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Thøgersen-Ntoumani C, Grunseit A, Holtermann A, Steiner S, Tudor-Locke C, Koster A, Johnson N, Maher C, Ahmadi M, Chau JY, Stamatakis E. Promoting vigorous intermittent lifestyle physical activity (vilpa) in middle-aged adults: an evaluation of the movsnax mobile app. BMC Public Health 2024; 24:2182. [PMID: 39135030 PMCID: PMC11318164 DOI: 10.1186/s12889-024-19549-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Most adults fail to meet the moderate to vigorous physical activity-based recommendations needed to maintain or improve health. Vigorous Intermittent Lifestyle Physical Activity (VILPA) refers to short (1-2 min) high-intensity activities that are integrated into activities of daily living. VILPA has shown strong potential to improve health and addresses commonly reported barriers to physical activity. However, it is unknown how VILPA can best be promoted among the adult population. This study aimed to evaluate the usability, user engagement, and satisfaction of a mobile application (MovSnax) designed to promote VILPA. METHODS A concurrent mixed methods design was used. It comprised four parts. Part A was a survey with n = 8 mHealth and physical activity experts who had used the app over 7-10 days. Part B was think-aloud interviews with n = 5 end-users aged 40-65 years old. Part C was a survey with a new group of 40-65-year-old end-users (n = 35) who had used the MovSnax app over 7-10 days. Part D was semi-structured interviews with n = 18 participants who took part in Part C. Directed content analysis was used to analyze the results from Parts A, B, and D, and descriptive statistics were used to analyze findings from Part C. RESULTS Participants reported positive views on the MovSnax app for promoting VILPA but also identified usability issues such as unclear purpose, difficulties in manual data entry, and limited customization options. Across the different data collections, they consistently emphasized the need for more motivational features, clearer feedback, and gamification elements to enhance engagement. Quantitative assessment showed satisfactory scores on objective measures but lower ratings on subjective aspects, possibly due to unfamiliarity with the VILPA concept and/or technical barriers. CONCLUSIONS The MovSnax app, tested in the present study, is the world's first digital tool aimed specifically at increasing VILPA. The findings of the present study underscore the need for further app refinement, focusing on clarifying its purpose and instructions, boosting user engagement through personalization and added motivational elements, enhancing accuracy in detecting VILPA bouts, implementing clearer feedback mechanisms, expanding customization choices (such as font size and comparative data), and ensuring transparent and meaningful activity tracking.
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Affiliation(s)
- Cecilie Thøgersen-Ntoumani
- Danish Centre for Motivation and Behaviour Science (DRIVEN), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anne Grunseit
- School of Public Health, Faculty of Health, University of Technology Sydney, Broadway, Ultimo, NSW, 2007, Australia
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sarah Steiner
- Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, 1 John Hopkins Drive, Camperdown, Sydney, New South Wales, 2050, Australia
| | - Catrine Tudor-Locke
- College of Health and Human Service, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Annemarie Koster
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Nathan Johnson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, 1 John Hopkins Drive, Camperdown, Sydney, New South Wales, 2050, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) Research Centre, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
| | - Matthew Ahmadi
- Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, 1 John Hopkins Drive, Camperdown, Sydney, New South Wales, 2050, Australia
| | - Josephine Y Chau
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Emmanuel Stamatakis
- Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, 1 John Hopkins Drive, Camperdown, Sydney, New South Wales, 2050, Australia
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Queiroz MADSD, Brasil CCP, Cabral CBM, Porto ACL, Barbosa PME, Sousa RCD, Alegria RFDG, Peixoto V. EHealth technologies in parental care for preterm infants: an integrative review. CIENCIA & SAUDE COLETIVA 2024; 29:e06212024. [PMID: 39140545 DOI: 10.1590/1413-81232024298.06212024] [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: 10/10/2023] [Accepted: 04/10/2024] [Indexed: 08/15/2024] Open
Abstract
The eHealth technologies promote parental care practices for preterm infants. Nonetheless, we should underscore the abundant information and available apps and disparities in these resources' quality, usability, and reliability. This article examines eHealth technologies directed at parents to care for preterm infants. An integrative review was conducted across the principal health databases (Capes, EBSCO, BVS, PubMed, Scholar, and SciELO), selecting works published from 2011 to 2022 in Portuguese and English, focusing on the use of eHealth technologies for the care of preterm infants. We identified 13 articles related to information and communication technologies in strategies for educating and promoting the health of preterm infants and their parents and the importance of evaluating and validating eHealth technologies in maternal and child health promotion. Properly validated eHealth technologies can be crucial in supporting parents in promoting health and providing care for preterm infants after hospital discharge, which, in turn, can drive the evolution of healthcare systems and improve clinical practices.
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Affiliation(s)
- Moisés Andrade Dos Santos de Queiroz
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza (UNIFOR). Av. Washington Soares 1321, Edson Queiroz. 60811-905 Fortaleza CE Brasil.
| | - Christina César Praça Brasil
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza (UNIFOR). Av. Washington Soares 1321, Edson Queiroz. 60811-905 Fortaleza CE Brasil.
| | - Cláudia Belém Moura Cabral
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza (UNIFOR). Av. Washington Soares 1321, Edson Queiroz. 60811-905 Fortaleza CE Brasil.
| | - Andrea Cintia Laurindo Porto
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza (UNIFOR). Av. Washington Soares 1321, Edson Queiroz. 60811-905 Fortaleza CE Brasil.
| | | | - Rachel Cassiano de Sousa
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza (UNIFOR). Av. Washington Soares 1321, Edson Queiroz. 60811-905 Fortaleza CE Brasil.
| | | | - Vânia Peixoto
- Escola Superior de Saúde Fernando Pessoa. Porto Portugal
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So JTH, Nambiar S, Byrne R, Gallegos D, Baxter KA. Designing Child Nutrition Interventions to Engage Fathers: Qualitative Analysis of Interviews and Co-Design Workshops. JMIR Pediatr Parent 2024; 7:e57849. [PMID: 38815260 PMCID: PMC11176881 DOI: 10.2196/57849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers' experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers. OBJECTIVE This study aims to explore fathers' experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers. METHODS Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops. RESULTS A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation-Behavior model. The interview data illuminated factors influencing fathers' initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers' diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men's caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child's age and targeted at fathers using comprehensive promotion strategies. CONCLUSIONS Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice.
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Affiliation(s)
- Jeffrey Tsz Hei So
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Smita Nambiar
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Rebecca Byrne
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Danielle Gallegos
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kimberley A Baxter
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Nuampa S, Sirithepmontree S, Sudphet M, Patil CL. 'The way to obtain freedom and equality': Experiences and needs of Thai adolescent mothers in terms of the use smartphone applications for breastfeeding support. PLoS One 2024; 19:e0300041. [PMID: 38557683 PMCID: PMC10984458 DOI: 10.1371/journal.pone.0300041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Breastfeeding brings about a positive impact on both child and maternal health in the short and long terms. However, adolescent mothers have a lower breastfeeding initiation rate and a shorter breastfeeding duration than adult mothers. Although mobile applications have been found to be the most widely used platform for breastfeeding support, there is still a lack of design specific for adolescents. AIM To explore the experiences, perspectives and needs of adolescent mothers and professional nurses using smartphone applications for breastfeeding support and the influence of this technology on healthcare in Thailand. METHODS This formative qualitative research of the 'Development of smartphone application for promoting breastfeeding and learning of infant responsiveness for Thai teenage pregnant women' study intends to design a smartphone application and develop an implementation plan. A purposive sample was used to elicit experiences from adolescent mothers and nurses. Data were collected from 48 adolescent mothers through in-depth interviews with six focus group discussions and 12 nurses, following the data saturation principle. Thematic analysis was conducted, and potential factors and needs were mapped to the capability, opportunity, and motivation model of behaviour change (COM-B). RESULTS Most adolescent mothers perceived the usefulness of smartphone apps as breastfeeding support resources. The qualitative findings of adolescent mothers were grouped into the following three themes: a friendly breastfeeding tool; allows them to manage their breastfeeding activities; and enhances the accessibility and equality of breastfeeding support. The professional nurses perceived the benefits of using smartphone applications in their work, which included the following three themes: reducing workload and making their work easier; preparation is always better; and increasing the standards of breastfeeding support. CONCLUSION Adolescent mothers and professional nurses showed favourable attitudes toward smartphone apps for breastfeeding support. These smartphone apps should be tailored to these groups to achieve optimal BF outcomes.
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Affiliation(s)
- Sasitara Nuampa
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Sudhathai Sirithepmontree
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Metpapha Sudphet
- Department of Obstetrics and Gynaecology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Crystal L. Patil
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America
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Phillips JC, Alfano AR, Barfield LC, Cain L, Sadjadi M, Morales E, Phillips-Beck W, Galarza MG, Torres M, Zindani S, Rayani A, Edwards K, Jones SG, Hannan J. Exploring Maternal and Infant Health App Development and Effectiveness Research: Scoping Review. JMIR Pediatr Parent 2024; 7:e46973. [PMID: 38055330 PMCID: PMC10858421 DOI: 10.2196/46973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Globally, high rates of maternal and infant mortality call for interventions during the perinatal period to engage pregnant people as well as their loved ones in care. Mobile health technologies have become ubiquitous in our lives and in health care settings. However, there is a need to further explore their safety and effectiveness to support and improve health outcomes locally and globally. OBJECTIVE The aim of this study was to review and synthesize published literature that described the development process or effectiveness evaluations of maternal and infant apps. METHODS We applied a methodological framework for scoping reviews as well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines; in addition, the systematic review platform Covidence (Veritas Health Innovation Ltd) was used to facilitate the review of included studies. Search terms were developed collaboratively, and health sciences-associated databases were searched for studies conducted between January 1, 2000, and February 4, 2022. We excluded studies about apps that only gathered or tracked data or targeted care providers. RESULTS A total of 1027 articles were included for title and abstract screening, of which 87 (8.47%) were chosen for full-text screening. Of these 87 articles, 74 (85%) were excluded with reasons, and 19 (22%) were included. Four articles were added at data extraction from hand searching and 2 others were excluded. Thus, we reviewed and synthesized data from 11 unique studies reported in 21 articles published between 2017 and 2021. The included studies represented 8 different countries. Most of the apps (8/11, 73%) were in English, although apps were also developed in Arabic, Bahasa Indonesia, and Nepali. The articles reviewed revealed the early stage of development of the field of maternal and infant health apps, with modest evidence of app use and achievement of study outcomes. Only 1 (9%) of the 11 apps was endorsed by an independent health care provider society. App development and evaluation processes emerged, and specific app features were identified as vital for well-functioning apps. End-user engagement occurred in some, but not all, parts of app research and development. CONCLUSIONS Apps to improve maternal and infant health are being developed and launched in enormous numbers, with many of them not developed with mothers' needs in mind. There are concerns about privacy, safety, and the standardization of current apps as well as a need for professional or institution-specific guidelines or best practices. Despite challenges inherent in currently available apps and their design processes, maternal and infant app technology holds promise for achieving health equity goals and improving maternal and child health outcomes. Finally, we propose recommendations for advancing the knowledge base for maternal and infant apps.
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Affiliation(s)
| | - Alliete R Alfano
- Department of Communication Sciences and Disorders, Florida International University, Miami, FL, United States
| | - Latisha C Barfield
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, United States
| | - Lisa Cain
- Chaplin School of Hospitality &Tourism Management, Florida International University, North Miami, FL, United States
| | - Masoud Sadjadi
- Knight Foundation School of Computing and Information Sciences, Florida International University, Miami, FL, United States
| | | | - Wanda Phillips-Beck
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, MB, Canada
| | - M Grisel Galarza
- Miller School of Medicine, Pediatrics/Neonatology, University of Miami, Miami, FL, United States
| | - Maritza Torres
- Miller School of Medicine, Pediatrics/Neonatology, University of Miami, Miami, FL, United States
| | - Sadaf Zindani
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Ahmad Rayani
- College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Khalee Edwards
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, United States
| | - Sande Gracia Jones
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, United States
| | - Jean Hannan
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, United States
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Charlesworth J, McAlpine T, Martin A, Scott J, Mullan B. Development, psychometric assessment, and predictive validity of a breastfeeding subjective norms scale among an Australian prospective cohort of first-time parents. Br J Health Psychol 2023; 28:690-704. [PMID: 36740759 DOI: 10.1111/bjhp.12648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/18/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Breastfeeding has a number of benefits for both mothers and their infants. Research has examined the psychosocial influences on breastfeeding, yielding important findings in relation to particular constructs that play a significant role in this vital health behaviour. One such construct is subjective norms. However, there are mixed findings in relation to the role of subjective norms in breastfeeding behaviours. This may be due to the lack of consistent measure of subjective norms across studies. Further, the influence of fathers' subjective norms on breastfeeding continuation remains unclear due to a lack of measurement. Thus, the aim of the current study was to develop and assess a reliable and valid subjective norms scale specific to breastfeeding for use among both mothers and fathers. DESIGN/METHODS Subjective norms items were developed by researchers in the domain and were tested among 949 couples. RESULTS Findings indicated that both subjective norms scales had excellent reliability, construct validity, and predictive validity. It was also found that both the mothers' and fathers' subjective norms scales tapped into two key structures: breastfeeding in general, and breastfeeding in public. Further, maternal subjective norms were predictive of breastfeeding behaviours but not paternal subjective norms. CONCLUSIONS These findings indicate that the developed subjective norms scales are reliable and valid and capture key elements of breastfeeding subjective norms among both mothers and fathers. Use of this measure in future research can help better understand the role of both mothers' and fathers' subjective norms in influencing breastfeeding behaviours.
