Application of mobile health to support the elderly during the COVID-19 outbreak: A systematic review

Impact of patient support programmes among patients with severe asthma treated with biological therapies: a systematic literature review and indirect treatment comparison

INTRODUCTION

Effective treatment of severe asthma requires patient adherence to inhaled and biological medications. Previous work has shown that patient support programmes (PSP) can improve adherence in patients with chronic diseases, but the impact of PSPs in patients with severe asthma treated with biologics has not been thoroughly investigated.

METHODS

We conducted a systematic literature review to understand the impact of PSPs on treatment adherence, asthma control and health-related quality of life (HRQoL) in patients with severe asthma. Embase, MEDLINE and EconLit databases were searched for studies published from 2003 (the year of the first biological approval for severe asthma) to June 2023 that described PSP participation among patients with severe asthma on biological treatment. Direct pooling of outcomes was not possible due to the heterogeneity across studies, so an indirect treatment comparison (ITC) was performed to determine the effect of PSP participation on treatment discontinuation. The ITC used patient-level data from patients treated with benralizumab either enrolled in a PSP (VOICE study, Connect 360 PSP) or not enrolled in a PSP (Benralizumab Patient Access Programme study) in the UK.

FINDINGS

25 records of 21 studies were selected. Six studies investigated the impact of PSPs on treatment adherence, asthma control or HRQoL. All six studies reported positive outcomes for patients enrolled in PSPs; the benefits of each PSP were closely linked to the services provided. The ITC showed that patients in the Connect 360 PSP group were less likely to discontinue treatment compared with the non-PSP group (OR 0.26, 95% CI 0.11 to 0.57, p<0.001).

CONCLUSIONS

PSPs contribute to positive clinical outcomes in patients with severe asthma on biological treatment. Future analyses will benefit from thorough descriptions of PSP services, and study designs that allow direct comparisons of patient outcomes with and without a PSP.

What is the next step of ICT development? The changes of ICT use in promoting elderly healthcare access: A systematic literature review

The objective of this study was to undertake a comprehensive review of the evidence published, with a focus on understanding the experiences of the elderly in leveraging Information and Communication Technology (ICT) for their healthcare needs during the COVID-19 period. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this review scrutinized all peer-reviewed articles in English sourced from PubMed, PsycINFO, Scopus, and Web of Science, targeting studies that focused exclusively on the elderly within the COVID-19 timeframe, incorporated ICT-based technology as intervention, and were associated with the assessment of the process of employing ICT for healthcare needs. The search strategy identified 1752 records, of which 34 studies met the inclusion criteria. The functionality of ICT was categorized, types of barriers were identified, and the subsequent changes that the elderly population underwent were synthesized and deliberated. This review offers valuable insights into the elderly's subjective experiences in utilizing ICT, which may offer guidance for future ICT development geared towards enhancing the well-being of the elderly. Future research should incorporate the perspectives of relevant healthcare providers in evaluating the effectiveness of ICT usage. Further studies are also needed on underserved elderly groups to provide a more holistic view.

Hearing Rehabilitation With a Chat-Based Mobile Auditory Training Program in Experienced Hearing Aid Users: Prospective Randomized Controlled Study

Background

Hearing rehabilitation with auditory training (AT) is necessary to improve speech perception ability in patients with hearing loss. However, face-to-face AT has not been widely implemented due to its high cost and personnel requirements. Therefore, there is a need for the development of a patient-friendly, mobile-based AT program.

Objective

In this study, we evaluated the effectiveness of hearing rehabilitation with our chat-based mobile AT (CMAT) program for speech perception performance among experienced hearing aid (HA) users.

Methods

A total of 42 adult patients with hearing loss who had worn bilateral HAs for more than 3 months were enrolled and randomly allocated to the AT or control group. In the AT group, CMAT was performed for 30 minutes a day for 2 months, while no intervention was provided in the control group. During the study, 2 patients from the AT group and 1 patient from the control group dropped out. At 0-, 1- and 2-month visits, results of hearing tests and speech perception tests, compliance, and questionnaires were prospectively collected and compared in the 2 groups.

Results

The AT group (n=19) showed better improvement in word and sentence perception tests compared to the control group (n=20; P=.04 and P=.03, respectively), while no significant difference was observed in phoneme and consonant perception tests (both P>.05). All participants were able to use CMAT without any difficulties, and 85% (17/20) of the AT group completed required training sessions. There were no changes in time or completion rate between the first and the second month of AT. No significant difference was observed between the 2 groups in questionnaire surveys.

Conclusions

After using the CMAT program, word and sentence perception performance was significantly improved in experienced HA users. In addition, CMAT showed high compliance and adherence over the 2-month study period. Further investigations are needed to validate long-term efficacy in a larger population.

TRIAL REGISTRATION

Clinical Research Information Service (CRiS) KCT0006509; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=22110&search_page=L.

