The difference in knowledge and attitudes of using mobile health applications between actual user and non-user among adults aged 50 and older

Nurses' perspectives on using mobile health applications in southeastern Iran: Awareness, attitude, and obstacles

INTRODUCTION

Nurses and patients can now ensure access to qualified healthcare using the new opportunities of mobile health (mHealth) applications (or apps). To use its potential effectively, understanding nurses' use of this technology is crucial. Here, we examined the awareness, attitudes, and obstacles to using mHealth apps among nurses.

METHODS

We applied a descriptive-analytical cross-sectional study from 08/04/2023 to 05/10/2023. Cochran's formula estimated the sample size of 267 nurses. The researchers used a researcher-made questionnaire for data collection. We used descriptive (mean, standard deviation, frequency, and percentage) and analytical (Pearson and Spearman correlation) statistics for data analysis.

RESULTS

Most nurses use a smartphone (86%), have an Android operating system installed (82%), and believe that mHealth is useful for nursing (85%), but do not use it for patient care (70.8%). The mean score for awareness, attitude, and obstacles regarding mHealth were 3.74 ±  0.657, 3.49 ±  0.513, and 3.50 ±  0.597 respectively. There was a significant positive correlation between the nurses' awareness and attitude (r = 0. 289, P < 0.05) and nurses' awareness and obstacles to using mHealth (r = 0. 171, P < 0.05), but a significant negative correlation between nurses' attitude and obstacles (r = -0. 031, P < 0.05).

CONCLUSION

Despite nurses' relatively favorable awareness and positive attitude towards the use of mHealth apps, most of them use these technologies for purposes other than patient care. Nurses considered patients' lack of digital health literacy (DHL) and reluctance to use these technologies as the main obstacles to using mHealth apps. Improving the DHL of users (nurses and especially patients) and providing them with free access to mHealth apps is essential. Ensuring security and making the applications easy to use, as well as educating users, are also important factors. Furthermore, promoting nurses' understanding of the benefits of mHealth and increasing their willingness to use these technologies is crucial.

Factors Associated With the Intention to Use mHealth Among Thai Middle-Aged Adults and Older Adults: Cross-Sectional Study

Background

Mobile health care (mHealth) apps are emerging worldwide as a vital component of internet health care, but there are issues, especially among older adults.

Objective

We aim to investigate the factors influencing the intention to use (ITU) mHealth apps, focusing on those with and without prior mHealth experience.

Methods

A cross-sectional study conducted from August 2022 to July 2023 included Thai citizens aged 45 years or older. Self-reported questionnaires collected data on sociodemographic information, health conditions, smartphone or tablet ownership, and mHealth usage experience. The Thai mHealth Senior Technology Acceptance Model questionnaires with a 10-point Likert scale evaluated mHealth acceptance. A multivariable logistic regression analysis, adjusted for age, gender, education, income, and living area, was performed for 2 subgroups: those who used ITU mHealth apps and those who did not.

Results

Of 1100 participants, 537 (48.8%) intended to use mHealth apps, while 563 (51.2%) did not. The ITU group had a younger average age, higher education levels, higher income, and fewer underlying diseases compared to those who did not intend to use mHealth apps. For those who had never used mHealth apps, having a smartphone was strongly associated with higher odds of ITU (adjusted odds ratio 2.81, 95% CI 1.6 to 4.93; P<.001), while having any underlying disease was associated with lower odds of ITU (adjusted odds ratio 0.63, 95% CI 0.42 to 0.97; P=.034). Higher acceptance levels, characterized by a positive attitude toward mHealth and lower fear of making mistakes, were also associated with higher ITU. For those with prior mHealth experience, acceptance in areas such as perceived ease of use, gerontechnology anxiety, and facilitating conditions was significantly associated with ITU.

Conclusions

Among inexperienced users, a positive attitude toward mHealth significantly enhanced ITU. Conversely, having an underlying disease decreased ITU, indicating a need for tailored mHealth apps. For experienced users, acceptance levels in areas such as ease of use and gerontechnology anxiety were crucial. Future research should explore specific mHealth apps for more targeted insights.

