies, termed prestudy surveys, conducted in 2017. The prestudy surveys were conducted in Prince Charles Hospital, Queensland, Australia, and consisted of questionnaires among a convenience sample of patients with ACS (n=30), a focus group discussion with health care professionals (n=10), and an online survey among cardiologists (n=15). Responses from the patient survey identified educational topics of MoTER-ACS. The focus group with health care professionals assisted with identifying educational materials, health monitoring, and self-management interventions. Based on the results of the cardiologists? survey, monitoring of symptoms related to heart failure exacerbation was considered as a weekly diary. Results: The MoTER-ACS app covers multimedia educational materials to adopt a healthy lifestyle and includes user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain, assisting patients in self-managing their condition. A web portal that is linked to the data from the smartphone app is available to clinicians to regularly access patients? data and provide support. Conclusions: The MoTER-ACS platform extends the capabilities of previous mobile health platforms by providing a home-based educational and self-management intervention for patients with ACS following discharge from the hospital. The MoTER-ACS intervention narrows the gap between existing hospital-based programs and home-based interventions by complementing the postdischarge program for patients with ACS. UR - http://formative.jmir.org/2020/12/e17542/ UR - http://dx.doi.org/10.2196/17542 UR - http://www.ncbi.nlm.nih.gov/pubmed/33337339 ID - info:doi/10.2196/17542 ER - TY - JOUR AU - Aida, Azusa AU - Svensson, Thomas AU - Svensson, Kishi Akiko AU - Chung, Ung-Il AU - Yamauchi, Toshimasa PY - 2020/12/9 TI - eHealth Delivery of Educational Content Using Selected Visual Methods to Improve Health Literacy on Lifestyle-Related Diseases: Literature Review JO - JMIR Mhealth Uhealth SP - e18316 VL - 8 IS - 12 KW - application KW - educational KW - eHealth KW - health literacy KW - lifestyle-related disease KW - mHealth KW - review N2 - Background: Lifestyle-related diseases, such as stroke, heart disease, and diabetes, are examples of noncommunicable diseases. Noncommunicable diseases are now the leading cause of death in the world, and their major causes are lifestyle related. The number of eHealth interventions is increasing, which is expected to improve individuals? health literacy on lifestyle-related diseases. Objective: This literature review aims to identify existing literature published in the past decade on eHealth interventions aimed at improving health literacy on lifestyle-related diseases among the general population using selected visual methods, such as educational videos, films, and movies. Methods: A systematic literature search of the PubMed database was conducted in April 2019 for papers written in English and published from April 2, 2009, through April 2, 2019. A total of 538 papers were identified and screened in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Finally, 23 papers were included in this review. Results: The 23 papers were characterized according to study characteristics (author and year of publication, study design and region where the study was conducted, study objective, service platform, target disease and participant age, research period, outcomes, and research method); the playback time of the educational videos, films, and movies; and the evaluation of the study?s impacts on health literacy. A total of 7 studies compared results using statistical methods. Of these, 5 studies reported significant positive effects of the intervention on health literacy and health-related measures (eg, physical activity, body weight). Although most of the studies included educational content aimed at improving health literacy, only 7 studies measured health literacy. In addition, only 5 studies assessed literacy using health literacy measurement tools. Conclusions: This review found that the provision of educational content was satisfactory in most eHealth studies using selected visual methods, such as videos, films, and movies. These findings suggest that eHealth interventions influence people?s health behaviors and that the need for this intervention is expected to increase. Despite the need to develop eHealth interventions, standardized measurement tools to evaluate health literacy are lacking. Further research is required to clarify acceptable health literacy measurements. UR - http://mhealth.jmir.org/2020/12/e18316/ UR - http://dx.doi.org/10.2196/18316 UR - http://www.ncbi.nlm.nih.gov/pubmed/33295296 ID - info:doi/10.2196/18316 ER - TY - JOUR AU - Brief, James AU - Chawla, Anupama AU - Lerner, Diana AU - Vitola, Bernadette AU - Woroniecki, Robert AU - Morganstern, Jeffrey PY - 2020/11/10 TI - The Impact of a Smartphone App on the Quality of Pediatric Colonoscopy Preparations: Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e18174 VL - 3 IS - 2 KW - colonoscopy KW - app KW - pediatrics KW - prep KW - smartphone KW - mobile phone KW - mHealth N2 - Background: Smartphone apps have been successfully used to help adults prepare for colonoscopies. However, no study to date has investigated the effect of a smartphone app on pediatric colonoscopy preparation. Objective: The aim of this study is to determine if an app (SB Colonoscopy Prep) designed to educate and guide patients through their colonoscopy preparation will yield benefits over paper-based instructions and information. Methods: In total, 46 patients aged 5-18 years received either app-based or written material with instructions on how to take their prep medications as well as information about the colonoscopy procedure. Prep quality, the number of calls to the gastroenterology service, and patient arrival time were recorded. After the procedure, a questionnaire was given to each patient through which they graded their knowledge of the procedure both before and after receiving the app or written material. Results: App users had higher mean Boston scores versus control subjects receiving written instructions (7.2 vs 5.9, P=.02), indicating better colonoscopy preps. In total, 75% (15/20) of app users and 41% (9/22) of written instruction users had preps categorized as ?excellent? on the Boston scale. We found no significant differences in knowledge about the procedure (app users: 10/20 [50%], written instruction users 8/22 [36%]; P=.37), phone calls to the gastroenterology clinic (n=6 vs n=2; P=.27), or arrival times at the endoscopy suite (44 min vs 46 min before the scheduled procedure time; P=.56). Conclusions: Smartphone app use was associated with an increased number of colonoscopy preps classified as ?excellent? on the Boston scale. There was no significant difference between app users and the control group regarding the number of calls to the gastroenterology clinic, patient arrival time, or patient knowledge about the procedure. Trial Registration: ClinicalTrials.gov NCT04590105; https://clinicaltrials.gov/ct2/show/NCT04590105 UR - https://pediatrics.jmir.org/2020/2/e18174 UR - http://dx.doi.org/10.2196/18174 UR - http://www.ncbi.nlm.nih.gov/pubmed/33170131 ID - info:doi/10.2196/18174 ER - TY - JOUR AU - Su, Yanfang AU - Heitner, Jesse AU - Yuan, Changzheng AU - Si, Yafei AU - Wang, Dan AU - Zhou, Zhiying AU - Zhou, Zhongliang PY - 2020/11/3 TI - Effect of a Text Messaging?Based Educational Intervention on Cesarean Section Rates Among Pregnant Women in China: Quasirandomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e19953 VL - 8 IS - 11 KW - cesarean section KW - short message service KW - SMS text messaging KW - quasirandomized controlled trial KW - mobile health N2 - Background: Consensus exists that appropriate regional cesarean rates should not exceed 15% of births, but China?s cesarean rate exceeds 50% in some areas, prompting numerous calls for its reduction. At present, China?s 2016 two-child policy has heightened the implications of national cesarean section trends. Objective: This study leveraged pervasive cellular phone access amongst Chinese citizens to test the effect of a low-cost and scalable prenatal advice program on cesarean section rates. Methods: Participants were pregnant women presenting for antenatal care at a clinic in Xi?an, China. Assignment was quasirandomized and utilized factorial assignment based on the expecting mother?s birthday. Participants were assigned to one of the following four groups, with each receiving a different set of messages: (1) a comparison group that received only a few ?basic? messages, (2) a group receiving messages primarily regarding care seeking, (3) a group receiving messages primarily regarding good home prenatal practices, and (4) a group receiving text messages of all groups. Messages were delivered throughout pregnancy and were tailored to each woman?s gestational week. The main outcome was the rates of cesarean delivery reported in the intervention arms. Data analysts were blinded to treatment assignment. Results: In total, 2115 women completed the trial and corresponding follow-up surveys. In the unadjusted analysis, the group receiving all texts was associated with an odds ratio of 0.77 (P=.06), though neither the care seeking nor good home prenatal practice set yielded a relevant impact. Adjusting for potentially confounding covariates showed that the group with all texts sent together was associated with an odds ratio of 0.67 (P=.01). Notably, previous cesarean section evoked an odds ratio of 11.78 (P<.001), highlighting that having a cesarean section predicts future cesarean section in a subsequent pregnancy. Conclusions: Sending pregnant women in rural China short informational messages with integrated advice regarding both care-seeking and good home prenatal practices appears to reduce women?s likelihood of undergoing cesarean section. Reducing clear medical indications for cesarean section seems to be the strongest potential pathway of the effect. Cesarean section based on only maternal request did not seem to occur regularly in our study population. Preventing unnecessary cesarean section at present may have a long-term impact on future cesarean section rates. Trial Registration: ClinicalTrials.gov NCT02037087; https://clinicaltrials.gov/ct2/show/NCT02037087. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2015-011016 UR - https://mhealth.jmir.org/2020/11/e19953 UR - http://dx.doi.org/10.2196/19953 UR - http://www.ncbi.nlm.nih.gov/pubmed/33141099 ID - info:doi/10.2196/19953 ER - TY - JOUR AU - Biebl, Theresia Johanna AU - Huber, Stephan AU - Rykala, Marzena AU - Kraft, Eduard AU - Lorenz, Andreas PY - 2020/10/28 TI - Attitudes and Expectations of Health Care Professionals Toward App-Based Therapy in Patients with Osteoarthritis of the Hip or Knee: Questionnaire Study JO - JMIR Mhealth Uhealth SP - e21704 VL - 8 IS - 10 KW - mobile health KW - digital health KW - self-management KW - osteoarthritis KW - smartphone KW - patient education KW - exercise therapy N2 - Background: The use of mobile health (mHealth) apps is becoming increasingly widespread. However, little is known about the attitudes, expectations, and basic acceptance of health care professionals toward such treatment options. As physical activity and behavior modification are crucial in osteoarthritis management, app-based therapy could be particularly useful for the self-management of this condition. Objective: The objective of the study was to determine the expectations and attitudes of medical professionals toward app-based therapy for osteoarthritis of the hip or knee. Methods: Health care professionals attending a rehabilitation congress and employees of a university hospital were asked to fill out a questionnaire consisting of 16 items. A total of 240 questionnaires were distributed. Results: A total of 127 participants completed the questionnaire. At 95.3% (121/127), the approval rate for app-based therapy for patients with osteoarthritis of the hip or knee was very high. Regarding possible concerns, aspects related to data protection and privacy were primarily mentioned (41/127, 32.3%). Regarding potential content, educational units, physiotherapeutic exercise modules, and practices based on motivation psychology were all met with broad approval. Conclusions: The study showed a high acceptance of app-based therapy for osteoarthritis, indicating a huge potential of this form of treatment to be applied, prescribed, and recommended by medical professionals. It was widely accepted that the content should reflect a multimodal therapy approach. UR - http://mhealth.jmir.org/2020/10/e21704/ UR - http://dx.doi.org/10.2196/21704 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112255 ID - info:doi/10.2196/21704 ER - TY - JOUR AU - Aida, Azusa AU - Svensson, Thomas AU - Svensson, Kishi Akiko AU - Urushiyama, Hirokazu AU - Okushin, Kazuya AU - Oguri, Gaku AU - Kubota, Naoto AU - Koike, Kazuhiko AU - Nangaku, Masaomi AU - Kadowaki, Takashi AU - Yamauchi, Toshimasa AU - Chung, Ung-Il PY - 2020/10/21 TI - Using mHealth to Provide Mobile App Users With Visualization of Health Checkup Data and Educational Videos on Lifestyle-Related Diseases: Methodological Framework for Content Development JO - JMIR Mhealth Uhealth SP - e20982 VL - 8 IS - 10 KW - apps KW - educational videos KW - health checkup KW - lifestyle-related disease KW - mHealth, prevention KW - telehealth KW - visualization N2 - Background: The number of people with lifestyle-related diseases continues to increase worldwide. Improving lifestyle behavior with health literacy may be the key to address lifestyle-related diseases. The delivery of educational videos using mobile health (mHealth) services can replace the conventional way of educating individuals, and visualization can replace the provision of health checkup data. Objective: This paper aimed to describe the development of educational content for MIRAMED, a mobile app aimed at improving users? lifestyle behaviors and health literacy for lifestyle-related diseases. Methods: All videos were based on a single unified framework to provide users with a consistent flow of information. The framework was later turned into a storyboard. The final video contents were created based on this storyboard and further discussions with leading experts and specialist physicians on effective communication