1
|
Seid A, Fufa DD, Bitew ZW. The use of internet-based smartphone apps consistently improved consumers' healthy eating behaviors: a systematic review of randomized controlled trials. Front Digit Health 2024; 6:1282570. [PMID: 38283582 PMCID: PMC10811159 DOI: 10.3389/fdgth.2024.1282570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Introduction Digital tools, such as mobile apps and the Internet, are being increasingly used to promote healthy eating habits. However, there has been inconsistent reporting on the effectiveness of smartphones and web-based apps in influencing dietary behaviors. Moreover, previous reviews have been limited in scope, either by focusing on a specific population group or by being outdated. Therefore, the purpose of this review is to investigate the impacts of smartphone- and web-based dietary interventions on promoting healthy eating behaviors worldwide. Methods A systematic literature search of randomized controlled trials was conducted using databases such as Google Scholar, PubMed, Global Health, Informit, Web of Science, and CINAHL (EBSCO). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to prepare the entire document. EndNote (version 20) was used for reference management. The risk of bias in the articles was assessed using the "Revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0)" by the Cochrane Collaboration. Narrative synthesis, using text and tables, was used to present the results. The study was registered in PROSPERO under protocol number CRD42023464315. Results This review analyzed a total of 39 articles, which consisted of 25 smartphone-based apps and 14 web-based apps. The studies involved a total of 14,966 participants. Out of the 25 studies, 13 (52%) showed that offline-capable smartphone apps are successful in promoting healthier eating habits. The impact of smartphone apps on healthy adults has been inconsistently reported. However, studies have shown their effectiveness in chronically ill patients. Likewise, internet-based mobile apps, such as social media or nutrition-specific apps, have been found to effectively promote healthy eating behaviors. These findings were consistent across 14 studies, which included healthy adults, overweight or obese adults, chronically ill patients, and pregnant mothers. Conclusion Overall, the findings suggest that smartphone apps contribute to improving healthy eating behaviors. Both nutrition-specific and social media-based mobile apps consistently prove effective in promoting long-term healthy eating habits. Therefore, policymakers in the food system should consider harnessing the potential of internet-based mobile apps and social media platforms to foster sustainable healthy eating behaviors.
Collapse
Affiliation(s)
- Awole Seid
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Desta Dugassa Fufa
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Haramaya Institute of Technology, Haramaya University, Dire Dawa, Ethiopia
| | - Zebenay Workneh Bitew
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
2
|
Zhang X, Raghavan V, Yang X. Health perceptions and attitudes on mobile health apps in China. Health Informatics J 2023; 29:14604582231207745. [PMID: 37837412 DOI: 10.1177/14604582231207745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Since the COVID-19 pandemic, the use of mobile health apps has been increasing significantly. Many have started using mobile health apps to manage their health and well-being. People need to develop healthy habits that will increase their job productivity, life expectancy and improve their social relationships. This study tests the Health Belief Model with adults in China in influencing health motivation and in turn improving their health behavior. A mobile and online survey was developed, and 120 usable responses were collected. A structural equation modeling was used to test the relationships between perceived benefits, perceived susceptibility, perceived barriers, health motivation, and health behavior. We found perceived self-efficacy, perceived benefits, and perceived susceptibility predicts health motivation, and health motivation predicts health behavior. We did not find that perceived barrier is a predictor for health motivation. We conclude that to encourage behavioral change, it is important to enhance self-efficacy and address the benefits; in the meantime, educating people on susceptibility is also important.
Collapse
Affiliation(s)
- Xiaoni Zhang
- Management, Information Systems and Quantitative Methods, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vijay Raghavan
- Information Systems & Analytics, Northern Kentucky University, Highland Heights, KY, USA
| | - Xueyan Yang
- Zhejiang Agriculture and Forestry University, Linan, China
| |
Collapse
|
3
|
Mobile health community loyalty development process in China: an empirical study from information seeking perspective. INFORMATION TECHNOLOGY & PEOPLE 2023. [DOI: 10.1108/itp-11-2021-0835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PurposeThis study aims to investigate the process of developing loyalty in the Chinese mobile health community from the information seeking perspective.Design/methodology/approachA covariance-based structural equation model was developed to explore the mobile health community loyalty development process from information seeking perspective and tested with LISREL 9.30 for the 191 mobile health platform user samples.FindingsThe empirical results demonstrate that the information seeking perspective offers an interesting explanation for the mobile health community loyalty development process. All hypotheses in the proposed research model are supported except the relationship between privacy and trust. The two types of mobile health community loyalty—attitudal loyalty and behavioral loyalty are explained with 58 and 37% variance.Originality/valueThis paper has brought out the information seeking perspective in the loyalty formation process in mobile health community and identified several important constructs for this perspective for the loyalty formation process including information quality, communication with doctors and communication with patients.
