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Monachelli R, Davis SW, Barnard A, Longmire M, Docherty JP, Oakley-Girvan I. Designing mHealth Apps to Incorporate Evidence-Based Techniques for Prolonging User Engagement. Interact J Med Res 2024; 13:e51974. [PMID: 38416858 PMCID: PMC11005439 DOI: 10.2196/51974] [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: 08/18/2023] [Revised: 11/14/2023] [Accepted: 02/27/2024] [Indexed: 03/01/2024] Open
Abstract
Maintaining user engagement with mobile health (mHealth) apps can be a challenge. Previously, we developed a conceptual model to optimize patient engagement in mHealth apps by incorporating multiple evidence-based methods, including increasing health literacy, enhancing technical competence, and improving feelings about participation in clinical trials. This viewpoint aims to report on a series of exploratory mini-experiments demonstrating the feasibility of testing our previously published engagement conceptual model. We collected data from 6 participants using an app that showed a series of educational videos and obtained additional data via questionnaires to illustrate and pilot the approach. The videos addressed 3 elements shown to relate to engagement in health care app use: increasing health literacy, enhancing technical competence, and improving positive feelings about participation in clinical trials. We measured changes in participants' knowledge and feelings, collected feedback on the videos and content, made revisions based on this feedback, and conducted participant reassessments. The findings support the feasibility of an iterative approach to creating and refining engagement enhancements in mHealth apps. Systematically identifying the key evidence-based elements intended to be included in an app's design and then systematically testing the implantation of each element separately until a satisfactory level of positive impact is achieved is feasible and should be incorporated into standard app design. While mHealth apps have shown promise, participants are more likely to drop out than to be retained. This viewpoint highlights the potential for mHealth researchers to test and refine mHealth apps using approaches to better engage users.
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Affiliation(s)
| | | | | | | | - John P Docherty
- Weill Cornell Medical College, White Plains, NY, United States
| | - Ingrid Oakley-Girvan
- Medable Inc, Palo Alto, CA, United States
- The Public Health Institute, Oakland, CA, United States
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2
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Sharma S, Gergen Barnett K, Maypole JJ, Grochow Mishuris R. Evaluation of mHealth Apps for Diverse, Low-Income Patient Populations: Framework Development and Application Study. JMIR Form Res 2022; 6:e29922. [PMID: 35147502 PMCID: PMC8881782 DOI: 10.2196/29922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/19/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background The use of mobile technology or smartphones has grown exponentially in the United States, allowing more individuals than ever internet access. This access has been especially critical to households earning less than US $30,000, the majority of whom indicate that smartphones are their main source of internet access. The increasing ubiquity of smartphones and virtual care promises to offset some of the health disparities that cut through the United States. However, disparities cannot be addressed if the medical information offered though smartphones is not accessible or reliable. Objective This study seeks to create a framework to review the strengths and weaknesses of mobile Health (mHealth) apps for diverse, low-income populations. Methods Focusing on smoking cessation, diabetes management, and medication adherence as models of disease management, we describe the process for selecting, evaluating, and obtaining patient feedback on mHealth apps. Results The top 2 scoring apps in each category were QuitNow! and Smoke Free-Quit Smoking Now for smoking cessation, Glucosio and MyNetDiary for diabetes management, and Medisafe and MyMeds for medication adherence. Conclusions We believe that this framework will prove useful for future mHealth app development, and clinicians and patient advisory groups in connecting culturally, educationally, and socioeconomically appropriate mHealth apps with low-income, diverse communities and thus work to bridge health disparities.
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Affiliation(s)
- Shreya Sharma
- Boston University School of Medicine, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Katherine Gergen Barnett
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States.,Department of Family Medicine, Boston University School of Medicine, Boston, MA, United States
| | - John Jack Maypole
- Department of Pediatrics, Boston Medical Center, Boston, CA, United States.,Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Rebecca Grochow Mishuris
- Department of Medicine, Boston Medical Center, Boston, MA, United States.,Department of Medicine, Boston University School of Medicine, Boston, MA, United States
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3
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Alamnia TT, Tesfaye W, Kelly M. The effectiveness of text message delivered interventions for weight loss in developing countries: A systematic review and meta-analysis. Obes Rev 2022; 23:e13339. [PMID: 34519151 DOI: 10.1111/obr.13339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/22/2022]
Abstract
Recent advances in mobile technologies have provided an opportunity to disseminate health information on a variety of health conditions. Randomized controlled trials (RCTs) have shown that text messaging helps people to lose weight, but the effectiveness of interventions varies between studies. Thus, this review aimed to (1) identify RCTs that used text messages for overweight management, (2) identify components of the interventions, and (3) test their effectiveness. PubMed, Web of Science, ProQuest, and Scopus databases were searched to identify relevant studies. Quality scores for selected articles were assessed using the Joanna Briggs Institute (JBI) critical appraisal tools for interventional studies. The effectiveness of the interventions was tested using random effect models. Twelve studies that met inclusion criteria were included in this review. Ten of the included studies reported that text message interventions had a significant effect on weight loss. The pooled mean difference in body mass index (BMI) change after the intervention was -0.43 kg/m2 (95% confidence interval, - 0.63 to - 0.23 kg/m2 ). Synthesis of the included studies provides evidence that (1) regular text messages; (2) interventions targeting weight monitoring, diet habit, and physical activity; and (3) the use of behavior change techniques led to significant weight loss.