Quality of the digital gp visits and characteristics of the users: retrospective observational study

OBJECTIVES

This study compares the demographics, diagnoses, re-admission rates, sick leaves, and prescribed medications of patients accessing digital general practitioner (GP) visits with those of patients opting for traditional face-to-face appointments in a primary health care setting.

DESIGN

The study adopted a retrospective analysis of patient record data collected in 2019, comparing visits to a digital primary health center with traditional health center visits.

SETTING

Primary health care.

PARTICIPANTS

The data encompassed patients who utilized the digital clinic and those who visited public health centers for primary health care services.

MAIN OUTCOME MEASURES

The study assessed demographics, health diagnoses, prescribed medications, sick leave recommendations, re-admission rates, and differences in costs between digital clinic and face-to-face visits. Secondary outcomes included a comparative analysis of medication categories, resolution rates for health problems, and potential impacts on health care utilization.

RESULTS

Digital clinic users were typically younger, more educated, and predominantly female compared with health centre users. Digital visits were well-suited for uncomplicated infections, while health centre appointments were associated with a higher prevalence of chronic conditions. Medication patterns differed between the two modalities, with digital clinic users receiving generic over-the-counter drugs and antibiotics, whereas health centre visits commonly involved cardiac and antihypertensive medications. Sick leave recommendations were slightly higher in the digital clinic, but the difference was not significant. Approximately 70% of health problems addressed in the digital clinic were successfully resolved, and the cost of digital visits was about 50,3% of face-to-face appointments.

CONCLUSION

Digital health care services offer a cost-efficient alternative for specific health problems, appealing to younger, educated individuals, when compared to the users of public health center, and may enable improvement of cost-effectiveness combined with acceptable demand management and patient segmentation practices. The results highlight the potential benefits of digital clinics, particularly for uncomplicated cases, while also emphasizing the importance of suitable referral mechanisms for in-person consultations.

Healthcare Professionals' Attitude to Using Mobile Health Technology and Its Associated Factors in a Resource-Limited Country-An Implication for Digital Health Implementers: A Cross Sectional Study

Background: Mobile health has become widely used within the healthcare system, and there is an increasing worldwide trend toward employing this innovation for behavior management, disease monitoring, the control and prevention of various health issues, and rising enrollment in healthcare services. Although mHealth is becoming more widely available, there is no evidence about the attitude of healthcare professionals toward mHealth in southwest Ethiopia. Therefore, this study is aimed at assessing the attitude of healthcare professionals to using mHealth technology and associated factors in Ethiopia. Methods: An institutional cross-sectional study was conducted among 422 healthcare professionals. Data were collected using a pretested interviewer-administered questionnaire, and the study was conducted from January 08 to February 10, 2023. EpiData Version 4.6 for entering the data and STATA Version 14 for analyzing the data were used. A multivariable logistic regression analysis was carried out to identify factors associated with healthcare professionals' attitudes to using mobile health technology. Results: A total of 415 study participants were included in the study. About 180 (43.4%) respondents had a favorable attitude toward mHealth technology in southwest public hospitals. Master's degree and above (adjusted odds ratio [AOR]: 3.67; 95% CI: 1.22, 4.10), good knowledge of mobile health technology (AOR: 4.08; 95% CI: 1.35, 5.31), more than 5 years of work experience (AOR: 3.09; 95% CI: 1.76, 5.60), had ICT infrastructure (AOR: 2.70; 95% CI: 1.38, 5.31), had own smart mobile (AOR: 3.67; 95% CI: 3.20, 4.31), and had taken computer-related training (AOR: 1.96; 95% CI: 1.03, 3.73) were positively associated with healthcare professionals' attitude to using mobile health technologies in southwest Ethiopia. Conclusions: Overall, healthcare professionals' attitude to using mobile health technologies in southwest Ethiopia was relatively low. Education level, good knowledge, years of work experience, ICT infrastructure, having a smart mobile, and having taken computer-related training were significant factors of attitude to using mobile health technologies. Considering these factors could provide insight into developing and adopting mobile health technologies in Ethiopia.

Problems and Barriers Related to the Use of mHealth Apps From the Perspective of Patients: Focus Group and Interview Study

BACKGROUND

Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered.

