Use of Mobile Health Applications for Health-Seeking Behavior Among US Adults

Assessing Differences in mHealth Usability and App Experiences Among Young African American Women: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

In North Carolina, HIV continues to disproportionately affect young African American women. Although mobile health (mHealth) technology appears to be a tool capable of making public health information more accessible for key populations, previous technology use and social determinants may impact users' mHealth experiences.

OBJECTIVE

The objective of this study was to evaluate mHealth usability, assessing differences based on previous technology use and social determinants among a sample of African American women in emerging adulthood.

METHODS

As part of a National Institute on Drug Abuse-funded randomized controlled trial with African American women (aged 18-25 years), counties were assigned to receive an evidence-based HIV risk reduction intervention through mHealth and participants were asked to complete usability surveys at 6- and 12-month follow-ups. Participants' first survey responses were analyzed through 2-tailed t tests and linear regression models to examine associations with previous technology use and social determinants (P<.05).

RESULTS

The mean System Usability Scale (SUS) score was 69.2 (SD 17.9; n=159), which was higher than the threshold of acceptability (68.0). Participants who had previously used a tablet indicated higher usability compared to participants without previous use (mean 72.9, SD 18.1 vs mean 57.6, SD 11.4; P<.001), and participants with previous smartphone use also reported higher usability compared to participants without previous use (mean 71.9, SD 18.3 vs mean 58.0, SD 10.7; P<.001). Differences in SUS scores were observed among those reporting homelessness (mean 58.3, SD 19.0 vs mean 70.8, SD 17.2; P=.01), unemployment (mean 65.9, SD 17.2 vs mean 71.6, SD 18.1; P=.04), or current school enrollment (mean 73.2, SD 18.5 vs mean 65.4, SD 16.5; P=.006). Statistically significant associations were not observed for food insecurity (mean 67.3, SD 18.6 vs mean 69.9, SD 17.7; P=.45).

CONCLUSIONS

Although above-average usability was observed overall, these findings demonstrate differences in mHealth usability based on past and current life experiences. As mHealth interventions become more prevalent, these findings may have important implications for ensuring that mHealth apps improve the reach of evidence-based interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02965014; https://clinicaltrials.gov/study/NCT02965014.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-018-5796-8.

Characterizing perceived usability and its correlation with smoking cessation: An analysis of user assessments of the smoking cessation app quitSTART

Background

As smartphone ownership has become common in all demographic groups in the United States, smartphone applications (apps) for smoking cessation have grown in popularity due to their potential for supporting the diverse populations in the United States who are attempting to quit smoking. Usability is commonly assessed in mobile health (mHealth) technology as an important aspect of the user experience that could influence users' adherence to a health app and health outcomes. However, the variation of perceived usability across demographic groups, and the implications of that variation for app success, have not been well studied.

Objective

The aims of this study were to characterize variation in the perceived usability of the National Cancer Institute Smokefree.gov Initiative smoking cessation app quitSTART across demographic groups, and to assess the correlation between perceived usability and short-term smoking cessation.

Methods

We conducted a secondary analysis of data from a randomized controlled trial conducted from 2020 to 2021, which used a 16-item modified version of the mHealth App Usability Questionnaire (MAUQ) to quantify perceived usability four weeks after app download among 131 smokers attempting to quit. Responses were coded on a 5-point Likert-type scale ranging from strongly disagree (1) to strongly agree (5) and total perceived usability was calculated as the sum of all 16 items (range: 16-80). Associations between participant demographic characteristics (gender, race, education level, age, etc.) and total usability were determined using an ANCOVA model. A multivariable logistic regression model was used to assess the association between usability and smoking cessation, also assessed 4 weeks after app download.

Results

The ANCOVA model demonstrated that race was associated with perceived usability, with participants from a racial minority group reporting higher total usability than White participants (p < 0.001). White participants had an adjusted mean total usability of 55.8 (95 % CI: 52.8, 58.8) while racial minority group participants had an adjusted mean total usability of 66.5 (95 % CI: 61.2, 71.6). Other participant demographic characteristics, such as gender and sexual minority status, were not associated with mean total usability. Total usability was positively associated with smoking cessation (OR: 1.04, 95 % CI: 1.00, 1.08, p = 0.031).

Conclusions

Total perceived usability of quitSTART was higher among adults from a racial minority group compared to White adults, and perceived usability was positively associated with cessation success. These findings emphasize the importance of ensuring high usability of mHealth smoking cessation apps for diverse populations.

Effectiveness of nurse-led electronic health interventions on illness management in patients with chronic heart failure: A systematic review and meta-analysis

BACKGROUND

Chronic heart failure (CHF) is a global health concern, and nurse-led electronic health is an effective management strategy for this condition.

OBJECTIVE

This systematic review and meta-analysis aimed to identify current patterns and strategies for nurse-led electronic health interventions and examine the effects of nurse-led electronic health interventions for illness management in patients with chronic heart failure.

DESIGN

This study combined a systematic review and meta-analyses.

PARTICIPANTS

Twenty-four articles, involving a total of 3660 patients, met the inclusion criteria.

METHODS

We conducted a large amount of literature review using seven English databases: namely PubMed, Embase, Web of Science, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and SCOPUS, along with three Chinese databases: China National Knowledge Infrastructure(CNKI), WanFang, and the VIP Database. Databases were searched from inception until September 2022. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The studies were independently screened by two reviewers who extracted of the details of those meeting the inclusion criteria study. The Joanna Briggs Institute randomized controlled trial checklist was used to evaluate the methodological value of each incorporation study. Meta-analysis was performed by the use of Manager 5.3.

RESULTS

The main patterns of electronic health intervention involve smartphone, Internet and specialized (portable) electronic monitoring devices that are used for the illness management of patients with chronic heart failure, mainly including providing self-management guidance for chronic heart failure, and tracking of the patient's health information, providing peer support, and facilizing medical and health resources. The collective findings of 9 studies reported that electronic health interventions improved self-care (MD: 15.30, 95 % CI: 1.59 to 29.02, p < 0.05). Regarding psychosocial well-being outcomes, the incorporative conclusions indicated that electronic health interventions effectively increased quality of life, reduced depression and anxiety, and improved patient satisfaction. Regarding disease-related examinations, electronic health interventions significantly increased cardiac function during the 6-minute walk test. Regarding healthy economic outcomes, electronic health interventions significantly decreased the rehospitalization rate and the cost of medical care services.

CONCLUSIONS

The findings of this review suggest that nurse-led electronic health interventions involving multiple patterns have an active influence on managing patients with chronic heart failure, including enhancing self-care, and medication adherence; increasing quality of life; reducing depression, anxiety, and improved patient satisfaction; increasing cardiac function, and reducing rehospitalization rate and hospitalization costs. Thus, it could be a promising alternative in the clinical settings.

REGISTRATION

CRD42023389450.

Use of Digital Health Resources by Sexual and Gender Minority Caregivers of Older Adults: Findings From the 2020 Caregiving in the U.S. Survey

We applied Andersen's Behavioral Model of Health Services Use to investigate the health needs and use of digital health resources among sexual and/or gender minority (SGM) caregivers. Data were from the Caregiving in the U.S. 2020 survey. Regression analyses were used to describe associations between predisposing, enabling, and need factors and usage of digital health resources. SGM caregivers provided more hours of care per week, reported higher levels of care intensity, and reported higher physical, emotional, and financial strain compared with non-SGM caregivers. Regression analyses indicated SGM status was a significant predictor of overall use of digital health resources. Younger caregivers, racial minority caregivers, those providing higher levels of care, and those reporting a poorer health status were more likely to use digital health resources. Digital health resources may be useful tools for SGM caregivers of older adults. More research is needed to investigate the reasons SGM caregivers use these resources.

Information seeking behavior on hepatitis B virus, and its associated factors among pregnant women at teaching and specialized hospitals, Northwest Ethiopia: A cross-sectional study

INTRODUCTION

Hepatitis B virus (HBV) infection continues to be a major public health issue worldwide. Health information-seeking behavior is critical to obtain information about health, diseases such as the Hepatitis B virus, health risks, and health promotion and it has become a major concern of health policymakers. However, there is little evidence of information-seeking behavior on the Hepatitis B virus in Ethiopia. So, this study aimed to assess Hepatitis B virus information-seeking behavior and its associated factors among pregnant women at teaching and Specialized Hospitals, in Northwest Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among pregnant women at teaching and specialized hospitals, in Northwest Ethiopia from May 01 to June 01, 2022. A total of 423 participants were selected using a systematic random sampling method. The data was collected through an interview-administered questionnaire by kobo-collect software. Then export into SPSS version 20 for analysis. Descriptive statistics, bi-variable, and multivariable logistic regression analyses were done to identify factors associated with Hepatitis B virus information-seeking behavior.

RESULTS

The proportion of information-seeking behavior on the Hepatitis B virus among pregnant women was 40.5% (CI = 35.7, 45.6). Education(diploma and above) [AOR = 3.3, 95% CI (1.31, 8.16)], more than one ANC visit [AOR = 5.99, 95% CI (3.20, 12.31)], smart-phone ownership [AOR = 4.1, 95%CI (1.35, 12.31)], internet access [AOR = 5.1, 95%CI (1.35, 15.60)], perceived susceptibility [AOR = 2.7, 95%CI (1.38, 5.31)], perceived severity [AOR = 3.7, 95%CI (2.06, 6.55)], and self-efficacy [AOR = 1.9, 95%CI (1.03, 3.73)] were factors influencing information seeking on Hepatitis B virus.

