TY - JOUR AU - Unger, A. Jennifer AU - Kinuthia, John AU - John-Stewart, Grace PY - 2017/12/08 TI - Texting Condolences: Adapting mHealth Programs After Unexpected Pregnancy and Infant Outcomes JO - JMIR Mhealth Uhealth SP - e176 VL - 5 IS - 12 KW - mHealth KW - infant loss KW - miscarriage UR - http://mhealth.jmir.org/2017/12/e176/ UR - http://dx.doi.org/10.2196/mhealth.8303 UR - http://www.ncbi.nlm.nih.gov/pubmed/29222078 ID - info:doi/10.2196/mhealth.8303 ER - TY - JOUR AU - Cole, A. Casey AU - Anshari, Dien AU - Lambert, Victoria AU - Thrasher, F. James AU - Valafar, Homayoun PY - 2017/12/13 TI - Detecting Smoking Events Using Accelerometer Data Collected Via Smartwatch Technology: Validation Study JO - JMIR Mhealth Uhealth SP - e189 VL - 5 IS - 12 KW - machine learning KW - neural networks KW - automated pattern recognition KW - smoking cessation KW - ecological momentary assessment KW - digital signal processing KW - data mining N2 - Background: Smoking is the leading cause of preventable death in the world today. Ecological research on smoking in context currently relies on self-reported smoking behavior. Emerging smartwatch technology may more objectively measure smoking behavior by automatically detecting smoking sessions using robust machine learning models. Objective: This study aimed to examine the feasibility of detecting smoking behavior using smartwatches. The second aim of this study was to compare the success of observing smoking behavior with smartwatches to that of conventional self-reporting. Methods: A convenience sample of smokers was recruited for this study. Participants (N=10) recorded 12 hours of accelerometer data using a mobile phone and smartwatch. During these 12 hours, they engaged in various daily activities, including smoking, for which they logged the beginning and end of each smoking session. Raw data were classified as either smoking or nonsmoking using a machine learning model for pattern recognition. The accuracy of the model was evaluated by comparing the output with a detailed description of a modeled smoking session. Results: In total, 120 hours of data were collected from participants and analyzed. The accuracy of self-reported smoking was approximately 78% (96/123). Our model was successful in detecting 100 of 123 (81%) smoking sessions recorded by participants. After eliminating sessions from the participants that did not adhere to study protocols, the true positive detection rate of the smartwatch based-detection increased to more than 90%. During the 120 hours of combined observation time, only 22 false positive smoking sessions were detected resulting in a 2.8% false positive rate. Conclusions: Smartwatch technology can provide an accurate, nonintrusive means of monitoring smoking behavior in natural contexts. The use of machine learning algorithms for passively detecting smoking sessions may enrich ecological momentary assessment protocols and cessation intervention studies that often rely on self-reported behaviors and may not allow for targeted data collection and communications around smoking events. UR - http://mhealth.jmir.org/2017/12/e189/ UR - http://dx.doi.org/10.2196/mhealth.9035 UR - http://www.ncbi.nlm.nih.gov/pubmed/29237580 ID - info:doi/10.2196/mhealth.9035 ER - TY - JOUR AU - van Heerden, Alastair AU - Sen, Debjeet AU - Desmond, Chris AU - Louw, Julia AU - Richter, Linda PY - 2017/12/05 TI - App-Supported Promotion of Child Growth and Development by Community Health Workers in Kenya: Feasibility and Acceptability Study JO - JMIR Mhealth Uhealth SP - e182 VL - 5 IS - 12 KW - child health KW - child development KW - monitoring and evaluation KW - parent support KW - mHealth N2 - Background: Early childhood is a critical phase of development. In low resource settings, monitoring this stage of development and providing appropriate and timely feedback is a challenge. Community-based service providers play a key role in promoting early childhood development in areas where government services are weak. These community-based service providers are also tasked with the collection of monitoring and evaluation data for donors and local government. Usually, collection of these data aims to provide accountability, learning, and correction leading to improvement. However, such data is rarely used beyond the accountability stage. Objective: The purpose of this study was to test the feasibility and acceptability of the Information for Action (IFA) mobile phone app. The IFA app was designed for use by community health volunteers (CHVs), and repackages routinely collected data about children into useful, offline decision support for caregivers and program managers. Methods: The IFA app was tested with a convenience sample of 10 CHVs in West Katweng?a, a sublocation of Rarieda subcounty in western Kenya. CHVs used the IFA app for 5 months as part of their regular home visits to households containing children aged 0 to 5 years, after which a qualitative assessment of the app was conducted. A total of 16 caregivers who received services from the CHVs were randomly selected to participate in 1 of 2 focus group discussions about their experience. Results: The app was reported to help facilitate interactive dialog between CHVs and caregivers, leading to improved quality of home visits. Caregivers described the app as shifting the relationship from feeling harassed by CHVs to experiencing genuine interest from CHVs. CHVs reported feasibility challenges primarily related to infrastructure. The limited battery life of mobile phones combined with the lack of readily available electricity made it difficult to keep the phones charged. CHVs reported initial anxiety as first-time mobile phones users, including concerns about using the IFA app. With time, increased levels of confidence were seen. Conclusions: Acceptability was high with both CHVs and caregivers, who reported an improvement in their client-provider relationship. A number of feasibility challenges were experienced. UR - http://mhealth.jmir.org/2017/12/e182/ UR - http://dx.doi.org/10.2196/mhealth.6911 UR - http://www.ncbi.nlm.nih.gov/pubmed/29208588 ID - info:doi/10.2196/mhealth.6911 ER - TY - JOUR AU - Lee, Yura AU - Park, Rang Yu AU - Kim, Junetae AU - Kim, Hoon Jeong AU - Kim, Sung Woo AU - Lee, Jae-Ho PY - 2017/12/13 TI - Usage Pattern Differences and Similarities of Mobile Electronic Medical Records Among Health Care Providers JO - JMIR Mhealth Uhealth SP - e178 VL - 5 IS - 12 KW - mobile applications KW - electronic health records KW - physicians KW - nurses KW - communication KW - rounds KW - patient handoff N2 - Background: Recently, many hospitals have introduced mobile electronic medical records (mEMRs). Although numerous studies have been published on the usability or usage patterns of mEMRs through user surveys, investigations based on the real data usage are lacking. Objective: Asan Medical Center, a tertiary hospital in Seoul, Korea, implemented an mEMR program in 2010. On the basis of the mEMR usage log data collected over a period of 4.5 years, we aimed to identify a usage pattern and trends in accordance with user occupation and to disseminate the factors that make the mEMR more effective and efficient. Methods: The mEMR log data were collected from March 2012 to August 2016. Descriptive analyses were completed according to user occupation, access time, services, and wireless network type. Specifically, analyses targeted were as follows: (1) the status of the mEMR usage and distribution of users, (2) trends in the number of users and usage amount, (3) 24-hour usage patterns, and (4) trends in service usage based on user occupations. Linear regressions were performed to model the relationship between the time, access frequency, and the number of users. The differences between the user occupations were examined using Student t tests for categorical variables. Results: Approximately two-thirds of the doctors and nurses