TY - JOUR AU - Willems, H. Sofie AU - Rao, Jyotsna AU - Bhambere, Sailee AU - Patel, Dipu AU - Biggins, Yvonne AU - Guite, W. Jessica PY - 2021/6/11 TI - Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity JO - JMIR Mhealth Uhealth SP - e25021 VL - 9 IS - 6 KW - coronavirus KW - digital health KW - multiplatform KW - chat KW - symptom tracking KW - well-being KW - COVID-19 KW - online platform KW - symptom KW - monitoring KW - follow-up UR - https://mhealth.jmir.org/2021/6/e25021 UR - http://dx.doi.org/10.2196/25021 UR - http://www.ncbi.nlm.nih.gov/pubmed/34033575 ID - info:doi/10.2196/25021 ER - TY - JOUR AU - Daniëls, M. Naomi E. AU - Hochstenbach, J. Laura M. AU - van Zelst, Catherine AU - van Bokhoven, A. Marloes AU - Delespaul, G. Philippe A. E. AU - Beurskens, M. Anna J. H. PY - 2021/6/1 TI - Factors That Influence the Use of Electronic Diaries in Health Care: Scoping Review JO - JMIR Mhealth Uhealth SP - e19536 VL - 9 IS - 6 KW - compliance KW - delivery of health care KW - diary KW - ecological momentary assessment KW - intention KW - motivation KW - scoping review N2 - Background: A large number of people suffer from psychosocial or physical problems. Adequate strategies to alleviate needs are scarce or lacking. Symptom variation can offer insights into personal profiles of coping and resilience (detailed functional analyses). Hence, diaries are used to report mood and behavior occurring in daily life. To reduce inaccuracies, biases, and noncompliance with paper diaries, a shift to electronic diaries has occurred. Although these diaries are increasingly used in health care, information is lacking about what determines their use. Objective: The aim of this study was to map the existing empirical knowledge and gaps concerning factors that influence the use of electronic diaries, defined as repeated recording of psychosocial or physical data lasting at least one week using a smartphone or a computer, in health care. Methods: A scoping review of the literature published between January 2000 and December 2018 was conducted using queries in PubMed and PsycInfo databases. English or Dutch publications based on empirical data about factors that influence the use of electronic diaries for psychosocial or physical purposes in health care were included. Both databases were screened, and findings were summarized using a directed content analysis organized by the Consolidated Framework for Implementation Research (CFIR). Results: Out of 3170 articles, 22 studies were selected for qualitative synthesis. Eleven themes were determined in the CFIR categories of intervention, user characteristics, and process. No information was found for the CFIR categories inner (eg, organizational resources, innovation climate) and outer (eg, external policies and incentives, pressure from competitors) settings. Reminders, attractive designs, tailored and clear data visualizations (intervention), smartphone experience, and intrinsic motivation to change behavior (user characteristics) could influence the use of electronic diaries. During the implementation process, attention should be paid to both theoretical and practical training. Conclusions: Design aspects, user characteristics, and training and instructions determine the use of electronic diaries in health care. It is remarkable that there were no empirical data about factors related to embedding electronic diaries in daily clinical practice. More research is needed to better understand influencing factors for optimal electronic diary use. UR - https://mhealth.jmir.org/2021/6/e19536 UR - http://dx.doi.org/10.2196/19536 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061036 ID - info:doi/10.2196/19536 ER - TY - JOUR AU - Moore, Kevin AU - O'Shea, Emma AU - Kenny, Lorna AU - Barton, John AU - Tedesco, Salvatore AU - Sica, Marco AU - Crowe, Colum AU - Alamäki, Antti AU - Condell, Joan AU - Nordström, Anna AU - Timmons, Suzanne PY - 2021/6/3 TI - Older Adults? Experiences With Using Wearable Devices: Qualitative Systematic Review and Meta-synthesis JO - JMIR Mhealth Uhealth SP - e23832 VL - 9 IS - 6 KW - wearable device KW - older adult KW - digital health KW - meta-synthesis KW - qualitative review KW - acceptance KW - adherence KW - mobile phone N2 - Background: Older adults may use wearable devices for various reasons, ranging from monitoring clinically relevant health metrics or detecting falls to monitoring physical activity. Little is known about how this population engages with wearable devices, and no qualitative synthesis exists to describe their shared experiences with long-term use. Objective: This study aims to synthesize qualitative studies of user experience after a multi-day trial with a wearable device to understand user experience and the factors that contribute to the acceptance and use of wearable devices. Methods: We conducted a systematic search in CINAHL, APA PsycINFO, PubMed, and Embase (2015-2020; English) with fixed search terms relating to older adults and wearable devices. A meta-synthesis methodology was used. We extracted themes from primary studies, identified key concepts, and applied reciprocal and refutational translation techniques; findings were synthesized into third-order interpretations, and finally, a ?line-of-argument? was developed. Our overall goal was theory development, higher-level abstraction, and generalizability for making this group of qualitative findings more accessible. Results: In total, we reviewed 20 papers; 2 evaluated fall detection devices, 1 tested an ankle-worn step counter, and the remaining 17 tested activity trackers. The duration of wearing ranged from 3 days to 24 months. The views of 349 participants (age: range 51-94 years) were synthesized. Four key concepts were identified and outlined: motivation for device use, user characteristics (openness to engage and functional ability), integration into daily life, and device features. Motivation for device use is intrinsic and extrinsic, encompassing many aspects of the user experience, and appears to be as, if not more, important than the actual device features. To overcome usability barriers, an older adult must be motivated by the useful purpose of the device. A device that serves its intended purpose adds value to the user?s life. The user?s needs and the support structure around the device?aspects that are often overlooked?seem to play a crucial role in long-term adoption. Our ?line-of-argument? model describes how motivation, ease of use, and device purpose determine whether a device is perceived to add value to the user?s life, which subsequently predicts whether the device will be integrated into the user?s life. Conclusions: The added value of a wearable device is the resulting balance of motivators (or lack thereof), device features (and their accuracy), ease of use, device purpose, and user experience. The added value contributes to the successful integration of the device into the daily life of the user. Useful device features alone do not lead to continued use. A support structure should be placed around the user to foster motivation, encourage peer engagement, and adapt to the user?s preferences. UR - https://mhealth.jmir.org/2021/6/e23832 UR - http://dx.doi.org/10.2196/23832 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081020 ID - info:doi/10.2196/23832 ER - TY - JOUR AU - Rodriguez-León, Ciro AU - Villalonga, Claudia AU - Munoz-Torres, Manuel AU - Ruiz, R. Jonatan AU - Banos, Oresti PY - 2021/6/3 TI - Mobile and Wearable Technology for the Monitoring of Diabetes-Related Parameters: Systematic Review JO - JMIR Mhealth Uhealth SP - e25138 VL - 9 IS - 6 KW - diabetes KW - monitoring KW - passive sensing KW - smartphone KW - wearable KW - mobile phone N2 - Background: Diabetes mellitus is a metabolic disorder that affects hundreds of millions of people worldwide and causes several million deaths every year. Such a dramatic scenario puts some pressure on administrations, care services, and the scientific community to seek novel solutions that may help control and deal effectively with this condition and its consequences. Objective: This study aims to review the literature on the use of modern mobile and wearable technology for monitoring parameters that condition the development or evolution of diabetes mellitus. Methods: A systematic review of articles published between January 2010 and July 2020 was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Manuscripts were identified through searching the databases Web of Science, Scopus, and PubMed as well as through hand searching. Manuscripts were included if they involved the measurement of diabetes-related parameters such as blood glucose level, performed physical activity, or feet condition via wearable or mobile devices. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Results: The search yielded 1981 articles. A total of 26 publications met the eligibility criteria and were included in the review. Studies predominantly used wearable devices to monitor diabetes-related parameters. The accelerometer was by far the most used sensor, followed by the glucose monitor and heart rate monitor. Most studies applied some type of processing to the collected data, mainly consisting of statistical analysis or machine learning for activity recognition, finding associations among health outcomes, and diagnosing conditions related to diabetes. Few studies have focused on type 2 diabetes, even when this is the most prevalent type and the only preventable one. None of the studies focused on common diabetes complications. Clinical trials were fairly limited or nonexistent in most of the studies, with a common lack of detail about cohorts and case selection, comparability, and outcomes. Explicit endorsement by ethics committees or review boards was missing in most studies. Privacy or security issues were seldom addressed, and even if they were addressed, they were addressed at a rather insufficient level. Conclusions: The use of mobile and wearable devices for the monitoring of diabetes-related parameters shows early promise. Its development can benefit patients with diabetes, health care professionals, and researchers. However, this field is still in its early stages. Future work must pay special attention to privacy and security issues, the use of new emerging sensor technologies, the combination of mobile and clinical data, and the development of validated clinical trials. UR - https://mhealth.jmir.org/2021/6/e25138 UR - http://dx.doi.org/10.2196/25138 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081010 ID - info:doi/10.2196/25138 ER - TY - JOUR AU - O'Connell, James AU - Abbas, Manzar AU - Beecham, Sarah AU - Buckley, Jim AU - Chochlov, Muslim AU - Fitzgerald, Brian AU - Glynn, Liam AU - Johnson, Kevin AU - Laffey, John AU - McNicholas, Bairbre AU - Nuseibeh, Bashar AU - O'Callaghan, Michael AU - O'Keeffe, Ian AU - Razzaq, Abdul AU - Rekanar, Kaavya AU - Richardson, Ita AU - Simpkin, Andrew AU - Storni, Cristiano AU - Tsvyatkova, Damyanka AU - Walsh, Jane AU - Welsh, Thomas AU - O'Keeffe, Derek PY - 2021/6/7 TI - Best Practice Guidance for Digital Contact Tracing Apps: A Cross-disciplinary Review of the Literature JO - JMIR Mhealth Uhealth SP - e27753 VL - 9 IS - 6 KW - digital contact tracing KW - automated contact tracing KW - COVID-19 KW - SARS-CoV-2 KW - mHealth KW - mobile app KW - app KW - tracing KW - monitoring KW - surveillance KW - review KW - best practice KW - design N2 - Background: Digital contact tracing apps have the potential to augment contact tracing systems and disrupt COVID-19 transmission by rapidly identifying secondary cases prior to the onset of infectiousness and linking them into a system of quarantine, testing, and health care worker case management. The international experience of digital contact tracing apps during the COVID-19 pandemic demonstrates how challenging their design and deployment are. Objective: This study aims to derive and summarize best practice guidance for the design of the ideal digital contact tracing app. Methods: A collaborative cross-disciplinary approach was used to derive best practice guidance for designing the ideal digital contact tracing app. A search of the