mHealth and memory aids: levels of smartphone ownership in patients

A Novel Educational Smartphone Application for Cognitively Healthy Seniors: A Pilot Study

Modern technologies surround people every day, including seniors. The aim of this pilot study was to create a maximally user-friendly mobile application in order to meet older users' individual needs. The research sample consisted of 13 older individuals at the age of 55+ years with a mean age of 67 years, living in the Czech Republic. The key assessment tools of this pilot study were the developed application and usability testing. The findings confirmed that the newly developed mobile application for teaching English met the needs of cognitively healthy seniors, and was acceptable and feasible. In addition, it indicated what technical (e.g., visual interface or easy navigation) and pedagogical (e.g., an instructional manual or adjusting to seniors' learning pace or clear instructions) aspects should be strictly followed when designing such an educational smartphone application. In addition, the authors of this pilot study provide several implications for pedagogical practice. Further research should include more empirical studies aimed at the exploration of educational mobile applications for older generation groups with respect to meeting their individual needs in order to enhance their overall well-being. However, such studies are, nowadays, very rare.

Digital biomarkers from geolocation data in bipolar disorder and schizophrenia: a systematic review

OBJECTIVE

The study sought to explore to what extent geolocation data has been used to study serious mental illness (SMI). SMIs such as bipolar disorder and schizophrenia are characterized by fluctuating symptoms and sudden relapse. Currently, monitoring of people with an SMI is largely done through face-to-face visits. Smartphone-based geolocation sensors create opportunities for continuous monitoring and early intervention.

MATERIALS AND METHODS

We searched MEDLINE, PsycINFO, and Scopus by combining terms related to geolocation and smartphones with SMI concepts. Study selection and data extraction were done in duplicate.

RESULTS

Eighteen publications describing 16 studies were included in our review. Eleven studies focused on bipolar disorder. Common geolocation-derived digital biomarkers were number of locations visited (n = 8), distance traveled (n = 8), time spent at prespecified locations (n = 7), and number of changes in GSM (Global System for Mobile communications) cell (n = 4). Twelve of 14 publications evaluating clinical aspects found an association between geolocation-derived digital biomarker and SMI concepts, especially mood. Geolocation-derived digital biomarkers were more strongly associated with SMI concepts than other information (eg, accelerometer data, smartphone activity, self-reported symptoms). However, small sample sizes and short follow-up warrant cautious interpretation of these findings: of all included studies, 7 had a sample of fewer than 10 patients and 11 had a duration shorter than 12 weeks.

CONCLUSIONS

The growing body of evidence for the association between SMI concepts and geolocation-derived digital biomarkers shows potential for this instrument to be used for continuous monitoring of patients in their everyday lives, but there is a need for larger studies with longer follow-up times.

Evaluation of a mobile health intervention to support asthma self-management and adherence in the pharmacy

Background Several effective mobile health (mHealth) interventions have been developed to support patients with their medication use, however hardly any is implemented in clinical practice. Process evaluations and user experiences are therefore important for further implementation. Objective To explore experiences, barriers, and facilitators of pharmacists and patients towards the use of the interactive ADolescent Adherence Patient Tool (ADAPT). In addition, the perceptions of pharmacists towards mHealth interventions in general were explored. Setting Dutch community pharmacies. Methods Pharmacists (N = 24) and adolescent asthma patients (N = 87; age 12–18) completed a questionnaire about the ADAPT intervention. Pharmacists who did not have access to the ADAPT intervention (N = 26) completed a questionnaire on their perceptions towards mHealth. Main outcome measure Experiences, barriers, and facilitators of pharmacists and patients. Results Most patients (78%) would recommend the ADAPT intervention to others, and thought that the pharmacy was the right place for mHealth aiming to support adherence (63%). The possibility to monitor asthma symptoms was highly appreciated by patients and pharmacists. Pharmacists were satisfied with ADAPT intervention (96%), and using the intervention was not time consuming (91%). The ADAPT intervention promoted contact with patients (74%) and facilitated the healthcare providing role of pharmacists (83%). Pharmacists who did not have access to the ADAPT intervention mentioned time constraints and funding as main barriers for using mHealth. Conclusion Pharmacists and patients perceived many beneficial effects and were positive about the the use of the interactive ADolescent Adherence Patient Tool (ADAPT) intervention. This study emphasizes opportunities for mHealth in improving the quality of care, which supports the need for further implementation in clinical practice.

Effective Engagement of Adolescent Asthma Patients With Mobile Health-Supporting Medication Adherence

Background

Mobile health (mHealth) apps have the potential to support patients’ medication use and are therefore increasingly used. Apps with broad functionality are suggested to be more effective; however, not much is known about the actual use of different functionalities and the effective engagement.