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Affiliation(s)
- Jessica Charlesworth
- Faculty of Health Sciences, enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Population Health Curtin University, Perth, Western Australia, Australia
| | - Thomas McAlpine
- Faculty of Health Sciences, enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Population Health Curtin University, Perth, Western Australia, Australia
| | - Annegret Martin
- School of Population Health Curtin University, Perth, Western Australia, Australia
| | - Jane Scott
- School of Population Health Curtin University, Perth, Western Australia, Australia
| | - Barbara Mullan
- Faculty of Health Sciences, enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Population Health Curtin University, Perth, Western Australia, Australia
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Guan V, Zhou C, Wan H, Zhou R, Zhang D, Zhang S, Yang W, Voutharoja BP, Wang L, Win KT, Wang P. A Novel Mobile App for Personalized Dietary Advice Leveraging Persuasive Technology, Computer Vision, and Cloud Computing: Development and Usability Study. JMIR Form Res 2023; 7:e46839. [PMID: 37549000 PMCID: PMC10442736 DOI: 10.2196/46839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The Australian Dietary Guidelines (ADG) translate the best available evidence in nutrition into food choice recommendations. However, adherence to the ADG is poor in Australia. Given that following a healthy diet can be a potentially cost-effective strategy for lowering the risk of chronic diseases, there is an urgent need to develop novel technologies for individuals to improve their adherence to the ADG. OBJECTIVE This study describes the development process and design of a prototype mobile app for personalized dietary advice based on the ADG for adults in Australia, with the aim of exploring the usability of the prototype. The goal of the prototype was to provide personalized, evidence-based support for self-managing food choices in real time. METHODS The guidelines of the design science paradigm were applied to guide the design, development, and evaluation of a progressive web app using Amazon Web Services Elastic Compute Cloud services via iterations. The food layer of the Nutrition Care Process, the strategies of cognitive behavioral theory, and the ADG were translated into prototype features guided by the Persuasive Systems Design model. A gain-framed approach was adopted to promote positive behavior changes. A cross-modal image-to-recipe retrieval model under an Apache 2.0 license was deployed for dietary assessment. A survey using the Mobile Application Rating Scale and semistructured in-depth interviews were conducted to explore the usability of the prototype through convenience sampling (N=15). RESULTS The prominent features of the prototype included the use of image-based dietary assessment, food choice tracking with immediate feedback leveraging gamification principles, personal goal setting for food choices, and the provision of recipe ideas and information on the ADG. The overall prototype quality score was "acceptable," with a median of 3.46 (IQR 2.78-3.81) out of 5 points. The median score of the perceived impact of the prototype on healthy eating based on the ADG was 3.83 (IQR 2.75-4.08) out of 5 points. In-depth interviews identified the use of gamification for tracking food choices and innovation in the image-based dietary assessment as the main drivers of the positive user experience of using the prototype. CONCLUSIONS A novel evidence-based prototype mobile app was successfully developed by leveraging a cross-disciplinary collaboration. A detailed description of the development process and design of the prototype enhances its transparency and provides detailed insights into its creation. This study provides a valuable example of the development of a novel, evidence-based app for personalized dietary advice on food choices using recent advancements in computer vision. A revised version of this prototype is currently under development.
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Affiliation(s)
- Vivienne Guan
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Chenghuai Zhou
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Hengyi Wan
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Rengui Zhou
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Dongfa Zhang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sihan Zhang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Wangli Yang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bhanu Prakash Voutharoja
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lei Wang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Khin Than Win
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Peng Wang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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8
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Xie EB, Jung JW, Kaur J, Benzies KM, Tomfohr-Madsen L, Keys E. Digital Parenting Interventions for Fathers of Infants From Conception to the Age of 12 Months: Systematic Review of Mixed Methods Studies. J Med Internet Res 2023; 25:e43219. [PMID: 37494086 PMCID: PMC10413237 DOI: 10.2196/43219] [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] [Received: 10/11/2022] [Revised: 04/27/2023] [Accepted: 06/06/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Digital interventions help address barriers to traditional health care services. Fathers play an important parenting role in their families, and their involvement is beneficial for family well-being. Although digital interventions are a promising avenue to facilitate father involvement during the perinatal period, most are oriented toward maternal needs and do not address the unique needs of fathers. OBJECTIVE This systematic review describes the digital interventions that exist or are currently being developed for fathers of infants from conception to 12 months postpartum. METHODS A systematic search of the MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Embase (using Ovid), and CINAHL (using EBSCO) databases was conducted to identify articles from database inception to June 2022, of which 39 met the inclusion criteria. Articles were included if they were peer-reviewed and described a digital intervention that targeted fathers of fetuses or infants aged ≤12 months. Systematic reviews, meta-analyses, and opinion pieces were excluded. Data from these studies were extracted and themed using a narrative synthesis approach. Quality appraisal of the articles was conducted using the Mixed Methods Appraisal Tool. RESULTS A total of 2816 articles were retrieved, of which 39 (1.38%) met the inclusion criteria for eligibility after removing duplicates and screening. Eligible articles included 29 different interventions across 13 countries. Most articles (22/29, 76%) described interventions that were exclusively digital. There were a variety of digital modalities, but interventions were most commonly designed to be delivered via a website or web-based portal (14/29, 48%). Just over half (21/39, 54%) of the articles described interventions designed to be delivered from pregnancy through the postpartum period. Only 26% (10/39) of the studies targeted fathers exclusively. A wide range of outcomes were included, with 54% (21/39) of the studies including a primary outcome related to intervention feasibility. Qualitative and mixed methods studies reported generally positive experiences with digital interventions and qualitative themes of the importance of providing support to partners, improving parenting confidence, and normalization of stress were identified. Of the 18 studies primarily examining efficacy outcomes, 13 (72%) reported a statistically significant intervention effect. The studies exhibited a moderate quality level overall. CONCLUSIONS New and expecting fathers use digital technologies, which could be used to help address father-specific barriers to traditional health care services. However, in contrast to the current state of digital interventions for mothers, father-focused interventions lack evaluation and evidence. Among the existing studies on digital interventions for fathers, there seem to be mixed findings regarding their feasibility, acceptability, and efficacy. There is a need for more development and standardized evaluation of interventions that target father-identified priorities. This review was limited by not assessing equity-oriented outcomes (eg, race and socioeconomic status), which should also be considered in future intervention development.
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Affiliation(s)
| | - James Wonkyu Jung
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jasleen Kaur
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Karen M Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Lianne Tomfohr-Madsen
- Department of Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth Keys
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- School of Nursing, The University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
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9
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Castro O, Mair JL, Salamanca-Sanabria A, Alattas A, Keller R, Zheng S, Jabir A, Lin X, Frese BF, Lim CS, Santhanam P, van Dam RM, Car J, Lee J, Tai ES, Fleisch E, von Wangenheim F, Tudor Car L, Müller-Riemenschneider F, Kowatsch T. Development of "LvL UP 1.0": a smartphone-based, conversational agent-delivered holistic lifestyle intervention for the prevention of non-communicable diseases and common mental disorders. Front Digit Health 2023; 5:1039171. [PMID: 37234382 PMCID: PMC10207359 DOI: 10.3389/fdgth.2023.1039171] [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: 09/07/2022] [Accepted: 04/06/2023] [Indexed: 05/28/2023] Open
Abstract
Background Non-communicable diseases (NCDs) and common mental disorders (CMDs) are the leading causes of death and disability worldwide. Lifestyle interventions via mobile apps and conversational agents present themselves as low-cost, scalable solutions to prevent these conditions. This paper describes the rationale for, and development of, "LvL UP 1.0″, a smartphone-based lifestyle intervention aimed at preventing NCDs and CMDs. Materials and Methods A multidisciplinary team led the intervention design process of LvL UP 1.0, involving four phases: (i) preliminary research (stakeholder consultations, systematic market reviews), (ii) selecting intervention components and developing the conceptual model, (iii) whiteboarding and prototype design, and (iv) testing and refinement. The Multiphase Optimization Strategy and the UK Medical Research Council framework for developing and evaluating complex interventions were used to guide the intervention development. Results Preliminary research highlighted the importance of targeting holistic wellbeing (i.e., both physical and mental health). Accordingly, the first version of LvL UP features a scalable, smartphone-based, and conversational agent-delivered holistic lifestyle intervention built around three pillars: Move More (physical activity), Eat Well (nutrition and healthy eating), and Stress Less (emotional regulation and wellbeing). Intervention components include health literacy and psychoeducational coaching sessions, daily "Life Hacks" (healthy activity suggestions), breathing exercises, and journaling. In addition to the intervention components, formative research also stressed the need to introduce engagement-specific components to maximise uptake and long-term use. LvL UP includes a motivational interviewing and storytelling approach to deliver the coaching sessions, as well as progress feedback and gamification. Offline materials are also offered to allow users access to essential intervention content without needing a mobile device. Conclusions The development process of LvL UP 1.0 led to an evidence-based and user-informed smartphone-based intervention aimed at preventing NCDs and CMDs. LvL UP is designed to be a scalable, engaging, prevention-oriented, holistic intervention for adults at risk of NCDs and CMDs. A feasibility study, and subsequent optimisation and randomised-controlled trials are planned to further refine the intervention and establish effectiveness. The development process described here may prove helpful to other intervention developers.
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Affiliation(s)
- Oscar Castro
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Jacqueline Louise Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Aishah Alattas
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Roman Keller
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Shenglin Zheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ahmad Jabir
- Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Xiaowen Lin
- Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Bea Franziska Frese
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions,Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Chang Siang Lim
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington DC, DC, United States
| | - Josip Car
- Centre for Population Health Sciences, LKCMedicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jimmy Lee
- Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Research Division, Institute of Mental Health, Singapore, Singapore
- North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - E Shyong Tai
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elgar Fleisch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions,Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Florian von Wangenheim
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Lorainne Tudor Car
- Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Falk Müller-Riemenschneider
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charite University Medical Centre Berlin, Berlin, Germany
| | - Tobias Kowatsch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
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Investigating Maternal Perspectives of Breastfeeding Support Targeted Towards Fathers in the Milk Man Mobile App Intervention. Matern Child Health J 2023; 27:954-964. [PMID: 36920713 PMCID: PMC10115714 DOI: 10.1007/s10995-023-03616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The support of her infant's father is one of the most important factors influencing a mother's breastfeeding success, and an increasing number of interventions are targeted towards fathers. Engaging fathers as agents to influence a maternal behavior is potentially problematic, yet few studies report on maternal experiences. OBJECTIVE This study aims to explore mothers' perspectives of their partners' use of Milk Man, a father-focused breastfeeding smartphone app, and the acceptability of this approach. MATERIALS AND METHODS New mothers (N = 459) whose partners had access to the app completed a questionnaire at six weeks postpartum. These data were used to determine knowledge, use and perspectives of the app. A sentiment analysis was conducted on responses to an open-ended question seeking maternal perspectives of the app. RESULTS Just over a quarter of mothers (28%) had been shown something from the app, and 37% had discussed something from Milk Man with their partner. There were 162 open-ended responses related to mothers' perspectives of the app. Relevant responses (n = 129) were coded to an overall sentiment node and then to a total of 23 child nodes (sub-nodes). Most comments were positive (94), with a smaller number either negative (25) or neutral (21). Negative comments related to the usability of the app and not its intent or content. CONCLUSION Mothers found the father-focussed breastfeeding app to be acceptable. When designing interventions targeting one group to affect the behaviour of another, inclusion of measures to gain the perspectives of both should be seen as an imperative.
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Bunik M, Jimenez-Zambrano A, Solano M, Beaty BL, Juarez-Colunga E, Zhang X, Moore SL, Bull S, Leiferman JA. Mother's Milk Messaging™: trial evaluation of app and texting for breastfeeding support. BMC Pregnancy Childbirth 2022; 22:660. [PMID: 36002798 PMCID: PMC9400217 DOI: 10.1186/s12884-022-04976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New mothers experience BF challenges but have limited evidence-based technology-enabled support. OBJECTIVES 1) Determine if using the Mother's Milk Messaging™ app improved aspects of breastfeeding and breastfeeding rates and 2) Describe engagement as well as themes from the qualitative feedback on the app. METHOD Randomized Controlled Trial National sample of primiparous, singleton mothers recruited online and then randomized using stratification by language into three arms: 1) BF text messages plus app; 2) BF text messages, app and physician-moderated private Facebook (FB) group; 3) Attention control group who received injury prevention texts. Exclusive breastfeeding rates as primary outcome and knowledge/attitude, confidence, and social support as secondary outcomes. We determined engagement through analysis of app usage metrics. We conducted and content-coded interviews with participants to learn more about app usage and BF experience. Due to the nature of the intervention participants could not be blinded. RESULTS There were a total of 346 participants in the trial, with 227 in the Intervention (n = 154 group 1 and n = 156 group 2) and 119 in the control group. Because of minimal Facebook activity, the two intervention groups 1 and 2 were combined. There were no differences in breastfeeding exclusivity and duration. (NS). Women in the intervention arm reported significantly higher confidence with breastfeeding and perceived social support to the control group (p < .05). Greater than 80% registered the app and those that engaged with the app had higher scores with time. Mothers appreciated receiving text messages and videos with reliable information. No harm was reported in this study. CONCLUSION MMM increased confidence with breastfeeding and with gathering social supports. Exclusively BF was high in all participants. Mothers perceived it as useful and dependable especially the texting.