indexed and gray literature was conducted to identify articles describing or evaluating digital contact tracing apps. MEDLINE was searched using a combination of free-text terms and Medical Subject Headings search terms. Gray literature sources searched were the World Health Organization Institutional Repository for Information Sharing, the European Centre for Disease Prevention and Control publications library, and Google, including the websites of many health protection authorities. Articles that were acceptable for inclusion in this evidence synthesis were peer-reviewed publications, cohort studies, randomized trials, modeling studies, technical reports, white papers, and media reports related to digital contact tracing. Results: Ethical, user experience, privacy and data protection, technical, clinical and societal, and evaluation considerations were identified from the literature. The ideal digital contact tracing app should be voluntary and should be equitably available and accessible. User engagement could be enhanced by small financial incentives, enabling users to tailor aspects of the app to their particular needs and integrating digital contact tracing apps into the wider public health information campaign. Adherence to the principles of good data protection and privacy by design is important to convince target populations to download and use digital contact tracing apps. Bluetooth Low Energy is recommended for a digital contact tracing app's contact event detection, but combining it with ultrasound technology may improve a digital contact tracing app's accuracy. A decentralized privacy-preserving protocol should be followed to enable digital contact tracing app users to exchange and record temporary contact numbers during contact events. The ideal digital contact tracing app should define and risk-stratify contact events according to proximity, duration of contact, and the infectiousness of the case at the time of contact. Evaluating digital contact tracing apps requires data to quantify app downloads, use among COVID-19 cases, successful contact alert generation, contact alert receivers, contact alert receivers that adhere to quarantine and testing recommendations, and the number of contact alert receivers who subsequently are tested positive for COVID-19. The outcomes of digital contact tracing apps' evaluations should be openly reported to allow for the wider public to review the evaluation of the app. Conclusions: In conclusion, key considerations and best practice guidance for the design of the ideal digital contact tracing app were derived from the literature. UR - https://mhealth.jmir.org/2021/6/e27753 UR - http://dx.doi.org/10.2196/27753 UR - http://www.ncbi.nlm.nih.gov/pubmed/34003764 ID - info:doi/10.2196/27753 ER - TY - JOUR AU - Lv, Meina AU - Wu, Tingting AU - Jiang, Shaojun AU - Chen, Wenjun AU - Zhang, Jinhua PY - 2021/6/11 TI - Effects of Telemedicine and mHealth on Systolic Blood Pressure Management in Stroke Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - JMIR Mhealth Uhealth SP - e24116 VL - 9 IS - 6 KW - stroke KW - systolic blood pressure KW - mHealth KW - telemedicine KW - meta-analysis KW - self-management N2 - Background: Stroke is a common, harmful disease with high recurrence and mortality rates. Uncontrolled blood pressure is an important and changeable risk factor for stroke recurrence. Telemedicine and mobile health (mHealth) interventions may have the potential to facilitate the control of blood pressure among stroke survivors, but their effect has not been established. Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of telemedicine and mHealth interventions on the control of systolic blood pressure among stroke survivors. Methods: The research literature published up to June 28, 2020, and consisting of RCTs related to telemedicine and mHealth interventions was searched in PubMed, EMBASE, Web of Science, and the Cochrane Library. The Cochrane risk of bias tool (RoB 2.0) was used to evaluate the quality of the studies. The Cochran Q test and I2 statistic were used to assess heterogeneity. Data were meta-analyzed using a random-effects model. Mean difference (MD) with 95% CI and 95% prediction interval (PI) were calculated. Results: In total, 9 RCTs with a total sample size of 1583 stroke survivors met the inclusion criteria. Compared with the usual care, telemedicine and mHealth had a significantly greater impact on the control of systolic blood pressure (MD ?5.49; 95% CI ?7.87 to ?3.10; P<.001; 95% PI ?10.46 to ?0.51). A subgroup analysis showed that the intervention mode of telephone plus SMS text messaging (MD ?9.09; 95% CI ?12.71 to ?5.46; P<.001) or only telephone (MD ?4.34; 95% CI ?6.55 to ?2.13; P<.001; 95% PI ?7.24 to ?1.45) had a greater impact on the control of systolic blood pressure than usual care. Among the stroke survivors with an intervention interval ?1 week (MD ?6.51; 95% CI ?9.36 to ?3.66; P<.001; 95% PI ?12.91 to ?0.10) or a baseline systolic blood pressure ?140 mm Hg (MD ?6.15; 95% CI ?9.44 to ?2.86; P<.001; 95% PI ?13.55 to 1.26), the control of systolic blood pressure using telemedicine and mHealth was better than that of usual care. Conclusions: In general, telemedicine and mHealth reduced the systolic blood pressure of stroke survivors by an average of 5.49 mm Hg compared with usual care. Telemedicine and mHealth are a relatively new intervention mode with potential applications for the control of systolic blood pressure among stroke survivors, especially those with hypertensive stroke. UR - https://mhealth.jmir.org/2021/6/e24116 UR - http://dx.doi.org/10.2196/24116 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114961 ID - info:doi/10.2196/24116 ER - TY - JOUR AU - König, Maria Laura AU - Attig, Christiane AU - Franke, Thomas AU - Renner, Britta PY - 2021/6/19 TI - Barriers to and Facilitators for Using Nutrition Apps: Systematic Review and Conceptual Framework JO - JMIR Mhealth Uhealth SP - e20037 VL - 9 IS - 6 KW - nutrition apps KW - mHealth KW - digital health KW - usage facilitators KW - usage barriers N2 - Background: Nutrition apps are effective in changing eating behavior and diet-related health risk factors. However, while they may curb growing overweight and obesity rates, widespread adoption is yet to be achieved. Hence, profound knowledge regarding factors motivating and hindering (long-term) nutrition app use is crucial for developing design guidelines aimed at supporting uptake and prolonged use of nutrition apps. Objective: In this systematic review, we synthesized the literature on barriers to and facilitators for nutrition app use across disciplines including empirical qualitative and quantitative studies with current users, ex-users, and nonusers of nutrition apps. Methods: A systematic literature search including 6 databases (PubMed, Web of Science, PsychINFO, PSYNDEX, PsycArticles, and SPORTDiscus) as well as backward and forward citation search was conducted. Search strategy, inclusion and exclusion criteria, and the planned data extraction process were preregistered. All empirical qualitative and quantitative studies published in German or English were eligible for inclusion if they examined adolescents (aged 13-18) or adults who were either current users, ex-users, and nonusers of nutrition apps. Based on qualitative content analysis, extracted individual barriers and facilitators were grouped into categories. Results: A total of 28 publications were identified as eligible. A framework with a 3-level hierarchy was designed which grouped 328 individual barriers and facilitators into 23 subcategories, 12 categories, and 4 clusters that focus on either the individual user (goal setting and goal striving, motivation, routines, lack of awareness of knowledge), different aspects of the app and the smartphone (features, usability of the app or food database, technical issues, data security, accuracy/trustworthiness, costs), positive and negative outcomes of nutrition app use, or interactions between the user and their social environment. Conclusions: The resulting conceptual framework underlines a pronounced diversity of reasons for (not) using nutrition apps, indicating that there is no ?one-size-fits-all? approach for uptake and prolonged use of nutrition apps. Hence, tailoring nutrition apps to needs of specific user groups seems promising for increasing engagement. UR - https://mhealth.jmir.org/2021/6/e20037/ UR - http://dx.doi.org/10.2196/20037 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/20037 ER - TY - JOUR AU - Salvi, Dario AU - Poffley, Emma AU - Tarassenko, Lionel AU - Orchard, Elizabeth PY - 2021/6/7 TI - App-Based Versus Standard Six-Minute Walk Test in Pulmonary Hypertension: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e22748 VL - 9 IS - 6 KW - cardiology KW - exercise test KW - pulmonary hypertension KW - mobile apps KW - GPS N2 - Background: Pulmonary arterial hypertension (PAH) is a chronic disease of the pulmonary vasculature that can lead to heart failure and premature death. Assessment of patients with PAH includes performing a 6-minute walk test (6MWT) in clinics. We developed a smartphone app to compute the walked distance (6MWD) indoors, by counting U-turns, and outdoors, by using satellite positioning. Objective: The goal of the research was to assess (1) accuracy of the indoor 6MWTs in clinical settings, (2) validity and test-retest reliability of outdoor 6MWTs in the community, (3) compliance, usability, and acceptance of the app, and (4) feasibility of pulse oximetry during 6MWTs. Methods: We tested the app on 30 PAH patients over 6 months. Patients were asked to perform 3 conventional 6MWTs in clinic while using the app in the indoor mode and one or more app-based 6MWTs in outdoor mode in the community per month. Results: Bland-Altman analysis of 70 pairs of conventional versus app-based indoor 6MWDs suggests that the app is sometimes inaccurate (14.6 m mean difference, lower and upper limit of agreement: ?133.35 m to 162.55 m). The comparison of 69 pairs of conventional 6MWDs and community-based outdoor 6MWDs within 7 days shows that community tests are strongly related to those performed in clinic (correlation 0.89), but the interpretation of the distance should consider that differences above the clinically significant threshold are not uncommon. Analysis of 89 pairs of outdoor tests performed by the same patient within 7 days shows that community-based tests are repeatable (intraclass correlation 0.91, standard error of measurement 36.97 m, mean coefficient of variation 12.45%). Questionnaires and semistructured interviews indicate that the app is usable and well accepted, but motivation to use it could be affected if the data are not used for clinical decision, which may explain low compliance in 52% of our cohort. Analysis of pulse oximetry data indicates that conventional pulse oximeters are unreliable if used during a walk. Conclusions: App-based outdoor 6MWTs in community settings are valid, repeatable, and well accepted by patients. More studies would be needed to assess the benefits of using the app in clinical practice. Trial Registration: ClinicalTrials.gov NCT04633538; https://clinicaltrials.gov/ct2/show/NCT04633538 UR - https://mhealth.jmir.org/2021/6/e22748 UR - http://dx.doi.org/10.2196/22748 UR - http://www.ncbi.nlm.nih.gov/pubmed/34096876 ID - info:doi/10.2196/22748 ER - TY - JOUR AU - Hwang, Sung Ho AU - Choi, Seong-Youl PY - 2021/6/17 TI - Development of an Android-Based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) App: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e25310 VL - 9 IS - 6 KW - Android driving app KW - driving safety KW - reliability KW - self-assessment KW - validity KW - mHealth KW - driving N2 - Background: Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea, a paper-based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) has been developed. Here, we implemented the SAFE-DR through an Android app, which provides the advantages of accessibility, convenience, and provision of diverse information, and verified its reliability and validity. Objective: This study tested the validity and reliability of a mobile app-based version of a self-report