A Systematic Review of Health Management Mobile Applications in COVID-19 Pandemic: Features, Advantages, and Disadvantages

Introduction

With the increasing accessibility of smartphones, their use has been considered in healthcare services. Mobile applications have played a pivotal role in providing health services during COVID-19. This study is aimed at identifying the features, advantages, and disadvantages of health management mobile applications during COVID-19.

Methods

This systematic review was conducted in PubMed, Scopus, and Web of Science using the related keywords up to November 2021. The original articles in English about the health management mobile applications in COVID-19 were selected. The study selection was done by two researchers independently according to inclusion and exclusion criteria. Data extraction was done using a data extraction form, and the results were summarized and reported in related tables and figures.

Results

Finally, 12 articles were included based on the criteria. The benefits of mobile health applications for health management during COVID-19 were in four themes and 19 subthemes, and the most advantages of the application were in disease management and the possibility of recording information by users, digital tracking of calls, and data confidentiality. Furthermore, the disadvantages of them have been presented in two themes and 14 subthemes. The most common disadvantages are reduced adherence to daily symptom reports, personal interpretation of questions, and result bias.

Conclusion

The study results showed that mobile applications have been effective in controlling the prevalence of COVID-19 by identifying virus-infested environments, identifying and monitoring infected people, controlling social distancing, and maintaining quarantine. It is suggested that usability, ethical and security considerations, protection of personal information, and privacy of users be considered in application design and development.

Empowering the digital health workforce in Latin America in the context of the COVID-19 pandemic: the Peruvian case

The COVID-19 pandemic has exposed significant gaps in healthcare access, quality, and the urgent need for enhancing the capacity of digital health human resources, particularly in Latin America. During the pandemic, online courses and telehealth initiatives supported by governmental agencies, the Pan American Health Organization, and other public and private resources, have played a crucial role in meeting training demands. This article discusses the role of capacity building programs in digital health within the context of Latin America, with a specific focus on the Peruvian case. We highlight the development of digital health competencies and related policies, while also describing selected experiences related to capacity building in this field. Additionally, we discuss the pivotal role of collaborative partnerships among institutions and countries, emphasizing the importance of culturally relevant training programs in digital health. These initiatives have the potential to accelerate training and research opportunities in Latin America, drawing on the involvement of government agencies, non-governmental organizations, industry, universities, professional societies, and communities.

Informing Patient-Provider Engagement for Shared Decision Making Through Mobile Health Applications

Objective

The study utilized a cross-sectional dataset to identify demographic and health factors associated with patient utilization of mHealth applications for engaging with healthcare providers. The focus was on adults with chronic health conditions as the primary app user group. The goal was to reveal specific barriers and facilitators to app adoption among smartphone users, with the aim of highlighting opportunities for upgrades that promote patient empowerment as a prerequisite for shared decision-making (SDM).

Methods

Data from the Health Information National Trends Survey (HINTS 5, Cycle 4, 2020) with 3865 respondents (≥18 years old) stratified analyses and weighted logistic regression were used.

Results

The study found that individuals having a wellness app on a smartphone increased the likelihood (OR 2.68, CI: 2.02-3.56, p-value < 0.0001) of discussing health conditions with providers. Furthermore, individuals with multiple chronic health conditions were more likely (OR 1.93, CI 1.26-2.95, p-value < 0.01) to use apps to use mobile health applications to engage with healthcare providers. Other significant variables affecting app usage such as race, marital status, and educational level.

Conclusion

Due to difficulties obtaining in-person healthcare, the COVID-19 epidemic forced a swift deployment of mHealth technologies. Even in the absence of a crisis, mobile health applications continue to be crucial for improving patient-provider engagement and developing novel approaches to healthcare delivery. During the pandemic, people with numerous chronic diseases used apps to stay in touch with doctors and maintain their reliance on these platforms. Nonetheless, different smartphone users continue to use mHealth application in different ways. The findings revealing barriers in mHealth app adoption among certain patient subgroups suggest opportunities for developers, in collaboration with users and providers, to enhance inclusion and acceptability when upgrading mHealth application platforms.

Effects of rebound exercises on balance and mobility of people with neurological disorders: A systematic review

BACKGROUND

Therapeutic rebound exercise is gaining popularity among the general population, but its effectiveness in individuals with neurological impairments remains uncertain. To shed light on this, a systematic review was conducted between November 2021 and March 2023 to study the impact of rebound exercise on balance and mobility in this group.

METHODS

Six databases were searched. Studies were included if written in English, peer-reviewed, had original research data and assessed the effect of rebound exercise in adults with neurological disorders. The outcomes measured were balance and mobility. Two reviewers independently appraised study quality using the Critical Appraisal Skills Program for Randomized Controlled Trials. Finally, a meta-summary of the included studies was completed, and a meta-analysis was performed using RevMan software version 5.3 to determine the effectiveness of the intervention.