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Affiliation(s)
- Maya Bunik
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,Children's Hospital Colorado, 13123 E. 16th Ave B032, Aurora, CO, 80045, USA.
| | - Andrea Jimenez-Zambrano
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Solano
- Children's Hospital Colorado, 13123 E. 16th Ave B032, Aurora, CO, 80045, USA
| | - Brenda L Beaty
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Juarez-Colunga
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Xuhong Zhang
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Susan L Moore
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sheana Bull
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jenn A Leiferman
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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12
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Dantas DC, Góes FGB, Santos ASTD, Silva ACSSD, Silva MDA, Silva LFD. Production and validation of educational video to encourage breastfeeding. Rev Gaucha Enferm 2022; 43:e20210247. [PMID: 35976384 DOI: 10.1590/1983-1447.2022.20210247.en] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/30/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To produce and validate an educational technology in health in video format to encourage breastfeeding in families. METHODS Methodological study, carried out in a virtual environment, from February to August 2021, in seven stages. The Content Validity Index was used, with desirable values equal to or greater than 0.70. RESULTS The video lasting 7 minutes and 38 seconds was validated by 20 expert judges and 20 pregnant women, postpartum women, and family members, using a Global Content Validity Index of 0.97 and 1.00, respectively. All items evaluated regarding functionality, usability, efficiency, audiovisual technique, environment, procedure, objectives, organization, video style, appearance and motivation reached indexes equal to or greater than 0.95. CONCLUSIONS The video produced is a validated educational technology that can be used to encourage breastfeeding with families, as it elucidates, in an innovative and creative way, different issues related to breastfeeding.
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Affiliation(s)
- Daniella Canejo Dantas
- Universidade Federal Fluminense (UFF), Instituto de Humanidades e Saúde, Departamento de Enfermagem. Rio das Ostras, Rio de Janeiro, Brasil
| | - Fernanda Garcia Bezerra Góes
- Universidade Federal Fluminense (UFF), Instituto de Humanidades e Saúde, Departamento de Enfermagem. Rio das Ostras, Rio de Janeiro, Brasil
| | | | | | - Maria da Anunciação Silva
- Universidade Federal Fluminense (UFF), Instituto de Humanidades e Saúde, Departamento de Enfermagem. Rio das Ostras, Rio de Janeiro, Brasil
| | - Liliane Faria da Silva
- Universidade Federal Fluminense (UFF), Escola de Enfermagem Aurora de Afonso Costa, Departamento de Enfermagem Materno-infantil e Psiquiátrica. Niterói, Rio de Janeiro, Brasil
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13
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Johnson RW, White BK, Gucciardi DF, Gibson N, Williams SA. Intervention Mapping of a Gamified Therapy Prescription App for Children With Disabilities: User-Centered Design Approach. JMIR Pediatr Parent 2022; 5:e34588. [PMID: 35943782 PMCID: PMC9399848 DOI: 10.2196/34588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/15/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) apps for children are increasing in availability and scope. Therapy (physiotherapy, speech pathology, and occupational therapy) prescription apps to improve home or school program adherence work best when developed to be highly engaging for children and when they incorporate behavior change techniques (BCTs) within their design. OBJECTIVE The aim of this study was to describe the development of a user-centered therapy prescription app for children (aged 6-12 years) with neurodevelopmental disabilities (eg, cerebral palsy, autism spectrum disorder, and intellectual disability) incorporating intervention mapping (IM) and gamified design. METHODS We used an iterative, user-centered app development model incorporating the first 3 steps of IM. We conducted a needs analysis with user feedback from our previous mHealth app study, a literature review, and a market audit. Change objectives were then specified in alignment with the psychological needs of autonomy, competence, and relatedness identified in self-determination theory. From these objectives, we then selected BCTs, stipulating parameters for effectiveness and how each BCT would be operationalized. A gamification design was planned and implemented focusing on maximizing engagement in children. In total, 2 rounds of consultations with parents, teachers, and therapists and 1 round of prototype app testing with children were conducted to inform app development, with a final iteration developed for further testing. RESULTS The IM process resulted in the specification of app elements, self-determination theory-informed BCTs, that were embedded into the app design. The gamification design yielded the selection of a digital pet avatar with a fantasy anime visual theme and multiple layers of incentives earned by completing prescribed therapy activities. Consultation groups with professionals working with children with disabilities (4 therapists and 3 teachers) and parents of children with disabilities (n=3) provided insights into the motivation of children and the pragmatics of implementing app-delivered therapy programs that informed the app development. User testing with children with disabilities (n=4) highlighted their enthusiasm for the app and the need for support in the initial phase of learning the app. App quality testing (Mobile Application Rating Scale-user version) with the children yielded means (out of 5) of 4.5 (SD 0.8) for engagement, 3.3 (SD 1.6) for function, 3.3 (SD 1.7) for aesthetics, and 4.3 (SD 1.1) for subjective quality. CONCLUSIONS mHealth apps designed for children can be greatly enhanced with a systematic yet flexible development process considering the specific contextual needs of the children with user-centered design, addressing the need for behavior change using the IM process, and maximizing engagement with gamification and strong visual design.
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Affiliation(s)
- Rowan W Johnson
- Therapy Services, Ability WA, Perth, Australia.,Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Becky K White
- Curtin School of Population Health, Curtin University, Perth, Australia.,Reach Health Promotion Innovations, Perth, Australia
| | - Daniel F Gucciardi
- Curtin School of Allied Health, Curtin University, Perth, Australia.,Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Noula Gibson
- Curtin School of Allied Health, Curtin University, Perth, Australia.,Department of Physiotherapy, Perth Children's Hospital, Perth, Australia
| | - Sian A Williams
- Curtin School of Allied Health, Curtin University, Perth, Australia.,Liggins Institute, The University of Auckland, Auckland, New Zealand
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14
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Chang YW, Hsu Y. Beauty Consumption Matchmaking Mechanism for Confirming the Requirement Specification of App Development in the Post-COVID-19 Era. Front Psychol 2022; 13:925905. [PMID: 35747682 PMCID: PMC9211766 DOI: 10.3389/fpsyg.2022.925905] [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: 04/22/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
COVID-19 began to spread worldwide in early 2020. Various governments have taken measures such as isolation, travel bans, and evacuation, mandating people to wear masks and go out less, in an attempt to prevent the spread of the virus. Governments also restrict human contact service industries, including beauty and hair salons. When the pandemic was very serious, consumers had great doubts about going for hairdressing so the beauty industry was greatly affected. This study designed and developed an app platform that considers the COVID-19 and is used for the psychological role of consumer safety. The methodology of this research is a qualitative study. Based on the Capability, Opportunity, Motivation, Behavior (COM-B) model, and presenting the context of capabilities, opportunities, and motives of the theoretical framework, this study investigates the factors that identify the demand for the development of the platform for the beauty industry app matching mechanism. Four groups of people including consumers, beauty technicians, store managers, and application development engineers all conduct interviews based on their ability, opportunity, and motivation after experiencing the using application of OpenBeautiful. The results found that all groups of people already had the knowledge and ability to avoid infection in a pandemic, so it was possible to establish the need and feasibility of using the app platform. The use of the beauty industry app platform can bring new consumption patterns and career opportunities, and can trigger more business behavior activities. Therefore, this study starts from the COM-B model, and then explores the user needs of the platform according to the COM-B model framework, and proposes the mechanism and platform of app matching. Finally, based on the conclusion of the study, we propose practices and suggestions for the future operation of the app matching platform.
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Affiliation(s)
- Yang-Wen Chang
- The Graduate Institute of Design Science, Tatung University, Taipei, Taiwan
| | - Yen Hsu
- The Graduate Institute of Design Science, Tatung University, Taipei, Taiwan
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15
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White BK, Burns SK, Giglia RC, Dhaliwal SS, Scott JA. Measuring User Engagement with a Socially Connected, Gamified Health Promotion Mobile App. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5626. [PMID: 35565015 PMCID: PMC9102982 DOI: 10.3390/ijerph19095626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 02/01/2023]
Abstract
Participant engagement is an important consideration in mHealth interventions and there are no standardised measurements available to guide researchers. This paper describes the engagement index customised for the Milk Man app, a mobile app designed to engage fathers with breastfeeding and parenting information. Participants were recruited from maternity hospitals in Perth, Western Australia. An engagement index with scores ranging from 0 to 100 was calculated. Kaplan Meier survival analysis was used to determine difference in duration of exclusive breastfeeding, and Pearson's chi square analysis was conducted to investigate the association of engagement level with demographic characteristics and exclusive breastfeeding at 6 weeks. While overall, partners of participants who installed Milk Man were less likely to have ceased exclusive breastfeeding at any time point from birth to six weeks postpartum, this result was modest and of borderline significance (log rank test p = 0.052; Breslow p = 0.046; Tarone-Ware p = 0.049). The mean engagement score was 29.7% (range 1-80%), median 27.6%. Engagement level had no impact on duration of exclusive breastfeeding and demographic factors were not associated with engagement level. This research demonstrates a range of metrics that can be used to quantify participant engagement. However, more research is needed to identify ways of measuring effective engagement.
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Affiliation(s)
- Becky K. White
- School of Population Health, Curtin University, Perth 6845, Australia; (B.K.W.); (S.K.B.)
| | - Sharyn K. Burns
- School of Population Health, Curtin University, Perth 6845, Australia; (B.K.W.); (S.K.B.)
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth 6845, Australia
| | | | - Satvinder S. Dhaliwal
- Curtin Health Innovation Research Institute, Curtin University, Perth 6845, Australia;
- Duke-NUS Medical School, National University of Singapore, Singapore 119077, Singapore
- Institute for Research in Molecular Medicine (INFORMM), University of Science, Pukau Pinang 11800, Malaysia
| | - Jane A. Scott
- School of Population Health, Curtin University, Perth 6845, Australia; (B.K.W.); (S.K.B.)
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth 6845, Australia
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16
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Khajehei M, Swain JA, Behroozpour E, Hajizadeh N, Parvaneh A. Mental fitness during transition to fatherhood. World J Obstet Gynecol 2022; 11:1-7. [DOI: 10.5317/wjog.v11.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/12/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
Transition into fatherhood is often marked by a period of adjustment, uncertainty and psychological distress and challenges for many men, along with social isolation and relationship problems. Risk factors for paternal mental health issues are maternal depression, marital distress, parenting stress, gender role stress, mismatched expectations for pregnancy and after childbirth, poor physical health, inadequate self-care behaviours, avoiding seeking help for mental health issues, and having a child with sleeping, feeding and temperament problems. Paternal depression, anxiety and post-traumatic stress disorder can have negative impacts on the social and emotional wellbeing of fathers, their partners and their children. Nevertheless, these issues are not widely acknowledged, recognised or treated. Men’s mental health illness is a silent crisis. They often fail to seek help due to their feeling of shame, stigma for a lack of emotional control, distress or anxiety related to utilising mental health support services, and underrating the severity of their symptoms. These necessitate the need for timely attention, psychological support and proper education to minimise their risk of mental health issues. Although research has indicated fathers’ inclination toward being included in practices such as the mental health assessment, perinatal education and postnatal educational approaches need to be inclusive of fathers and encourage them to seek support for their paternal mental health issues and parenting difficulties.
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Affiliation(s)
- Marjan Khajehei
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, New South Wales, Australia
- Department of Medicine and Health, Westmead Clinical School, University of Sydney, Sydney 2000, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney 2000, New South Wales, Australia
| | - Julie Ann Swain
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, New South Wales, Australia
| | | | - Negar Hajizadeh
- Department of Education, Azad University of Sadra, Shiraz 25858, Iran
| | - Ali Parvaneh
- Department of Education, Azad University of Sadra, Shiraz 25858, Iran
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17
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Poduval S, Ross J, Pal K, Newhouse N, Hamilton F, Murray E. Web-Based Structured Education for Type 2 Diabetes: Interdisciplinary User-Centered Design Approach. JMIR Hum Factors 2022; 9:e31567. [PMID: 35029531 PMCID: PMC8800092 DOI: 10.2196/31567] [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: 06/25/2021] [Revised: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Digital health research encompasses methods from human-computer interaction and health research. OBJECTIVE This paper aims to describe how these methods were combined to develop HeLP-Diabetes: Starting Out, a web-based structured education program for people newly diagnosed with type 2 diabetes. METHODS The development process consisted of three phases: initial design for effectiveness, optimization for usability, and in the wild testing in the National Health Service with people newly diagnosed with type 2 diabetes, and further revisions. We adopted an iterative user-centered approach and followed steps from the human-computer interaction design life cycle and the Medical Research Council guidelines on developing and evaluating complex interventions. RESULTS The initial design process resulted in an 8-session program containing information and behavior change techniques targeting weight loss, being more active, and taking medication. The usability testing was highlighted at an early stage, where changes needed to be made to the language and layout of the program. The in the wild testing provided data on uptake of and barriers to use. The study suggested low uptake and completion of the program, but those who used it seemed to benefit from it. The qualitative findings suggested that barriers to use included an expectation that the program would take too long. This informed refinements to the program. CONCLUSIONS The use of interdisciplinary methods resulted in an iterative development process and refinements to the program that were based on user needs and data on uptake. The final intervention was more suitable for a definitive evaluation than the initial version. The description of our approach informs other digital health researchers on how to make interventions more sensitive to user needs.