OBJECTIVE

The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients.

METHODS

Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories ("validity," "usability," "technology," "use and adherence," "data privacy and security," "patient-physician relationship," "knowledge and skills," "individuality," "implementation," and "costs") identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology.

RESULTS

A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention.

CONCLUSIONS

There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients.

Effects of an Electronic Medical Records-Linked Diabetes Self-Management System on Treatment Targets in Real Clinical Practice: Retrospective, Observational Cohort Study

BACKGRUOUND

This study evaluated the effects of a mobile diabetes management program called "iCareD" (College of Medicine, The Catholic University of Korea) which was integrated into the hospital's electronic medical records system to minimize the workload of the healthcare team in the real clinical practice setting.

METHODS

In this retrospective observational study, we recruited 308 patients. We categorized these patients based on their compliance regarding their use of the iCareD program at home; compliance was determined through self-monitored blood glucose inputs and message subscription rates. We analyzed changes in the ABC (hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol) levels from the baseline to 12 months thereafter, based on the patients' iCareD usage patterns.

RESULTS

The patients comprised 92 (30%) non-users, 170 (55%) poor-compliance users, and 46 (15%) good-compliance users; the ABC target achievement rate showed prominent changes in good-compliance groups from baseline to 12 months (10.9% vs. 23.9%, P<0.05), whereas no significant changes were observed for poor-compliance users and non-users (13.5% vs. 18.8%, P=0.106; 20.7% vs. 14.1%, P=0.201; respectively).

CONCLUSION

Implementing the iCareD can improve the ABC levels of patients with diabetes with minimal efforts of the healthcare team in real clinical settings. However, the improvement of patients' compliance concerning the use of the system without the vigorous intervention of the healthcare team needs to be solved in the future.

Mobile Apps for Common Noncommunicable Disease Management: Systematic Search in App Stores and Evaluation Using the Mobile App Rating Scale

Background

The success of mobile apps in improving the lifestyle of patients with noncommunicable diseases through self-management interventions is contingent upon the emerging growth in this field. While users of mobile health (mHealth) apps continue to grow in number, little is known about the quality of available apps that provide self-management for common noncommunicable diseases such as diabetes, hypertension, and obesity.

Objective

We aimed to investigate the availability, characteristics, and quality of mHealth apps for common noncommunicable disease health management that included dietary aspects (based on the developer's description), as well as their features for promoting health outcomes and self-monitoring.

Methods

A systematic search of English-language apps on the Google Play Store (Google LLC) and Apple App Store (Apple Inc) was conducted between August 7, 2022, and September 13, 2022. The search terms used included weight management, obesity, diabetes, hypertension, cardiovascular diseases, stroke, and diet. The selected mHealth apps' titles and content were screened based on the description that was provided. Apps that were not designed with self-management features were excluded. We analyzed the mHealth apps by category and whether they involved health care professionals, were based on scientific testing, and had self-monitoring features. A validated and multidimensional tool, the Mobile App Rating Scale (MARS), was used to evaluate each mHealth app's quality based on a 5-point Likert scale from 1 (inadequate) to 5 (excellent).

Results

Overall, 42 apps were identified. Diabetes-specific mHealth apps accounted for 7% (n=3) of the market, hypertension apps for 12% (n=5), and general noncommunicable disease management apps for 21% (n=9). About 38% (n=16) of the apps were for managing chronic diseases, while 74% (n=31) were for weight management. Self-management features such as weight tracking, BMI calculators, diet tracking, and fluid intake tracking were seen in 86% (n=36) of the apps. Most mHealth apps (n=37, 88%) did not indicate whether there was involvement of health professionals in app development. Additionally, none of the apps reported scientific evidence demonstrating their efficacy in managing health. The overall mean MARS score was 3.2 of 5, with a range of 2.0 to 4.1. Functionality was the best-rated category (mean score 3.9, SD 0.5), followed by aesthetics (mean score 3.2, SD 0.9), information (mean score 3.1, SD 0.7), and engagement (mean score 2.9, SD 0.6).