RESULTS

Five studies were included comprising 130 participants aged 31.32±7.67 to 58±12 years, 72% male and 28% female. Participants were in-patients with stroke (49%), multiple sclerosis (24%), Parkinson's disease (15%) and spinal cord injury (12%). The included papers had moderate to high methodological quality. The timed up-and-go test revealed that the rebound group participants could walk 6.08 seconds quicker over three to eight weeks. Pooled results show that rebound exercise significantly improves mobility (-0.53[-0.94, -0.11], p = 0.01), but no significant improvement was observed in balance.

CONCLUSION

Rebound exercise has shown the potential to improve mobility in people with neurological disorders. However, the findings should be in the context that the included studies are few and participants were in in-patient settings. PROSPERO registration: CRD42021298030.

The resistance toward COVID-19 contact tracing apps: A study of psychological reactance among young adults in Italy

Western governments' attempts to encourage young adults to adopt COVID-19 contact tracing apps (CTAs) have been unsuccessful. Drawing on psychological reactance theory, we propose that government-imposed containment measures (e.g., lockdowns, curfews) may cause young adults to resist CTAs. We investigate how and when threats to freedom posed by government-imposed containment measures to young adults reduce their CTA adoption intentions. We conducted a survey of young adults during the second general lockdown (March‒April 2021) in Italy. The results show that when young Italian adults focus on the restrictive nature of government-imposed containment measures, their sense of freedom is threatened. Threats to freedom produce psychological states of either helplessness or reactance, depending on if young Italian adults think they can recover their freedom. Helpless young adults are motivated to adopt CTAs because they seek guidance from containment measures. Reactant young adults resist CTAs because they exhibit aversive psychological states toward containment measures. These results offer relevant insights for policymakers. They shed light on young Italian adults' resistance toward CTAs. They also inform governments on how to interact more efficiently with young adults if a novel pandemic should occur.

Analysis of Driving Factors in the Intention to Use the Virtual Nursing Home for the Elderly: A Modified UTAUT Model in the Chinese Context

As a unique form of mobile health service (m-Health) for elderly care in China, the virtual nursing home is considered a reliable alternative to the traditional model of home-based care, but services from virtual nursing homes are infrequently used by the elderly in practice. Thus, this study aims to measure the driving factors affecting the behavioral intention to use the virtual nursing home by designing a research framework that combined the unified theory of acceptance and use of technology (UTAUT) with the technology acceptance model (TAM). Furthermore, a new variable, conformist mentality, is proposed as a moderator. In order to validate the model, a well-structured questionnaire using mature scales was used, and the linear regression analysis method was conducted on 200 valid data samples collected during a field study in Harbin, China. The results show that performance expectancy, effort expectancy, and social influence significantly affect behavioral intention. However, the effect of facilitating conditions is not significant. Moreover, performance expectancy and effort expectancy have a positive effect on attitude toward use, and attitude toward use not only affects behavioral intention but also plays a mediating role in the effect of performance expectancy and effort expectancy on behavioral intention. This study also innovatively proposes and confirms conformist mentality as a moderator to strengthen the driving effect of social influence on behavioral intention. This is the first time that conformist mentality is introduced as a moderator in a study on the behavioral perception and acceptance of virtual nursing homes among Chinese older adults. Based on these findings, this study offers theoretical contributions and management implications that are conducive to the sustainable development of virtual nursing homes, thereby making extensive contributions to this field. Additionally, it also aids in the contextual expansion of the UTAUT model.

The intention to use mHealth applications among Dutch older adults prior and during the COVID pandemic

Background

Mobile health (mHealth) applications are widely valued for their potential to increase self-management among older adults and reduce their healthcare demands. However, the intention to use mHealth of Dutch older adults before the COVID-19 pandemic was modest. Healthcare access was considerably reduced during the pandemic and mHealth services substituted for in person health services. As older adults utilize health services more frequently and have been particularly vulnerable to the pandemic, they can be viewed to have especially benefitted from the transition toward mHealth services. Furthermore, one might expect their intention to use these services and reap the potential benefits has increased, especially during the pandemic.

Objective

The aim of this study was to examine whether the intention of Dutch older adults to use medical applications increased during the COVID pandemic and how the explanatory power of the extended Technology Acceptance Model (TAM) developed for this purpose was affected by the onset of the pandemic.

Methods

We conducted a cross-sectional survey using two samples collected before (n = 315) and after (n = 501) the onset of the pandemic. Data was collected using questionnaires which were distributed digitally and on paper, by convenience sampling and snowballing. Participants were 65 years or older, lived independently or in a senior living facility, without cognitive impairment. A controlled analysis was performed to test for significant differences in the intention to use mHealth. The before and after differences in extended TAM variables and their relationship with intention to use (ITU) were analyzed using controlled (multivariate) logistic and linear regression models. These models were also used to explore whether the onset of the pandemic had an effect on ITU not captured by the extended TAM model.