CONCLUSION

The overall proportion of information-seeking behavior on HBV among pregnant women was low. To improve information-seeking behavior on HBV among pregnant women we should connect the women to the internet and technology. Creating women's awareness about the Hepatitis B virus severity and their venerability and increasing their antenatal care (ANC) visits, self-efficacy, internet access, and women's education can improve information seeking about the Hepatitis B virus.

Willingness to pay for health apps, its sociodemographic correlates, and reasons for being unwilling to pay

Background

Knowledge about whether, how much, and why individuals are willing to pay for health apps is limited.

Objectives

This study aimed to examine (1) the proportion of individuals willing to pay for health apps, (2) their willingness to pay (WTP; i.e. the maximum price the individual is willing to pay) for health apps, (3) the sociodemographic correlates determining whether individuals are willing to pay for these apps, (4) the sociodemographic correlates of their WTP, and (5) reasons for being unwilling to pay.

Methods

Six hundred adults were invited to participate in a questionnaire survey examining their sociodemographic characteristics, WTP for health apps, and reasons for being unwilling to pay. Sociodemographic characteristics and WTP for health apps were analyzed using descriptive statistics. Logistic regression was applied to examine the sociodemographic variables correlated with whether individuals were willing to pay for health apps. Among those who were willing to pay, log-linear regression was conducted to examine the sociodemographic correlates of their WTP. The reasons for unwillingness to pay were descriptively analyzed.

Results

A total of 577 individuals completed the questionnaire. Of them, 58.9% were willing to pay for health apps. Their median WTP was HK$50 (HK$1 ≈ US$0.13). Participants with a bachelor's degree or higher and those who had previously installed health apps were more inclined to pay for health apps. WTP was positively associated with the maximum price previously paid for a health app. The most frequently cited reasons for being unwilling to pay were the belief that the government should provide free health apps, distrust in health apps, and a lack of awareness of health apps and their benefits.

Conclusions

This study provides insights that can inform strategies to enhance the marketability, affordability, and accessibility of health apps.

Factors Influencing Telehealth Service Use and Health Outcomes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Cross-Sectional Study

BACKGROUND

Several studies have demonstrated the efficacy and user acceptance of telehealth in managing patients with chronic conditions, including continuous ambulatory peritoneal dialysis (CAPD). However, the rates of telehealth service use in various patient groups have been low and have declined over time, which may affect important health outcomes. Telehealth service use in patients undergoing CAPD has been recognized as a key challenge that needs to be examined further.

OBJECTIVE

This study aimed to explore the rates of telehealth service use over 4 months, identify factors influencing its use, and examine the relationship between telehealth service use and health outcomes in Thai people undergoing CAPD.

METHODS

This cross-sectional study, which was a part of a pragmatic randomized controlled trial study, was conducted at a dialysis center in Bangkok, Thailand. The study included patients who were undergoing CAPD. These patients were randomly enrolled in the intervention group to receive telehealth service and additional standard care for 4 months. Data were collected using self-reported questionnaires, including a demographic form, Functional, Communicative, and Critical Health Literacy Scale, Perceived Usefulness Questionnaire, Brief Illness Perception Questionnaire, Patient-Doctor Relationship Questionnaire, and Kidney Disease Quality of Life 36 Questionnaire. Additionally, Google Analytics was used to obtain data on the actual use of the telehealth service. These data were analyzed using descriptive statistics, repeated-measures ANOVA, and regression analyses.

RESULTS

A total of 159 patients were included in this study. The mean rate of telehealth service use throughout the period of 4 months was 62.06 (SD 49.71) times. The rate of telehealth service use was the highest in the first month (mean 23.48, SD 16.28 times) and the lowest in the third month (mean 11.09, SD 11.48 times). Independent variables explained 27.6% of the sample variances in telehealth service use. Older age (β=.221; P=.002), higher perceived usefulness (β=.414; P<.001), unemployment (β=-.155; P=.03), and positive illness perception (β=-.205; P=.004) were associated with a significantly higher rate of telehealth service use. Regarding the relationship between telehealth service use and health outcomes, higher rates of telehealth service use were linked to better quality of life (β=.241; P=.002) and lower peritonitis (odds ratio 0.980, 95% CI 0.962-0.997; P=.03).

CONCLUSIONS

This study provides valuable insights into factors impacting telehealth service use, which in turn affect health outcomes in patients undergoing CAPD.

Integration of a Smartphone HF-Dedicated App in the Remote Monitoring of Heart Failure Patients with Cardiac Implantable Electronic Devices: Patient Access, Acceptance, and Adherence to Use

(200 w) Introduction. Remote monitoring (RM) of cardiac implantable electronic device (CIED) diagnostics helps to identify patients potentially at risk of worsening heart failure (HF). Additionally, knowledge of patient HF-related symptoms is crucial for decision making. Patient smartphone applications may represent an ideal option to remotely collect this information.

PURPOSE

To assess real-world HF patient access, acceptance, and adherence to use of an HF-dedicated smartphone application (HF app).

METHODS

In this study, 10 Italian hospitals administered a survey on smartphone/app use to HF patients with CIED. The subgroup who accepted it downloaded the HF app. Mean 1-year adherence of the HF app use was evaluated.

RESULTS

A total of 495 patients (67 ± 13 years, 79% males, 26% NYHA III-IV) completed the survey, of which 84% had access to smartphones and 85% were willing to use the HF app. In total, 311/495 (63%) downloaded the HF app. Patients who downloaded the HF app were younger and had higher school qualification. Patients who were ≥60 years old had higher mean 1-year adherence (54.1%) than their younger counterparts (42.7%; p < 0.001). Hospitals with RM-dedicated staff had higher mean 1-year patient adherence (64.0% vs. 33.5%; p < 0.001). Adherence to HF app decreased from 63.3% (weeks_1-13) to 42.2% (weeks_40-52, p < 0.001).

CONCLUSIONS

High access and acceptance of smartphones/apps by HF patients with CIED allow HF app use for RM of patient signs/symptoms. Younger patients with higher school qualifications are more likely to accept HF app; however, older patients have higher long-term adherence.

Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study

BACKGROUND

Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one's state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm.

OBJECTIVE

This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users' perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions.

METHODS

Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions.

RESULTS

Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one's state of health, and preventing health problems. In total, 66.62% (1333/2001) of internet users engaged in this behavior. Health care-related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition).

CONCLUSIONS

Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key.

Examining Disparities in Ownership and Use of Digital Health Technology Between Rural and Urban Adults in the US: An Analysis of the 2019 Health Information National Trends Survey

BACKGROUND

Although research shows that digital health tools (DHT) are increasingly integrated with healthcare in the United States, very few studies have investigated the rural-urban differences in DHT adoption at the national level. Individuals in rural communities experience disproportionately greater rates of chronic diseases and face unique challenges in accessing health care. Studies have shown that digital technology can improve access and support rural health by overcoming geographic barriers to care.

OBJECTIVE

 To evaluate the rates of ownership and preferences for utilization of DHT as a measure of interest among rural adults compared to their urban counterparts in the United States using a National Inpatient Survey.

METHODS

 Data was drawn from the 2019 (n= 5438) iteration of the Health Information National Trends Survey (HINTS 5 cycle 3). Chi-square tests and weighted multivariable logistic regressions were conducted to examine rural-urban differences regarding ownership, usage, and use of digital health tools to interact with health care systems while adjusting for health-related characteristics and sociodemographic factors.

RESULTS

The ownership rates of digital health technology (DHT) devices, including tablets, smart phones, health apps, and wearable devices, were comparable between rural and urban residents. For tablets, the ownership rates were 54.52% among rural residents and 60.24% among urban residents, with an adjusted odds ratio (OR) of 0.87 (95% confidence interval {CI}: 0.61, 1.24). The ownership rates of health apps were 51.41% and 53.35% among rural and urban residents, respectively, with an adjusted OR of 0.93 (95% CI: 0.62, 1.42). For smartphones, the ownership rates were 81.64% among rural residents and 84.10% among urban residents, with an adjusted OR of 0.81 (95% CI: 0.59, 1.11). Additionally, rural residents were equally likely to use DHT in managing their healthcare needs. Both groups were equally likely to have reported their smart device as helpful in discussions with their healthcare providers (OR 0.90; 95% CI 63 - 1.30; p = 0.572). Similarly, there were similar odds of reporting that DHT had helped them to track progress on a health-related goal (e.g., quitting smoking, losing weight, or increasing physical activity) (OR 1.17; 95% CI 0.75 - 1.83; p = 0.491), and to make medical decisions (OR 1.05; 95% CI 0.70 - 1.59; p = 0.797). However, they had lower rates of internet access and were less likely to use DHT for communicating with their healthcare providers.

CONCLUSION

 We found that rural residents are equally likely as urban residents to own and use DHT to manage their health. However, they were less likely to communicate with their health providers using DHT. With increasing use of DHT in healthcare, future research that targets reasons for geographical digital access disparities is warranted.

Evidence requirements of permanently listed digital health applications (DiGA) and their implementation in the German DiGA directory: an analysis

BACKGROUND

With its digital health application (DiGA)-system, Germany is considered one of Europe's pioneers in the field of evidence-based digital health. Incorporating DiGA into standard medical care must be based on evidence-based success factors; however, a comprehensive overview of the evidence required of scientific studies for their approval is lacking.

OBJECTIVE

The study aims to, (1) identify specific requirements defined by the Federal Institute for Drugs and Medical Devices (German: Bundesinstitut für Arzneimittel- und Medizinprodukte; BfArM) to design adequate studies, proving a positive healthcare effect, and (2) to assess the evidence given for applications permanently listed in the DiGA directory.

METHODS

A multi-step approach was used: (1) identification of the evidence requirements for applications permanently listed in the DiGA directory, (2) identification of the evidence available supporting them.