assessment for elderly persons contextualized to the South Korean culture and compared it with a paper-based test. Methods: In this mixed methods study, we recruited and interviewed 567 elderly drivers (aged 65 years and older) between August 2018 and May 2019. For participants who provided consent, the app-based test was repeated after 2 weeks and an additional paper-based test (Driver 65 Plus test) was administered. Using the collected data, we analyzed the reliability and validity of the app-based SAFE-DR. The internal consistency of provisional items in each subdomain of the SAFE-DR and the test-retest stability were analyzed to examine reliability. Exploratory factor analysis was performed to examine the validity of the subdomain configuration. To verify the appropriateness of using an app-based test for older drivers possibly unfamiliar with mobile technology, the correlation between the results of the SAFE-DR app and the paper-based offline test was also analyzed. Results: In the reliability analysis, Cronbach ? for all items was 0.975 and the correlation of each item with the overall score ranged from r=0.520 to r=0.823; 4 items with low correlations were removed from each of the subdomains. In the retest after 2 weeks, the mean correlation coefficient across all items was r=0.951, showing very high reliability. Exploratory factor analysis on 40 of the 44 items established 5 subdomains: on-road (8 items), coping (16 items), cognitive functions (5 items), general conditions (8 items), and medical health (3 items). A very strong negative correlation of ?0.864 was observed between the total score for the app-based SAFE-DR and the paper-based Driver 65 Plus with decorrelation scales. The app-based test was found to be reliable. Conclusions: In this study, we developed an app-based self-report assessment tool for elderly drivers and tested its reliability and validity. This app can help elderly individuals easily assess their own driving skills. Therefore, this assessment can be used to educate drivers and for preventive screening for elderly drivers who want to renew their driver?s licenses in South Korea. In addition, the app can contribute to safe driving among elderly drivers. UR - https://mhealth.jmir.org/2021/6/e25310 UR - http://dx.doi.org/10.2196/25310 UR - http://www.ncbi.nlm.nih.gov/pubmed/33934068 ID - info:doi/10.2196/25310 ER - TY - JOUR AU - Stara, Vera AU - Vera, Benjamin AU - Bolliger, Daniel AU - Rossi, Lorena AU - Felici, Elisa AU - Di Rosa, Mirko AU - de Jong, Michiel AU - Paolini, Susy PY - 2021/6/19 TI - Usability and Acceptance of the Embodied Conversational Agent Anne by People With Dementia and Their Caregivers: Exploratory Study in Home Environment Settings JO - JMIR Mhealth Uhealth SP - e25891 VL - 9 IS - 6 KW - dementia KW - older adults with dementia KW - embodied conversational agent KW - virtual personal assistant KW - virtual agent KW - virtual companion KW - design for older adults with dementia N2 - Background: Information and communication technologies are tools that are able to support cognitive functions, monitor health and movements, provide reminders to maintain residual memory abilities, and promote social support, especially among patients with dementia. Among these technologies, embodied conversational agents (ECAs) are seen as screen-based entities designed to stimulate human face-to-face conversation skills, allowing for natural human-machine interaction. Unfortunately, the evidence that such agents deliver care benefits in supporting people affected by dementia and their caregivers has not yet been well studied. Therefore, research in this area is essential for the entire scientific community. Objective: This study aims to evaluate the usability and acceptability of the virtual agent Anne by people living with dementia. The study is also designed to assess the ability of target users to use the system independently and receive valuable information from it. Methods: We conducted a 4-week trial that involved 20 older adults living with dementia and 14 family caregivers in home environment settings in Italy. This study used a mixed methods approach, balancing quantitative and qualitative instruments to gather data from users. Telemetry data were also collected. Results: Older users were particularly engaged in providing significant responses and participating in system improvements. Some of them clearly discussed how technical problems related to speech recognition had a negative impact on the intention to use, adaptiveness, usefulness, and trust. Moreover, the usability of the system achieved an encouraging score, and half of the sample recognized a role of the agent Anne. This study confirms that the quality of automatic speech recognition and synthesis is still a technical issue and has room for improvement, whereas the touch screen modality is almost stable and positively used by patients with dementia. Conclusions: This study demonstrated the ability of target users to use the system independently in their home environment; overall, the involved participants shared good engagement with the system, approaching the virtual agents as a companion able to support memory and enjoyment needs. Therefore, this research provides data that sustain the use of ECAs as future eHealth systems that are able to address the basic and higher-level needs of people living with dementia. This specific field of research is novel and poorly discussed in the scientific community. This could be because of its novelty, yet there is an urgent need to strengthen data, research, and innovation to accelerate the implementation of ECAs as a future method to offer nonpharmacological support to community-dwelling people with dementia. UR - https://mhealth.jmir.org/2021/6/e25891/ UR - http://dx.doi.org/10.2196/25891 UR - http://www.ncbi.nlm.nih.gov/pubmed/34170256 ID - info:doi/10.2196/25891 ER - TY - JOUR AU - Mekonnen, Abebaw Zeleke AU - Gelaye, Alemu Kassahun AU - Were, Martin AU - Tilahun, Binyam PY - 2021/6/15 TI - Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia JO - JMIR Mhealth Uhealth SP - e27603 VL - 9 IS - 6 KW - mHealth KW - eHealth KW - mobile phone KW - text message KW - short message service KW - reminder KW - immunization KW - vaccination KW - Ethiopia N2 - Background: Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message?based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. Objective: This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. Methods: A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. Results: A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. Conclusions: Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. Trial Registration: Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839 UR - https://mhealth.jmir.org/2021/6/e27603 UR - http://dx.doi.org/10.2196/27603 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128813 ID - info:doi/10.2196/27603 ER - TY - JOUR AU - Kim, Youngkyu AU - Oh, Jeongmin AU - Choi, Seung-Ho AU - Jung, Ahra AU - Lee, June-Goo AU - Lee, Se Yoon AU - Kim, Ki Jun PY - 2021/6/18 TI - A Portable Smartphone-Based Laryngoscope System for High-Speed Vocal Cord Imaging of Patients With Throat Disorders: Instrument Validation Study JO - JMIR Mhealth Uhealth SP - e25816 VL - 9 IS - 6 KW - smartphone KW - mobile phone KW - endoscope KW - high-speed imaging KW - vocal cord KW - low-cost device KW - mHealth KW - otorhinolaryngology KW - head and neck KW - throat N2 - Background: Currently, high-speed digital imaging (HSDI), especially endoscopic HSDI, is routinely used for the diagnosis of vocal cord disorders. However, endoscopic HSDI devices are usually large and costly, which limits access to patients in underdeveloped countries and in regions with inadequate medical infrastructure. Modern smartphones have sufficient functionality to process the complex calculations that are required for processing high-resolution images and videos with a high frame rate. Recently, several attempts have been made to integrate medical endoscopes with smartphones to make them more accessible to people in underdeveloped countries. Objective: This study aims to develop a smartphone adaptor for endoscopes, which enables smartphone-based vocal cord imaging, to demonstrate the feasibility of performing high-speed vocal cord imaging via the high-speed imaging functions of a high-performance smartphone camera, and to determine the acceptability of the smartphone-based high-speed vocal cord imaging system for clinical applications in developing countries. Methods: A customized smartphone adaptor optical relay was designed for clinical endoscopy using selective laser melting?based 3D printing. A standard laryngoscope was attached to the smartphone adaptor to acquire high-speed vocal cord endoscopic images. Only existing basic functions of the smartphone camera were used for HSDI of the vocal cords. Extracted still frames were observed for qualitative glottal volume and shape. For image processing, segmented glottal and vocal cord areas were calculated from whole HSDI frames to characterize the amplitude of the vibrations on each side of the glottis, including the frequency, edge length, glottal areas, base cord, and lateral phase differences over the acquisition time. The device was incorporated into a preclinical videokymography diagnosis routine to compare functionality. Results: Smartphone-based HSDI with the smartphone-endoscope adaptor could achieve 940 frames per second and a resolution of 1280 by 720 frames, which corresponds to the detection of 3 to 8 frames per vocal cycle at double the spatial resolution of existing devices. The device was used to image the vocal cords of 4 volunteers: 1 healthy individual and 3 patients with vocal cord paralysis, chronic laryngitis, or vocal cord polyps. The resultant image stacks were sufficient for most diagnostic purposes. The cost of the device including the smartphone was lower than that of existing HSDI devices. The image processing and analytics demonstrated the successful calculation of relevant diagnostic variables from the acquired images. Patients with vocal pathologies were easily differentiable in the quantitative data. Conclusions: A smartphone-based HSDI endoscope system can function as a point-of-care clinical diagnostic device. The resulting analysis is of higher quality than that accessible by videostroboscopy and promises comparable quality and greater accessibility than HSDI. In particular, this system is suitable for use as an accessible diagnostic tool in underdeveloped areas with inadequate medical service infrastructure. UR - https://mhealth.jmir.org/2021/6/e25816 UR - http://dx.doi.org/10.2196/25816 UR - http://www.ncbi.nlm.nih.gov/pubmed/34142978 ID - info:doi/10.2196/25816 ER - TY - JOUR AU - Houchen-Wolloff, Linzy AU - Orme, Mark AU - Barradell, Amy AU - Clinch, Lisa AU - Chaplin, Emma AU - Gardiner, Nikki AU - Singh, J. Sally PY - 2021/6/11 TI - Web-Based Self-management Program (SPACE for COPD) for Individuals Hospitalized With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Nonrandomized Feasibility Trial of Acceptability JO - JMIR Mhealth Uhealth SP - e21728 VL - 9 IS - 6 KW - COPD KW - telehealth KW - digital health KW - internet KW - rehabilitation KW - quantitative KW - qualitative KW - exercise N2 - Background: Hospital admissions due to the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are costly for individuals and health services. Pulmonary rehabilitation (PR) is known to reduce hospital readmissions when delivered after hospitalization, but the uptake and completion of PR following hospitalization remains poor (<10% of those eligible in the UK audit data). A web-based platform of the SPACE (Self-management Program of Activity Coping and Education) for COPD (chronic obstructive pulmonary disease) has previously shown promising results in patients with stable COPD but has not been tested following an AECOPD. Objective: This study aims to assess the feasibility and acceptability of a web-based self-management program. Methods: A nonrandomized feasibility study for patients with confirmed AECOPD who were deemed web literate was conducted. All patients consented during their