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Affiliation(s)
- Tilahun Tewabe Alamnia
- Research School of Population Health, Australian National University, Canberra, Australia.,College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wubshet Tesfaye
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Matthew Kelly
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
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4
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Oakley-Girvan I, Davis SW, Kurian A, Rosas LG, Daniels J, Palesh OG, Mesia RJ, Kamal AH, Longmire M, Divi V. Development of a Mobile Health App (TOGETHERCare) to Reduce Cancer Care Partner Burden: Product Design Study. JMIR Form Res 2021; 5:e22608. [PMID: 34398787 PMCID: PMC8398739 DOI: 10.2196/22608] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/13/2020] [Accepted: 06/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. OBJECTIVE We aimed to develop a mobile app incorporating user preferences to enable cancer survivors' care partners to monitor the survivors' health and to provide care partner resources. METHODS An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. RESULTS Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient's health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. CONCLUSIONS TOGETHERCare, a novel mobile app, was developed with user input to track the care partner's health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. TRIAL REGISTRATION ClinicalTrials.gov NCT04018677; https://clinicaltrials.gov/ct2/show/NCT04018677.
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Affiliation(s)
| | | | | | - Lisa G Rosas
- Stanford University, Stanford, CA, United States
| | | | | | | | | | | | - Vasu Divi
- Stanford University, Stanford, CA, United States
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Ability to Reach Low-Income Smokers Enrolled in a Randomised Controlled Trial Varies with Time of Month. J Smok Cessat 2019; 13:227-232. [PMID: 31452822 DOI: 10.1017/jsc.2017.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Because of financial pressures, low-income individuals sometimes run out of cellphone service towards the end of the month. Aims To determine if the time of month affects ability to reach low-income smokers by telephone. Methods We reviewed data from a completed trial in the United States of emergency department (ED)-initiated tobacco dependence treatment for low-income smokers at a busy, academic ED in an urban community. We recorded the date of each one-month follow-up call, and divided each month into four time blocks: Week 1, Week 2, Week 3, and Week 4. Results A total of 2,049 phone calls were made to reach 769 participants. Of these calls, 677 (33%) resulted in contact; 88% of all participants were contacted. Using generalised estimating equations with Week 4 as reference, the odds of a successful contact at Weeks 1, 2, and 3 were, respectively, 1.52 (95% CI 1.18, 1.96), 1.30 (95% CI 1.01, 1.66), and 1.37 (95% CI 1.07, 1.76). Conclusions Study participants became progressively difficult to reach. This result may reflect low-income smokers' decreased rates of active telephone service later in the month and suggests a mechanism to improve follow-up rates in future studies of low-income populations.
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Morano JP, Clauson K, Zhou Z, Escobar-Viera CG, Lieb S, Chen IK, Kirk D, Carter WM, Ruppal M, Cook RL. Attitudes, Beliefs, and Willingness Toward the Use of mHealth Tools for Medication Adherence in the Florida mHealth Adherence Project for People Living With HIV (FL-mAPP): Pilot Questionnaire Study. JMIR Mhealth Uhealth 2019; 7:e12900. [PMID: 31271150 PMCID: PMC6636233 DOI: 10.2196/12900] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/31/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background Antiretroviral (ART) adherence among people living with HIV (PLWH) continues to be a challenge despite advances in HIV prevention and treatment. Mobile health (mHealth) interventions are increasingly deployed as tools for ART adherence. However, little is known about the uptake and attitudes toward commercially available, biprogrammatic mobile apps (ie, designed for both smartphone and short message service [SMS] messaging) among demographically diverse PLWH. Objectives The Florida mHealth Adherence Project for PLWH (FL-mAPP) is an innovative pilot study that aimed to determine the acceptability of a commercially available, biprogrammatic mHealth intervention platform to ensure medication adherence and gauge the current attitudes of PLWH toward current and future mHealth apps. Methods A predeveloped, commercially available, biprogrammatic mHealth platform (Care4Today Mobile Health Manager, Johnson & Johnson, New Brunswick, NJ) was deployed, with self-reported ART adherence recorded in the app and paper survey at both short term (30-day) or long-term (90-day) follow-ups. Consented participants completed baseline surveys on sociodemographics and attitudes, beliefs, and willingness toward the use of mHealth interventions for HIV care using a 5-point Likert scale. Chi-square tests and multivariate logistic regression analyses identified correlations with successful uptake of the mHealth platform. Results Among 132 PLWH, 66% (n=87) initially agreed to use the mHealth platform, of which 54% (n=47) successfully connected to the platform. Of the 87 agreeing to use the mHealth platform, we found an approximate 2:1 ratio of persons agreeing to try the smartphone app (n=59) versus the SMS text messages (n=28). Factors correlating with mHealth uptake were above high school level education (adjusted odds ratio 2.65; P=.05), confidence that a clinical staff member would assist with mHealth app use (adjusted odds ratio 2.92, P=.048), belief that PLWH would use such an mHealth app (adjusted odds ratio 2.89; P=.02), and ownership of a smartphone in contrast to a “flip-phone” model (adjusted odds ratio 2.80; P=.05). Of the sample, 70.2% (n=92) reported daily interest in receiving medication adherence reminders via an app (80.4% users versus 64.7% nonusers), although not significantly different among the user groups (P=.06). In addition, 34.8% (n=16) of mHealth users reported a theoretical “daily” interest and 68.2% (n=58) of non-mHealth users reported no interest in using an mHealth app for potentially tracking alcohol or drug intake (P=.002). Conclusions This commercially available, biprogrammatic mHealth platform showed feasibility and efficacy for enhanced ART and medication adherence within public health clinics and successfully included older age groups. Successful use of the platform among demographically diverse PLWH is important for HIV implementation science and promising for uptake on a larger scale.