RESULTS

All DiGA permanently listed in the DiGA directory (13 applications) are included in the formal analysis. Most DiGA addressed mental health (n = 7), and can be prescribed for one or two indications (n = 10). All permanently listed DiGA have demonstrated their positive healthcare effect through a medical benefit, and most of them provide evidence for one defined primary endpoint. All DiGA manufacturers conducted a randomized controlled trial.

DISCUSSION

It is striking that- although patient-relevant structural and procedural improvements show high potential for improving care, especially in terms of processes - all DiGA have provided a positive care effect via a medical benefit. Although BfArM accepts study designs with a lower level of evidence for the proof of a positive healthcare effect, all manufacturers conducted a study with a high level of evidence.

CONCLUSION

The results of this analysis indicate that permanently listed DiGA meet higher standards than required by the guideline.

A Scoping Literature Review of Rural Beliefs and Attitudes toward Telehealth Utilization

The purpose of this scoping literature review was to understand what is known about how the rural profile influences beliefs regarding telehealth utilization. Rural nursing theory (RNT) provided a framework for the review. Search criteria were limited to peer-reviewed studies conducted in Europe, the United States, Canada, Australia, and New Zealand. A variety of search terms related to patient telehealth perceptions generated 213 unique articles, of which 10 met the inclusion criteria. Included studies incorporated qualitative methodologies and were from Australia, Canada, Sweden, or the United States. The review highlighted four themes related to the rural profile's influence on telehealth beliefs: importance of familiar relationships, concerns with privacy and confidentiality, acceptance of limited access to care, and resourcefulness and frugality. These themes echo concepts within RNT. Nurses and other health professionals must acknowledge the rural profile's influence on a person's decision to use telehealth in order to provide optimal care.

Evaluating the Feasibility, Acceptability, and Preliminary Efficacy of SupportMoms-Uganda, an mHealth-Based Patient-Centered Social Support Intervention to Improve the Use of Maternity Services Among Pregnant Women in Rural Southwestern Uganda: Randomized Controlled Trial

BACKGROUND

SMS text messaging and other mobile health (mHealth) interventions may improve knowledge transfer, strengthen access to social support (SS), and promote positive health behaviors among women in the perinatal period. However, few mHealth apps have been taken to scale in sub-Saharan Africa.

OBJECTIVE

We evaluated the feasibility, acceptability, and preliminary efficacy of a novel, mHealth-based, and patient-centered messaging app designed using behavioral science frameworks to promote maternity service use among pregnant women in Uganda.

METHODS

We performed a pilot randomized controlled trial between August 2020 and May 2021 at a referral hospital in Southwestern Uganda. We included 120 adult pregnant women enrolled in a 1:1:1 ratio to receive routine antenatal care (ANC; control), scheduled SMS text or audio messages from a novel messaging prototype (scheduled messaging [SM]), and SM plus SMS text messaging reminders to 2 participant-identified social supporters (SS). Participants completed face-to-face surveys at enrollment and in the postpartum period. The primary outcomes were feasibility and acceptability of the messaging prototype. Other outcomes included ANC attendance, skilled delivery, and SS. We conducted qualitative exit interviews with 15 women from each intervention arm to explore the intervention mechanisms. Quantitative and qualitative data were analyzed using STATA and NVivo, respectively.

RESULTS

More than 85% and 75% of participants received ≥85% of the intended SMS text messages or voice calls, respectively. More than 85% of the intended messages were received within 1 hour of the expected time; 18% (7/40) of women experienced network issues for both intervention groups. Over 90% (36/40) of the intervention participants found this app useful, easy to use, engaging, and compatible and strongly recommended it to others; 70% (28/40), 78% (31/40), and 98% (39/40; P=.04) of women in the control, SM, and SS arms, respectively, had a skilled delivery. Half (20/40), 83% (33/40), and all (40/40; P=.001) of the women in the control, SM, and SS arms attended ≥4 ANC visits, respectively. Women in the SS arm reported the highest support (median 3.4, IQR 2.8-3.6; P=.02); <20% (8/40; P=.002) missed any scheduled ANC visit owing to lack of transportation. Qualitative data showed that women liked the app; they were able to comprehend ANC and skilled delivery benefits and easily share and discuss tailored information with their significant others, who in turn committed to providing them the needed support to prepare and seek help.

CONCLUSIONS

We demonstrated that developing a novel patient-centered and tailored messaging app that leverages SS networks and relationships is a feasible, acceptable, and useful approach to communicate important targeted health-related information and support pregnant women in rural Southwestern Uganda to use available maternity care services. Further evaluation of maternal-fetal outcomes and integration of this intervention into routine care is needed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04313348; https://clinicaltrials.gov/ct2/show/NCT04313348.

Functions of mHealth Diabetes Apps That Enable the Provision of Pharmaceutical Care: Criteria Development and Evaluation of Popular Apps

Personal digital health apps for managing diabetes should include functions that enable the provision of pharmaceutical care services and allow within-app communication with pharmacists and other healthcare providers, thereby improving patient outcomes. The primary aim of this study was to assess the functions of diabetes apps that were relevant to providing pharmaceutical care services (i.e., medication management, adherence, non-pharmacological management, interoperability, and communication). Sixteen criteria related to pharmaceutical care were developed and then used to assess ten popular diabetes apps. The highest numbers of pharmaceutical care criteria were met by the apps Diabetes:M and mySugr (11 criteria); Contour™Diabetes, Dario Health, and OneTouch Reveal^® (ten); and DiabetesConnect and ESYSTA (nine); followed by Glucose Buddy (eight), meala (seven), and lumind (three). The most prevalent functions were related to promoting adherence and non-pharmacological management, but most criteria relevant to medication management were lacking. Five apps allowed within-app communication between patients and healthcare professionals (HCPs); however, no app included communication with pharmacists. High-quality diabetes apps are powerful tools to support pharmaceutical care and remotely monitor diabetes patients. Improvements are needed as they often lack many medication management functions, including within-app communication with HCPs (especially pharmacists). To maximize diabetes app use and improve outcomes, app developers should consider including pharmacists alongside other healthcare providers when customizing app designs.

The use and acceptability of diet-related apps and websites in Australia: Cross-sectional study

Objective

Diet-related apps and websites are developed to help improve dietary intake. The aim of this study is to explore the use and acceptability of diet-related apps and websites in Australia.

Methods

In a cross-sectional study, 241 participants (mean age = 40.6 years) completed an online survey about demographic characteristics, lifestyle behaviours and health concerns, experience and confidence in technology use, and preferences, attitudes and perception of diet app and website use. Descriptive analysis and unadjusted multiple logistic regression were used to explore data.

Results

Overall, 63.5% of participants were current or previous app users. App users were more confident in using technology, more concerned about diet and weight, and more trusting of information provided in diet-related apps compared to non-app users (p ≤ .05). Features such as food tracking, nutrient check and barcode scanning were preferred by both users and non-users. The likelihood of using diet-related apps was higher for those who trust the app information (OR 5.51, 95%CI: 2.40-12.66), often count calories (OR 2.28, 95%CI: 1.01-5.24) and are often on diet (OR 4.16, 95% CI: 1.21-14.21) compared to their counterparts.

Conclusions

More than half of the Australians that participated in this study used diet-related apps and websites. App features that allow the user to accurately record and monitor food intake and scan barcodes may motivate app use. Future public health strategies may take advantage of diet-related apps and websites to improve dietary behaviour at the population level and reduce the burden of obesity and non-communicable diseases.

Impact of the Mobile Game FightHPV on Cervical Cancer Screening Attendance: Retrospective Cohort Study

BACKGROUND

The wide availability of mobile phones has made it easy to disseminate health-related information and make it accessible. With gamification, mobile apps can nudge people to make informed health choices, including attending cervical cancer screening.

OBJECTIVE

This matched retrospective cohort study examined the association between exposure to the FightHPV mobile app gamified educational content and having a cervical exam in the following year.

METHODS

Women aged 20 to 69 years who signed an electronic consent form after downloading the FightHPV app in 2017 (intervention group) were matched 1:6 with women of the same age and with the same screening history (reference group) in 2015. To estimate the impact of exposure to the FightHPV app, we estimated cumulative incidence and hazard ratios (HRs) with 95% CIs. We used data from the Norwegian Cervical Cancer Screening Program database and Statistics Norway to determine screening participation and outcomes, respectively.

RESULTS

We matched 3860 women in the control group to 658 women in the intervention group; 6 months after enrollment, 29.6% (195/658) of the women in the intervention group and 15.21% (587/3860) of those in the reference group underwent a cervical exam (P<.01). Women exposed to the FightHPV app were 2 times more likely to attend screening (adjusted HR 2.3, 95% CI 2.0-2.7), during which they were 13 times more likely to be diagnosed with high-grade abnormality (adjusted HR 12.7, 95% CI 5.0-32.5) than the women in the reference group.

CONCLUSIONS

Exposure to the FightHPV app significantly increased cervical cancer screening attendance across the various analyses and improved detection of women with high risk for cervical cancer. For the first time, we demonstrated the effectiveness of gamification combined with mobile technology in cancer prevention by empowering women to make active health-related decisions. Gamification can significantly improve the understanding of complicated scientific concepts behind interventions and increase the acceptance of proposed cancer control measures.

Digital Connectedness in the Jackson Heart Study: Cross-sectional Study

Background

Although new approaches for data collection, such as mobile technology and teleresearch, have demonstrated new opportunities for the conduct of more timely and less costly surveys in community-based studies, literature on the feasibility of conducing cardiovascular disease research using mobile health (mHealth) platforms among middle-aged and older African Americans has been limited.