used the mEMR. The number of logs studied was 7,144,459. Among 3859 users, 2333 (60.46%) users were nurses and 1102 (28.56%) users were doctors. On average, the mEMR was used 1044 times by 438 users per day. The number of users and amount of access logs have significantly increased since 2012 (P<.001). Nurses used the mEMR 3 times more often than doctors. The use of mEMR by nurses increased by an annual average of 51.5%, but use by doctors decreased by an annual average of 7.7%. For doctors, the peak usage periods were observed during 08:00 to 09:00 and 17:00 to 18:00, which were coincident with the beginning of ward rounds. Conversely, the peak usage periods for the nurses were observed during 05:00 to 06:00, 12:00 to 13:00, and 20:00 to 21:00, which effectively occurred 1 or 2 hours before handover. In more than 80% of all cases, the mEMR was accessed via a nonhospital wireless network. Conclusions: The usage patterns of the mEMR differed between doctors and nurses according to their different workflows. In both occupations, mEMR was highly used when personal computer access was limited and the need for patient information was high, such as during ward rounds or handover periods. UR - http://mhealth.jmir.org/2017/12/e178/ UR - http://dx.doi.org/10.2196/mhealth.8855 UR - http://www.ncbi.nlm.nih.gov/pubmed/29237579 ID - info:doi/10.2196/mhealth.8855 ER - TY - JOUR AU - Mazoteras Pardo, Victoria AU - Losa Iglesias, E. Marta AU - López Chicharro, José AU - Becerro de Bengoa Vallejo, Ricardo PY - 2017/12/15 TI - The QardioArm App in the Assessment of Blood Pressure and Heart Rate: Reliability and Validity Study JO - JMIR Mhealth Uhealth SP - e198 VL - 5 IS - 12 KW - blood pressure KW - heart rate KW - reliability KW - validity KW - mobile apps N2 - Background: Self-measurement of blood pressure is a priority strategy for managing blood pressure. Objective: The aim of this study was to evaluate the reliability and validity of blood pressure and heart rate following the European Society of Hypertension?s international validation protocol, as measured with the QardioArm, a fully automatic, noninvasive wireless blood pressure monitor and mobile app. Methods: A total of 100 healthy volunteers older than 25 years from the general population of Ciudad Real, Spain, participated in a test-retest validation study with two measurement sessions separated by 5 to 7 days. In each measurement session, seven systolic blood pressure, diastolic blood pressure, and heart rate assessments were taken, alternating between the two devices. The test device was the QardioArm and the previously validated criterion device was the Omron M3. Sessions took place at a single study site with an evaluation room that was maintained at an appropriate temperature and kept free from noises and distractions. Results: The QardioArm displayed very consistent readings both within and across sessions (intraclass correlation coefficients=0.80-0.95, standard errors of measurement=2.5-5.4). The QardioArm measurements corresponded closely to those from the criterion device (r>.96) and mean values for the two devices were nearly identical. The QardioArm easily passed all validation standards set by the European Society of Hypertension International Protocol. Conclusions: The QardioArm mobile app has validity and it can be used free of major measurement error. UR - http://mhealth.jmir.org/2017/12/e198/ UR - http://dx.doi.org/10.2196/mhealth.8458 UR - http://www.ncbi.nlm.nih.gov/pubmed/29246880 ID - info:doi/10.2196/mhealth.8458 ER - TY - JOUR AU - Rincon, Esther AU - Monteiro-Guerra, Francisco AU - Rivera-Romero, Octavio AU - Dorronzoro-Zubiete, Enrique AU - Sanchez-Bocanegra, Luis Carlos AU - Gabarron, Elia PY - 2017/12/04 TI - Mobile Phone Apps for Quality of Life and Well-Being Assessment in Breast and Prostate Cancer Patients: Systematic Review JO - JMIR Mhealth Uhealth SP - e187 VL - 5 IS - 12 KW - cancer KW - mHealth KW - app KW - mobile phone KW - quality of life KW - well-being N2 - Background: Mobile phone health apps are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. Although the number of publications and health apps focusing on cancer is increasing, there are still few specifically designed for the most prevalent cancers diagnosed: breast and prostate cancers. There is a need to review the effect of these apps on breast and prostate cancer patients? quality of life (QoL) and well-being. Objective: The purposes of this study were to review the scientific literature on mobile phone apps targeting breast or prostate cancer patients and involving QoL and well-being (anxiety and depression symptoms) and analyze the clinical and technological characteristics, strengths, and weaknesses of these apps, as well as patients? user experience with them. Methods: We conducted a systematic review of peer-reviewed literature from The Cochrane Library, Excerpta Medica Database, PsycINFO, PubMed, Scopus, and MEDLINE to identify studies involving apps focused on breast and/or prostate cancer patients and QoL and/or well-being published between January 1, 2000, and July 12, 2017. Only trial studies which met the inclusion criteria were selected. The systematic review was completed with a critical analysis of the apps previously identified in the health literature research that were available from the official app stores. Results: The systematic review of the literature yielded 3862 articles. After removal of duplicates, 3229 remained and were evaluated on the basis of title and abstract. Of these, 3211 were discarded as not meeting the inclusion criteria, and 18 records were selected for full text screening. Finally, 5 citations were included in this review, with a total of 644 patients, mean age 52.16 years. Four studies targeted breast cancer patients and 1 focused on prostate cancer patients. Four studies referred to apps that assessed QoL. Only 1 among the 5 analyzed apps was available from the official app store. In 3 studies, an app-related intervention was carried out, and 2 of them reported an improvement on QoL. The lengths of the app-related interventions varied from 4 to 12 weeks. Because 2 of the studies only tracked use of the app, no effect on QoL or well-being was found. Conclusions: Despite the existence of hundreds of studies involving cancer-focused mobile phone apps, there is a lack of rigorous trials regarding the QoL and/or well-being assessment in breast and/or prostate cancer patients. A strong and collective effort should be made by all health care providers to determine those cancer-focused apps that effectively represent useful, accurate, and reliable tools for cancer patients? disease management. Trial Registration: PROSPERO CRD42017073069; https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID= CRD42017073069 (Archived by WebCite at http://www.webcitation.org/6v38Clb9T) UR - http://mhealth.jmir.org/2017/12/e187/ UR - http://dx.doi.org/10.2196/mhealth.8741 UR - http://www.ncbi.nlm.nih.gov/pubmed/29203459 ID - info:doi/10.2196/mhealth.8741 ER - TY - JOUR AU - Dou, Kaili AU - Yu, Ping AU - Deng, Ning AU - Liu, Fang AU - Guan, YingPing AU - Li, Zhenye AU - Ji, Yumeng AU - Du, Ningkai AU - Lu, Xudong AU - Duan, Huilong PY - 2017/12/06 TI - Patients? Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test JO - JMIR Mhealth Uhealth SP - e177 VL - 5 IS - 12 KW - smartphone KW - mobile health KW - patients KW - hypertension KW - chronic disease KW - disease management N2 - Background: Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. Objective: The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients? acceptance of smartphone health technology for chronic disease management. Methods: Multiple theories and factors that may influence patients? acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients? acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients? actual use of a smartphone health app. The partial least square method was used to test the theoretical model. Results: The model accounted for .412 of the variance in patients? intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients? smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients? intentions to use the technology. Age and gender had no significant influence on patients? acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management. Conclusions: This study developed a theoretical model to predict patients? acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients? awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community. UR - https://mhealth.jmir.org/2017/12/e177/ UR - http://dx.doi.org/10.2196/mhealth.7886 UR - http://www.ncbi.nlm.nih.gov/pubmed/29212629 ID - info:doi/10.2196/mhealth.7886 ER - TY - JOUR AU - Välimäki, Maritta AU - Anttila, Katriina AU - Anttila, Minna AU - Lahti, Mari PY - 2017/12/08 TI - Web-Based Interventions Supporting Adolescents and Young People With Depressive Symptoms: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e180 VL - 5 IS - 12 KW - Internet KW - adolescent KW - depression KW - meta-analysis KW - information and communication technology KW - intervention KW - systematic review KW - treatment as usual N2 - Background: Although previous studies on information and communication technology (ICT)?based intervention on mental health among adolescents with depressive symptoms have already been combined in a number of systematic reviews, coherent information is still missing about interventions used, participants? engagement of these interventions, and how these interventions work. Objective: We conducted a systematic review and meta-analysis of trials to describe the effectiveness of Web-based interventions to support adolescents with depression or depressive symptoms, anxiety, and stress. We also explored the content of the interventions, as there has previously been a lack of coherent understanding of the detailed content of the Web-based interventions for these purposes. Methods: We included parallel randomized controlled trials targeted at adolescents, or young people in the age range of 10 and 24 years, with symptoms or diagnoses of depression and anxiety. The interventions were from original studies aimed to support mental health among adolescents, and they were delivered via Web-based information and communication technology. Results: Out of 2087 records identified, 27 papers (22 studies) met the inclusion criteria. On the basis of a narrative analysis of 22 studies, a variety of Web-based interventions were found; the most commonly used intervention was based on cognitive behavioral therapy. Meta-analysis was further conducted with 15 studies (4979 participants). At the end of the intervention, a statistically significant improvement was found in the intervention group (10 studies) regarding depressive symptoms (P=.02, median 1.68, 95% CI 3.11-0.25) and after 6 months (3 studies; P=.01, median 1.78, 95% CI 3.20-0.37). Anxiety symptoms (8 studies; P<.001, median 1.47, 95% CI 2.36-0.59) and moods and feelings (2 studies; P=.04, median 5.55, 95% CI 10.88-0.22) improved as well in the Web-based intervention group, but there was no difference in stress scores. However, adolescents in the intervention group left the study early more often, both in short-term studies (11 studies; P=.007, median 1.31, 95% CI 1.08-1.58) and mid-term studies (3 studies; P=.02, median 1.65, 95% CI 1.09-2.49). We did not find any studies that had assessed the costs of the Web-based interventions. Conclusions: Despite widely reported promises that information technology use is beneficial to adolescents with depression, the results of our review show only short-term effects on adolescents? mental well-being, whereas long-term effects remain questionable because of the limited number of studies reviewed. Information about the economic benefits of Web-based interventions is still lacking. The quality of the studies, especially biases related to attrition rates and selective reporting, still needs serious attention. UR - http://mhealth.jmir.org/2017/12/e180/ UR - http://dx.doi.org/10.2196/mhealth.8624 UR - http://www.ncbi.nlm.nih.gov/pubmed/29222079 ID - info:doi/10.2196/mhealth.8624 ER - TY - JOUR AU - Plow, Matthew AU - Golding, Meghan PY - 2017/12/01 TI - Using mHealth Technology in a Self-Management Intervention to Promote Physical Activity Among Adults With Chronic Disabling Conditions: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e185 VL - 5 IS - 12 KW - disabled persons KW - exercise KW - self-care KW - mobile applications KW - motor activity KW - behavior KW - self-efficacy KW - goals KW - social support Introduction N2 - Background: Physical activity is considered a comprehensive approach for managing limitations in physical function among adults with chronic disabling conditions. However, adults with chronic disabling conditions often face many barriers to engaging in physical activity. A strategy to promote physical activity among adults with chronic disabling conditions is to encourage the use of mobile health (mHealth) apps. Objective: The objective of this pilot study was to examine the potential benefits of using commercially available mHealth apps in a self-management intervention among 46 adults with musculoskeletal or neurological conditions. Methods: Participants were randomized to one of 3 intervention groups: (1) mHealth-based self-management intervention, (2) paper-based self-management intervention, and (3) contact-control intervention. Participants in all 3 groups met in person once and received 3 follow-up phone calls with a trained graduate assistant. Participants in the mHealth-based and paper-based groups received a computer tablet or a paper diary, respectively, to facilitate goal setting, self-monitoring, and action planning. Participants in the contact-control group received information on healthy behaviors without being taught skills to change behaviors. The following outcomes were measured at baseline and at the 7th week: physical activity (Physical Activity and Disability Survey?revised), psychosocial factors (self-efficacy, self-regulation, and social support), and physical function (Patient Report Outcomes Measurement Information System, 6-min walk test, 1-min chair stands, and 1-min arm curls). Results: Repeated-measures multivariate analysis of variance (MANOVA) indicated significant differences between groups in physical activity levels (Wilks ?=0.71, F6,76=2.34, P=.04). Both the mHealth-based and paper-based groups had large effect size increases in planned exercise and leisure-time physical activity compared with the contact-control group (Cohen d=1.20 and d=0.82, respectively). Repeated-measures MANOVA indicated nonsignificant differences between groups in psychosocial factors (Wilks ?=0.85, F6,76=1.10, P=.37). However, both the mHealth-based and paper-based groups had moderate effect size improvements in self-efficacy (d=0.48 and d=0.75, respectively) and self-regulation (d=0.59 and d=0.43, respectively) compared with the contact-control group. Repeated-measures MANOVA indicated nonsignificant differences between groups in physical function (Wilks ?