Collapse
|
4
|
Zhu Y, Zhao Z, Guo J, Wang Y, Zhang C, Zheng J, Zou Z, Liu W. Understanding Use Intention of mHealth Applications Based on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT-2) Model in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3139. [PMID: 36833830 PMCID: PMC9960455 DOI: 10.3390/ijerph20043139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has significantly impacted the healthcare industry, especially public health resources and resource allocation. With the change in people's lifestyles and increased demand for medical and health care in the post-pandemic era, the Internet and home healthcare have rapidly developed. As an essential part of Internet healthcare, mobile health (mHealth) applications help to fundamentally address the lack of medical resources and meet people's healthcare needs. In this mixed-method study, we conducted in-depth interviews with 20 users in China (mean age = 26.13, SD = 2.80, all born in China) during the pandemic, based on the unified theory of acceptance and use of technology 2 (UTAUT-2) mode, and identified four dimensions of user needs in mHealth scenarios: convenience, control, trust, and emotionality. Based on the interview results, we adjusted the independent variables, deleted the hedonic motivation and the habit, and added the perceived trust and perceived risk as the variables. Using a structural equation model (SEM), we designed the questionnaire according to the qualitative results and collected data from 371 participants (above 18 years old, 43.9% male) online to examine the interrelationships these variables. The results show that performance expectancy (β = 0.40, p < 0.001), effort expectancy (β = 0.40, p < 0.001), social influence (β = 0.14, p < 0.05), facilitating condition (β = 0.15, p < 0.001), and perceived trust (β = 0.31, p < 0.001) had positive effects on use intention. Perceived risk (β = -0.31, p < 0.001) harmed use intention, and price value (β = 0.10, p > 0.5) had no significant effects on use intention. Finally, we discussed design and development guidelines that can enhance user experience of mHealth applications. This research combines the actual needs and the main factors affecting the use intention of users, solves the problems of low satisfaction of user experience, and provides better strategic suggestions for developing mHealth applications in the future.
Collapse
Affiliation(s)
- Yancong Zhu
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Zhenhong Zhao
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Jingxian Guo
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Yanna Wang
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Chengwen Zhang
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Jiayu Zheng
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Zheng Zou
- Stanford Center at Peking University, Stanford University, Beijing 100871, China
| | - Wei Liu
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| |
Collapse
|
5
|
Pal S, Biswas B, Gupta R, Kumar A, Gupta S. Exploring the factors that affect user experience in mobile-health applications: A text-mining and machine-learning approach. JOURNAL OF BUSINESS RESEARCH 2023; 156:113484. [PMID: 36475057 PMCID: PMC9715352 DOI: 10.1016/j.jbusres.2022.113484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 05/03/2023]
Abstract
Recent years have witnessed an increased demand for mobile health (mHealth) platforms owing to the COVID-19 pandemic and preference for doorstep delivery. However, factors impacting user experiences and satisfaction levels across these platforms, using customer reviews, are still largely unexplored in academic research. The empirical framework we proposed in this paper addressed this research gap by analysing unmonitored user comments for some popular mHealth platforms. Using topic-modelling techniques, we identified the impacting factors (predictors) and categorised them into two major dimensions based on strategic adoption and motivational association. Findings from our study suggest that time and money, convenience, responsiveness, and availability emerge as significant predictors for delivering a positive user experience on m-health platforms. Next, we identified substantial moderating effects of review polarity on the predictors related to brand association and hedonic motivation, such as online booking and video consultation. Further, we also identified the top predictors for successful user experience across these platforms. Recommendations from our study will benefit business managers by offering an improved service design leading to higher user satisfaction across these m-health platforms.
