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Koyuncu A, Ari A. Filling the gaps in the evaluation and selection of mobile health technologies in respiratory medicine. Expert Rev Respir Med 2024. [PMID: 38795074 DOI: 10.1080/17476348.2024.2361048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/24/2024] [Indexed: 05/27/2024]
Abstract
INTRODUCTION Mobile health (mHealth) technology in respiratory medicine is a fast-growing and promising technology that is popular among patients and healthcare providers (HCPs). They provide reminders and step-by-step instructions for the correct inhalation technique, monitor patients' adherence to treatment, and facilitate communication between patients and HCPs. AREAS COVERED While numerous mHealth apps have been developed over the years, most applications do not have supporting evidence. Selecting the best mHealth app in respiratory medicine is challenging due to limited studies carrying out mHealth app selection. Although mHealth technologies play an important part in the future of respiratory medicine, there is no single guide on the evaluation and selection of mHealth technologies for patients with pulmonary diseases. This paper aims to provide an overview of mHealth technologies, particularly emphasizing digital inhalers and standalone applications used in asthma. Additionally, it offers insights into the evaluation, selection, and pertinent considerations surrounding mHealth applications in respiratory medicine. EXPERT OPINION Evaluating mHealth apps will take time, resources, and collaboration between stakeholders such as governmental regulatory bodies, subject-matter experts, and industry representatives. Filling the gaps in the evaluation and selection of the mHealth app will improve clinical decision-making, personalized treatments, self-management and disease monitoring in respiratory medicine.
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Affiliation(s)
- Ayfer Koyuncu
- Graduate School of Science and Engineering, Bioengineering Department, Hacettepe University, Ankara, Turkey
| | - Arzu Ari
- College of Health Professions Department of Respiratory Care, Regent's Professor and Associate Dean for Research, Texas State University, Round Rock, TX, USA
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Solomon DH, Altwies H, Santacroce L, Ellrodt J, Pham T, Stratton J, Landman A, Dalal A, Collins J, Rudin RS. A Mobile Health Application Integrated in the Electronic Health Record for Rheumatoid Arthritis Patient-Reported Outcomes: A Controlled Interrupted Time-Series Analysis of Impact on Visit Efficiency. Arthritis Rheumatol 2024; 76:677-683. [PMID: 38087859 DOI: 10.1002/art.42774] [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: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE Patient-reported outcome (PRO) collection between visits for rheumatoid arthritis (RA) could improve visit efficiency, reducing in-person visits for patients with stable symptoms while facilitating access for those with symptoms. We examined whether a mobile health PRO application integrated in the electronic health record (EHR) could reduce visit volume for those with RA. METHODS We developed an application for RA that prompted patients every other day to complete brief PRO questionnaires. Results of the application were integrated into the EHR. We tested the application in a controlled interrupted time-series analysis between 2020 and 2023. Rheumatologists received EHR-based messages based on PRO results recommending the patient receive a visit earlier or later than scheduled. The primary outcome was monthly visit volume during the year before versus the year after initiation. RESULTS A total of 150 patients with RA consented and used the application. The median age was 62 years, 83% were female, 7% had fewer than 2 years of disease, and 50% were seropositive; 150 controls were well matched. Among those in the application cohort, the estimated monthly median visit volume in the year before use of the application was 31.2 (95% confidence interval [95% CI] 28.0-34.3); in controls, this was 30.4 (95% CI 27.3-33.6). In the year using the application, the estimated monthly visit volume was 36.8 (95% CI 33.4-40.3) compared to 38.7 (95% CI 35.2-42.3) in controls. The difference in the differences between the cohorts was not statistically significant (-2.7 visits, 95% CI -9.3 to 4.0). No differences were noted in flare rates or visit delays. CONCLUSION In this initial trial of a PRO application intervention to improve visit efficiency, we found no association with reduced visit volume.
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Affiliation(s)
- Daniel H Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hallie Altwies
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leah Santacroce
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jack Ellrodt
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tammy Pham
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jacklyn Stratton
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Adam Landman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anuj Dalal
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jamie Collins
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Moorthy P, Weinert L, Schüttler C, Svensson L, Sedlmayr B, Müller J, Nagel T. Attributes, Methods, and Frameworks Used to Evaluate Wearables and Their Companion mHealth Apps: Scoping Review. JMIR Mhealth Uhealth 2024; 12:e52179. [PMID: 38578671 PMCID: PMC11031706 DOI: 10.2196/52179] [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: 08/25/2023] [Revised: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Wearable devices, mobile technologies, and their combination have been accepted into clinical use to better assess the physical fitness and quality of life of patients and as preventive measures. Usability is pivotal for overcoming constraints and gaining users' acceptance of technology such as wearables and their companion mobile health (mHealth) apps. However, owing to limitations in design and evaluation, interactive wearables and mHealth apps have often been restricted from their full potential. OBJECTIVE This study aims to identify studies that have incorporated wearable devices and determine their frequency of use in conjunction with mHealth apps or their combination. Specifically, this study aims to understand the attributes and evaluation techniques used to evaluate usability in the health care domain for these technologies and their combinations. METHODS We conducted an extensive search across 4 electronic databases, spanning the last 30 years up to December 2021. Studies including the keywords "wearable devices," "mobile apps," "mHealth apps," "physiological data," "usability," "user experience," and "user evaluation" were considered for inclusion. A team of 5 reviewers screened the collected publications and charted the features based on the research questions. Subsequently, we categorized these characteristics following existing usability and wearable taxonomies. We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. RESULTS A total of 382 reports were identified from the search strategy, and 68 articles were included. Most of the studies (57/68, 84%) involved the simultaneous use of wearables and connected mobile apps. Wrist-worn commercial consumer devices such as wristbands were the most prevalent, accounting for 66% (45/68) of the wearables identified in our review. Approximately half of the data from the medical domain (32/68, 47%) focused on studies involving participants with chronic illnesses or disorders. Overall, 29 usability attributes were identified, and 5 attributes were frequently used for evaluation: satisfaction (34/68, 50%), ease of use (27/68, 40%), user experience (16/68, 24%), perceived usefulness (18/68, 26%), and effectiveness (15/68, 22%). Only 10% (7/68) of the studies used a user- or human-centered design paradigm for usability evaluation. CONCLUSIONS Our scoping review identified the types and categories of wearable devices and mHealth apps, their frequency of use in studies, and their implementation in the medical context. In addition, we examined the usability evaluation of these technologies: methods, attributes, and frameworks. Within the array of available wearables and mHealth apps, health care providers encounter the challenge of selecting devices and companion apps that are effective, user-friendly, and compatible with user interactions. The current gap in usability and user experience in health care research limits our understanding of the strengths and limitations of wearable technologies and their companion apps. Additional research is necessary to overcome these limitations.
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Affiliation(s)
- Preetha Moorthy
- Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lina Weinert
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
- Section for Oral Health, Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Christina Schüttler
- Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Laura Svensson
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Brita Sedlmayr
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Julia Müller
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Nagel
- Human Data Interaction Lab, Mannheim University of Applied Sciences, Mannheim, Germany
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Ibarra-Noriega AM, Yansane A, Mullins J, Simmons K, Skourtes N, Holmes D, White J, Kalenderian E, Walji MF. Evaluating and improving the usability of a mHealth platform to assess postoperative dental pain. JAMIA Open 2024; 7:ooae018. [PMID: 38476372 PMCID: PMC10928307 DOI: 10.1093/jamiaopen/ooae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Objectives The use of interactive mobile health (mHealth) applications to monitor patient-reported postoperative pain outcomes is an emerging area in dentistry that requires further exploration. This study aimed to evaluate and improve the usability of an existing mHealth application. Materials and methods The usability of the application was assessed iteratively using a 3-phase approach, including a rapid cognitive walkthrough (Phase I), lab-based usability testing (Phase II), and in situ pilot testing (Phase III). The study team conducted Phase I, while providers and patients participated in Phase II and III. Results The rapid cognitive walkthrough identified 23 potential issues that could negatively impact user experience, with the majority classified as system issues. The lab-based usability testing yielded 141 usability issues.; 43% encountered by patients and 57% by dentists. Usability problems encountered during pilot testing included undelivered messages due to mobile phone carrier and service-related issues, errors in patients' phone number data entry, and problems in provider training. Discussion Through collaborative and iterative work with the vendor, usability issues were addressed before launching a trial to assess its efficacy. Conclusion The usability of the mHealth application for postoperative dental pain was remarkably improved by the iterative analysis and interdisciplinary collaboration.
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Affiliation(s)
- Ana M Ibarra-Noriega
- Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX 77054, United States
| | - Alfa Yansane
- Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143, United States
| | | | | | | | | | - Joel White
- Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143, United States
| | - Elsbeth Kalenderian
- Marquette University School of Dentistry, Milwaukee, WI 53233, United States
- Department of Dental Management, School of Dentistry, University of Pretoria, Pretoria, 0002, South Africa
| | - Muhammad F Walji
- Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX 77054, United States
- Department of Clinical and Health Informatics, UTHealth Houston McWilliams School of Biomedical Informatics, Houston, TX 77030, United States
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Roldán-Ruiz AM, Merino-Godoy MDLÁ, Peregrín-Rubio A, Yot-Dominguez C, da Costa EIMT. Assessing the Hands-on Usability of the Healthy Jeart App Specifically Tailored to Young Users. Healthcare (Basel) 2024; 12:408. [PMID: 38338293 PMCID: PMC10855254 DOI: 10.3390/healthcare12030408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The widespread adoption of mobile devices by adolescents underscores the potential to harness these tools to instill healthy habits into their daily lives. An exemplary manifestation of this initiative is the Healthy Jeart app, crafted with the explicit goal of fostering well-being. METHODOLOGY This study, framed within an applied investigation, adopts an exploratory and descriptive approach, specifically delving into the realm of user experience analysis. The focus of this research is a preliminary examination aimed at understanding users' perceived usability of the application. To glean insights, a comprehensive questionnaire was administered to 101 teenagers, seeking their evaluations on various usability attributes. The study took place during 2022. RESULTS The findings reveal a considerable consensus among users regarding the evaluated usability aspects. However, the areas for improvement predominantly revolve around managing the information density, particularly for a subset of end users grappling with overwhelming content. Additionally, recommendations are put forth to streamline the confirmation process for user suggestions and comments. CONCLUSION This analysis illuminates both the strengths of the app and areas ripe for refinement, paving the way for a more user-centric and efficacious Healthy Jeart application.
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Affiliation(s)
- Ana Maria Roldán-Ruiz
- Information Technologies Department, School of Engineering, University of Huelva, 21007 Huelva, Spain;
| | | | - Antonio Peregrín-Rubio
- Centre for Advanced Studies in Physics, Mathematics and Computing, Andalusian Inter-University Institute in Data Science and Computational Intelligence, University of Huelva, 21007 Huelva, Spain;
| | - Carmen Yot-Dominguez
- Didactics and Educational Organization Department, Faculty of Education Sciences, University of Seville, 41001 Seville, Spain;
| | - Emília Isabel Martins Teixeira da Costa
- Nursing Department, Health School, University of Algarve, 8000 Faro, Portugal;
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal
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Gale N, Jones U, Rees T, Hicks A, Davies J, Holliday S, Hopkinson J. A cancer personalised activity and lifestyle tool (CAN-PAL): A codesign study with patients and healthcare professionals. J Clin Nurs 2024; 33:572-579. [PMID: 38062580 DOI: 10.1111/jocn.16931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/21/2023] [Accepted: 11/01/2023] [Indexed: 01/19/2024]
Abstract
AIMS To codesign a cancer personalised activity and lifestyle tool (CAN-PAL) based on an existing tool. To help cancer care workers support people affected by cancer to plan and integrate physical activity into lifestyles. DESIGN Mixed-methods codesign study. METHODS Phase 1: Focus groups with people affected by cancer (n = 10) or interviews (n = 2) to discuss suitable physical activities and adaptation of the existing tool. Data were recorded, transcribed and analysed thematically. Themes informed the design of the prototype CAN-PAL and user guide. Phase 2: Healthcare professionals considered the potential use of the CAN-PAL prototype and completed an online survey including the system usability scale and free text responses. RESULTS Phase 1: Identified suitable physical activities and four themes were identified including: Capability, benefits, barriers and resources which informed the prototype CAN-PAL and user guide. Phase 2: The user survey was completed by 12 healthcare professionals. Median (range) system usability scale was 80 (50-95) (best score 100), scores >68 indicate good or better usability. Themes from the free text comments included strengths, amendments, considerations and limitations. Results were used to finalise CAN-PAL and the user guide. CONCLUSION The codesigned CAN-PAL tool had good usability. Further work is needed to evaluate the impact of CAN-PAL on activity levels and behaviour in people affected by cancer. RELEVANCE TO CLINICAL PRACTICE People affected by cancer need support to undertake physical activity. The purpose of CAN-PAL is to assist cancer care workers to support people affected by cancer to plan and integrate physical activity into lifestyles. PATIENT OR PUBLIC CONTRIBUTION Public partners considered the findings from Phase 1 and 2 and informed the design of the prototype, final CAN-PAL and user guide and coauthored the paper. REPORTING METHOD The study adhered to relevant EQUATOR guidelines; the study was reported according to the COREQ checklist.