with app users about lifestyle-related diseases. Results: The app uses visualization of personal health checkup data and educational videos on lifestyle-related diseases based on the current health guidelines, scientific evidence, and expert opinions of leading specialist physicians in the respective fields. A total of 8 videos were created for specific lifestyle-related diseases affecting 8 organs: (1) brain?cerebrovascular disorder, (2) eyes?diabetic retinopathy, (3) lungs?chronic obstructive pulmonary disease, (4) heart?ischemic heart disease, (5) liver?fatty liver, (6) kidneys?chronic kidney disease (diabetic kidney disease), (7) blood vessels?peripheral arterial disease, and (8) nerves?diabetic neuropathy. Conclusions: Providing enhanced mHealth education using novel digital technologies to visualize conventional health checkup data and lifestyle-related diseases is an innovative strategy. Future studies to evaluate the efficacy of the developed content are planned. UR - http://mhealth.jmir.org/2020/10/e20982/ UR - http://dx.doi.org/10.2196/20982 UR - http://www.ncbi.nlm.nih.gov/pubmed/33084586 ID - info:doi/10.2196/20982 ER - TY - JOUR AU - Lee, Young Da AU - Yoo, Seung-Hyun AU - Min, Pil Kyong AU - Park, Cheol-Young PY - 2020/9/18 TI - Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial JO - JMIR Mhealth Uhealth SP - e19153 VL - 8 IS - 9 KW - diabetes mellitus KW - health services research KW - mobile applications KW - diabetes KW - mHealth KW - app KW - lifestyle KW - self-management KW - volunteer KW - participation N2 - Background: The role of mobile health care (mHealth) in glycemic control has been investigated, but its impact on self-management skills and its psychological aspects have not been studied. Objective: We evaluated the efficacy of mHealth-based diabetes self-management education and the effect of voluntary participation on its effects. Methods: This study was a randomized controlled open-label trial conducted for 6 months at Kangbuk Samsung Hospital. Participants in the control group (n=31) maintained their previous diabetes management strategies. Participants in the intervention group (n=41) additionally received mHealth-based diabetes self-management education through a mobile app and regular individualized feedback from health care professionals. The primary outcome was change in glycated hemoglobin (HbA1c) level over 6 months between the 2 groups (intervention versus control) and within each group (at 6 months versus baseline). The secondary outcomes were changes in body mass index, blood pressure, lipid profile, and questionnaire scores (the Korean version of the Summary of Diabetes Self-Care Activities Questionnaire, an Audit of Diabetes Dependent Quality of Life, the Appraisal of Diabetes Scale, and Problem Areas in Diabetes) over 6 months between groups and within each group. Results: A total of 66 participants completed this study. HbA1c (P=.04), total cholesterol level (P=.04), and Problem Areas in Diabetes scores (P=.02) significantly decreased; total diet (P=.03) and self-monitoring of blood glucose level scores (P=.01), based on the Summary of Diabetes Self-Care Activities Questionnaire, markedly increased within the intervention group. These significant changes were observed in self-motivated participants who were recruited voluntarily via advertisements. Conclusions: mHealth-based diabetes self-management education was effective at improving glycemic control and diabetes self-management skills and lowering diabetes-related distress in voluntary participants. Trial Registration: ClinicalTrials.gov NCT03468283; http://clinicaltrials.gov/ct2/show/NCT03468283 UR - http://mhealth.jmir.org/2020/9/e19153/ UR - http://dx.doi.org/10.2196/19153 UR - http://www.ncbi.nlm.nih.gov/pubmed/32945775 ID - info:doi/10.2196/19153 ER - TY - JOUR AU - Alenazi, A. Hanan AU - Jamal, Amr AU - Batais, A. Mohammed PY - 2020/9/11 TI - Identification of Type 2 Diabetes Management Mobile App Features and Engagement Strategies: Modified Delphi Approach JO - JMIR Mhealth Uhealth SP - e17083 VL - 8 IS - 9 KW - diabetes KW - mobile features KW - engagement strategies KW - mobile app KW - Delphi consensus N2 - Background: Diabetes is a significant public health issue. Saudi Arabia has the highest prevalence of type 2 diabetes mellitus (T2DM) in the Arab world. Currently, it affects 31.6% of the general population, and the prevalence of T2DM is predicted to rise to 45.36% by 2030. Mobile health (mHealth) offers improved and cost-effective care to people with T2DM. However, the efficiency of engagement strategies and features of this technology need to be reviewed and standardized according to stakeholder and expert perspectives. Objective: The main objective of this study was to identify the most agreed-upon features for T2DM self-management mobile apps; the secondary objective was to identify the most agreed-upon strategies that prompt users to use these apps. Methods: In this study, a 4-round modified Delphi method was applied by experts in the domain of diabetes care. Results: In total, 11 experts with a mean age of 47.09 years (SD 11.70) consented to participate in the study. Overall, 36 app features were generated. The group of experts displayed weak agreement in their ranking of intervention components (Kendall W=0.275; P<.001). The top 5 features included insulin dose adjustment according to carbohydrate counting and blood glucose readings (5.36), alerting a caregiver of abnormal or critical readings (6.09), nutrition education (12.45), contacts for guidance if required (12.64), and offering patient-specific education tailored to the user?s goals, needs, and blood glucose readings (12.90). In total, 21 engagement strategies were generated. Overall, the experts showed a moderate degree of consensus in their strategy rankings (Kendall W=0.454; P<.001). The top 5 engagement strategies included a user-friendly design (educational and age-appropriate design; 2.82), a free app (3.73), allowing the user to communicate or send information/data to a health care provider (HCP; 5.36), HCPs prescribing the mobile app in the clinic and asking about patients? app use compliance during clinical visits (6.91), and flexibility and customization (7.91). Conclusions: This is the first study in the region consisting of a local panel of experts from the diabetes field gathering together. We used an iterative process to combine the experts? opinions into a group consensus. The results of this study could thus be useful for health app developers and HCPs and inform future decision making on the topic. UR - http://mhealth.jmir.org/2020/9/e17083/ UR - http://dx.doi.org/10.2196/17083 UR - http://www.ncbi.nlm.nih.gov/pubmed/32678798 ID - info:doi/10.2196/17083 ER - TY - JOUR AU - Peuchot, Jeremy AU - Allard, Etienne AU - Dureuil, Bertrand AU - Veber, Benoit AU - Compère, Vincent PY - 2020/9/10 TI - Efficiency of Text Message Contact on Medical Safety in Outpatient Surgery: Retrospective Study JO - JMIR Mhealth Uhealth SP - e14346 VL - 8 IS - 9 KW - outpatient surgery KW - short message service (SMS) KW - patient information KW - organizational KW - cost KW - unanticipated admission KW - preoperative instructions N2 - Background: Establishing pre- and postoperative contact with patients is part of successful medical management in outpatient surgery. In France, this is mostly done via telephone. Automated information with short message service (SMS) reminders might be an interesting alternative to increase the rate of compliance with preoperative instructions, but no study has shown the safety of this approach. Objective: The objective of this study was to evaluate the impact of pre- and postoperative automated information with SMS reminders on medical safety in outpatient surgery. Methods: We conducted a retrospective, single-center, nonrandomized, controlled study with a before-after design. All adult patients who had outpatient surgery between September 2016 and December 2017 in our university hospital center were included. Before April 2017, patients were contacted by telephone by an outpatient surgery nurse. After April 2017, patients were contacted by SMS reminder. All patients were contacted the day before and the day after surgery. Patients contacted by SMS reminder were also contacted on day 7 after surgery. The primary end point was the conversion rate to full-time hospitalization. Secondary end points were hospitalization causes (anesthetic, surgical, organizational) and hospitalization costs. Results: A total of 4388 patients were included, 2160 before and 2228 after the introduction of SMS reminders. The conversion rate to full-time hospitalization was 34/4388 (0.77%) with a difference between SMS group (8/2228, 0.36%) and telephone group (26/2160, 1.20%). The cost of SMS reminders was estimated as half that of telephone calls. Conclusions: In this work, we report a decrease in the rate of conversion to full-time hospitalization with the use of pre- and postoperative SMS reminders. This new approach could represent a safe and cost-effective method in an outpatient surgery setting. UR - https://mhealth.jmir.org/2020/9/e14346 UR - http://dx.doi.org/10.2196/14346 UR - http://www.ncbi.nlm.nih.gov/pubmed/32909948 ID - info:doi/10.2196/14346 ER - TY - JOUR AU - Garg, Rani Priyanka AU - Uppal, Leena AU - Mehra, Sunil AU - Mehra, Devika PY - 2020/9/8 TI - Mobile Health App for Self-Learning on HIV Prevention Knowledge and Services Among a Young Indonesian Key Population: Cohort Study JO - JMIR Mhealth Uhealth SP - e17646 VL - 8 IS - 9 KW - mHealth KW - Indonesia KW - HIV KW - key populations N2 - Background: Indonesia is the only country in the Asia Pacific region where the incidence of HIV is still on the rise, and its prevalence is extremely high among the key populations such as men who have sex with men, transgender women, and people who inject/use drugs. Mobile health (mHealth) apps provide an innovative platform for delivering tailored HIV prevention and care among these populations more efficiently than possible through the direct face-to-face approach. Objective: The aim of this study was to assess the role of a peer-customized mobile app based on the principle of self-learning for improving HIV prevention knowledge and access to health services among men who have sex with men, transgender women (known as Waria in Indonesia), and people who use drugs in Indonesia. Methods: A prospective intervention cohort study was conducted among the key populations in five provinces of Indonesia (Jakarata, West Java, East Java, Special Region of Yogyakarta, and Bali). The data were evaluated using a pre-post assessment survey conducted on a sample of 200 unique users, including 50 men who have sex with men and transgender women each, and 100 people who use drugs, with a follow-up response rate of 98% and 70%, respectively. An mHealth app named RUMAH SELA was developed and implemented among the key populations. Results: From baseline to the endpoint of the study, there was a significant increase in comprehensive HIV-related knowledge from 20% (10/49) to 60% (29/49), 22% (11/49) to 57% (28/49), and 49% (34/70) to 74% (52/70) among men who have sex with men (P=.004), transgender women (P<.001), and people who use drugs (P<.001), respectively. There was also a reduction in sexual activities without condom use from 22% (11/49) to 19% (9/49), 18% (9/49) to 12% (6/49), and 21% (15/70) to 10% (7/70) among men who have sex with men (P=.45), transgender women (P=.25), and people who use drugs (P<.001), respectively. There was an uptake of HIV testing by 31% (15/49) for men who have sex with men, 49% (24/49) for transgender women, and 26% (18/70) for people who use drugs after using the app. There was a reduction in injecting drugs with a used needle in drug users from 45/70 (78%) to 15/70 (26%). Measures of self-esteem increased among men who have sex with men (mean 26.4 vs mean 27.1), transgender women (mean 26.5 vs mean 27.8; P=.02), and people who use drugs (mean 24.0 vs mean 25.0). In addition, 27% (7/24) of men who have sex with men, 25% (4/15) of transgender women, and 11% (2/18) of drug users made an appointment for an HIV test through the app. The app was quite highly accepted by the key populations as nearly a quarter felt that they became more confident in discussing issues about sexuality, more than 80% found that the app provided sufficient knowledge about HIV, and more than half of the participants found the app to be user friendly. Conclusions: This one-of-a-kind mHealth intervention with an mHealth app as a self-learning tool is effective in increasing HIV-related knowledge and behavior, and access to services with strong acceptability by the community. There is a need to scale up such interventions for efficacy testing in a larger population to provide evidence for national-level mHealth programs addressing HIV. UR - https://mhealth.jmir.org/2020/9/e17646 UR - http://dx.doi.org/10.2196/17646 UR - http://www.ncbi.nlm.nih.gov/pubmed/32896831 ID - info:doi/10.2196/17646 ER - TY - JOUR AU - Jansen, Ronelle AU - Reid, Marianne PY - 2020/8/19 TI - Communication Technology Use by Caregivers of Adolescents With Mental Health Issues: Systematic Review JO - JMIR Mhealth Uhealth SP - e13179 VL - 8 IS - 8 KW - caregiver KW - communication technology KW - adolescent KW - mental health issues KW - systematic review KW - self-efficacy, knowledge KW - parental skills KW - IMBP N2 - Background: Caregivers of adolescents with mental health issues experience challenges that may result in the caregivers having a variety of unmet needs. There is a growing need to support these caregivers. Effective support to strengthen positive caregiving behavior in caregivers may address their challenges. Communication technologies offer novel opportunities to assist these caregivers and may contribute to strengthening caregiver behavior. However, little is known about the use of communication technologies among caregivers of adolescents with mental health issues. Objective: The study aimed to answer the question: ?What is the best evidence available to strengthen positive behavior of caregivers of adolescents with mental health issues using communication technology.? Methods: A systematic review of articles published between January 2007 and August 2018 was conducted. Searches included articles of multiple study designs