Conclusions

The quality of mHealth apps for managing chronic diseases was heterogeneous, with roughly half of them falling short of acceptable standards for both quality and content. The majority of apps contained scant information about scientific evidence and the developer's history. To increase user confidence and accomplish desired health outcomes, mHealth apps should be optimized with the help of health care professionals. Future studies on mHealth content analysis should focus on other diseases as well.

Facilitators and barriers in acceptance of telemedicine among healthcare providers in Pakistan: A cross-sectional survey

Objectives

This study aimed to assess healthcare professionals' awareness and acceptance of telemedicine residing in Pakistan.

Materials and Methods

A cross-sectional study was conducted across Pakistan from November 2021 to March 2022. Data entry was done through a self-administered questionnaire. In this survey, the non-probability purposive sampling method was adopted. Medical doctors from all specialties that fall into the age category of 20-60 years were included in this study. Statistical Package for Social Sciences (SPSS) version 22.0 was used for univariate data analysis.

Results

Among the 860 healthcare professionals who received the survey, 198 responded (23.0% response rate). The mean ± SD age of the participants was 31.16 ± 8.56. The results were found to be statistically significant for knowledge about telemedicine among healthcare professionals workplace, that is, healthcare professionals working in the private sector indicated a high level of awareness regarding telemedicine as compared to those in the public sector (p = 0.03). A significant difference (p-value ⩽ 0.05) in knowledge was seen among doctors working in the public sector and those working in a private setup. Results indicate significant positive associations between telemedicine utilization and perceived benefits over disadvantages (β = 1.03, p = 0.017), reliance among healthcare professionals (β = 1.22, p = 0.008), and enhancement in healthcare quality (β = 1.42, p = 0.001). Moreover, familiarity with telemedicine correlates strongly with its usage (β = 2.56, p < 0.000).

Conclusion

Overall, healthcare professionals exhibited satisfactory knowledge regarding telemedicine and showed an accepting attitude toward telemedicine. Our study recommends enhancing the importance of Telemedicine training at the Healthcare professionals' level to produce quality service delivery in healthcare organizations.

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.

Automated Machine Learning Analysis of Patients With Chronic Skin Disease Using a Medical Smartphone App: Retrospective Study

BACKGROUND

Rapid digitalization in health care has led to the adoption of digital technologies; however, limited trust in internet-based health decisions and the need for technical personnel hinder the use of smartphones and machine learning applications. To address this, automated machine learning (AutoML) is a promising tool that can empower health care professionals to enhance the effectiveness of mobile health apps.

OBJECTIVE

We used AutoML to analyze data from clinical studies involving patients with chronic hand and/or foot eczema or psoriasis vulgaris who used a smartphone monitoring app. The analysis focused on itching, pain, Dermatology Life Quality Index (DLQI) development, and app use.

METHODS

After extensive data set preparation, which consisted of combining 3 primary data sets by extracting common features and by computing new features, a new pseudonymized secondary data set with a total of 368 patients was created. Next, multiple machine learning classification models were built during AutoML processing, with the most accurate models ultimately selected for further data set analysis.

RESULTS

Itching development for 6 months was accurately modeled using the light gradient boosted trees classifier model (log loss: 0.9302 for validation, 1.0193 for cross-validation, and 0.9167 for holdout). Pain development for 6 months was assessed using the random forest classifier model (log loss: 1.1799 for validation, 1.1561 for cross-validation, and 1.0976 for holdout). Then, the random forest classifier model (log loss: 1.3670 for validation, 1.4354 for cross-validation, and 1.3974 for holdout) was used again to estimate the DLQI development for 6 months. Finally, app use was analyzed using an elastic net blender model (area under the curve: 0.6567 for validation, 0.6207 for cross-validation, and 0.7232 for holdout). Influential feature correlations were identified, including BMI, age, disease activity, DLQI, and Hospital Anxiety and Depression Scale-Anxiety scores at follow-up. App use increased with BMI >35, was less common in patients aged >47 years and those aged 23 to 31 years, and was more common in those with higher disease activity. A Hospital Anxiety and Depression Scale-Anxiety score >8 had a slightly positive effect on app use.