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Affiliation(s)
- Jamie P Morano
- Department of Infectious Diseases and International Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Clinical Research Unit, University of South Florida, Florida Department of Health - Hillsborough, Tampa, FL, United States
| | - Kevin Clauson
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Lipscomb University, Nashville, TN, United States
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States.,Southern Alcohol HIV Research Consortium Center for Translational HIV Research, University of Florida, Gainesville, FL, United States
| | - César G Escobar-Viera
- Center for Research on Media, Technology, and Health - Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Spencer Lieb
- The AIDS Institute / Florida Consortium for HIV/AIDS Research, Tampa, FL, United States
| | - Irene K Chen
- Department of Infectious Diseases and International Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Clinical Research Unit, University of South Florida, Florida Department of Health - Hillsborough, Tampa, FL, United States
| | - David Kirk
- Clinical Research Unit, University of South Florida, Florida Department of Health - Hillsborough, Tampa, FL, United States
| | - Willie M Carter
- Immunology Clinical Research Unit, Florida Department of Health - Orange County, Orlando, FL, United States
| | - Michael Ruppal
- The AIDS Institute / Florida Consortium for HIV/AIDS Research, Tampa, FL, United States
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States.,Southern Alcohol HIV Research Consortium Center for Translational HIV Research, University of Florida, Gainesville, FL, United States
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Tarver WL, Haggstrom DA. The Use of Cancer-Specific Patient-Centered Technologies Among Underserved Populations in the United States: Systematic Review. J Med Internet Res 2019; 21:e10256. [PMID: 31012855 PMCID: PMC6658273 DOI: 10.2196/10256] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/31/2018] [Accepted: 09/14/2018] [Indexed: 12/11/2022] Open
Abstract
Background In the United States, more than 1.6 million new cases of cancer are estimated to be diagnosed each year. However, the burden of cancer among the US population is not shared equally, with racial and ethnic minorities and lower-income populations having a higher cancer burden compared with their counterparts. For example, African Americans have the highest mortality rates and shortest survival rates for most cancers compared with other racial or ethnic groups in the United States. A wide range of technologies (eg, internet-based [electronic health, eHealth] technologies, mobile [mobile health, mHealth] apps, and telemedicine) available to patients are designed to improve their access to care and empower them to participate actively in their care, providing a means to reduce health care disparities; however, little is known of their use among underserved populations. Objective The aim of this study was to systematically review the current evidence on the use of cancer-specific patient-centered technologies among various underserved populations. Methods Computer-based search was conducted in the following academic databases: (1) PubMed (cancer subset), (2) MEDLINE, (3) PsycINFO, and (4) CINAHL. We included studies that were peer-reviewed, published in the English language, and conducted in the United States. Each study was individually assessed for relevance, with any disagreements being reconciled by consensus. We used a 3-step inclusion process in which we examined study titles, abstracts, and full-text papers for assessment of inclusion criteria. We systematically extracted information from each paper meeting our inclusion criteria. Results This review includes 71 papers that use patient-centered technologies that primarily targeted African Americans (n=31), rural populations (n=14), and Hispanics (n=12). A majority of studies used eHealth technologies (n=41) finding them to be leading sources of cancer-related health information and significantly improving outcomes such as screening among nonadherent individuals and increasing knowledge about cancer and cancer screening. Studies on mHealth found that participants reported overall favorable responses to receiving health information via short message service (SMS) text message; however, challenges were experienced with respect to lack of knowledge of how to text among some participants. More complex mobile technologies (eg, a tablet-based risk assessment tool) were also found favorable to use and acceptable among underserved populations; however, they also resulted in more significant barriers, for example, participants expressed concerns regarding security and unfamiliarity with the technology and preferred further instruction and assistance in its use. Conclusions There is a growing body of literature exploring patient-centered technology and its influence on care of underserved populations. In this review, we find that these technologies seem to be effective, especially when tailored, in improving patient and care-related outcomes. Despite the potential of patient-centered technologies and the receptivity of underserved populations, challenges still exist with respect to their effective use and usability.