Objective

The purpose of this study was to contribute to the knowledge regarding the penetrance of internet and mobile technologies, such as cellphones or smartphones in existing large cohort studies of cardiovascular disease.

Methods

A digital connectedness survey was conducted in the Jackson Heart Study (JHS), a Mississippi-based African American cohort study, as part of the annual follow-up calls with participants from July 2017 to February 2019.

Results

Of the 4024 participants contacted, 2564 (63.7%) completed the survey. Among survey respondents, 2262 (88.2%) reported use of internet or cellphone, and 1593 (62.1%) had a smartphone. Compared to nonusers (n=302), internet or cellphone users (n=2262) were younger (mean age 80.1, SD 8.0 vs 68.2, SD 11.3 years), more likely to be affluent (n=778, 40.1% vs n=39, 15.4%), and had greater than high school education (n=1636, 72.5% vs n=85, 28.1%). Internet or cellphone users were less likely to have cardiovascular disease history compared to nonusers (136/2262, 6.6% vs 41/302, 15.8%). The prevalence of current smoking and average BMI were similar between internet or cellphone users and nonusers. Among internet or cellphone users, 1316 (58.3%) reported use of email, 504 (22.3%) reported use of apps to track or manage health, and 1269 (56.1%) expressed interest in using JHS-developed apps.

Conclusions

Our findings suggest that it is feasible to use mHealth technologies to collect survey data among African Americans already enrolled in a longitudinal study. Our findings also highlight the need for more efforts to reduce the age and education divide in access and use of internet and smartphones for tracking health and research in African American communities.

Effect of Digital-Tool-Supported Basal Insulin Titration Algorithm in Reaching Glycemic Control in Patients with Type 2 Diabetes in Mexico

BACKGROUND

My Dose Coach (MDC) is a mobile application combined with a web portal that can suggest optimized basal insulin (BI) injection doses using Self-Measured Plasma Glucose (SMPG) and hypoglycemia data. This study aimed to evaluate its efficacy on patients reaching SMPG and Fasting blood glucose (FBG) target range 90-130 mg/dl (5-7.2 mmol/L) goals without severe hypoglycemic episodes. We also addressed the mean reduction in glycated hemoglobin (A1C), FBG, and SMPG and the improvement in the WHO's Five Well Being Index (WBI).

METHODS

This prospective pilot study involved the use of MDC in outpatients with type 2 diabetes (T2DM) from a Hospital in Northern Mexico. Patients on treatment with any BI were included in the study. The follow-up was of 16 weeks. Student t-tests or McNemar test were used for effect comparisons.

RESULTS

We included 158 patients (46.8% women), mean (SD) age 51 (10.3) years. We achieved SMPG target range in 58.9% [mean (95CI) reduction of 30.9 mg/dl (22.5-37.7; P < .001)] of the patients [66(28) days], with no severe hypoglycemia events. FBG goal was reached in 55.7% [mean (95CI) reduction of 63.4 mg/dl (49.6-77.2; P < .001)]. The mean (95CI) reduction of A1C was 1.78% (1.47-2, P < .01) with the last observation carried forward. There was a mean (95CI) increase of 2.23 (-3, -1.4, P < .01) points in WBI scale.

CONCLUSIONS

MDC successfully helped to achieve FBG and SMPG goals, reduced A1C, and increased WBI with no severe hypoglycemia events.

Evaluating Health Care Provider Perspectives on the Use of Mobile Apps to Support Patients With Heart Failure Management: Qualitative Descriptive Study

Background

Nonadherence to diet and medical therapies in heart failure (HF) contributes to poor HF outcomes. Mobile apps may be a promising way to improve adherence because they increase knowledge and behavior change via education and monitoring. Well-designed apps with input from health care providers (HCPs) can lead to successful adoption of such apps in practice. However, little is known about HCPs’ perspectives on the use of mobile apps to support HF management.

Objective

The aim of this study is to determine HCPs’ perspectives (needs, motivations, and challenges) on the use of mobile apps to support patients with HF management.

Methods

A qualitative descriptive study using one-on-one semistructured interviews, informed by the diffusion of innovation theory, was conducted among HF HCPs, including cardiologists, nurses, and nurse practitioners. Transcripts were independently coded by 2 researchers and analyzed using content analysis.

Results

The 21 HCPs (cardiologists: n=8, 38%; nurses: n=6, 29%; and nurse practitioners: n=7, 33%) identified challenges and opportunities for app adoption across 5 themes: participant-perceived factors that affect app adoption—these include patient age, technology savviness, technology access, and ease of use; improved delivery of care—apps can support remote care; collect, share, and assess health information; identify adverse events; prevent hospitalizations; and limit clinic visits; facilitating patient engagement in care—apps can provide feedback and reinforcement, facilitate connection and communication between patients and their HCPs, support monitoring, and track self-care; providing patient support through education—apps can provide HF-related information (ie, diet and medications); and participant views on app features for their patients—HCPs felt that useful apps would have reminders and alarms and participative elements (gamification, food scanner, and quizzes).

Conclusions

HCPs had positive views on the use of mobile apps to support patients with HF management. These findings can inform effective development and implementation strategies of HF management apps in clinical practice.

Separating Features From Functionality in Vaccination Apps: Computational Analysis

BACKGROUND

Some latest estimates show that approximately 95% of Americans own a smartphone with numerous functions such as SMS text messaging, the ability to take high-resolution pictures, and mobile software apps. Mobile health apps focusing on vaccination and immunization have proliferated in the digital health information technology market. Mobile health apps have the potential to positively affect vaccination coverage. However, their general functionality, user and disease coverage, and exchange of information have not been comprehensively studied or evaluated computationally.

OBJECTIVE

The primary aim of this study is to develop a computational method to explore the descriptive, usability, information exchange, and privacy features of vaccination apps, which can inform vaccination app design. Furthermore, we sought to identify potential limitations and drawbacks in the apps' design, readability, and information exchange abilities.

METHODS

A comprehensive codebook was developed to conduct a content analysis on vaccination apps' descriptive, usability, information exchange, and privacy features. The search and selection process for vaccination-related apps was conducted from March to May 2019. We identified a total of 211 apps across both platforms, with iOS and Android representing 62.1% (131/211) and 37.9% (80/211) of the apps, respectively. Of the 211 apps, 119 (56.4%) were included in the final study analysis, with 42 features evaluated according to the developed codebook. The apps selected were a mix of apps used in the United States and internationally. Principal component analysis was used to reduce the dimensionality of the data. Furthermore, cluster analysis was used with unsupervised machine learning to determine patterns within the data to group the apps based on preselected features.

RESULTS

The results indicated that readability and information exchange were highly correlated features based on principal component analysis. Of the 119 apps, 53 (44.5%) were iOS apps, 55 (46.2%) were for the Android operating system, and 11 (9.2%) could be found on both platforms. Cluster 1 of the k-means analysis contained 22.7% (27/119) of the apps; these were shown to have the highest percentage of features represented among the selected features.

CONCLUSIONS

We conclude that our computational method was able to identify important features of vaccination apps correlating with end user experience and categorize those apps through cluster analysis. Collaborating with clinical health providers and public health officials during design and development can improve the overall functionality of the apps.

Profile of adults users of smartphone applications for monitoring the level of physical activity and associated factors: A cross-sectional study

Background

There are currently more than 200 million smartphones in Brazil. The potential of mobile technologies for favorable changes in health behavior such as physical activity has been previously described in the literature. Results of surveys in developed countries indicate that applications (APPs) are developed for people who are better educated, younger, and with higher incomes compared to non-users. However, the profile of users in developing countries like Brazil is not well-known. Understanding the profile of APP users might ease the development turned to physically inactive people and those at higher cardiovascular risk. Furthermore, the physiological and functional factors associated with the use of such APP are unknown.

Objectives

To characterize the profile of APP users to monitor the physical activity level (PAL) and assess the demographic, socioeconomic, clinical, physiological, and functional characteristics associated with the use of smartphone APPs to monitor physical activity in Brazilian adults.

Methods

We assessed 176 asymptomatic men and 178 women (43 ± 12 years; 27 ± 5 kg/m2). We initially asked participants about their current use of a smartphone APP containing PAL monitoring functionality, such as exercise session logs and/or step counts. In a cross-sectional design, we investigated schooling, socioeconomic status (Critério Brasil), and classic self-reported cardiovascular risk factors. We evaluated several physiological and functional variables such as maximum O2 consumption on a treadmill (VO2 max), blood pressure, body composition (bioelectrical impedance), handgrip strength, and isokinetic muscle strength of the dominant lower limb. Participants used a triaxial accelerometer for 7 days to quantify daily physical activity. We also assessed health-related quality of life (WHOQOL BREF), perceived stress (PSS14 Scale), and the built environment (NEWS Scale). We compared continuous variables using the Student's t-test and categorical variables using the χ2 test, between APP users and non-users. After univariate analysis, we included the main variables associated with the use of APP in a multiple logistic regression model.

Results

One hundred and two participants (28.3%), unrelated to gender, reported using a smartphone APP for physical activity at the time of assessment. Except for perceived stress and the built environment that were not associated with the use of APP, users of APP were younger and had higher education, lower cardiovascular risk, better socioeconomic status, a better quality of life, better cardiorespiratory function, better body composition, greater physical fitness and more moderate to vigorous physical activity in daily life. The results of the multiple logistic regression showed that age, hypertension, VO2 max, socioeconomic status (Critério Brasil), and quality of life (WHOQOL BREF total score) were the variables most significantly associated with the use of the APP.

Conclusions

Our results indicate that smartphone APPs to monitor physical activity are developed for younger adults with better socioeconomic status, lower cardiovascular risk, higher quality of life, and greater cardiorespiratory fitness. Greater efforts are needed to develop a science-based APP for people who most need this technology, enabling greater potential to prevent undesirable health outcomes in asymptomatic adults.