from EBSCO Host and Scopus platforms with prespecified eligibility criteria. Methodological quality was evaluated using the applicable Critical Appraisal Skills Programme and Joanna Briggs Institute assessment tools. Results: The search yielded 1746 articles. Altogether, 5 articles met the eligibility criteria and were included in the review for data synthesis. Data analysis and synthesis identified three thematic conclusions reflecting the types of communication technologies used, caregivers as the target population, and strengthening of positive behavior through determinants of the Integrated Model of Behavior Prediction. Conclusions: The review reported the usefulness of communication technology by caregivers. Caregivers also demonstrated improvement in self-efficacy, knowledge, parent-child communication, and parental skills reflecting positive behavior. Although the use of communication technology is expanding as a supportive intervention to address caregivers? needs, the evidence for usefulness among caregivers of adolescents with mental health issues is still scarce. More research and information related to preferred methods of communication delivery among caregivers of adolescents is still needed. UR - http://mhealth.jmir.org/2020/8/e13179/ UR - http://dx.doi.org/10.2196/13179 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663143 ID - info:doi/10.2196/13179 ER - TY - JOUR AU - Langford, Aisha AU - Orellana, Kerli AU - Kalinowski, Jolaade AU - Aird, Carolyn AU - Buderer, Nancy PY - 2020/8/12 TI - Use of Tablets and Smartphones to Support Medical Decision Making in US Adults: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e19531 VL - 8 IS - 8 KW - smartphone KW - mHealth KW - eHealth KW - mobile phone KW - cell phone KW - tablets KW - ownership KW - decision making KW - health communication KW - telemedicine KW - monitoring KW - physiologic KW - surveys and questionnaires N2 - Background: Tablet and smartphone ownership have increased among US adults over the past decade. However, the degree to which people use mobile devices to help them make medical decisions remains unclear. Objective: The objective of this study is to explore factors associated with self-reported use of tablets or smartphones to support medical decision making in a nationally representative sample of US adults. Methods: Cross-sectional data from participants in the 2018 Health Information National Trends Survey (HINTS 5, Cycle 2) were evaluated. There were 3504 responses in the full HINTS 5 Cycle 2 data set; 2321 remained after eliminating respondents who did not have complete data for all the variables of interest. The primary outcome was use of a tablet or smartphone to help make a decision about how to treat an illness or condition. Sociodemographic factors including gender, race/ethnicity, and education were evaluated. Additionally, mobile health (mHealth)- and electronic health (eHealth)-related factors were evaluated including (1) the presence of health and wellness apps on a tablet or smartphone, (2) use of electronic devices other than tablets and smartphones to monitor health (eg, Fitbit, blood glucose monitor, and blood pressure monitor), and (3) whether people shared health information from an electronic monitoring device or smartphone with a health professional within the last 12 months. Descriptive and inferential statistics were conducted using SAS version 9.4. Weighted population estimates and standard errors, univariate odds ratios, and 95% CIs were calculated, comparing respondents who used tablets or smartphones to help make medical decisions (n=944) with those who did not (n=1377), separately for each factor. Factors of interest with a P value of <.10 were included in a subsequent multivariable logistic regression model. Results: Compared with women, men had lower odds of reporting that a tablet or smartphone helped them make a medical decision. Respondents aged 75 and older also had lower odds of using a tablet or smartphone compared with younger respondents aged 18-34. By contrast, those who had health and wellness apps on tablets or smartphones, used other electronic devices to monitor health, and shared information from devices or smartphones with health care professionals had higher odds of reporting that tablets or smartphones helped them make a medical decision, compared with those who did not. Conclusions: A limitation of this research is that information was not available regarding the specific health condition for which a tablet or smartphone helped people make a decision or the type of decision made (eg, surgery, medication changes). In US adults, mHealth and eHealth use, and also certain sociodemographic factors are associated with using tablets or smartphones to support medical decision making. Findings from this study may inform future mHealth and other digital health interventions designed to support medical decision making. UR - https://mhealth.jmir.org/2020/8/e19531 UR - http://dx.doi.org/10.2196/19531 UR - http://www.ncbi.nlm.nih.gov/pubmed/32784181 ID - info:doi/10.2196/19531 ER - TY - JOUR AU - Maidment, W. David AU - Heyes, Rachel AU - Gomez, Rachel AU - Coulson, S. Neil AU - Wharrad, Heather AU - Ferguson, A. Melanie PY - 2020/8/5 TI - Evaluating a Theoretically Informed and Cocreated Mobile Health Educational Intervention for First-Time Hearing Aid Users: Qualitative Interview Study JO - JMIR Mhealth Uhealth SP - e17193 VL - 8 IS - 8 KW - hearing loss KW - hearing aids KW - telemedicine KW - behavioral medicine KW - qualitative research KW - mobile phone N2 - Background: Adults living with hearing loss have highly variable knowledge of hearing aids, resulting in suboptimal use or nonuse. This issue can be addressed by the provision of high-quality educational resources. Objective: This study aims to assess the everyday experiences of first-time hearing aid users when using a newly developed, theoretically informed cocreated mobile health (mHealth) educational intervention called m2Hear. This intervention aims to deliver greater opportunities for individualization and interactivity compared with our previously developed multimedia intervention, C2Hear. Methods: A total of 16 first-time hearing aid users trialed m2Hear for a period of 10-weeks in their everyday lives, after which individual semistructured interviews were completed. The data were analyzed using an established deductive thematic analysis procedure underpinned by the Capability, Opportunity, Motivation-Behavior model. The model stipulates that to engage in a target behavior, an individual must have physical and psychological capability, physical and social opportunity, and automatic and reflective motivation. Results: Capability?m2Hear was viewed as a concise and comprehensive resource, suitable for a range of digital literacy skills. It was stated that m2Hear could be conveniently reused to provide useful reminders that facilitate knowledge of hearing aids and communication. Opportunity?m2Hear was simple and straightforward to use, enabling greater individualization and independence. The availability of m2Hear via mobile technologies also improved accessibility. Motivation?m2Hear provided greater support and reassurance, improving confidence and empowering users to self-manage their hearing loss. Conclusions: Overall, this qualitative study suggests that m2Hear supports first-time hearing aid users to successfully self-manage their hearing loss postfitting. Furthermore, this study demonstrates the utility of employing a combined theoretical and ecologically valid approach in the development of mHealth educational resources to meet the individual self-management needs of adults living with hearing loss. Trial Registration: ClinicalTrials.gov NCT03136718; https://clinicaltrials.gov/ct2/show/NCT03136718 UR - https://mhealth.jmir.org/2020/8/e17193 UR - http://dx.doi.org/10.2196/17193 UR - http://www.ncbi.nlm.nih.gov/pubmed/32755885 ID - info:doi/10.2196/17193 ER - TY - JOUR AU - Wang, Tze-Fang AU - Huang, Rou-Chen AU - Yang, Su-Chen AU - Chou, Chyuan AU - Chen, Lee-Chen PY - 2020/7/27 TI - Evaluating the Effects of a Mobile Health App on Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer Surgery: Quasiexperimental Study JO - JMIR Mhealth Uhealth SP - e18132 VL - 8 IS - 7 KW - care needs KW - health information KW - mobile health app KW - oral cancer KW - technology acceptance KW - quality of life N2 - Background: Intervention with a mobile Health (mHealth) app can improve the efficacy of early detection of oral cancer and the outcomes for patients taking oral anticancer medications. The quality of life of oral cancer patients is significantly reduced within three months after surgery; also, their needs for nursing care and health information increase, mainly due to side effects and associated psychological problems. Objective: This study aimed to evaluate changes in the care needs and quality of life of patients with oral cancer after receiving the intervention of a newly developed mHealth app. Methods: After surgery, oral cancer patients were divided into an experimental group (n=50) who received the mHealth app intervention and a control group (n=50) who received routine health care and instruction. After 3 months of intervention, survey questionnaires were used to assess the patients? quality of life, nursing care needs, and acceptance of the mHealth app. Results: The physiological care needs were significantly decreased in the experimental group compared with the control group (P<.05). Although the differences were not statistically significant, the psychological needs, communication needs, and care support needs all improved after the mHealth app intervention. The overall improvement in quality of life was higher in the experimental group than in the control group (?7.24 vs ?4.36). In terms of intention to use, perceived usefulness, and perceived ease of use, the acceptability scores of the mHealth app were significantly increased after 3 months of intervention (P<.05). Conclusions: Compared with routine health care and instruction, for patients after surgery, the education/information intervention using the mHealth app significantly reduced their nursing care needs, improved their quality of life, and increased their acceptance of using an mHealth app on a mobile device. These findings can provide a theoretical basis for future health care app design and improvement. This study suggests that an mHealth app should be incorporated into the routine care of oral cancer patients to provide medical information quickly and improve their self-management abilities, thereby reducing the patients? need for physiological care and improving their quality of life. Trial Registration: ClinicalTrials.gov NCT04049968; https://www.clinicaltrials.gov/ct2/show/NCT04049968 UR - http://mhealth.jmir.org/2020/7/e18132/ UR - http://dx.doi.org/10.2196/18132 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716303 ID - info:doi/10.2196/18132 ER - TY - JOUR AU - Garvelink, Marjolein Mirjam AU - Agbadjé, Tatiana Titilayo AU - Freitas, Adriana AU - Bergeron, Lysa AU - Petitjean, Thomas AU - Dugas, Michèle AU - Blair, Louisa AU - Archambault, Patrick AU - Roy, Noémie AU - Jones, Allyson AU - Légaré, France PY - 2020/7/22 TI - Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study JO - JMIR Mhealth Uhealth SP - e16979 VL - 8 IS - 7 KW - internet-based intervention KW - frail elderly KW - caregivers KW - decision making KW - personal autonomy KW - housing for the elderly N2 - Background: Older adults desire to stay independent at home for as long as possible. We developed an interactive website to inform older adults and caregivers about ways to achieve this. Objective: This study aimed to perform an in-depth exploration among potential end users about how to improve the interactive website to better inform older adults and caregivers about ways to stay independent at home. Methods: To complement the results of a quantitative survey on the usability and acceptability of the website before implementation, we conducted a qualitative descriptive study. Using multiple recruitment strategies, we recruited a purposeful sample of older adults (aged ?65 years) and caregivers of older adults struggling to stay independent at home. We conducted face-to-face or telephonic interviews in either English or French. In addition, we collected sociodemographic characteristics, other characteristics of participants (eg, health, digital profile, and perception of retirement homes), and experiences with using the website (factors facilitating the use of the website, barriers to its use, and suggestions for improvement). Interviews were audio recorded, transcribed verbatim, and thematically analyzed by two researchers. Results: We recruited 15 participants, including 5 older adults (mean age 75 years, SD 6) and 10 caregivers (mean age 57 years, SD 14). The mean interview time was 32 min (SD 14). Most older adults had either mobility or health problems or both, and many of them were receiving home care services (eg, blood pressure measurement and body care). Overall, participants found the website easy to navigate using a computer, reassuring, and useful for obtaining information. Barriers were related to navigation (eg, difficult to navigate with a cellphone), relevance (eg, no specific section for caregivers), realism (eg, some resources presented are not state funded), understandability (eg, the actors? accents were difficult to understand), and accessibility (eg, not adapted for low digital literacy). Suggestions for improvement included a needs assessment section to direct users to the support appropriate to their needs, addition of information about moving into residential care, a section for caregivers, distinction between state-provided and private support services, simpler language, expansion of content to be relevant to all of Canada, and video subtitles for the hearing impaired. Conclusions: Users provided a wealth of information about the needs of older adults who were facing a loss of autonomy and about what such a website could usefully provide. The request for less generic and more personalized information reflects the wide range of needs that electronic health innovations, such as our interactive website, need to address. After integrating the changes suggested, the new website?Support for Older Adults to Stay