Results

While the two samples differed in ITU (p = 0.017; uncontrolled) there was no statistically significant difference in ITU in the controlled logistic regression analysis (p = 0.107). The scores of the extended TAM variables explaining intention to use were all significantly higher, except for Subjective norm and Feelings of Anxiety. The relationships of these variables with intention to use before and after the onset of the pandemic were similar, except for Social relationships which lost its significance. We found no indications of effects of the pandemic on intention to use not captured by our instrument.

Conclusion

The intention to use mHealth applications of Dutch older adults has not changed since the onset of the pandemic. The extended TAM model has robustly explained intention to use, with only minor differences after the first months of the pandemic. Interventions targeting facilitation and support are likely to promote the uptake of mHealth. Follow-up studies are needed to investigate whether the pandemic has had long term effects on the ITU of the older adult.

Impact of digital economic development and environmental pollution on residents' health: an empirical analysis based on 279 prefecture-level cities in China

BACKGROUND

The digital economy based on the internet and IT is developing rapidly in China, which makes a profound impact on urban environmental quality and residents' health activities. Thus, this study introduces environmental pollution as a mediating variable based on Grossman's health production function to explore the impact of digital economic development on the health of the population and its influence path.

METHODS

Based on the panel data of 279 prefecture-level cities in China from 2011 to 2017, this paper investigates the acting mechanism of digital economic development on residents' health by employing a combination of mediating effects model and spatial Durbin model.

RESULTS

The development of digital economy makes direct improvement on residents' health condition, which is also obtained indirectly by means of environmental pollution mitigation. Besides, from the perspective of spatial spillover effect, the development of digital economy also has a significant promoting effect on the health of adjacent urban residents, and further analysis reveals that the promoting effect in the central and western regions of China is more pronounced than that in the eastern region.

CONCLUSIONS

Digital economy can have a direct promoting effect on the health of residents, and environmental pollution has an intermediary effect between digital economy and residents' health; At the same time, there is also a regional heterogeneity among the three relationships. Therefore, this paper believes that the government should continue to formulate and implement scientific digital economy development policies at the macro and micro levels to narrow the regional digital divide, improve environmental quality and enhance the health level of residents.

Mobile care app development process: using the ADDIE model to manage symptoms after breast cancer surgery (step 1)

The use of mobile applications is widespread in patient monitoring or education today. This study aims to describe the design and development process of a mobile app that supports patient self-care after breast cancer surgery. We used the ADDIE model to develop and test the mobile app. ADDIE (Analysis, Design, Development, Implementation, Evaluation) is a systematic approach based on a standard instructional design model for creating training materials. The model consists of five phases, each with its own set of steps. Once the steps within each phase are completed, the model progresses to the next phase, ultimately resulting in a "usable" product. Different team collaborations were established within each phase, and support was obtained from multiple experts during the design process. Thanks to this model, the information that patients need was transformed into a technological product. This article, which explains the stages of the product design process for mobile applications, provides information that may be helpful to researchers working on similar products.

Older Adult Engagement With Symptom Reporting in a COVID-19 Citizen Science Application

The current study examined the frequency and predictors of older adults' engagement with symptom reporting in COVIDWATCHER, a mobile health (mHealth) citizen science application. Citizen science is a type of participatory research that leverages information provided by community members. There were 1,028 COVIDWATCHER participants who engaged with symptom reporting between April 2020 and January 2021. Approximately 13.5% (n = 139) were adults aged ≥65 years. We used a Wilcoxon test to compare the mean frequency of engagement with symptom reporting by older adults (i.e., aged ≥65 years) to younger adults (i.e., aged ≤64 years) and multivariable linear regression to explore the predictors of engagement with symptom reporting. There was a significant difference in engagement with symptom reporting between adults aged ≥65 years compared to those aged ≤64 years (p < 0.001). In our final model, age (β = 26.0; 95% confidence interval [14.8, 34.2]) was a significant predictor for engagement with symptom reporting. These results help further our understanding of older adult engagement with mHealth-enabled citizen science for symptom reporting. [Journal of Gerontological Nursing, 49(4), 6-11.].