Mobile Health Interventions and RCTs: Structured Taxonomy and Research Framework

Mobile Health Interventions (MHIs) have addressed a range of healthcare challenges and have been evaluated using Randomized Controlled Trials (RCTs) to establish clinical effectiveness. Using PRISMA we conducted a systematic literature review of RCTs for MHIs and identified 70 studies which were analyzed and classified using Nickerson-Varshney-Muntermann (NVM) taxonomy. From the resultant iterations of the taxonomy, we extracted insights from the categorized studies. RCTs cover a wide range of health conditions including chronic diseases, general wellness, unhealthy practices, family planning, end-of-life, and post-transplant care. The MHIs that were utilized by the RCTs were varied as well, although most studies did not find significant differences between MHIs and usual care. The challenges for MHI-based RCTs include the use of technologies, delayed outcomes, patient recruitment, patient retention, and complex regulatory requirements. These variances can lead to a higher rate of Type I/Type II errors. Further considerations are the impact of infrastructure, contextual and cultural factors, and reductions in the technological relevancy of the intervention itself. Finally, due to the delayed effect of most outcomes, RCTs of insufficient duration are unable to measure significant, lasting improvements. Using the insights from seventy identified studies, we developed a classification of existing RCTs along with guidelines for MHI-based RCTs and a research framework for future RCTs. The framework offers opportunities for (a) personalization of MHIs, (b) use of richer technologies, and (c) emerging areas for RCTs.

Mobile Health Use by Older Individuals at Risk of Cardiovascular Disease and Type 2 Diabetes Mellitus in an Australian Cohort: Cross-sectional Survey Study

Background

The digital transformation has the potential to change health care toward more consumers’ involvement, for example, in the form of health-related apps which are already widely available through app stores. These could be useful in helping people understand their risk of chronic conditions and helping them to live more healthily.

Objective

With this study, we assessed mobile health app use among older Australians in general and among those who were at risk of cardiovascular disease or type 2 diabetes mellitus.

Methods

In this cross-sectional analysis, we used data from the second follow-up wave of the 45 and Up Study. It is a cohort study from New South Wales, Australia, with 267,153 participants aged 45 years and older that is based on a random sample from the Services Australia (formerly the Australian Government Department of Human Services) Medicare enrollment database. The 2019 follow-up questionnaire contained questions about technology and mobile health use. We further used data on prescribed drugs and hospitalizations to identify participants who already had cardiovascular disease or diabetes or who were at risk of these conditions. Our primary outcome measure was mobile health use, defined as having used a mobile health app before. We used descriptive statistics and multivariate logistic regression to answer the research questions.

Results

Overall, 31,946 individuals with a median age of 69 (IQR 63-76) years had completed the follow-up questionnaire in 2019. We classified half (16,422/31,946, 51.41%) of these as being at risk of cardiovascular disease or type 2 diabetes mellitus and 38.04% (12,152/31,946) as having cardiovascular disease or type 1 or type 2 diabetes mellitus. The proportion of mobile health app users among the at-risk group was 31.46% (5166/16,422) compared to 29.16% (9314/31,946) in the total sample. Those who used mobile health apps were more likely to be female, younger, without physical disability, and with a higher income. People at risk of cardiovascular disease or type 2 diabetes mellitus were not statistically significantly more likely to use mobile health than were people without risk (odds ratio 1.06, 95% CI 0.97-1.16; P=.18; adjusted for age, sex, income, and physical disability).

Conclusions

People at risk of cardiovascular disease or type 2 diabetes mellitus were not more likely to use mobile health apps than were people without risk. Those who used mobile health apps were less likely to be male, older, with a physical disability, and with a lower income. From the results, we concluded that aspects of equity must be considered when implementing a mobile health intervention to reach all those that can potentially benefit from it.

The Use of Digital Health Tools for Health Promotion Among Women With and Without Chronic Diseases: Insights From the 2017-2020 Health Information National Trends Survey

Background

In the United States, almost 90% of women are at risk of at least one chronic condition. However, the awareness, management, and monitoring of these conditions are low and present a substantial public health problem. Digital health tools can be leveraged to reduce the alarmingly high rates of chronic condition–related mortality and morbidity in women.

Objective

This study aimed to investigate the 4-year trend of digital health use for health promotion among women with chronic conditions in the United States.

Methods

Data for this study were obtained from the 2017 to 2020 iterations of the Health Information Trends Survey 5. Separate weighted logistic regression models were conducted to test the unadjusted and adjusted association of the study variables and each digital health use. The 95% CI, adjusted odds ratio (aOR), and P value (.05) were reported. Analysis was conducted using Stata 17 software.

Results

In total, 8573 women were included in this study. The weighted prevalence of the use of a smartphone or tablet for various activities were as follows: track health goals, 50.3% (95% CI 48.4%-52.2%; 3279/7122); make a health decision, 43.6% (95% CI 41.9%-45.3%; 2998/7101); and discuss with a provider, 40% (95% CI 38.2%-41.8%; 2834/7099). In the preceding 12 months, 33% (95% CI 30.9%-35.2%; 1395/4826) of women used an electronic wearable device, 18.7% (95% CI 17.3%-20.2%; 1532/7653) shared health information, and 35.2% (95% CI 33.2%-37.3%; 2262/6349) sent or received an SMS text message with a health professional. Between 2017 and 2020, the weighted prevalence of having 0, 1, and multiple chronic conditions were 37.4% (2718/8564), 33.4% (2776/8564), and 29.3% (3070/8564), respectively. However, slightly above half (52.2%, 95% CI 0.50%-0.53%; 4756/8564) of US women reported having at least one chronic disease. Women with multiple chronic conditions had higher odds of using their tablet or smartphone to achieve a health-related goal (aOR 1.43, 95% CI 1.16-1.77; P=.001) and discuss with their provider (aOR 1.55 95% CI 1.20-2.00; P=.001) than those without any chronic conditions. Correspondingly, in the past 12 months, the odds of using an electronic wearable device (aOR 1.40, 95% CI 1.00-1.96; P=.04), sharing health information (aOR 1.91, 95% CI 1.46-2.51; P<.001), and communicating via SMS text messaging with a provider (aOR 1.31, 95% CI 1.02-1.68; P=.03) were significantly higher among women with chronic conditions than those without a chronic condition.

Conclusions

This study suggests that women with chronic conditions accept and integrate digital health tools to manage their care. However, certain subpopulations experience a digital disconnect that may exacerbate existing health inequities. Implications for research and opportunities to leverage and integrate digital health tools to prevent, monitor, manage, and treat chronic conditions in women are discussed.

Benefits of mHealth Co-design for African American and Hispanic Adults: Multi-Method Participatory Research for a Health Information App

Background

Participatory research methodologies can provide insight into the use of mobile health (mHealth) apps, cultural preferences and needs, and health literacy issues for racial and ethnic groups, such as African Americans and Hispanics who experience health disparities.

Objective

This methodological paper aims to describe a 1-year multi-method participatory research process that directly engaged English-speaking African American and bilingual or Spanish-speaking Hispanic adults in designing a prevention-focused, personalized mHealth, information-seeking smartphone app. We report design team participants’ experiences with the methods to show why our approach is valuable in producing apps that are more aligned with their needs.

Methods

Three design sessions were conducted to inform the iteration of a prevention-focused, personalized mHealth, information-seeking app. The research team led sessions with 2 community member design teams. Design team participants described their goals, motives, and interests regarding prevention information using different approaches, such as collage and card sorting (design session 1), interaction with the app prototype (design session 2), and rating of cultural appropriateness strategies (design session 3).

Results

Each design team had 5 to 6 participants: 2 to 3 male participants and 3 female participants aged between 30 and 76 years. Design team participants shared their likes and dislikes about the sessions and the overall experience of the design sessions. Both African American and Hispanic teams reported positive participation experience. The primary reasons included the opportunity for their views to be heard, collectively working together in the design process, having their apprehension about mHealth reduced, and an opportunity to increase their knowledge of how they could manage their health through mHealth. The feedback from each session informed the following design sessions and a community-engaged process. In addition, the specific findings for each design session informed the design of the app for both communities.

Conclusions

This multi-method participatory research process revealed 4 key lessons learned and recommendations for future research in mHealth app design for African Americans and Hispanics. Lesson 1—community partnerships are key because they provide the chain of trust that helps African American and Hispanic participants feel comfortable participating in app research. Lesson 2—community-based participatory research principles continue to yield promising results to engage these populations in mHealth research. Lesson 3—interactive design sessions uncover participants’ needs and development opportunities for mHealth tools. Lesson 4—multiple design sessions with different methods provide an in-depth understanding of participants’ mHealth preferences and needs. Future developers should consider these methods and lessons to ensure health apps in the marketplace contribute to eliminating health disparities and achieving health equity.

Predictors of Smartphone and Tablet Use Among Patients With Hypertension: Secondary Analysis of Health Information National Trends Survey Data

BACKGROUND

Uncontrolled hypertension leads to significant morbidity and mortality. The use of mobile health technology, such as smartphones, for remote blood pressure (BP) monitoring has improved BP control. An increase in BP control is more significant when patients can remotely communicate with their health care providers through technologies and receive feedback. Little is known about the predictors of remote BP monitoring among hypertensive populations.

OBJECTIVE

The objective of this study is to quantify the predictors of smartphone and tablet use in achieving health goals and communicating with health care providers via SMS text messaging among hypertensive patients in the United States.