Independent at Home (SUSTAIN)?will be implemented and made available to better assist older adults and caregivers in staying independent at home. UR - https://mhealth.jmir.org/2020/7/e16979 UR - http://dx.doi.org/10.2196/16979 UR - http://www.ncbi.nlm.nih.gov/pubmed/32412908 ID - info:doi/10.2196/16979 ER - TY - JOUR AU - Pereira, Claudio Antonio Augusto AU - Destro, Regina Juliana AU - Picinin Bernuci, Marcelo AU - Garcia, França Lucas AU - Rodrigues Lucena, Franklin Tiago PY - 2020/7/21 TI - Effects of a WhatsApp-Delivered Education Intervention to Enhance Breast Cancer Knowledge in Women: Mixed-Methods Study JO - JMIR Mhealth Uhealth SP - e17430 VL - 8 IS - 7 KW - mHealth KW - WhatsApp KW - cancer education KW - breast cancer N2 - Background: Breast cancer is the leading cause of cancer-related death in the female population. Health education interventions based on the use of mobile technologies enable the development of health self-care skills and have emerged as alternative strategies for the control of breast cancer. In previous studies, WhatsApp has stood out as a useful tool in health education strategies; however, it has not yet been applied for breast cancer education. Objective: This study aimed to analyze the potential of WhatsApp as a health education tool used to improve women's knowledge on the risk reduction of breast cancer. It also aimed to understand how women feel sensitized within the WhatsApp group throughout the intervention and how they incorporate information posted to improve knowledge about early detection and risk reduction methods. Methods: The study involved a pre-post health educational intervention with 35 women (aged 45-69 years) included in a WhatsApp group to share information (audio, video, text, and images) over 3 weeks on the early detection and risk reduction of breast cancer. Data were collected through questionnaires on topics related to risk reduction, as well as qualitative content analysis of group interactions. Effectiveness and feasibility were analyzed through conversations and the comparison of the scores obtained in the questionnaires before and after the intervention. Results: A total of 293 messages were exchanged (moderator 120 and users 173). The average scores of the participants were 11.21 and 13.68 points before and after the educational intervention, respectively, with sufficient sample evidence that the difference was significant (P<.001). The intervention enabled women to improve their knowledge on all topics addressed, especially ?myths and truths,? ?incidence,? ?clinical manifestations,? and ?protective factors.? Some themes emerged from the interactions in the group, including group dynamics, general doubts, personal narratives, religious messages, daily news, and events. Conclusions: The use of groups for women in WhatsApp for health education purposes seems to be a viable alternative in strategies on breast cancer control, especially as it provides a space for the exchange of experiences and disinhibition. However, the need for a moderator to answer the questions and the constant distractions by members of the group represent important limitations that should be considered when improving this strategy. UR - http://mhealth.jmir.org/2020/7/e17430/ UR - http://dx.doi.org/10.2196/17430 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706726 ID - info:doi/10.2196/17430 ER - TY - JOUR AU - Papa, Roberta AU - Efthymiou, Areti AU - Lamura, Giovanni AU - Piccinini, Flavia AU - Onorati, Giulia AU - Papastavrou, Evridiki AU - Tsitsi, Theologia AU - Casu, Giulia AU - Boccaletti, Licia AU - Manattini, Alessandra AU - Seneca, Rita AU - Vaz de Carvalho, Carlos AU - Durão, Rita AU - Barbabella, Francesco AU - Andréasson, Frida AU - Magnusson, Lennart AU - Hanson, Elizabeth PY - 2020/6/17 TI - Review and Selection of Online Resources for Carers of Frail Adults or Older People in Five European Countries: Mixed-Methods Study JO - JMIR Mhealth Uhealth SP - e14618 VL - 8 IS - 6 KW - informal carers KW - mobile apps KW - websites KW - usability KW - reliability N2 - Background: Informal carers have a crucial role in the care of older people, but they are at risk of social isolation and psychological exhaustion. Web-based services like apps and websites are increasingly used to support informal carers in addressing some of their needs and tasks, such as health monitoring of their loved ones, information and communication, and stress management. Despite the growing number of available solutions, the lack of knowledge or skills of carers about the solutions often prevent their usage. Objective: This study aimed to review and select apps and websites offering functionalities useful for informal carers of frail adults or older people in 5 European countries (Cyprus, Greece, Italy, Portugal, and Sweden). Methods: A systematic online search was conducted from January 2017 to mid-March 2017 using selected keywords, followed by an assessment based on a set of commonly agreed criteria and standardized tools. Selected resources were rated and classified in terms of scope. Focus groups with informal carers were conducted to validate the list and the classification of resources. The activities were conducted in parallel in the participating countries using common protocols and guidelines, a standardization process, and scheduled group discussions. Results: From a total of 406 eligible resources retrieved, 138 apps and 86 websites met the inclusion criteria. Half of the selected resources (109/224, 48.7%) were disease-specific, and the remaining resources included information and utilities on a variety of themes. Only 38 resources (38/224, 17.0%) were devoted specifically to carers, addressing the management of health disturbances and diseases of the care recipient and focusing primarily on neurodegenerative diseases. Focus groups with the carers showed that almost all participants had no previous knowledge of any resource specifically targeting carers, even if interest was expressed towards carer-focused resources. The main barriers for using the resources were low digital skills of the carers and reliability of health-related apps and websites. Results of the focus groups led to a new taxonomy of the resources, comprising 4 categories: carer?s wellbeing, managing health and diseases of the care recipient, useful contacts, and technologies for eldercare. Conclusions: The review process allowed the identification of online resources of good quality. However, these resources are still scarce due to a lack of reliability and usability that prevent users from properly benefiting from most of the resources. The involvement of end users provided added value to the resource classification and highlighted the gap between the potential benefits from using information and communication technologies and the real use of online resources by carers. UR - http://mhealth.jmir.org/2020/6/e14618/ UR - http://dx.doi.org/10.2196/14618 UR - http://www.ncbi.nlm.nih.gov/pubmed/32554378 ID - info:doi/10.2196/14618 ER - TY - JOUR AU - Tian, Xu AU - Xu, Ling-Li AU - Liu, Xiao-Ling AU - Chen, Wei-Qing PY - 2020/6/1 TI - Enhanced Patient Education for Colonic Polyp and Adenoma Detection: Meta-Analysis of Randomized Controlled Trials JO - JMIR Mhealth Uhealth SP - e17372 VL - 8 IS - 6 KW - colonoscopy KW - bowel preparation KW - patient education KW - polyp detection rate KW - adenoma detection rate KW - meta-analysis N2 - Background: To improve patients? comprehension of bowel preparation instructions before colonoscopy, enhanced patient education (EPE) such as cartoon pictures or other visual aids, phone calls, mobile apps, multimedia education and social media apps have been proposed. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas. Objective: This meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas. Methods: We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used a random effects model to calculate summary estimates of the polyp detection rate (defined as the number of patients with at least one polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (defined as the number of patients with at least one adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (defined as the number of patients with at least one advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (defined as the number of patients with at least one sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate (defined as the number of patients with at least one cancer divided by the total number of patients undergoing selective colonoscopy), or adenoma detection rate - plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes. Results: We included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with an increased polyp detection rate (9 trials; 3781 participants; risk ratio [RR] 1.19, 95% CI 1.05-1.35; P<.05; I2=42%) and adenoma detection rate (5 trials; 2133 participants; RR 1.37, 95% CI 1.15-1.64; P<.001; I2=0%), which were established by TSA. Pooled result from the inverse-variance model illustrated an increase in the sessile serrated adenoma detection rate (3 trials; 1248 participants; odds ratio 1.76, 95% CI 1.22-2.53; P<.05; I2=0%). One trial suggested an increase in the adenoma detection rate - plus (RR 4.39, 95% CI 2.91-6.61; P<.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for the advanced adenoma detection rate and cancer detection rate, respectively. Conclusions: The current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the polyp detection rate, adenoma detection rate, and sessile serrated adenoma detection rate. However, further trials are warranted to determine the efficacy of EPE for advanced adenoma detection rate, adenoma detection rate - plus, and cancer detection rate because of limited data. UR - https://mhealth.jmir.org/2020/6/e17372 UR - http://dx.doi.org/10.2196/17372 UR - http://www.ncbi.nlm.nih.gov/pubmed/32347798 ID - info:doi/10.2196/17372 ER - TY - JOUR AU - Hussain, Tasmeen AU - Smith, Patricia AU - Yee, M. Lynn PY - 2020/5/28 TI - Mobile Phone?Based Behavioral Interventions in Pregnancy to Promote Maternal and Fetal Health in High-Income Countries: Systematic Review JO - JMIR Mhealth Uhealth SP - e15111 VL - 8 IS - 5 KW - mHealth KW - mobile health KW - pregnancy KW - smartphone KW - text messaging KW - mobile applications KW - software KW - chronic disease KW - health behavior N2 - Background: Chronic diseases have recently had an increasing effect on maternal-fetal health, especially in high-income countries. However, there remains a lack of discussion regarding health management with technological approaches, including mobile health (mHealth) interventions. Objective: This study aimed to systematically evaluate mHealth interventions used in pregnancy in high-income countries and their effects on maternal health behaviors and maternal-fetal health outcomes. Methods: This systematic review identified studies published between January 1, 2000, and November 30, 2018, in MEDLINE via PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were eligible for inclusion if they included only pregnant women in high-income countries and evaluated stand-alone mobile phone interventions intended to promote healthy maternal beliefs, behaviors, and/or maternal-fetal health outcomes. Two researchers independently reviewed and categorized aspects of full-text articles, including source, study design, intervention and control, duration, participant age, attrition rate, main outcomes, and risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was registered in PROSPERO before initiation. Results: Of the 2225 records examined, 28 studies were included and categorized into 4 themes: (1) gestational weight gain, obesity and physical activity (n=9); (2) smoking cessation (n=9); (3) influenza vaccination (n=2); and (4) general prenatal health, preventive strategies, and miscellaneous topics (n=8). Reported sample sizes ranged from 16 to 5243 with a median of 91. Most studies were performed in the United States (18/28, 64%) and were randomized controlled trials (21/28, 75%). All participants in the included studies were pregnant at the time of study initiation. Overall, 14% (4/28) of studies showed association between intervention use and improved health outcomes; all 4 studies focused on healthy gestational weight. Among those, 3 studies showed intervention use was associated with less overall gestational weight gain. These 3 studies involved interventions with text messaging or an app in combination with another communication strategy (Facebook or email). Regarding smoking cessation, influenza vaccination, and miscellaneous topics, there was some evidence of positive effects on health behaviors and beliefs, but very limited correlation with improved health outcomes. Data and interventions were heterogeneous, precluding a meta-analysis. Conclusions: In high-income countries, utilization of mobile phone?based health behavior interventions in pregnancy demonstrates some correlation with positive beliefs, behaviors, and health outcomes. More effective interventions are multimodal in terms of features and tend to focus on healthy gestational weight gain. UR - https://mhealth.jmir.org/2020/5/e15111 UR - http://dx.doi.org/10.2196/15111 UR - http://www.ncbi.nlm.nih.gov/pubmed/32463373 ID - info:doi/10.2196/15111 ER - TY - JOUR AU - Bowman, Cassandra AU - Lunyera, Joseph AU - Alkon, Aviel AU - Boulware, Ebony L. AU - St Clair Russell, Jennifer AU - Riley, Jennie AU - Fink, C. Jeffrey AU - Diamantidis, Clarissa PY - 2020/5/28 TI - A Patient Safety Educational Tool for Patients With Chronic Kidney Disease: Development and Usability Study JO - JMIR Form Res SP - e16137 VL - 4 IS - 5 KW - patient safety KW - chronic kidney disease KW - patient education KW - mhealth N2 - Background: Chronic kidney disease (CKD) is a health condition that threatens patient safety; however, few interventions provide patient-centered education about kidney-specific safety hazards. Objective: We sought to develop and test the usability of a mobile tablet?based educational tool designed to promote patient awareness of relevant safety topics in CKD. Methods: We used plain language principles to develop content for the educational tool, targeting four patient-actionable safety objectives that are relevant for individuals with CKD. These four objectives included avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs); hypoglycemia