Collapse
Affiliation(s)
- Shounak Pal
- PricewaterhouseCoopers Private Limited, India
| | - Baidyanath Biswas
- Enterprise and Innovation Group, DCU Business School, Dublin City University, Ireland
| | - Rohit Gupta
- Operations Management Area, Indian Institute of Management, Ranchi, India
| | - Ajay Kumar
- AIM Research Center on Artificial Intelligence in Value Creation, EMLYON Business School, Ecully, France
| | - Shivam Gupta
- Department of Information Systems, Supply Chain Management & Decision Support, NEOMA Business School, Reims, France
| |
Collapse
|
6
|
Sun HT, Fan XR, Gu YZ, Lu YH, Qiu JL, Yang QL, Li JH, Gu J, Hao C. WeChat-based HIV E-report, A New Manner for HIV Serostatus Request and Disclosure and Their Associated Factors Among Men Who Have Sex with Men: Prospective Subgroup Analysis of Randomized Controlled Trails (Preprint). JMIR Mhealth Uhealth 2022; 11:e44513. [PMID: 37155223 DOI: 10.2196/44513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Requesting and disclosing HIV serostatus is associated with a reduction in HIV transmission among men who have sex with men (MSM). However, the reliability of common methods for HIV serostatus requests and disclosure is unsatisfactory. Validated approaches for requesting and disclosing HIV serostatus are necessary. OBJECTIVE The objective of this study was to investigate the use of the HIV e-report as authentic evidence of HIV serostatus among the MSM community in Guangzhou, China. Additionally, the study aimed to explore its correlates with HIV serostatus requesting and disclosure receiving behavior. METHODS This study is a subgroup analysis of a cluster randomized controlled trial (RCT) that enrolled 357 participants during the first year. Participants in this RCT were recruited from the WeChat-based HIV testing service miniprogram developed by Guangzhou Center for Disease Control and Prevention, China. Participants completed web-based questionnaires at baseline and at the month 3 follow-up, which covered sociodemographic characteristics, HIV-related information, HIV serostatus requests, HIV serostatus disclosure receiving, and HIV e-report usage. Univariate and multivariate logistic regressions were used for data analysis. RESULTS The WeChat-based HIV e-report was available in Guangzhou when the RCT project started. At the month 3 follow-up, 32.2% (115/357) of participants had their own HIV e-reports, and 37.8% (135/357) of them had received others' HIV e-reports. For HIV serostatus requests, 13.1% (27/205) and 10.5% (16/153) of participants started to use HIV e-reports to ask the HIV serostatus of regular and casual male sex partners, respectively. Of the regular and casual male sex partners, 27.3% (42/154) and 16.5% (18/109), respectively, chose HIV e-reports to disclose HIV serostatus. Compared to MSM who did not have HIV e-reports, those who said, "I had had my own HIV e-report(s) but hadn't sent to others" (multivariate odds ratio 2.71, 95% CI 1.19-6.86; P=.02) and "I had had my own HIV e-reports and had sent to others" (multivariate odds ratio 2.67, 95% CI 1.07-7.73; P=.048) were more likely to request HIV serostatus from their partners. Whereas no factor was associated with HIV serostatus disclosure received from partners. CONCLUSIONS The HIV e-report has been accepted by the MSM community in Guangzhou and could be applied as a new optional way for HIV serostatus request and disclosure. This innovative intervention could be effective in promoting infectious disease serostatus disclosure among the related high-risk population. TRIAL REGISTRATION ClinicalTrials.gov NCT03984136; https://clinicaltrials.gov/show/NCT03984136. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12879-021-06484-y.
Collapse
Affiliation(s)
- Hai-Tong Sun
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Ru Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Yu-Zhou Gu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yong-Heng Lu
- Lingnan Community Support Center, Guangzhou, China
| | - Jia-Ling Qiu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Qing-Ling Yang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Jing-Hua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
7
|
Exploring the Relationship Between Usage and Outcomes of an eHealth Cardiac Rehabilitation Intervention: Subanalysis of a Randomized Controlled Trial. COMPUTERS, INFORMATICS, NURSING : CIN 2022:00024665-990000000-00073. [PMID: 36730738 DOI: 10.1097/cin.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study aimed to explore the relationship between patients' characteristics and eHealth cardiac rehabilitation adherence and between eHealth usage metrics and behavior change. A subanalysis of 73 patients in the intervention group who received eHealth cardiac rehabilitation was conducted. Usage metrics on the number of Web site logins, health data uploads, and times of peer interaction and professional consultation were captured. Linear regression analysis was used. Participants (n = 73) were predominantly male with an average age of 55.53 (SD, 7.3) years. Younger age, having been treated with percutaneous coronary intervention, and hypertension predict higher Web site logins, whereas higher education, comorbidity with hypertension and diabetes, larger family size, and having been treated with percutaneous coronary intervention predict higher chatroom engagement. The Web site logins, Web site data uploads, chatroom nurse consultation, age, number of family members, drinking, and coresidency status were identified as significant correlates and explained 41.8% of the improvement in behavior change. This study demonstrated empirical evidence that Web site visits, health data uploads, and nurse consultations are crucial for behavior modification. Further studies may monitor usage metrics and investigate self-reported usage to explore the role of peer interaction in modifying behavior. Trial registration: Chinese Clinical Trial Registry: ChiCTR1800020411.