hospitalization and received access to the website following discharge in addition to usual care. The program aims to facilitate patients to better understand and manage their condition through education and home-based exercises. Participants were asked to complete the Bristol COPD Knowledge Questionnaire at baseline and after 6 months. A total of 14 participants were also interviewed (n=8 completers; n=6 noncompleters) regarding their experiences with the web-based program and trial. The interviews were analyzed using thematic analysis. Results: In total, 2080 patients were screened for eligibility, of which 100 patients (age: mean 71.2 years, SD 9.3 years; male: 55/100, 55%; forced expiratory volume in 1 second/forced vital capacity ratio: mean 0.46, SD 0.14; pack-years: mean 50.2, SD 31.0; current smokers: 35/100, 35%) were recruited (4.8% of those screened). The main reason for ineligibility was a lack of web literacy (1366/1980, 68.98%). In total, 18% (18/100) of patients had completed the web program by 6 months, with others still registered in the program (27/100, 27%), and more than half did not register (55/100, 55%). There was a mean change in Bristol COPD Knowledge Questionnaire scores at 6 months of 7.8 (SD 10.2) points. Qualitative interviews identified three main themes: preparing for, engagement with, and benefits of the study and program. A total of 57% (57/100) accepted a referral to PR on discharge and 19% (19/100) had completed the program after 6 months. Conclusions: On the basis of the challenges of recruiting, retaining, and engaging participants in a web-based self-management program, it is not a feasible approach to roll out widely. This study acknowledges that this is a challenging time for patients with an AECOPD to engage in exercise and self-management education. However, for patients who were able to engage in such an intervention, the completion rate of PR was double the previous audit estimates from the United Kingdom, disease knowledge improved, and the intervention was of value to patients. Trial Registration: ISRCTN Registry 13081008; https://www.isrctn.com/ISRCTN13081008 UR - https://mhealth.jmir.org/2021/6/e21728 UR - http://dx.doi.org/10.2196/21728 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114960 ID - info:doi/10.2196/21728 ER - TY - JOUR AU - Chen, Mingrong AU - Wu, Tingting AU - Lv, Meina AU - Chen, Chunmei AU - Fang, Zongwei AU - Zeng, Zhiwei AU - Qian, Jiafen AU - Jiang, Shaojun AU - Chen, Wenjun AU - Zhang, Jinhua PY - 2021/6/11 TI - Efficacy of Mobile Health in Patients With Low Back Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials JO - JMIR Mhealth Uhealth SP - e26095 VL - 9 IS - 6 KW - mobile health KW - mHealth KW - low back pain KW - meta-analysis KW - pain intensity KW - disability N2 - Background: Low back pain is one of the most common health problems and a main cause of disability, which imposes a great burden on patients. Mobile health (mHealth) affects many aspects of people?s lives, and it has progressed rapidly, showing promise as an effective intervention for patients with low back pain. However, the efficacy of mHealth interventions for patients with low back pain remains unclear; thus, further exploration is necessary. Objective: The purpose of this study was to evaluate the efficacy of mHealth interventions in patients with low back pain compared to usual care. Methods: This was a systematic review and meta-analysis of randomized controlled trials designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. We searched for studies published in English before October 2020 in the PubMed, EMBASE, Web of Science, and Cochrane Library databases. Two researchers independently scanned the literature, extracted data, and assessed the methodological quality of the included studies. Bias risks were assessed using the Cochrane Collaboration tool. We used RevMan 5.4 software to perform the meta-analysis. Results: A total of 9 studies with 792 participants met the inclusion criteria. The simultaneous use of mHealth and usual care showed a better reduction in pain intensity than usual care alone, as measured by the numeric rating scale (mean difference [MD] ?0.85, 95% CI ?1.29 to ?0.40; P<.001), and larger efficacy in reducing disability, as measured by the Rolland-Morris Disability Questionnaire (MD ?1.54, 95% CI ?2.35 to ?0.73; P<.001). Subgroup analyses showed that compared with usual care, mHealth using telephone calls significantly reduced pain intensity (MD ?1.12, 95% CI ?1.71 to ?0.53; P<.001) and disability score (MD ?1.68, 95% CI ?2.74 to ?0.63; P<.001). However, without the use of telephone calls, mHealth had no obvious advantage over usual care in improving pain intensity (MD ?0.48, 95% CI ?1.16 to 0.20; P=.16) and the disability score (MD ?0.41, 95% CI ?1.88 to 1.05; P=.58). The group that received a more sensitive feedback intervention showed a significantly reduced disability score (MD ?4.30, 95% CI ?6.95 to ?1.69; P=.001). Conclusions: The use of simultaneous mHealth and usual care interventions has better efficacy than usual care alone in reducing pain intensity and disability in patients with low back pain. Moreover, the results of subgroup analysis revealed that mHealth using telephone calls might play a positive role in improving pain intensity and disability in patients with low back pain. UR - https://mhealth.jmir.org/2021/6/e26095 UR - http://dx.doi.org/10.2196/26095 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114965 ID - info:doi/10.2196/26095 ER - TY - JOUR AU - Maddison, Ralph AU - Jiang, Yannan AU - Stewart, Ralph AU - Scott, Tony AU - Kerr, Andrew AU - Whittaker, Robyn AU - Benatar, Jocelyn AU - Rolleston, Anna AU - Estabrooks, Paul AU - Dale, Leila PY - 2021/6/9 TI - An Intervention to Improve Medication Adherence in People With Heart Disease (Text4HeartII): Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e24952 VL - 9 IS - 6 KW - cardiovascular disease KW - self-management KW - text messaging KW - risk factors N2 - Background: Mobile health technologies have the potential to improve the reach and delivery of interventions for promoting long-term secondary prevention of coronary heart disease. Objective: This study aims to determine the effectiveness of an SMS text messaging intervention (Text4HeartII) for improving adherence to medication and lifestyle changes over and above usual care in people with coronary heart disease at 24 and 52 weeks. Methods: A two-arm, parallel, randomized controlled trial was conducted in New Zealand. Participants with a recent acute coronary syndrome were randomized to receive usual cardiac services alone (control, n=153) or a 24-week SMS text message program for supporting self-management plus usual cardiac services (n=153). The primary outcome was adherence to medication at 24 weeks, defined as a medication possession ratio of 80% or more for aspirin, statin, and antihypertensive therapy. Secondary outcomes included medication possession ratio at 52 weeks, self-reported medication adherence, adherence to healthy lifestyle behaviors, and health-related quality of life at 24 and 52 weeks. Results: Participants were predominantly male (113/306, 80.3%) and European New Zealanders (210/306, 68.6%), with a mean age of 61 years (SD 11 years). Groups were comparable at baseline. National hospitalization and pharmacy dispensing recordswere available for all participants; 92% (282/306, 92.1%) of participants completed a 24-week questionnaire and 95.1% (291/306) of participants completed a 52-week questionnaire. Adherence with 3 medication classes were lower in the intervention group than in the control group (87/153, 56.8% vs 105/153, 68.6%, odds ratio 0.60, 95% CI 0.38-0.96; P=.03) and 52 weeks (104/153, 67.9% vs 83/153, 54.2%; odds ratio 0.56, 95% CI 0.35-0.89; P=.01). Self-reported medication adherence scores showed the same trend at 52 weeks (mean difference 0.3; 95% CI 0.01-0.59; P=.04). Moreover, self-reported adherence to health-related behaviors was similar between groups. Conclusions: Text4HeartII did not improve dispensed medication or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies and highlights that the benefits of text interventions may depend on the context in which they are used. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000422426; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2468-z UR - https://mhealth.jmir.org/2021/6/e24952 UR - http://dx.doi.org/10.2196/24952 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106081 ID - info:doi/10.2196/24952 ER - TY - JOUR AU - Buck, Christoph AU - Keweloh, Christian AU - Bouras, Adam AU - Simoes, J. Eduardo PY - 2021/6/16 TI - Efficacy of Short Message Service Text Messaging Interventions for Postoperative Pain Management: Systematic Review JO - JMIR Mhealth Uhealth SP - e20199 VL - 9 IS - 6 KW - systematic literature review KW - pain management KW - opioid KW - short message service (SMS) KW - postoperative N2 - Background: Addiction to opiates and synthetic opioids poses a major threat to public health worldwide, with pharmaceutical opioids prescribed to manage pain constituting the main problem. To counteract this threat, suitable pain management strategies should be implemented in health care. Monitoring pain management seems to be feasible using telemedicine with a certain degree of resource intensity and digitization. As a communication channel for this type of monitoring, SMS appears to be a valid alternative. Objective: The aim of this systematic literature review was to (1) provide information on the state of research regarding postoperative pain management via SMS, (2) establish a basic understanding of SMS-based pain management, and (3) provide insight into the feasibility of these management strategies. The research question was as follows: Is postoperative pain management feasible and effective utilizing SMS? Methods: A systematic literature review was performed mainly following the PRISMA guidelines and another guide on performing a systematic literature review for information systems?related research. A search string was developed based on the objectives and research question, and eight databases were searched. Results: The initial search resulted in 2083 records, which could be narrowed down by applying various exclusion criteria. Thereby, 11 articles were identified as relevant, which were accordingly analyzed and evaluated by full-text screening. In all articles, pain management interventions were performed using SMS communication between health care professionals and patients or their legal guardians. A prospective approach was predominantly chosen as the study design (91%) with the leading research objective of determining the intervention?s feasibility (73%). The primary reason for sending SMS messages was to monitor patients (64%). Overall, the use of SMS improved adherence, acceptance, and satisfaction regarding postoperative pain management. With an average response rate of approximately 89.5% (SD 3.8%), the reliability of SMS as a communication and monitoring tool was further emphasized. This response rate is significantly higher than that for email interventions (66.63%, P<.001). Conclusions: This study provides a comprehensive picture of the current status on postoperative pain management by SMS. Communication via SMS was beneficial in all interventions, even preoperative. Six SMS interventions could be certified by the respective institutional review board and three were Health Insurance Portability and Accountability Act?compliant. Therefore, the results of this study could be leveraged to address the opioid epidemic. Overall, the research question could be confirmed. Future research should extend this systematic literature review regarding preoperative pain management. Based on these findings, a pre- and postoperative communication model should be developed to address the opioid epidemic effectively. UR - https://mhealth.jmir.org/2021/6/e20199 UR - http://dx.doi.org/10.2196/20199 UR - http://www.ncbi.nlm.nih.gov/pubmed/34132646 ID - info:doi/10.2196/20199 ER - TY - JOUR AU - Sun, Ruo-Ting AU - Han, Wencui AU - Chang, Hsin-Lu AU - Shaw, J. Michael PY - 2021/6/2 TI - Motivating Adherence to Exercise