awareness (among individuals with diabetes); temporary cessation of certain medications during acute volume depletion to prevent acute kidney injury (ie, ?sick day protocol?); and contrast dye risk awareness. Our teaching strategies optimized human-computer interaction and content retention using audio, animation, and clinical vignettes to reinforce themes. For example, using a vignette of a patient with CKD with pain and pictures of common NSAIDs, participants were asked ?Which of the following pain medicines are safe for Mr. Smith to take for his belly pain?? Assessment methods consisted of preknowledge and postknowledge surveys, with provision of correct responses and explanations. Usability testing of the tablet-based tool was performed among 12 patients with any stage of CKD, and program tasks were rated upon completion as no error, noncritical error (self-corrected), or critical error (needing assistance). Results: The 12 participants in this usability study were predominantly 65 years of age or older (n=7, 58%) and female (n=7, 58%); all participants owned a mobile device and used it daily. Among the 725 total tasks that the participants completed, there were 31 noncritical errors (4.3%) and 15 critical errors (2.1%); 1 participant accounted for 30 of the total errors. Of the 12 participants, 10 (83%) easily completed 90% or more of their tasks. Most participants rated the use of the tablet as very easy (n=7, 58%), the activity length as ?just right? (rather than too long or too short) (n=10, 83%), and the use of clinical vignettes as helpful (n=10, 83%); all participants stated that they would recommend this activity to others. The median rating of the activity was 8 on a scale of 1 to 10 (where 10 is best). We incorporated all participant recommendations into the final version of the educational tool. Conclusions: A tablet-based patient safety educational tool is acceptable and usable by individuals with CKD. Future studies leveraging iterations of this educational tool will explore its impact on health outcomes in this high-risk population. UR - http://formative.jmir.org/2020/5/e16137/ UR - http://dx.doi.org/10.2196/16137 UR - http://www.ncbi.nlm.nih.gov/pubmed/32463366 ID - info:doi/10.2196/16137 ER - TY - JOUR AU - Hoffmann, Alexandra AU - Faust-Christmann, A. Corinna AU - Zolynski, Gregor AU - Bleser, Gabriele PY - 2020/5/26 TI - Toward Gamified Pain Management Apps: Mobile Application Rating Scale?Based Quality Assessment of Pain-Mentor?s First Prototype Through an Expert Study JO - JMIR Form Res SP - e13170 VL - 4 IS - 5 KW - mHealth KW - chronic pain KW - stress management KW - pain management KW - health app KW - gamification KW - health professional N2 - Background: The use of health apps to support the treatment of chronic pain is gaining importance. Most available pain management apps are still lacking in content quality and quantity as their developers neither involve health experts to ensure target group suitability nor use gamification to engage and motivate the user. To close this gap, we aimed to develop a gamified pain management app, Pain-Mentor. Objective: To determine whether medical professionals would approve of Pain-Mentor?s concept and content, this study aimed to evaluate the quality of the app?s first prototype with experts from the field of chronic pain management and to discover necessary improvements. Methods: A total of 11 health professionals with a background in chronic pain treatment and 2 mobile health experts participated in this study. Each expert first received a detailed presentation of the app. Afterward, they tested Pain-Mentor and then rated its quality using the mobile application rating scale (MARS) in a semistructured interview. Results: The experts found the app to be of excellent general (mean 4.54, SD 0.55) and subjective quality (mean 4.57, SD 0.43). The app-specific section was rated as good (mean 4.38, SD 0.75). Overall, the experts approved of the app?s content, namely, pain and stress management techniques, behavior change techniques, and gamification. They believed that the use of gamification in Pain-Mentor positively influences the patients? motivation and engagement and thus has the potential to promote the learning of pain management techniques. Moreover, applying the MARS in a semistructured interview provided in-depth insight into the ratings and concrete suggestions for improvement. Conclusions: The experts rated Pain-Mentor to be of excellent quality. It can be concluded that experts perceived the use of gamification in this pain management app in a positive manner. This showed that combining pain management with gamification did not negatively affect the app?s integrity. This study was therefore a promising first step in the development of Pain-Mentor. UR - http://formative.jmir.org/2020/5/e13170/ UR - http://dx.doi.org/10.2196/13170 UR - http://www.ncbi.nlm.nih.gov/pubmed/32452803 ID - info:doi/10.2196/13170 ER - TY - JOUR AU - Summers, Charlotte AU - Curtis, Kristina PY - 2020/3/4 TI - Novel Digital Architecture of a ?Low Carb Program? for Initiating and Maintaining Long-Term Sustainable Health-Promoting Behavior Change in Patients with Type 2 Diabetes JO - JMIR Diabetes SP - e15030 VL - 5 IS - 1 KW - type 2 diabetes KW - behaviour change KW - nutrition KW - digital intervention KW - low carb KW - type 2 diabetes remission KW - eHealth UR - http://diabetes.jmir.org/2020/1/e15030/ UR - http://dx.doi.org/10.2196/15030 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130113 ID - info:doi/10.2196/15030 ER - TY - JOUR AU - Blackwell, M. Tenya AU - Dill, J. LeConte AU - Hoepner, A. Lori AU - Geer, A. Laura PY - 2020/2/13 TI - Using Text Messaging to Improve Access to Prenatal Health Information in Urban African American and Afro-Caribbean Immigrant Pregnant Women: Mixed Methods Analysis of Text4baby Usage JO - JMIR Mhealth Uhealth SP - e14737 VL - 8 IS - 2 KW - Text4baby KW - mHealth KW - pregnancy KW - text messaging KW - health information KW - prenatal health KW - disparities N2 - Background: The Text4baby (T4B) mobile health (mHealth) program is acclaimed to provide pregnant women with greater access to prenatal health care, resources, and information. However, little is known about whether urban African American and Afro-Caribbean immigrant pregnant women in the United States are receptive users of innovative health communication methods or of the cultural and systematic barriers that inhibit their behavioral intent to use T4B. Objective: This study aimed to understand the lived experiences of urban African American and Afro-Caribbean immigrant pregnant women with accessing quality prenatal health care and health information; to assess usage of mHealth for seeking prenatal health information; and to measure changes in participants? knowledge, perceptions, and behavioral intent to use the T4B mHealth educational intervention. Methods: An exploratory sequential mixed methods study was conducted among pregnant women and clinical professionals for a phenomenological exploration with focus groups, key informants, interviews, and observations. Qualitative themes were aligned with behavioral and information technology communications theoretical constructs to develop a survey instrument used. repeated-measures pre- and post-test design to evaluate changes in participants? knowledge, attitudes, and beliefs, of mHealth and T4B after a minimum of 4 weeks? exposure to the text message?based intervention. Triangulation and mixing of both qualitative and quantitative data occurred primarily during the survey development and also during final analysis. Results: A total of 9 women participated in phase 1, and 49 patients signed up for T4B and completed a 31-item survey at baseline and again during follow-up. Three themes were identified: (1) patient-provider engagement, (2) social support, and (3) acculturation. With time as a barrier to quality care, inadequate patient-provider engagement left participants feeling indifferent about the prenatal care and information they received in the clinical setting. Of 49 survey participants, 63% (31/49) strongly agreed that T4B would provide them with extra support during their pregnancy. On a Likert scale of 1 to 5, participants? perception of the usefulness of T4B ranked at 4.26, and their perception of the compatibility and relative advantage of using T4B ranked at 4.41 and 4.15, respectively. At follow-up, there was a 14% increase in participants reporting their intent to use T4B and a 28% increase from pretest and posttest in pregnant women strongly agreeing to speak more with their doctor about the information learned through T4B. Conclusions: Urban African American and Afro-Caribbean immigrant pregnant women in Brooklyn endure a number of social and ecological determinants like low health literacy, income, and language that serve as barriers to accessing quality prenatal health care and information, which negatively impacts prenatal health behaviors and outcomes. Our study indicates a number of systematic, political, and other microsystem-level factors that perpetuate health inequities in our study population. UR - http://mhealth.jmir.org/2020/2/e14737/ UR - http://dx.doi.org/10.2196/14737 UR - http://www.ncbi.nlm.nih.gov/pubmed/32053117 ID - info:doi/10.2196/14737 ER - TY - JOUR AU - Patchen, Loral AU - Ellis, Lindsey AU - Ma, Xuyen Tony AU - Ott, Corilyn AU - Chang, K. Katie H. AU - Araya, Brook AU - Atreyapurapu, Sravanthi AU - Alyusuf, Amal AU - Gaines Lanzi, Robin PY - 2020/1/31 TI - Engaging African American Youth in the Development of a Serious Mobile Game for Sexual Health Education: Mixed Methods Study JO - JMIR Serious Games SP - e16254 VL - 8 IS - 1 KW - sexual health KW - sex education KW - African Americans KW - youth KW - adolescents KW - video games KW - games, experimental KW - community-based participatory research KW - user-centered design N2 - Background: Although teen pregnancy rates decreased dramatically in the United States over the past decade, the rates of sexually transmitted infections (STIs) among adolescents and young adults increased. STI rates disproportionately affect African American youth and young adults. Innovative, accessible, and culturally relevant sexual health interventions are urgently needed. Objective: This study aimed to identify the optimal modality for a game-based sexual health intervention; develop the educational, entertainment, and technological aspects of the serious game; and demonstrate its usability and acceptance by the target population. Methods: This project was grounded in formative data collection with community-based participatory research principles and practices combined with a user-centered design and development approach. Sexually Active Adolescent?Focused Education (SAAFE) was developed using input and feedback from African American youths aged 15 to 21 years who participated in a youth advisory board and focus group discussions to inform the co-design and cocreation of the serious game. The process was highly iterative with multiple sessions for user input following design changes. It proceeded in 3 stages. Social cognitive theory and problem-solving theory were leveraged to provide evidence-based, trauma-informed education through a serious game. Usability testing assessed the quality of user experience with the prototype. Results: Across all 3 stages, a total of 86 self-identified African American males and females aged 15 to 21 years from the District of Columbia and Birmingham, Alabama, participated. Participants requested a dating simulation game. They wanted SAAFE to be customizable, realistic, entertaining, educational, modern, and experiential, linking consequences to their gameplay decisions. Usability testing resulted in an initial System Usability Survey score of 77.7, placing the game in the 82nd percentile and above average for usability. Conclusions: Initial results suggest that the SAAFE prototype is a promising intervention to engage African American youth in sexual health education using a role-playing game. If proven efficacious, the game has the potential to meet the need for sex education, counterbalance unhealthy portrayals of sex in popular media, and respond to the disparities in the STI epidemic. UR - http://games.jmir.org/2020/1/e16254/ UR - http://dx.doi.org/10.2196/16254 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012041 ID - info:doi/10.2196/16254 ER - TY - JOUR AU - Kamal, Ayeesha AU - Khoja, Adeel AU - Usmani, Bushra AU - Magsi, Shahvaiz AU - Malani, Aresha AU - Peera, Zahra AU - Sattar, Saadia AU - Ahmed Akram, Masood AU - Shahnawaz, Sumaira AU - Zulfiqar, Maryam AU - Muqeet, Abdul AU - Zaidi, Fabiha AU - Sayani, Saleem AU - Artani, Azmina AU - Azam, Iqbal AU - Saleem, Sarah PY - 2020/1/28 TI - Effect of 5-Minute Movies Shown via a Mobile Phone App on Risk Factors and Mortality After Stroke in a Low- to Middle-Income Country: Randomized Controlled Trial for the Stroke Caregiver Dyad Education Intervention (Movies4Stroke) JO - JMIR Mhealth Uhealth SP - e12113 VL - 8 IS - 1 KW - stroke KW - mobile health KW - noncommunicable diseases KW - adherence N2 - Background: Pakistan is the sixth most populous nation in the world and has an estimated 4 million stroke survivors. Most survivors are taken care of by community-based caregivers, and there are no inpatient rehabilitation facilities. Objective: The objective of this study was to evaluate the effectiveness and safety of locally designed 5-min movies rolled out in order of relevance that are thematically delivered in a 3-month program to deliver poststroke education to stroke survivor and caregiver dyads returning to the community. Methods: This study was a randomized controlled, outcome assessor?blinded, parallel group, single-center superiority trial in which participants (stroke survivor-caregiver dyads) with first-ever stroke (both ischemic and hemorrhagic) incidence were randomized within 48 hours of their stroke into either the video-based education intervention group or the control group. The video-based education intervention group had health education delivered through short videos that were shown to the participants and their caregivers at the time of admission, before discharge, and the first and third months of follow-up after discharge. The control group had standardized care including