METHODS

This study was a cross-sectional, secondary analysis of the 2017 and 2018 Health Information National Trends Survey 5, cycles 1 and 2 data. A total of 3045 respondents answered "Yes" to the question "Has a doctor or other healthcare provider ever told you that you had high blood pressure or hypertension?", which defined the subpopulation used in this study. We applied the Health Information National Trends Survey full sample weight to calculate the population estimates and 50 replicate weights to calculate the SEs of the estimates. We used design-adjusted descriptive statistics to describe the characteristics of respondents who are hypertensive based on relevant survey items. Design-adjusted multivariable logistic regression models were fitted to estimate predictors of achieving health goals with the help of smartphone or tablet and sending or receiving an SMS text message to or from a health care provider in the last 12 months.

RESULTS

An estimated 36.9%, SE 0.9% (183,285,150/497,278,883) of the weighted adult population in the United States had hypertension. The mean age of the hypertensive population was 58.3 (SE 0.48) years. Electronic communication with the doctor or doctor's office through email or internet (odds ratio 2.93, 95% CI 1.85-4.63; P<.001) and having a wellness app (odds ratio 1.82, 95% CI 1.16-2.86; P=.02) were significant predictors of using SMS text message communication with a health care professional, adjusting for other demographic and technology-related variables. The odds of achieving health-related goals with the help of a tablet or smartphone declined significantly with older age (P<.001) and ownership of basic cellphones (P=.04). However, they increased significantly with being a woman (P=.045) or with being married (P=.03), having a wellness app (P<.001), using devices other than smartphones or tablets to monitor health (P=.008), making health treatment decisions (P=.048), and discussing with a provider (P=.02) with the help of a tablet or smartphone.

CONCLUSIONS

Intervention measures accounting for age, gender, marital status, and the patient's technology-related health behaviors are required to increase smartphone and tablet use in self-care and SMS text message communication with health care providers.

The Digital Divide and Seeking Health Information on Smartphones in Asia: Survey Study of Ten Countries

Background

Although recent developments in mobile health have elevated the importance of how smartphones empower individuals to seek health information, research investigating this phenomenon in Asian countries has been rare.

Objective

The goal of our study was to provide a comprehensive profile of mobile health information seekers and to examine the individual- and country-level digital divide in Asia.

Methods

With survey data from 10 Asian countries (N=9086), we ran multilevel regression models to assess the effect of sociodemographic factors, technological factors, and country-level disparities on using smartphones to seek health information.

Results

Respondents who were women (β=.13, P<.001), parents (β=.16, P<.001), employed (β=.08, P=.002), of higher social status (β=.08, P<.001), and/or from countries with low health expenditures (β=.19, P=.02) were more likely to use smartphones to seek health information. In terms of technological factors, technology innovativeness (β=.10, P<.001) and frequency of smartphone use (β=.42, P<.001) were important factors of health information seeking, whereas the effect of online information quality was marginal (β=–.04, P<.001).

Conclusions

Among smartphone users in Asia, health information seeking varies according to individuals’ socioeconomic status, their innovativeness toward technology, and their frequency of smartphone use. Although smartphones widen the digital divide among individuals with different socioeconomic status, they also bridge the divide between countries with varying health expenditures. Smartphones appear to be a particularly useful complement to manage health in developing countries.

Developing and validating a new scale to measure the acceptability of health apps among adolescents

Background

The acceptability of health interventions is centrally important to achieving their desired health outcomes. The construct of acceptability of mobile health interventions among adolescents is neither well-defined nor consistently operationalized.

Objectives

Building on the theoretical framework of acceptability, these two studies developed and assessed the reliability and validity of a new scale to measure the acceptability of mobile health applications (“apps”) among adolescents.

Methods

We followed a structured scale development process including exploratory factor analyses (EFAs), confirmatory factor analyses (CFAs), and employed structural equation modeling (SEM) to assess the relationship between the scale and app usage. Adolescent participants used the Fooducate healthy eating app and completed the acceptability scale at baseline and one-week follow-up.

Results

EFA (n = 182) determined that the acceptability of health apps was a multidimensional construct with six latent factors: affective attitude, burden, ethicality, intervention coherence, perceived effectiveness, and self-efficacy. CFA (n = 161) from the second sample affirmed the six-factor structure and the unidimensional structures for each of the six subscales. However, CFA did not confirm the higher-order latent factor model suggesting that the six subscales reflect unique aspects of acceptability. SEM indicated that two of the subscales—ethicality and self-efficacy—were predictive of health app usage at one-week follow-up.

Conclusions

These results highlight the importance of ethicality and self-efficacy for health app acceptability. Future research testing and adapting this new acceptability scale will enhance measurement tools in the fields of mobile health and adolescent health.

A Survey Research on the Willingness of Gynecologists to Employ Mobile Health Applications

In gynecological care, mHealth (mobile health) technology may play an important role. Medical professionals' willingness to use this technology is the key to its acceptance. Most doctors utilize mobile health technology; however, there is still room for improvement in the use of mHealth. Gynecologists were asked to participate in this research to see how open they were to use mobile health technologies. In this descriptive-analytical investigation, the researchers determined the average scores for each variable. The overall mean for preparedness to embrace mobile medical technology is 1.8 out of 2, as shown in Table 1. When it came to their desire to embrace mobile health technology, doctors' years of experience correlated negatively with their age. According to our findings, the amount of interest in mobile health technology is high. Patients' private information must be protected throughout the usage of this technology though. Mobile health technology may effectively reach patients in remote areas, but it is not a substitute for face-to-face encounters with medical professionals.

Tracking Lower Urinary Tract Symptoms and Tamsulosin Side Effects Among Older Men Using a Mobile App (PERSONAL): Feasibility and Usability Study

Background

Continuous α1a-blockade is the first-line treatment for lower urinary tract symptoms (LUTS) among older men with suspected benign prostatic hyperplasia. Variable efficacy and safety for individual men necessitate a more personalized, data-driven approach to prescribing and deprescribing tamsulosin for LUTS in older men.

Objective

We aim to evaluate the feasibility and usability of the PERSONAL (Placebo–Controlled, Randomized, Patient-Selected Outcomes, N-of-1 Trials) mobile app for tracking daily LUTS severity and medication side effects among older men receiving chronic tamsulosin therapy.

Methods

We recruited patients from the University of California, San Francisco health care system to participate in a 2-week pilot study. The primary objectives were to assess recruitment feasibility, study completion rates, frequency of symptom tracking, duration of tracking sessions, and app usability rankings measured using a follow-up survey. As secondary outcomes, we evaluated whether daily symptom tracking led to changes in LUTS severity, perceptions of tamsulosin, overall quality of life, medication adherence between baseline and follow-up surveys, and perceived app utility.

Results

We enrolled 19 men within 23 days, and 100% (19/19) of the participants completed the study. Each participant selected a unique combination of symptoms to track and recorded data in the PERSONAL app, with a median daily completion rate of 79% (11/14 days). The median duration of the app session was 44 (IQR 33) seconds. On a scale of 1 (strongly disagree) to 5 (strongly agree), the participants reported that the PERSONAL app was easy to use (mean 4.3, SD 1.0), that others could learn to use it quickly (mean 4.2, SD 0.9), and that they felt confident using the app (mean 4.4, SD 0.8). LUTS severity, quality of life, and medication adherence remained unchanged after the 2-week study period. Fewer men were satisfied with tamsulosin after using the app (14/19, 74% vs 17/19, 89% at baseline), although the perceived benefit from tamsulosin remained unchanged (18/19, 95% at baseline and at follow-up). In total, 58% (11/19) of the participants agreed that the PERSONAL app could help people like them manage their urinary symptoms.

Conclusions

This pilot study demonstrated the high feasibility and usability of the PERSONAL mobile app to track patient-selected urinary symptoms and medication side effects among older men taking tamsulosin to manage LUTS. We observed that daily symptom monitoring had no adverse effects on the secondary outcomes. This proof-of-concept study establishes a framework for future mobile app studies, such as digital n-of-1 trials, to collect comprehensive individual-level data for personalized LUTS management in older men.

Perceptions and Attitudes Toward the Use of a Mobile Health App for Remote Monitoring of Gingivitis and Willingness to Pay for Mobile Health Apps (Part 3): Mixed Methods Study

Background

Gum infection, known as gingivitis, is a global issue. Gingivitis does not cause pain; however, if left untreated, it can worsen, leading to bad breath, bleeding gums, and even tooth loss, as the problem spreads to the underlying structures anchoring the teeth in the jaws. The asymptomatic nature of gingivitis leads people to postpone dental appointments until clinical signs are obvious or pain is evident. The COVID-19 pandemic has necessitated social distancing, which has caused many people to postpone dental visits and neglect gingival health. iGAM is a dental mobile health (mHealth) app that remotely monitors gum health, and an observational study demonstrated the ability of iGAM to reduce gingivitis. We found that a weekly dental selfie using the iGAM app reduced the signs of gingivitis and promoted oral health in a home-based setting.

Objective

The aim of this mixed methods study is to assess perceptions, attitudes, willingness to pay, and willingness to use an mHealth app.

Methods

The first qualitative phase of the study included eight semistructured interviews, and the second quantitative phase included data collected from responses to 121 questionnaires.

Results

There was a consensus among all interviewees that apps dealing with health-related issues (mHealth apps) can improve health. Three themes emerged from the interviews: the iGAM app is capable of improving health, the lack of use of medical apps, and a contradiction between the objective state of health and the self-definition of being healthy. Participants were grouped according to how they responded to the question about whether they believed that mHealth apps could improve their health. Participants who believed that mHealth apps can enhance health (mean 1.96, SD 1.01) had a higher willingness to pay for the service (depending on price) than those who did not believe in app efficacy (mean 1.31, SD 0.87; t₁₁₉=−2417; P=.02). A significant positive correlation was found between the amount a participant was willing to pay and the benefits offered by the app (rs=0.185; P=.04).