=0.94, F8,66=0.27, P=.97). There were small and nonsignificant changes between the mHealth-based and paper-based groups with regard to most outcomes. However, the mHealth-based group had moderate effect size increases (d=0.47) in planned exercise and leisure-time physical activity compared with the paper-based group. Conclusions: We found that using commercially available mHealth apps in a self-management intervention shows promise in promoting physical activity among adults with musculoskeletal and neurological conditions. Further research is needed to identify the best ways of using commercially available mobile apps in self-management interventions. Trial Registration: Clinicaltrials.gov NCT02833311; https://clinicaltrials.gov/ct2/show/NCT02833311 (Archived by WebCite at http://www.webcitation.org/6vDVSAw1w) UR - http://mhealth.jmir.org/2017/12/e185/ UR - http://dx.doi.org/10.2196/mhealth.6394 UR - http://www.ncbi.nlm.nih.gov/pubmed/29196279 ID - info:doi/10.2196/mhealth.6394 ER - TY - JOUR AU - Quinn, C. Charlene AU - Swasey, K. Krystal AU - Crabbe, F. J. Christopher AU - Shardell, D. Michelle AU - Terrin, L. Michael AU - Barr, A. Erik AU - Gruber-Baldini, L. Ann PY - 2017/12/07 TI - The Impact of a Mobile Diabetes Health Intervention on Diabetes Distress and Depression Among Adults: Secondary Analysis of a Cluster Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e183 VL - 5 IS - 12 KW - diabetes distress KW - mobile health KW - depression KW - diabetes KW - Diabetes Distress Scale KW - Patient Health Questionnaire KW - women KW - emotional well-being N2 - Background: Diabetes is a complex, demanding disease that requires the constant attention of patients. The burden of self-management, including different medication regimens, routine self-care activities, and provider visits, has an impact on patients? emotional well-being. Diabetes distress and depression are two important components of emotional well-being that may negatively affect diabetes outcomes. Objective: The aim was to determine the impact of the 1-year Mobile Diabetes Intervention Study cluster randomized clinical trial on emotional well-being measured by diabetes distress and depression among adults with type 2 diabetes (T2D). Methods: A total of 163 adults with not-well-managed T2D were enrolled from community primary care practices. Primary care practices were cluster randomized into either a usual care control group or intervention group. Intervention participants were given a mobile phone with coaching software including a Web portal to communicate with providers. A priori established secondary outcomes included distress measured by the Diabetes Distress Scale (DDS), with subscales measuring emotional burden, interpersonal distress, physician-related distress, and regimen-related distress, as well as depression measured by the Patient Health Questionnaire (PHQ-9). Linear mixed models were used to calculate the effect of the intervention on diabetes distress levels over time, both overall and separately by sex, and to determine if the intervention affected distress or depression. The impact of total DDS on changes in HbA1c was also studied. Results: There were no significant treatment group effects for DDS total (baseline: P=.07; differences over time: P=.38) or for depression (P=.06 over time). Significant declines in total DDS were observed over the 12-month intervention period (P=.01). Regimen-related distress significantly decreased for all study participants (P<.001), but no significant change over time was observed for emotional burden (P=.83), interpersonal distress (P=.64), or physician-related distress (P=.73). Women in both the usual care and intervention groups were more likely to have higher overall DDS, emotional burden, physician-related distress, and regimen-related distress, but not interpersonal distress. Women also reported higher baseline depression compared to men (P=.006). Overall, depression decreased over the treatment period (P=.007), but remained unaffected by group assignment (P=.06) or by sex (P=.97). Diabetes distress had no effect on the change in HbA1c (P=.91) over the treatment period. Conclusions: Although we found no definitive overall or sex-specific effect of the intervention on diabetes distress or depression, this study makes an important contribution to the understanding of mobile health interventions and the impact on emotional health. Our study verified previous work that although diabetes distress and depression are highly correlated, these measures are not evaluating the same construct. Design of future mobile technology provides an opportunity to personalize, contextualize, and intervene in the emotional well-being of persons with diabetes. Trial Registration: Clinicaltrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by WebCite at http://www.webcitation.org/6vVgRCLAF) UR - http://mhealth.jmir.org/2017/12/e183/ UR - http://dx.doi.org/10.2196/mhealth.8910 UR - http://www.ncbi.nlm.nih.gov/pubmed/29217502 ID - info:doi/10.2196/mhealth.8910 ER - TY - JOUR AU - Tonkin, Emma AU - Jeffs, Lauren AU - Wycherley, Philip Thomas AU - Maher, Carol AU - Smith, Ross AU - Hart, Jonathon AU - Cubillo, Beau AU - Brimblecombe, Julie PY - 2017/12/12 TI - A Smartphone App to Reduce Sugar-Sweetened Beverage Consumption Among Young Adults in Australian Remote Indigenous Communities: Design, Formative Evaluation and User-Testing JO - JMIR Mhealth Uhealth SP - e192 VL - 5 IS - 12 KW - behavior KW - diet KW - health promotion KW - Indigenous KW - Telemedicine KW - mobile applications KW - public health N2 - Background: The disproportionate burden of noncommunicable disease among Indigenous Australians living in remote Indigenous communities (RICs) is a complex and persistent problem. Smartphones are increasingly being used by young Indigenous adults and therefore represent a promising method to engage them in programs seeking to improve nutritional intake. Objective: This study aimed to consult RIC members to inform the content of a smartphone app that can be used to monitor and reduce sugar-sweetened beverage intake in RICs. Methods: The study was conducted in two phases. The formative phase involved a simulated grocery selection activity with think aloud (?think aloud shop?), a semistructured interview, a questionnaire outlining current smartphone and app use, and a paper prototyping activity. A preliminary end-user testing phase involved a think aloud prototype test and a semistructured interview regarding user satisfaction. Convenience sampling was used to recruit 20 18- to 35-year-old smartphone users for each phase from two RICs in the Northern Territory, Australia. Thematic analysis of transcribed audio recordings was used to identify determinants of food choice from the think aloud shop; themes related to the Theory of Planned Behavior (TPB) from the eating behaviors interview; and usability, comprehension, and satisfaction with the app from the preliminary end-user testing. Results: Smartphone use in RICs is currently different to that found in urban environments; in particular, extremely low use of Facebook, restricted variety of phone types, and limited Internet access. Findings regarding promoting app engagement indicate that utilizing an opt-in approach to social features such as leader boards and team challenges is essential. The inclusion of games was also shown to be important for satisfaction, as were the use of audio features, contextually embedded dissemination, and streamlined app design for comprehension in this target group. Conclusions: This research provides critical insights and concrete recommendations for the development of lifestyle improvement apps targeted toward disadvantaged young adults in nonurban settings, specifically RICs. It serves as a framework for future app development projects using a consultative user-centered design approach, supporting calls for the increased use of this strategy in app development. UR - http://mhealth.jmir.org/2017/12/e192/ UR - http://dx.doi.org/10.2196/mhealth.8651 UR - http://www.ncbi.nlm.nih.gov/pubmed/29233803 ID - info:doi/10.2196/mhealth.8651 ER - TY - JOUR AU - Litterbach, Eloise-Kate AU - Russell, G. Catherine AU - Taki, Sarah AU - Denney-Wilson, Elizabeth AU - Campbell, J. Karen AU - Laws, A. Rachel PY - 2017/12/18 TI - Factors Influencing Engagement and Behavioral Determinants of Infant Feeding in an mHealth Program: Qualitative Evaluation of the Growing Healthy Program JO - JMIR Mhealth Uhealth SP - e196 VL - 5 IS - 12 KW - mobile health KW - parents KW - personal satisfaction KW - behavior KW - infant KW - obesity KW - prevention and control N2 - Background: Infant feeding practices, including breastfeeding and optimal formula