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Affiliation(s)
- Nichola Gale
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Una Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Tracy Rees
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Alexandra Hicks
- Public Partner, School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Janet Davies
- Public Partner, School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Jane Hopkinson
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Semonella M, Marchesi G, Andersson G, Dekel R, Pietrabissa G, Vilchinsky N. Usability study of SOSteniamoci: An internet-based intervention platform to support informal caregivers in Italy. Digit Health 2024; 10:20552076231225082. [PMID: 38235418 PMCID: PMC10793194 DOI: 10.1177/20552076231225082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
Background Providing informal care can be experienced as stressful and lead to caregiver burden. Internet-based interventions, a specific form of eHealth, have proven to be a good option to support informal caregivers. SOSteniamoci, an internet-based intervention already tested in Lithuania, was translated and adapted for Italian caregivers. Objective As many novel eHealth solutions have been rejected by end-users due to usability problems, we aimed to evaluate the usability of the adapted platform, using a computer-based prototype. Methods The following methods and metrics were applied: 1. task analysis, using audio and video recordings that included three usability metrics: task completion rate, frequency of errors, and frequency of help requests; 2. the system usability scale (SUS); and 3. a semi-structured interview to collect additional data about the system's design and overall satisfaction. Results Ten informal caregivers (60% female; age M = 47.8, SD = 15.21) provided insights and suggestions for increasing the usability of the platform. The platform was considered satisfactory, with a mean score on the SUS of 75 (SD = 13.07) out of 100. The task analysis measurements highlighted difficulties in how to log in to the platform, understanding what the intervention is about, and texting the therapist. The same difficulties were also mentioned during the post-experience interview. Thus, improvements were subsequently made to enhance users' experience when navigating the platform. Finally, the platform overall was found to be intuitive and friendly, and the contents were appreciated. Conclusion To maintain participants' engagement and prevent drop-out, it is crucial to test the usability of internet-based interventions. Even though the platform proved to be user-friendly, intuitive and easy to use, several enhancements were implemented based on participants' feedback. Thus, the usability of internet-based interventions should be tested, and end-users must be involved in the development process of such solutions.
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Affiliation(s)
| | - Gloria Marchesi
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy
| | - Gerhard Andersson
- Department of Behavioural Science and Learning, Linköping University, Linkoping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Rachel Dekel
- School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Noa Vilchinsky
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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Noser AE, Lancaster BD, Hommel KA, Roberts CM, King JA, Alt E, Fredericks EM, Ramsey RR. Use of Behavior Change Techniques and Quality of Commercially Available Inflammatory Bowel Disease Apps. Dig Dis Sci 2023:10.1007/s10620-023-07884-7. [PMID: 36933116 DOI: 10.1007/s10620-023-07884-7] [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: 05/01/2022] [Accepted: 02/15/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Inclusion of evidence-based behavior change techniques (e.g., self-monitoring) in mobile health apps has the potential to promote adherence to inflammatory bowel disease treatment. While inflammatory bowel disease management apps exist, the extent to which they incorporate behavior change techniques remains unknown. AIMS The present study systematically evaluated the content and quality of free, commercially available inflammatory bowel disease management apps. METHODS Apps were identified using a systematic search of the Apple App and Google Play stores. Apps were evaluated using Abraham and Michie's taxonomy of 26 behavior change techniques. A literature search was conducted to identify behavior change techniques specific and relevant for people with inflammatory bowel disease. App quality was assessed using the Mobile App Rating Scale with scores ranging from 1 (Inadequate) to 5 (Excellent). RESULTS A total of 51 inflammatory bowel disease management apps were evaluated. Apps included 0-16 behavior change techniques (Mean = 4.55) and 0-10 inflammatory bowel disease management behavior change techniques (Mean = 3.43). App quality ranged from 2.03 to 4.62 (Mean = 3.39) out of 5.00. Two apps, My IBD Care: Crohn's & Colitis and MyGiHealth GI Symptom Tracker, included the highest number of overall and inflammatory bowel disease management behavior change techniques along with high-quality scores. Bezzy IBD was the only app with a high number of overall and inflammatory bowel disease management behavior change techniques with a primary focus on social support/change. CONCLUSION Most inflammatory bowel disease management apps reviewed included evidence-based inflammatory bowel disease management behavior change techniques.
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Affiliation(s)
- Amy E Noser
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Minneapolis, MN, 55414, USA.
| | - Brittany D Lancaster
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Caroline M Roberts
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica A King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elizabeth Alt
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Baines R, Hoogendoorn P, Stevens S, Chatterjee A, Ashall-Payne L, Andrews T, Leigh S. Navigating Medical Device Certification: A Qualitative Exploration of Barriers and Enablers Amongst Innovators, Notified Bodies and Other Stakeholders. Ther Innov Regul Sci 2023; 57:238-250. [PMID: 36194368 PMCID: PMC9531632 DOI: 10.1007/s43441-022-00463-4] [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: 05/30/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medical device certification has undergone significant changes in recent years. However, exploration of stakeholder experiences remains relatively limited, particularly in the context of software as a medical device. This study sought to explore stakeholder experiences of medical device certification across both the UK and EU. METHODS Semi-structured interviews (n = 22) analysed using inductive-thematic analysis, synthesised using activity theory. RESULTS Innovators, consultants and notified bodies share more similarities than differences when discussing barriers and enablers to achieving medical device certification. Systemic tensions between existing rules, tools, community understanding and division of labour currently undermine the intended aim of certification processes. Existing rules are considered complex, with small and medium-sized enterprises considered disproportionality affected, resulting in several unintended outcomes including the perceived 'killing' of innovation. Existing certification processes are described as unfit for purpose, unethical and unsustainable. CONCLUSION Stakeholder experiences suggest that the intention of establishing a robust and sustainable regulatory framework capable of ensuring a high level of safety whilst also supporting innovation is not yet being realised. Failure to enact desired changes may further jeopardise future innovations, outcomes and care quality.
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Affiliation(s)
- Rebecca Baines
- The Organisation for the Review of Care and Health Applications (ORCHA), Daresbury, WA4 4AB UK ,University of Plymouth, Plymouth, PL4 8AA UK
| | - Petra Hoogendoorn
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Sebastian Stevens
- The Organisation for the Review of Care and Health Applications (ORCHA), Daresbury, WA4 4AB UK ,University of Plymouth, Plymouth, PL4 8AA UK
| | | | - Liz Ashall-Payne
- The Organisation for the Review of Care and Health Applications (ORCHA), Daresbury, WA4 4AB UK ,Warwick Medical School, University of Warwick, Coventry, UK
| | - Tim Andrews
- The Organisation for the Review of Care and Health Applications (ORCHA), Daresbury, WA4 4AB UK ,Warwick Medical School, University of Warwick, Coventry, UK
| | - Simon Leigh
- The Organisation for the Review of Care and Health Applications (ORCHA), Daresbury, WA4 4AB, UK. .,Warwick Medical School, University of Warwick, Coventry, UK.
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Mavragani A, Johnston FH, Campbell SL, Williamson GJ, Lucani C, Bowman DMJS, Cooling N, Jones PJ. Evaluating User Preferences, Comprehension, and Trust in Apps for Environmental Health Hazards: Qualitative Case Study. JMIR Form Res 2022; 6:e38471. [PMID: 36548030 PMCID: PMC9816954 DOI: 10.2196/38471] [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: 04/04/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Climate change is projected to increase environmental health hazard risks through fire-related air pollution and increased airborne pollen levels. To protect vulnerable populations, it is imperative that evidence-based and accessible interventions are available. The environmental health app, AirRater, was developed in 2015 in Australia to provide information on multiple atmospheric health hazards in near real time. The app allows users to view local environmental conditions, and input and track their personal symptoms to enable behaviors that protect health in response to environmental hazards. OBJECTIVE This study aimed to develop insights into users' perceptions of engagement, comprehension, and trust in AirRater to inform the future development of environmental health apps. Specifically, this study explored which AirRater features users engaged with, what additional features or functionality needs users felt they required, users' self-perception of understanding app information, and their level of trust in the information provided. METHODS A total of 42 adult AirRater users were recruited from 3 locations in Australia to participate in semistructured interviews to capture location- or context-specific experiences. Participants were notified of the recruitment opportunity through multiple avenues including newsletter articles and social media. Informed consent was obtained before participation, and the participants were remunerated for their time and perspectives. A preinterview questionnaire collected data including age range, any preexisting conditions, and location (postcode). All participant data were deidentified. Interviews were recorded, transcribed, and analyzed using thematic analysis in NVivo 12 (QSR International). RESULTS Participants discussed app features and functionality, as well as their understanding of, and trust in, the information provided by the app. Most (26/42, 62%) participants used and valued visual environmental hazard features, especially maps, location settings, and hazard alerts. Most (33/42, 78%) found information in the app easy to understand and support their needs, irrespective of their self-reported literacy levels. Many (21/42, 50%) users reported that they did not question the accuracy of the data presented in the app. Suggested enhancements include the provision of meteorological information (eg, wind speed or direction, air pressure, UV rating, and humidity), functionality enhancements (eg, forecasting, additional alerts, and the inclusion of health advice), and clarification of existing information (eg, symptom triggers), including the capacity to download personal summary data for a specified period. CONCLUSIONS Participants' perspectives can inform the future development of environmental health apps. Specifically, participants' insights support the identification of key elements for the optimal development of environmental health app design, including streamlining, capacity for users to customize, use of real time data, visual cues, credibility, and accuracy of data. The results also suggest that, in the future, iterative collaboration between developers, environmental agencies, and users will likely promote better functional design, user trust in the data, and ultimately better population health outcomes.
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Affiliation(s)
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Public Health Services, Tasmanian Department of Health, Hobart, Australia
| | - Sharon L Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Public Health Services, Tasmanian Department of Health, Hobart, Australia
| | | | - Chris Lucani
- School of Natural Sciences, University of Tasmania, Hobart, Australia
| | | | - Nick Cooling
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Penelope J Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Digital health tools to support parents with parent-infant sleep and mental well-being. NPJ Digit Med 2022; 5:185. [PMID: 36543920 PMCID: PMC9772418 DOI: 10.1038/s41746-022-00732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
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Linardon J, Westrupp EM, Macdonald JA, Mikocka-Walus A, Stokes MA, Greenwood CJ, Youssef GJ, Teague S, Hutchinson D, Sciberras E, Fuller-Tyszkiewicz M. Monitoring Australian parents' shifting receptiveness to digital mental health interventions during the COVID-19 pandemic. Aust N Z J Psychiatry 2022; 56:1503-1514. [PMID: 34963330 DOI: 10.1177/00048674211065985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nascent evidence indicates that the mental health of parents and children has markedly declined during the COVID-19 pandemic. Considering disruptions to traditional face-to-face mental health services resultant from stay-at-home orders, the potential value of digital mental health interventions has become extremely apparent. Despite this, uptake of digital interventions remains poor, indicating that a better understanding is needed of factors that determine a willingness to use digital platforms. METHOD The present multi-wave, longitudinal study of 2365 Australian parents explored between-person and within-person predictors of intentions to use digital interventions during the pandemic. RESULTS More than one-third of parents reported likely use of a self-guided and therapist-guided digital intervention, with the most endorsed reason for use being to support their child's mental health. Between-person baseline predictors of higher intention ratings were parent's prior mental illness, not living with a partner and recent environmental stressors. Within-person predictors of higher intention ratings were endorsement of mindful parenting strategies, child access to the Internet, better perceived management of child's education, lower social support and financial hardship. CONCLUSION Findings demonstrate that willingness to engage in digital interventions fluctuates in response to changing circumstances. Identifying novel ways to increase acceptance and uptake of digital interventions based on modifiable predictors established here is needed to realize the full potential of these modes of care in times of need.
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Affiliation(s)
- Jake Linardon
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Elizabeth M Westrupp
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
| | - Antonina Mikocka-Walus
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Mark A Stokes
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Christopher J Greenwood
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Samantha Teague
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Delyse Hutchinson
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
- The National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Emma Sciberras
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
| | - Matthew Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
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Mehdizadeh H, Asadi F, Nazemi E, Mehrvar A, Yazdanian A, Emami H. Usability evaluation and Compatibility test of digital self-management support system for children with cancer and their caregivers: using cloud automation testing platform (Preprint). JMIR Pediatr Parent 2022; 6:e43867. [PMID: 36995746 PMCID: PMC10132021 DOI: 10.2196/43867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Despite the increasing development of different smartphone apps in the health care domain, most of these apps lack proper evaluation. In fact, with the rapid development of smartphones and wireless communication infrastructure, many health care systems around the world are using these apps to provide health services for people without sufficient scientific efforts to design, develop, and evaluate them. OBJECTIVE The objective of this study was to evaluate the usability of CanSelfMan, a self-management app that provides access to reliable information to improve communication between health care providers and children with cancer and their parents/caregivers, facilitating remote monitoring and promoting medication adherence. METHODS We performed debugging and compatibility tests in a simulated environment to identify possible errors. Then, at the end of the 3-week period of using the app, children with cancer and their parents/caregivers filled out the User Experience Questionnaire (UEQ) to evaluate the usability of the CanSelfMan app and their level of user satisfaction. RESULTS During the 3 weeks of CanSelfMan use, 270 cases of symptom evaluation and 194 questions were recorded in the system by children and their parents/caregivers and answered by oncologists. After the end of the 3 weeks, 44 users completed the standard UEQ user experience questionnaire. According to the children's evaluations, attractiveness (mean 1.956, SD 0.547) and efficiency (mean 1.934, SD 0.499) achieved the best mean results compared with novelty (mean 1.711, SD 0.481). Parents/caregivers rated efficiency at a mean of 1.880 (SD 0.316) and attractiveness at a mean of 1.853 (SD 0.331). The lowest mean score was reported for novelty (mean 1.670, SD 0.225). CONCLUSIONS In this study, we describe the evaluation process of a self-management system to support children with cancer and their families. Based on the feedback and scores obtained from the usability evaluation, it seems that the children and their parents find CanSelfMan to be an interesting and practical idea to provide reliable and updated information on cancer and help them manage the complications of this disease.