Collapse
|
8
|
Zhang Y, Zhang X, Li Y, Lin Z, Li X, Tu X, Zhou Y, Qian D, Liu H. The Utilization of Mobile Phones in Health Information Seeking in Rural China. LIBRI 2022. [DOI: 10.1515/libri-2021-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
This study aims to investigate the mobile phone utilization for health information seeking among adults who are 45 years or older in rural areas in China. Using Andersen’s Behavioral Model (BM), we examine the factors that influence the target group’s behaviors of online health information seeking and contacting healthcare providers via mobile phones. By using stratified sampling method, we conducted a survey among 607 rural adults who were 45 years or older from six villages in Jiangsu Province, China. The results reveal that participants can be excluded from such services for not using a smartphone. eHealth information literacy could serve as a strong influential factor for online health information seeking and contacting healthcare providers via mobile phones. Participants with lower emotional wellbeing are more inclined to seek health information online via mobile phones. The results indicate variables such as utilization of technological devices and eHealth literacy should be included in Andersen’s model when investigating the utilization of mHealth services. This study contributes to the literature on mHealth adoption in rural areas in China and has implications for practitioners to tailor the mHealth service for socio-economically disadvantaged groups.
Collapse
Affiliation(s)
- Yao Zhang
- Business School, Nankai University , 121 Baidi Road, Nankai, 300071 , Tianjin , China
| | - Xueying Zhang
- Department of Journalism and Mass Communication , North Carolina Agricultural and Technical State University , 6113 Morgan Ashley Dr. , Greensboro , NC , 27410 , USA
| | - Yuelin Li
- Business School, Nankai University , 121 Baidi Road, Nankai, 300071 , Tianjin , China
| | - Zhenping Lin
- School of Health Policy and Management , Nanjing Medical University , 101 Longmian Avenue, Jiangning, 211166 , Nanjing , Jiangsu , China
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior , University of South Carolina , Columbia , SC , USA
| | - Xiaoming Tu
- Department of Mathematics & Computer Science , School of Basic Medical Science, Nanjing Medical University , Nanjing , China
| | - Yeqin Zhou
- School of Humanities and Social Sciences , Nanjing Medical University , Nanjing , Jiangsu , China
| | - Dongfu Qian
- School of Health Policy and Management , Nanjing Medical University , Nanjing , Jiangsu , China
| | - Huan Liu
- Department of Marketing , Business School, Nankai University , Tianjin , China
| |
Collapse
|
9
|
Kim HM. Social comparison of fitness social media postings by fitness app users. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
Clements M, Kaufman N, Mel E. Using Digital Health Technology to Prevent and Treat Disease. Diabetes Technol Ther 2022; 24:S76-S95. [PMID: 35475695 DOI: 10.1089/dia.2022.2505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mark Clements
- Children's Mercy Hospitals & Clinics, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - Neal Kaufman
- Fielding School of Public Health, Geffen School of Medicine, University of California Los Angeles, CA
- Canary Health Inc., Los Angeles, CA
| | - Eran Mel
- Jesse Z. and Sara Lea Shaffer Institute for Endocrinology and Diabetes National Center for Childhood Diabetes, Petah Tikva, Israel
| |
Collapse
|
11
|
Sun Y, Li Y, He FJ, Liu H, Sun J, Luo R, Guo C, Zhang P. Process Evaluation of an Application-Based Salt Reduction Intervention in School Children and Their Families (AppSalt) in China: A Mixed-Methods Study. Front Public Health 2022; 10:744881. [PMID: 35359790 PMCID: PMC8963959 DOI: 10.3389/fpubh.2022.744881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background Salt reduction is a cost-effective, and rather challenging public health strategy for controlling chronic diseases. The AppSalt program is a school-based multi-component mobile health (mhealth) salt reduction program designed to tackle the high salt intake in China. This mixed-methods process evaluation was conducted to investigate the implementation of this program across sites, identify factors associated with the implementation, and collect evidence to optimize the intervention design for future scale-up. Methods Mixed methods were used sequentially to collect data regarding five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data were collected during the intervention process. Participation rate of intervention activities was calculated and compared across cities. The quantitative data was used for the selection of representative intervention participants for the qualitative interviews. Qualitative data were collected in face-to-face semi-structured interviews with purposively selected students (n = 33), adult family members (n = 33), teachers (n = 9), heads of schools (n = 9), key informants from local health, and education departments (n = 8). Thematic analysis technique was applied to analyze the interview transcripts using NVivo. The qualitative data were triangulated with the quantitative data during the interpretation phase. Results The total number of families recruited for the intervention was 1,124. The overall retention rate of the AppSalt program was 97%. The intervention was implemented to a high level of fidelity against the protocol. About 80% of intervention participants completed all the app-based salt reduction courses, with a significant difference across the three cities (Shijiazhuang: 95%; Luzhou: 73%; Yueyang: 64%). The smartphone app in this program was perceived as a feasible and engaging health education tool by most intervention participants and key stakeholders. Through the interviews with participants and key stakeholders, we identified some barriers to implementing this program at primary schools, including the left-behind children who usually live with their grandparents and have limited access of smartphones; perceived adverse effects of smartphones on children (e.g., eyesight damage); and overlooked health education curriculum at Chinese primary schools. Conclusion This process evaluation demonstrated the feasibility and acceptability of using smartphone applications delivered through the education system to engage families in China to reduce excessive salt intake. Clinical Trial Registration The AppSalt study was registered at www.chictr.org.cn, identifier: ChiCTR1800017553. The date of registration is August 3, 2018.