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Affiliation(s)
- Shoba Poduval
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Jamie Ross
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Kingshuk Pal
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Fiona Hamilton
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Elizabeth Murray
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
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18
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Dantas DC, Góes FGB, Santos ASTD, Silva ACSSD, Silva MDA, Silva LFD. Produção e validação de vídeo educativo para o incentivo ao aleitamento materno. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210247.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: Produzir e validar uma tecnologia educacional em saúde em formato de vídeo, para o incentivo ao aleitamento materno junto às famílias. Métodos: Estudo metodológico, realizado em ambiente virtual, de fevereiro a agosto de 2021, em sete etapas. Utilizou-se o Índice de Validade de Conteúdo, tendo como desejáveis valores iguais ou maiores a 0,70. Resultados: O vídeo, com duração de 7 minutos e 38 segundos, foi validado por 20 juízes especialistas e 20 gestantes, puérperas e familiares, mediante Índice de Validade de Conteúdo Global de 0,97 e 1,00, respectivamente. Todos os itens avaliados quanto à funcionalidade, usabilidade, eficiência, técnica audiovisual, ambiente, procedimento, objetivos, organização, estilo do vídeo, aparência e motivação alcançaram índices iguais ou maiores a 0,95. Conclusões: O vídeo produzido é uma tecnologia educacional validada, que pode ser utilizada para incentivar o aleitamento materno junto às famílias, pois elucida, de maneira inovadora e criativa, distintas questões relacionadas à amamentação.
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Warsinsky S, Schmidt-Kraepelin M, Rank S, Thiebes S, Sunyaev A. Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING). J Med Internet Res 2021; 23:e30390. [PMID: 34505840 PMCID: PMC8463952 DOI: 10.2196/30390] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so. OBJECTIVE This study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions. METHODS We used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field. RESULTS Our results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions. CONCLUSIONS Conceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions.
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Affiliation(s)
- Simon Warsinsky
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Sascha Rank
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Scott Thiebes
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ali Sunyaev
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
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20
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Hutton JS, Huang G, Wiley C, DeWitt T, Ittenbach RF. Randomized Trial of a Mobile App Introduced During Well-Visits to Enhance Guidance for Reading With Young Children. Acad Pediatr 2021; 21:977-987. [PMID: 34020099 DOI: 10.1016/j.acap.2021.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/28/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To estimate feasibility, usability and efficacy of a mobile parenting app (Rx for Success; RxS) to enhance reading guidance provided to parents of young children during well-visits. METHODS This trial was conducted at a clinic serving primarily families of Hispanic ethnicity and low-socioeconomic status (SES) where Reach Out and Read (ROR) is standard practice. It involved 252 parent-child dyads in 2 age groups (~6-months old, ~18-months old) randomized during well-visits to receive RxS or a children's book modeling alternatives to screen time (Control) by research coordinators. RxS involves videos, activities and "push" messages. Follow-up assessments were conducted approximately 6 months later, including impression and use, shared reading behaviors, child language and screen time. RESULTS A total of 217 dyads completed both visits (110 RxS, 107 Control). Time to introduce RxS was under 3 minutes and 32% of parents experienced largely minor performance issues. Parent impression of RxS was favorable for both age groups at baseline and follow-up, though use was infrequent, attributable to a desire for more relevant and updated content. Significant findings favoring RxS included shared reading as a favorite activity, more frequent shared reading reported at 12 months and higher language scores at 24 months. Screen time was equivalent between cohorts, exceeding American Academy of Pediatrics guidelines. CONCLUSIONS A mobile app introduced to parents of young children from low-SES backgrounds was feasible during well-visits, rated as helpful, and effective to enhance shared reading at younger and language at older ages. While a potentially impactful enhancement to ROR, features needing improvement were identified.
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Affiliation(s)
- John S Hutton
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio; Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio.
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center (G Huang and RF Ittenbach), Cincinnati, Ohio
| | - Catherine Wiley
- Community Health Center at Connecticut Children's Hospital (C Wiley), Hartford, Conn
| | - Thomas DeWitt
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio; Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center (JS Hutton and T DeWitt), Cincinnati, Ohio
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center (G Huang and RF Ittenbach), Cincinnati, Ohio
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Song T, Yu P, Bliokas V, Probst Y, Peoples GE, Qian S, Houston L, Perez P, Amirghasemi M, Cui T, Hitige NPR, Smith NA. A Clinician-Led, Experience-Based Co-Design Approach for Developing mHealth Services to Support the Patient Self-management of Chronic Conditions: Development Study and Design Case. JMIR Mhealth Uhealth 2021; 9:e20650. [PMID: 34283030 PMCID: PMC8335618 DOI: 10.2196/20650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/09/2020] [Accepted: 05/17/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite the increasing use of mobile health (mHealth) services, such as mHealth apps or SMS text messaging services, that support the patient self-management of chronic conditions, many existing mHealth services lack theoretical guidance. In addition, although often the target audience for requirement acquisition at the initial mHealth app design stage, it is a common challenge for them to fully conceptualize their needs for mHealth services that help self-manage chronic conditions. OBJECTIVE This study proposes a novel co-design approach with the initial requirements for mHealth services proposed by clinicians based on their experiences in guiding patients to self-manage chronic conditions. A design case is presented to illustrate our innovative approach to designing an mHealth app that supports the self-management of patients with obesity in their preparation for elective surgery. METHODS We adopted a clinician-led co-design approach. The co-design approach consisted of the following four cyclic phases: understanding user needs, identifying an applicable underlying theory, integrating the theory into the prototype design, and evaluating and refining the prototype mHealth services with patients. Expert panel discussions, a literature review, intervention mapping, and patient focus group discussions were conducted in these four phases. RESULTS In stage 1, the expert panel proposed the following three common user needs: motivational, educational, and supportive needs. In stage 2, the team selected the Social Cognitive Theory to guide the app design. In stage 3, the team designed and developed the key functions of the mHealth app, including automatic push notifications; web-based resources; goal setting and monitoring; and interactive health-related exchanges that encourage physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in response to a patient's risk level, as informed by the person's response to a baseline health survey. In stage 4, the prototype mHealth app was used to capture further requirements from patients in the two focus group discussions. Focus group participants affirmed the potential benefits of the app and suggested more requirements for the function, presentation, and personalization needs. The app was improved based on these suggestions. CONCLUSIONS This study reports an innovative co-design approach that was used to leverage the clinical experiences of clinicians to produce the initial prototype app and the approach taken to allow patients to effectively voice their needs and expectations for the mHealth app in a focus group discussion. This approach can be generalized to the design of any mHealth service that aims to support the patient self-management of chronic conditions.
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Affiliation(s)
- Ting Song
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Smart Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Vida Bliokas
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Yasmine Probst
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Gregory E Peoples
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Siyu Qian
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Lauren Houston
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Pascal Perez
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Smart Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Mehrdad Amirghasemi
- Smart Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Tingru Cui
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - Nadeesha Pathiraja Rathnayaka Hitige
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Natalie Anne Smith
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Department of Anaesthesia, Wollongong Hospital, Wollongong, Australia
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Scott JA, Burns SK, Hauck YL, Giglia RC, Jorgensen AM, White BK, Martin A, Robinson S, Dhaliwal SS, Binns CW, Maycock BR. Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial. JMIR Pediatr Parent 2021; 4:e24579. [PMID: 33843604 PMCID: PMC8076985 DOI: 10.2196/24579] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding. OBJECTIVE The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. METHODS The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. RESULTS A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. CONCLUSIONS This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12884-015-0601-5.
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Affiliation(s)
- Jane Anne Scott
- School of Population Health, Curtin University, Perth, Australia
| | - Sharyn K Burns
- School of Population Health, Curtin University, Perth, Australia
| | - Yvonne L Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Roslyn C Giglia
- School of Population Health, Curtin University, Perth, Australia
| | | | - Becky Kate White
- School of Population Health, Curtin University, Perth, Australia
| | - Annegret Martin
- School of Population Health, Curtin University, Perth, Australia
| | - Suzanne Robinson
- School of Population Health, Curtin University, Perth, Australia
| | - Satvinder S Dhaliwal
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore
| | - Colin W Binns
- School of Population Health, Curtin University, Perth, Australia
| | - Bruce R Maycock
- School of Population Health, Curtin University, Perth, Australia
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Nicholas JC, Ntoumanis N, Smith BJ, Quested E, Stamatakis E, Thøgersen-Ntoumani C. Development and feasibility of a mobile phone application designed to support physically inactive employees to increase walking. BMC Med Inform Decis Mak 2021; 21:23. [PMID: 33478495 PMCID: PMC7819207 DOI: 10.1186/s12911-021-01391-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/10/2021] [Indexed: 01/21/2023] Open
Abstract
Background Physical inactivity is a global health concern. mHealth interventions have become increasingly popular, but to date, principles of effective communication from Self-Determination Theory have not been integrated with behavior change techniques to optimize app effectiveness. We outline the development of the START app, an app combining SDT principles and 17 purposefully chosen BCTs to support inactive office employees to increase their walking during a 16-week randomized controlled trial. We also explored acceptability, engagement with, associations between app usage and behavioral engagement, and perceived impact of the app in supporting behavior change.
Methods Following development, fifty insufficiently physically active employees (M age = 44.21 ± 10.95 years; BMI = 29.02 ± 5.65) were provided access and instructions on use of the app. A mixed methods design was used to examine feasibility of the app, including the User Mobile App Rating Scale, app engagement data, step counts, and individual interviews. Linear mixed modeling and inductive thematic analysis were used to analyze quantitative and qualitative data, respectively. Results Walkers rated the app quality favorably (M = 3.68 out of 5). Frequency of entering step counts (i.e., frequency of self-monitoring) on a weekly basis positively predicted weekly step counts measured via Fitbits at both the between-and within-individual levels. App features (entering daily step counts, reminders, and motivational messages) were perceived to assist walkers in fostering goal achievement by building competence and via self-monitoring. Conclusions The START app may be a useful component of walking interventions designed to increase walking in the workplace. Apps designed to promote walking behavior may be effective if they target users’ competence and integrate BCTs. Trial Registration: This study was part of a pilot larger randomized controlled trial, in which a component of the intervention involved the use of the mobile app. The trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618000807257) on 11 May 2018 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375049&isReview=true.
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Affiliation(s)
- Joanna Catherine Nicholas
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Western Australian Academy of Performing Arts, Edith Cowan University, Mount Lawley, Perth, WA, 6050, Australia
| | - Nikos Ntoumanis
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Brendan John Smith
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Eleanor Quested
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Emmanuel Stamatakis
- Charles Perkins Centre L6 West, Hub D17, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Cecilie Thøgersen-Ntoumani
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
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Mieso B, Neudecker M, Furman L. Mobile Phone Applications to Support Breastfeeding Among African-American Women: a Scoping Review. J Racial Ethn Health Disparities 2020; 9:32-51. [PMID: 33219430 DOI: 10.1007/s40615-020-00927-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Racial disparities persist with respect to breastfeeding. The use of health e-technology is increasing, with promise for a role in improving breastfeeding outcomes. OBJECTIVE We undertook a scoping review of both individual breastfeeding apps and the literature on breastfeeding apps to map the available evidence on app-based breastfeeding support for African-American mothers. DESIGN A systematic search of online databases identified 241 English language papers published on or before June 2020 that included e-technology in support of breastfeeding. We included those that (1) described individual human subjects research studies utilizing any research design, (2) described app-based breastfeeding support, and (3) could be pertinent for African-American mothers, and assessed for inclusion and relevance for this population. We also searched app stores for breastfeeding apps, and evaluated features with a rubric. Our aim was to identify if gaps exist relative to breastfeeding support for African-Americans. RESULTS Of the 15 publications meeting inclusion criteria, 9 focused on app development, 4 examined user experience, and 3 examined breastfeeding outcomes with use of an app (one study overlapped categories). The percentage of African-American participants ranged from 100% (2 studies) to none (7 studies); 3 studies (20%) focused on African-American mothers' breastfeeding experience. Of 77 apps that met inclusion criteria, just one was both breastfeeding-focused by content and targeted for African-Americans by picture predominance. CONCLUSIONS The quality of studies was generally high and many included African-American participants, but research focused on breastfeeding apps specifically for African-American mothers/parents is limited, creating a meaningful gap in the literature.
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Affiliation(s)
- Bethel Mieso
- Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Mandy Neudecker
- Department of Pediatrics, Division of General Academic Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, 11000 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Lydia Furman
- Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA. .,Department of Pediatrics, Division of General Academic Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, 11000 Euclid Avenue, Cleveland, OH, 44106, USA.
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25
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Shoneye CL, Mullan B, Begley A, Pollard CM, Jancey J, Kerr DA. Design and Development of a Digital Weight Management Intervention (ToDAy): Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e17919. [PMID: 32641284 PMCID: PMC7511863 DOI: 10.2196/17919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/15/2020] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support. OBJECTIVE The ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors. METHODS This qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis. RESULTS Qualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence. CONCLUSIONS This study explores users' capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/12782.
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Affiliation(s)
- Charlene L Shoneye
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Barbara Mullan
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Andrea Begley
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Christina M Pollard
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,East Metropolitan Health Service, Perth, Western Australia, Australia
| | - Jonine Jancey
- Collaboration for Evidence Research & Impact in Public Health, School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Deborah A Kerr
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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26
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Casilang CG, Stonbraker S, Japa I, Halpern M, Messina L, Steenhoff AP, Lowenthal ED, Fleisher L. Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic. JMIR Pediatr Parent 2020; 3:e20312. [PMID: 32821063 PMCID: PMC7474414 DOI: 10.2196/20312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide. OBJECTIVE This study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ≤5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs. METHODS Participants were recruited from 3 outpatient sites: the Niños Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes. RESULTS All participants (N=35) reported having a mobile phone, and 29 (83%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding. CONCLUSIONS There is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding.