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Affiliation(s)
- Hamed Mehdizadeh
- Health Information Technology Department, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farkhondeh Asadi
- Health Information Technology and Management Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Eslam Nazemi
- Department of Electrical and Computer Engineering, Shahid Beheshti University, Tehran, Iran
| | - Azim Mehrvar
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Azade Yazdanian
- Health Information Technology Department, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hassan Emami
- Health Information Technology and Management Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Pape M, Färber T, Seiferth C, Roth T, Schroeder S, Wolstein J, Herpertz S, Steins-Loeber S. A Tailored Gender-Sensitive mHealth Weight Loss Intervention (I-GENDO): Development and Process Evaluation. JMIR Form Res 2022; 6:e38480. [PMID: 36301614 PMCID: PMC9650578 DOI: 10.2196/38480] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/11/2022] [Accepted: 08/29/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Given the increase in the prevalence of overweight and obesity worldwide, the number of digital weight loss interventions has also risen. However, these interventions often lack theoretical background and data on long-term effectiveness. The consideration of individual and gender differences in weight-related psychological parameters might enhance the efficacy and sustainability of mobile-based weight loss interventions. OBJECTIVE This paper presented an introduction to and the process evaluation of a 12-week gender-sensitive mobile health (mHealth) weight loss intervention (I-GENDO) combining computer-based and self-tailoring features. METHODS Between August 2020 and August 2021, individuals with overweight (BMI 25.0-29.9 kg/m²), those with obesity class I (BMI 30.0-34.9 kg/m²), and those with obesity class II (BMI 35.0-39.9 kg/m²) were recruited to the I-GENDO project, a multicenter study in Germany. The mHealth intervention aimed at targeting individual psychological factors associated with the development and persistence of overweight and obesity (eg, emotional eating) using computer-based tailoring. Moreover, the intervention took a gender-sensitive approach by implementing self-tailoring of gender-targeted module versions. The computer-based assignment of the main modules, self-selection of gender-targeted module versions, and use patterns were evaluated while considering gender. Moreover, gender differences in the usability assessment were analyzed. RESULTS Data from the intervention arm of the study were processed. A total of 116 individuals with overweight and obesity (77/116, 66.4% women; age mean 47.28, SD 11.66 years; BMI mean 33.58, SD 3.79 kg/m2) were included in the analyses. Overall, the compliance (90/109, 82.6%) and satisfaction with the app (mean 86% approval) were high and comparable with those of other mobile weight loss interventions. The usability of the intervention was rated with 71% (5.0/7.0 points) satisfaction. More women obtained the main module that focused on emotion regulation skills. Most men and women selected women-targeted versions of the main modules. Women used the app more frequently and longer than men. However, women and men did not differ in the progress of use patterns throughout the intervention. CONCLUSIONS We developed a tailored gender-sensitive mHealth weight loss intervention. The usability of and engagement with the intervention were satisfactory, and the overall satisfaction with the intervention was also high. Gender differences must be considered in the evaluation of the effectiveness and sustainability of the intervention.
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Affiliation(s)
- Magdalena Pape
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital of the Ruhr-University Bochum, Bochum, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Tanja Färber
- Department of Pathopsychology, University of Bamberg, Bamberg, Germany
| | - Caroline Seiferth
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Tanja Roth
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Stefanie Schroeder
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- Department of Pathopsychology, University of Bamberg, Bamberg, Germany
| | - Joerg Wolstein
- Department of Pathopsychology, University of Bamberg, Bamberg, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
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15
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Lee J, Lee MA. Validation and usability study of the framework for a user needs-centered mHealth app selection. Int J Med Inform 2022; 167:104877. [PMID: 36174415 DOI: 10.1016/j.ijmedinf.2022.104877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/17/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most mHealth app users rely on an app's rankings, star ratings, or reviews, which may not reflect users' individual healthcare needs. To help healthcare providers, researchers, and users select an optimal mHealth app, the Method of App Selection based on User Needs (MASUN) 1.01 was developed and tested in prior research. Initial testing found the need for improvement. OBJECTIVE This multiple-phase study aimed to simplify and improve MASUN 1.0, resulting in MASUN 2.0, and verify the feasibility and usability of MASUN 2.0. METHODS This study was conducted in three phases: (1) modification of MASUN 1.0 to improve its importance, applicability, relevance, and clarity, in consultation with 21 experts in medical or nursing informatics; (2) validation of the draft MASUN 2.0, with 13 experts; and (3) feasibility testing of MASUN 2.0 and usability evaluation of the best app found through MASUN 2.0. Menstrual apps were used to test the framework. RESULTS From Phases 1 and 2, MASUN 2.0, the framework for mHealth App selection, was derived with improved simplicity, usability, and applicability through a reduced number of tasks and time required. In Phase 3, after screening and scoring 2377 menstrual apps, five candidate apps were selected and evaluated by five clinical experts, five app experts, and five potential users. Finally, 194 users evaluated the usability of the app selected as the best. The best app helped users understand their health-related syndromes and patterns. Additionally, user-provided scores for impact, usefulness, and ease of use for the app were higher than for others. CONCLUSIONS This study successfully modified MASUN 1.0 into MASUN 2.0 and verified MASUN 2.0 through content validity, feasibility, and usability testing. The selected apps through MASUN 2.0 helped health consumers more easily address health discomfort. Future research should extend this work to an automated system and different medical conditions with multiple stakeholders for digital health equity.
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Affiliation(s)
- Jisan Lee
- Department of Nursing Science, College of Life & Health Sciences, Hoseo University, Asan, Republic of Korea.
| | - Mikyoung Angela Lee
- Doswell Endowed Chair for Informatics and Healthcare Transformation and Professor, College of Nursing, Texas Woman's University, Dallas, TX, United States
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16
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Mathisen TF, Johansen FR. The Impact of Smartphone Apps Designed to Reduce Food Waste on Improving Healthy Eating, Financial Expenses and Personal Food Waste: Crossover Pilot Intervention Trial Studying Students’ User Experiences. JMIR Form Res 2022; 6:e38520. [PMID: 36053667 PMCID: PMC9482070 DOI: 10.2196/38520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/01/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Global sustainability and individual health need coordinated attention. While individuals are recommended a healthy diet to reduce the burden of noncommunicable diseases, global attention to natural resource conservation is also needed. The latter specifically means effective measures to reduce food waste.
Objective
This pilot study evaluates the experiences of students and effect from using smartphone apps designed to reduce food waste on personal healthy eating, financial expenses, and food waste.
Methods
A total of 6 students from different study programs (mean age 24.7, SD 2.9) were recruited to evaluate 2 different apps designed to reduce food waste and to register food consumption, food waste, and financial food expenses before and after the app trials. The apps evaluated were the commercially available TotalCtrl Home and Too-Good-To-Go. Results were analyzed by mixed methods, comprising statistical analyses for quantifiable data and thematic analyses for qualitative data. The apps were used separately in random order, each for 1 month. Primary outcome was user expectations to and experiences from the use of the apps, which were obtained by semistructured interviews. Secondary outcomes were changes in food waste volume, financial food expenses, and healthy eating. While information on food waste and food expenses was obtained by weighing food waste and registering food costs for 2 weeks before and after app trials, scores for consuming healthy diets were calculated from registered food records by scoring criteria matched to national recommendations for healthy eating.
Results
Awareness on food waste increased after app trials, but experiences with apps pointed toward several potential for technical and content improvements. The students reported that there were too many manual operations in the apps to induce permanent use (TotalCtrl Home), that services seemed more concerned about the producers’ interests than the individual’s needs (Too-Good-To-Go), and that they missed a composite app that included functions to promote healthy eating and overview of budget and expenses as well as of food waste (both apps). Use of apps designed to reduce food waste and personal costs and to improve healthy eating did not result in any measurable effects, that is, no change in food waste (mean change 0.81, SD 1.5 kg; P=.13), healthy eating (mean change –0.24, SD 0.43; P=.24), or personal food expenses (mean change 47.5 NOK or US $4.8, SD 416.9 NOK or US $42.5; P=.39).
Conclusions
Apps may aid in increased awareness of food waste at the producer and consumer levels. Large-scale studies with longer duration are needed to see if apps may induce measurable changes in food waste, healthy eating, and financial expenses.
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Affiliation(s)
| | - Frode Ramstad Johansen
- Faculty of Computer Sciences, Engineering and Economics, Østfold University College, Halden, Norway
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17
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Yamamoto K, Ito M, Sakata M, Koizumi S, Hashisako M, Sato M, Stoyanov SR, Furukawa TA. Japanese Version of the Mobile App Rating Scale (MARS): Development and Validation. JMIR Mhealth Uhealth 2022; 10:e33725. [PMID: 35197241 PMCID: PMC9052018 DOI: 10.2196/33725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/19/2021] [Accepted: 02/17/2022] [Indexed: 12/18/2022] Open
Abstract
Background The number of mobile health (mHealth) apps continues to rise each year. Widespread use of the Mobile App Rating Scale (MARS) has allowed objective and multidimensional evaluation of the quality of these apps. However, no Japanese version of MARS has been made available to date. Objective The purposes of this study were (1) to develop a Japanese version of MARS and (2) to assess the translated version’s reliability and validity in evaluating mHealth apps. Methods To develop the Japanese version of MARS, cross-cultural adaptation was used using a universalist approach. A total of 50 mental health apps were evaluated by 2 independent raters. Internal consistency and interrater reliability were then calculated. Convergent and divergent validity were assessed using multitrait scaling analysis and concurrent validity. Results After cross-cultural adaptation, all 23 items from the original MARS were included in the Japanese version. Following translation, back-translation, and review by the author of the original MARS, a Japanese version of MARS was finalized. Internal consistency was acceptable by all subscales of objective and subjective quality (Cronbach α=.78-.89). Interrater reliability was deemed acceptable, with the intraclass correlation coefficient (ICC) ranging from 0.61 to 0.79 for all subscales, except for “functionality,” which had an ICC of 0.40. Convergent/divergent validity and concurrent validity were also considered acceptable. The rate of missing responses was high in several items in the “information” subscale. Conclusions A Japanese version of MARS was developed and shown to be reliable and valid to a degree that was comparable to the original MARS. This Japanese version of MARS can be used as a standard to evaluate the quality and credibility of mHealth apps.
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Affiliation(s)
- Kazumichi Yamamoto
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan.,Research Unit, Institute for Airway Disease, Takarazuka, Japan
| | - Masami Ito
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Masatsugu Sakata
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Shiho Koizumi
- Department of Health Informatics, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | | | - Masaaki Sato
- Organ Transplantation Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Stoyan R Stoyanov
- Institute of Health & Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
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Grosser F, Herrmann S, Bretschneider M, Timpel P, Schildt J, Bentrup M, Schwarz PEH. Design of the DAVOS Study: Diabetes Smartphone App, a Fully Automatic Transmission of Data From the Blood Glucose Meter and Insulin Pens Using Wireless Technology to Enhance Diabetes Self-Management-A Study Protocol for a Randomized Controlled Trial. J Diabetes Sci Technol 2022; 17:742-750. [PMID: 35393874 DOI: 10.1177/19322968221075333] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the treatment of diabetes mellitus, the challenge is to integrate adequate self-management into clinical care. Customization including goal setting, monitoring, and feedback could be achieved through digitization. Digital linking between different devices could simplify and promote self-management. The aim of this study is to evaluate the outcome of diabetes treatment assisted by a digital health application compared with standard diabetes therapy. METHODS The DAVOS study is a 6-month-period prospective, multicentric, randomized controlled trial. In total, 154 diabetes patients (age ≥18; treated with insulin) will be recruited and randomized into control group or intervention group. Both groups will receive standard diabetes care. The intervention group will additionally use a diabetes app. HbA1c value will be monitored on three separate defined visits. Primary endpoint is the overall reduction of HbA1c value. Secondary endpoints (eg, usability of the app) will be determined through patient-reported outcome questionnaires. DISCUSSION Through enhanced interaction of health care professionals, providers of the app, and patients, the study aims to demonstrate improvement in the self-management of diabetes. As part of the closure management, all patients will be invited to use the examined application after completion of the study. The DAVOS study will be conducted in accordance with the valid version of the present study protocol and the internationally recognized International Conference on Harmonization-Good Clinical Practice (ICH-GCP) Guidelines. Special attention will be paid to European, national, and regional requirements for the approval, provision, and use of medical devices. The study was registered in the German Register of Clinical Trials (DRKS) with number DRKS00025996.