Conclusions

Potential mHealth users will be willing to pay for app use depending on their perception of the app’s ability to help them personally, provided they define themselves as currently unhealthy.

The development of the postpartum mobile support application and the effect of the application on mothers' anxiety and depression symptoms

OBJECTIVE

The study aimed to develop the postpartum mobile support application to support postpartum mothers and to examine the effects of the use of mobile app on mothers' anxiety level and depression symptoms.

RESEARCH DESIGN/SETTING

It is a parallel group pretest-posttest randomized controlled study carried out between July 2017 and February 2020. The mothers (62 in the experiment and 62 in the control group) who gave birth in full-term at a university hospital in Konya province in Turkey and who had healthy newborns constituted the study group. Data were collected using the Information Form, the STAI State and Continuity Anxiety Scale, and the Edinburgh Postpartum Depression Scale. Mixed pattern variance analysis (mixed anova), t test in dependent groups, t test and chi square analysis in independent groups were used to analyze the data.

FINDINGS

Most of the mothers who used the application fed their baby only with breast milk and felt more sufficient about breastfeeding. The depression symptoms of mothers using the postpartum mobile support application was lower than that of the mothers in the control group; however, it was found that the application was not adequate alone to decrease anxiety levels and depression symptoms (p > 0.05).

CONCLUSIONS

The postpartum mobile support application is an important and useful source in accessing reliable information; however, it was found to be insufficient to lower anxiety levels and prevent depression symptoms at the end of the six-week postpartum period.

Use of smartphones, mobile apps and wearables for health promotion by people with anxiety or depression: An analysis of a nationally representative survey data

People with mental illness have increased cardiovascular risk factors, which contributes significantly to mortality in this population. Digital interventions have emerged as promising models to promote physical health, although their potential for use in mental health populations is relatively unexplored. We examined the potential for using digital tools for health promotion by people with common mental disorders like anxiety or depression. Using data from the 2019 edition of the Health Information National Trends Survey (HINTS 5), we evaluated differences between individuals with self-reported history of diagnosed depression/anxiety and the general population with respect to ownership, usage, and perceived usefulness of digital tools for managing their health. Overall, individuals with anxiety or depression were as likely as the general population to use digital devices for their care. Those with anxiety or depression who had health apps were more likely to report intentions to lose weight than those without health apps. Significant sociodemographic predictors of digital tools usage included gender, age, income, and education level. People with anxiety or depression own and use digital health tools at similarly high rates to the general population, suggesting that these tools present a novel opportunity for health promotion among people with these disorders.

Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies

Background

Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities.

Objective

This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage.

Methods

A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R.

Results

A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83).

Conclusions

A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.

Using an mHealth App (iGAM) to Reduce Gingivitis Remotely (Part 2): Prospective Observational Study

BACKGROUND

Gingivitis is a nonpainful, inflammatory condition that can be managed at home. Left untreated, gingivitis can lead to tooth loss. Periodic dental examinations are important for early diagnosis and treatment of gum diseases. To contain the spread of the coronavirus, governments, including in Israel, have restricted movements of their citizens which might have caused routine dental checkups to be postponed.

OBJECTIVE

This study aimed to examine the ability of a mobile health app, iGAM, to reduce gingivitis, and to determine the most effective interval between photograph submissions.

METHODS

A prospective observational cohort study with 160 unpaid participants divided into 2 equal groups using the iGAM app was performed. The intervention group photographed their gums weekly for 8 weeks. The wait-list control group photographed their gums at the time of recruitment and 8 weeks later. After photo submission, the participants received the same message "we recommended that you read the information in the app regarding oral hygiene habits." A single-blinded researcher examined all the images and scored them according to the Modified Gingival Index (MGI).

RESULTS

The average age of the intervention group was 26.77 (SD 7.43) and 28.53 (SD 10.44) for the wait-list control group. Most participants were male (intervention group: 56/75,74.7%; wait-list control group: 34/51, 66.7%) and described themselves as "secular"; most were "single" non-smokers (intervention group: 56/75, 74.7%; wait-list control group: 40/51, 78.4%), and did not take medications (intervention group: 64/75, 85.3%; wait-list control group: 40/51, 78.4%). A total of 126 subjects completed the study. A statistically significant difference (P<.001) was found in the dependent variable (MGI). Improvements in gingival health were noted over time, and the average gingivitis scores were significantly lower in the intervention group (mean 1.16, SD 1.18) than in the wait-list control group (mean 2.16, SD 1.49) after 8 weeks. Those with more recent dental visits had a lower MGI (P=.04). No association was found between knowledge and behavior. Most participants were familiar with the recommendations for maintaining oral health, yet they only performed some of them.

CONCLUSIONS

A dental selfie taken once a week using an mobile health app (iGAM) reduced the signs of gingivitis and promoted oral health. Selfies taken less frequently yielded poorer results. During the current pandemic, where social distancing recommendations may be causing people to avoid dental clinics, this app can remotely promote gum health.

Feature Availability Comparison in Free and Paid Versions of Popular Smartphone Weight Management Applications

OBJECTIVE

Characterize capabilities of nutrition applications (apps) for weight management and associations between features, ratings, and app installations.

DESIGN

Calorie tracking apps with weight management as a primary outcome were selected from the Apple App Store and Google Play Store using keywords "diet" and "weight loss."

METHODS

Reviewers assessed free and upgraded versions of nutrition apps (n = 15) for features within 4 categories: (1) dietary intake, (2) anthropometrics, (3) physical activity, and (4) behavior change strategies.

OUTCOME MEASURES

Presence of specific app features, app ratings, and app installations.

ANALYSIS

Descriptive statistics of free and paid app versions. Spearman rank-order correlations were used to determine associations between feature inclusion, app ratings, and installations.

RESULTS

The apps had the greatest number of features in the dietary intake category. Additional dietary intake features were those most likely obtained through a subscription purchase. Behavior change content was absent from most apps. The macronutrient adjustment feature was strongly associated with average app ratings (r_s = 0.74; P < 0.002) and with subscription costs (r_s = 0.60; P < 0.019).

CONCLUSIONS AND IMPLICATIONS

This study found most nutrition apps possess an abundance of features dedicated to dietary intake, anthropometric, and physical activity tracking while also being notably devoid of behavior change content features.

Mobile health in preventive cardiology: current status and future perspective

PURPOSE OF REVIEW

Despite cutting edge acute interventions and growing preventive strategies supported by robust clinical trials, cardiovascular disease (CVD) has stubbornly persisted as a leading cause of death in the United States and globally. The American Heart Association recognizes mobile health technologies (mHealth) as an emerging strategy in the mitigation of CVD risk factors, with significant potential for improving population health. The purpose of this review is to highlight and summarize the latest available literature on mHealth applications and provide perspective on future directions and barriers to implementation.

RECENT FINDINGS

While available randomized controlled trials and systematic reviews tend to support efficacy of mHealth, published literature includes heterogenous approaches to similar problems with inconsistent results. Some of the strongest recent evidence has been focused on the use of wearables in arrhythmia detection. Systematic reviews of mHealth approaches demonstrate benefit when applied to risk factor modification in diabetes, cigarette smoking cessation, and physical activity/weight loss, while also showing promise in multi risk factor modification via cardiac rehabilitation.

SUMMARY

Evidence supports efficacy of mHealth in a variety of applications for CVD prevention and management, but continued work is needed for further validation and scaling. Future directions will focus on platform optimization, data and sensor consolidation, and clinical workflow integration. Barriers include application heterogeneity, lack of reimbursement structures, and inequitable access to technology. Policies to promote access to technology will be critical to evidence-based mHealth technologies reaching diverse populations and advancing health equity.

Patient connectivity with healthcare professionals and health insurer using digital health technologies during the COVID-19 pandemic: a German cross-sectional study

Background

Digital health technologies enable patients to make a personal contribution to the improvement of their health by enabling them to manage their health. In order to exploit the potential of digital health technologies, Internet-based networking between patients and health care providers is required. However, this networking and access to digital health technologies are less prevalent in sociodemographically deprived cohorts. The paper explores how the use of digital health technologies, which connect patients with health care providers and health insurers has changed during the COVID-19 pandemic.

Methods

The data from a German-based cross-sectional online study conducted between April 29 and May 8, 2020, were used for this purpose. A total of 1.570 participants were included in the study. Accordingly, the influence of sociodemographic determinants, subjective perceptions, and personal competencies will affect the use of online booking of medical appointments and medications, video consultations with providers, and the data transmission to health insurers via an app.

Results

The highest level of education (OR 1.806) and the presence of a chronic illness (OR 1.706) particularly increased the likelihood of using online booking. With regard to data transmission via an app to a health insurance company, the strongest increase in the probability of use was shown by belonging to the highest subjective social status (OR 1.757) and generation Y (OR 2.303). Furthermore, the results show that the higher the subjectively perceived restriction of the subjects' life situation was due to the COVID-19 pandemic, the higher the relative probability of using online booking (OR 1.103) as well as data transmission via an app to a health insurance company (OR 1.113). In addition, higher digital literacy contributes to the use of online booking (OR 1.033) and data transmission via an app to the health insurer (OR 1.034).

Conclusions

Socially determined differences can be identified for the likelihood of using digital technologies in health care, which persist even under restrictive conditions during the COVID-19 pandemic. Thus, the results indicate a digital divide with regard to the technologies investigated in this study.