Objective

The aim of this study was to explore the use and the effective engagement of adolescents (aged 12 to 18 years) with the Adolescent Adherence Patient Tool (ADAPT).

Methods

The ADAPT intervention consisted of an app for patients, which was connected to a management system for their pharmacist. The aim of the ADAPT intervention was to improve medication adherence and, therefore, the app contained multiple functionalities: questionnaires to monitor symptoms and adherence, medication reminders, short movies, pharmacist chat, and peer chat. For this study, data of the ADAPT study and a cluster randomized controlled trial were used. Adolescents with asthma had 6 months’ access to the ADAPT intervention, and all app usage was securely registered in a log file.

Results

In total, 86 adolescents (mean age 15.0, SD 2.0 years) used the ADAPT app 17 times (range 1-113) per person. Females used the app more often than males (P=.01) and for a longer period of time (P=.03). On average, 3 different functionalities were used, and 13% of the adolescents used all functionalities of the app. The questionnaires to monitor symptoms and adherence were used by most adolescents. The total app use did not affect adherence; however, activity in the pharmacist chat positively affected medication adherence (P=.03), in particular, if patients sent messages to their pharmacist (P=.01).

Conclusions

mHealth apps for adolescents with asthma should contain different functionalities to serve the diverging needs and preferences of individual patients. Suggested key functionalities to promote use and effectiveness in adolescents with asthma are questionnaires to monitor symptoms and a health care provider chat.

Designing meaningful outcome parameters using mobile technology: a new mobile application for telemonitoring of patients with heart failure

Aims

Health data captured by commercially available smart devices may represent meaningful patient‐reported outcome measures (PROMs) in heart failure (HF) patients. The purpose of this study was to test this hypothesis by evaluating the feasibility of a new telemonitoring concept for patients following initial HF hospitalization.

Methods and results

We designed a cardio patient monitoring platform (CPMP) that comprised mobile iOS‐based applications for patients' smartphone/smartwatch and the equivalent application on a physicians' tablet. It allowed for safe and continuous data transmission of self‐measured physiological parameters, activity data, and patient‐reported symptoms. In a prospective feasibility trial with 692 patient days from 10 patients hospitalized for newly diagnosed HF with reduced ejection fraction (mean left ventricular ejection fraction (LVEF) 26.5 ± 9.8%), we examined the CPMP during the first 2 months following discharge (69 ± 15 observation days per patient). The mean daily step count recorded by the mobile devices emerged as a promising new PROM. Its 14 day average increased over the study period (3612 ± 3311 steps/day at study inclusion and 7069 ± 5006 steps/day at end of study; P < 0.0001). It is unique for continuously reflecting real‐life activity and correlated significantly with traditional surrogate parameters of cardiac performance including LVEF (r = 0.44; 95% CI 0.07–0.71; P = 0.0232), 6 min walk test (r = 0.67; 95% CI 0.38–0.84; P = 0.0002), and scores in health‐related quality of life questionnaires.

Conclusions

We provide the first patient monitoring platform for HF patients that relies on commercially available iOS/watchOS‐based devices. Our study suggests it is ready for implementation as a tool for recording meaningful PROMs in future HF trials and telemonitoring.

Patients' Perception of App-based Educational and Behavioural Interventions for Enhancing Oral Anticancer Medication Adherence

Well-designed smartphone apps can potentially help in enhancing adherence to oral anticancer medications (OAMs). The objective of this study was to evaluate patients' perception on inclusion of various adherence-enhancing strategies as features of an app and their interest in using such app. A cross-sectional survey was conducted at the National Cancer Centre Singapore. A structured self-administered questionnaire was used to collect data from patients taking OAMs. Final analysis was based on 409 surveys and most of the respondents were female (291, 71.1%), Chinese (332, 81.2%), married (296, 72.4%) and breast cancer patients (211, 51.6%). Close to two-thirds of respondents rated medication information (65.0%), disease information (60.2%) and side effect self-management (60.2%) features as having the highest level of importance in an adherence app. Three hundred thirty-two (81.2%) of the respondents owned a smartphone, among which 92 (27.7%) reported using health-related apps. From respondents with smartphones, 219 (66.0%) were interested in using an app for OAM adherence. Age 65 and older compared to 21-54 years old (adjusted OR = 0.34; 95% CI = 0.15-0.76) and current use of a health app (adjusted OR = 1.91; 95% CI = 1.07-3.41) were significant predictors of interest to adopt an adherence app. In conclusion, patients value the inclusion of educational and behavioural interventions in adherence apps. Developers of adherence apps should consider including tools for side effect self-management and provision of information to educate patients on their medications and disease condition.