The Potential of the Remote Monitoring Digital Solutions to Sustain the Mental and Emotional Health of the Elderly during and Post COVID-19 Crisis in Romania

The COVID-19 pandemic amplified the elderly's aging-related dysfunctionalities and vulnerabilities. Research surveys, aimed at evaluating the socio-physical-emotional state of the elderly and obtaining data on their access to medical services and information media services during the pandemic, were carried out on Romanian respondents aged 65+. Identification and mitigation of the risk of emotional and mental long-term decline of the elderly after SARS-CoV-2 infection, based on the implementation of a specific procedure, can be performed through Remote Monitoring Digital Solutions (RMDSs). The aim of this paper is to propose a procedure for the identification and mitigation of the risk of emotional and mental long-term decline of the elderly after SARS-CoV-2 infection that comprises RMDS. The importance of using the knowledge obtained by COVID-19-related surveys corroborating the necessity of including personalized RMDS in the procedure is highlighted. The Non-invasive Monitoring System and Health Assessment of the Elderly in a Smart Environment (RO-SmartAgeing) is an RMDS designed to address the improved preventative and proactive support for diminishing this risk and to provide suitable assistance for the elderly through a safe and efficient smart environment. Its comprehensive functionalities targeted supporting primary healthcare assistance, specific medical conditions-as the mental and emotional disorders post-SARS-CoV-2 infection-and enlarged access to aging-related information, together with customizable features, illustrated the match with the requirements included in the proposed procedure.

Technology readiness and the older citizen’s acceptance of m-health services in India

Purpose

The purpose of this study was to create a theoretical model by combining the technology acceptance model (TAM) with the theory of technology readiness (TR) and then empirically test it to identify the key factors influencing older citizens’ intention to adopt and use mobile health (m-health), which has emerged as a tool to facilitate health-care rights for all.

Design/methodology/approach

The convenience sampling method was used to collect data from 465 respondents aged 60 and up from the Delhi-National capital region of India using a questionnaire survey method. The data collected for this study were analyzed using partial least squares structural equation modeling using SmartPLS 3.0.

Findings

The study’s findings indicate that all TR components influence perceived usefulness (PU) and ease of use. The exception is discomfort, which does not affect perceived ease of use (PEOU). Furthermore, PU and PEOU influenced the older citizen’s attitude toward m-health, and attitude influenced their intention to use m-health applications.

Originality/value

To the best of the authors’ knowledge, this is the first study to apply the TAM in combination with TR index to examine the acceptability of m-health consulting by the older citizen in an emerging economy like India.

Factors Influencing the Aged in the Use of Mobile Healthcare Applications: An Empirical Study in China

Mobile healthcare applications are of significant potential value in the development of the aged-care industry due to their great convenience, high efficiency, and low cost. Since the cognition and utilization rates of mobile healthcare applications for the elderly are still low, this study explored the factors that affect the elderly's adoption of mobile healthcare applications. This study conducted a questionnaire survey on the elderly in China and received 365 valuable responses. This study combined the technology acceptance model, protection motivation theory, and perceived risk theory to build a research model of factors affecting the use of mobile healthcare applications by the elderly. The data were analyzed using a structural equation model. The results were as follows: according to the empirical research, (1) perceived usefulness and perceived ease of use positively affect the use attitude of the elderly; perceived usefulness and user attitude positively affect the behavior intention of the elderly; perceived ease of use positively affects perceived usefulness; (2) perceived severity has a significant positive correlation with use attitude; perceived susceptibility and attitude to use have no significant impact; (3) perceived risk is negatively correlated with the use attitude and behavioral intention. The above-mentioned factors should be taken into consideration during the development of mobile healthcare applications for the aged to upgrade the overall service quality of mobile healthcare applications, thus enhancing the operational level of mobile healthcare applications and the health literacy of the aged.

Use of and Satisfaction With Mobile Health Education During the COVID-19 Pandemic in Thailand: Cross-sectional Study

BACKGROUND

RamaCovid is a mobile health (mHealth) education system that provides the Thai population with information about COVID-19 and self-risk assessment. RamaCovid has a chatbot system that provides automatic conversations (available 24 hours per day) and a live chat function that allows users to directly communicate with health professionals (available 4 hours per day in the evening). The system consists of (1) COVID-19 vaccine information, (2) self-care after vaccination, (3) frequently asked questions, (4) self-risk assessment, (5) hospital finding, (6) contact number finding, and (7) live chat with a health professional.

OBJECTIVE

This study investigates the use of and satisfaction with the RamaCovid system.

METHODS

Overall, 400 people were recruited via RamaCovid by broadcasting an infographic about the study. Questionnaires collected demographic data, users' experiences of RamaCovid, and the use of and satisfaction with the system. The questions were answered using a 5-point Likert scale. Descriptive statistics were used to describe the participant characteristics and their use of and satisfaction with the RamaCovid system. The Mann-Whitney U test was performed to examine the difference in use and satisfaction between the adult and older adult groups.

RESULTS

The participants showed high use of and satisfaction with the RamaCovid system. They used the information to take care of themselves and their family, and they gained information about their COVID-19 risk. The users were satisfied with the system because the information was easy to understand, trustworthy, and up to date. However, the older adult group had lower use of and satisfaction with the system compared to the adult group.