Collapse
Affiliation(s)
- Yuewen Sun
- Nutrition and Lifestyle Department, The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Yuan Li
- Nutrition and Lifestyle Department, The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Feng J He
- Barts and The London School of Medicine and Dentistry, Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Hueiming Liu
- Health Systems Science Department, The George Institute for Global Health, Sydney, NSW, Australia
| | - Jingwen Sun
- Nutrition and Lifestyle Department, The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Rong Luo
- Nutrition and Lifestyle Department, The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Chunlei Guo
- Nutrition and Lifestyle Department, The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Puhong Zhang
- Nutrition and Lifestyle Department, The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
12
|
Li Z, Gan L, Zheng H, Ni Y, Sun H, Yang X. Innovative Strategies and Efforts of Clinical Pharmacy Services During and After COVID-19 Epidemic: Experience from Shanghai Children's Hospital. Risk Manag Healthc Policy 2021; 14:4759-4764. [PMID: 34858072 PMCID: PMC8630467 DOI: 10.2147/rmhp.s324937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), the result of infection by the SARS-CoV-2 virus, has caused a global pandemic. To respond to this outbreak rapidly and properly, clinical pharmacists in Shanghai Children’s Hospital carried out innovative measures based on previous artificial intelligence experiences, such as using service robots for contactless drug delivery between Fever Clinic and Pharmacy Storage, providing telemedicine counseling on specific platforms and offering multimedia health education. With good control of the pandemic in Shanghai, these contactless services have been retained and expanded at the patients’ request. The aim of this article is to share our strategies and efforts with peers who are fighting against COVID-19 in other countries and regions.
Collapse
Affiliation(s)
- Zhiling Li
- Department of Pharmacy, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, People's Republic of China
| | - Li Gan
- Department of Logistics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, People's Republic of China
| | - Huan Zheng
- Department of Cardiology, Worldpath Clinic International, Shanghai, 200120, People's Republic of China
| | - Yujia Ni
- Department of Logistics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, People's Republic of China
| | - Huajun Sun
- Department of Pharmacy, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, People's Republic of China
| | - Xiaodong Yang
- Department of Logistics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, People's Republic of China
| |
Collapse
|
13
|
Dai Z, Wang Y, Hang C, Zhu K, Meng X. Telemedicine for ear diseases with the smartphone otoscopes via WeChat in the COVID-19 era. Am J Otolaryngol 2021; 42:102997. [PMID: 33770717 DOI: 10.1016/j.amjoto.2021.102997] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE This study aimed to evaluate the outcomes and satisfaction of ear patients who participated in the smartphone otoscopes telemedicine via WeChat. METHODS Patients in this study included newly diagnosed outpatients and online patients who did not undergo an outpatient diagnosis. Patients performed regular ear self-examinations, took pictures at home using their smartphone endoscopes, and submitted images to a WeChat community. Otolaryngologist gave timely online feedback. All of the following data were recorded: patients age and gender, disease duration, outpatient diagnosis, side, telemedicine duration, number of telemedicine visits, outcomes, satisfaction. RESULTS A total of 74 patients were included in the study, including 39 males and 35 females, with an average age of 31.1 ± 13.7 years (range 4-55 years). Of these patients, 68 were outpatients, and 6 directly participated in telemedicine online. The patient's disease duration ranged from 1 day to 15 days, with an average of 4.0 ± 3.0 days. The mean duration was 8.1 days (range: 3-21 days) for telemedicine. The mean number of visits was 2.7 times (range: 2-6 times) for telemedicine. 68 (91.9%) of the 74 patients were cured, 6 (8.1%) were improved, and 0 (0%) were ineffective. Almost all patients were pleased with the telemedicine service, 71.9 0% were very satisfied (n = 62), 28.10% were very satisfied (n = 11), and 0% were dissatisfied (n = 0). CONCLUSIONS Smartphone otoscopes telemedicine can decrease outpatient follow-up, reduce the risk of cross-infection, increase telemedicine accuracy, and improve patient satisfaction. It is worthy of clinical application in the COVID-19 era.