Efficacy of memory aids after traumatic brain injury: A single case series

BACKGROUND

Individuals living with traumatic brain injury commonly have difficulties with prospective memory-the ability to remember a planned action at the intended time. Traditionally a memory notebook has been recommended as a compensatory memory aid. Electronic devices have the advantage of providing a cue at the appropriate time to remind participants to refer to the memory aid and complete tasks. Research suggests these have potential benefit in neurorehabilitation.

OBJECTIVE

This study aimed to investigate the efficacy of a memory notebook and specifically a smartphone as a compensatory memory aid.

METHODS

A single case series design was used to assess seven participants. A no-intervention baseline was followed by training and intervention with either the smartphone alone, or a memory notebook and later the smartphone. Memory was assessed with weekly assigned memory tasks.

RESULTS

Participants using a smartphone showed improvements in their ability to complete assigned memory tasks accurately and within the assigned time periods. Use of a smartphone provided additional benefits over and above those already seen for those who received a memory notebook first.

CONCLUSIONS

Smartphones have the potential to be a useful and cost effective tool in neurorehabilitation practice.

Effects of smartphone-based memory training for older adults with subjective memory complaints: a randomized controlled trial

OBJECTIVES

We explored whether newly developed application (Smartphone-based brain Anti-aging and memory Reinforcement Training, SMART) improved memory performance in older adults with subjective memory complaints (SMC).

METHOD

A total of 53 adults (range: 50-68 years; 52.8% female) were randomized into either one of two intervention groups [SMART (n = 18) vs. Fit Brains® (n = 19)] or a wait-list group (n = 16). Participants in the intervention groups underwent 15-20 minutes of training per day, five days per week for 8 weeks. We used objective cognitive measures to evaluate changes with respect to four domains: attention, memory, working memory (WM), and response inhibition. In addition, we included self-report questionnaires to assess levels of SMC, depression, and anxiety.

RESULTS

Total WM quotient [t(17) = 6.27, p < .001] as well as auditory-verbal WM score [t(17) = 4.45, p < .001] increased significantly in the SMART group but not in the control groups. Self-reports of memory contentment, however, increased in the Fit Brains® group only [t(18) = 2.12, p < .05).

CONCLUSION

Use of an 8-week smartphone-based memory training program may improve WM function in older adults. However, objective improvement in performance does not necessarily lead to decreased SMC.

Wide Disagreement Between Alternative Assessments of Premorbid Physical Activity: Subjective Patient and Surrogate Reports and Objective Smartphone Data

OBJECTIVES

Surrogate-decision maker and patient self-reported estimates of the distances walked prior to acute illness are subjective and may be imprecise. It may be possible to extract objective data from a patient's smartphone, specifically, step and global position system data, to quantify physical activity. The objectives were to 1) assess the agreement between surrogate-decision maker and patient self-reported estimates of distance and time walked prior to resting and daily step-count and 2) determine the feasibility of extracting premorbid physical activity (step and global position system) data from critically ill patients.

DESIGN

Prospective cohort study.

SETTING

Quaternary ICU.

PATIENTS

Fifty consecutively admitted adult patients who owned a smartphone, who were ambulatory at baseline, and who remained in ICU for more than 48 hours participated.

MEASURMENTS AND MAIN RESULTS

There was no agreement between patients and surrogates for all premorbid walking metrics (mean bias 108% [99% lower to 8,700% higher], 83% [97% to 2,100%], and 71% [96% to 1,080%], for distance, time, and steps, respectively). Step and/or global position system data were successfully extracted from 24 of 50 phones (48%; 95% CI, 35-62%). Surrogate-decision makers, but not patient self-reported, estimates of steps taken per day correlated with smartphone data (surrogates: n = 13, ρ = 0.56, p < 0.05; patients: n = 13, ρ = 0.30, p = 0.317).

CONCLUSION

There was a lack of agreement between surrogate-decision maker and patient self-reported subjective estimates of distance walked. Obtaining premorbid physical activity data from the current-generation smartphones was feasible in approximately 50% of patients.

First steps in designing an all-in-one ICT-based device for persons with cognitive impairment: evaluation of the first mock-up

Background

This project Smart Assisted Living involving Informal careGivers++ (SALIG) intends to develop an ICT-based device for persons with cognitive impairment combined with remote support possibilities for significant others and formal caregivers. This paper presents the identification of the target groups’ needs and requirements of such device and the evaluation of the first mock-up, demonstrated in a tablet.

Methods

The inclusive design method that includes end-users in the design process was chosen. First, a scoping review was conducted in order to examine the target group’s need of an ICT-based device, and to gather recommendations regarding its design and functionalities. In order to capture the users’ requirements of the design and functionalities of the device three targeted focus groups were conducted. Based on the findings from the publications and the focus groups a user requirement specification was developed. After that a design concept and a first mock-up was developed in an iterative process. The mock-up was evaluated through interviews with persons with cognitive impairment, health care professionals and significant others. Data were analysed using content analysis.