Plans Through a Personalized Mobile Health App: Enhanced Action Design Research Approach JO - JMIR Mhealth Uhealth SP - e19941 VL - 9 IS - 6 KW - adherence KW - mobile health KW - motivation KW - personality KW - MBTI KW - action design research KW - mobile phone N2 - Background: Physical inactivity is a global issue that affects people?s health and productivity. With the advancement of mobile technologies, many apps have been developed to facilitate health self-management. However, few studies have examined the effectiveness of these mobile health (mHealth) apps in motivating exercise adherence. Objective: This study aims to demonstrate the enhanced action design research (ADR) process and improve the design of mHealth apps for exercise self-management. Specifically, we investigate whether sending motivational messages improves adherence to exercise plans, whether the motivational effect is affected by personality, the impact of message type and repetition, and the process of involving a field experiment in the design process and learning new design principles from the results. Methods: This formative research was conducted by proposing an enhanced ADR process. We incorporated a field experiment into the process to iteratively refine and evaluate the design until it converges into a final mHealth app. We used the Apple ResearchKit to develop the mHealth app and promoted it via trainers at their gyms. We targeted users who used the app for at least two months. Participants were randomly assigned to 1 of the 12 groups in a 2×3×2 factorial design and remained blinded to the assigned intervention. The groups were defined based on personality type (thinking or feeling), message type (emotional, logical, or none), and repetition (none or once). Participants with different personality types received tailored and repeated messages. Finally, we used the self-reported completion rate to measure participants? adherence level to exercise plans. By analyzing users? usage patterns, we could verify, correct, and enhance the mHealth app design principles. Results: In total, 160 users downloaded the app, and 89 active participants remained during the 2-month period. The results suggest a significant main effect of personality type and repetition and a significant interaction effect between personality type and repetition. The adherence rate of people with feeling personality types was 18.15% higher than that of people with thinking types. Emotional messages were more effective than logical messages in motivating exercise adherence. Although people received repeated messages, they were more likely to adhere to exercise plans. With repeated reminders, the adherence rates of people with thinking personality types were significantly improved by 27.34% (P<.001). Conclusions: This study contributes to the literature on mHealth apps. By incorporating a field experiment into the ADR process, we demonstrate the benefit of combining design science and field experiments. This study also contributes to the research on mHealth apps. The principles learned from this study can be applied to improve the effectiveness of mHealth apps. The app design can be considered a foundation for the development of more advanced apps for specific diseases, such as diabetes and asthma, in future research. UR - https://mhealth.jmir.org/2021/6/e19941 UR - http://dx.doi.org/10.2196/19941 UR - http://www.ncbi.nlm.nih.gov/pubmed/34076580 ID - info:doi/10.2196/19941 ER - TY - JOUR AU - Mascheroni, Alessandro AU - Choe, Kyoung Eun AU - Luo, Yuhan AU - Marazza, Michele AU - Ferlito, Clara AU - Caverzasio, Serena AU - Mezzanotte, Francesco AU - Kaelin-Lang, Alain AU - Faraci, Francesca AU - Puiatti, Alessandro AU - Ratti, Luca Pietro PY - 2021/6/8 TI - The SleepFit Tablet Application for Home-Based Clinical Data Collection in Parkinson Disease: User-Centric Development and Usability Study JO - JMIR Mhealth Uhealth SP - e16304 VL - 9 IS - 6 KW - Parkinson disease KW - ecological momentary assessment KW - finger-tapping test KW - subjective scales KW - sleep diaries KW - tablet application KW - home-based system N2 - Background: Parkinson disease (PD) is a common, multifaceted neurodegenerative disorder profoundly impacting patients' autonomy and quality of life. Assessment in real-life conditions of subjective symptoms and objective metrics of mobility and nonmotor symptoms such as sleep disturbance is strongly advocated. This information would critically guide the adaptation of antiparkinsonian medications and nonpharmacological interventions. Moreover, since the spread of the COVID-19 pandemic, health care practices are being reshaped toward a more home-based care. New technologies could play a pivotal role in this new approach to clinical care. Nevertheless, devices and information technology tools might be unhandy for PD patients, thus dramatically limiting their widespread employment. Objective: The goals of the research were development and usability evaluation of an application, SleepFit, for ecological momentary assessment of objective and subjective clinical metrics at PD patients? homes, and as a remote tool for researchers to monitor patients and integrate and manage data. Methods: An iterative and user-centric strategy was employed for the development of SleepFit. The core structure of SleepFit consists of (1) an electronic finger-tapping test; (2) motor, sleepiness, and emotional subjective scales; and (3) a sleep diary. Applicable design, ergonomic, and navigation principles have been applied while tailoring the application to the specific patient population. Three progressively enhanced versions of the application (alpha, v1.0, v2.0) were tested by a total of 56 patients with PD who were asked to perform multiple home assessments 4 times per day for 2 weeks. Patient compliance was calculated as the proportion of completed tasks out of the total number of expected tasks. Satisfaction on the latest version (v2.0) was evaluated as potential willingness to use SleepFit again after the end of the study. Results: From alpha to v1.0, SleepFit was improved in graphics, ergonomics, and navigation, with automated flows guiding the patients in performing tasks throughout the 24 hours, and real-time data collection and consultation were made possible thanks to a remote web portal. In v2.0, the kiosk-mode feature restricts the use of the tablet to the SleepFit application only, thus preventing users from accidentally exiting the application. A total of 52 (4 dropouts) patients were included in the analyses. Overall compliance (all versions) was 88.89% (5707/6420). SleepFit was progressively enhanced and compliance increased from 87.86% (2070/2356) to 89.92% (2899/3224; P=.04). Among the patients who used v2.0, 96% (25/26) declared they would use SleepFit again. Conclusions: SleepFit can be considered a state-of-the-art home-based system that increases compliance in PD patients, ensures high-quality data collection, and works as a handy tool for remote monitoring and data management in clinical research. Thanks to its user-friendliness and modular structure, it could be employed in other clinical studies with minimum adaptation efforts. Trial Registration: ClinicalTrials.gov NCT02723396; https://clinicaltrials.gov/ct2/show/NCT02723396 UR - https://mhealth.jmir.org/2021/6/e16304 UR - http://dx.doi.org/10.2196/16304 UR - http://www.ncbi.nlm.nih.gov/pubmed/34100767 ID - info:doi/10.2196/16304 ER - TY - JOUR AU - Aljedaani, Bakheet AU - Babar, Ali M. PY - 2021/6/21 TI - Challenges With Developing Secure Mobile Health Applications: Systematic Review JO - JMIR Mhealth Uhealth SP - e15654 VL - 9 IS - 6 KW - systematic literature review KW - mHealth apps KW - secure apps KW - developers KW - security knowledge N2 - Background: Mobile health (mHealth) apps have gained significant popularity over the last few years due to their tremendous benefits, such as lowering health care costs and increasing patient awareness. However, the sensitivity of health care data makes the security of mHealth apps a serious concern. Poor security practices and lack of security knowledge on the developers? side can cause several vulnerabilities in mHealth apps. Objective: In this review paper, we aimed to identify and analyze the reported challenges concerning security that developers of mHealth apps face. Additionally, our study aimed to develop a conceptual framework with the challenges for developing secure apps faced by mHealth app development organizations. The knowledge of such challenges can help to reduce the risk of developing insecure mHealth apps. Methods: We followed the systematic literature review method for this review. We selected studies that were published between January 2008 and October 2020 since the major app stores launched in 2008. We selected 32 primary studies using predefined criteria and used a thematic analysis method for analyzing the extracted data. Results: Of the 1867 articles obtained, 32 were included in this review based on the predefined criteria. We identified 9 challenges that can affect the development of secure mHealth apps. These challenges include lack of security guidelines and regulations for developing secure mHealth apps (20/32, 63%), developers? lack of knowledge and expertise for secure mHealth app development (18/32, 56%), lack of stakeholders? involvement during mHealth app development (6/32, 19%), no/little developer attention towards the security of mHealth apps (5/32, 16%), lack of resources for developing a secure mHealth app (4/32, 13%), project constraints during the mHealth app development process (4/32, 13%), lack of security testing during mHealth app development (4/32, 13%), developers? lack of motivation and ethical considerations (3/32, 9%), and lack of security experts? engagement during mHealth app development (2/32, 6%). Based on our analysis, we have presented a conceptual framework that highlights the correlation between the identified challenges. Conclusions: While mHealth app development organizations might overlook security, we conclude that our findings can help them to identify the weaknesses and improve their security practices. Similarly, mHealth app developers can identify the challenges they face to develop mHealth apps that do not pose security risks for users. Our review is a step towards providing insights into the development of secure mHealth apps. Our proposed conceptual framework can act as a practice guideline for practitioners to enhance secure mHealth app development. UR - https://mhealth.jmir.org/2021/6/e15654 UR - http://dx.doi.org/10.2196/15654 UR - http://www.ncbi.nlm.nih.gov/pubmed/34152277 ID - info:doi/10.2196/15654 ER - TY - JOUR AU - Paganini, Sarah AU - Terhorst, Yannik AU - Sander, Bosse Lasse AU - Catic, Selma AU - Balci, Sümeyye AU - Küchler, Ann-Marie AU - Schultchen, Dana AU - Plaumann, Katrin AU - Sturmbauer, Sarah AU - Krämer, Violetta Lena AU - Lin, Jiaxi AU - Wurst, Ramona AU - Pryss, Rüdiger AU - Baumeister, Harald AU - Messner, Eva-Maria PY - 2021/6/9 TI - Quality of Physical Activity Apps: Systematic Search in App Stores and Content Analysis JO - JMIR Mhealth Uhealth SP - e22587 VL - 9 IS - 6 KW - sports KW - exercise KW - mobile apps KW - mHealth KW - quality indicators KW - systematic review N2 - Background: Physical inactivity is a major contributor to the development and persistence of chronic diseases. Mobile health apps that foster physical activity have the potential to assist in behavior change. However, the quality of the mobile health apps available in app stores is hard to assess for making informed decisions by end users and health care providers. Objective: This study aimed at systematically reviewing and analyzing the content and quality of physical activity apps available in the 2 major app stores (Google Play and App Store) by using the German version of the Mobile App Rating Scale (MARS-G). Moreover, the privacy and security measures were assessed. Methods: A web crawler was used to systematically search for apps promoting physical activity in the Google Play store and App Store. Two independent raters used the MARS-G to assess app quality. Further, app characteristics, content and