Mobile personal health records for pregnancy monitoring functionalities: Analysis and potential

Prenatal anxiety recognition model integrating multimodal physiological signal

Anxiety among pregnant women can significantly impact their overall well-being. However, the development of data-driven HCI interventions for this demographic is often hindered by data scarcity and collection challenges. In this study, we leverage the Empatica E4 wristband to gather physiological data from pregnant women in both resting and relaxed states. Additionally, we collect subjective reports on their anxiety levels. We integrate features from signals including Blood Volume Pulse (BVP), Skin Temperature (SKT), and Inter-Beat Interval (IBI). Employing a Support Vector Machine (SVM) algorithm, we construct a model capable of evaluating anxiety levels in pregnant women. Our model attains an emotion recognition accuracy of 69.3%, marking achievements in HCI technology tailored for this specific user group. Furthermore, we introduce conceptual ideas for biofeedback on maternal emotions and its interactive mechanism, shedding light on improved monitoring and timely intervention strategies to enhance the emotional health of pregnant women.

Quality of Care in Hospitals and the Use of Mobile-Based Personal Health Record Applications: An Exploratory Study Using National Hospital Evaluation Data

The use of mobile-based personal health record (m-PHR) applications at the hospital level has been minimally studied. This study aimed to investigate the relationship between m-PHR use and quality of care. A cross-sectional study design was employed, analyzing data from 99 hospitals. Two data sources were utilized: a previous m-PHR investigation conducted from 26 May to 30 June 2022 and a hospital evaluation dataset on quality of care. The use of m-PHR applications was measured by the number of m-PHR application downloads. Three independent variables were assessed: quality of care in the use of antibiotic drugs, injection drugs, and polypharmacy with ≥6 drugs. A generalized linear model was used for the analysis. The hospitals providing high-quality care, as evaluated based on the rate of antibiotic prescription (relative risk [RR], 3.328; 95% confidence interval [CI], 1.840 to 6.020; p < 0.001) and polypharmacy (RR, 2.092; 95% CI, 1.027 to 4.261; p = 0.042), showed an increased number of m-PHR downloads. Among the hospital covariates, public foundation status and being part of multi-hospital systems were associated with the number of m-PHR downloads (p < 0.05). This exploratory study found a positive relationship between quality of care and m-PHR use. Hospitals providing high-quality care may also excel in various activities, including m-PHR application use.

Mobile health apps for pregnant women usability and quality rating scales: a systematic review

OBJECTIVE

This study is to identify the apps used by pregnant women during the technology era and to choose the best app from the point of view of pregnant women and experts.

METHODS

The article is a research article that uses PRISMA flowchart. Given that there are many apps in the field of pregnancy and due to technological advances, the articles of the last 13 years that have been scientifically published in the databases of Google Scholar, PubMed, and Science Direct have been analyzed. The most widely used and, at the same time, the best app is introduced in terms of its high usability in users' attitude. Finally, Apps will be compared in terms of accuracy, precision, and usability of the dimensions of Jacob Nielsen's five principles.

RESULTS

According to the search strategy, 23 articles were identified qualitatively by reviewing both authors. Then, the types of apps were divided into three general categories, pregnant entertainment apps, pregnant information apps, and monitoring apps for mothers' physical health. Finally, 10 apps were selected and the Amila app was introduced as the best due to its high usability (Effectiveness %66.66) and users' satisfaction or women's choice (%98).

CONCLUSION

Using trusted apps to maintain their health and reduce traffic will be very important. Given that this research article was written with the aim of choosing the best app, that not only provides the required information to mothers, but also the ability to interact with doctors and specialists.

'Putting all my eggs into the app': Self, relational and systemic surveillance of mothers' use of digital technologies during the transition to parenting

This paper builds on thematic findings from a larger study that explored how digital technologies (e.g. smartphones, apps, search engines) shape expectant and new mothers' early parenting practices. An overarching theme that arose across these mothers' experiences which deserved deeper exploration was relational digital surveillance. In the context of this paper, relational digital surveillance describes how mothers evaluate their sense of preparedness, goodness or suitability for motherhood as they transition into parenting in relation to: their own use of digital technologies when caring for their pregnant bodies (self-surveillance), partners' and family members' commentary and/or judgement regarding their use of digital technologies to support their parenting and decision-making (familial surveillance) in addition to service/health care providers' commentary and/or judgement concerning their technology use (systemic surveillance). Mothers' use of digital technologies in this study not only provided others (partners, family members, health care providers) with means to watch over their actions and bodies as they transitioned into motherhood but offered a new evaluative dimension for others to scrutinize their behaviour as a new mother. Such understandings of relational digital surveillance within the transition to parenting context raise critical questions concerning the promotion and commercialization of digital self-surveillance technologies among expectant/new parents given the ways these technologies can further push the boundaries of hegemonic mothering practices and contribute to feelings of inadequacy and self-doubt. Alternatively, these insights offer avenues where health care providers can intervene to facilitate activities that enhance digital health literacy skills and mitigate parents' exposure to platforms that amplify anxieties.