CONCLUSIONS

This study provides valuable insights into the relationship between data characteristics and targeted outcomes in patients with chronic eczema or psoriasis, highlighting the potential of smartphone and AutoML techniques in improving chronic disease management and patient care.

Predicting Internet Use and Digital Competence Among Older Adults Using Performance Tests of Visual, Physical, and Cognitive Functioning: Longitudinal Population-Based Study

BACKGROUND

The rapidly increasing role of the internet in obtaining basic services poses challenges, especially for older adults' capabilities of getting the services they need. Research on the predictors of older adults' internet use and digital competence is especially relevant given that people are living longer than before, and the age profile of many societies is changing rapidly.

OBJECTIVE

We aimed to examine the associations of objective measures of physical and cognitive impairment with the nonuse of the internet for services and low digital competence among older adults.

METHODS

A longitudinal population-based design was used that combined data from performance tests and self-rated questionnaires. Data were gathered in 2017 and 2020 among 1426 older adults aged between 70 and 100 years in Finland. Logistic regression analyses were used to examine the associations.

RESULTS

Those who had poor near (odds ratio [OR] 1.90, 95% CI 1.36-2.66) or distant vision (OR 1.81, 95% CI 1.21-2.71), restricted or failed abduction of upper arms (OR 1.81, 95% CI 1.28-2.85), and poor results from the word list memory (OR 3.77, 95% CI 2.65-5.36) or word list delayed recall (OR 2.12, 95% CI 1.48-3.02) tests had greater odds for nonuse of the internet for services than their counterparts. Moreover, those who had poor near (OR 2.18, 95% CI 1.57-3.02) or distant vision (OR 2.14, 95% CI 1.43-3.19), poor results from the chair stand test (OR 1.57, 95% CI 1.06-2.31), restricted or failed abduction of upper arms (OR 1.74, 95% CI 1.10-2.76), and poor results from the word list memory (OR 3.41, 95% CI 2.32-5.03) or word list delayed recall (OR 2.05, 95% CI 1.39-3.04) tests had greater odds of low digital competence than their counterparts.

CONCLUSIONS

According to our results, older adults' impaired physical and cognitive functioning may hamper their possibilities of accessing internet services such as digital health care services. Our results should be considered when planning digital health care services intended to be used by older adults; that is, digital solutions should also be suitable for older adults with impairments. Furthermore, face-to-face services should be provided for those who cannot use digital services, even if they are assisted properly.

Chronic kidney disease patients' views of readiness and ability to use mHealth apps

BACKGROUND

The use of mobile health (mHealth) applications, which provide opportunities to improve health and lessen health inequalities, is increasing. Studies assessing the readiness and ability of patients in Malaysia with chronic kidney disease (CKD) to use mobile phone apps to manage their health are limited.

AIMS

This study aimed to assess the readiness and ability to use mHealth apps among patients with CKD in north-east Peninsular Malaysia.

METHODS

A cross-sectional study was undertaken, using a convenience sample of 100 CKD medical inpatients in a tertiary teaching hospital. A structured, self-administered questionnaire on readiness and ability to use mHealth apps was adopted.

FINDINGS

Nearly one in five patients (18%) actively used health applications. More than three-quarters (77%) were aged >40 years and a similar proportion were ready to use mHealth apps (78%), and nearly half (46%) were confident about connecting their device to wifi. There was a correlation between ability and readiness to use mHealth apps (r=0.4; P<0.05).

CONCLUSIONS

Fewer than half of participants had a good command of mHealth applications. Therefore, support on the use of these apps is needed, and healthcare managers need to consider this.

A Smartphone-Based Intervention for Anxiety and Depression in Racially and Ethnically Diverse Adults (EASE): Protocol for a Randomized Controlled Trial

BACKGROUND

Clear health disparities have emerged in the rates of COVID-19 exposure, hospitalization, and death among Black, Hispanic, and American Indian (BHAI) individuals, relative to non-Hispanic White (NHW) individuals. BHAI populations have been disproportionately affected by lower behavioral health access and heightened negative mental health outcomes during the pandemic.

OBJECTIVE

This project directly addresses health disparities in access to behavioral health care during the COVID-19 pandemic among BHAI populations via an adaptation of the established, initially validated, low-cost, mobile app Easing Anxiety Sensitivity for Everyone (EASE) among individuals with symptoms of elevated anxiety or depression or both.