functions, and privacy and security measures were assessed. The correlation between user star ratings and MARS was calculated. Exploratory regression analysis was conducted to determine relevant predictors for the overall quality of physical activity apps. Results: Of the 2231 identified apps, 312 met the inclusion criteria. The results indicated that the overall quality was moderate (mean 3.60 [SD 0.59], range 1-4.75). The scores of the subscales, that is, information (mean 3.24 [SD 0.56], range 1.17-4.4), engagement (mean 3.19 [SD 0.82], range 1.2-5), aesthetics (mean 3.65 [SD 0.79], range 1-5), and functionality (mean 4.35 [SD 0.58], range 1.88-5) were obtained. An efficacy study could not be identified for any of the included apps. The features of data security and privacy were mainly not applied. Average user ratings showed significant small correlations with the MARS ratings (r=0.22, 95% CI 0.08-0.35; P<.001). The amount of content and number of functions were predictive of the overall quality of these physical activity apps, whereas app store and price were not. Conclusions: Apps for physical activity showed a broad range of quality ratings, with moderate overall quality ratings. Given the present privacy, security, and evidence concerns inherent to most rated apps, their medical use is questionable. There is a need for open-source databases of expert quality ratings to foster informed health care decisions by users and health care providers. UR - https://mhealth.jmir.org/2021/6/e22587 UR - http://dx.doi.org/10.2196/22587 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106073 ID - info:doi/10.2196/22587 ER - TY - JOUR AU - Shen, Chunying AU - Jiang, Bin AU - Yang, Qilian AU - Wang, Chengnan AU - Lu, Z. Kevin AU - Gu, Meng AU - Yuan, Jing PY - 2021/6/15 TI - Mobile Apps for Drug?Drug Interaction Checks in Chinese App Stores: Systematic Review and Content Analysis JO - JMIR Mhealth Uhealth SP - e26262 VL - 9 IS - 6 KW - drug interaction KW - MARS KW - app KW - drug safety KW - drugs KW - mHealth N2 - Background: As a computerized drug?drug interaction (DDI) alert system has not been widely implemented in China, health care providers are relying on mobile health (mHealth) apps as references for checking drug information, including DDIs. Objective: The main objective of this study was to evaluate the quality and content of mHealth apps supporting DDI checking in Chinese app stores. Methods: A systematic review was carried out in November 2020 to identify mHealth apps providing DDI checking in both Chinese iOS and Android platforms. We extracted the apps? general information (including the developer, operating system, costs, release date, size, number of downloads, and average rating), scientific or clinical basis, and accountability, based on a multidimensional framework for evaluation of apps. The quality of mHealth apps was evaluated by using the Mobile App Rating Scale (MARS). Descriptive statistics, including numbers and percentages, were calculated to describe the characteristics of the apps. For each app selected for evaluation, the section-specific MARS scores were calculated by taking the arithmetic mean, while the overall MARS score was described as the arithmetic mean of the section scores. In addition, the Cohen kappa (?) statistic was used to evaluate the interrater agreement. Results: A total of 7 apps met the selection criteria, and only 3 included citations. The average rating score for Android apps was 3.5, with a minimum of 1.0 and a maximum of 4.9, while the average rating score for iOS apps was 4.7, with a minimum of 4.2 and a maximum of 4.9. The mean MARS score was 3.69 out of 5 (95% CI 3.34-4.04), with the lowest score of 1.96 for Medication Guidelines and the highest score of 4.27 for MCDEX mobile. The greatest variation was observed in the information section, which ranged from 1.41 to 4.60. The functionality section showed the highest mean score of 4.05 (95% CI 3.71-4.40), whereas the engagement section resulted in the lowest average score of 3.16 (95% CI 2.81-3.51). For the information quality section, which was the focus of this analysis, the average score was 3.42, with the MCDEX mobile app having the highest score of 4.6 and the Medication Guidelines app having the lowest score of 1.9. For the overall MARS score, the Cohen interrater ? was 0.354 (95% CI 0.236-0.473), the Fleiss ? was 0.353 (95% CI, 0.234-0.472), and the Krippendorff ? was 0.356 (95% CI 0.237-0.475). Conclusions: This study systematically reviewed the mHealth apps in China with a DDI check feature. The majority of investigated apps demonstrated high quality with accurate and comprehensive information on DDIs. However, a few of the apps that had a massive number of downloads in the Chinese market provided incorrect information. Given these apps might be used by health care providers for checking potential DDIs, this creates a substantial threat to patient safety. UR - https://mhealth.jmir.org/2021/6/e26262 UR - http://dx.doi.org/10.2196/26262 UR - http://www.ncbi.nlm.nih.gov/pubmed/33962910 ID - info:doi/10.2196/26262 ER - TY - JOUR AU - Odukoya, Ololade Oluwakemi AU - Ohazurike, Chidumga AU - Akanbi, Maxwell AU - O'Dwyer, C. Linda AU - Isikekpei, Brenda AU - Kuteyi, Ewemade AU - Ameh, O. Idaomeh AU - Osadiaye, Olanlesi AU - Adebayo, Khadijat AU - Usinoma, Adewunmi AU - Adewole, Ajoke AU - Odunukwe, Nkiruka AU - Okuyemi, Kola AU - Kengne, Pascal Andre PY - 2021/6/9 TI - mHealth Interventions for Treatment Adherence and Outcomes of Care for Cardiometabolic Disease Among Adults Living With HIV: Systematic Review JO - JMIR Mhealth Uhealth SP - e20330 VL - 9 IS - 6 KW - mHealth KW - HIV KW - cardiometabolic disease KW - text messaging KW - mobile KW - systematic review KW - telephone calls KW - wearable devices KW - smartphones KW - desktop KW - web-based KW - mobile apps N2 - Background: The success of antiretroviral therapy has led to an increase in life expectancy and an associated rise in the risk of cardiometabolic diseases (CMDs) among people living with HIV. Objective: Our aim was to conduct a systematic review to synthesize the existing literature on the patterns of use and effects of mobile health (mHealth) interventions for improving treatment adherence and outcomes of care for CMD among people living with HIV. Methods: A systematic search of multiple databases, including PubMed-MEDLINE, Embase, CINAHL, Scopus, Web of Science, African Journals online, ClinicalTrials.gov, and the World Health Organization Global Index Medicus of peer-reviewed articles, was conducted with no date or language restrictions. Unpublished reports on mHealth interventions for treatment adherence and outcomes of care for CMD among adults living with HIV were also included in this review. Studies were included if they had at least 1 component that used an mHealth intervention to address treatment adherence or 1 or more of the stated outcomes of care for CMD among people living with HIV. Results: Our search strategy yielded 1148 unique records. In total, 10 articles met the inclusion criteria and were included in this review. Of the 10 studies, only 4 had published results. The categories of mHealth interventions ranged from short messaging, telephone calls, and wearable devices to smartphone and desktop web-based mobile apps. Across the different categories of interventions, there were no clear patterns in terms of consistency in the use of a particular intervention, as most studies (9/10, 90%) assessed a combination of mHealth interventions. Short messaging and telephone calls were however the most common interventions. Half of the studies (5/10, 50%) reported on outcomes that were indirectly linked to CMD, and none of them provided reliable evidence for evaluating the effectiveness of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. Conclusions: Due to the limited number of studies and the heterogeneity of interventions and outcome measures in the studies, no definitive conclusions could be drawn on the patterns of use and effects of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. We therefore recommend that future trials should focus on standardized outcomes for CMD. We also suggest that future studies should consider having a longer follow-up period in order to determine the long-term effects of mHealth interventions on CMD outcomes for people living with HIV. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018086940; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018086940 UR - https://mhealth.jmir.org/2021/6/e20330 UR - http://dx.doi.org/10.2196/20330 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106075 ID - info:doi/10.2196/20330 ER - TY - JOUR AU - Twimukye, Adelline AU - Bwanika Naggirinya, Agnes AU - Parkes-Ratanshi, Rosalind AU - Kasirye, Ronnie AU - Kiragga, Agnes AU - Castelnuovo, Barbara AU - Wasswa, Jacob AU - Nabaggala, Sarah Maria AU - Katabira, Elly AU - Lamorde, Mohammed AU - King, Lisa Rachel PY - 2021/6/14 TI - Acceptability of a Mobile Phone Support Tool (Call for Life Uganda) for Promoting Adherence to Antiretroviral Therapy Among Young Adults in a Randomized Controlled Trial: Exploratory Qualitative Study JO - JMIR Mhealth Uhealth SP - e17418 VL - 9 IS - 6 KW - HIV KW - mHealth KW - young adults KW - adherence KW - qualitative KW - Uganda N2 - Background: Adherence to treatment is critical for successful treatment outcomes. Although factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere owing to psychosocial issues such as stigma, ART-related side effects, and a lack of access to treatment. The Call for Life Uganda (CFLU) mobile health (mHealth) tool is a mobile phone?based technology that provides text messages or interactive voice response functionalities through a web interface and offers 4 modules of support. Objective: This study aims to describe the acceptability and feasibility of a mobile phone support tool to promote adherence to ART among young adults in a randomized controlled trial. Methods: An exploratory qualitative design with a phenomenological approach at 2 study sites was used. A total of 17 purposively selected young adults with HIV infection who had used the mHealth tool CFLU from 2 clinics were included. In total, 11 in-depth interviews and 1 focus group discussion were conducted to examine the following topics: experience with the CFLU tool (benefits and challenges), components of the tool, the efficiency of the system (level of comfort, ease, or difficulty in using the system), how CFLU resolved adherence challenges, and suggestions to improve CFLU. Participants belonged to 4 categories of interest: young adults on ART for the prevention of mother-to-child transmission, young adults switching to or on the second-line ART, positive partners in an HIV-discordant relationship, and young adults initiating the first-line ART. All young adults had 12 months of daily experience using the tool. Data were analyzed using NVivo version 11 software (QSR International Limited) based on a thematic approach. Results: The CFLU mHealth tool was perceived as an acceptable intervention; young adults reported improvement in medication adherence, strengthened clinician-patient relationships, and increased health knowledge from health tips. Appointment reminders and symptom reporting were singled out as beneficial and helped to address the problems of forgetfulness and stigma-related issues. HIV-related stigma was reported by a few young people. Participants requested extra support for scaling up CFLU to make it more youth friendly. Improving the tool to reduce technical issues, including network outages and a period of software failure, was suggested. They suggested that in addition to digital solutions, other support, including the promotion of peer support meetings and the establishment of a designated space and staff members for youth, was also important. Conclusions: This mHealth tool was an acceptable and feasible strategy for improving ART adherence and retention among young adults in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 UR - https://mhealth.jmir.org/2021/6/e17418 UR - http://dx.doi.org/10.2196/17418 UR - http://www.ncbi.nlm.nih.gov/pubmed/34121665 ID - info:doi/10.2196/17418 ER - TY - JOUR AU - Wickerson, Lisa AU - Helm, Denise AU - Gottesman, Chaya AU - Rozenberg, Dmitry AU - Singer, G. Lianne AU - Keshavjee, Shaf AU - Sidhu, Aman PY - 2021/6/17 TI - Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation JO - JMIR Mhealth Uhealth SP - e28708 VL - 9 IS - 6 KW - telerehabilitation KW - lung KW - transplant KW - rehabilitation KW - COVID-19 KW - usage KW - satisfaction KW - app KW - outcome KW - telemedicine N2 - Background: The COVID-19 pandemic resulted in a rapid shift from center-based rehabilitation to telerehabilitation for chronic respiratory disease and lung transplantation due to infection control precautions. Clinical experience with this delivery model on a large scale has not been described. Objective: The aim of this study is to describe usage and satisfaction of providers and lung transplant (LTx) candidates and recipients and functional outcomes following the broad implementation of telerehabilitation with remote patient monitoring during the first wave of the COVID-19 pandemic. Methods: This study was a program evaluation of providers, LTx candidates, and early LTx recipients who used a web-based, remote monitoring app for at least four weeks between March 16 and September 1, 2020, to participate in telerehabilitation. Within-subjects analysis was performed for physical activity, Self-efficacy For Exercise (SEE) scale score, aerobic and resistance exercise volumes, 6-minute walk test results, and Short Physical Performance Battery (SPPB) results. Results: In total, 78 LTx candidates and 33 recipients were included (57 [51%] males, mean age 58 [SD 12] years, 58 [52%] with interstitial lung disease, 34 [31%] with chronic obstructive pulmonary disease). A total of 50 (64%) LTx candidates and 17 (51%) LTx recipients entered ?10 prescribed exercise sessions into the app during the study time frame. In addition, 35/42 (83%) candidates agreed the app helped prepare them for surgery and 18/21 (85%) recipients found the app helpful in their self-recovery. The strongest barrier perceived by physiotherapists delivering the telerehabilitation was patient access to home exercise and monitoring equipment. Between the time of app registration and ?4 weeks on the waiting list, 26 LTx candidates used a treadmill, with sessions increasing in mean duration (from 16 to 22 minutes, P=.002) but not speed (from 1.7 to 1.75 mph, P=.31). Quadriceps weight (pounds) for leg extension did not change (median 3.5, IQR 2.4-5 versus median 4.3, IQR 3-5; P=.08; n=37). On the Rapid Assessment of Physical Activity questionnaire (RAPA), 57% of LTx candidates scored as active, which improved to 87% (P=.02; n=23). There was a decrease in pretransplant 6-minute walk distance (6MWD) from 346 (SD 84) meters to 307 (SD 85) meters (P=.002; n=45) and no change in the SPPB result (12 [IQR 9.5-12] versus 12 [IQR 10-12]; P=.90; n=42). A total of 9 LTx recipients used a treadmill that increased in speed (from 1.9 to 2.7 mph; P=.003) between hospital discharge and three months posttransplant. Quadriceps weight increased (3 [IQR 0-3] pounds versus 5 [IQR 3.8-6.5] pounds; P<.001; n=15). At three months posttransplant, 76% of LTx recipients scored as active (n=17), with a high total SEE score of 74 (SD 11; n=12). In addition, three months posttransplant, 6MWD was 62% (SD 18%) predicted (n=8). Conclusions: We were able to provide telerehabilitation despite challenges around exercise equipment. This early experience will inform the development of a robust and equitable telerehabilitation model beyond the COVID-19 pandemic. UR - https://mhealth.jmir.org/2021/6/e28708 UR - http://dx.doi.org/10.2196/28708 UR - http://www.ncbi.nlm.nih.gov/pubmed/34048354 ID - info:doi/10.2196/28708 ER - TY - JOUR AU - Domingos, Célia AU - Costa, Soares Patrício AU - Santos, Correia Nadine AU - Pêgo, Miguel José PY - 2021/6/29 TI - European Portuguese Version of the User Satisfaction Evaluation Questionnaire (USEQ): Transcultural Adaptation and Validation Study JO - JMIR Mhealth Uhealth SP - e19245 VL - 9 IS - 6 KW - satisfaction KW - usability KW - reliability KW - validity KW - seniors KW - elderly KW - technology KW - wearables N2 - Background: Wearable activity trackers have the potential to encourage users to adopt healthier lifestyles by tracking daily health information. However, usability is a critical factor in technology adoption. Older adults may be more resistant to accepting novel technologies. Understanding the difficulties that older adults face when using activity trackers may be useful for implementing strategies to promote their use. Objective: The purpose of this study was to conduct a transcultural adaptation of the User Satisfaction Evaluation Questionnaire (USEQ) into European Portuguese and validate the adapted questionnaire. Additionally, we aimed to provide information about older adults? satisfaction regarding the use of an activity tracker (Xiaomi Mi Band 2). Methods: The USEQ was translated following internationally accepted guidelines. The psychometric evaluation of the final version of the translated USEQ was assessed based on structural validity using exploratory and confirmatory factor analyses. Construct validity was examined using divergent and discriminant validity analysis, and internal consistency was evaluated using Cronbach ? and McDonald ? coefficients. Results: A total of 110 older adults completed the questionnaire. Confirmatory factor analysis supported the conceptual unidimensionality of the USEQ (?24=7.313, P=.12, comparative fit index=0.973, Tucker-Lewis index=0.931, goodness of fit index=0.977, root mean square error of approximation=0.087, standardized root mean square residual=0.038). The internal consistency showed acceptable reliability (Cronbach ?=.677, McDonald ?=0.722). Overall, 90% of the participants reported excellent satisfaction with the Xiaomi Mi Band 2. Conclusions: The findings support the use of this translated USEQ as a valid and reliable tool for measuring user satisfaction with wearable activity trackers in older adults, with psychometric properties consistent with the original version. UR - https://mhealth.jmir.org/2021/6/e19245 UR - http://dx.doi.org/10.2196/19245 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185018 ID - info:doi/10.2196/19245 ER - TY - JOUR AU - Wei, Jing AU - Boger, Jennifer PY - 2021/6/1 TI - Sleep Detection for Younger Adults, Healthy Older Adults, and Older Adults Living With Dementia Using Wrist Temperature and Actigraphy: Prototype Testing and Case Study Analysis JO - JMIR Mhealth Uhealth SP - e26462 VL - 9 IS - 6 KW - sleep monitoring KW - wearables KW - accelerometer KW - wrist temperature KW - circadian rhythm KW - younger adults KW - older adults KW - dementia KW - mobile phone N2 - Background: Sleep is essential for one?s health and quality of life. Wearable technologies that use motion and temperature sensors have made it possible to self-monitor sleep. Although there is a growing body of research on sleep monitoring using wearable devices for healthy young-to-middle-aged adults, few studies have focused on older adults, including those living with dementia. Objective: This study aims to investigate the impact of age and dementia on sleep detection through movement and wrist temperature. Methods: A total of 10 younger adults, 10 healthy older adults, and 8 older adults living with dementia (OAWD) were recruited. Each participant wore a Mi Band 2 (accemetry-based sleep detection) and our custom-built wristband (actigraphy and wrist temperature) 24 hours a day for 2 weeks and was asked to keep a daily sleep journal. Sleep parameters detected by the Mi Band 2 were compared with sleep journals, and visual analysis of actigraphy and temperature data was performed. Results: The absolute differences in sleep onset and offset between the sleep journals and Mi Band 2 were 39 (SD 51) minutes and 31 (SD 52) minutes for younger adults, 49 (SD 58) minutes and 33 (SD 58) minutes for older adults, and 253 (SD 104) minutes and 161 (SD 94) minutes for OAWD. The Mi Band 2 was unable to accurately detect sleep in 3 healthy older adults and all OAWDs. The average sleep and wake temperature difference of OAWD (1.26 °C, SD 0.82 °C) was significantly lower than that of healthy older adults (2.04 °C, SD 0.70 °C) and healthy younger adults (2.48 °C, SD 0.88 °C). Actigraphy data showed that older adults had more movement during sleep compared with younger adults and that this trend appears to increase for those with dementia. Conclusions: The Mi Band 2 did not accurately detect sleep in older adults who had greater levels of nighttime movement. As more nighttime movement appears to be a phenomenon that increases in prevalence with age and even more so with dementia, further research needs to be conducted with a larger sample size and greater diversity of commercially available wearable devices to explore these trends more conclusively. All participants, including older adults and OAWD, had a distinct sleep and wake wrist temperature contrast, which suggests that wrist temperature could be leveraged to create more robust and broadly applicable sleep detection algorithms. UR - https://mhealth.jmir.org/2021/6/e26462 UR - http://dx.doi.org/10.2196/26462 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061038 ID - info:doi/10.2196/26462 ER - TY - JOUR AU - Webster, E. Dan AU - Tummalacherla, Meghasyam AU - Higgins, Michael AU - Wing, David AU - Ashley, Euan AU - Kelly, E. Valerie AU - McConnell, V. Michael AU - Muse, D. Evan AU - Olgin, E. Jeffrey AU - Mangravite, M. Lara AU - Godino, Job AU - Kellen, R. Michael AU - Omberg, Larsson PY - 2021/6/4 TI - Smartphone-Based VO2max Measurement With Heart Snapshot in Clinical and Real-world Settings With a Diverse Population: Validation Study JO - JMIR Mhealth Uhealth SP - e26006 VL - 9 IS - 6 KW - VO2max KW - heart rate KW - digital health KW - real-world data KW - cardiorespiratory fitness KW - remote monitoring KW - mobile phone KW - smartphone KW - validation N2 - Background: Maximal oxygen consumption (VO2max) is one of the most predictive biometrics for cardiovascular health and overall mortality. However, VO2max is rarely measured in large-scale research studies or routine clinical care because of the high cost, participant burden, and requirement for specialized equipment and staff. Objective: To overcome the limitations of clinical VO2max measurement, we aim to develop a digital VO2max estimation protocol that can be self-administered remotely using only the sensors within a smartphone. We also aim to validate this measure within a broadly representative population across a spectrum of smartphone devices. Methods: Two smartphone-based VO2max estimation protocols were developed: a 12-minute run test (12-MRT) based on distance measured by GPS and a 3-minute step test (3-MST) based on heart rate recovery measured by a camera. In a 101-person cohort, balanced across age deciles and sex, participants completed a gold standard treadmill-based VO2max measurement, two silver standard clinical protocols, and the smartphone-based 12-MRT and 3-MST protocols in the clinic and at home. In a separate 120-participant cohort, the video-based heart rate measurement underlying the 3-MST was measured for accuracy in individuals across the spectrum skin tones while using 8 different smartphones ranging in cost from US $99 to US $999. Results: When compared with gold standard VO2max testing, Lin concordance was pc=0.66 for 12-MRT and pc=0.61 for 3-MST. However, in remote settings, the 12-MRT was significantly less concordant with the gold standard (pc=0.25) compared with the 3-MST (pc=0.61), although both had high test-retest reliability (12-MRT intraclass correlation coefficient=0.88; 3-MST intraclass correlation coefficient=0.86). On the basis of the finding that 3-MST concordance was generalizable to remote settings whereas 12-MRT was not, the video-based heart rate measure within the 3-MST was selected for further investigation. Heart rate measurements in any of the combinations of the six Fitzpatrick skin tones and 8 smartphones resulted in a concordance of pc?0.81. Performance did not correlate with device cost, with all phones selling under US $200 