feeding practices, can play a role in the prevention of childhood obesity. The ubiquity of smartphone ownership among women of childbearing age provides important opportunities for the delivery of low-cost, broad reach parenting interventions delivered by mobile phone (mHealth or mobile health interventions). Little is known about how parents engage with mHealth programs targeting infant feeding and how such programs might influence infant feeding practices. Objective: The objectives of this study were to explore participant views on (1) factors influencing engagement with the Growing healthy program, an mHealth program targeting healthy infant feeding practices from birth to 9 months of age, and (2) the ways in which the program influenced behavioral determinants of capability, opportunity, and motivation for breastfeeding and optimal formula feeding behaviors. Methods: Semistructured, telephone interviews were conducted with a purposeful sample (n=24) of mothers participating in the Growing healthy program. Interviews explored participants? views about engagement with the program and its features, and the ways the program influenced determinants of infant feeding behaviors related to breastfeeding and optimal formula feeding. The interview schedule was informed by the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Results: Participants reported that engagement fluctuated depending on need and the degree to which the program was perceived to fit with existing parenting beliefs and values. Participants identified that the credibility of the program source, the user friendly interface, and tailoring of content and push notifications to baby?s age and key transition points promoted engagement, whereas technical glitches were reported to reduce engagement. Participants discussed that the program increased confidence in feeding decisions. For breastfeeding mothers, this was achieved by helping them to overcome doubts about breast milk supply, whereas mothers using formula reported feeling more confident to feed to hunger and satiety cues rather than encouraging infants to finish the bottle. Participants discussed that the program provided around-the-clock, readily accessible, nonjudgmental information and support on infant feeding and helped to reinforce information received by health professionals or encouraged them to seek additional help if needed. Participants reflected that their plans for feeding were typically made before joining the program, limiting the potential for the program to influence this aspect of motivation. Rather, the program provided emotional reassurance to continue with current feeding plans. Conclusions: Our findings suggest that engagement with the program was influenced by an interplay between the program features and needs of the user. Participants reported that the program enhanced confidence in feeding decisions by providing a 24/7 accessible, expert, nonjudgmental support for infant feeding that complemented health professional advice. It is likely that interventions need to commence during pregnancy to maximize the impact on breastfeeding intentions and plans. UR - http://mhealth.jmir.org/2017/12/e196/ UR - http://dx.doi.org/10.2196/mhealth.8515 UR - http://www.ncbi.nlm.nih.gov/pubmed/29254908 ID - info:doi/10.2196/mhealth.8515 ER - TY - JOUR AU - Frie, Kerstin AU - Hartmann-Boyce, Jamie AU - Jebb, Susan AU - Albury, Charlotte AU - Nourse, Rebecca AU - Aveyard, Paul PY - 2017/12/22 TI - Insights From Google Play Store User Reviews for the Development of Weight Loss Apps: Mixed-Method Analysis JO - JMIR Mhealth Uhealth SP - e203 VL - 5 IS - 12 KW - weight loss KW - mobile applications KW - telemedicine KW - consumer behavior N2 - Background: Significant weight loss takes several months to achieve, and behavioral support can enhance weight loss success. Weight loss apps could provide ongoing support and deliver innovative interventions, but to do so, developers must ensure user satisfaction. Objective: The aim of this study was to conduct a review of Google Play Store apps to explore what users like and dislike about weight loss and weight-tracking apps and to examine qualitative feedback through analysis of user reviews. Methods: The Google Play Store was searched and screened for weight loss apps using the search terms weight loss and weight track*, resulting in 179 mobile apps. A content analysis was conducted based on the Oxford Food and Activity Behaviors taxonomy. Correlational analyses were used to assess the association between complexity of mobile health (mHealth) apps and popularity indicators. The sample was then screened for popular apps that primarily focus on weight-tracking. For the resulting subset of 15 weight-tracking apps, 569 user reviews were sampled from the Google Play Store. Framework and thematic analysis of user reviews was conducted to assess which features users valued and how design influenced users? responses. Results: The complexity (number of components) of weight loss apps was significantly positively correlated with the rating (r=.25; P=.001), number of reviews (r=.28; P<.001), and number of downloads (r=.48; P<.001) of the app. In contrast, in the qualitative analysis of weight-tracking apps, users expressed preference for simplicity and ease of use. In addition, we found that positive reinforcement through detailed feedback fostered users? motivation for further weight loss. Smooth functioning and reliable data storage emerged as critical prerequisites for long-term app usage. Conclusions: Users of weight-tracking apps valued simplicity, whereas users of comprehensive weight loss apps appreciated availability of more features, indicating that complexity demands are specific to different target populations. The provision of feedback on progress can motivate users to continue their weight loss attempts. Users value seamless functioning and reliable data storage. UR - http://mhealth.jmir.org/2017/12/e203/ UR - http://dx.doi.org/10.2196/mhealth.8791 UR - http://www.ncbi.nlm.nih.gov/pubmed/29273575 ID - info:doi/10.2196/mhealth.8791 ER - TY - JOUR AU - Eckersberger, Elisabeth AU - Pearson, Erin AU - Andersen, Kathryn AU - Hossain, Altaf AU - Footman, Katharine AU - Biswas, Kanti Kamal AU - Nuremowla, Sadid AU - Reiss, Kate PY - 2017/12/14 TI - Developing mHealth Messages to Promote Postmenstrual Regulation Contraceptive Use in Bangladesh: Participatory Interview Study JO - JMIR Mhealth Uhealth SP - e174 VL - 5 IS - 12 KW - abortion KW - reproductive health services KW - contraception KW - family planning KW - mHealth KW - Bangladesh N2 - Background: Abortions are restricted in Bangladesh, but menstrual regulation is an approved alternative, defined as a procedure of regulating the menstrual cycle when menstruation is absent for a short duration. Use of contraception after menstrual regulation can reduce subsequent unintended pregnancy, but in Bangladesh, the contraceptive method mix is dominated by short-term methods, which have higher discontinuation and failure rates. Mobile phones are a channel via which menstrual regulation clients could be offered contraceptive support after leaving the clinic. Objective: This study aimed to support the development of a mobile phone intervention to support postmenstrual regulation family planning use in Bangladesh. It explored what family planning information women want to receive after having a menstrual regulation procedure, whether they would like to receive this information via their mobile phone, and if so, what their preferences are for the way in which it is delivered. Methods: We conducted participatory interviews with 24 menstrual regulation clients in Dhaka and Sylhet divisions in Bangladesh. Women were recruited from facilities in urban and peri-urban areas, which included public sector clinics supported by Ipas, an international nongovernmental organization (NGO), and NGO clinics run by Marie Stopes. Main themes