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Affiliation(s)
- Franziska Grosser
- Department of Prevention and Care of Diabetes, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Sandra Herrmann
- Department of Prevention and Care of Diabetes, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Maxi Bretschneider
- Department of Prevention and Care of Diabetes, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Patrick Timpel
- Department of Prevention and Care of Diabetes, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Janko Schildt
- Emperra GmbH E-Health Technologies, Potsdam, Germany
| | | | - Peter E H Schwarz
- Department of Prevention and Care of Diabetes, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
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Morton E, Nicholas J, Yang L, Lapadat L, Barnes SJ, Provencher MD, Depp C, Chan M, Kulur R, Michalak EE. Evaluating the quality, safety, and functionality of commonly used smartphone apps for bipolar disorder mood and sleep self-management. Int J Bipolar Disord 2022; 10:10. [PMID: 35368207 PMCID: PMC8977125 DOI: 10.1186/s40345-022-00256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Individuals with bipolar disorder (BD) are increasingly turning to smartphone applications (apps) for health information and self-management support. While reviews have raised concerns regarding the effectiveness and safety of publicly available apps for BD, apps surveyed may not reflect what individuals with BD are using. The present study had two aims: first, to characterize the use of health apps to support mood and sleep amongst people with BD, and second, to evaluate the quality, safety and functionality of the most commonly used self-management apps. Methods A web-based survey was conducted to explore which apps people with BD reported using to support self-management of mood and sleep. The characteristics of the most commonly nominated apps were described using a standardized framework, including their privacy policy, clinical foundations, and functionality. Results Respondents (n = 919) were 77.9% female with a mean age of 36.9 years. 41.6% of participants (n = 382) reported using a self-management app to support mood or sleep. 110 unique apps were nominated in relation to mood, and 104 unique apps nominated in relation to sleep; however, most apps were only mentioned once. The nine most frequently nominated apps related to mood and sleep were subject to further evaluation. All reviewed apps offered a privacy policy, however user control over data was limited and the complexity of privacy policies was high. Only one app was developed for BD populations. Half of reviewed apps had published peer-reviewed evidence to support their claims of efficacy, but little research was specific to BD. Conclusion Findings illustrate the potential of smartphone apps to increase the reach of psychosocial interventions amongst people with BD. Apps were largely created by commercial developers and designed for the general population, highlighting a gap in the development and dissemination of evidence-informed apps for BD. There may be risks in using generic health apps for BD self-management; clinicians should enquire about patients’ app use to foster conversations about their particular benefits and limitations. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00256-6.
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20
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Almoallim S, Sas C. Functionalities Review of Digital Wellbeing Apps: Towards Research-informed Design Implications for Interventions Limiting Smartphone Use. JMIR Form Res 2022; 6:e31730. [PMID: 35188897 PMCID: PMC9066336 DOI: 10.2196/31730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/13/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Much research in human-computer interaction has focused on well-being and how it can be better supported through a range of technologies, from affective interfaces to mindfulness systems. At the same time, we have seen a growing number of commercial digital well-being apps. However, there has been limited scholarly work reviewing these apps. Objective This paper aims to report on an autoethnographic study and functionality review of the 39 most popular commercial digital well-being apps on Google Play Store and 17 apps described in academic papers. Methods From 1250 apps on Google Play Store, we selected 39 (3.12%) digital well-being apps, and from Google Scholar, we identified 17 papers describing academic apps. Both sets of digital well-being apps were analyzed through a review of their functionalities based on their descriptions. The commercial apps were also analyzed through autoethnography, wherein the first author interacted with them to understand how these functionalities work and how they may be experienced by users in their daily lives. Results Our findings indicate that these apps focus mostly on limiting screen time, and we advanced a richer conversation about such apps, articulating the distinctions among monitoring use, tracking use against set limits, and 4 specific interventions supporting limited use. Conclusions We conclude with 6 implications for designing digital well-being apps, namely calling to move beyond screen time and support the broader focus of digital well-being; supporting meaningful use rather than limiting meaningless use; leveraging (digital) navigation in design for friction; supporting collaborative interaction to limit phone overuse; supporting explicit, time-based visualizations for monitoring functionality; and supporting the ethical design of digital well-being apps.
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Affiliation(s)
- Sultan Almoallim
- School of Computing and Communications, Lancaster University, Bailrigg, Lancaster, GB
| | - Corina Sas
- School of Computing and Communications, Lancaster University, Bailrigg, Lancaster, GB
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21
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Brown JM, Franco-Arellano B, Froome H, Siddiqi A, Mahmood A, Arcand J. The Content, Quality, and Behavior Change Techniques in Nutrition-Themed Mobile Apps for Children in Canada: App Review and Evaluation Study. JMIR Mhealth Uhealth 2022; 10:e31537. [PMID: 35171100 PMCID: PMC8892278 DOI: 10.2196/31537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/04/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background Children increasingly use mobile apps. Strategies to increase child engagement with apps include the use of gamification and images that incite fun and interaction, such as food. However, the foods and beverages that children are exposed to while using apps are unknown and may vary by app type. Objective The aim of this study is to identify the app content (ie, types of foods and beverages) included in nutrition-themed apps intended for children, to assess the use of game-like features, and to examine app characteristics such as overall quality and behavior change techniques (BCTs). Methods This analysis used a cross-sectional database of nutrition-themed apps intended for children (≤12 years), collected between May 2018 and June 2019 from the Apple App Store and Google Play Store (n=259). Apps were classified into four types: food games or nongames that included didactic nutrition guides, habit trackers, and other. Food and beverages were identified in apps and classified into 16 food categories, as recommended (8/16, 50%) and as not recommended (8/16, 50%) by dietary guidelines, and quantified by app type. Binomial logistic regression assessed whether game apps were associated with foods and beverages not recommended by guidelines. App quality, overall and by subscales, was determined using the Mobile App Rating Scale. The BCT Taxonomy was used to classify the different behavioral techniques that were identified in a subsample of apps (124/259, 47.9%). Results A total of 259 apps displayed a median of 6 (IQR 3) foods and beverages. Moreover, 62.5% (162/259) of apps were classified as food games, 27.4% (71/259) as didactic nutrition guides, 6.6% (17/259) as habit trackers, and 3.5% (9/259) as other. Most apps (198/259, 76.4%) displayed at least one food or beverage that was not recommended by the dietary guidelines. Food game apps were almost 3 times more likely to display food and beverages not recommended by the guidelines compared with nongame apps (β=2.8; P<.001). The overall app quality was moderate, with a median Mobile App Rating Scale score of 3.6 (IQR 0.7). Functionality was the subscale with the highest score (median 4, IQR 0.3). Nutrition guides were more likely to be educational and contain informative content on healthy eating (score 3.7), compared with the other app types, although they also scored significantly lower in engagement (score 2.3). Most apps (105/124, 84.7%) displayed at least one BCT, with the most common BCT being information about health consequences. Conclusions Findings suggest nutrition-themed apps intended for children displayed food and beverage content not recommended by dietary guidelines, with gaming apps more likely to display not recommended foods than their nongame counterparts. Many apps have a moderate app quality, and the use of consequences (instead of rewards) was the most common BCT.
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Affiliation(s)
| | | | - Hannah Froome
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Amina Siddiqi
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Amina Mahmood
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
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22
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Poh Loh K, Liu J, Ganzhorn S, Sanabria G, Schnall R. Establishing a usability cut-point for the Health Information Technology Usability Evaluation Scale (Health-ITUES). Int J Med Inform 2022; 160:104713. [PMID: 35144102 PMCID: PMC8903058 DOI: 10.1016/j.ijmedinf.2022.104713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Health Information Technology Usability Evaluation Scale (Health-ITUES) is a validated and reliable instrument to evaluate usability of information technology (IT) tools. In this study, we aimed to establish the optimal cut-point of the Health-ITUES to identify usability of IT tools. METHODS Adult participants were recruited to a trial evaluating a mobile app for self-managing HIV. Participants completed the Health-ITUES at the 3- and 6-month follow-up. Health-ITUES is a 20-item questionnaire that assesses four subscales: impact, perceived usefulness, perceived ease of use, and user control. The total score ranged from 1 to 5 and a higher score indicates greater usability. App use was defined as the proportion of activities completed by participants in both study arms. The selection of an optimal cut-point involved a series of multiple linear regression models with 500 bootstrap replications to examine the relationship between the Health-ITUES total score and app use, controlling for potential covariates. RESULTS We included 158 participants; mean age was 49.7 years (SD 10.3), 71% were African American/Black, and 72% were non-Hispanic. Mean Health-ITUES total scores at 3 and 6 months were 4.39 (SD 0.75) and 4.43 (SD 0.75), respectively. App use completedby participants from baseline to the 3-month follow-up visits was 0.61 (SD 0.36, range 0-1.72) and from 3-month to the 6-month follow-up visits was 0.51 (SD 0.37). Participants who reported greater Health-ITUES total score completed more activities [β = 0.18, 95% Confidence Interval (CI) 0.10-0.27]. The optimal cut-point of 4.32 (95% CI: 4.25-4.56) yielded the lowest p-value to identify usability of IT tools. CONCLUSIONS In this study of adults with HIV, we identified an optimal cut-point of 4.32 on the Health-ITUES total score to define usability. Further studies are needed to validate this cut-point.
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Hajesmaeel-Gohari S, Khordastan F, Fatehi F, Samzadeh H, Bahaadinbeigy K. The most used questionnaires for evaluating satisfaction, usability, acceptance, and quality outcomes of mobile health. BMC Med Inform Decis Mak 2022; 22:22. [PMID: 35081953 PMCID: PMC8793175 DOI: 10.1186/s12911-022-01764-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Various questionnaires are used for evaluating satisfaction, usability, acceptance, and quality outcomes of mobile health (mHealth) services. Using the best one to meet the needs of an mHealth study is a challenge for researchers. Therefore, this study aimed to review and determine the frequently used questionnaires for evaluating the mentioned outcomes of mHealth services. Methods The PubMed database was searched for conducting this review in April 2021. Papers that used a referenced questionnaire to evaluate the satisfaction, usability, acceptance, or quality outcomes of mHealth were included. The first author’s name, year of publication, evaluation outcome, and evaluation questionnaire were extracted from relevant papers. Data were analyzed using descriptive statistics. Results In total, 247 papers were included in the study. Questionnaires were used for usability (40%), quality (34.5%), acceptance (8.5%), and satisfaction (4%) outcomes, respectively. System usability scale (36.5%), mobile application rating scale (35.5%), post study system usability questionnaire (6%), user mobile application rating scale (5%), technology acceptance model (4.5%), computer system usability questionnaire (2.5%), net promoter score (2%), health information technology usability evaluation scale (2%), the usefulness, satisfaction, and ease of use (1.5%), client satisfaction questionnaire (1.5%), unified theory of acceptance and use of technology (1.5%), questionnaire for user interaction satisfaction (1%), user experience questionnaire (1%), and after-scenario questionnaire (1%) were the most used questionnaires, respectively. Conclusion Despite the existence of special questionnaires for evaluating several outcomes of mHealth, general questionnaires with fewer items and higher reliability have been used more frequently. Researchers should pay more attention to questionnaires with a goal-based design. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01764-2.
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Affiliation(s)
- Sadrieh Hajesmaeel-Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Firoozeh Khordastan
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Fatehi
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Hamidreza Samzadeh
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
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24
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Fischer T, Stumpf P, Schwarz PEH, Timpel P. Video-based smartphone app ('VIDEA bewegt') for physical activity support in German adults: a single-armed observational study. BMJ Open 2022; 12:e052818. [PMID: 35078839 PMCID: PMC8796221 DOI: 10.1136/bmjopen-2021-052818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to investigate the effect of the video-based smartphone app 'VIDEA bewegt' over eight programme weeks on physical activity in German adults. DESIGN The study used a single-arm observational design, assessing the app's effectiveness under real-life conditions. Data were collected from July 2019 to July 2020. SETTING The app is enabling users to access video-based educational content via their smartphone. A clinical visit or in-person contact was not required. PARTICIPANTS All individuals registered in the freely available app were invited to take part in the study. INTERVENTIONS The app aims to increase physical activity in everyday life. It combines educative videos on lifestyle-related benefits and instructional videos of strength and endurance exercises to do at home with motivational components like goal setting, documentation of progress and personalised messages. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were physical activity based one MET minutes per week (metabolic equivalent) and step numbers.Secondary outcomes included physical self-efficacy (motivational, maintenance, recovery self-efficacy), health-related quality of life: Mental Health Component Summary score and Physical Health Component Summary score. RESULTS Of 97 people included in the data analysis, 55 successfully completed the programme and all questionnaires. Significant increases over eight programme weeks (between T0 and T2) were observed in physical activity based on MET minutes per week, health-related quality of life, and recovery self-efficacy. Time spent sitting and body mass index significantly decreased for those completing the programme. CONCLUSIONS Although significant benefits of physical activity were observed following a complete-case analysis, results should be dealt with caution. Studies with a larger and less heterogeneous sample and robust study designs able to measure causal effects would be desirable. TRIAL REGISTRATION NUMBER DRKS00017392.