Safety considerations for assessing the quality of apps used during pregnancy: A scoping review

Objective

Pregnant women are increasingly turning to apps targeting knowledge and behaviour change for supporting healthy lifestyles and managing medical conditions. Yet, there is growing concern over the credibility and safety of content within mobile health (mHealth) apps. This scoping review aimed to systematically and thematically consolidate safety considerations described in reviews evaluating pregnancy-specific apps.

Methods

PubMed, Ovid MEDLINE® and EPub, CINAHL, Web of Science, Cochrane Libraries, and SCOPUS were systematically searched to identify reviews that assessed apps targeting pregnant women. Data related to safety were extracted and thematically analysed to establish a set of relevant safety considerations.

Results

Sixteen reviews met the inclusion criteria. The included reviews assessed an average of 27 apps each and targeted pregnancy topics, such as nutrition and physical activity. Five major and 20 minor themes were identified, including information, transparency, credibility, privacy and security, and app tailoring. Information, transparency, and credibility relate to the evidence base of information within the app, privacy and security of apps relate to the protection of personal information and data, and app tailoring relates to the consideration of contextual factors, such as local guidelines and digital health literacy.

Conclusions

Results present possible safety considerations when evaluating pregnancy-specific apps and emphasise a clear need for consumer guidance on how to make informed decisions around engagement and use of mHealth apps during pregnancy.

Utility, Value, and Benefits of Contemporary Personal Health Records: Integrative Review and Conceptual Synthesis

Background

Contemporary personal health record (PHR) technologies offer a useful platform for individuals to maintain a lifelong record of personally reported and clinically sourced data from various points of medical care.

Objective

This paper presents an integrative review and synthesis of the extant literature on PHRs. This review draws upon multiple lenses of analysis and deliberates value perspectives of PHRs at the product, consumer, and industry levels.

Methods

Academic databases were searched using multiple keywords related to PHRs for the years 2001-2020. Three research questions were formulated and used as selection criteria in our review of the extant literature relevant to our study.

Results

We offer a high-level functional utility model of PHR features and functions. We also conceptualize a consumer value framework of PHRs, highlighting the applications of these technologies across various health care delivery activities. Finally, we provide a summary of the benefits of PHRs for various health care constituents, including consumers, providers, payors, and public health agencies.

Conclusions

PHR products offer a myriad of content-, connectivity-, and collaboration-based features and functions for their users. Although consumers benefit from the tools provided by PHR technologies, their overall value extends across the constituents of the health care delivery chain. Despite advances in technology, our literature review identifies a shortfall in the research addressing consumer value enabled by PHR tools. In addition to scholars and researchers, our literature review and proposed framework may be especially helpful for value analysis committees in the health care sector that are commissioned for the appraisal of innovative health information technologies such as PHRs.

The role of smart monitoring digital health care system based on smartphone application and personal health record platform for patients diagnosed with coronavirus disease 2019

Background

The massive outbreak of the novel coronavirus disease 2019 (COVID-19) in Daegu city and Gyeongsangbuk-do, Republic of Korea (ROK), caused the exponential increase in new cases exceeding 5000 within 6 weeks. Therefore, the community treatment center (CTC) with a digital health care monitoring system based on the smartphone application and personal health record platform (PHR) was implemented. Thus, we report our experience in one of the CTCs to investigate the role of CTC and the feasibility of the digital health care monitoring system in the COVID-19 pandemic.

Methods

The Gyeongbuk-Daegu 2 CTC was set up at the private residential facility. Admission criteria were 1) patients < 65 years with COVID-19, 2) patients without underlying medical comorbidities, and 3) COVID-19 disease severity of mild class. Admitted patients were placed under monitoring of vital signs and symptoms. Clinical information was collected using the smartphone application or telephone communication. Collected information was displayed on the PHR platform in a real-time fashion for close monitoring.

Results

From Mar 3, 2020, to Mar 26, 2020, there was a total of 290 patients admitted to the facility. Males were 104 (35.9%). The median age was 37 years. The median time between the COVID-19 diagnosis and admission was 7 days. Five patients were identified and were transferred to the designed COVID-19 treatment hospital for their urgent medical needs. The smartphone application usage to report vital signs and symptoms was noted in 96% of the patients. There were no deaths of the patients.