covered in the interviews were factors affecting the use of contraception, what information and support women want after their menstrual regulation procedure, how respondents would prefer to receive information about contraception, and other key issues for mobile health (mHealth) interventions, such as language and privacy. As part of the in-depth interviews, women were shown and played 6 different messages about contraception on the research assistant?s phone, which they were given to operate, and were then asked to give feedback. Results: Women were open to both receiving messages about family planning methods on their mobile phones and talking to a counselor about family planning methods over the phone after their menstrual regulation. Women most commonly wanted information about the contraceptive method they were currently using and wanted this information to be tailored to their particular needs. Women preferred voice messages to text and liked the interactive voice message format. When asked to repeat and identify the main points of the messages, women demonstrated good understanding of the content. Women did not seem too concerned with privacy or with others reading the messages and welcomed including their husbands in speaking to a counselor. Conclusions: This study found that menstrual regulation clients are very interested in receiving information on their phones to support family planning use and wanted more information about the method of contraception they were using. Participatory voicemail was the preferred modality. UR - http://mhealth.jmir.org/2017/12/e174/ UR - http://dx.doi.org/10.2196/mhealth.6969 UR - http://www.ncbi.nlm.nih.gov/pubmed/29242175 ID - info:doi/10.2196/mhealth.6969 ER - TY - JOUR AU - Zhao, Jing AU - Freeman, Becky AU - Li, Mu PY - 2017/12/06 TI - How Do Infant Feeding Apps in China Measure Up? A Content Quality Assessment JO - JMIR Mhealth Uhealth SP - e186 VL - 5 IS - 12 KW - apps KW - mobile phone KW - Chinese N2 - Background: Globally, with the popularization of mobile phones, the number of health-related mobile phone apps has skyrocketed to 259,000 in 2016. In the digital era, people are accessing health information through their fingertips. In China, there are several apps that claim to provide infant feeding and nutrition guidance. However, the quality of information in those apps has not been extensively assessed. Objective: We aimed to assess the quality of Chinese infant feeding apps using comprehensive quality assessment criteria and to explore Chinese mothers? perceptions on apps? quality and usability. Methods: We searched for free-to-download Chinese infant feeding apps in the iTunes and Android App Stores. We conducted a comprehensive assessment of the accountability, scientific basis, accuracy of information relevant to infant feeding, advertising policy, and functionality and carried out a preliminary screening of infant formula advertisements in the apps. In addition, we also conducted exploratory qualitative research through semistructured interviews with Chinese mothers in Shanghai to elicit their views about the quality of apps. Results: A total of 4925 apps were screened, and 26 apps that met the selection criteria were evaluated. All 26 apps were developed by commercial entities, and the majority of them were rated poorly. The highest total score was 62.2 (out of approximately 100) and the lowest was 16.7. In the four quality domains assessed, none of them fulfilled all the accountability criteria. Three out of 26 apps provided information covering the three practices from the World Health Organization?s infant feeding recommendations. Only one app described its advertising policy in its terms of usage. The most common app functionality was a built-in social forum (19/26). Provision of a website link was the least common functionality (2/26). A total of 20 out of 26 apps promoted infant formula banner advertisements on their homepages. In addition, 12 apps included both e-commerce stores and featured infant formula advertisements. In total, 21 mothers were interviewed face-to-face. Mothers highly valued immediate access to parenting information and multifunctionality provided by apps. However, concerns regarding incredible information and commercial activities in apps, as well as the desire for information and support offered by health care professionals were expressed. Conclusions: The findings provide valuable information on Chinese infant feeding apps. The results are concerning, particularly with the relative absence of scientific basis and credibility and the large number of commercial advertisements that are displayed. Apps do seem to be able to provide an opportunity for mothers to access health information and support; it is time for tighter controls on content and advertisements. Ongoing app research and development should focus on implementation of a standard framework, which would drive the development of high-quality apps to support healthy infant feeding through cooperation among academics, health professionals, app users, app developers, and government bodies. UR - http://mhealth.jmir.org/2017/12/e186/ UR - http://dx.doi.org/10.2196/mhealth.8764 UR - http://www.ncbi.nlm.nih.gov/pubmed/29212627 ID - info:doi/10.2196/mhealth.8764 ER - TY - JOUR AU - Xie, Bo AU - Su, Zhaohui AU - Zhang, Wenhui AU - Cai, Run PY - 2017/12/14 TI - Chinese Cardiovascular Disease Mobile Apps? Information Types, Information Quality, and Interactive Functions for Self-Management: Systematic Review JO - JMIR Mhealth Uhealth SP - e195 VL - 5 IS - 12 KW - mobile health KW - mHealth KW - cardiovascular disease KW - CVD KW - patient preferences KW - information quality KW - self-management KW - mobile applications KW - mobile apps KW - China N2 - Background: China has a large population with cardiovascular disease (CVD) that requires extensive self-management. Mobile health (mHealth) apps may be a useful tool for CVD self-management. Little is currently known about the types and quality of health information provided in Chinese CVD mobile apps and whether app functions are conducive to promoting CVD self-management. Objective: We undertook a systematic review to evaluate the types and quality of health information provided in Chinese CVD mobile apps and interactive app functions for promoting CVD self-management. Methods: Mobile apps targeting end users in China with CVD conditions were selected in February 2017 through a multi-stage process. Three frameworks were used to evaluate the selected apps: (1) types of health information offered were assessed using our Health Information Wants framework, which encompasses 7 types of information; (2) quality of information provided in the apps was assessed using the 11 guidelines recommended by the National Library of Medicine of the National Institutes of Health; and (3) types of interactive app functions for CVD self-management were assessed using a 15-item framework adapted from the literature, including our own prior work. Results: Of 578 apps identified, 82 were eligible for final review. Among these, information about self-care (67/82, 82%) and information specifically regarding CVD (63/82, 77%) were the most common types of information provided, while information about health care providers (22/82, 27%) and laboratory tests (5/82, 6%) were least common. The most common indicators of information quality were the revealing of apps? providers (82/82, 100%) and purpose (82/82, 100%), while the least common quality indicators were the revealing of how apps? information was selected (1/82, 1%) and app sponsorship (0/82, 0%). The most common interactive functions for CVD self-management were those that enabled user interaction with the app provider (57/82, 70%) and with health care providers (36/82, 44%), while the least common interactive functions were those that enabled lifestyle management (13/82, 16%) and psychological health management (6/82, 