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Affiliation(s)
- Tillmann Fischer
- Department for Prevention and Care of Diabetes, University Hospital Dresden Clinic and Polyclinic III, Dresden, Germany
| | - Paul Stumpf
- Department for Prevention and Care of Diabetes, University Hospital Dresden Clinic and Polyclinic III, Dresden, Germany
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, University Hospital Dresden Clinic and Polyclinic III, Dresden, Germany
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, University Hospital Dresden Clinic and Polyclinic III, Dresden, Germany
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25
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Iskandarsyah A, Shabrina A, Siswadi AGP. Usability and Acceptability of JAGA SEHAT: Mobile Application to Improve Knowledge About Healthy Lifestyle. J Multidiscip Healthc 2022; 15:115-124. [PMID: 35082497 PMCID: PMC8785129 DOI: 10.2147/jmdh.s342913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/11/2022] [Indexed: 01/18/2023] Open
Abstract
Purpose The use of mHealth has great potential to overcome many barriers in healthcare and become powerful tools to promote health. We developed Jaga Sehat (“Stay Healthy”), an Indonesian version of the mHealth app which was created as a form of health education for the general population. The current study aimed to test the usability and acceptability of the Jaga Sehat mHealth app. Patients and Methods A total of 113 dentistry students who participated in the first-year initiation program at a state university in West Java, Indonesia were recruited. Participants were asked to download, use the app and complete an online questionnaire. Open response questions explored participants’ recommendations for future improvement. Descriptive statistics were used to analyze participants responses, and content analysis was carried out to analyze open-ended responses. Results In general, participants perceived that Jaga Sehat mHealth app was useful, well-designed app, functional, and easy to use. We found that most of participants gave positive feedback and considered it as having high usability and acceptability. Conclusion Participants reported that Jaga Sehat mHealth app was functional, easy to use and have a good design. The language and material were clear and easy to understand. The app could encourage and help them lead a healthy lifestyle; therefore, they would recommend this app for others.
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Affiliation(s)
- Aulia Iskandarsyah
- Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
- Center for Psychological Innovation and Research, Universitas Padjadjaran, Bandung, Indonesia
- Correspondence: Aulia Iskandarsyah, Faculty of Psychology, Universitas Padjadjaran, Jl. Raya Bandung Sumedang KM 21, Jatinangor, 45363, West Java, Indonesia, Tel +62 8112106260, Fax +62 2287920376, Email
| | - Arina Shabrina
- Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
| | - Ahmad Gimmy Pratama Siswadi
- Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
- Center for Psychological Innovation and Research, Universitas Padjadjaran, Bandung, Indonesia
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26
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Towards Understanding the Usability Attributes of AI-Enabled eHealth Mobile Applications. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2021:5313027. [PMID: 34970424 PMCID: PMC8714331 DOI: 10.1155/2021/5313027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/30/2021] [Accepted: 11/16/2021] [Indexed: 12/28/2022]
Abstract
Mobile application (app) use is increasingly becoming an essential part of our daily lives. Due to their significant usefulness, people rely on them to perform multiple tasks seamlessly in almost all aspects of everyday life. Similarly, there has been immense progress in artificial intelligence (AI) technology, especially deep learning, computer vision, natural language processing, and robotics. These technologies are now actively being implemented in smartphone apps and healthcare, providing multiple healthcare services. However, several factors affect the usefulness of mobile healthcare apps, and usability is an important one. There are various healthcare apps developed for each specific task, and the success of these apps depends on their performance. This study presents a systematic review of the existing apps and discusses their usability attributes. It highlights the usability models, outlines, and guidelines proposed in previous research for designing apps with improved usability characteristics. Thirty-nine research articles were reviewed and examined to identify the usability attributes, framework, and app design conducted. The results showed that satisfaction, efficiency, and learnability are the most important usability attributes to consider when designing eHealth mobile apps. Surprisingly, other significant attributes for healthcare apps, such as privacy and security, were not among the most indicated attributes in the studies.
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27
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Petracca F, Tempre R, Cucciniello M, Ciani O, Pompeo E, Sannino L, Lovato V, Castaman G, Ghirardini A, Tarricone R. An Electronic Patient-Reported Outcome Mobile App for Data Collection in Type A Hemophilia: Design and Usability Study. JMIR Form Res 2021; 5:e25071. [PMID: 34855619 PMCID: PMC8686465 DOI: 10.2196/25071] [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: 10/16/2020] [Revised: 02/28/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background There is currently limited evidence on the level and intensity of physical activity in individuals with hemophilia A. Mobile technologies can offer a rigorous and reliable alternative to support data collection processes but they are often associated with poor user retention. The lack of longitudinal continuity in their use can be partly attributed to the insufficient consideration of stakeholder inputs in the development process of mobile apps. Several user-centered models have been proposed to guarantee that a thorough knowledge of the end user needs is considered in the development process of mobile apps. Objective The aim of this study is to design and validate an electronic patient-reported outcome mobile app that requires sustained active input by individuals during POWER, an observational study that aims at evaluating the relationship between physical activity levels and bleeding in patients with hemophilia A. Methods We adopted a user-centered design and engaged several stakeholders in the development and usability testing of this mobile app. During the concept generation and ideation phase, we organized a need-assessment focus group (FG) with patient representatives to elicit specific design requirements for the end users. We then conducted 2 exploratory FGs to seek additional inputs for the app’s improvement and 2 confirmatory FGs to validate the app and test its usability in the field through the mobile health app usability questionnaire. Results The findings from the thematic analysis of the need-assessment FG revealed that there was a demand for sense making, for simplification of app functionalities, for maximizing integration, and for minimizing the feeling of external control. Participants involved in the later stages of the design refinement contributed to improving the design further by upgrading the app’s layout and making the experience with the app more efficient through functions such as chatbots and visual feedback on the number of hours a wearable device had been worn, to ensure that the observed data were actually registered. The end users rated the app highly during the quantitative assessment, with an average mobile health app usability questionnaire score of 5.32 (SD 0.66; range 4.44-6.23) and 6.20 (SD 0.43; range 5.72-6.88) out of 7 in the 2 iterative usability testing cycles. Conclusions The results of the usability test indicated a high, growing satisfaction with the electronic patient-reported outcome app. The adoption of a thorough user-centered design process using several types of FGs helped maximize the likelihood of sustained retention of the app’s users and made it fit for data collection of relevant outcomes in the observational POWER study. The continuous use of the app and the actual level of engagement will be evaluated during the ongoing trial. Trial Registration ClinicalTrials.gov NCT04165135; https://clinicaltrials.gov/ct2/show/NCT04165135
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Affiliation(s)
- Francesco Petracca
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy
| | | | - Maria Cucciniello
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy.,University of Edinburgh Business School, Edinburgh, United Kingdom
| | - Oriana Ciani
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy.,Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
| | | | | | | | - Giancarlo Castaman
- SODc Malattie Emorragiche e della Coagulazione, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Rosanna Tarricone
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy.,Department of Social and Political Sciences, Bocconi University, Milan, Italy
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28
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Muro-Culebras A, Escriche-Escuder A, Martin-Martin J, Roldán-Jiménez C, De-Torres I, Ruiz-Muñoz M, Gonzalez-Sanchez M, Mayoral-Cleries F, Biró A, Tang W, Nikolova B, Salvatore A, Cuesta-Vargas AI. Tools for Evaluating the Content, Efficacy, and Usability of Mobile Health Apps According to the Consensus-Based Standards for the Selection of Health Measurement Instruments: Systematic Review. JMIR Mhealth Uhealth 2021; 9:e15433. [PMID: 34855618 PMCID: PMC8686474 DOI: 10.2196/15433] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/13/2020] [Accepted: 04/16/2021] [Indexed: 12/23/2022] Open
Abstract
Background There are several mobile health (mHealth) apps in mobile app stores. These apps enter the business-to-customer market with limited controls. Both, apps that users use autonomously and those designed to be recommended by practitioners require an end-user validation to minimize the risk of using apps that are ineffective or harmful. Prior studies have reviewed the most relevant aspects in a tool designed for assessing mHealth app quality, and different options have been developed for this purpose. However, the psychometric properties of the mHealth quality measurement tools, that is, the validity and reliability of the tools for their purpose, also need to be studied. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) initiative has developed tools for selecting the most suitable measurement instrument for health outcomes, and one of the main fields of study was their psychometric properties. Objective This study aims to address and psychometrically analyze, following the COSMIN guideline, the quality of the tools that are used to measure the quality of mHealth apps. Methods From February 1, 2019, to December 31, 2019, 2 reviewers searched PubMed and Embase databases, identifying mHealth app quality measurement tools and all the validation studies associated with each of them. For inclusion, the studies had to be meant to validate a tool designed to assess mHealth apps. Studies that used these tools for the assessment of mHealth apps but did not include any psychometric validation were excluded. The measurement tools were analyzed according to the 10 psychometric properties described in the COSMIN guideline. The dimensions and items analyzed in each tool were also analyzed. Results The initial search showed 3372 articles. Only 10 finally met the inclusion criteria and were chosen for analysis in this review, analyzing 8 measurement tools. Of these tools, 4 validated ≥5 psychometric properties defined in the COSMIN guideline. Although some of the tools only measure the usability dimension, other tools provide information such as engagement, esthetics, or functionality. Furthermore, 2 measurement tools, Mobile App Rating Scale and mHealth Apps Usability Questionnaire, have a user version, as well as a professional version. Conclusions The Health Information Technology Usability Evaluation Scale and the Measurement Scales for Perceived Usefulness and Perceived Ease of Use were the most validated tools, but they were very focused on usability. The Mobile App Rating Scale showed a moderate number of validated psychometric properties, measures a significant number of quality dimensions, and has been validated in a large number of mHealth apps, and its use is widespread. It is suggested that the continuation of the validation of this tool in other psychometric properties could provide an appropriate option for evaluating the quality of mHealth apps.
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Affiliation(s)
- Antonio Muro-Culebras
- Grupo Clinimetría (F-14), University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Adrian Escriche-Escuder
- Grupo Clinimetría (F-14), University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Jaime Martin-Martin
- Grupo Clinimetría (F-14), University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Cristina Roldán-Jiménez
- Grupo Clinimetría (F-14), University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Irene De-Torres
- Physical Medicine and Rehabilitation Unit, Regional University Hospital of Malaga, Málaga, Spain
| | - Maria Ruiz-Muñoz
- Grupo Clinimetría (F-14), University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Manuel Gonzalez-Sanchez
- Grupo Clinimetría (F-14), University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | | | | | - Wen Tang
- Faculty of Science and Technology, Bournemouth University, Bournemouth, United Kingdom
| | | | | | - Antonio Ignacio Cuesta-Vargas
- Grupo Clinimetría (F-14), University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain.,School of Clinical Science, Faculty of Health Science, Queensland University Technology, Queensland, Australia
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29
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Alessa T, Hawley M, de Witte L. Identification of the Most Suitable App to Support the Self-Management of Hypertension: Systematic Selection Approach and Qualitative Study. JMIR Mhealth Uhealth 2021; 9:e29207. [PMID: 34787586 PMCID: PMC8663499 DOI: 10.2196/29207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/23/2021] [Accepted: 08/01/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Smartphone apps are increasingly being used to aid in hypertension self-management, and a large and ever-growing number of self-management apps have been commercially released. However, very few of these are potentially effective and secure, and researchers have yet to establish the suitability of specific hypertension apps to particular contexts. OBJECTIVE The aim of this study is to identify the most suitable hypertension app in the context of Saudi Arabia and its health system. METHODS This study used a 2-stage approach to selecting the most suitable app for hypertension self-management. First, a systematic selection approach was followed to identify a shortlist of the most suitable apps according to the criteria of potential effectiveness, theoretical underpinning, and privacy and security. Second, an exploratory qualitative study was conducted to select the most suitable from the shortlist: 12 doctors were interviewed, and 22 patients participated in 4 focus groups. These explored participants' attitudes towards self-management apps in general, and their views towards the apps identified via the systematic selection process. The qualitative data were analyzed using framework analysis. RESULTS In the first stage, only 5 apps were found to be potentially effective while also having a theoretical underpinning and protecting users' data. In the second stage, both doctors and patients were generally interested in using hypertension apps, but most had no experience with these apps due to a lack of awareness of their availability and suitability. Patients and doctors liked apps that combine intuitive interfaces with a pleasant and clear visual design, in-depth features (eg, color-coded feedback accompanied with textual explanations), activity-specific reminders, and educational content regarding hypertension and potential complications. When the pros and cons of the 5 apps were discussed, 3 apps were identified as being more suitable, with Cora Health rated the highest by the participants. CONCLUSIONS Only 5 apps were deemed potentially effective and secure. Patients' and doctors' discussions of the pros and cons of these 5 apps revealed that 3 out of the 5 are clearly more suitable, with the Cora Health app being judged most suitable overall.
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Affiliation(s)
- Tourkiah Alessa
- Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Mark Hawley
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Luc de Witte
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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30
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Zand A, Nguyen A, Reynolds C, Khandadash A, Esrailian E, Hommes D. Patient Experience and Satisfaction with an e-Health Care Management Application for Inflammatory Bowel Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211747. [PMID: 34831502 PMCID: PMC8619840 DOI: 10.3390/ijerph182211747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022]
Abstract
Background: Rising healthcare expenditures have been partially attributed to suboptimal management of inflammatory bowel diseases (IBD). Electronic health interventions may help improve care management for IBD patients, but there is a need to better understand patient perspectives on these emerging technologies. Aims: The primary aim was to evaluate patient satisfaction and experience with the UCLA eIBD mobile application, an integrative care management platform with disease activity monitoring tools and educational modules. The secondary objective was to capture patient feedback on how to improve the mobile application. Methods: We surveyed IBD patients treated at the UCLA Center for Inflammatory Bowel Diseases. The patient experience survey assessed the patients’ overall satisfaction with the application, perception of health outcomes after participation in the program, and feedback on educational modules as well as areas for application improvement. Results: 50 patients were included. The responses indicated that the patients were greatly satisfied with the ease of patient–provider communication within the application and appointment scheduling features (68%). A majority of respondents (54%) also reported that program participation resulted in improved perception of disease control and quality of life. Lastly, a majority of participants (79%) would recommend this application to others. Conclusions: Mobile tools such as UCLA eIBD have promising implications for integration into patients’ daily lives. This patient satisfaction study suggests the feasibility of using this mobile application by patients and providers. We further showed that UCLA eIBD and its holistic approach led to improved patient experience and satisfaction, which can provide useful recommendations for future electronic health solutions.