METHODS

The EASE trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. Participants (N=800; n=200, 25%, Black; n=200, 25%, Hispanic; n=200, 25%, American Indian; and n=200, 25%, NHW) are randomized to receive either EASE or an active comparison condition for anxiety and depression. Participants compete an online prescreener, an enrollment call to provide informed consent, a baseline survey, a 6-month intervention period, and 3- and 6-month postbaseline assessments. Select participants also complete a 3- and 6-month postbaseline qualitative interview via phone or an online platform (eg, Zoom). Participants complete 2 scheduled daily ecological momentary assessments (EMAs) during the 6-month study period. These twice-daily EMAs guide a just-in-time approach to immediate, personalized behavioral health care.

RESULTS

Outcomes include reductions in anxiety and depressive symptoms and functional impairment at 3 and 6 months postrandomization. We also will examine putative mechanisms (eg, anxiety sensitivity [AS] and COVID-19-specific stress and fear) of the intervention effects. Further, as treatment effects may differ across sociocultural factors, perceived discrimination, social support, and socioeconomic status (SES) will be evaluated as potential moderators of treatment effects on the primary outcomes. Process evaluation using data collected during the study, as well as individual interviews with participants, will complement quantitative data.

CONCLUSIONS

Data from this efficacy trial will determine whether EASE successfully improves symptoms of anxiety and depression and whether these improvements outperform an active comparison control app. If successful, findings from this study have the potential to decrease anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae. Data from this study may be used to support an implementation and dissemination trial of EASE within real-world behavioral health and social service settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05074693; https://clinicaltrials.gov/ct2/show/NCT05074693.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40713.

Bridging the Generational Digital Divide in the Healthcare Environment

Increasing technological advances have generated a digital dependency in the population, resulting in a group of digitally excluded vulnerable people that lack basic digital skills. The aim of this study was to assess the digital divide in patients in relation to the healthcare environment. We explored the extent and effects of the digital health divide by undertaking a systematic review of the academic literature and comparing our findings with the results of a cross-sectional in-person survey answered by 881 people at four community pharmacies. In terms of the sociodemographic profile of the patients, we collected data regarding their gender, age, education level, and location (periphery or urban). The parameters evaluated were use of the internet to search for health information, use of telemedicine, use of different medical/healthcare applications, understanding explanations given by physicians regarding health, and asking pharmacists for help about newly prescribed treatments. Moreover, 168 pharmacists answered an online survey about how often they helped patients to make health center appointments or to download their COVID-19 vaccination certificate. Gender did not influence these results, but age, education level, and population location did. Those with the lowest levels of education required more help to request a health center appointment. People with high education levels and those living in an urban environment more often searched the internet for information about treatments that were new to them. Finally, people living in periphery areas received more help from their pharmacists, 60% of which said they had helped patients to download their COVID-19 vaccination certificate, with 24% of them saying they helped patients with this on a daily basis.

Ageism in healthcare technology: the older patients’ aspirations for improved online accessibility

Objective

To identify concerns, barriers and facilitators impacting the use of patient portals by older patients as well as desired features in future updates.

Materials and Methods

This is a cross-sectional study consisting of 2 focus group discussions culminating in an anonymous survey administered to women who were 65 years and older receiving urogynecologic care in Northwest Ohio.

Results

Of the 205 women surveyed (91% response rate), providers and healthcare systems play the primary 2 roles (73% and 69%, respectively) in facilitating patients’ use of patient portal systems and telehealth applications. Barriers to use revolved around technical difficulties (50%), privacy concerns (45%), and cost of technology (24%). The most important features desired were the ability to modify the text size within the application (47%) and an intuitive, simple interface (46%). Additional assistance for navigating technical challenges was suggested, specifically set-up of accounts (36%), saving and sharing information with caregivers (35%), and sign-in and navigation of portals (32%).

Conclusion

The paucity of age-aligned medical access software and products may lead to worsening of digital exclusion and disparities in healthcare. Portal application developers and healthcare systems must advance efforts that consider the needs of those who may be older when designing patient portals.