CONCLUSIONS

RamaCovid is an example of the successful implementation of mHealth education. It was an alternative way to work with the call center during the COVID-19 pandemic and increased access to health information and health care services. Providing ongoing updated information, improving the attractiveness of the media information, and the age group difference are important issues for further system development.

A Health App for Post-Pandemic Years (HAPPY) for people with physiological and psychosocial distress during the post-pandemic era: Protocol for a randomized controlled trial

Objective

This article describes a protocol for a randomized controlled trial to evaluate the effects of a three-level Health App for Post-Pandemic Years (HAPPY) on alleviating post-pandemic physiological and psychosocial distress.

Methods

Convenience and snowball sampling methods will be used to recruit 814 people aged 18+ with physiological and/or psychosocial distress. The experimental group will receive a 24-week intervention consisting of an 8-week regular supervision phase and a 16-week self-help phase. Based on their assessment results, they will be assigned to receive interventions on mindfulness, energy conservation techniques, or physical activity training. The waitlist control group will receive the same intervention in Week 25. The primary outcome will be changes in psychosocial distress, measured using the Kessler Psychological Distress Scale (K10). Secondary outcomes will include changes in levels of fatigue (Chinese version of the Brief Fatigue Inventory), sleep quality (Chinese version of the Pittsburgh Sleep Quality Index), pain intensity (Numeric Rating Scale), positive appraisal (Short version of the 18-item Cognitive Emotion Regulation Questionnaire), self-efficacy (Chinese version of the General Self-efficacy Scale), depression and anxiety (Chinese version of the 21-item Depression Anxiety Stress Scale), and event impact (Chinese version of the 22-item Impact of Event Scale-Revised). All measures will be administered at baseline (T0), Week 8 after the supervision phase (T1), and 24 weeks post-intervention (T2). A generalized estimating equations model will be used to examine the group, time, and interaction (Time × Group) effect of the interventions on the outcome assessments (intention-to-treat analysis) across the three time points, and to compute a within-group comparison of objective physiological parameters and adherence to the assigned interventions in the experimental group.

Conclusions

The innovative, three-level mobile HAPPY app will promote beneficial behavioral strategies to alleviate post-pandemic physiological and psychosocial distress.

Trial registration

ClinicalTrials.gov, NCT05459896. Registered on 15 July 2022.

A systematic review of digital health technologies for the care of older adults during COVID-19 pandemic

Objective

During the Coronavirus Disease 2019 (COVID-19) pandemic, digital health technologies (DHTs) became increasingly important, especially for older adults. The objective of this systematic review was to synthesize evidence on the rapid implementation and use of DHTs among older adults during the COVID-19 pandemic.

Methods

A structured, electronic search was conducted on 9 November 2021, and updated on 5 January 2023, among five databases to select DHT interventional studies conducted among older adults during the pandemic. The bias of studies was assessed using Version 2 of the Cochrane Risk-of-Bias Tool for randomized trials (RoB 2) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I).

Results

Among 20 articles included in the review, 14 (70%) focused on older adults with chronic diseases or symptoms, such as dementia or cognitive impairment, type 2 diabetes, and obesity. DHTs included traditional telehealth interventions via telephone, video, and social media, as well as emerging technologies such as Humanoid Robot and Laser acupuncture teletherapy. Using RoB 2 and ROBINS-I, four studies (20%) were evaluated as high or serious overall risk of bias. DHTs have shown to be effective, feasible, acceptable, and satisfactory for older adults during the COVID-19 pandemic compared to usual care. In addition, some studies also highlighted challenges with technology, hearing difficulties, and communication barriers within the vulnerable population.

Conclusions

During the COVID-19 pandemic, DHTs had the potential to improve various health outcomes and showed benefits for older adults' access to health care services.

Perceptions on Extending the Use of Technology after the COVID-19 Pandemic Resolves: A Qualitative Study with Older Adults

The COVID-19 pandemic of the last two years has affected the lives of many individuals, especially the most vulnerable and at-risk population groups, e.g., older adults. While social distancing and isolation are shown to be effective at decreasing the transmission of the virus, these actions have also increased loneliness and social isolation. To combat social distancing from family and friends, older adults have turned to technology for help. In the health sector, these individuals also had a variety of options that strengthened eHealth care services. This study analyzed the technologies used during the COVID-19 pandemic by a group of older people, as well as explored their expectations of use after the pandemic period. Qualitative and ethnographic interviews were conducted with 10 Portuguese older adults, and data were collected over a period of seven months between 2020 and 2021. The research demonstrated that the use of current and new technologies in the post-pandemic future is likely to be related to overcoming: (i) insecurity regarding privacy issues; (ii) difficulties in using technologies due to the level of use of digital technology; and (iii) the human distancing and impersonal consequences of using these technologies.