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Affiliation(s)
- Clarisse G Casilang
- Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Centro de Salud Divina Providencia, Consuelo, Dominican Republic.,Clínica de Familia La Romana, La Romana, Dominican Republic.,Children's Hospital of Orange County, Orange, CA, United States
| | - Samantha Stonbraker
- Clínica de Familia La Romana, La Romana, Dominican Republic.,School of Nursing, Columbia University, New York, NY, United States
| | - Ingrid Japa
- Centro de Salud Divina Providencia, Consuelo, Dominican Republic
| | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Luz Messina
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Andrew P Steenhoff
- Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Elizabeth D Lowenthal
- Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Linda Fleisher
- Fox Chase Cancer Center, Philadelphia, PA, United States
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Patchen L, Ellis L, Harrington CB, Ma T, Mohanraj R, Andrews V, Evans WD. Engaging African American Parents to Develop a Mobile Health Technology for Breastfeeding: KULEA-NET. J Hum Lact 2020; 36:448-460. [PMID: 32525434 PMCID: PMC11330581 DOI: 10.1177/0890334420930208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND African Americans breastfeed less than other groups, which has implications for health throughout the life course. Little is known about mobile health technologies to support breastfeeding. RESEARCH AIMS This study proceeded in two phases. The aim of Phase 1 was to identify ideal technological components and content of a mobile health intervention. The aim of Phase 2 was to determine the usability of a prototype, KULEA-NET, based on the Phase 1 findings. METHODS For this mixed-methods study, we used community-based participatory research methods and user-centered technology design methods. We used open coding in NVivo 11 to organize data from focus groups and in-depth interviews, then we analyzed the data. We then developed a prototype and tested the prototype's usability with the System Usability Scale. Fifty pregnant and postpartum African Americans from the District of Columbia participated. RESULTS Participants preferred an app with text messaging technology and identified areas for intervention: self-efficacy, parent-child attachment beliefs, social support, public breastfeeding and social desirability, and returning to work. Desired features included local resources, support person access, baby care logs, identification of public breastfeeding venues, and peer discussions. The System Usability Scale score was 73.8, which indicates above average usability. CONCLUSIONS A mobile health technology like KULEA-NET can be used to meet the breastfeeding needs of African Americans, build social desirability, and complement traditional health care. The appeal of an African American-specific intervention is unclear. Responding to mixed feeding practices is challenging. KULEA-NET is a mobile breastfeeding intervention guided by the preferences of African American parents and offers promising usability metrics.
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Affiliation(s)
- Loral Patchen
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lindsey Ellis
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | | | - Tony Ma
- Benten Technologies, Manassas, VA, USA
| | | | - Virginia Andrews
- George Washington University, Washington, District of Columbia, USA
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Doan TTD, Binns C, Pham NM, Zhao Y, Dinh TPH, Bui TTH, Tran TC, Nguyen XH, Giglia R, Xu F, Lee A. Improving Breastfeeding by Empowering Mothers in Vietnam: A Randomised Controlled Trial of a Mobile App. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5552. [PMID: 32752026 PMCID: PMC7432632 DOI: 10.3390/ijerph17155552] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022]
Abstract
Breastfeeding provides benefits to the infant and mother; however, the rates of breastfeeding, particularly exclusive breastfeeding, remain below optimal levels in many Asian countries. The aim of this study is to review the benefits of breastfeeding to mothers and infants and current rates of breastfeeding in Vietnam, and to evaluate the effectiveness of a mobile application on exclusive breastfeeding among mothers in Vietnam. A two-arm, parallel triple-blinded randomised controlled trial will be conducted among 1000 mothers in Hanoi City, Vietnam, during 2020-2021. Eligible participants are pregnant women who will seek antenatal care from health facilities at 24-36 weeks of gestation and plan to deliver at two participating hospitals, own a smartphone, and carry a singleton foetus. Permuted-block randomisation method stratified by maternal age, education and parity will be used to ensure an equal number of participants in each group. A smartphone app will be developed to deliver breastfeeding and non-breastfeeding information to the intervention and control group, respectively. Data will be collected at baseline, before hospital discharge, and at 1, 4, and 6 months postpartum. This study envisages demonstrating whether a smartphone-based intervention can be effective at improving breastfeeding in Vietnam. Trials registration: ACTRN12619000531112.
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Affiliation(s)
- Thi Thuy Duong Doan
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
| | - Colin Binns
- School of Public Health, Curtin University, Bentley, WA 6102, Australia; (N.M.P.); (Y.Z.)
| | - Ngoc Minh Pham
- School of Public Health, Curtin University, Bentley, WA 6102, Australia; (N.M.P.); (Y.Z.)
- Department of Epidemiology, Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 250000, Vietnam
| | - Yun Zhao
- School of Public Health, Curtin University, Bentley, WA 6102, Australia; (N.M.P.); (Y.Z.)
| | - Thi Phuong Hoa Dinh
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
| | - Thi Thu Ha Bui
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
| | - Trung Chuyen Tran
- Faculty of Information Technology, Department of Hanoi University of Mining and Geology, 18 Vien Street-Bac Tu Liem District, Hanoi 10000, Vietnam;
| | - Xuan Hoai Nguyen
- Faculty of IT, Ho Chi Minh University of Technology (HUTECH), Ho Chi Minh 700000, Vietnam;
| | | | - Fenglian Xu
- Data Analysis & Surgical Outcomes Unit (DASO), Royal North Shore Hospital, St Leonards, NSW 2065, Australia;
| | - Andy Lee
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
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Cheng H, Tutt A, Llewellyn C, Size D, Jones J, Taki S, Rossiter C, Denney-Wilson E. Content and Quality of Infant Feeding Smartphone Apps: Five-Year Update on a Systematic Search and Evaluation. JMIR Mhealth Uhealth 2020; 8:e17300. [PMID: 32459187 PMCID: PMC7287747 DOI: 10.2196/17300] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background Parents use apps to access information on child health, but there are no standards for providing evidence-based advice, support, and information. Well-developed apps that promote appropriate infant feeding and play can support healthy growth and development. A 2015 systematic assessment of smartphone apps in Australia about infant feeding and play found that most apps had minimal information, with poor readability and app quality. Objective This study aimed to systematically evaluate the information and quality of smartphone apps providing information on breastfeeding, formula feeding, introducing solids, or infant play for consumers. Methods The Google Play store and Apple App Store were searched for free and paid Android and iPhone Operating System (iOS) apps using keywords for infant feeding, breastfeeding, formula feeding, and tummy time. The apps were evaluated between September 2018 and January 2019 for information content based on Australian guidelines, app quality using the 5-point Mobile App Rating Scale, readability, and suitability of health information. Results A total of 2196 unique apps were found and screened. Overall, 47 apps were evaluated, totaling 59 evaluations for apps across both the Android and iOS platforms. In all, 11 apps had affiliations to universities and health services as app developers, writers, or editors. Furthermore, 33 apps were commercially developed. The information contained within the apps was poor: 64% (38/59) of the evaluations found no or low coverage of information found in the Australian guidelines on infant feeding and activity, and 53% (31/59) of the evaluations found incomplete or incorrect information with regard to the depth of information provided. Subjective app assessment by health care practitioners on whether they would use, purchase, or recommend the app ranged from poor to acceptable (median 2.50). Objective assessment of the apps’ engagement, functionality, aesthetics, and information was scored as acceptable (median 3.63). The median readability score for the apps was at the American Grade 8 reading level. The suitability of health information was rated superior or adequate for content, reading demand, layout, and interaction with the readers. Conclusions The quality of smartphone apps on infant feeding and activity was moderate based on the objective measurements of engagement, functionality, aesthetics, and information from a reliable source. The overall quality of information on infant feeding and activity was poor, indicated by low coverage of topics and incomplete or partially complete information. The key areas for improvement involved providing evidence-based information consistent with the Australian National Health and Medical Research Council’s Infant Feeding Guidelines. Apps supported and developed by health care professionals with adequate health service funding can ensure that parents are provided with credible and reliable resources.
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Affiliation(s)
- Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Centre of Research Excellence in Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown, Australia
| | - Alison Tutt
- Child and Family Health Nursing, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Catherine Llewellyn
- Child and Family Health Nursing, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Donna Size
- Child and Family Health Nursing, Sydney Local Health District, NSW Health, Camperdown, Australia.,Lactation Clinic, Royal Prince Alfred Hospital, NSW Health, Camperdown, Australia
| | - Jennifer Jones
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Child and Family Health Nursing, Sydney Local Health District, NSW Health, Camperdown, Australia.,Sydney Institute for Women, Children and their Families, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Sarah Taki
- Centre of Research Excellence in Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown, Australia.,Health Promotion, Population Health Research & Evaluation Hub, Sydney Local Health District, NSW Health, Camperdown, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Centre of Research Excellence in Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown, Australia.,Sydney Institute for Women, Children and their Families, Sydney Local Health District, NSW Health, Camperdown, Australia
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30
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Eysenbach G, Zanini C, Amann J, Scheel-Sailer A, Brach M, Stucki G, Rubinelli S. Selecting Evidence-Based Content for Inclusion in Self-Management Apps for Pressure Injuries in Individuals With Spinal Cord Injury: Participatory Design Study. JMIR Mhealth Uhealth 2020; 8:e15818. [PMID: 32432559 PMCID: PMC7270844 DOI: 10.2196/15818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/17/2020] [Accepted: 03/25/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Technological solutions, particularly mobile health (mHealth), have been shown to be potentially viable approaches for sustaining individuals' self-management of chronic health conditions. Theory-based interventions are more successful, as evidence-based information is an essential prerequisite for appropriate self-management. However, several reviews have shown that many existing mobile apps fail to be either theoretically grounded or based on evidence. Although some authors have attempted to address these two issues by focusing on the design and development processes of apps, concrete efforts to systematically select evidence-based content are scant. OBJECTIVE The objective of this study was to present a procedure for the participatory identification of evidence-based content to ground the development of a self-management app. METHODS To illustrate the procedure, we focused on the prevention and management of pressure injuries (PIs) in individuals with spinal cord injury (SCI). The procedure involves the following three steps: (1) identification of existing evidence through review and synthesis of existing recommendations on the prevention and self-management of PIs in SCI; (2) a consensus meeting with experts from the field of SCI and individuals with SCI to select the recommendations that are relevant and applicable to community-dwelling individuals in their daily lives; and (3) consolidation of the results of the study. RESULTS In this case study, at the end of the three-step procedure, the content for an mHealth intervention was selected in the form of 98 recommendations. CONCLUSIONS This study describes a procedure for the participatory identification and selection of disease-specific evidence and professional best practices to inform self-management interventions. This procedure might be especially useful in cases of complex chronic health conditions, as every recommendation in these cases needs to be evaluated and considered in light of all other self-management requirements. Hence, the agreement of experts and affected individuals is essential to ensure the selection of evidence-based content that is considered to be relevant and applicable.
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Affiliation(s)
| | - Claudia Zanini
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Julia Amann
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Technology, Health Ethics and Policy Lab, ETH Zürich, Zürich, Switzerland
| | - Anke Scheel-Sailer
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Stephenson A, Garcia-Constantino M, McDonough SM, Murphy MH, Nugent CD, Mair JL. Iterative four-phase development of a theory-based digital behaviour change intervention to reduce occupational sedentary behaviour. Digit Health 2020; 6:2055207620913410. [PMID: 32257366 PMCID: PMC7099670 DOI: 10.1177/2055207620913410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/21/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction As high amounts of occupational sitting have been associated with negative
health consequences, designing workplace interventions to reduce sedentary
behaviour (SB) is of public health interest. Digital technology may serve as
a cost-effective and scalable platform to deliver such an intervention. This
study describes the iterative development of a theory-based, digital
behaviour change intervention to reduce occupational SB. Methods The behaviour change wheel and The Behaviour Change Technique Taxonomy were
used to guide the intervention design process and form a basis for selecting
the intervention components. The development process consisted of four
phases: phase 1 – preliminary research, phase 2 – consensus workshops, phase
3 – white boarding and phase 4 – usability testing. Results The process led to the development and refinement of a smartphone application
– Worktivity. The core component was self-monitoring and feedback of SB at
work, complemented by additional features focusing on goal setting, prompts
and reminders to break up prolonged periods of sitting, and educational
facts and tips. Key features of the app included simple data entry and
personalisation based on each individual’s self-reported sitting time.
Results from the ‘think-aloud’ interviews (n=5) suggest
Worktivity was well accepted and that users were positive about its
features. Conclusion This study led to the development of Worktivity, a theory-based and
user-informed mobile app intervention to reduce occupational SB. It is the
first app of its kind developed with the primary aim of reducing
occupational SB using digital self-monitoring. This paper provides a
template to guide others in the development and evaluation of
technology-supported behaviour change interventions.