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Affiliation(s)
- Will L Tarver
- VA Health Services Research and Development, Center for Health Information & Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Department of Health Policy & Management, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - David A Haggstrom
- VA Health Services Research and Development, Center for Health Information & Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, IN, United States.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
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Goodman JR, Theis R, Shenkman E. Communicating with underserved audiences. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2017. [DOI: 10.1108/ijphm-11-2016-0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this research is to understand how low-income, ethnically diverse, Medicaid recipients read, interpret and use culturally tailored health communications, specifically health plan report cards and health intervention/wellness program recruitment materials.
Design/methodology/approach
The paper reports two exploratory studies on message design. Researchers considered 12 focus groups for Study 1, consisting of 51 African-American, Hispanic and non-Hispanic White men and women who were enrolled in Medicaid and had a behavioral health diagnosis and a chronic disease. Researchers considered 22 focus groups for Study 2, consisting of 102 Hispanic, African-American and non-Hispanic White women enrolled in Medicaid.
Findings
The paper provides qualitative insights into how underserved populations interpret the visual and verbal aspects of health communications. Key findings include problems with cultural tailoring and monetary incentives for health improvement program participation, message components that show respect and are more likely to be read, how visuals can expand verbal messages and provide symbolic models and specifics on the desired image content.
Research limitations/implications
Because of the qualitative approach, the research results may lack generalizability. Thus, researchers suggest conducting quantitative studies to test these findings.
Practical implications
The paper includes implications for the development of powerful verbal and visual messaging for underserved populations. Additionally, the findings suggest a need to include emotional response in health communication theories and to incorporate visual communication theories in message design studies.
Originality/value
Research on health communication with underserved populations is limited, yet these populations have higher incidences of death and disability from disease. This paper fulfills a need to discover best health communication practices with underserved populations.
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Boyum S, Kreuter MW, McQueen A, Thompson T, Greer R. Getting help from 2-1-1: A statewide study of referral outcomes. JOURNAL OF SOCIAL SERVICE RESEARCH 2016; 42:402-411. [PMID: 28260823 PMCID: PMC5336263 DOI: 10.1080/01488376.2015.1109576] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The 2-1-1 information and referral helpline connects economically vulnerable Americans with needed health and social services in their communities. This longitudinal study followed a random sample of 2-1-1 callers in Missouri (n=1,235) to determine the results of the referrals they received. One month after calling 2-1-1, most remembered receiving (93%), tried contacting (91%) and reached (82%) at least one referral they received. Far fewer (36%) received assistance from the referral, ranging from 17% for housing assistance to 67% for food assistance. Callers receiving assistance were much more likely than those not receiving assistance to report at 1-month follow-up that their problem had been resolved (OR=3.0, 95% CI=2.2, 4.1), although this was less true among callers with multiple unmet basic needs. Findings explain how 2-1-1 helps callers resolve problems, but also identifies missed opportunities in the current system. Future research could elucidate how 2-1-1 callers resolve problems and find ways to improve outcomes for the most disadvantaged 2-1-1 callers.
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Affiliation(s)
- Sonia Boyum
- Health Communication Research Laboratory, Washington University in St. Louis, St. Louis, Missouri
| | - Matthew W Kreuter
- Health Communication Research Laboratory, Washington University in St. Louis, St. Louis, Missouri
| | - Amy McQueen
- Health Communication Research Laboratory, Washington University in St. Louis, St. Louis, Missouri
| | - Tess Thompson
- The Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
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Jardine J, Fisher J, Carrick B. Apple's ResearchKit: smart data collection for the smartphone era? J R Soc Med 2015; 108:294-6. [PMID: 26268915 DOI: 10.1177/0141076815600673] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Jennifer Jardine
- Women's Health Research Unit, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
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