7%). None of the apps covered all 7 types of health information, all 11 indicators of information quality, or all 15 interactive functions for CVD self-management. Conclusions: Chinese CVD apps are insufficient in providing comprehensive health information, high-quality information, and interactive functions to facilitate CVD self-management. End users should exercise caution when using existing apps. Health care professionals and app developers should collaborate to better understand end users? preferences and follow evidence-based guidelines to develop mHealth apps conducive to CVD self-management. UR - http://mhealth.jmir.org/2017/12/e195/ UR - http://dx.doi.org/10.2196/mhealth.8549 UR - http://www.ncbi.nlm.nih.gov/pubmed/29242176 ID - info:doi/10.2196/mhealth.8549 ER - TY - JOUR AU - Pereira-Salgado, Amanda AU - Westwood, A. Jennifer AU - Russell, Lahiru AU - Ugalde, Anna AU - Ortlepp, Bronwen AU - Seymour, F. John AU - Butow, Phyllis AU - Cavedon, Lawrence AU - Ong, Kevin AU - Aranda, Sanchia AU - Breen, Sibilah AU - Kirsa, Suzanne AU - Dunlevie, Andrew AU - Schofield, Penelope PY - 2017/12/06 TI - Mobile Health Intervention to Increase Oral Cancer Therapy Adherence in Patients With Chronic Myeloid Leukemia (The REMIND System): Clinical Feasibility and Acceptability Assessment JO - JMIR Mhealth Uhealth SP - e184 VL - 5 IS - 12 KW - mobile phone KW - neoplasms KW - Internet KW - medication adherence N2 - Background: Optimal dosing of oral tyrosine kinase inhibitor therapy is critical to treatment success and survival of patients with chronic myeloid leukemia (CML). Drug intolerance secondary to toxicities and nonadherence are significant factors in treatment failure. Objective: The objective of this study was to develop and pilot-test the clinical feasibility and acceptability of a mobile health system (REMIND) to increase oral drug adherence and patient symptom self-management among people with CML (chronic phase). Methods: A multifaceted intervention was iteratively developed using the intervention development framework by Schofield and Chambers, consisting of defining the patient problem and iteratively refining the intervention. The clinical feasibility and acceptability were examined via patient and intervention nurse interviews, which were audiotaped, transcribed, and deductively content analyzed. Results: The intervention comprised 2 synergistically operating elements: (1) daily medication reminders and routine assessment of side effects with evidence-based self-care advice delivered in real time and (2) question prompt list (QPL) questions and routinely collected individual patient adherence and side effect profile data used to shape nurses? consultations, which employed motivational interviewing to support adoption of self-management behaviors. A total of 4 consultations and daily alerts and advice were delivered over 10 weeks. In total, 58% (10/17) of patients and 2 nurses participated in the pilot study. Patients reported several benefits of the intervention: help in establishing medication routines, resolution of symptom uncertainty, increased awareness of self-care, and informed decision making. Nurses also endorsed the intervention: it assisted in establishing pill-taking routines and patients developing effective solutions to adherence challenges. Conclusions: The REMIND system with nurse support was usable and acceptable to both patients and nurses. It has the potential to improve adherence and side-effect management and should be further evaluated. UR - http://mhealth.jmir.org/2017/12/e184/ UR - http://dx.doi.org/10.2196/mhealth.8349 UR - http://www.ncbi.nlm.nih.gov/pubmed/29212628 ID - info:doi/10.2196/mhealth.8349 ER - TY - JOUR AU - Badawy, M. Sherif AU - Thompson, A. Alexis AU - Kuhns, M. Lisa PY - 2017/12/22 TI - Medication Adherence and Technology-Based Interventions for Adolescents With Chronic Health Conditions: A Few Key Considerations JO - JMIR Mhealth Uhealth SP - e202 VL - 5 IS - 12 KW - adolescents KW - adherence KW - compliance KW - technology interventions KW - mobile apps KW - text messaging UR - http://mhealth.jmir.org/2017/12/e202/ UR - http://dx.doi.org/10.2196/mhealth.8310 UR - http://www.ncbi.nlm.nih.gov/pubmed/29273573 ID - info:doi/10.2196/mhealth.8310 ER - TY - JOUR AU - Robbins, Rebecca AU - Krebs, Paul AU - Jagannathan, Ram AU - Jean-Louis, Girardin AU - Duncan, T. Dustin PY - 2017/12/19 TI - Health App Use Among US Mobile Phone Users: Analysis of Trends by Chronic Disease Status JO - JMIR Mhealth Uhealth SP - e197 VL - 5 IS - 12 KW - smartphone KW - telemedicine KW - chronic disease N2 - Background: Mobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chronic illness use or perceive mobile apps. Objective: The objective of this study was to explore behaviors and perceptions about mobile phone?based apps for health among individuals with chronic conditions. Methods: Data were collected from a national cross-sectional survey of 1604 mobile phone users in the United States that assessed mHealth use, beliefs, and preferences. This study examined health app use, reason for download, and perceived efficacy by chronic condition. Results: Among participants, having between 1 and 5 apps was reported by 38.9% (314/807) of respondents without a condition and by 6.6% (24/364) of respondents with hypertension. Use of health apps was reported 2 times or more per day by 21.3% (172/807) of respondents without a condition, 2.7% (10/364) with hypertension, 13.1% (26/198) with obesity, 12.3% (20/163) with diabetes, 12.0% (32/267) with depression, and 16.6% (53/319) with high cholesterol. Results of the logistic regression did not indicate a significant difference in health app download between individuals with and without chronic conditions (P>.05). Compared with individuals with poor health, health app download was more likely among those with self-reported very good health (odds ratio [OR] 3.80, 95% CI 2.38-6.09, P<.001) and excellent health (OR 4.77, 95% CI 2.70-8.42, P<.001). Similarly, compared with individuals who report never or rarely engaging in physical activity, health app download was more likely among those who report exercise 1 day per week (OR 2.47, 95% CI 1.6-3.83, P<.001), 2 days per week (OR 4.77, 95% CI 3.27-6.94, P<.001), 3 to 4 days per week (OR 5.00, 95% CI 3.52-7.10, P<.001), and 5 to 7 days per week (OR 4.64, 95% CI 3.11-6.92, P<.001). All logistic regression results controlled for age, sex, and race or ethnicity. Conclusions: Results from this study suggest that individuals with poor self-reported health and low rates of physical activity, arguably those who stand to benefit most from health apps, were least likely to report download and use these health tools. UR - http://mhealth.jmir.org/2017/12/e197/ UR - http://dx.doi.org/10.2196/mhealth.7832 UR - http://www.ncbi.nlm.nih.gov/pubmed/29258981 ID - info:doi/10.2196/mhealth.7832 ER - TY - JOUR AU - El Amrani, Leila AU - Oude Engberink, Agnes AU - Ninot, Gregory AU - Hayot, Maurice AU - Carbonnel, François PY - 2017/12/21 TI - Connected Health Devices for Health Care in French General Medicine Practice: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e193 VL - 5 IS - 12 KW - general practice KW - physician-patient relations KW - monitoring, ambulatory KW - wireless technology KW - medical informatics KW - telemedicine N2 - Background: The integration of Connected Health Devices (CHDs) is growing within mobile health (mHealth) and telemedicine, encouraged by institutions and industries. The idea is to improve lifestyle habits and health behaviors as a preventive goal in an aging population with fewer physicians available. However, their ill-defined place in health care does not promote their use in current medical practice. Objective: The primary objective of this study was to quantify CHDs? use rate by general practitioners (GPs). A secondary objective was to evaluate their benefits and limitations in usual