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Affiliation(s)
- Aria Zand
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (A.N.); (C.R.); (A.K.); (E.E.); (D.H.)
- Department of Digestive Diseases, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence:
| | - Audrey Nguyen
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (A.N.); (C.R.); (A.K.); (E.E.); (D.H.)
| | - Courtney Reynolds
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (A.N.); (C.R.); (A.K.); (E.E.); (D.H.)
| | - Ariela Khandadash
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (A.N.); (C.R.); (A.K.); (E.E.); (D.H.)
| | - Eric Esrailian
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (A.N.); (C.R.); (A.K.); (E.E.); (D.H.)
| | - Daniel Hommes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (A.N.); (C.R.); (A.K.); (E.E.); (D.H.)
- Department of Digestive Diseases, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Tobias G, Spanier AB. Using an mHealth App (iGAM) to Reduce Gingivitis Remotely (Part 2): Prospective Observational Study. JMIR Mhealth Uhealth 2021; 9:e24955. [PMID: 34528897 PMCID: PMC8485186 DOI: 10.2196/24955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/28/2020] [Accepted: 08/02/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Gingivitis is a nonpainful, inflammatory condition that can be managed at home. Left untreated, gingivitis can lead to tooth loss. Periodic dental examinations are important for early diagnosis and treatment of gum diseases. To contain the spread of the coronavirus, governments, including in Israel, have restricted movements of their citizens which might have caused routine dental checkups to be postponed. OBJECTIVE This study aimed to examine the ability of a mobile health app, iGAM, to reduce gingivitis, and to determine the most effective interval between photograph submissions. METHODS A prospective observational cohort study with 160 unpaid participants divided into 2 equal groups using the iGAM app was performed. The intervention group photographed their gums weekly for 8 weeks. The wait-list control group photographed their gums at the time of recruitment and 8 weeks later. After photo submission, the participants received the same message "we recommended that you read the information in the app regarding oral hygiene habits." A single-blinded researcher examined all the images and scored them according to the Modified Gingival Index (MGI). RESULTS The average age of the intervention group was 26.77 (SD 7.43) and 28.53 (SD 10.44) for the wait-list control group. Most participants were male (intervention group: 56/75,74.7%; wait-list control group: 34/51, 66.7%) and described themselves as "secular"; most were "single" non-smokers (intervention group: 56/75, 74.7%; wait-list control group: 40/51, 78.4%), and did not take medications (intervention group: 64/75, 85.3%; wait-list control group: 40/51, 78.4%). A total of 126 subjects completed the study. A statistically significant difference (P<.001) was found in the dependent variable (MGI). Improvements in gingival health were noted over time, and the average gingivitis scores were significantly lower in the intervention group (mean 1.16, SD 1.18) than in the wait-list control group (mean 2.16, SD 1.49) after 8 weeks. Those with more recent dental visits had a lower MGI (P=.04). No association was found between knowledge and behavior. Most participants were familiar with the recommendations for maintaining oral health, yet they only performed some of them. CONCLUSIONS A dental selfie taken once a week using an mobile health app (iGAM) reduced the signs of gingivitis and promoted oral health. Selfies taken less frequently yielded poorer results. During the current pandemic, where social distancing recommendations may be causing people to avoid dental clinics, this app can remotely promote gum health.
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Affiliation(s)
- Guy Tobias
- Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Assaf B Spanier
- Department of Software Engineering, Azrieli College of Engineering, Jerusalem, Israel
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Briggs T, Quick V, Hallman WK. Feature Availability Comparison in Free and Paid Versions of Popular Smartphone Weight Management Applications. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:732-741. [PMID: 34315678 DOI: 10.1016/j.jneb.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Characterize capabilities of nutrition applications (apps) for weight management and associations between features, ratings, and app installations. DESIGN Calorie tracking apps with weight management as a primary outcome were selected from the Apple App Store and Google Play Store using keywords "diet" and "weight loss." METHODS Reviewers assessed free and upgraded versions of nutrition apps (n = 15) for features within 4 categories: (1) dietary intake, (2) anthropometrics, (3) physical activity, and (4) behavior change strategies. OUTCOME MEASURES Presence of specific app features, app ratings, and app installations. ANALYSIS Descriptive statistics of free and paid app versions. Spearman rank-order correlations were used to determine associations between feature inclusion, app ratings, and installations. RESULTS The apps had the greatest number of features in the dietary intake category. Additional dietary intake features were those most likely obtained through a subscription purchase. Behavior change content was absent from most apps. The macronutrient adjustment feature was strongly associated with average app ratings (rs = 0.74; P < 0.002) and with subscription costs (rs = 0.60; P < 0.019). CONCLUSIONS AND IMPLICATIONS This study found most nutrition apps possess an abundance of features dedicated to dietary intake, anthropometric, and physical activity tracking while also being notably devoid of behavior change content features.
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Affiliation(s)
- Telema Briggs
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ.
| | - Virginia Quick
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ
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Herbst R, Rybak T, Meisman A, Whitehead M, Rosen B, Crosby LE, Klein MD, Real FJ. A Virtual Reality Resident Training Curriculum on Behavioral Health Anticipatory Guidance: Development and Usability Study. JMIR Pediatr Parent 2021; 4:e29518. [PMID: 34081601 PMCID: PMC8244725 DOI: 10.2196/29518] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Behavioral health disorders have steadily increased and been exacerbated by the COVID-19 pandemic. Though behavioral health disorders can be successfully mitigated with early implementation of evidence-based parent management strategies, education for pediatric residents on behavioral health anticipatory guidance has been limited to date, with training challenges compounded by the physical distancing requirements of the COVID-19 pandemic. Virtual reality (VR) simulations provide an opportunity to train residents on this complex competency by allowing deliberate practice of necessary skills while adhering to current social distancing guidelines. OBJECTIVE This study explored the usability of a VR-based behavioral health anticipatory guidance curriculum for pediatric residents. METHODS This mixed methods study included 14 postgraduate third-year pediatric residents who completed the behavioral health anticipatory guidance VR curriculum. Residents completed the MEC Spatial Presence Questionnaire to assess immersion in the virtual environment. Semistructured interviews were used to elucidate residents' perspectives on the curriculum's content and format. The interviews were analyzed using conventional content analysis. RESULTS Quantitatively, residents reported a high degree of immersion, spatial presence, and cognitive involvement. Most residents (11/14, 79%) agreed or strongly agreed that it seemed as though they took part in the action of the simulation. Qualitatively, two themes emerged from the data: (1) the curriculum expands behavioral health anticipatory guidance and motivational interviewing knowledge and skills and (2) VR technology is uniquely positioned to develop competence. These themes revealed that the curriculum expanded their current level of knowledge and skill, addressed training gaps, and was applicable to all residents. Additionally, residents experienced VR as immersive, feasible, realistic to the clinic setting, and a safe space to practice and learn new skills. CONCLUSIONS Pilot data indicates that VR may be an effective tool to teach pediatric residents behavioral health anticipatory guidance, meeting a current gap in medical education training. This VR curriculum is particularly relevant in the context of the COVID-19 pandemic given the increased behavioral health concerns of families.
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Affiliation(s)
- Rachel Herbst
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Tiffany Rybak
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Andrea Meisman
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Monica Whitehead
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Brittany Rosen
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lori E Crosby
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Melissa D Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Francis J Real
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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Maharaj A, Lim D, Murphy R, Serlachius A. Comparing Two Commercially Available Diabetes Apps to Explore Challenges in User Engagement: Randomized Controlled Feasibility Study. JMIR Form Res 2021; 5:e25151. [PMID: 34132640 PMCID: PMC8277312 DOI: 10.2196/25151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/16/2020] [Accepted: 05/07/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Diabetes apps represent a promising addition to face-to-face self-management interventions, which can be time and resource intensive. However, few randomized controlled trials have evaluated the efficacy of diabetes apps, in particular as a stand-alone intervention without additional clinical support. OBJECTIVE We used a feasibility randomized trial design to investigate differences in user engagement between 2 commercially available apps (free versions of Glucose Buddy and mySugr) over 2 weeks in adults with type 2 diabetes. Feasibility was assessed based on recruitment uptake, adherence to the diabetes apps, and follow-up rates. We also hypothesized that the diabetes app mySugr would demonstrate higher user engagement at follow-up due to its use of gamification. We also predicted higher user engagement would be associated with improved self-care behaviors and illness beliefs. METHODS Adults with type 2 diabetes attending outpatient diabetes clinics in Auckland were recruited and randomized (1:1 without blinding) to use either the Glucose Buddy or mySugr diabetes apps. User engagement, self-care behaviors, and illness beliefs were measured 2 weeks after baseline. Spearman rank correlations, Mann-Whitney tests, and Wilcoxon signed-rank tests were used to explore associations between the outcome measures and to investigate possible changes between and within groups. Six participants were interviewed to further explore acceptability and usability. RESULTS In total, 58 participants (29 per group) completed the 2-week follow-up, of whom only 38 reported using the apps (Glucose Buddy: n=20; mySugr: n=18). Both groups reported low engagement (Glucose Buddy: median 4 days; mySugr: median 6.5 days; P=.06; use for both groups: median 10 minutes). No changes were observed in self-care or illness beliefs in either group. Out of the self-care behaviors, only blood glucose testing was significantly associated with minutes of app use (P=.02). The interviews suggested that although both apps were deemed acceptable, they were generally viewed as time-consuming and too complicated to use. CONCLUSIONS Low engagement with both Glucose Buddy and mySugr reflect the challenges associated with engaging users with diabetes apps. Due to low engagement and loss to follow-up, the changes in outcome measures should be interpreted with caution. The results highlight the need for more clinical support as well as involvement from end users and behavior change specialists in order to incorporate evidence-based behavior change techniques to motivate and provide value to users. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12618000424202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374671.
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Affiliation(s)
- Alita Maharaj
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Lim
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Linardon J, King T, Shatte A, Fuller-Tyszkiewicz M. Usability Evaluation of a Cognitive-Behavioral App-Based Intervention for Binge Eating and Related Psychopathology: A Qualitative Study. Behav Modif 2021; 46:1002-1020. [PMID: 34075803 DOI: 10.1177/01454455211021764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite their promise as a scalable intervention modality for binge eating and related problems, reviews show that engagement of app-based interventions is variable. Issues with usability may account for this. App developers should undertake usability testing so that any problems can be identified and fixed prior to dissemination. We conducted a qualitative usability evaluation of a newly-developed app for binge eating in 14 individuals with a diagnostic- or subthreshold-level binge eating symptoms. Participants completed a semi-structured interview and self-report measures. Qualitative data were organized into six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Qualitative and quantitative results indicated that the app demonstrated good usability. Key advantages reported were its flexible content-delivery formats, level of interactivity, easy-to-understand information, and ability to track progress. Concerns with visual aesthetics and lack of professional feedback were raised. Findings will inform the optimal design of app-based interventions for eating disorder symptoms.
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Affiliation(s)
| | | | - Adrian Shatte
- Federation University, School of Engineering, Information Technology & Physical Sciences, Berwick, AU-VIC, Australia
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36
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Harrington L. Evaluation of Behavior Change Techniques in Mobile Health Apps. AACN Adv Crit Care 2021; 31:126-128. [PMID: 32525993 DOI: 10.4037/aacnacc2020267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Linda Harrington
- Linda Harrington is an Independent Consultant, Health Informatics and Digital Strategy, and Adjunct Faculty at Texas Christian University, 2800 South University Drive, Fort Worth, TX 76109
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Usability Evaluation of the Novel Smartphone Application, HPV Vaccine: Same Way, Same Day, Among Pediatric Residents. Acad Pediatr 2021; 21:742-749. [PMID: 33279739 DOI: 10.1016/j.acap.2020.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Scalable, deliberate practice training strategies to administer evidence-based recommendations are necessary to improve human papillomavirus (HPV) vaccination rates. We sought to characterize resident clinicians' perceptions regarding the usability of the HPV Vaccine: Same Way, Same Day smartphone application (app). Usability, a critical aspect of digital programs to promote behavior change, was evaluated. METHODS Fifteen third-year pediatric residents were recruited to complete a usability evaluation of the HPV Vaccine: Same Way, Same Day app, which includes simulated role-play scenarios in which users interact, as a pediatrician avatar, with an animated parent hesitant to accept the vaccine for her child. The app provides information about the vaccine and utilizes deliberate practice, a purposeful and systematic approach to improve performance, to teach evidence-based vaccine recommendation practices, including motivational interviewing skills. Data were derived from in-depth, semistructured interviews with pediatric residents. We used a constructivist general inductive approach to illuminate perspectives via inductive coding and pattern identification. Garrison's theoretical construct on self-directed learning was used to cluster themes into conceptual categories. RESULTS We classified interview data in 3 conceptual categories: self-management, internal monitoring and motivational principles. Residents described the app as interactive, easy to use, succinct, informative, engaging, and practical. All residents would recommend the HPV Vaccine: Same Way, Same Day app to a colleague. Residents suggested adding more complex cases for future iterations. CONCLUSIONS From their perspective, pediatric residents reported that an app using deliberate practice principles has the potential to inform and advance providers' counseling skills regarding the HPV vaccine.