predischarge education and counseling according to defined protocols. All participants enrolled in the video education intervention and control groups were followed for 12 months after discharge for outcome assessment in the outpatient stroke clinics. The primary outcome measures were the proportion of participants achieving control of blood pressure, blood sugar, and blood cholesterol in the video intervention versus the control group. Several predefined secondary outcomes were included in this study, of which we report the mortality and functional disability in this paper. Analysis was by performed using the intention-to-treat principle. Results: A total of 310 stroke survivors and their caregiver dyads (participant dyads) were recruited over a duration of 6 months. In total, 155 participant dyads were randomized into the intervention and control groups, each. The primary outcome of control of three major risk factors revealed that at 12 months, there was a greater percentage of participants with a systolic BP<125 mm Hg (18/54, 33% vs 11/52, 21%; P=.16), diastolic BP<85 mm Hg (44/54, 81% vs 37/52, 71%; P=.21), HbA1c level<7% (36/55, 65% vs 30/40, 75%; P=.32), and low-density lipoprotein level<100 mg/dL (36/51, 70% vs 30/45, 67%; P=.68) in the intervention group than in the control group. The secondary outcome reported is the mortality among the stroke survivors because the number of stroke-related complications was higher in the control group than in the intervention group (13/155, 8.4% vs 2/155, 1.3%), and this difference was statistically significant (P<.001). Conclusions: The Movies4Stroke trial failed to achieve its primary specified outcome. However, secondary outcomes that directly related to survival skills of stroke survivors demonstrated the effectiveness of the video-based intervention on improving stroke-related mortality and survival without disability. Trial Registration: ClinicalTrials.gov NCT02202330; https://www.clinicaltrials.gov/ct2/show/NCT02202330 UR - http://mhealth.jmir.org/2020/1/e12113/ UR - http://dx.doi.org/10.2196/12113 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012080 ID - info:doi/10.2196/12113 ER - TY - JOUR AU - Roosan, Don AU - Li, Yan AU - Law, Anandi AU - Truong, Huy AU - Karim, Mazharul AU - Chok, Jay AU - Roosan, Moom PY - 2019/11/25 TI - Improving Medication Information Presentation Through Interactive Visualization in Mobile Apps: Human Factors Design JO - JMIR Mhealth Uhealth SP - e15940 VL - 7 IS - 11 KW - visual perception KW - adverse drug event KW - human factors design KW - mobile health N2 - Background: Despite the detailed patient package inserts (PPIs) with prescription drugs that communicate crucial information about safety, there is a critical gap between patient understanding and the knowledge presented. As a result, patients may suffer from adverse events. We propose using human factors design methodologies such as hierarchical task analysis (HTA) and interactive visualization to bridge this gap. We hypothesize that an innovative mobile app employing human factors design with an interactive visualization can deliver PPI information aligned with patients? information processing heuristics. Such an app may help patients gain an improved overall knowledge of medications. Objective: The objective of this study was to explore the feasibility of designing an interactive visualization-based mobile app using an HTA approach through a mobile prototype. Methods: Two pharmacists constructed the HTA for the drug risperidone. Later, the specific requirements of the design were translated using infographics. We transferred the wireframes of the prototype into an interactive user interface. Finally, a usability evaluation of the mobile health app was conducted. Results: A mobile app prototype using HTA and infographics was successfully created. We reiterated the design based on the specific recommendations from the usability evaluations. Conclusions: Using HTA methodology, we successfully created a mobile prototype for delivering PPI on the drug risperidone to patients. The hierarchical goals and subgoals were translated into a mobile prototype. UR - http://mhealth.jmir.org/2019/11/e15940/ UR - http://dx.doi.org/10.2196/15940 UR - http://www.ncbi.nlm.nih.gov/pubmed/31763991 ID - info:doi/10.2196/15940 ER - TY - JOUR AU - Therkildsen, Bülow Signe AU - Hansen, Houlind Linda AU - Jensen, Dinesen Laura Emilie AU - Finderup, Jeanette PY - 2019/11/21 TI - A Patient Decision Aid App for Patients With Chronic Kidney Disease: Questionnaire Study JO - JMIR Form Res SP - e13786 VL - 3 IS - 4 KW - mobile phone KW - app KW - patient decision aid KW - dialysis KW - decisional conflict KW - usability N2 - Background: The Dialysis Guide (DG) is a patient decision aid (PDA) available as an app and developed for mobile phones for patients with chronic kidney disease facing the decision about dialysis modality. Objective: The aim of this study was to uncover the applicability of the DG as a PDA. Methods: The respondents completed a questionnaire before and after using the DG. The respondents' decisional conflicts were examined using the Decisional Conflict Scale, and the usability of the app was examined using the System Usability Scale (SUS). The change in decisional conflict was determined with a paired t test. Results: A total of 22 respondents participated and their mean age was 65.05 years; 20 out of 22 (90%) had attended a patient school for kidney disease, and 13 out of 22 (59%) had participated in a conversation about dialysis choice with a health professional. After using the DG, the respondents' decisional conflicts were reduced, though the reduction was not statistically significant (P=.49). The mean SUS score was 66.82 (SD 14.54), corresponding to low usability. Conclusions: The DG did not significantly reduce decisional conflict, though the results indicate that it helped the respondents decide on dialysis modality. Attending a patient school and having a conversation about dialysis modality choice with a health professional is assumed to have had an impact on the decisional conflict before using the DG. The usability of the DG was not found to be sufficient, which might be caused by the respondents? average age. Thus, the applicability of the DG cannot be definitively determined. UR - http://formative.jmir.org/2019/4/e13786/ UR - http://dx.doi.org/10.2196/13786 UR - http://www.ncbi.nlm.nih.gov/pubmed/31750836 ID - info:doi/10.2196/13786 ER - TY - JOUR AU - Shan, Wei AU - Wang, Ying AU - Luan, Jing AU - Tang, Pengfei PY - 2019/10/23 TI - The Influence of Physician Information on Patients? Choice of Physician in mHealth Services Using China?s Chunyu Doctor App: Eye-Tracking and Questionnaire Study JO - JMIR Mhealth Uhealth SP - e15544 VL - 7 IS - 10 KW - mHealth KW - physician information KW - choice KW - trust N2 - Background: Mobile health (mHealth) is becoming more popular as a way of sharing medical information. For the patient, it saves time, reduces the need for travel, reduces the cost of searching for information, and brings medical services ?to your fingertips.? However, it also brings information overload and makes the patient?s choice of physician more difficult. Objective: This study aimed to identify the types of physician information that play a key role in patients? choice of physician and to explore the mechanism by which this information contributes to this choice. Methods: Based on the stimulus-organism-response (SOR) model and online trust theory, we proposed a research model to explain the influence of physician information on patients? choice of physician. The model was based on cognitive trust and affective trust and considered the moderating role of patient expertise. Study 1 was an eye-tracking experiment (n=42) to identify key factors affecting patients? choice of physician. Study 2 was a questionnaire study (n=272); Partial Least Squares Structural Equation Modeling was used to validate the research model. Results: The results of Study 1 revealed that seven types of physician information played a key role in patients? choice of physician. The results of Study 2 revealed that (1) physicians? profile photo information affected patients? choice of physician by positively influencing affective trust (P<.001); (2) physicians? nonprofile photo information affected patients? choice of physician by positively influencing cognitive trust (P<.001); (3) patient-generated information affected patients? choice of physician by positively affecting cognitive trust (P<.001) and affective trust (P<.001), and patient expertise played a positive moderating role on both (P=.04 and P=.01, respectively); and (4) cognitive trust and affective trust both positively affected patients? choice of physician, with affective trust playing a more significant role (P<.001 and P<.001, respectively). Conclusions: Seven types of physician information were mainly used by patients when choosing physicians offering mHealth services; trust played an important role in this choice. In addition, the level of patient expertise was an important variable in moderating the influence of physician information and patients? trust. This paper supports the theoretical basis of information selection and processing by patients. These findings can help guide app developers in the construction of medical apps and in the management of physician information in order to facilitate patients? choice of physician. UR - http://mhealth.jmir.org/2019/10/e15544/ UR - http://dx.doi.org/10.2196/15544 UR - http://www.ncbi.nlm.nih.gov/pubmed/31647466 ID - info:doi/10.2196/15544 ER - TY - JOUR AU - Timmers, Thomas AU - Janssen, Loes AU - van der Weegen, Walter AU - Das, Dirk AU - Marijnissen, Willem-Jan AU - Hannink, Gerjon AU - van der Zwaard, C. Babette AU - Plat, Adriaan AU - Thomassen, Bregje AU - Swen, Jan-Willem AU - Kool, B. Rudolf AU - Lambers Heerspink, Okke Frederik PY - 2019/10/21 TI - The Effect of an App for Day-to-Day Postoperative Care Education on Patients With Total Knee Replacement: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e15323 VL - 7 IS - 10 KW - patient education KW - postoperative care KW - smartphone KW - self-management KW - ehealth KW - telemedicine N2 - Background: Patients who undergo primary Total Knee Replacement surgery (TKR) are often discharged within 1-3 days after surgery. With this relatively short length of hospital stay, a patient?s self-management is a crucial factor in optimizing the outcome of their treatment. In the case of TKR, self-management primarily involves adequate pain management, followed by physiotherapy exercises and daily self-care activities. Patients are educated on all these topics by hospital staff upon discharge from the hospital but often struggle to comprehend this information due to its quantity, complexity, and the passive mode of communication used to convey it. Objective: This study primarily aims to determine whether actively educating TKR patients with timely, day-to-day postoperative care information through an app could lead to a decrease in their level of pain compared to those who only receive standard information about their recovery through the app. In addition, physical functioning, quality of life, ability to perform physiotherapy exercises and daily self-care activities, satisfaction with information, perceived involvement by the hospital, and health care consumption were also assessed. Methods: A multicenter randomized controlled trial was performed in five Dutch hospitals. In total, 213 patients who had undergone elective, primary, unilateral TKR participated. All patients had access to an app for their smartphone and tablet to guide them after discharge. The intervention group could unlock day-to-day information by entering a personal code. The control group only received weekly, basic information. Primary (level of pain) and secondary outcomes (physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption) were measured using self-reported online questionnaires. All outcomes were measured weekly in the four weeks after discharge, except for physical functioning and quality of life, which were measured at baseline and at four weeks after discharge. Data was analyzed using Student t tests, chi-square tests, and linear mixed models for repeated measures. Results: In total, 114 patients were enrolled in the intervention group (IG) and 99 in the control group (CG). Four weeks after discharge, patients in the IG performed significantly better than patients in the CG on all dimensions of pain: pain at rest (mean 3.45 vs mean 4.59; P=.001), pain during activity (mean 3.99 vs mean 5.08; P<.001) and pain at night (mean 4.18 vs mean 5.21; P=.003). Additionally, significant differences were demonstrated in favor of the intervention group for all secondary outcomes. Conclusions: In the four weeks following TKR, the active and day-to-day education of patients via the app significantly decreased their level of pain and improved their physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption compared to standard patient education. Given the rising number of TKR patients and the increased emphasis on self-management, we suggest using an app with timely postoperative care education as a standard part of care. Trial Registration: Netherlands Trial Register NTR7182; https://www.trialregister.nl/trial/6992 UR - https://mhealth.jmir.org/2019/10/e15323 UR - http://dx.doi.org/10.2196/15323 UR - http://www.ncbi.nlm.nih.gov/pubmed/31638594 ID - info:doi/10.2196/15323 ER - TY - JOUR AU - Abbasgholizadeh Rahimi, Samira AU - Archambault, M. Patrick AU - Ravitsky, Vardit AU - Lemoine, Marie-Eve AU - Langlois, Sylvie AU - Forest, Jean-Claude AU - Giguère, C. Anik M. AU - Rousseau, François AU - Dolan, G. James AU - Légaré, France PY - 2019/10/8 TI - An Analytical Mobile App for Shared Decision Making About Prenatal Screening: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e13321 VL - 8 IS - 10 KW - shared decision making KW - multiple criteria decision analysis KW - analytic hierarchy process KW - decision aid KW - prenatal screening KW - mobile app N2 - Background: Decisions about prenatal screening to assess the risk of genetic conditions such as Down syndrome are complex and should be well informed. Moreover, the number of available tests is increasing. Shared decision making (SDM) about testing could be