care. Methods: A cross-sectional study through an Internet-based survey was addressed to French GPs via regional medical unions and continuous education agencies, supplemented with an informative website, from March 2015 to July 2015. Surveys where either the form was insufficiently filled or the main question was left unanswered were excluded from the study. Results: A total of 1084 answers were analyzed, of which 19.46% (211/1084, 95% CI 17.1-21.8) GPs used CHDs, and 10.15% (110/1084, 95% CI 8.5-12.1) prescribed a CHD. CHD users statistically prescribed more CHDs (7.38% [80/1084] in the user group vs 2.86% [31/1084] in nonusers; P<.001) and were more likely to use them in the future. Major interests in their utilization were in patient monitoring for 84.96% (921/1084) and patient education for 75.83% (822/1084), especially for diabetes (89.67%, 972/1084) and hypertension (84.13%, 912/1084). Generated data had to be managed securely by the patient primarily for 85.79% (930/1084) of the GPs. CHDs had to not constrain GPs outside clinical consultation, nor restrain their time for 75.83% (822/1084). Additional actors in patient care were not desired for 79.98% (867/1084) of the GPs. Questions about data management issues and technical difficulties were raised. Conclusions: CHDs are little used by French GPs and even less prescribed to their patients, as only a few GPs use these tools. Their benefits as tools of patient empowerment, although expected, remain to be demonstrated in real-life setups. UR - http://mhealth.jmir.org/2017/12/e193/ UR - http://dx.doi.org/10.2196/mhealth.7427 UR - http://www.ncbi.nlm.nih.gov/pubmed/29269336 ID - info:doi/10.2196/mhealth.7427 ER - TY - JOUR AU - Nilsson, Ulrica AU - Dahlberg, Karuna AU - Jaensson, Maria PY - 2017/12/3 TI - The Swedish Web Version of the Quality of Recovery Scale Adapted for Use in a Mobile App: Prospective Psychometric Evaluation Study JO - JMIR Mhealth Uhealth SP - e188 VL - 5 IS - 12 KW - psychometric evaluation KW - postoperative recovery KW - Web version KW - evaluation studies KW - mobile application KW - Quality of Recovery scale N2 - Background: The 40-item Quality of Recovery (QoR-40) questionnaire is well validated for measuring self-assessed postoperative recovery. The Swedish version of the 40-item Quality of Recovery (QoR-40) has been developed into a Web-based questionnaire, the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire, adapted for use in a mobile app, Recovery Assessment by Phone Points, or RAPP. Objective: The aim of this study was to test the validity, reliability, responsiveness, and clinical acceptability and feasibility of SwQoR. Methods: We conducted a prospective psychometric evaluation study including 494 patients aged ?18 years undergoing day surgery at 4 different day-surgery departments in Sweden. SwQoR was completed daily on postoperative days 1 to 14. Results: All a priori hypotheses were confirmed, supporting convergent validity. There was excellent internal consistency (Cronbach alpha range .91-.93), split-half reliability (coefficient range .87-.93), and stability (ri=.99, 95% CI .96-.99; P<.001). Cohen d effect size was 1.00, with a standardized response mean of 1.2 and a percentage change from baseline of 59.1%. An exploratory factor analysis found 5 components explaining 57.8% of the total variance. We noted a floor effect only on postoperative day 14; we found no ceiling effect. Conclusions: SwQoR is valid, has excellent reliability and high responsiveness, and is clinically feasible for the systematic follow-up of patients? postoperative recovery. UR - http://mhealth.jmir.org/2017/12/e188/ UR - http://dx.doi.org/10.2196/mhealth.9061 UR - http://www.ncbi.nlm.nih.gov/pubmed/29229590 ID - info:doi/10.2196/mhealth.9061 ER - TY - JOUR AU - Jake-Schoffman, E. Danielle AU - Silfee, J. Valerie AU - Waring, E. Molly AU - Boudreaux, D. Edwin AU - Sadasivam, S. Rajani AU - Mullen, P. Sean AU - Carey, L. Jennifer AU - Hayes, B. Rashelle AU - Ding, Y. Eric AU - Bennett, G. Gary AU - Pagoto, L. Sherry PY - 2017/12/18 TI - Methods for Evaluating the Content, Usability, and Efficacy of Commercial Mobile Health Apps JO - JMIR Mhealth Uhealth SP - e190 VL - 5 IS - 12 KW - mHealth KW - mobile health KW - mobile applications KW - telemedicine/methods KW - treatment efficacy KW - behavioral medicine KW - chronic disease UR - http://mhealth.jmir.org/2017/12/e190/ UR - http://dx.doi.org/10.2196/mhealth.8758 UR - http://www.ncbi.nlm.nih.gov/pubmed/29254914 ID - info:doi/10.2196/mhealth.8758 ER - TY - JOUR AU - Koh, Elizabeth Hyeseung AU - Oh, Jeeyun AU - Mackert, Michael PY - 2017/12/11 TI - Predictors of Playing Augmented Reality Mobile Games While Walking Based on the Theory of Planned Behavior: Web-Based Survey JO - JMIR Mhealth Uhealth SP - e191 VL - 5 IS - 12 KW - mobile phone KW - pedestrians KW - safety on the street KW - psychological models KW - predictive value of tests KW - intention KW - age factors KW - attitude KW - social norms KW - self-efficacy KW - habits KW - immersion KW - self-report N2 - Background: There has been a sharp increase in the number of pedestrians injured while using a mobile phone, but little research has been conducted to explain how and why people use mobile devices while walking. Therefore, we conducted a survey study to explicate the motivations of mobile phone use while walking Objective: The purpose of this study was to identify the critical predictors of behavioral intention to play a popular mobile game, Pokemon Go, while walking, based on the theory of planned behavior (TPB). In addition to the three components of TPB, automaticity, immersion, and enjoyment were added to the model. This study is a theory-based investigation that explores the underlying mechanisms of mobile phone use while walking focusing on a mobile game behavior. Methods: Participants were recruited from a university (study 1; N=262) and Amazon Mechanical Turk (MTurk) (study 2; N=197) in the United States. Participants completed a Web-based questionnaire, which included measures of attitude, subjective norms, perceived behavioral control (PBC), automaticity, immersion, and enjoyment. Participants also answered questions regarding demographic items. Results: Hierarchical regression analyses were conducted to examine hypotheses. The model we tested explained about 41% (study 1) and 63% (study 2) of people?s intention to play Pokemon Go while walking. The following 3 TPB variables were significant predictors of intention to play Pokemon Go while walking in study 1 and study 2: attitude (P<.001), subjective norms (P<.001), and PBC (P=.007 in study 1; P<.001 in study 2). Automaticity tendency (P<.001), immersion (P=.02), and enjoyment (P=.04) were significant predictors in study 1, whereas enjoyment was the only significant predictor in study 2 (P=.01). Conclusions: Findings from this study demonstrated the utility of TPB in predicting a new behavioral domain?mobile use while walking. To sum up, younger users who are habitual, impulsive, and less immersed players are more likely to intend to play a mobile game while walking. UR - http://mhealth.jmir.org/2017/12/e191/ UR - http://dx.doi.org/10.2196/mhealth.8470 UR - http://www.ncbi.nlm.nih.gov/pubmed/29229586 ID - info:doi/10.2196/mhealth.8470 ER - TY - JOUR AU - Shawen, Nicholas AU - Lonini, Luca AU - Mummidisetty, Krishna Chaithanya AU - Shparii, Ilona AU - Albert, V. Mark AU - Kording, Konrad AU - Jayaraman, Arun PY - 2017/12/20 TI - Addendum of: Fall Detection in Individuals With Lower Limb Amputations Using Mobile Phones: Machine Learning Enhances Robustness for Real-World Applications JO - JMIR Mhealth Uhealth SP - e167 VL - 5 IS - 12 KW - fall detection KW - lower limb amputation KW - mobile phones KW - machine learning UR - http://mhealth.jmir.org/2017/12/e167/ UR - http://dx.doi.org/10.2196/mhealth.9177 UR - http://www.ncbi.nlm.nih.gov/pubmed/29261509 ID - info:doi/10.2196/mhealth.9177 ER -