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Radcliffe E, Lippincott B, Anderson R, Jones M. A Pilot Evaluation of mHealth App Accessibility for Three Top-Rated Weight Management Apps by People with Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073669. [PMID: 33915917 PMCID: PMC8036471 DOI: 10.3390/ijerph18073669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Abstract
Growing evidence demonstrates that people with disabilities face more challenges in accessing healthcare and wellness resources, compared to non-disabled populations. As mobile applications focused on health and wellness (mHealth apps) become prevalent, it is important that people with disabilities can access and use mHealth apps. At present, there is no source of unified information about the accessibility and usability of mHealth apps for people with disabilities. We set out to create such a source, establishing a systematic approach for evaluating app accessibility. Our goal was to develop a simple, replicable app evaluation process to generate useful information for people with disabilities (to aid suitable app selection) and app developers (to improve app accessibility and usability). We collected data using two existing assessment instruments to test three top-rated weight management apps with nine users representing three disability groups: vision, dexterity, and cognitive impairment. Participants with visual impairments reported the lowest accessibility ratings, most challenges, and least tolerance for issues. Participants with dexterity impairments experienced significant accessibility-related difficulties. Participants with cognitive impairments experienced mild difficulties and higher tolerances for issues. Our pilot protocol will be applied to test mHealth apps and populate a “curation” website to assist consumers in selecting mHealth apps.
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Affiliation(s)
- Erin Radcliffe
- Shepherd Center, Atlanta, GA 30309, USA; (B.L.); (R.A.); (M.J.)
- Correspondence:
| | - Ben Lippincott
- Shepherd Center, Atlanta, GA 30309, USA; (B.L.); (R.A.); (M.J.)
| | - Raeda Anderson
- Shepherd Center, Atlanta, GA 30309, USA; (B.L.); (R.A.); (M.J.)
- Department of Sociology, Georgia State University, Atlanta, GA 30302, USA
| | - Mike Jones
- Shepherd Center, Atlanta, GA 30309, USA; (B.L.); (R.A.); (M.J.)
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Mwaisaka J, Gonsalves L, Thiongo M, Waithaka M, Sidha H, Alfred O, Mukiira C, Gichangi P. Young People's Experiences Using an On-Demand Mobile Health Sexual and Reproductive Health Text Message Intervention in Kenya: Qualitative Study. JMIR Mhealth Uhealth 2021; 9:e19109. [PMID: 33448930 PMCID: PMC7846443 DOI: 10.2196/19109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/20/2020] [Accepted: 09/14/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Digital health usability assessments can help explain how well mobile health (mHealth) apps targeting young people with sexual and reproductive health (SRH) information performed and whether the intended purpose was achieved. However, few digital health assessments have been conducted to evaluate young people's perceptions regarding mHealth system interactions and content relevance on a wide range of SRH topics. In addition, the majority of randomized controlled trials (RCTs) have focused on push messaging platforms; therefore, the mHealth field lacks sufficient RCTs investigating on-demand mHealth SRH platforms. OBJECTIVE The objective of this study was to explore young people's experiences using an on-demand SRH mHealth platform in Kenya. METHODS We used qualitative data related to the usability of an mHealth platform, Adolescent/Youth Reproductive Mobile Access and Delivery Initiatives for Love and Life Outcome (ARMADILLO), collected at the end of the intervention period. A total of 30 in-depth interviews (IDIs) were held with the intervention participants (15 women and 15 men) to elicit their experiences, opinions, and perspectives on the design and content of the ARMADILLO platform. The study participants were randomly selected from a list of intervention arm participants to participate in the IDIs. The interviews were later transcribed verbatim, translated into English, and coded and analyzed thematically using NVivo version 12 software (QSR International). RESULTS Respondents reported varied user experiences and levels of satisfaction, ranging from ease of use by the majority of the respondents to systematic frustrations that prevented some participants from progressing to other stages. Interesting features of the mHealth platform included the immediate response participants received when requesting messages, weekly remunerated quizzes, and perceived ability of educative and informative content and messages to change behaviors. Proposed enhancements to the platform included revising some concepts and words for easy understanding and increasing the interactivity of the platform, whereby young people could seek clarity when they came across difficult terms or had additional questions about the information they received. CONCLUSIONS The importance of understanding the range of health literacy and technological variations when dealing with young people cannot be overemphasized. Young people, as mHealth end users, must be considered throughout intervention development to achieve optimum functionality. In addition, young people targeted with mHealth SRH interventions must be sensitized to the interactions on mHealth platforms or any other digital health apps if implemented in a nonresearch setting for optimal use by the targeted audience.
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Affiliation(s)
- Jefferson Mwaisaka
- International Centre for Reproductive Health, Kenya, Mombasa, Kenya.,Department of Population Family and Reproductive Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Lianne Gonsalves
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Mary Thiongo
- International Centre for Reproductive Health, Kenya, Mombasa, Kenya
| | - Michael Waithaka
- International Centre for Reproductive Health, Kenya, Mombasa, Kenya
| | - Hellen Sidha
- National Council for Populations and Development, Kenya, Nairobi, Kenya
| | - Otieno Alfred
- Population Studies and Research Institute, University of Nairobi, Nairobi, Kenya
| | - Carol Mukiira
- African Institute for Development Policy, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health, Kenya, Mombasa, Kenya.,Ghent University, Ghent, Belgium.,Technical University of Mombasa, Mombasa, Kenya
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Shilbayeh SAR, Ismail SAER. Patient experience with an educational mobile health application: A pilot study on usability and feasibility in a Saudi population. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1843883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Sireen Abdul Rahim Shilbayeh
- Computer Science Department, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University Riyadh, Saudi Arabia
| | - Sahar Abd El Rahman Ismail
- Department of Computer Science, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
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Scott IA, Scuffham P, Gupta D, Harch TM, Borchi J, Richards B. Going digital: a narrative overview of the effects, quality and utility of mobile apps in chronic disease self-management. AUST HEALTH REV 2020; 44:62-82. [PMID: 30419185 DOI: 10.1071/ah18064] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/04/2018] [Indexed: 12/16/2022]
Abstract
Objective Smartphone health applications (apps) are being increasingly used to assist patients in chronic disease self-management. The effects of such apps on patient outcomes are uncertain, as are design features that maximise usability and efficacy, and the best methods for evaluating app quality and utility. Methods In assessing efficacy, PubMed, Cochrane Library and EMBASE were searched for systematic reviews (and single studies if no systematic review was available) published between January 2007 and January 2018 using search terms (and synonyms) of 'smartphone' and 'mobile applications', and terms for each of 11 chronic diseases: asthma, chronic obstructive lung disease (COPD), diabetes, chronic pain, serious mental health disorders, alcohol and substance addiction, heart failure, ischaemic heart disease, cancer, cognitive impairment, chronic kidney disease (CKD). With regard to design features and evaluation methods, additional reviews were sought using search terms 'design', 'quality,' 'usability', 'functionality,' 'adherence', 'evaluation' and related synonyms. Results Of 13 reviews and six single studies assessing efficacy, consistent evidence of benefit was seen only with apps for diabetes, as measured by decreased glycosylated haemoglobin levels (HbA1c). Some, but not all, studies showed benefit in asthma, low back pain, alcohol addiction, heart failure, ischaemic heart disease and cancer. There was no evidence of benefit in COPD, cognitive impairment or CKD. In all studies, benefits were clinically marginal and none related to morbid events or hospitalisation. Twelve design features were identified as enhancing usability. An evaluation framework comprising 32 items was formulated. Conclusion Evidence of clinical benefit of most available apps is very limited. Design features that enhance usability and maximise efficacy were identified. A provisional 'first-pass' evaluation framework is proposed that can help decide which apps should be endorsed by government agencies following more detailed technical assessments and which could then be recommended with confidence by clinicians to their patients. What is known about the topic? Smartphone health apps have attracted considerable interest from patients and health managers as a means of promoting more effective self-management of chronic diseases, which leads to better health outcomes. However, most commercially available apps have never been evaluated for benefits or harms in clinical trials, and there are currently no agreed quality criteria, standards or regulations to ensure health apps are user-friendly, accurate in content, evidence based or efficacious. What does this paper add? This paper presents a comprehensive review of evidence relating to the efficacy, usability and evaluation of apps for 11 common diseases aimed at assisting patients in self-management. Consistent evidence of benefit was only seen for diabetes apps; there was absent or conflicting evidence of benefit for apps for the remaining 10 diseases. Benefits that were detected were of marginal clinical importance, with no reporting of hard clinical end-points, such as mortality or hospitalisations. Only a minority of studies explicitly reported using behaviour change theories to underpin the app intervention. Many apps lacked design features that the literature identified as enhancing usability and potential to confer benefit. Despite a plethora of published evaluation tools, there is no universal framework that covers all relevant clinical and technical attributes. An inclusive list of evaluation criteria is proposed that may overcome this shortcoming. What are the implications for practitioners? The number of smartphone apps will continue to grow, as will the appetite for patients and clinicians to use them in chronic disease self-management. However, the evidence to date of clinical benefit of most apps already available is very limited. Design features that enhance usability and clinical efficacy need to be considered. In making decisions about which apps should be endorsed by government agencies and recommended with confidence by clinicians to their patients, a comprehensive but workable evaluation framework needs to be used by bodies assuming the roles of setting and applying standards.
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Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane 4102, Australia. Email
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University (Nathan campus), 170 Kessels Road, Nathan, Brisbane 4111, Australia. Email
| | - Deepali Gupta
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane 4102, Australia. Email
| | - Tanya M Harch
- eHealth Queensland, 2/315 Brunswick St, Fortitude Valley, Brisbane 4006, Australia.
| | - John Borchi
- eHealth Queensland, 2/315 Brunswick St, Fortitude Valley, Brisbane 4006, Australia.
| | - Brent Richards
- Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, Australia. Email
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Using Technology to Improve Women's Health Care. Ochsner J 2020; 20:422-425. [PMID: 33408581 PMCID: PMC7755557 DOI: 10.31486/toj.19.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Technology is being integrated into all aspects of health care. While many applications offer novel experiences, the evidence supporting translation to improved education or care is evolving. Methods: We review ways that technology is affecting a variety of fields pertinent to women's health, including patient communication, physician education, and health care performance. Results: In the Ochsner Health Department of Obstetrics and Gynecology, we have developed a platform known as Connected Maternity Online Monitoring—Connected MOM—to encourage remote monitoring during the prenatal course. We are also assessing improvements in quality and safety through a centralized fetal heart rate monitoring bunker known as TeleStork. Conclusion: Through systematic integration of technology into the delivery of women's health care at Ochsner, we hope to demonstrate sustainable improvements in physician skills, patient access, and quality and safety.
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Psihogios AM, Stiles-Shields C, Neary M. The Needle in the Haystack: Identifying Credible Mobile Health Apps for Pediatric Populations during a Pandemic and beyond. J Pediatr Psychol 2020; 45:1106-1113. [PMID: 33068424 PMCID: PMC7588098 DOI: 10.1093/jpepsy/jsaa094] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 01/19/2023] Open
Abstract
Background The COVID-19 pandemic has ignited wider clinical adoption of digital health tools, including mobile health apps (mHealth apps), to address mental and behavioral health concerns at a distance. While mHealth apps offer many compelling benefits, identifying effective apps in the crowded and largely unregulated marketplace is laborious. Consumer demand and industry productivity are increasing, although research is slower, making it challenging for providers to determine the most credible and safe apps for patients in need. Objectives/Methods This commentary offers a practical, empirically guided framework and associated resources for selecting appropriate mHealth apps for pediatric populations during the pandemic and beyond. Results In the first stage, Narrow the target problem, end user, and contender apps. Beginning the search with continuously updated websites that contain expert app ratings can help expedite this process (e.g., Psyberguide). Second, Explore each contender app’s: (a) scientific and theoretical support (e.g., are app components consistent with health behavior change theories?), (b) privacy policies, and (c) user experience (e.g., through crowdsourcing feedback about app usability and appeal via social media). Third, use clinical expertise and stakeholder feedback to Contextualize whether the selected app is a good fit for a particular patient and/or caregiver (e.g., by considering age, race/ethnicity, ability, gender, sexual orientation, technology access), including conducting a brief self-pilot of the app. Conclusion Youth are increasingly turning to technology for support, especially during the pandemic, and pediatric psychologists must be primed to recommend the most credible tools. We offer additional recommendations for rapidly disseminating evidence-based apps to the public.