Mobile health apps use among Jordanian outpatients: A descriptive study

Our purpose in this descriptive cross-sectional study was to examine the prevalence of mobile health (mHealth) apps use, factors associated with downloading mHealth apps, and to describe characteristics of mHealth apps use among Jordanian patients in government-sponsored outpatient clinics. A total of 182 (41.6%) of the 438 outpatients who completed questionnaires downloaded mHealth apps. Common reasons for downloading mHealth apps included tracking physical activity, losing weight, learning exercises, as well as monitoring, and controlling diet. More than two thirds of the users (70%) stopped using the apps they downloaded due to loss of interest, lack of anticipated support, too time consuming, or better apps available. The most common personal reasons for never downloading mHealth apps were lack of interest, in good health, and the most common technical reasons included a limited data plan, lack of trust, cost, and complexity of the apps. We also found that gender, age, weight, and educational level influenced the decision whether to download mHealth apps or not. We have shown the potential in mHealth apps use among Jordanian patients is promising, and health care systems must adopt this technology as well as work through population needs and preferences to supply it.

Exploring the Use of Mobile and Wearable Technology among University Student Athletes in Lebanon: A Cross-Sectional Study

The markets of commercial wearables and health and fitness apps are constantly growing globally, especially among young adults and athletes, to track physical activity, energy expenditure and health. Despite their wide availability, evidence on use comes predominantly from the United States or Global North, with none targeting college student-athletes in low- and middle-income countries. This study was aimed to explore the use of these technologies among student-athletes at the American University of Beirut (AUB). We conducted a cross-sectional survey of 482 participants (average age 20 years) enrolled in 24 teams during Fall 2018; 230 students successfully completed the web-based survey, and 200 provided valid data. Fifty-three (26.5%) have owned a fitness tracker, mostly for self-monitoring. The most popular were Fitbit, Apple Watch, and Garmin. Similarly, 82 students (40%) used apps, primarily MyFitnessPal, Apple Health, and Samsung Health. Nevertheless, many participants discontinued use due to loss of interest or technical issues (breaking, usability, obsolescence, or lack of engagement). Wearable devices were considered superior to mobile phones alone as physical activity monitors. However, forming regular habits made self-monitoring via technology irrelevant. Further research is needed to better understand what motivates continuous use among student-athletes, who could use trackers to improve athletic performance and overall health.

Healthcare-seeking behaviours in college students and young adults: a review

BACKGROUND/AIMS

To review the literature on college students' healthcare-seeking behaviours to uncover the current evidence and promote better healthcare-seeking behaviours and essentially better health outcomes in young adults.

METHODS

The researchers conducted an extensive literature review using CINAHL, Cochrane, PubMed, EBSCOhost and Google Scholar in the years 2018 and 2019. The search was limited to the past 18 years (2000-2018) and to studies reported in the English language focused on the general healthcare-seeking behaviour of college students. The search was also extended to young adults (aged 18-39 years).

RESULTS

A total of 56 articles were identified for abstract review and only 28 articles met the inclusion criteria for the final review. The following themes emerged to organise our findings: healthcare-seeking behaviour among college students, health information resource utilisation and its influence on healthcare-seeking behaviours and barriers to accessing care among college students.

CONCLUSIONS

This review summarises the current body of knowledge related to healthcare-seeking behaviour among college students, health information resource utilisation and its influence on healthcare-seeking behaviour and barriers to accessing care among this population. Important measures further to address the health needs and interventions for addressing these needs among the college student population are discussed.

Person-Generated Health Data in Women's Health: Protocol for a Scoping Review

Background

Due to their ability to collect person-generated health data, digital tools and connected health devices may hold great utility in disease prevention, chronic disease self-monitoring and self-tracking, as well as in tailoring information and educational content to fit individual needs. Facilitators and barriers to the use of digital health technologies vary across demographics, including sex. The “femtech” market is growing rapidly, and women are some of the largest adopters of digital health technologies.

Objective

This paper aims to provide the background and methods for conducting a scoping review on the use of person-generated health data from connected devices in women’s health. The objectives of the scoping review are to identify the various contexts of digital technologies in women’s health and to consolidate women’s views on the usability and acceptability of the devices.

Methods

Searches were conducted in the following databases: Medline, Embase, APA PsycInfo, CINAHL Complete, and Web of Science Core Collection. We included articles from January 2015 to February 2020. Screening of articles was done independently by at least two authors in two stages. Data charting is being conducted in duplicate. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist.

Results

Our search identified 9102 articles after deduplication. As of November 2020, the full-text screening stage is almost complete and data charting is in progress. The scoping review is expected to be completed by Fall 2021.

Conclusions

This scoping review will broadly map the literature regarding the contexts and acceptability of digital health tools for women. The results from this review will be useful in guiding future digital health and women’s health research.

International Registered Report Identifier (IRRID)

DERR1-10.2196/26110

Online medical services utilization evaluated through the lens of socioecological theory and the information-motivation-behavioral skills model: evidence from China

Online medical services (OMS) have become increasingly advantageous, but there are still several barriers to utilization among patients. This study aims to explore the factors influencing OMS utilization (OMSU) for patients in micro-, meso-, and macrosystems based on socioecological theory (SET) and from the perspective of the information-motivation-behavioral skills (IMB) model. We selected 1065 participants through multistage stratified cluster random sampling in Jiangsu, China. In microsystems, information and behavioral skills were positively associated with intention (β = 0.84; β = 3.21) and actual utilization (OR = 1.69; OR = 1.69). Education level (β = 0.83) and personal motivation (β = 1.68) were positively related to intention. Chronic diseases (OR = 2.03) had a positive relationship with actual use. In mesosystems, recommendations from people around the patients (β = 1.14; OR = 1.99), provision of OMS in the nearest primary medical facility (β = 0.98; OR = 3.60), and provision of instructional information by medical institutions (β = 1.01; OR = 1.65) were related to OMSU. The average monthly household income (β = 0.54) was related to intention. Patients who had information about the OMSU experiences of people around them (OR = 1.73) correlated with actual utilization. In macrosystems, the social medical insurance type (OR = 0.66) was associated with OMSU. This study supports the applicability of the SET and IMB model to interpret patients' OMSU.

Communicating personalized risk of diabetes and offering weight reduction program choice: Recruitment, participation, and outcomes

OBJECTIVE

Low patient recruitment into diabetes prevention programs is a challenge. The primary aim of this study was to demonstrate that an increased recruitment rate can be achieved by communicating personalized risk of progression to type 2 diabetes, estimating risk reduction with weight loss, and offering program choice. Secondary aims included program participation rate, weight loss, and short-term decreased diabetes risk.

METHODS

In this single-arm study, persons with prediabetes from 3 primary care sites received a letter that communicated their personalized risk of progression to diabetes within 3-years, estimated risk reduction with 5, 10, 15 % weight loss, reported in pounds, and offered a choice of 5 free, 6-month, programs. A one-sided test was used to compare the recruitment rate against the maximum expected rate of (10 %).

RESULTS

Recruitment response rate was 25.3 % (81/328, 95 % CI=[20.0 %, 29.4 %]) which was significantly higher than expected (p < 0.0001). Overall, 65 % of participants completed >75 % of contacts. BMI, HbA1c, and diabetes risk (all p < 0.0001) improved at 6 months; BMI (p < 0.0001) and HbA1c (p < 0.05) improved at 12 months.

CONCLUSION

Recruitment response rate was better than expected.

PRACTICE IMPLICATIONS

Communicating personalized risk and reduction estimates with a choice of programs resulted in favorable outcomes, sustained at 1-year.

Linking health information seeking to patient-centered communication and healthy lifestyles: an exploratory study in China

The existing research routinely measures the influence of health information-seeking behavior (HISB) as a whole, which does not capture the complexity and diversity of media channel usage in HISB. The influence of HISB on patient's lifestyle behaviors and the mediation process through patient-centered communication (PCC) in medical encounters has been understudied in previous literature. Drawing from Street's three-stage model, this study conducted a secondary analysis of the Health Information National Trends Survey in China to investigate the influences of HISB across five different media outlets (e.g. information-oriented media, entertainment-oriented media, search engines, social media and mobile health applications) on two types of healthy lifestyles (e.g. physical activity, fruit and vegetable consumption), by the mediation of PCC. PROCESS path-analysis with bootstrapping estimation was used to test the hypothesized relationships. The results revealed that HISB is positively related to PCC, and PCC positively predicts frequent engagement in healthy lifestyles. Moreover, PCC partially mediates the effect of information-oriented media HISB on healthy lifestyles and fully mediates the effect of HISB through the other four media sources. This study highlights the essential stage of PCC transferring HISB to engagement in healthy lifestyles and draws attention to the varying influences of media channels carrying different characteristics.

Barriers to and Facilitators for Using Nutrition Apps: Systematic Review and Conceptual Framework

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.

Influencing Factors of Acceptance and Use Behavior of Mobile Health Application Users: Systematic Review

Purpose/Significance: Mobile health applications provide a convenient way for users to obtain health information and services. Studying the factors that influence users’ acceptance and use of mobile health applications (apps or Apps) will help to improve users’ actual usage behavior. Method/Process: Based on the literature review method and using the Web of Science core database as the data source, this paper summarizes the relevant research results regarding the influencing factors of the acceptance and use behavior of mobile health application users and makes a systematic review of the influencing factors from the perspectives of the individual, society, and application (app or App) design. Result/Conclusion: In terms of the individual dimension, the users’ behavior is influenced by demographic characteristics and motivations. Social attributes, source credibility, and legal issues all affect user behavior in the social dimension. In the application design dimension, functionality, perceived ease of use and usefulness, security, and cost are the main factors. At the end of the paper, suggestions are given to improve the users’ acceptability of mobile health applications and improve their use behavior.