Collapse
|
14
|
Liao Y, Wang Y, Liu Y, McNeill A, Tang J. Effectiveness of the WeChat-based smoking cessation intervention ('WeChat WeQuit' program) in China: study protocol for a randomized controlled trial. Addiction 2021; 116:1279-1290. [PMID: 32567065 DOI: 10.1111/add.15166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/23/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Since its first release in 2011, WeChat (Chinese pinyin: Wei Xin) has been widely used to promote health. As the most popular all-in-one social media application providing free instant messaging, voice, text, pictures, videos and location information exchange via smartphone, WeChat holds promise for delivering smoking cessation services to a large number of people at low unit cost in China, a country with more than 300 million smokers. This protocol is for a study that aims to assess the efficacy of a WeChat-based smoking cessation intervention ('WeChat WeQuit') for treatment-seeking smokers in China. DESIGN In this two-arm randomized controlled trial (RCT), the control group will receive only a digital version of a booklet of 'Happy Quit'. The intervention group will also receive the 2 weeks pre- and 12 weeks post-quit 'WeChat WeQuit' intervention. Both groups will be followed-up to 26 weeks (6 months) after quit day. SETTING This on-line trial has no restrictions on setting or location. PARTICIPANTS Chinese-speaking current smokers (have smoked ≥100 cigarettes in their life-time and currently smoke cigarettes) aged 18+ years willing to make a quit attempt within 1 month (n = 2000) will be recruited by on- and off-line advertising. Potential participants will register their interest by sending WeChat messages or text messages, or making a voice call. MEASUREMENTS The primary outcome measure is self-reported 26-week continuous smoking abstinence with biological verification [test by clinic visit: expired carbon monoxide concentration <10 parts per million (p.p.m.) or by mailing cotinine urine dipsticks: urine cotinine <200 ng/ml]. Secondary outcome measures include: 7-day point prevalence abstinence at weeks 1, 4, 8, 12, 16, 20 and 26 after-quit day; self-reported 12-week continuous smoking abstinence and 26-week continuous smoking abstinence; reductions in number of cigarettes smoked per day; and rates of participation in and completion of the smoking-cessation program. CONCLUSIONS If the 'WeChat WeQuit' program is found to be effective, it will be an accessible, affordable and widely implementable intervention to help cigarette smokers to quit. The potential public health impact of its expansion into underserved regions or communities is considerable.
Collapse
Affiliation(s)
- Yanhui Liao
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, Hangzhou, China.,Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang, Hangzhou, China.,Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yunfei Wang
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China
| | - Yueheng Liu
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jinsong Tang
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, Hangzhou, China.,Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang, Hangzhou, China.,Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China
| |
Collapse
|
15
|
Automatic Detection of COVID-19 Based on Short-Duration Acoustic Smartphone Speech Analysis. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 5:201-217. [PMID: 33723525 PMCID: PMC7948650 DOI: 10.1007/s41666-020-00090-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/11/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022]
Abstract
Currently, there is an increasing global need for COVID-19 screening to help reduce the rate of infection and at-risk patient workload at hospitals. Smartphone-based screening for COVID-19 along with other respiratory illnesses offers excellent potential due to its rapid-rollout remote platform, user convenience, symptom tracking, comparatively low cost, and prompt result processing timeframe. In particular, speech-based analysis embedded in smartphone app technology can measure physiological effects relevant to COVID-19 screening that are not yet digitally available at scale in the healthcare field. Using a selection of the Sonde Health COVID-19 2020 dataset, this study examines the speech of COVID-19-negative participants exhibiting mild and moderate COVID-19-like symptoms as well as that of COVID-19-positive participants with mild to moderate symptoms. Our study investigates the classification potential of acoustic features (e.g., glottal, prosodic, spectral) from short-duration speech segments (e.g., held vowel, pataka phrase, nasal phrase) for automatic COVID-19 classification using machine learning. Experimental results indicate that certain feature-task combinations can produce COVID-19 classification accuracy of up to 80% as compared with using the all-acoustic feature baseline (68%). Further, with brute-forced n-best feature selection and speech task fusion, automatic COVID-19 classification accuracy of upwards of 82–86% was achieved, depending on whether the COVID-19-negative participant had mild or moderate COVID-19-like symptom severity.