Conclusions

Our results suggest that implementation of the CTC using a commercial residence facility and digital health care technology may offer valuable solutions to the challenges posed by the COVID-19 outbreak.

Energy efficiency in software: A case study on sustainability in personal health records

A personal health record is an eHealth technology in which users can observe their progress over time for a given condition. A research gap was identified in the literature concerning the study of the amount of energy that these systems need for their operation, and the energy efficiency that may be attained depending on their design. After the selection of five representative personal health records, a total of 20 tasks commonly done, and based on previous work, were performed with regard to two proposed scenarios, namely patient use and health personnel usage. The power consumption of the main components of a host machine was measured during the performance of the proposed duties. To that end, a hardware tool called the Energy Efficiency Tester was employed. The data collected were analyzed statistically, and significant differences were found in the respective consumption of the display (χ2 (4) = 23.782, p = 0.000), the processor (χ2 (4) = 29.018, p = 0.000) and the whole PC (χ2 (4) = 28.582, p = 0.000). For all of these components, NoMoreClipBoard was the personal health record that required the least energy (57.699 W for the display, 3.162 W for the processor and 181.113 W for the whole PC). A total of two strong correlations were found in the energy consumption between the hard disk and the graphics card (r = 0.791, p < 0.001), and the processor and the PC (r = 0.950, p < 0.001). Some features generated special amounts of power consumption, such as the news wall found on PatientsLikeMe, or the use of load icons that had an impact on most PC components. In addition, an in-depth analysis of the user interfaces was performed. A discussion was carried out on the design of the user interfaces, also taking into account recommendations drawn from the literature, checking for their implementation in the personal health records selected. With the aim of promoting sustainability among software developers, a best practice guideline on sustainable software design was proposed. Basic sustainability recommendations were collected for professionals to consider when developing a software system in general, and a personal health record in particular.

Mobile Technology for Improved Contraceptive Care in Morocco

The fulfillment of unmet needs for contraception can help women reach their reproductive goals. Therefore, there is a growing concern worldwide about contraception and women's knowledge of making an advised choice about it. In this aspect, an outgrown number of apps are now available providing information concerning contraception whether it concerns natural contraception or modern contraception. However, vast amounts of these apps contain inaccurate sexual health facts and non-evidence-based information concerning contraception. On these bases, and in respect to: (1) the needs of women to effectively prevent unintended pregnancies while conducting a stress-free healthy lifestyle. (2) the World Health Organization (WHO) Medical Eligibility Criteria (MEC) for contraception's recommendations, and (3) the results/recommendations of a field study conducted in the reproductive health center 'Les Orangers' in Rabat to collect the app's requirements, we developed an evidence-based patient-centered contraceptive app referred to as 'MyContraception'. Thereafter, we conducted a set of functional tests to ensure that the MyContraception solution is performing as expected and is conform to the software functional requirements previously set before moving to non-functional requirements evaluation. Since customer's feedback is valuable to non-functional testing, we choose to evaluate potential users' feedback. Moreover, giving that mobile app testing is a complex process involving different skill sets, we elaborated a rigorous experimental design to conduct an empirical evaluation of the MyContraception solution, which will exhaustively assess the overall quality of this solution and examine its effects on improving the quality of patient-centered contraception care.

Designing an IT Ecosystem for Pregnancy Care Management Based on Pervasive Technologies

Pregnancy care is a topic of interest for both academia and practitioners. Novel pervasive technologies and applications, such as mobile technologies, wearables and IoT, open a wide corpus of possibilities for fostering pregnancy care management, and reducing risks and problems, improving communication among stakeholders and society development. This article introduces a model of a pregnancy care IT ecosystem based on the integration of various services in a semantically enriched e-health ecosystem. As proof of concept, both the web and mobile applications that aim to help pregnant women and gynaecologists were designed and employed in a real environment. An evaluation of the developed ecosystem was performed on a sample of 500 pregnant women and 100 doctors. After pilot usage, a survey was used to collect the data from participants, and assess the acceptance of the developed system. Results show that quality, usability and usefulness are on a high level, and that both pregnant women and doctors are ready for more extensive use of the system. In addition, research findings imply that employing pervasive technologies could bring significant benefits to all the parties in pregnancy care systems.