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Affiliation(s)
- Aoife Stephenson
- Centre for Physical Activity and Health Research, Faculty of Life and Health Sciences, Ulster University, UK.,Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, UK
| | - Matias Garcia-Constantino
- School of Computing, Faculty of Computing, Engineering and the Built Environment, Ulster University, UK
| | - Suzanne M McDonough
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, UK.,School of Physiotherapy, University of Otago, New Zealand
| | - Marie H Murphy
- Centre for Physical Activity and Health Research, Faculty of Life and Health Sciences, Ulster University, UK
| | - Chris D Nugent
- School of Computing, Faculty of Computing, Engineering and the Built Environment, Ulster University, UK
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Meedya S, Win K, Yeatman H, Fahy K, Walton K, Burgess L, McGregor D, Shojaei P, Wheatley E, Halcomb E. Developing and testing a mobile application for breastfeeding support: The Milky Way application. Women Birth 2020; 34:e196-e203. [PMID: 32081557 DOI: 10.1016/j.wombi.2020.02.006] [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] [Received: 08/27/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Supporting women to continue breastfeeding is a global challenge. The Milky Way Program is an effective face to face intervention to increase breastfeeding rates up to six months postpartum. The sustainability and access to the Milky Way Program could be enhanced by transforming it into a mobile application allowing women to access relevant information from their own place at a convenient time. AIM To explore the process of transforming the Milky Way Program into an acceptable and usable mobile health application. METHOD Stakeholders including multidisciplinary researchers and end-users designed the application based on the Milky Way Program by using Persuasive System Design principles. A mixed-method approach was used in the development and evaluation process. Seven women were recruited through convenience sampling to pilot test the application. The women's feedback was collected through an online survey six weeks after birth and individual interviews at four months postpartum. FINDINGS Women in the pilot study reported that the breastfeeding application was well designed, easy to use, interactive, reassuring and evidence-based with credible sources of information. CONCLUSION The Persuasive System Design model combined with end-user engagement can feasibly inform the development of an acceptable and usable mobile health application for breastfeeding based on a proven clinical intervention. Further rigorous testing is required to evaluate the effectiveness of the application on breastfeeding initiation and duration.
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Affiliation(s)
- Shahla Meedya
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Khin Win
- School of Computing & Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Heather Yeatman
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Kathleen Fahy
- School of Nursing, Midwifery and Social Work, University of Queensland, Queensland, NSW, Australia.
| | - Karen Walton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Lois Burgess
- School of Management, Operations & Marketing, Faculty of Business, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Deborah McGregor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | | | - Eden Wheatley
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
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Ferraz Dos Santos L, Borges RF, de Azambuja DA. Telehealth and Breastfeeding: An Integrative Review. Telemed J E Health 2019; 26:837-846. [PMID: 31633467 DOI: 10.1089/tmj.2019.0073] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This is an integrative review of scientific articles, published from 2000 to 2018, that address strategies for breastfeeding through telehealth. Telehealth is the safe and low cost use of information and communication technologies (ICTs) in health care. The objective is to identify the scientific production on the subject of telehealth as a support strategy for breastfeeding. Methods: A qualitative research study was carried out with emphasis on the integrative review of the Embase, Bireme, and PubMed databases, in Portuguese, English, and Spanish. The descriptors used were "breastfeeding" and "telemedicine." Results: Twenty-three articles were identified and categorized as (1) synchronous support for telephone calls and/or videoconference; (2) asynchronous support for audio and text messaging, interactive websites, and mobile application; and (3) systematic review and meta-analysis. Experiences demonstrated viability to implementation, impact on exclusive breastfeeding time, and maintenance of breastfeeding, as well as positive user satisfaction. Conclusion: Viable telehealth strategies exist to support breastfeeding. With the existence of telehealth hubs, structured more than 10 years in Brazil, there seems to be potential in the development of projects in the area. There is room for innovation and for the expansion of telehealth services already offered.
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Diniz CMM, Leal LP, Guedes TG, Linhares FMP, Pontes CM. Contribuições dos aplicativos móveis para a prática do aleitamento materno: revisão integrativa. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Identificar as contribuições dos aplicativos móveis para a prática do aleitamento materno. Métodos Revisão integrativa da literatura, realizada nas bases de dados CINAHL, BDENF, Medline/PubMed, Scopus, LILACS, Web of Science e nas bibliotecas virtuais Cocharane e Scielo, para responder a questão norteadora: Quais as contribuições dos aplicativos móveis para a prática do aleitamento materno?. As buscas ocorreram entre setembro a novembro de 2017, utilizando os descritores “aplicativos móveis”, “aleitamento materno”, “período pós-parto”, “gestante” e “apoio social”. Após os cruzamentos desses descritores, identificou-se 530 artigos, que ao aplicar os critérios de elegibilidade, restaram nove estudos, avaliados quanto ao rigor metodológico e nível de evidência. Na extração dos dados empregou-se um instrumento validado e adaptado. Resultados Os aplicativos móveis que contribuíram para prática do aleitamento materno foram informacionais. Ofertaram orientações sobre promoção do aleitamento materno, alimentação infantil, uso de álcool na amamentação e posições para amamentar. Vários foram utilizados na coleta de dados referentes aos problemas, experiências e barreiras na amamentação; frequência da mamada; início do uso de fórmulas ou da alimentação complementar. Os aplicativos que continham a rede social de apoio na amamentação e os submetidos aos processos avaliativos tiveram pouca expressividade. Conclusão Os aplicativos foram direcionados apenas com objetivo de apoio informativo as nutrizes e sua rede social, na amamentação. Porém, apresentam lacunas quanto à qualidade de informações, usabilidade, aceitabilidade e eficácia desses aplicativos, como também não ficou evidenciado se a construção dos mesmos foi alicerçados na literatura científica.
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Tang K, Gerling K, Chen W, Geurts L. Information and Communication Systems to Tackle Barriers to Breastfeeding: Systematic Search and Review. J Med Internet Res 2019; 21:e13947. [PMID: 31573903 PMCID: PMC6818436 DOI: 10.2196/13947] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/18/2019] [Accepted: 07/19/2019] [Indexed: 01/19/2023] Open
Abstract
Background Breastfeeding has many benefits for newborns, mothers, and the wider society. The World Health Organization recommends mothers to feed newborns exclusively with breastmilk for the first 6 months after birth, but breastfeeding rates in many countries fail to align with the recommendations because of various barriers. Breastfeeding success is associated with a number of determinants, such as self-efficacy, intention to breastfeed, and attitudes toward breastfeeding. Information and communication technology (ICT) has been leveraged to support breastfeeding by means of improving knowledge or providing practical supports in different maternal stages. Previous reviews have examined and summarized the effectiveness and credibility of interventions; however, no review has been done from a human-computer interaction perspective that is concerned with novel interaction techniques and the perspective of end users. Objective The objective of this review was to provide a comprehensive overview of existing digital interventions that support breastfeeding by investigating systems’ objective, technology design, validation process, and quality attributes, both in terms of clinical parameters as well as usability and user experience. Methods A systematic search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the following libraries: PubMed, Science Direct, Association for Computing Machinery Digital Library (ACM Digital Library), and Institute of Electrical and Electronics Engineers Xplore (IEEE Xplore). Results A total of 35 papers discussing 30 interventions were included. The main goals of these interventions were organized into 4 categories: breastfeeding education (n=12), breastfeeding promotion (n=8), communication support (n=6), and daily practical support (n=4). Of the interventions, 13 target mothers in the postnatal period. Most interventions come in forms of client communication systems (n=18), which frequently leverage Web technologies, text message, and mobile apps to provide breastfeeding support. Systems predominantly focus on mothers; validation strategies were rather heterogeneous, with 12 user studies concerning usability and user experience and 18 clinical validation studies focusing on the effects of the interventions on breastfeeding determinants; 5 papers did not report results. Generally, straightforward systems (eg, communication tools or Web-based solutions) seem to be more effective than complex interventions (eg, games). Conclusions Existing information and communication systems offer effective means of improving breastfeeding outcomes, but they do not address all relevant periods in parenthood (eg, the antenatal period) and often do not involve important stakeholders, such as partners. There is an opportunity to leverage more complex technical systems to open up avenues for the broader design of ICT to support breastfeeding; however, considering evaluation outcomes of existing support systems of higher complexity, such systems need to be designed with care.
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Affiliation(s)
- Kymeng Tang
- e-Media Research Lab, KU Leuven, Leuven, Belgium
| | | | - Wei Chen
- Center for Intelligent Medical Electronics, Fudan University, Shanghai, China
| | - Luc Geurts
- e-Media Research Lab, KU Leuven, Leuven, Belgium
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36
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Taki S, Russell CG, Lymer S, Laws R, Campbell K, Appleton J, Ong KL, Denney-Wilson E. A Mixed Methods Study to Explore the Effects of Program Design Elements and Participant Characteristics on Parents' Engagement With an mHealth Program to Promote Healthy Infant Feeding: The Growing Healthy Program. Front Endocrinol (Lausanne) 2019; 10:397. [PMID: 31293515 PMCID: PMC6603091 DOI: 10.3389/fendo.2019.00397] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/05/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose: Mobile health (mHealth) interventions have great potential to promote health. To increase consumer engagement in mHealth interventions it is necessary to address factors that influence the target demographic. The Growing healthy (GH) program is the first obesity prevention program delivered via a smartphone app and website offering evidence-based information on infant feeding from birth until 9 months of age. This sub-study aimed to explore how the design features, quality of the app and participant characteristics influenced parents' engagement with the GH app. Methods: A sequential mixed methods design was used. The GH app participants (225/301) were considered for this sub-study. Participant app engagement was measured through a purpose-built Engagement Index (EI) using app metrics. Participants were categorized as low, moderately or highly engaged based on their EI score upon completing the 9 months program and were then invited to participate in semi-structured telephone interviews. Participants who used the app program, given an EI score and expressed interest to participate in these interviews were eligible. The interviews explored factors that influenced app engagement including delivery features and quality. Thematic analysis networks was used for analysis. Results: 108/225 expressed interest and 18 interviews were conducted from low (n = 3), moderately (n = 7), or highly (n = 8) engaged participants based on purposeful sampling. Participants defined as highly engaged were likely to be a first-time parent, felt the app content to be trustworthy and the app design facilitated easy navigation and regularly opened the push notifications. Participants defined as having low or moderate engagement were likely to have experience from previous children, felt they had sufficient knowledge on infant feeding and the app did not provide further information, or experienced technological issues including app dysfunction due to system upgrades. Conclusions/Implications: This study demonstrated a novel approach to comprehensively analyse engagement in an mHealth intervention through quantitative (Engagement Index) and qualitative (interviews) methods. It provides an insight on maximizing data collected from these programs for measuring effectiveness and to understand users of various engagement levels interaction with program features. Measuring this can determine efficacy and refine programs to meet user requirements.
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Affiliation(s)
- Sarah Taki
- Health Promotion Unit, Population Health, Sydney Local Health District, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, NSW, Australia
- Faculty of Health, University Technology Sydney, Broadway, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
| | - Catherine Georgina Russell
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, NSW, Australia
- School of Exercise and Nutrition, Centre for Advanced Sensory Science, Deakin University, Burwood, VIC, Australia
| | - Sharyn Lymer
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, NSW, Australia
- Ministry of Health, New South Wales Health, Sydney, NSW, Australia
| | - Rachel Laws
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Centre of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Karen Campbell
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Centre of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Jessica Appleton
- Faculty of Health, University Technology Sydney, Broadway, NSW, Australia
- Sydney Nursing School, University of Sydney and Sydney Local Health District, Camperdown, NSW, Australia
| | - Kok-Leong Ong
- Centre for Data Analytics and Cognition, La Trobe University, Melbourne, VIC, Australia
| | - Elizabeth Denney-Wilson
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, NSW, Australia
- Faculty of Health, University Technology Sydney, Broadway, NSW, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- Sydney Nursing School, University of Sydney and Sydney Local Health District, Camperdown, NSW, Australia
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White B, Giglia RC, White JA, Dhaliwal S, Burns SK, Scott JA. Gamifying Breastfeeding for Fathers: Process Evaluation of the Milk Man Mobile App. JMIR Pediatr Parent 2019; 2:e12157. [PMID: 31518324 PMCID: PMC6716479 DOI: 10.2196/12157] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 04/24/2019] [Accepted: 05/17/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Mobile technology offers unique opportunities to reach people with health promotion interventions. Breastfeeding is an important public health issue, and fathers are a key support. Milk Man is a father-focused breastfeeding app that sought to engage fathers with information and conversation about breastfeeding, with the goal to impact positively on breastfeeding duration. OBJECTIVE The study aimed to describe the process evaluation of the Milk Man app that was trialed in the Parent Infant Feeding Initiative randomized controlled trial. METHODS The app used an information library, gamification, push notifications, and social connectivity via a Web-based conversation forum, which included polls and conversation starters, to engage fathers with breastfeeding information. Fathers had access to the app from approximately 32 weeks of gestation to 6 months postpartum. Process evaluation data were collected from a self-completed questionnaire administered via a Web-based link sent to participants at 6 weeks postpartum, and app analytics data were collected directly from the app. Quantitative data from both sources and qualitative responses to open-ended questions were used to triangulate findings to investigate patterns of usage and the effectiveness of each app engagement strategy to motivate and engage users. RESULTS A total of 80.3% (586/730) of participants, who were randomized to receive the app, downloaded Milk Man. Push notifications and interest in what other fathers had posted in the forum were the 2 main motivators to app use. Fathers used the app most while their partners were still pregnant and in the weeks immediately after the birth of their baby. Perspectives on the gamification strategy were varied. However, at 6 weeks postpartum, approximately one-third of fathers still using the app said that the gamification elements were encouraging the app use. The ease of use of the app and the design were important elements that were rated positively. The conversation forum emerged as the hub of app activity; all but 1 of the most accessed library articles and external organization links had been prompted as part of a conversation starter. Fathers posted comments in the conversation forum 1126 times (average of 2.21 per user) and voted in polls 3096 times (average of 6 per user). CONCLUSIONS These results demonstrate that the Milk Man app was an acceptable source of breastfeeding information and support that fathers and fathers-to-be are prepared to use throughout the perinatal period. The app showed encouraging results with facilitating conversation between partners. The conversation forum was clearly central to the success of the app, and fathers provided suggestions for improvement. Gamification results were varied, yet it was a key motivator for some users. These results provide valuable insight into the acceptability of the engagement strategies, including motivations for use and user perspectives on the app. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?ACTRN=12614000605695.