Results

Several useful recommendations of the design and functionalities of the SALIG device for persons with cognitive impairment were identified. The main benefit of the mock-up was that it was a single device with a set of functionalities installed on a tablet and designed for persons with cognitive impairment. An additional benefit was that it could be used remotely by significant others and formal caregivers.

Conclusion

The SALIG device has the potentials to facilitate everyday life for persons with cognitive impairment, their significant others and the work situation for formal caregivers. The results may provide guidance in the development of different types of technologies for the target population and for people with diverse disabilities. Further work will focus on developing a prototype to be empirically tested by persons with cognitive impairment, their significant others and formal caregivers.

Mobile telephone apps in mental health practice: uses, opportunities and challenges

Smartphones are used by patients and clinicians alike. Vast numbers of software applications (apps) run on smartphones and carry out useful functions. Clinician- and patient-oriented mental health apps have been developed. In this article, we provide an overview of apps that are relevant for mental health. We look at clinician-oriented apps that support assessment, diagnosis and treatment as well as patient-oriented apps that support education and self-management. We conclude by looking at the challenges that apps pose with a discussion of possible solutions.

Strategic use of reminders: Influence of both domain-general and task-specific metacognitive confidence, independent of objective memory ability

How do we decide whether to use external artifacts and reminders to remember delayed intentions, versus relying on unaided memory? Experiment 1 (N=400) showed that participants' choice to forgo reminders in an experimental task was independently predicted by subjective confidence and objective ability, even when the two measures were themselves uncorrelated. Use of reminders improved performance, explaining significant variance in intention fulfilment even after controlling for unaided ability. Experiment 2 (N=303) additionally investigated a pair of unrelated perceptual discrimination tasks, where the confidence and sensitivity of metacognitive judgments was decorrelated from objective performance using a staircase procedure. Participants with lower confidence in their perceptual judgments set more reminders in the delayed-intention task, even though confidence was unrelated to objective accuracy. However, memory confidence was a better predictor of reminder setting. Thus, propensity to set reminders was independently influenced by (a) domain-general metacognitive confidence; (b) task-specific confidence; and (c) objective ability.

Mobile technologies: expectancy, usage, and acceptance of clinical staff and patients at a university medical center

BACKGROUND

Despite their increasing popularity, little is known about how users perceive mobile devices such as smartphones and tablet PCs in medical contexts. Available studies are often restricted to evaluating the success of specific interventions and do not adequately cover the users' basic attitudes, for example, their expectations or concerns toward using mobile devices in medical settings.

OBJECTIVE

The objective of the study was to obtain a comprehensive picture, both from the perspective of the patients, as well as the doctors, regarding the use and acceptance of mobile devices within medical contexts in general well as the perceived challenges when introducing the technology.

METHODS

Doctors working at Hannover Medical School (206/1151, response 17.90%), as well as patients being admitted to this facility (213/279, utilization 76.3%) were surveyed about their acceptance and use of mobile devices in medical settings. Regarding demographics, both samples were representative of the respective study population. GNU R (version 3.1.1) was used for statistical testing. Fisher's exact test, two-sided, alpha=.05 with Monte Carlo approximation, 2000 replicates, was applied to determine dependencies between two variables.

RESULTS

The majority of participants already own mobile devices (doctors, 168/206, 81.6%; patients, 110/213, 51.6%). For doctors, use in a professional context does not depend on age (P=.66), professional experience (P=.80), or function (P=.34); gender was a factor (P=.009), and use was more common among male (61/135, 45.2%) than female doctors (17/67, 25%). A correlation between use of mobile devices and age (P=.001) as well as education (P=.002) was seen for patients. Minor differences regarding how mobile devices are perceived in sensitive medical contexts mostly relate to data security, patients are more critical of the devices being used for storing and processing patient data; every fifth patient opposed this, but nevertheless, 4.8% of doctors (10/206) use their devices for this purpose. Both groups voiced only minor concerns about the credibility of the provided content or the technical reliability of the devices. While 8.3% of the doctors (17/206) avoided use during patient contact because they thought patients might be unfamiliar with the devices, (25/213) 11.7% of patients expressed concerns about the technology being too complicated to be used in a health context.

CONCLUSIONS

Differences in how patients and doctors perceive the use of mobile devices can be attributed to age and level of education; these factors are often mentioned as contributors of the problems with (mobile) technologies. To fully realize the potential of mobile technologies in a health care context, the needs of both the elderly as well as those who are educationally disadvantaged need to be carefully addressed in all strategies relating to mobile technology in a health context.