performing better than pc>0.92. Conclusions: These findings demonstrate the importance of validating mobile health measures in the real world across a diverse cohort and spectrum of hardware. The 3-MST protocol, termed as heart snapshot, measured VO2max with similar accuracy to supervised in-clinic tests such as the Tecumseh (pc=0.94) protocol, while also generalizing to remote and unsupervised measurements. Heart snapshot measurements demonstrated fidelity across demographic variation in age and sex, across diverse skin pigmentation, and between various iOS and Android phone configurations. This software is freely available for all validation data and analysis code. UR - https://mhealth.jmir.org/2021/6/e26006 UR - http://dx.doi.org/10.2196/26006 UR - http://www.ncbi.nlm.nih.gov/pubmed/34085945 ID - info:doi/10.2196/26006 ER - TY - JOUR AU - Bai, Ran AU - Xiao, Le AU - Guo, Yu AU - Zhu, Xuequan AU - Li, Nanxi AU - Wang, Yashen AU - Chen, Qinqin AU - Feng, Lei AU - Wang, Yinghua AU - Yu, Xiangyi AU - Wang, Chunxue AU - Hu, Yongdong AU - Liu, Zhandong AU - Xie, Haiyong AU - Wang, Gang PY - 2021/6/17 TI - Correction: Tracking and Monitoring Mood Stability of Patients With Major Depressive Disorder by Machine Learning Models Using Passive Digital Data: Prospective Naturalistic Multicenter Study JO - JMIR Mhealth Uhealth SP - e30540 VL - 9 IS - 6 UR - https://mhealth.jmir.org/2021/6/e30540 UR - http://dx.doi.org/10.2196/30540 UR - http://www.ncbi.nlm.nih.gov/pubmed/34138725 ID - info:doi/10.2196/30540 ER - TY - JOUR AU - Schütz, Narayan AU - Saner, Hugo AU - Botros, Angela AU - Pais, Bruno AU - Santschi, Valérie AU - Buluschek, Philipp AU - Gatica-Perez, Daniel AU - Urwyler, Prabitha AU - Müri, M. René AU - Nef, Tobias PY - 2021/6/11 TI - Contactless Sleep Monitoring for Early Detection of Health Deteriorations in Community-Dwelling Older Adults: Exploratory Study JO - JMIR Mhealth Uhealth SP - e24666 VL - 9 IS - 6 KW - sleep restlessness KW - telemonitoring KW - digital biomarkers KW - contactless sensing KW - pervasive computing KW - home-monitoring KW - older adults KW - toss and turns KW - sleep monitoring KW - body movements in bed N2 - Background: Population aging is posing multiple social and economic challenges to society. One such challenge is the social and economic burden related to increased health care expenditure caused by early institutionalizations. The use of modern pervasive computing technology makes it possible to continuously monitor the health status of community-dwelling older adults at home. Early detection of health issues through these technologies may allow for reduced treatment costs and initiation of targeted preventive measures leading to better health outcomes. Sleep is a key factor when it comes to overall health and many health issues manifest themselves with associated sleep deteriorations. Sleep quality and sleep disorders such as sleep apnea syndrome have been extensively studied using various wearable devices at home or in the setting of sleep laboratories. However, little research has been conducted evaluating the potential of contactless and continuous sleep monitoring in detecting early signs of health problems in community-dwelling older adults. Objective: In this work we aim to evaluate which contactlessly measurable sleep parameter is best suited to monitor perceived and actual health status changes in older adults. Methods: We analyzed real-world longitudinal (up to 1 year) data from 37 community-dwelling older adults including more than 6000 nights of measured sleep. Sleep parameters were recorded by a pressure sensor placed beneath the mattress, and corresponding health status information was acquired through weekly questionnaires and reports by health care personnel. A total of 20 sleep parameters were analyzed, including common sleep metrics such as sleep efficiency, sleep onset delay, and sleep stages but also vital signs in the form of heart and breathing rate as well as movements in bed. Association with self-reported health, evaluated by EuroQol visual analog scale (EQ-VAS) ratings, were quantitatively evaluated using individual linear mixed-effects models. Translation to objective, real-world health incidents was investigated through manual retrospective case-by-case analysis. Results: Using EQ-VAS rating based self-reported perceived health, we identified body movements in bed?measured by the number toss-and-turn events?as the most predictive sleep parameter (t score=?0.435, P value [adj]=<.001). Case-by-case analysis further substantiated this finding, showing that increases in number of body movements could often be explained by reported health incidents. Real world incidents included heart failure, hypertension, abdominal tumor, seasonal flu, gastrointestinal problems, and urinary tract infection. Conclusions: Our results suggest that nightly body movements in bed could potentially be a highly relevant as well as easy to interpret and derive digital biomarker to monitor a wide range of health deteriorations in older adults. As such, it could help in detecting health deteriorations early on and provide timelier, more personalized, and precise treatment options. UR - https://mhealth.jmir.org/2021/6/e24666 UR - http://dx.doi.org/10.2196/24666 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114966 ID - info:doi/10.2196/24666 ER - TY - JOUR AU - Osmanlliu, Esli AU - Rafie, Edmond AU - Bédard, Sylvain AU - Paquette, Jesseca AU - Gore, Genevieve AU - Pomey, Marie-Pascale PY - 2021/6/9 TI - Considerations for the Design and Implementation of COVID-19 Contact Tracing Apps: Scoping Review JO - JMIR Mhealth Uhealth SP - e27102 VL - 9 IS - 6 KW - COVID-19 KW - contact tracing KW - exposure notification KW - app KW - design KW - implementation KW - participatory KW - eHealth KW - surveillance KW - monitoring KW - review N2 - Background: Given the magnitude and speed of SARS-CoV-2 transmission, achieving timely and effective manual contact tracing has been a challenging task. Early in the pandemic, contact tracing apps generated substantial enthusiasm due to their potential for automating tracing and reducing transmission rates while enabling targeted confinement strategies. However, although surveys demonstrate public interest in using such apps, their actual uptake remains limited. Their social acceptability is challenged by issues around privacy, fairness, and effectiveness, among other concerns. Objective: This study aims to examine the extent to which design and implementation considerations for contact tracing apps are detailed in the available literature, focusing on aspects related to participatory and responsible eHealth innovation, and synthesize recommendations that support the development of successful COVID-19 contact tracing apps and related eHealth technologies. Methods: Searches were performed on five databases, and articles were selected based on eligibility criteria. Papers pertaining to the design, implementation, or acceptability of contact tracing apps were included. Articles published since 2019, written in English or French, and for which the full articles were available were considered eligible for analysis. To assess the scope of the knowledge found in the current literature, we used three complementary frameworks: (1) the Holistic Framework to Improve the Uptake and Impact of eHealth Technologies, (2) the Montreal model, and (3) the Responsible Innovation in Health Assessment Tool. Results: A total of 63 articles qualified for the final analysis. Less than half of the selected articles cited the need for a participatory process (n=25, 40%), which nonetheless was the most frequently referenced item of the Framework to Improve the Uptake and Impact of eHealth Technologies. Regarding the Montreal model, stakeholder consultation was the most frequently described level of engagement in the development of contact tracing apps (n=24, 38%), while collaboration and partnership were cited the least (n=2, 3%). As for the Responsible Innovation in Health framework, all the articles (n=63, 100%) addressed population health, whereas only 2% (n=1) covered environmental considerations. Conclusions: Most studies lacked fundamental aspects of eHealth development and implementation. Our results demonstrate that stakeholders of COVID-19 contact tracing apps lack important information to be able to critically appraise this eHealth innovation. This may have contributed to the modest uptake of contact tracing apps worldwide. We make evidence-informed recommendations regarding data management, communication, stakeholder engagement, user experience, and implementation strategies for the successful and responsible development of contact tracing apps. UR - https://mhealth.jmir.org/2021/6/e27102 UR - http://dx.doi.org/10.2196/27102 UR - http://www.ncbi.nlm.nih.gov/pubmed/34038376 ID - info:doi/10.2196/27102 ER - TY - JOUR AU - Kolasa, Katarzyna AU - Mazzi, Francesca AU - Leszczuk-Czubkowska, Ewa AU - Zrubka, Zsombor AU - Péntek, Márta PY - 2021/6/10 TI - State of the Art in Adoption of Contact Tracing Apps and Recommendations Regarding Privacy Protection and Public Health: Systematic Review JO - JMIR Mhealth Uhealth SP - e23250 VL - 9 IS - 6 KW - COVID-19 KW - contact tracing app KW - data accessibility KW - data privacy KW - mobile app KW - digital health KW - digital contact tracing N2 - Background: During the COVID-19 pandemic, contact tracing apps have received a lot of public attention. The ongoing debate highlights the challenges of the adoption of data-driven innovation. We reflect on how to ensure an appropriate level of protection of individual data and how to maximize public health benefits that can be derived from the collected data. Objective: The aim of the study was to analyze available COVID-19 contact tracing apps and verify to what extent public health interests and data privacy standards can be fulfilled simultaneously in the process of the adoption of digital health technologies. Methods: A systematic review of PubMed and MEDLINE databases, as well as grey literature, was performed to identify available contact tracing apps. Two checklists were developed to evaluate (1) the apps? compliance with data privacy standards and (2) their fulfillment of public health interests. Based on both checklists, a scorecard with a selected set of minimum requirements was created with the goal of estimating whether the balance between the objective of data privacy and public health interests can be achieved in order to ensure the broad adoption of digital technologies. Results: Overall, 21 contact tracing apps were reviewed. In total, 11 criteria were defined to assess the usefulness of each digital technology for public health interests. The most frequently installed features related to contact alerting and governmental accountability. The least frequently installed feature was the availability of a system of medical or organizational support. Only 1 app out of 21 (5%) provided a threshold for the population coverage needed for the digital solution to be effective. In total, 12 criteria were used to assess the compliance of contact tracing apps with data privacy regulations. Explicit user consent, voluntary use, and anonymization techniques were among the most frequently fulfilled criteria. The least often implemented criteria were provisions of information about personal data breaches and data gathered from children. The balance between standards of data protection and public health benefits was achieved best by the COVIDSafe app and worst by the Alipay Health Code app. Conclusions: Contact tracing apps with high levels of compliance with standards of data privacy tend to fulfill public health interests to a limited extent. Simultaneously, digital technologies with a lower level of data privacy protection allow for the collection of more data. Overall, this review shows that a consistent number of apps appear to comply with standards of data privacy, while their usefulness from a public health perspective can still be maximized. UR - https://mhealth.jmir.org/2021/6/e23250 UR - http://dx.doi.org/10.2196/23250 UR - http://www.ncbi.nlm.nih.gov/pubmed/34033581 ID - info:doi/10.2196/23250 ER -