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Affiliation(s)
- Becky White
- School of Public Health, Curtin University, Perth, Australia
| | - Roslyn C Giglia
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - James A White
- Reach Health Promotion Innovations, Perth, Australia
| | | | - Sharyn K Burns
- School of Public Health, Curtin University, Perth, Australia.,Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, Australia
| | - Jane A Scott
- School of Public Health, Curtin University, Perth, Australia.,Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, Australia
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van Beukering M, Velu A, van den Berg L, Kok M, Mol BW, Frings-Dresen M, de Leeuw R, van der Post J, Peute L. Usability and Usefulness of a Mobile Health App for Pregnancy-Related Work Advice: Mixed-Methods Approach. JMIR Mhealth Uhealth 2019; 7:e11442. [PMID: 31094353 PMCID: PMC6532337 DOI: 10.2196/11442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/14/2018] [Accepted: 12/27/2018] [Indexed: 01/19/2023] Open
Abstract
Background Pregnant women are often unaware of the potential risks that working conditions can cause to them and their unborn child. A mobile health (mHealth) app, the Pregnancy and Work (P and W) app, developed by a multidisciplinary team and based on an evidence-based guideline for occupational physicians, aims to provide advice on work adjustment during pregnancy. Objective This study evaluates the usability of the mHealth P and W app and the perceived usefulness of the work advice, the main goal of the app, by potential end users. Methods A total of 12 working pregnant women participated in think aloud usability sessions and performed 9 tasks. All think aloud sessions were recorded, transcribed, and coanalyzed. The usability problems were rated for their severity in accordance with Nielsen severity scale. The completion rates and time taken for completion of tasks were registered. In addition, participants were questioned on demographics and user characteristics and were asked to evaluate the value of the app by filling in the Intrinsic Motivation Inventory (IMI) score and the System Usability Scale (SUS) questionnaire. Results In total, 82 usability problems with a severity ≥1 were identified, of which 40 had severity ≥3. The main usability problems concerned the interpretation of terminology used in the app’s questionnaires and difficulties in finding and understanding the work advice. Furthermore, 10 out of 12 participants were able to open the work advice page in the app. Only 7 out of these 10 participants understood and intended to follow the work advice. The overall mean IMI score was relatively high (5 out of 7), indicating that the participants did indeed value the use of the app. This IMI score corresponded to the overall mean SUS score (68 out of 100) and the mean grade given to the P and W app (7 out of 10). Conclusions This think aloud usability study showed that the information provided in the P and W app was considered valuable by the end users, working pregnant women, and it meets their needs; however, usability issues severely impacted the perceived usefulness of the work advice given in the app.
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Affiliation(s)
- Monique van Beukering
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Adeline Velu
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Liesbeth van den Berg
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Monique Frings-Dresen
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Robert de Leeuw
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Joris van der Post
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Linda Peute
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Taki S, Russell CG, Wen LM, Laws RA, Campbell K, Xu H, Denney-Wilson E. Consumer Engagement in Mobile Application (App) Interventions Focused on Supporting Infant Feeding Practices for Early Prevention of Childhood Obesity. Front Public Health 2019; 7:60. [PMID: 30984732 PMCID: PMC6448001 DOI: 10.3389/fpubh.2019.00060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: There has been increasing interest in using mobile applications ("apps") for innovative health service delivery and public health interventions. This paper describes two independent studies investigating mothers' or pregnant women's perceptions of, interest in and experiences with technological devices, apps and websites about infant feeding practices. Methods: Study 1 was a cross-sectional survey conducted with 107 pregnant women in their third trimester in late 2016 and early 2017. Multiple logistic regression analyses were conducted to examine factors associated with their app usage. The second was a qualitative study of 29 mothers of infants aged <1 year conducted in 2014. Thematic network analysis was used to explore the themes from the transcribed interviews. Results: Study 1 found that the use of apps was common among the pregnant women, with 100% having previously downloaded an app on their phone either free or paid. About 60% had used an app for health purposes. The majority reported that they were likely to use an app promoting healthy infant feeding practices, including 30% extremely likely and 53% very likely. Women with university or other tertiary level of education were more likely to use an app for promoting healthy infant feeding practices than those with other levels of education (adjusted odds ratio 3.22, 95% confidence interval 1.28-8.13). The qualitative interviews found that all the mothers were interested in a mobile program to support them with infant feeding practices. Participants felt they would benefit from individualized messages although did not want them to be sent too frequently. Further, participants also expressed the importance of having non-judgmental information and they were interested in receiving information using different modes such as videos, SMS or an app. Conclusions: Both studies suggest that using apps for promoting healthy infant feeding practices is acceptable from the perspective of mothers. There is great potential for health promotion practitioners to be engaged in app development for the purpose of promoting health in early years and health promotion in general.
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Affiliation(s)
- Sarah Taki
- Health Promotion Unit, Camperdown, NSW, Australia.,Sydney School of Public Health, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
| | - Catherine G Russell
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre for Advanced Sensory Science, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Li M Wen
- Health Promotion Unit, Camperdown, NSW, Australia.,Sydney School of Public Health, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
| | - Rachel A Laws
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Karen Campbell
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Huilan Xu
- Health Promotion Unit, Camperdown, NSW, Australia
| | - Elizabeth Denney-Wilson
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia
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Aqil A, Allport BS, Johnson SB, Nelson T, Labrique AB, Marcell AV. Content to share with expectant fathers: Views of professionals focused on father involvement. Midwifery 2019; 70:119-126. [DOI: 10.1016/j.midw.2018.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/31/2018] [Accepted: 12/23/2018] [Indexed: 11/26/2022]
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Kuliukas L, Hauck YL, Jorgensen A, Kneebone K, Burns SK, Maycock BR, Scott JA. Process evaluation of a peer-led antenatal breastfeeding class for fathers: perceptions of facilitators and participants. BMC Pregnancy Childbirth 2019; 19:48. [PMID: 30696411 PMCID: PMC6352333 DOI: 10.1186/s12884-019-2198-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/18/2019] [Indexed: 11/19/2022] Open
Abstract
Background The Parent Infant Feeding Initiative (PIFI) was a factorial, randomised controlled trial that aimed to prolong exclusive breastfeeding by targeting expecting fathers. One of the intervention strategies evaluated was a father-focused breastfeeding class facilitated by a male peer facilitator. The aim of this mixed-methods descriptive study was to 1) evaluate the feedback provided from participants of the class and 2) explore the motivations and experiences of volunteer male peer facilitators trained to deliver the class. Methods Father-focused breastfeeding antenatal (FFAB) classes were conducted in six Western Australian hospitals between August 2015 and December 2016. Following each peer facilitated FFAB class, expecting father participants completed an evaluation form to assess their satisfaction with the format, facilitation and content, in addition to whether their expectations and confidence to manage breastfeeding problems had changed. Feedback to open-ended questions was analysed using content analysis to identify learnings and suggestions for improvements. At the completion of PIFI, individual telephone interviews were undertaken with 14 peer facilitators to gain insight into their motivations for volunteering and experiences of conducting the classes. Transcripts from interviews were analysed using Braun and Clarke’s six phases for thematic analysis. Results Participant evaluation forms were completed by 678 of the 697 father participants (98%). Overall satisfaction with class format, facilitation and content was high with 90% or more of fathers either strongly agreeing or agreeing with each positively-phrased evaluation item. Class participants enjoyed interacting with other fathers, appreciated validation of their role, were not always aware of the importance of breastfeeding or potential difficulties, valued the anticipatory guidance around what to expect in the early weeks of parenting and appreciated learning practical breastfeeding support strategies. Peer facilitators indicated they felt well prepared and supported to conduct FFAB classes. Analysis of interview transcripts revealed common experiences of the peer facilitators incorporating four themes: ‘Highlights of being a facilitator’, ‘Challenges’, ‘Mourning the project completion’ and ‘Satisfaction with training and support’. Conclusion Father-focused breastfeeding classes supported by volunteer male peer facilitators are a feasible and acceptable way of engaging fathers as breastfeeding supporters. Trial registration ACTRN12614000605695. Registered 6 June 2014.
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Affiliation(s)
- Lesley Kuliukas
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Yvonne L Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia. .,King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
| | - Anita Jorgensen
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Kelly Kneebone
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Sharyn K Burns
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Perth, Western Australia, Australia
| | - Bruce R Maycock
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Perth, Western Australia, Australia
| | - Jane A Scott
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Perth, Western Australia, Australia
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Bardus M, Ali A, Demachkieh F, Hamadeh G. Assessing the Quality of Mobile Phone Apps for Weight Management: User-Centered Study With Employees From a Lebanese University. JMIR Mhealth Uhealth 2019; 7:e9836. [PMID: 30672742 PMCID: PMC6364203 DOI: 10.2196/mhealth.9836] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 09/15/2018] [Accepted: 09/24/2018] [Indexed: 12/29/2022] Open
Abstract
Background Evaluating the quality of mobile health apps for weight loss and weight management is important to understand whether these can be used for obesity prevention and treatment. Recent reviews call for more research on multidimensional aspects of app quality, especially involving end users, as there are already many expert reviews on this domain. However, no quantitative study has investigated how laypersons see popular apps for weight management and perceive different dimensions of app quality. Objective This study aimed to explore how laypersons evaluate the quality of 6 free weight management apps (My Diet Coach, SparkPeople, Lark, MyFitnessPal, MyPlate, and My Diet Diary), which achieved the highest quality ratings in a related and recent expert review. Methods A user-centered study was conducted with 36 employees of a Lebanese university. Participants enrolled in the study on a rolling basis between October 2016 and March 2017. Participants were randomly assigned an app to use for 2 weeks. App quality was evaluated at the end of the trial period using the Mobile App Rating Scale user version (uMARS). uMARS assesses the dimensions of engagement, functionality, aesthetics, information, and subjective quality on 5-point scales. Internal consistency and interrater agreement were examined. The associations between uMARS scores and users’ demographic characteristics were also explored using nonparametric tests. Analyses were completed in November 2017. Results Overall, the 6 apps were of moderately good quality (median uMARS score 3.6, interquartile range [IQR] 0.3). The highest total uMARS scores were achieved by Lark (mean 4.0 [SD 0.5]) and MyPlate (mean 3.8 [SD 0.4]), which also achieved the highest subjective quality scores (Lark: mean 3.3 [SD 1.4]; MyPlate: mean 3.3 [SD 0.8]). Functionality was the domain with the highest rating (median 3.9, IQR 0.3), followed by aesthetics (median 3.7, IQR 0.5), information (median 3.7, IQR 0.1), and engagement (median 3.3, IQR 0.2). Subjective quality was judged low (median 2.5, IQR 0.9). Overall, subjective quality was strongly and positively related (P<.001) with total uMARS score (ρ=.75), engagement (ρ=.68), information, and aesthetics (ρ=.60) but not functionality (ρ=.40; P=.02). Higher engagement scores were reported among healthy (P=.003) and obese individuals (P=.03), who also showed higher total uMARS (P=.04) and subjective quality (P=.05) scores. Conclusions Although the apps were considered highly functional, they were relatively weak in engagement and subjective quality scores, indicating a low propensity of using the apps in the future. As engagement was the subdomain most strongly associated with subjective quality, app developers and researchers should focus on creating engaging apps, holding constant the functionality, aesthetics, and information quality. The tested apps (in particular Lark and MyPlate) were perceived as more engaging and of higher quality among healthy, obese individuals, making them a promising mode of delivery for self-directed interventions promoting weight control among the sampled population or in similar and comparable settings.
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Affiliation(s)
- Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ahmed Ali
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Farah Demachkieh
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,SANAD - The Home Hospice Organization of Lebanon, Beirut, Lebanon
| | - Ghassan Hamadeh
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Virani A, Duffett-Leger L, Letourneau N. Parenting apps review: in search of good quality apps. Mhealth 2019; 5:44. [PMID: 31620471 PMCID: PMC6789304 DOI: 10.21037/mhealth.2019.08.10] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 08/15/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Parenting can be challenging, and in this digital age, first-time parents actively access mobile applications or "apps" to adjust to their new roles. Apps are now technologically-savvy parents' go-to tool for accessing information, tracking their babies' development, editing and sharing photos, and much more. While apps have the potential to make parenting easier, the abundance of low-quality apps makes the process of finding a reliable one arduous for parents. Therefore, the objective of this app review paper was to provide a list of quality parenting apps that parents can use. METHODS The Google Play Store was searched on June 1st, 2018 for available parenting apps using 18 search terms: mum, mom, mommy, mama, mother, father, dad, daddy, papa, newborn, baby, infant, kid, child, children, family, parent, and parenting. The eligible apps (n=16) were evaluated on engagement, functionality, aesthetics, and information domains using Mobile App Rating Scale (MARS). RESULTS The authors identified 4,300 free apps on the initial search, of which n=16 apps were included in the review. All 16 apps were freely available to the public on Google Play Store. Most apps (n=13) were also available on the iOS platform. All eligible apps had a privacy policy, and half of the apps contained advertisements. Most apps (n=12) were updated within the last year and received 4.5 or above ratings from users. Babybrains app, developed by a neuroscientist, had the lowest number of downloads (one thousand) whereas, BabyCenter, a commercial app, had the highest number of downloads (ten million). A majority of apps (n=11) received MARS scores between 4.2 and 4.4/5, with four apps received highest MARS score of 4.5/5, and one app received the lowest MARS rating of 4/5. CONCLUSIONS Apps play an increasingly important role in supporting new parents in their first year of parenthood due to convenience and ease of accessibility. Health care professionals are in an ideal position to support technologically savvy parents in locating good quality apps; therefore, they should support the evaluation of existing parenting apps to ensure that the parents are presented with the up to date and best options.