facilitated by decision aids powered by mobile technology. Objective: In this mixed methods study, we aim to (1) assess women?s needs and preferences regarding using an app for considering prenatal screening, (2) develop a decision model using the analytical hierarchy process, and (3) develop an analytical app and assess its usability and usefulness. Methods: In phase 1, we will assess the needs of 90 pregnant women and their partners (if available). We will identify eligible participants in 3 clinical sites (a midwife-led birthing center, a family practice clinic, and an obstetrician-led hospital-based clinic) in Quebec City and Montreal, Canada. Using semistructured interviews, we will assess participants? attitudes toward mobile apps for decision making about health, their current use of apps for health purposes, and their expectations of an app for prenatal testing decisions. Self-administered questionnaires will collect sociodemographic information, intentions to use an app for prenatal testing, and perceived importance of decision criteria. Qualitative data will be transcribed verbatim and analyzed thematically. Quantitative data will be analyzed using descriptive statistics and the analytic hierarchy process (AHP) method. In phase 2, we will develop a decision model using the AHP whereby users can assign relative importance to criteria when deciding between options. We will validate the model with potential users and a multidisciplinary team of patients, family physicians, primary care researchers, decision sciences experts, engineers, and experts in SDM, genetics, and bioethics. In phase 3, we will develop a prototype of the app using the results of the first 2 phases, pilot test its usefulness and usability among a sample of 15 pregnant women and their partners (if available), and improve it through 3 iterations. Data will be collected with a self-administered questionnaire. Results will be analyzed using descriptive statistics. Results: Recruitment for phase 1 will begin in 2019. We expect results to be available in 2021. Conclusions: This study will result in a validated analytical app that will provide pregnant women and their partners with up-to-date information about prenatal screening options and their risks and benefits. It will help them clarify their values and enable them to weigh the options to make informed choices consistent with their preferences and values before meeting face-to-face with their health care professional. The app will be easy to update with the latest information and will provide women with a user-friendly experience using their smartphones or tablets. This study and the resulting app will contribute to high-quality SDM between pregnant women and their health care team. International Registered Report Identifier (IRRID): DERR1-10.2196/13321 UR - https://www.researchprotocols.org/2019/10/e13321 UR - http://dx.doi.org/10.2196/13321 UR - http://www.ncbi.nlm.nih.gov/pubmed/31596249 ID - info:doi/10.2196/13321 ER - TY - JOUR AU - Aguirre, Ayala Patricia Estefania AU - Lotto, Matheus AU - Strieder, Paola Anna AU - Cruvinel, Pereira Agnes Fátima AU - Cruvinel, Thiago PY - 2019/09/03 TI - The Effectiveness of Educational Mobile Messages for Assisting in the Prevention of Early Childhood Caries: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e13656 VL - 8 IS - 9 KW - eHealth KW - dental caries KW - randomized controlled trial N2 - Background: In 2017, approximately 3.7 billion downloads of health apps were made on mobile phones and tablets. In this sense, a massive number of people could benefit by electronic mobile?based health interventions, making information available even with the lack of material and human resources. Hence, the use of electronic apps for dental education might be extremely useful for the prevention of early childhood caries (ECC). Objective: This study aims to evaluate the effectiveness of messages sent via mobile phones as an adjuvant method for the prevention of ECC. Methods: A single-blinded, randomized, and parallel-group clinical trial will be conducted with dyads of parents or caregivers and children aged between 36 and 60 months, recruited from kindergartens and schools of Bauru, São Paulo. The determination of sample size resulted in a total of 104 dyads of parents and children, considering a power of 80%, a significance level of 5%, and an attrition of 30%. This sample will be randomly assigned to test and control groups, being divided in 52 dyads per group according to the health literacy levels of parents and the age, gender, and oral health status of children. Every 2 weeks, only participants in the test group will receive messages via WhatsApp containing preventive and education-related ECC information. The dyads will visit the dentist every 3 months during a year for the assessment of primary outcomes (sugar consumption and the International Caries Detection and Assessment System, visible plaque, and community periodontal indices) and to receive dental care measures. Secondary outcomes (electronic health literacy and general perceived self-efficacy) will be determined only at baseline and after 12-month follow-up. The quality of randomization will be evaluated throughout the study, comparing the test and control groups systematically by Student t tests for continuous variables and chi-square tests for categorical variables. Listwise deletion method will be applied in cases of dropouts, if the missing values satisfy the criteria of missing completely at random; otherwise, multiple imputation data strategy will be conducted. The Kolmogorov-Smirnov and Levene tests will be used to determine the normality and homogeneity of data, respectively, which will indicate further statistical analyses for elucidating significant differences between groups (P<.05). A Student t test or Mann-Whitney U test will be employed for parametric or nonparametric analyses, respectively. Results: The project was funded in 2018, and enrollment was completed in August 2019. Allocation is currently under way and the first results are expected to be submitted for publication in 2020. Conclusions: The results will contribute to understanding the importance of educational mobile messages toward the adoption of healthy behaviors for the prevention of ECC in a given population. Trial Registration: Brazilian Registry of Clinical Trials Universal Trial Number U1111-1216-1393; http://www.ensaiosclinicos.gov.br/rg/RBR-2b6r7q/ International Registered Report Identifier (IRRID): PRR1-10.2196/13656 UR - https://www.researchprotocols.org/2019/9/e13656/ UR - http://dx.doi.org/10.2196/13656 UR - http://www.ncbi.nlm.nih.gov/pubmed/31482856 ID - info:doi/10.2196/13656 ER - TY - JOUR AU - Richards, Rebecca AU - Kinnersley, Paul AU - Brain, Kate AU - Staffurth, John AU - Wood, Fiona PY - 2019/07/31 TI - The Preferences of Patients With Cancer Regarding Apps to Help Meet Their Illness-Related Information Needs: Qualitative Interview Study JO - JMIR Mhealth Uhealth SP - e14187 VL - 7 IS - 7 KW - education, medical KW - medical information exchange KW - smartphone KW - mobile apps N2 - Background: The shift from inpatient to outpatient and community cancer care means that more patients with cancer need to manage their condition at home, without the direct supervision of their clinician. Subsequently, research has reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. Before designing an app intervention to help patients with cancer to meet their information needs, in-depth qualitative research is required to gain an understanding of the views of the target users. Objective: We aimed to develop an app intervention to help patients meet their illness-related information needs in noninpatient settings. This study explored the information needs of patients with cancer and their preferences for an app and desired app features. Specifically, the perceived acceptability of an app, desired app features, and the potential benefits and disadvantages of, and barriers to, an app were explored. Methods: Qualitative, one-on-one semistructured interviews were conducted with patients with urological, colorectal, breast, or gynecological cancers (N=23) across two hospitals in South Wales. Interviews were audio-taped, transcribed, and analyzed using a thematic analysis. Results: Findings indicated that barriers to information exchange and understanding in consultations, and identification of reliable information sources between consultations, appeared to contribute to patients? unmet information needs. Consequently, app feature suggestions included a question prompt list, a glossary of cancer terms, a resources feature, and a contacts feature. Anticipated benefits of this type of app included a more informed patient, improved quality of life, decreased anxiety, and increased confidence to participate in their care. The anticipated barriers to app use are likely to be temporary or can be minimized with regard to these findings during app development and implementation. Conclusions: This study highlights the desire of patients with cancer for an app intervention to help them meet their information needs during and between consultations with their clinicians. This study also highlights the anticipated acceptability and benefits of this type of intervention; however, further research is warranted. UR - http://mhealth.jmir.org/2019/7/e14187/ UR - http://dx.doi.org/10.2196/14187 UR - http://www.ncbi.nlm.nih.gov/pubmed/31368446 ID - info:doi/10.2196/14187 ER - TY - JOUR AU - Steeb, Theresa AU - Wessely, Anja AU - Mastnik, Sebastian AU - Brinker, Josef Titus AU - French, Einar Lars AU - Niesert, Anne-Charlotte AU - Berking, Carola AU - Heppt, Vincent Markus PY - 2019/07/02 TI - Patient Attitudes and Their Awareness Towards Skin Cancer?Related Apps: Cross-Sectional Survey JO - JMIR Mhealth Uhealth SP - e13844 VL - 7 IS - 7 KW - skin cancer KW - melanoma KW - mobile applications KW - telemedicine KW - awareness KW - patient education N2 - Background: In the emerging era of digitalization and electronic health, skin cancer?related apps represent useful tools to support dermatologic consultation and examination. Yet, little is known about how patients perceive the value of such apps. Objective: The aim of this study was to investigate patient attitudes and their awareness toward skin cancer?related apps. Methods: A cross-sectional study including 200 patients from the oncological outpatient unit was conducted at the University Hospital (LMU Munich, Germany) between September and December 2018. Patients were asked to complete a self-administered questionnaire on the popularity and usefulness of health-related and skin cancer?related apps. A descriptive analysis was performed with the expression of categorical variables as frequencies and percentages. For continuous variables, the median and range were indicated. Contingency tables and chi-square tests were performed to investigate associations between sociodemographic data and selected items of the questionnaire. Results: A total of 98.9% (195/197) of patients had never used skin cancer?related apps or could not remember. In 49.7% (93/187) of cases, patients were unsure about the usefulness of skin cancer apps, whereas 42.6% (78/183) thought that skin cancer apps could supplement or support the professional skin examination performed by a physician. However, 47.9% (90/188) were interested in acquiring more information by their dermatologists about skin cancer apps. Young age (P=.002), male gender (P=.02), a previous history of melanoma (P=.004), and higher educational level (P=.002) were significantly associated with a positive attitude. Nevertheless, 55.9% (105/188) preferred a printed patient brochure on skin cancer to downloading and using an app. Conclusions: The experience and knowledge of skin cancer?related apps was surprisingly low in this population, although there was a high general interest in more information about such apps. Printed patient brochures were the preferred information source. UR - https://mhealth.jmir.org/2019/7/e13844/ UR - http://dx.doi.org/10.2196/13844 UR - http://www.ncbi.nlm.nih.gov/pubmed/31267978 ID - info:doi/10.2196/13844 ER - TY - JOUR AU - Tam, Tammie AU - Baer, R. Maria AU - Hsu, L. Lewis AU - Law, Y. Jennie PY - 2019/06/20 TI - An Electronic Teaching Module for Improving Knowledge of Self-Management of Vaso-Occlusive Pain Crises in Patients With Sickle Cell Disease: Pilot Questionnaire Study JO - JMIR Mhealth Uhealth SP - e13501 VL - 7 IS - 6 KW - patient education KW - teaching materials KW - portable electronic applications KW - sickle cell disease N2 - Background: For patients with sickle cell disease (SCD), effective management of vaso-occlusive crises (VOCs) is integral to provision of care, as nearly all affected individuals will suffer from VOCs in their lifetime. A recent systematic review of technological interventions to improve self-management in the care of SCD concluded that electronic health has the potential to improve the care of individuals with SCD. Objective: The aim of this study was to assess the value of an electronic teaching module (ETM) provided by Emmi Solutions for educating adult SCD patients on VOC self-management and treatment options for SCD. Methods: A pretest assessed adults with SCD for baseline knowledge with regard to self-management of VOCs. Participants then watched the 35-min ETM and completed a posttest and survey on the ETM. Results: A total of 20 adults enrolled. Their knowledge scores improved (pretest median 66.5% and posttest median 85%; P<.001). In total, 18 participants (18/20, 90%) agreed that they ?learned a lot? or ?learned something? from the ETM. The most common topic about which they reported learning was hydroxyurea. A total of 12 participants (12/20, 60%) agreed with the statement that they ?would recommend the module to a friend or family member with sickle cell disease.? Conclusions: The ETM is associated with an increase in knowledge in patients with SCD. Limitations of the study include small sample size, no assessment of knowledge before premodule questionnaire completion, and no longitudinal follow-up. Identifying patients with SCD who demonstrate affinity for self-education via an ETM may further enhance utility of this tool to educate and empower patients. UR - http://mhealth.jmir.org/2019/6/e13501/ UR - http://dx.doi.org/10.2196/13501 UR - http://www.ncbi.nlm.nih.gov/pubmed/31223120 ID - info:doi/10.2196/13501 ER - TY - JOUR AU - Ponum, Mahvish AU - Hasan, Osman AU - Khan, Saadia PY - 2019/05/14 TI - EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases JO - Interact J Med Res SP - e12664 VL - 8 IS - 2 KW - infectious diseases KW - mHealth KW - causes of death N2 - Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. UR - http://www.i-jmr.org/2019/2/e12664/ UR - http://dx.doi.org/10.2196/12664 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094329 ID - info:doi/10.2196/12664 ER - TY - JOUR AU - Athilingam, Ponrathi AU - Jenkins, Bradlee AU - Redding, A. Barbara PY - 2019/04/25 TI - Reading Level and Suitability of Congestive Heart Failure (CHF) Education in a Mobile App (CHF Info App): Descriptive Design Study JO - JMIR Aging SP - e12134 VL - 2 IS - 1 KW - health literacy KW - reading level KW - patient education KW - heart failure KW - mobile app N2 - Background: Education at the time of diagnosis or at discharge after an index illness is a vital component of improving outcomes in congestive heart failure (CHF). About 90 million Americans have limited health literacy and have a readability level at or below a 5th-grade level, which could affect their understanding of education provided at the time of diagnosis or discharge from hospital. Objective: The aim of this paper was to assess the suitability and readability level of a mobile phone app, the CHF Info App. Methods: A descriptive design was used to assess the reading level and suitability of patient educational materials included in the CHF Info App. The suitability assessment of patient educational materials included in the CHF Info App was independently assessed by two of the authors using the 26-item Suitability Assessment of Materials (SAM) tool. The reading grade level for each of the 10 CHF educational modules included in the CHF Info App was assessed using the comprehensive online Text Readability Consensus Calculator based on the seven most-common readability formulas: the Flesch Reading Ease Formula, the Gunning Fog Index, the Flesch-Kincaid Grade Level Formula, the Coleman-Liau Index, the Simplified Measure of Gobbledygook Index, the Automated Readability Index, and the Linsear Write Formula. The reading level included the text-scale score, the ease-of-reading score, and the corresponding grade level. Results: The educational materials included in the CHF Info App ranged from a 5th-grade to an 8th-grade reading level, with a mean of a 6th-grade level, which is recommended by the American Medical Association. The SAM tool result demonstrated adequate-to-superior levels in all four components assessed, including content, appearance, visuals, and layout and design, with a total score of 77%, indicating superior suitability. Conclusions: The authors conclude that the CHF Info App will be suitable and meet the recommended health literacy level for American adult learners. Further testing of the CHF Info App in a longitudinal study is warranted to determine improvement in CHF knowledge. UR - http://aging.jmir.org/2019/1/e12134/ UR - http://dx.doi.org/10.2196/12134 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518265 ID - info:doi/10.2196/12134 ER - TY - JOUR AU - Adam, Maya AU - McMahon, A. Shannon AU - Prober, Charles AU - Bärnighausen, Till PY - 2019/01/30 TI - Human-Centered Design of Video-Based Health Education: An Iterative, Collaborative, Community-Based Approach JO - J Med Internet Res SP - e12128 VL - 21 IS - 1 KW - human-centered design KW - health promotion KW - health behavior KW - health knowledge, attitudes, practice KW - community health workers KW - telemedicine KW - eHealth KW - mHealth UR - http://www.jmir.org/2019/1/e12128/ UR - http://dx.doi.org/10.2196/12128 UR - http://www.ncbi.nlm.nih.gov/pubmed/30698531 ID - info:doi/10.2196/12128 ER - TY - JOUR AU - Timmers, Thomas AU - Janssen, Loes AU - Pronk, Yvette AU - van der Zwaard, C. Babette AU - Koëter, Sander AU - van Oostveen, Dirk AU - de Boer, Stefan AU - Kremers, Keetie AU - Rutten, Sebastiaan AU - Das, Dirk AU - van Geenen, CI Rutger AU - Koenraadt, LM Koen AU - Kusters, Rob AU - van der Weegen, Walter PY - 2018/12/21 TI - Assessing the Efficacy of an Educational Smartphone or Tablet App With Subdivided and Interactive Content to Increase Patients? Medical Knowledge: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e10742 VL - 6 IS - 12 KW - patient education KW - shared decision making KW - smartphone KW - decision aid KW - orthopedics N2 - Background: Modern health care focuses on shared decision making (SDM) because of its positive effects on patient satisfaction, therapy compliance, and outcomes. Patients? knowledge about their illness and available treatment options, gained through medical education, is one of the key drivers for SDM. Current patient education relies heavily on medical consultation and is known to be ineffective. Objective: This study aimed to determine whether providing patients with information in a subdivided, categorized, and interactive manner via an educational app for smartphone or tablet might increase the knowledge of their illness. Methods: A surgeon-blinded randomized controlled trial was conducted with 213 patients who were referred to 1 of the 6 Dutch hospitals by their general practitioner owing to knee complaints that were indicative of knee osteoarthritis. An interactive app that, in addition to standard care, actively sends informative and pertinent content to patients about their illness on a daily basis by means of push notifications in the week before their consultation. The primary outcome was the level of perceived and actual knowledge that patients had about their knee complaints and the relevant treatment options after the intervention. Results: In total, 122 patients were enrolled in the control group and 91 in the intervention group. After the intervention, the level of actual knowledge (measured on a 0-36 scale) was 52% higher in the app group (26.4 vs 17.4, P<.001). Moreover, within the app group, the level of perceived knowledge (measured on a 0-25 scale) increased by 22% during the week within the app group (from 13.5 to 16.5, P<.001), compared with no gain in the control group. Conclusions: Actively offering patients information in a subdivided (per day), categorized (per theme), and interactive (video and quiz questions) manner significantly increases the level of perceived knowledge and demonstrates a higher level of actual knowledge, compared with standard care educational practices. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN98629372; http://www.isrctn.com/ISRCTN98629372 (Archived by WebCite at http://www.webcitation.org/73F5trZbb) UR - http://mhealth.jmir.org/2018/12/e10742/ UR - http://dx.doi.org/10.2196/10742 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578185 ID - info:doi/10.2196/10742 ER - TY - JOUR AU - Birrell, Louise AU - Deen, Hannah AU - Champion, Elizabeth Katrina AU - Newton, C. Nicola AU - Stapinski, A. Lexine AU - Kay-Lambkin, Frances AU - Teesson, Maree AU - Chapman, Cath PY - 2018/12/20 TI - A Mobile App to Provide Evidence-Based Information About Crystal Methamphetamine (Ice) to the Community (Cracks in the Ice): Co-Design and Beta Testing JO - JMIR Mhealth Uhealth SP - e11107 VL - 6 IS - 12 KW - internet KW - methamphetamine KW - mobile apps KW - mobile phone KW - substance-related disorder N2 - Background: Despite evidence of increasing harms and community concern related to the drug crystal methamphetamine (?ice?), there is a lack of easily accessible, evidence-based information for community members affected by its use, and to date, no evidence-based mobile apps have specifically focused on crystal methamphetamine. Objective: This study aims to describe the co-design and beta testing of a mobile app to provide evidence-based, up-to-date information about crystal methamphetamine to the general community. Methods: A mobile app about crystal methamphetamine was developed in 2017. The development process involved multiple stakeholders (n=12), including technology and drug and alcohol experts, researchers, app developers, a consumer expert with lived experience, and community members. Beta testing was conducted with Australian general community members (n=34), largely recruited by the Web through Facebook advertising. Participants were invited to use a beta version of the app and provide feedback about the content, visual appeal, usability, engagement, features, and functions. In addition, participants were asked about their perceptions of the app?s influence on awareness, understanding, and help-seeking behavior related to crystal methamphetamine, and about their knowledge about crystal methamphetamine before and after using the app. Results: The vast majority of participants reported the app was likely to increase awareness and understanding and encourage help-seeking. The app received positive ratings overall and was well received. Specifically, participants responded positively to the high-quality information provided, usability, and visual appeal. Areas suggested for improvement included reducing the amount of text, increasing engagement, removing a profile picture, and improving navigation through the addition of a ?back? button. Suggested improvements were incorporated prior to the app?s public release. App use was associated with an increase in perceived knowledge about crystal methamphetamine; however, this result was not statistically significant. Conclusions: The Cracks in the Ice mobile app provides evidence-based information about the drug crystal methamphetamine for the general community. The app is regularly updated, available via the Web and offline, and was developed in collaboration with experts and end users. Initial results indicate that it is easy to use and acceptable to the target group. UR - https://mhealth.jmir.org/2018/12/e11107/ UR - http://dx.doi.org/10.2196/11107 UR - http://www.ncbi.nlm.nih.gov/pubmed/30573443 ID - info:doi/10.2196/11107 ER - TY - JOUR AU - Bashi, Nazli AU - Hassanzadeh, Hamed AU - Varnfield, Marlien AU - Wee, Yong AU - Walters, Darren AU - Karunanithi, Mohanraj PY - 2018/10/31 TI - Multidisciplinary Smartphone-Based Interventions to Empower Patients With Acute Coronary Syndromes: Qualitative Study on Health Care Providers? Perspectives JO - JMIR Cardio SP - e10183 VL - 2 IS - 2 KW - acute coronary syndrome KW - focus group KW - health care professionals KW - mobile phone KW - multidisciplinary KW - thematic analysis N2 - Background: Postdischarge interventions are limited in patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and travel from remote areas. Smartphones have become a viable lifestyle technology to deliver educational and health interventions following discharge from hospital. Objective: The purpose of this study was to identify the requirements for the delivery of a mobile health intervention for the postdischarge management of patients with ACS via a multidisciplinary focus group. Methods: We conducted a focus group among health care professionals (n=10) from a large metropolitan hospital in May 2017. These participants from a multidisciplinary team contributed to a 1-hour discussion by responding to 8 questions relating to the applicability of smartphone-based educational and health interventions. Descriptive statistics of the focus group data were analyzed using SPSS. The qualitative data were analyzed according to relevant themes extracted from the focus group transcription, using a qualitative description software program (NVivo 11) and an ontology-based concept mapping approach. Results: The mean age of the participants was 47 (SD 8) years: 3 cardiologists; 2 nurse practitioners; 2 clinical nurses; 2 research scientists; and 1 physiotherapist. Of these participants, 70% (7/10) had experience using electronic health intervention during their professional practice. A total of 7 major themes and their subthemes emerged from the qualitative analysis. Health care providers indicated that comprehensive education on diet, particularly providing daily meal plans, is critical for patients with ACS. In terms of ACS symptoms, a strong recommendation was to focus on educating patients instead of daily monitoring of chest pain and shortness of breathing due to subjectivity and insufficient information for clinicians. Participants pointed that monitoring health measures such as blood pressure and body weight may result in increased awareness of patient physical health, yet may not be sufficient to support patients with ACS via the smartphone-based intervention. Therefore, monitoring pain and emotional status along with other health measures was recommended. Real-time support via FaceTime or video conferencing was indicated as motivational and supportive for patient engagement and self-monitoring. The general demographics of patients with ACS being older, having a low educational level, and a lack of computer skills were identified as potential barriers for engagement with the smartphone-based intervention. Conclusions: A smartphone-based program that incorporates the identified educational materials and health interventions would motivate patients with ACS to engage in the multidisciplinary intervention and improve their health outcomes following discharge from hospital. UR - http://cardio.jmir.org/2018/2/e10183/ UR - http://dx.doi.org/10.2196/10183 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758781 ID - info:doi/10.2196/10183 ER - TY - JOUR AU - Bashi, Nazli AU - Fatehi, Farhad AU - Fallah, Mina AU - Walters, Darren AU - Karunanithi, Mohanraj PY - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/10.2196/10057 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758762 ID - info:doi/10.2196/10057 ER - TY - JOUR AU - AlJaberi, Hana PY - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/10.2196/cardio.8543 UR - http://www.ncbi.nlm.nih.gov/pubmed/29473644 ID - info:doi/10.2196/cardio.8543 ER - TY - JOUR AU - Mirk, M. Sean AU - Wegrzyn, Marie Nicole PY - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/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 - 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 N2 - 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/ UR - http://dx.doi.org/10.2196/mhealth.4021 UR - http://www.ncbi.nlm.nih.gov/pubmed/26139587 ID - info:doi/10.2196/mhealth.4021 ER -