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Affiliation(s)
- Alexandra M Psihogios
- Division of Oncology and Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Martha Neary
- Department of Psychological Science, University of California, Irvine, CA.,One Mind PsyberGuide
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Chirambo GB, Muula AS, Thompson M, Hardy VE, Heavin C, Connor YO, Mastellos N, Andersson B, Donoghue JO. End-user perspectives of two mHealth decision support tools: Electronic Community Case Management in Northern Malawi. Int J Med Inform 2020; 145:104323. [PMID: 33232917 DOI: 10.1016/j.ijmedinf.2020.104323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/17/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The introduction of a paper-based Community Case Management (CCM) in Malawi has contributed to a reduction of child morbidity and mortality rates. In addition, the introduction of electronic Community Case Management (eCCM) (smartphones with built in CCM apps) may help to reduce the under-five mortality rates even further. PURPOSE It is not uncommon for Apps with a similar area of interest to develop different features to assist the end users. Such differences between Apps may have a significant role to play in its overall adoption and integration. The purpose of this research was to explore end users perspectives of two eCCM decision support tools developed and implemented by the Supporting LIFE project (SL eCCM App) and D-Tree International's (Mangologic eCCM App)in Northern Malawi. METHODS A mixed methods approach was applied, involving a survey of 109 users (106 Health Surveillance Assistants (HSAs), and 3 Integrated Management of Childhood Il6lnesses (IMCI) coordinators). This was followed up with semi-structured interviews with 34 respondents (31 HSAs, and 3 IMCI coordinators). Quantitative data was analyzed using SPSS version 20 where descriptive statistics and Chi-Squared tests were generated. Qualitative data were analyzed based on thematic analysis. RESULTS Participants reported that both Apps could assist the HSAs in the management of childhood illnesses. However, usability differed between the two apps where the Supporting LIFE eCCM App was found to be easier to use (61%) compared to the Mangologic eCCM App (4%). Both Apps were perceived to provide credible and accurate information. CONCLUSION It is essential that the quality of the data within Mobile Health (mHealth) Apps is high, however even Apps with excellent levels of data quality may not succeed if the overall usability of the App is low. Therefore it is essential that the Apps has high levels of data quality, usability and credibility. The results of this study will help inform mobile Health (mHealth) App designers in developing future eCCM Apps as well as researchers and policy makers when considering the adoption of mHealth solutions in the future in Malawi and other LMICs.
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Affiliation(s)
- Griphin Baxter Chirambo
- Faculty of Health Sciences, Mzuzu University, Private Bag 201, Luwinga, Mzuzu, Malawi; School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi.
| | - Adamson S Muula
- School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi; Africa Centre of Excellence in Public Health and Herbal Medicine, University of Malawi, College of Medicine, Malawi
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Victoria E Hardy
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Ciara Heavin
- Health Information Systems Research Centre, University College Cork, Cork, Ireland
| | - Yvonne O' Connor
- Health Information Systems Research Centre, University College Cork, Cork, Ireland
| | - Nikolaos Mastellos
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Bo Andersson
- Department of Informatics, Lund University, Lund, Sweden
| | - John O' Donoghue
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK; Assert Research Centre, University College Cork, Ireland; Malawi eHealth Research Centre, University College Cork, Ireland
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Real FJ, Meisman A, Rosen BL. Usability matters for virtual reality simulations teaching communication. MEDICAL EDUCATION 2020; 54:1067-1068. [PMID: 32914443 PMCID: PMC7687289 DOI: 10.1111/medu.14314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Francis J. Real
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 2011, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue Cincinnati, OH 45267 United States
| | - Andrea Meisman
- Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center 3333 Burnet Avenue Cincinnati, OH 45229 United States
| | - Brittany L. Rosen
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue Cincinnati, OH 45267 United States
- Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center 3333 Burnet Avenue Cincinnati, OH 45229 United States
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Nebeker C, Bartlett Ellis RJ, Torous J. Development of a decision-making checklist tool to support technology selection in digital health research. Transl Behav Med 2020; 10:1004-1015. [PMID: 31120511 PMCID: PMC7543075 DOI: 10.1093/tbm/ibz074] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Digital technologies offer researchers new approaches to test personalized and adaptive health interventions tailored to an individual. Yet, research leveraging technologies to capture personal health data involve technical and ethical consideration during the study design phase. No guidance exists to facilitate responsible digital technology selection for research purposes. A stakeholder-engaged and iterative approach was used to develop, test, and refine a checklist designed to aid researchers in selecting technologies for their research. First, stakeholders (n = 7) discussed and informed key decision-making domains to guide app/device selection derived from the American Psychiatric Association's framework that included safety, evidence, usability, and interoperability. We added "ethical principles" to the APA's hierarchical model and created a checklist that was used by a small group of behavioral scientists (n = 7). Findings revealed the "ethical principles" domains of respect, beneficence, and justice cut across each decision-making domains and the checklist questions/prompts were revised accordingly and can be found at thecore.ucsd.edu. The refined checklist contains four decision-making domains with prompts/questions and ethical principles embedded within the domains of privacy, risk/benefit, data management, and access/evidence. This checklist is the first step in leading the narrative of decision-making when selecting digital health technologies for research. Given the dynamic and rapidly evolving nature of digital health technology use in research, this tool will need to be further evaluated for usefulness in technology selection.
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Affiliation(s)
- Camille Nebeker
- Department of Family Medicine and Public Health, School of Medicine, UC San Diego, La Jolla, CA, USA
- Center for Wireless and Population Health Systems, UC San Diego, La Jolla, CA, USA
| | | | - John Torous
- Beth Israel Deconess Medical Center, Harvard University, Boston, MA, USA
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Ondersma SJ, Walters ST. Clinician's Guide to Evaluating and Developing eHealth Interventions for Mental Health. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2020; 2:26-33. [PMID: 36101886 PMCID: PMC9175830 DOI: 10.1176/appi.prcp.2020.20190036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/11/2020] [Accepted: 02/26/2020] [Indexed: 11/30/2022] Open
Abstract
Objective This review aimed to examine key information regarding technology‐delivered interventions for patients with mental health and/or substance use disorders and to provide support for efforts by psychiatrists and other mental health professionals in recommending applications or helping to develop new technology‐delivered interventions. Methods The authors reviewed existing information about the appraisal, development, and evaluation of technology‐delivered interventions (eHealth interventions). Results High‐level guidance is available for clinicians who want to evaluate eHealth applications for their patients. Clinicians should be familiar with existing models of eHealth intervention development and with traditional as well as unique elements in the evaluation of efficacy for these approaches. However, existing intervention development models have not been empirically validated, and only one includes empirical optimization as an inherent part of its process. Conclusions Because of the proliferation of eHealth interventions, mental health professionals should bring to this area the same level of content knowledge, understanding of development and evaluation processes, and rigorous skepticism as they do for pharmacotherapy and therapist‐delivered behavioral interventions. eHealth interventions are rapidly transforming mental health treatment. Clinicians should apply the same rigor to evaluating eHealth interventions that they apply to pharmacological treatments or other behavioral therapies. High‐level guidance and recommendations regarding ideal eHealth intervention development are available to aid in such evaluation, but empirical evidence in support of these guidelines is lacking.
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Affiliation(s)
- Steven J. Ondersma
- Merrill Palmer Skillman InstituteDepartment of Psychiatry and Behavioral NeurosciencesWayne State UniversityDetroit
| | - Scott T. Walters
- Department of Health Behavior and Health SystemsSchool of Public HealthUniversity of North Texas Health Science CenterFort Worth
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Kapoor A, Nambisan P, Baker E. Mobile applications for breast cancer survivorship and self-management: A systematic review. Health Informatics J 2020; 26:2892-2905. [PMID: 32842830 DOI: 10.1177/1460458220950853] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The use of mobile technology and mobile apps has become pervasive in our daily lives for completing a variety of daily tasks. Mobile health (mHealth) apps can provide an accessible platform for self-management among breast cancer (BC) survivors, as they recover from not just the intensive cancer treatments, but also their associated side-effects. They also offer a means to learn about survivorship topics and connect with peer survivors online, irrespective of their geographical location. This study is an attempt to assess the availability and characterize the self-management features of free mobile apps for breast cancer survivors on the Google Play (Android) and Apple App Store (iOS). Out of 249 such apps for the Android, only eight satisfied initial criteria, while only one of 174 iOS apps that met inclusion criteria was included for further analysis. A content analysis of the nine apps that met inclusion criteria was conducted to assess the inclusion of the following mHealth self-management features derived from the Chronic Care Model: symptom tracking; survivorship education; information-sharing with family and/or caregivers; scheduling follow-up visits; personal alerts and reminders; and social networking. Survivorship education was found to be the most common self-management feature among the apps reviewed, followed by social networking. The results of this study highlight the dearth of available mHealth resources for BC survivors. Future efforts in app development should involve survivors and healthcare providers to ensure comprehensive resources that address their unmet needs are made more accessible.
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Harada N, Harada S, Ito J, Atsuta R, Hori S, Takahashi K. Mobile Health App for Japanese Adult Patients With Asthma: Clinical Observational Study. J Med Internet Res 2020; 22:e19006. [PMID: 32795993 PMCID: PMC7455863 DOI: 10.2196/19006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 12/20/2022] Open
Abstract
Background Inappropriate asthma control reduces quality of life and causes increased exacerbations. Mobile health (mHealth) employs information and communication technology for surveying health-related issues. Objective This noninterventional, observational study assessed current real-world asthma control levels among Japanese patients with asthma and cough variant asthma (CVA) using the Zensoku-Log app. Methods We developed the app using the ResearchKit platform and conducted a mobile-based, self-reporting, observational survey among patients with asthma and CVA. The app was downloaded 7855 times between February 2016 and February 2018, and enabled collection of data on symptoms, comorbidities, quality of life, medications, asthma control, and adherence. Results Of the 1744 eligible participants (median age 33 years; range 20-74 years; male-to-female ratio 38.7:61.3), 50.97% (889/1744) reported unscheduled visits, 62.84% (1096/1744) reported regularly scheduled visits, 23.14% (402/1737) smoked, and 40.75% (705/1730) had pets. In addition, 91.89% (1598/1739) of participants had atopic predisposition, including allergic rhinitis and atopic dermatitis. Daily inhaled corticosteroid and oral corticosteroid treatment had been prescribed for 89.45% (1552/1735) and 22.07% (383/1735) of participants, respectively. Although an asthma control questionnaire demonstrated poor asthma control in 58.48% (1010/1727), a leukotriene receptor antagonist, theophylline, and a long-acting muscarinic antagonist had been prescribed for only 30.66% (532/1735), 15.91% (276/1735), and 4.38% (76/1735), respectively. The Adherence Starts with Knowledge 12 total score was 29. In the 421 participants who repeated the questionnaire, asthma control increased significantly between the initial and last rounds (P=.002). Conclusions Users of this mHealth app in Japan had poorly controlled asthma and may need more treatment for asthma and their comorbidities. Repeated app users demonstrated improved asthma control. Trial Registration UMIN Clinical Trial Registry UMIN000021043; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023913.
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Affiliation(s)
- Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Sonoko Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.,Atopy (Allergy) Research Center, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Jun Ito
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Ryo Atsuta
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Hori
- Department of Electric Medical Intelligence Management, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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Larbi D, Randine P, Årsand E, Antypas K, Bradway M, Gabarron E. Methods and Evaluation Criteria for Apps and Digital Interventions for Diabetes Self-Management: Systematic Review. J Med Internet Res 2020; 22:e18480. [PMID: 32628125 PMCID: PMC7381260 DOI: 10.2196/18480] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/24/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is growing evidence that apps and digital interventions have a positive impact on diabetes self-management. Standard self-management for patients with diabetes could therefore be supplemented by apps and digital interventions to increase patients' skills. Several initiatives, models, and frameworks suggest how health apps and digital interventions could be evaluated, but there are few standards for this. And although there are many methods for evaluating apps and digital interventions, a more specific approach might be needed for assessing digital diabetes self-management interventions. OBJECTIVE This review aims to identify which methods and criteria are used to evaluate apps and digital interventions for diabetes self-management, and to describe how patients were involved in these evaluations. METHODS We searched CINAHL, EMBASE, MEDLINE, and Web of Science for articles published from 2015 that referred to the evaluation of apps and digital interventions for diabetes self-management and involved patients in the evaluation. We then conducted a narrative qualitative synthesis of the findings, structured around the included studies' quality, methods of evaluation, and evaluation criteria. RESULTS Of 1681 articles identified, 31 fulfilled the inclusion criteria. A total of 7 articles were considered of high confidence in the evidence. Apps were the most commonly used platform for diabetes self-management (18/31, 58%), and type 2 diabetes (T2D) was the targeted health condition most studies focused on (12/31, 38%). Questionnaires, interviews, and user-group meetings were the most common methods of evaluation. Furthermore, the most evaluated criteria for apps and digital diabetes self-management interventions were cognitive impact, clinical impact, and usability. Feasibility and security and privacy were not evaluated by studies considered of high confidence in the evidence. CONCLUSIONS There were few studies with high confidence in the evidence that involved patients in the evaluation of apps and digital interventions for diabetes self-management. Additional evaluation criteria, such as sustainability and interoperability, should be focused on more in future studies to provide a better understanding of the effects and potential of apps and digital interventions for diabetes self-management.
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Affiliation(s)
- Dillys Larbi
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Pietro Randine
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Computer Science, Faculty of Science and Technology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Eirik Årsand
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Computer Science, Faculty of Science and Technology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Konstantinos Antypas
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- SINTEF Digital, Oslo, Norway
| | - Meghan Bradway
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Elia Gabarron
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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