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Affiliation(s)
- Anila Virani
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
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Edwards EA, Caton H, Lumsden J, Rivas C, Steed L, Pirunsarn Y, Jumbe S, Newby C, Shenvi A, Mazumdar S, Smith JQ, Greenhill D, Griffiths CJ, Walton RT. Creating a Theoretically Grounded, Gamified Health App: Lessons From Developing the Cigbreak Smoking Cessation Mobile Phone Game. JMIR Serious Games 2018; 6:e10252. [PMID: 30497994 PMCID: PMC6293248 DOI: 10.2196/10252] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/25/2018] [Accepted: 07/28/2018] [Indexed: 12/11/2022] Open
Abstract
Background Gaming techniques are increasingly recognized as effective methods for changing behavior and increasing user engagement with mobile phone apps. The rapid uptake of mobile phone games provides an unprecedented opportunity to reach large numbers of people and to influence a wide range of health-related behaviors. However, digital interventions are still nascent in the field of health care, and optimum gamified methods of achieving health behavior change are still being investigated. There is currently a lack of worked methodologies that app developers and health care professionals can follow to facilitate theoretically informed design of gamified health apps. Objective This study aimed to present a series of steps undertaken during the development of Cigbreak, a gamified smoking cessation health app. Methods A systematic and iterative approach was adopted by (1) forming an expert multidisciplinary design team, (2) defining the problem and establishing user preferences, (3) incorporating the evidence base, (4) integrating gamification, (5) adding behavior change techniques, (6) forming a logic model, and (7) user testing. A total of 10 focus groups were conducted with 73 smokers. Results Users found the app an engaging and motivating way to gain smoking cessation advice and a helpful distraction from smoking; 84% (62/73) of smokers said they would play again and recommend it to a friend. Conclusions A dedicated gamified app to promote smoking cessation has the potential to modify smoking behavior and to deliver effective smoking cessation advice. Iterative, collaborative development using evidence-based behavior change techniques and gamification may help to make the game engaging and potentially effective. Gamified health apps developed in this way may have the potential to provide effective and low-cost health interventions in a wide range of clinical settings.
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Affiliation(s)
- Elizabeth A Edwards
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Hope Caton
- Faculty of Science, Engineering Computing, Kingston University, London, United Kingdom
| | - Jim Lumsden
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.,School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Carol Rivas
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Social Science Research Unit, University College London, London, United Kingdom
| | - Liz Steed
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yutthana Pirunsarn
- Faculty of Science, Engineering Computing, Kingston University, London, United Kingdom
| | - Sandra Jumbe
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Chris Newby
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Aditi Shenvi
- Centre for Complexity Science, University of Warwick, Coventry, United Kingdom
| | - Samaresh Mazumdar
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jim Q Smith
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Darrel Greenhill
- Faculty of Science, Engineering Computing, Kingston University, London, United Kingdom
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Robert T Walton
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Sharpe JD, Kamara MT. A systematic evaluation of mobile apps to improve the uptake of and adherence to HIV pre-exposure prophylaxis. Sex Health 2018; 15:587-594. [PMID: 30347177 DOI: 10.1071/sh18120] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/02/2018] [Indexed: 01/06/2023]
Abstract
Background Pre-exposure prophylaxis, or PrEP, has been shown to be effective at reducing the risk of HIV infection, yet persons at-risk for acquiring HIV exhibit suboptimal uptake of and adherence to this prevention modality. Although PrEP use among all at-risk groups is low, mobile apps have been shown to increase the use of PrEP; however, it is unknown whether currently available apps have been designed with features to facilitate PrEP uptake and adherence. METHODS The Google Play store and Apple App store were systematically searched for currently available PrEP-related apps. A qualitative evaluation was conducted on apps that met the inclusion criteria for the presence of features that can contribute to PrEP uptake and adherence, and the quality of apps was assessed using the Mobile Apps Rating Scale (MARS) tool. RESULTS From the systematic search, less than 2% (11/621) of the identified apps were relevant to improving PrEP uptake and adherence. Demonstrating a moderate capacity for facilitating PrEP use, the 11 PrEP-related apps, on average, contained features that addressed two of four factors that can contribute to the uptake of PrEP, particularly features that provided comprehensive information on PrEP and resources to locate providers and clinics offering PrEP services. Findings from the app quality assessment suggested that existing PrEP-related apps are of acceptable quality (mean overall MARS score: 3.2 on a five-point scale). CONCLUSION Overall, currently available mobile apps for PrEP demonstrate some promise as potential avenues for increasing PrEP uptake and adherence among persons at-risk for HIV infection.
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Affiliation(s)
- J Danielle Sharpe
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR 3050J, Atlanta, GA 30322, USA
| | - Mustapha T Kamara
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610, USA
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Wheaton N, Lenehan J, Amir LH. Evaluation of a Breastfeeding App in Rural Australia: Prospective Cohort Study. J Hum Lact 2018; 34:711-720. [PMID: 30235043 DOI: 10.1177/0890334418794181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND New mothers often need support to establish and maintain breastfeeding, and rural women may find it difficult to access breastfeeding resources locally. There are many smartphone applications for breastfeeding mothers; however, very few have been developed by health professionals. We evaluated a smartphone application, Breastfeeding Solutions, developed by U.S. IBCLC Nancy Mohrbacher. Research aims: The aims were (a) to explore usability of the application among rural Australian breastfeeding women and (b) to describe participants' infant feeding outcomes compared with the general population. METHODS A prospective longitudinal self-report survey design was used. Data were collected via online questionnaires at baseline and at 3 and 6 months from a convenience sample of new mothers. The setting was southwest Victoria, Australia, from 2016 to 2017. Descriptive statistics were used to answer research aims. RESULTS Of the initial 46 participants who received the app, 63% ( n = 29) completed surveys at 3 and 6 months. Usability was assessed at 3 months: 93.5% of participants (29 of 31) rated the application favorably, whereas 96.8% (30 of 31) found the application helpful and 87.1% (27 of 31) would recommend it to other mothers. At the 6-month survey, 79% of participants ( n = 23) were breastfeeding; 10% ( n = 3) had stopped breastfeeding during the first 3 months. The local breastfeeding rate at 6 months was approximately 50% according to routinely collected data; however, we cannot infer that the application was responsible for the difference. CONCLUSION The smartphone application was acceptable to breastfeeding women in an Australian rural setting. Further evaluation using a user-centered design could improve rural postpartum women's access to reliable, evidence-based information.
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Affiliation(s)
| | | | - Lisa H Amir
- 3 Judith Lumley Centre, La Trobe University, Melbourne, Australia
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Schindler-Ruwisch JM, Roess A, Robert RC, Napolitano MA, Chiang S. Social Support for Breastfeeding in the Era of mHealth: A Content Analysis. J Hum Lact 2018; 34:543-555. [PMID: 29787686 DOI: 10.1177/0890334418773302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several barriers to successful breastfeeding exist, including a lack of support from peers or professionals. With the emergence of mobile health (mHealth) tools to provide additional breastfeeding support, a more thorough review of social support resources was needed. Research Aim: The aim of this study was to determine mHealth breastfeeding support resources and characterize the type of social support they provide. METHODS A content analysis of mHealth programs ( n = 65), including text messaging ( n = 12) and mobile applications ( n = 53), was conducted on the basis of searches of the iTunes and Google Play stores ( n = 50) and PubMed, the Cumulative Index of Nursing and Allied Health, and American Business Information/INFORM Complete Plus ( n = 15). Results were then dual-coded for key characteristics and types of support provided. RESULTS Thirty-eight apps (76%) were free to users, 14 (28%) were offered in a variety of languages, and 47 (94%) provided informational support. The mobile applications were targeted largely to postpartum women, focused on breastfeeding duration, and included troubleshooting information. Mobile applications often included media components ( n = 12 [24%]); few were tailored or personalized ( n = 5 [10%]) and interactive ( n = 15 [30%]). Text-messaging programs were available in a variety of countries ( n = 7 [58%]) and provided mostly informational support ( n = 5 [42%]), were pro-breastfeeding ( n = 12 [100%]), were targeted to both pregnant and postpartum women ( n = 6 [50%]), focused on both breastfeeding initiation and duration ( n = 9 [75%]), and had two-way interactivity ( n = 6 [50%]) and personalization ( n = 5 [42%]). CONCLUSIONS Although freely available mobile applications and text-messaging programs exist, with potential for wide reach, the majority provide only informational support. These programs would benefit from additional study of their usefulness.
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Affiliation(s)
| | - Amira Roess
- 1 The George Washington University, Washington, DC, USA
| | | | | | - Shawn Chiang
- 1 The George Washington University, Washington, DC, USA
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White BK, Giglia RC, Scott JA, Burns SK. How New and Expecting Fathers Engage With an App-Based Online Forum: Qualitative Analysis. JMIR Mhealth Uhealth 2018; 6:e144. [PMID: 29914862 PMCID: PMC6028763 DOI: 10.2196/mhealth.9999] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/08/2018] [Accepted: 04/25/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Breastfeeding is important for infants, and fathers are influential in supporting their partner in their decision to breastfeed and how long they breastfeed for. Fathers can feel excluded from traditional antenatal education and support opportunities but highly value social support from peers. Online health forums can be a useful source of social support, yet little is known about how fathers would use a conversation forum embedded in a breastfeeding-focused app. Milk Man is a mobile app that aimed to increase paternal support for breastfeeding using a range of strategies, including a conversation forum. OBJECTIVE The aim of this study was to examine how fathers used a breastfeeding-focused conversation forum contained within a mobile app throughout the perinatal period. METHODS A qualitative analysis of comments posted by users in the online forum contained within the Milk Man app was conducted. The app contained a library of information for fathers, as well as a conversation forum. Thematic analysis was used to organize and understand the data. The NVivo 11 software package was used to code comments into common nodes, which were then organized into key themes. RESULTS In all, 208 contributors (35.5% [208/586] of those who had access to the app) posted at least once within the forum. In total, 1497 comments were included for analysis. These comments were coded to 3799 individual nodes and then summarized to 54 tree nodes from which four themes emerged to describe how fathers used the app. Themes included seek and offer support, social connection, informational support provision, and sharing experiences. Posting in the forum was concentrated in the antenatal period and up to approximately 6 weeks postpartum. CONCLUSIONS These data show that fathers are prepared to use a breastfeeding-focused online forum in a variety of ways to facilitate social support. Fathers can be difficult to reach in the perinatal period, yet engaging them and increasing social support is important. This research demonstrates the acceptability of an innovative way of engaging new and expecting fathers.
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Affiliation(s)
- Becky K White
- School of Public Health, Curtin University, Perth, Australia
| | - Roslyn C Giglia
- School of Public Health, Curtin University, Perth, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Jane A Scott
- School of Public Health, Curtin University, Perth, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, Australia
| | - Sharyn K Burns
- School of Public Health, Curtin University, Perth, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, Australia
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White BK, Burns SK, Giglia RC, Scott JA. Designing evaluation plans for health promotion mHealth interventions: a case study of the Milk Man mobile app. Health Promot J Austr 2018; 27:198-203. [PMID: 27784506 DOI: 10.1071/he16041] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/07/2016] [Indexed: 01/31/2023] Open
Abstract
Evaluating complex health promotion interventions that use mobile apps requires comprehensive and adaptive evaluation plans. As mobile usage becomes increasingly sophisticated and personalised, broad evaluation plans are important in determining the impact and efficacy of a mobile health (mHealth) app. Evaluation should consider user feedback and outcome measures, as well as examine elements such as the robustness of the technology, the intervention principles and engagement strategies, and the interaction of the user with the technology. This paper introduces four mHealth evaluation models and tools and describes the evaluation plan that has been developed for Milk Man, a breastfeeding app targeting new and expectant fathers. Milk Man is a socially connected, gamified app that is being tested in a large Randomised Control Trial (RCT). While there is a need for mobile apps to be evaluated in adequately powered RCTs, trialling mobile apps over a long period of time presents challenges. Incorporating robust evaluation design will help ensure that technological performance, app intervention principles, as well as health and behavioural outcomes are measured. The detail and scope of the Milk Man app evaluation plan will ensure the findings add to the evidence base and have broad relevance to health promotion practitioners. So what? Evidence about the efficacy of mHealth interventions is an emerging area and appropriate evaluation skills are needed. This paper illustrates an evaluation planning approach for mHealth interventions that could be adapted for use by health promotion practitioners and researchers.
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Affiliation(s)
- Becky K White
- School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA 6845, Australia
| | - Sharyn K Burns
- School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA 6845, Australia
| | - Roslyn C Giglia
- School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA 6845, Australia
| | - Jane A Scott
- School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA 6845, Australia
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