Understanding User Requirements for a Senior-Friendly Mobile Health Application

The advancement of mobile technologies has motivated countries around the world to aim for smarter health management to support senior citizens. However, the use of mobile health applications (mHealth apps) among senior citizens appears to be low. Thus, drawing upon user expectations, the present study examined user requirements for a senior-friendly mHealth application. A total of 74 senior citizens were interviewed to explore the difficulties they encounter when using existing mobile apps. This study followed Nielsen’s usability model to identify user requirements from five aspects, namely learnability, efficiency, memorability, error, and satisfaction. Based on the results, a guideline was proposed pertaining to usability and health management features. This guideline offers suggestions for mHealth app issues related to phrasing, menus, simplicity, error messages, icons and buttons, navigation, and layout, among others. The study also found that speech recognition technology can help seniors access information quickly. The proposed guideline and findings offer valuable input for software and app developers in building more engaging and senior-friendly mHealth apps.

Development and Usability Assessment of a Mobile App (Demensia KITA) to Support Dementia Caregivers in Malaysia: A Study Protocol

The impact of dementia on caregivers is complex and multi-dimensional. In low- and middle-income settings, caregivers are often left without adequate support, despite their multiple needs. These include health information, caregiving skills, social and emotional support, and access to local resources-all of which can be partially fulfilled by technology. In recent years, mobile apps have emerged and proven useful for caregivers. We found a few existing apps suitable for Malaysian users in terms of affordability and cultural and linguistic compatibility. Our study aims to design a mobile app that suits dementia caregivers in Malaysia and consists of three phases. Phase I is content development that employs Focus Group Discussion (FGD) and Nominal Group Technique (NGT) involving field experts. Phase II comprises a mobile app (Demensia KITA) designed in collaboration with a software developer specializing in mobile health apps. Phase III entails testing the usability of the app using the Malay version of the mHealth App Usability Questionnaire (M-MAUQ). This study protocol elaborates on the rigorous steps of designing a mobile app and testing its usability, along with anticipated challenges. Our protocol will provide insight for future researchers, healthcare providers, and policymakers and pave the way for better use of digital technology in the field of aging and caregiving.

mHealth Interventions to Improve Cancer Screening and Early Detection: Scoping Review of Reviews

BACKGROUND

Cancer screening provision in resource-constrained settings tends to be opportunistic, and uptake tends to be low, leading to delayed presentation and treatment and poor survival.

OBJECTIVE

The aim of this study was to identify, review, map, and summarize findings from different types of literature reviews on the use of mobile health (mHealth) technologies to improve the uptake of cancer screening.

METHODS

The review methodology was guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Ovid MEDLINE, PyscINFO, and Embase were searched from inception to May 2021. The eligible criteria included reviews that focused on studies of interventions that used mobile phone devices to promote and deliver cancer screening and described the effectiveness or implementation of mHealth intervention outcomes. Key data fields such as study aims, types of cancer, mHealth formats, and outcomes were extracted, and the data were analyzed to address the objective of the review.

RESULTS

Our initial search identified 1981 titles, of which 12 (0.61%) reviews met the inclusion criteria (systematic reviews: n=6, 50%; scoping reviews: n=4, 33%; rapid reviews: n=1, 8%; narrative reviews: n=1, 8%). Most (57/67, 85%) of the interventions targeted breast and cervical cancer awareness and screening uptake. The most commonly used mHealth technologies for increasing cancer screening uptake were SMS text messages and telephone calls. Overall, mHealth interventions increased knowledge about screening and had high acceptance among participants. The likelihood of achieving improved uptake-related outcomes increased when interventions used >1 mode of communication (telephone reminders, physical invitation letters, and educational pamphlets) together with mHealth.

CONCLUSIONS

mHealth interventions increase cancer screening uptake, although multiple modes used in combination seem to be more effective.

Mobile health applications: awareness, attitudes, and practices among medical students in Malaysia

BACKGROUND

The popularity of mobile health (mHealth) applications (or apps) in the field of health and medical education is rapidly increasing, especially since the COVID-19 pandemic. We aimed to assess awareness, attitudes, practices, and factors associated with the mHealth app usage among medical students.

METHODS

We conducted a cross-sectional study involving medical students at a government university in Sarawak, Malaysia, from February to April 2021. Validated questionnaires were administered to all consenting students. These questionnaires included questions on basic demographic information as well as awareness, attitude toward, and practices with mHealth apps concerned with medical education, health and fitness, and COVID-19 management.

RESULTS

Respondents had favorable attitudes toward mHealth apps (medical education [61.8%], health and fitness [76.3%], and COVID-19 management [82.7%]). Respondents' mean attitude scores were four out of five for all three app categories. However, respondents used COVID-19 management apps more frequently (73.5%) than those for medical education (35.7%) and fitness (39.0%). Usage of all three app categories was significantly associated with the respondent's awareness and attitude. Respondents in the top 20% in term of household income and study duration were more likely to use medical education apps. The number of respondents who used COVID-19 apps was higher in the top 20% household income group than in the other income groups. The most common barrier to the use of apps was uncertainty regarding the most suitable apps to choose.