Collapse
|
16
|
Zhang A, Nikoloski Z, Albala SA, Yip W, Xu J, Mossialos E. Patient Choice of Health Care Providers in China: Primary Care Facilities versus Hospitals. Health Syst Reform 2020; 6:e1846844. [PMID: 33314985 DOI: 10.1080/23288604.2020.1846844] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
As China's health system is faced with challenges of overcrowded hospitals, there is a great need to better understand the recent patterns and determinants of people's choice between primary care facilities and hospitals for outpatient care. Based on recent individual-level data from the China Health and Retirement Longitudinal Survey (CHARLS) and official province-level data from China health statistical yearbooks, we examine the patterns of outpatient visits to primary care facilities versus hospitals among middle-aged and older individuals and explore both supply- and demand-side correlates that explain these patterns. We find that 53% of outpatient visits were paid to primary care facilities as opposed to hospitals in 2015, compared to 60% in 2011. Both supply and demand factors were associated with this decline. On the supply side, we find that the density of primary care facilities did not account for this decline, but higher densities of hospitals and licensed doctors were associated with lower use of primary care facilities. On the demand side, we find that individuals with higher socioeconomic status and greater health care needs were less likely to use primary health care facilities. Our findings suggest that a high concentration of health care professionals in hospitals diverts patients away from primary care facilities. Staffing the primary care facilities with a well-trained health care workforce is the key to a well-functioning primary care system. The findings also suggest a need to address demand-side inequality issues.
Collapse
Affiliation(s)
- Anwen Zhang
- Adam Smith Business School, University of Glasgow , Glasgow, UK
| | - Zlatko Nikoloski
- Department of Health Policy, London School of Economics and Political Science , London, UK
| | - Sarah Averi Albala
- UCL Institute for Innovation and Public Purpose, University College London , London, UK
| | - Winnie Yip
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University , Boston, Massachusetts, USA
| | - Jin Xu
- China Center for Health Development Studies, Peking University , Beijing, China
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science , London, UK
| |
Collapse
|
17
|
Abstract
Telemedicine has the potential to deliver high-quality, affordable health care to underserved populations that otherwise would not have adequate access to care. The authors provide a snapshot of several telemedicine initiatives that have used information and communication technologies to connect patients with health care providers across various Asian countries with differing socioeconomic statuses. They highlight several factors thought to contribute to the success of telemedicine programs, such as financial sustainability, ease of use, and utilization of existing resources. Challenges these programs have faced include lack of technological infrastructure, limitations in funding, and conflicting health system priorities.
Collapse
|
18
|
Important Factors Affecting User Experience Design and Satisfaction of a Mobile Health App-A Case Study of Daily Yoga App. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17196967. [PMID: 32977635 PMCID: PMC7579610 DOI: 10.3390/ijerph17196967] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 12/18/2022]
Abstract
In recent years, mobile health (mHealth) has gained popularity. Yoga apps help users to exercise at home and improve their health. It is worth discussing how to give yogis a better experience and higher satisfaction to improve their willingness to keep using yoga apps. In this study, the Daily Yoga app was selected as the research object to explore important factors related to its user experience design and user satisfaction. Through a literature review and Delphi method composed of eight experts, this study put forward the important criteria framework of user experience design for the Daily Yoga app and then, used the DEMATEL (Decision Making and Trial Evaluation Laboratory)-based ANP (Analytic Network Process) method to determine the factors’ importance order and the causal relationships among them. Finally, combined with the results of an importance–performance analysis of 16 real users, we discuss the improvement measures. The research results show that the yoga class is the most critical factor in the user experience design of the Daily Yoga app, the target plan is a factor that is in great need of improvement, and having an attractive interface can improve user experience. The evaluation model of the study can act as a reference for improving user experience with the Daily Yoga app, and can also be widely used in the process of user experience design, questionnaire production, and evaluation optimization of mHealth app and related applications.
Collapse
|
19
|
Zhang W, Yang X, Zhao J, Yang F, Jia Y, Cui C, Yang X. Depression and Psychological-Behavioral Responses Among the General Public in China During the Early Stages of the COVID-19 Pandemic: Survey Study. J Med Internet Res 2020; 22:e22227. [PMID: 32886066 PMCID: PMC7501583 DOI: 10.2196/22227] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background The COVID-19 pandemic has recently spread dramatically worldwide, raising considerable concerns and resulting in detrimental effects on the psychological health of people who are vulnerable to the disease. Therefore, assessment of depression in members of the general public and their psychological and behavioral responses is essential for the maintenance of health. Objective This study aimed to assess the prevalence of depression and the associated factors among the general public during the early stages of the COVID-19 pandemic in China. Methods A cross-sectional survey with convenience sampling was conducted from February 11 to 16, 2020, in the early stages of the COVID-19 outbreak in China. A self-administrated smartphone questionnaire based on the Patient Health Questionnaire-9 (PHQ-9) and psychological and behavioral responses was distributed to the general public. Hierarchical multiple regression analysis and multivariate logistic regression analysis were conducted to explore the associated factors of depression.aA cross-sectional survey with convenience sampling was conducted from February 11 to 16, 2020, in the early stages of the COVID-19 outbreak in China. A self-administrated smartphone questionnaire based on the Patient Health Questionnaire-9 (PHQ-9) and psychological and behavioral responses was distributed to the general public. Hierarchical multiple regression analysis and multivariate logistic regression analysis were conducted to explore the associated factors of depression. Results The prevalence of depression (PHQ-9 score ≥10) among the general public during the COVID-19 pandemic was 182/1342 (13.6%). Regression analysis indicated that feeling stressed, feeling helpless, persistently being worried even with support, never feeling clean after disinfecting, scrubbing hands and items repeatedly, hoarding food, medicine, or daily supplies, and being distracted from work or study were positively associated with depression, while social support and being calm were negatively associated with depression. Conclusions The general public suffered from high levels of depression during the early stages of the COVID-19 pandemic. Thus, COVID-19–related mood management and social support should be provided to attenuate depression in the general public.