Supporting Management of Noncommunicable Diseases With Mobile Health (mHealth) Apps: Experimental Study

BACKGROUND

Noncommunicable diseases (NCDs) are the leading global health problem in this century and are the principal causes of death and health care spending worldwide. Mobile health (mHealth) apps can help manage and prevent NCDs if people are willing to use them as supportive tools. Still, many people are reluctant to adopt these technologies. Implementing new apps could result in earlier intervention for many health conditions, preventing more serious complications.

OBJECTIVE

This research project aimed to test the factors that facilitate the adoption of mHealth apps by users with NCDs. We focused on determining, first, what user interface (UI) qualities and complexity levels appeal to users in evaluating mHealth apps. We also wanted to determine whether people prefer that the data collected by an mHealth app be analyzed using a physician or an artificial intelligence (AI) algorithm. The contribution of this work is both theoretical and practical. We examined users' considerations when adopting mHealth apps that promote healthy lifestyles and helped them manage their NCDs. Our results can also help direct mHealth app UI designers to focus on the most appealing aspects of our findings.

METHODS

A total of 347 respondents volunteered to rate 3 models of mHealth apps based on 16 items that measured instrumentality, aesthetics, and symbolism. Respondents rated each model after reading 1 of 2 different scenarios. In one scenario, a physician analyzed the data, whereas, in the other, the data were analyzed by an AI algorithm. These scenarios tested the degree of trust people placed in AI algorithms versus the "human touch" of a human physician regarding analyzing data collected by an mHealth app.

RESULTS

As shown by the responses, the involvement of a human physician in the application had a significant effect (P<.001) on the perceived instrumentality of the simple model. The complex model with more controls was rated significantly more aesthetic when associated with a physician performing data analysis rather than an AI algorithm (P=.03).

CONCLUSIONS

Generally, when participants found a human touch in the mHealth app (connection to a human physician who they assumed would analyze their data), they judged the app more favorably. Simple models were evaluated more positively than complex ones, and aesthetics and symbolism were salient predictors of preference. These trends suggest that designers and developers of mHealth apps should keep the designs simple and pay special attention to aesthetics and symbolic value.

The role of age and digital competence on the use of online health and social care services: A cross-sectional population-based survey

OBJECTIVE

Online health and social care services are getting widespread which increases the risk that less advantaged groups may not be able to access these services resulting in digital exclusion. We examined the combined effects of age and digital competence on the use of online health and social care services.

METHODS

We used a large representative population-based sample of 4495 respondents from Finland. Paper-based self-assessment questionnaire with an online response option was mailed to participants. The associations were analyzed using survey weighted logistic regression, exploring potential non-linear effects of age and controlling for potential sex differences.

RESULTS

Higher age, starting from around the age of 60 was associated with a lower likelihood of using online services for receiving test results, renewing prescriptions and scheduling appointments. Good digital competence was able to hinder the age-related decline in online services use, but only up to around the age of 80.

CONCLUSIONS

Our results suggest that older adults are at risk of digital exclusion, and not even good digital competence alleviates this risk among the oldest. We suggest that health and social care providers should consider older users' needs and abilities more thoroughly and offer easy to use online services. More digital support and training possibilities should be provided for older people. It is equally important that face-to-face and telephone services will be continued to be provided for those older people who are not able to use online services even when supported.

Pilot study of smartphone-based health outcome tracking (OurBrainBank) for glioblastoma patients

Background

Patients with glioblastoma (GBM) typically have high symptom burden impacting on quality of life. Mobile apps may help patients track their condition and provide real-time data to clinicians and researchers. We developed a health outcome reporting app (OurBrainBank [OBB]) for GBM patients. Our primary aim was to explore the feasibility and take-up of OBB. Secondary aims were to examine the potential value of OBB app usage for patient well-being and clinical research.

Methods

Participants (or caregiver proxies) completed baseline surveys and tracked 10 health outcomes over time. We evaluated usage and engagement, and relationships between clinical/sociodemographic variables and OBB use. Participant satisfaction and feedback were described. To demonstrate usefulness for clinical research, health outcomes were compared with corresponding items on a validated measure (EQ-5D-5L).