CONCLUSION

Our study highlighted a discrepancy between awareness of mHealth apps and positive attitudes toward them and their use. Recognition of barriers to using mHealth apps by relevant authorities may be necessary to increase the usage of these apps.

Investigation of the effects of mechanical and underfloor heating systems on the COVID-19 viruses distribution

Investigation of the spread of pollutants and especially pathogenic particles in the interior of today's buildings has become an integral part of the design of such buildings. When the Coronavirus is prevalent in the world, it is necessary to pay attention to the spread of the virus in the interior of residential apartments. In the present study, the Coronavirus particles emitted from the sneezing of a sick person in the bedroom of a residential apartment were tracked. Meanwhile, the degree of exposure of a mannequin that has been placed in the living room playing the role of a healthy person is examined. In this research, a segregated solution of steady-state flow and an unsteady particle solution have been separately used: a suitable, accurate, and optimal solution in particle studies. A comparison of the results shows that underfloor heating creates a healthier space around the healthy person's respiratory system, but instead, we will see more polluted areas around the sick person. According to the PRE results, the PRE value for a mechanical heating system is higher than a floor heating system. Therefore, it is recommended to use mechanical heating system in the apartments where the person with COVID-19 is hospitalized.

COVID-19 Mobile Health Apps: An Overview of Mobile Applications in Indonesia

Background

Mobile health applications (mHealth apps) have been widely used for various purposes for mitigating the COVID-19 pandemic, such as self-assessment, contact tracing, disseminating information, minimizing exposure, and reducing face-to-face health consultation. The objective of this study is to systematically review COVID-19 related mHealth apps and highlight gaps to inform the development of future mHealth initiatives in Indonesia.

Methods

A systematic search strategy using a PRISMA flowchart was used to identify mHealth apps available in Google Play and Apple Play stores. We searched mHealth apps using certain specific terms related to COVID-19 outbreaks. The inclusion criteria were apps-based smartphone users related to COVID-19 using local language, free of cost, available in the Google Play and Apple Play Stores, and supported by the Indonesian government. We excluded games, apps on infectious diseases unrelated to COVID-19 specifically, and apps with non-Bahasa Indonesia (Indonesian language). The selected mHealth apps were assessed based on two measures: (1) the WHO guidelines on digital health intervention and (2) the four dimensions of the mHealth technology fit framework. In addition, user feedback from experienced and non-experienced users was conducted to evaluate four dimensions of the apps.

Results

A total of 339 mHealth apps were generated from the initial search, remaining seven selected apps that met inclusion criteria. The results highlighted that mHealth apps reviewed had still not been widely used by the general public. The applications were purposed to disseminate information, conduct a self-risk assessment, provide an online community forum, and telemedicine or teleconsultation regarding COVID-19. Data services, including data storage, aggregation, and data exchange, are available in most apps. The rarest function found was contact tracing and assisting health management and health workers, such as the availability of testing facilities, reporting test results, and prescribing medication. The main issues reported were the lack of data security and data privacy protection, integration and infrastructures, usability, and usefulness.

Conclusion

Our study highlighted the necessity to improve mHealth apps' functions related to assisting health workers and the function of digital contact tracing. An effort to increase public awareness regarding the use of mHealth is also necessary to streamline the function of this innovation. Policymakers must consider usefulness, usability, integration, and infrastructure issues to improve their mHealth function.

Addressing the Social Determinants of Health in South Korea: Moderating Role of mHealth Technologies

Mobile health (mHealth) technologies may reduce or widen health inequalities. Despite the extensive literature in support of both of these contrasting views, little attention has been paid to the role of mHealth technologies with regard to social strata and health in the context of South Korea, a country with one of the highest usages of smartphones worldwide. This study examined the effects of social determinants on health self-efficacy and health status and explored how mHealth technologies moderate the impacts of social determinants on health outcomes. Data were collected via online surveys from 29 July to 3 August 2021. Survey data from 1187 Korean adults showed that men had higher levels of health self-efficacy than women. The higher an individual’s education level, the greater their subjective health status. Individuals with higher levels of monthly household income, social capital, and healthcare quality reported higher levels of health self-efficacy and superior health status. The use of mHealth technologies moderated the associations between social determinants and health outcomes. Specifically, monthly household income and social capital had smaller effects on health self-efficacy and health status among those who used higher levels of mHealth technologies. Among higher users of mHealth technologies, females reported better health status than males, while men showed better health status than women in the low-user group. These findings highlight the effectiveness of mHealth technologies in addressing health disparities.