Wearable Health Devices in Health Care: Narrative Systematic Review

BACKGROUND

With the rise of mobile medicine, the development of new technologies such as smart sensing, and the popularization of personalized health concepts, the field of smart wearable devices has developed rapidly in recent years. Among them, medical wearable devices have become one of the most promising fields. These intelligent devices not only assist people in pursuing a healthier lifestyle but also provide a constant stream of health care data for disease diagnosis and treatment by actively recording physiological parameters and tracking metabolic status. Therefore, wearable medical devices have the potential to become a mainstay of the future mobile medical market.

OBJECTIVE

Although previous reviews have discussed consumer trends in wearable electronics and the application of wearable technology in recreational and sporting activities, data on broad clinical usefulness are lacking. We aimed to review the current application of wearable devices in health care while highlighting shortcomings for further research. In addition to daily health and safety monitoring, the focus of our work was mainly on the use of wearable devices in clinical practice.

METHODS

We conducted a narrative review of the use of wearable devices in health care settings by searching papers in PubMed, EMBASE, Scopus, and the Cochrane Library published since October 2015. Potentially relevant papers were then compared to determine their relevance and reviewed independently for inclusion.

RESULTS

A total of 82 relevant papers drawn from 960 papers on the subject of wearable devices in health care settings were qualitatively analyzed, and the information was synthesized. Our review shows that the wearable medical devices developed so far have been designed for use on all parts of the human body, including the head, limbs, and torso. These devices can be classified into 4 application areas: (1) health and safety monitoring, (2) chronic disease management, (3) disease diagnosis and treatment, and (4) rehabilitation. However, the wearable medical device industry currently faces several important limitations that prevent further use of wearable technology in medical practice, such as difficulties in achieving user-friendly solutions, security and privacy concerns, the lack of industry standards, and various technical bottlenecks.

CONCLUSIONS

We predict that with the development of science and technology and the popularization of personalized health concepts, wearable devices will play a greater role in the field of health care and become better integrated into people's daily lives. However, more research is needed to explore further applications of wearable devices in the medical field. We hope that this review can provide a useful reference for the development of wearable medical devices.

Smartphone-Based Maternal Education for the Complementary Feeding of Undernourished Children Under 3 Years of Age in Food-Secure Communities: Randomised Controlled Trial in Urmia, Iran

The mothers’ nutritional literacy is an important determinant of child malnourishment. We assessed the effect of a smartphone-based maternal nutritional education programme for the complementary feeding of undernourished children under 3 years of age in a food-secure middle-income community. The study used a randomised controlled trial design with one intervention arm and one control arm (n = 110; 1:1 ratio) and was performed at one well-child clinic in Urmia, Iran. An educational smartphone application was delivered to the intervention group for a 6-month period while the control group received treatment-as-usual (TAU) with regular check-ups of the child’s development at the well-child centre and the provision of standard nutritional information. The primary outcome measure was change in the indicator of acute undernourishment (i.e., wasting) which is the weight-for-height z-score (WHZ). Children in the smartphone group showed greater wasting status improvement (WHZ +0.65 (95% Confidence Interval (CI) ± 0.16)) than children in the TAU group (WHZ +0.31 (95% CI ± 0.21); p = 0.011) and greater reduction (89.6% vs. 51.5%; p = 0.016) of wasting caseness (i.e., WHZ < −2; yes/no). We conclude that smartphone-based maternal nutritional education in complementary feeding is more effective than TAU for reducing undernourishment among children under 3 years of age in food-secure communities.

Mobile health applications for postnatal care: Review and analysis of functionalities and technical features

BACKGROUND

Providing a continuum of care from antenatal, childbirth and postnatal period results in reduced maternal and neonatal morbidity and mortality. Timely, high quality postnatal care is crucial for maximizing maternal and newborn health. In this vein, the use of postnatal mobile applications constitutes a promising strategy.

METHODS

A Systematic Literature Review (SLR) protocol was adopted to perform the selection, data extraction and functional evaluation of the available postnatal apps on iOS and Android platforms. The analysis of the functionalities and technical features of the apps selected was performed according to a 37-items assessment questionnaire developed on the basis of the scientific literature of postnatal care and a preliminary analysis of available postnatal apps RESULTS: A total of 48 postnatal apps were retrieved from the app repositories of the iOS and Android platforms. The results of the functional content analysis show that the postnatal apps selected relatively achieved low scores owing to the complexity and the ramification of the postnatal care.

CONCLUSIONS

The present study helps in identifying areas related to the postnatal care that require further endeavors to be properly addressed. It also provides directions for developers to leverage the advancement and innovation on mobile technology to build complete and well-suited postnatal apps.

Advances in obstetric telemonitoring: a systematic review

BACKGROUND

Obstetric telemonitoring can improve gestational care, reducing the need fortravel, and can be used in different contexts to enable early detection of complications and prevention of intercurrences, providing local intervention before hospitalization.