Results

From March 2018 to February 2021, OBB was downloaded by 630 individuals, with 15 207 sets of 10 health outcomes submitted. Higher engagement was associated with being a patient rather than a caregiver (χ ²(2,568) = 28.6, P < .001), having higher self-rated health scores at baseline (F(2,460) = 4.8, P = .009) and more previous experience with mobile apps (χ ²(2,585) = 9.6, P = .008). Among the 66 participants who completed a feedback survey, most found health outcome tracking useful (average 7/10), and would recommend the app to others (average 8.4/10). The OBB health outcomes mapped onto corresponding EQ-5D-5L items, suggesting their validity.

Conclusions

OBB can efficiently collect GBM patients’ health outcomes. The long-term goal is to create a unique database of thousands of deidentified GBM patients, with open access to qualified researchers.

The Associations Between Mental Health Problems and Attitudes Toward Web-Based Health and Social Care Services: Evidence From a Finnish Population-Based Study

BACKGROUND

The significance of web-based health and social care services has been highlighted in recent years. There is a risk that the digitalization of public services will reinforce the digital and social exclusion of vulnerable groups, such as individuals with mental health problems.

OBJECTIVE

This study aims to examine the associations between mental health problems and attitudes toward web-based health and social care services in the general population. The attitudes measured include lack of interest, perceived need for face-to-face encounters, and concern for safety. The study also evaluates whether sociodemographic characteristics (age, gender, education level, and poverty) modify these associations.

METHODS

Cross-sectional population-based data were collected from 4495 Finnish adults in 2017. Linear regression was used to examine the main effects and interactions of poor mental health and sociodemographic characteristics on attitudes toward web-based health and social care services.

RESULTS

The results show that mental health was associated with attitudes toward web-based health and social care services. Individuals with mental health problems were especially concerned about the safety of web-based services. Poor mental health was independently associated with negative attitudes toward web-based services over the effects of sociodemographic factors. Some of the associations between poor mental health and negative attitudes toward web-based services were stronger among older people and men. With regard to sociodemographic characteristics, particularly higher age, low education, and poverty were associated with negative attitudes toward web-based health and social care services.

CONCLUSIONS

Poor mental health is associated with negative attitudes toward web-based health and social care services and thus indirectly with exclusion. It seems that being older and being male both reinforce the link between poor mental health and exclusion. In supporting the digital inclusion of people with mental health problems, attention should be paid to guidance and counseling, reliability, and the user-friendliness of web-based services as well as to the prevention of poverty. In addition, it is essential to see web-based services as complementary to, and not a substitute for, face-to-face services.

Who is more likely to adopt and comply with the electronic patient-reported outcome measure (ePROM) mobile application? A real-world study with cancer patients undergoing active treatment

PURPOSE

This study aims to identify factors associated with the adoption and compliance of electronic patient-reported outcome measure (ePROM) use among cancer patients in a real-world setting.

METHODS

This prospective cohort study was conducted at the Samsung Medical Center in Seoul, Korea, from September 2018 to January 2019. Cancer patients aged 18 years or older who owned smartphones and who were receiving chemotherapy or radiation therapy were eligible for this study. Patients were asked to use the app to report their symptoms every 7 days for a total of 21 days (3 weeks). Logistic regression was performed to identify the factors associated with the adoption and compliance.

RESULTS

Among 580 patients, 417 (71.9%) adopted the ePROM app and 159 (27.4%) out of 417 had good compliance. Patients who had greater expectations regarding the ease of use (adjusted odds ratio [aOR] 2.67, 95% CI: 1.28-5.57) and usefulness (aOR 1.69, 95% CI: 1.05-2.72) of the ePROM app were more likely to adopt the app than those who did not. Patients who had greater satisfaction with usefulness (aOR 1.89, 95% CI 1.10-3.25) were more likely to comply with using the app, but satisfaction with ease of use was not related to the compliance.

CONCLUSION

While expectation regarding the ease of use and usefulness of the ePROM app was associated with the adoption of the app, satisfaction with ease of use was not related to compliance with the ePROM app. Satisfaction with usefulness was associated with the compliance of ePROM app use.