Collapse
Affiliation(s)
- Weiyu Zhang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Xiaoting Yang
- Department of Gastroenterology, Benxi General Hospital, Liaoning Health Industry Group, Benxi, China
| | - Jinfeng Zhao
- The University of Auckland, Auckland, New Zealand
| | - Fengzhi Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Yajing Jia
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Can Cui
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Xiaoshi Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| |
Collapse
|
20
|
Gong E, Gu W, Luo E, Tan L, Donovan J, Sun C, Yang Y, Zang L, Bao P, Yan LL. Development and Local Contextualization of Mobile Health Messages for Enhancing Disease Management Among Community-Dwelling Stroke Patients in Rural China: Multimethod Study. JMIR Mhealth Uhealth 2019; 7:e15758. [PMID: 31845901 PMCID: PMC6938591 DOI: 10.2196/15758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rural China has experienced an increasing health burden because of stroke. Stroke patients in rural communities have relatively poor awareness of and adherence to evidence-based secondary prevention and self-management of stroke. Mobile technology represents an innovative way to influence patient behaviors and improve their self-management. OBJECTIVE This study is part of the System-Integrated Technology-Enabled Model of Care (the SINEMA trial) to improve the health of stroke patients in resource-poor settings in China. This study aimed to develop and pilot-test a mobile phone message-based package, as a component of the SINEMA intervention. METHODS The SINEMA trial was conducted in Nanhe County, Hebei Province, China. A total of 4 villages were selected for pretrial contextual research and pilot study. The 5 stages for developing the mobile phone messages were as follows: (1) conducting literature review on existing message banks and analyzing the characteristics of these banks; (2) interviewing stroke patients and caregivers to identify their needs; (3) drafting message contents and designing dispatching algorithms for a 3-month pilot testing; (4) collecting feedback from pilot participants through questionnaire survey and in-depth interviews on facilitators and barriers related to their acceptance and understanding of messages; and (5) finalizing the message-based intervention based on participants' feedback for the SINEMA trial. RESULTS On the basis of 5 existing message banks screened out of 120 papers and patients' needs identified from 32 in-depth interviews among stroke patients and caregivers, we developed a message bank containing 224 messages for a pilot study among 54 community-dwelling stroke patients from 4 villages. Of 54 participants, 51 (response rate: 94.4%) completed the feedback survey after receiving daily messages for 3 months. Participants' mean age was 68 years (SD 9.2), and about half had never been to school. We observed a higher proportion of participants who were in favor of voice messages (23/42, 54%) than text messages (14/40, 35%). Among participants who received voice messages (n=43) and text messages (n=40), 41 and 30, respectively, self-reported a full or partial understanding of the contents, and 39 (39/43, 91%) and 32 (32/40, 80%), respectively, rated the messages as helpful. Analyses of the 32 interviews further revealed that voice messages containing simple and single-theme content, in plain language, with a repeated structure, a slow playback speed, and recorded in local dialect, were preferred by rural stroke patients. In addition, the dispatching algorithm and tools may also influence the acceptance of message-based interventions. CONCLUSIONS By applying multiple methodologies and conducting a pilot study, we designed and fine-tuned a voice message-based intervention package for promoting secondary prevention among community-dwelling stroke patients in rural China. Design of the content and dispatching algorithm should engage both experts and end users and adequately consider the needs and preferences of recipients.
Collapse
Affiliation(s)
- Enying Gong
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Wanbing Gu
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Erdan Luo
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
| | - Liwei Tan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- School of Public Health, Fudan University, Shanghai, China
| | - Julian Donovan
- Northumbria Healthcare National Health Service Foundation Trust, Wallsend, United Kingdom
| | - Cheng Sun
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Ying Yang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Longkai Zang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Second School of Clinical Medicine, Wuhan University, Wuhan, China
| | - Peng Bao
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Ningxia Medical University, Yinchuan, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Duke Global Health Institute, Durham, NC, United States
| |
Collapse
|