OBJECTIVE

This paper aims to identify advances, contributions and limitations of obstetric telemonitoring using mobile technologies.

METHODS

A systematic review was performed on the Pubmed, Medline, LILACS, Cochrane, Scielo, Embase, ACM Surveys, and IEEE databases, from 2008 to 2018. PRISMA and CASP were used to analyze methodological rigour.

RESULTS

26 papers were included. The majority of the studies related to pregnant women, prenatal care, high-risk pregnancies and homecare. Only 2 articles related to postpartum and none related to delivery. Among the technological resources, the articles presented smartphone applications, which interact with external telemonitoring devices (such as electrodes attached to the body and thermometers) or request information about maternal and / or fetal health status. Based on those devices, decision-making by health professionals is more reliable, since data is obtained by digital devices that have a greater accuracy. The variety of studies is enormous and achieve promising results. However, there are still important gaps to be addressed. Many studies only cover isolated aspects of maternal health, e.g. blood pressure, which somehow limits clinical decision-making. All authors have described concerns about usability, but not all of them had actually performed usability tests. Interventions through obstetric telemonitoring can be applied to a wide range of domains, at various levels of healthcare complexity. There are still few investments in studies in developing countries, where maternal and fetal morbidity and mortality are higher.

CONCLUSION

The area of obstetrical telemonitoring has a great potential for contributing with better gestational outcomes, early detection of complications, prevention of intercurrences, providing local intervention even before hospitalization. Development of obstetric telemonitoring systems wich collect complete obstetric parameter integrated with the periods of childbirth and postpartum is recommended.

Evaluating the Privacy Policies of Mobile Personal Health Records for Pregnancy Monitoring

A mobile personal health record (mPHR) for pregnancy monitoring allows the pregnant woman to track and manage her personal health data. However, owing to the privacy and security issues that may threaten the exchange of this sensitive data, a privacy policy should be established. The aim of this study is to evaluate the privacy policies of 19 mPHRs for pregnancy monitoring (12 for iOS and 7 for Android) using a template covering the characteristics of privacy, security, and standards and regulations. The findings of this study show that none of the privacy policies evaluated entirely comply with the characteristics studied. The developers of mPHRs for pregnancy monitoring are, therefore, requested to improve and pay more attention to the structure and the content of the privacy policies of their apps.

Big Data Management for Healthcare Systems: Architecture, Requirements, and Implementation

The growing amount of data in healthcare industry has made inevitable the adoption of big data techniques in order to improve the quality of healthcare delivery. Despite the integration of big data processing approaches and platforms in existing data management architectures for healthcare systems, these architectures face difficulties in preventing emergency cases. The main contribution of this paper is proposing an extensible big data architecture based on both stream computing and batch computing in order to enhance further the reliability of healthcare systems by generating real-time alerts and making accurate predictions on patient health condition. Based on the proposed architecture, a prototype implementation has been built for healthcare systems in order to generate real-time alerts. The suggested prototype is based on spark and MongoDB tools.

Chinese Mobile Health APPs for Hypertension Management: A Systematic Evaluation of Usefulness

Objective

To analyze and compare the usefulness of hypertension management APPs released in the Chinese market; to understand the general situations, characteristics, problems, and trends in hypertension management mHealth APPs; and to identify the gaps between mainland China products and non-mainland China products with the aim to provide recommendations for developers in industry and assist hypertensive patients in selecting suitable APPs.

Methods

The hypertension management APPs available by October 2016 in China were analyzed from the perspective of data items and function usefulness. Sample sets were determined through PRISMA. An evaluation item set was developed based on the usability framework of TURF and the Chinese Guideline for the Management of Hypertension and used to quantitatively analyze the functionalities and data items collected from the sample APPs from the perspective of designers, users, and activity models.

Results

Among the 73 Chinese-supported APPs, none of the hypertension management APPs could fully cover the usefulness item set (mean = 37.4%). Regarding the use of mobile terminal hardware, only cameras and positioning sensors are commonly used in information collection. Regarding the data items and services provided, the most commonly collected data are “demographic information” (88% versus 100%) and “vital signs” (76% versus 100%), but APPs developed in mainland China and non-mainland China provided significantly different services and profit-making patterns. Regarding data security and privacy protection, the APPs from mainland China provided far lower usefulness (31% versus 56%).

Conclusions

mHealth APPs can promptly and efficiently acquire sign-related data by improving the professionality and scientificity of data about healthy living habits. APPs also improve the preventive usefulness of the collected data and bring about new opportunities for the management and control of hypertension. Other important research trends include privacy protection and data security.