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Hasebe K, Kojima T, Okanoue Y, Yuki R, Yamamoto H, Otsuki S, Fujimura S, Hori R. Novel evaluation method for facial nerve palsy using 3D facial recognition system in iPhone. Auris Nasus Larynx 2024; 51:460-464. [PMID: 38520978 DOI: 10.1016/j.anl.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE While subjective methods like the Yanagihara system and the House-Brackmann system are standard in evaluating facial paralysis, they are limited by intra- and inter-observer variability. Meanwhile, quantitative objective methods such as electroneurography and electromyography are time-consuming. Our aim was to introduce a swift, objective, and quantitative method for evaluating facial movements. METHODS We developed an application software (app) that utilizes the facial recognition functionality of the iPhone (Apple Inc., Cupertino, USA) for facial movement evaluation. This app leverages the phone's front camera, infrared radiation, and infrared camera to provide detailed three-dimensional facial topology. It quantitatively compares left and right facial movements by region and displays the movement ratio of the affected side to the opposite side. Evaluations using the app were conducted on both normal and facial palsy subjects and were compared with conventional methods. RESULTS Our app provided an intuitive user experience, completing evaluations in under a minute, and thus proving practical for regular use. Its evaluation scores correlated highly with the Yanagihara system, the House-Brackmann system, and electromyography. Furthermore, the app outperformed conventional methods in assessing detailed facial movements. CONCLUSION Our novel iPhone app offers a valuable tool for the comprehensive and efficient evaluation of facial palsy.
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Affiliation(s)
- Koki Hasebe
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kawahara-cho 54, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tsuyoshi Kojima
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kawahara-cho 54, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Yusuke Okanoue
- Department of Otolaryngology, Head and Neck Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan
| | - Ryohei Yuki
- Department of Otolaryngology, Head and Neck Surgery, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480, Japan
| | - Hirotaka Yamamoto
- Department of Otolaryngology, Head and Neck Surgery, Shizuoka City Shizuoka Hospital, 4-27-1 Kita Ando, Aoi-ku, Shizuoka 420-8527, Japan
| | - Shuya Otsuki
- Department of Otolaryngology, Head and Neck Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan
| | - Shintaro Fujimura
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kawahara-cho 54, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Ryusuke Hori
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan
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Tran S, Smith L, Carter S. Understanding Patient Perspectives on the Use of Gamification and Incentives in mHealth Apps to Improve Medication Adherence: Qualitative Study. JMIR Mhealth Uhealth 2024; 12:e50851. [PMID: 38743461 DOI: 10.2196/50851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/20/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Medication nonadherence remains a significant health and economic burden in many high-income countries. Emerging smartphone interventions have started to use features such as gamification and financial incentives with varying degrees of effectiveness on medication adherence and health outcomes. A more consistent approach to applying these features, informed by patient perspectives, may result in more predictable and beneficial results from this type of intervention. OBJECTIVE This qualitative study aims to identify patient perspectives on the use of gamification and financial incentives in mobile health (mHealth) apps for medication adherence in Australian patients taking medication for chronic conditions. METHODS A total of 19 participants were included in iterative semistructured web-based focus groups conducted between May and December 2022. The facilitator used exploratory prompts relating to mHealth apps, gamification, and financial incentives, along with concepts raised from previous focus groups. Transcriptions were independently coded to develop a set of themes. RESULTS Three themes were identified: purpose-driven design, trust-based standards, and personal choice. All participants acknowledged gamification and financial incentives as potentially effective features in mHealth apps for medication adherence. However, they also indicated that the effectiveness heavily depended on implementation and execution. Major concerns relating to gamification and financial incentives were perceived trivialization and potential for medication abuse, respectively. CONCLUSIONS The study's findings provide a foundation for developers seeking to apply these novel features in an app intervention for a general cohort of patients. However, the study highlights the need for standards for mHealth apps for medication adherence, with particular attention to the use of gamification and financial incentives. Future research with patients and stakeholders across the mHealth app ecosystem should be explored to formalize and validate a set of standards or framework.
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Affiliation(s)
- Steven Tran
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Stephen Carter
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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Ahmed S, Trimmer C, Khan W, Tuck A, Rodak T, Agic B, Kavic K, Wadhawan S, Abbott M, Husain MO, Husain MI, McKenzie K, Quintana Y, Naeem F. A mixed methods analysis of existing assessment and evaluation tools (AETs) for mental health applications. Front Public Health 2024; 12:1196491. [PMID: 38774052 PMCID: PMC11106355 DOI: 10.3389/fpubh.2024.1196491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/17/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Mental health Applications (MH Apps) can potentially improve access to high-quality mental health care. However, the recent rapid expansion of MH Apps has created growing concern regarding their safety and effectiveness, leading to the development of AETs (Assessment and Evaluation Tools) to help guide users. This article provides a critical, mixed methods analysis of existing AETs for MH Apps by reviewing the criteria used to evaluate MH Apps and assessing their effectiveness as evaluation tools. Methods To identify relevant AETs, gray and scholarly literature were located through stakeholder consultation, Internet searching via Google and a literature search of bibliographic databases Medline, APA PsycInfo, and LISTA. Materials in English that provided a tool or method to evaluate MH Apps and were published from January 1, 2000, to January 26, 2021 were considered for inclusion. Results Thirteen relevant AETs targeted for MH Apps met the inclusion criteria. The qualitative analysis of AETs and their evaluation criteria revealed that despite purporting to focus on MH Apps, the included AETs did not contain criteria that made them more specific to MH Apps than general health applications. There appeared to be very little agreed-upon terminology in this field, and the focus of selection criteria in AETs is often IT-related, with a lesser focus on clinical issues, equity, and scientific evidence. The quality of AETs was quantitatively assessed using the AGREE II, a standardized tool for evaluating assessment guidelines. Three out of 13 AETs were deemed 'recommended' using the AGREE II. Discussion There is a need for further improvements to existing AETs. To realize the full potential of MH Apps and reduce stakeholders' concerns, AETs must be developed within the current laws and governmental health policies, be specific to mental health, be feasible to implement and be supported by rigorous research methodology, medical education, and public awareness.
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Affiliation(s)
- Sarah Ahmed
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Chris Trimmer
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Wishah Khan
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Branka Agic
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kelsey Kavic
- Mental Health Commission of Canada, Ottawa, ON, Canada
| | | | | | - M. Omair Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - M. Ishrat Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kwame McKenzie
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuri Quintana
- Harvard Medical School, Harvard University, Boston, MA, United States
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Farooq Naeem
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Cunningham AC, Prentice C, Peven K, Wickham A, Bamford R, Radovic T, Klepchukova A, Fomina M, Cunningham K, Hill S, Hantsoo L, Payne J, Zhaunova L, Ponzo S. Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e54124. [PMID: 38696773 PMCID: PMC11099814 DOI: 10.2196/54124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one's own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access. OBJECTIVE The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image. METHODS We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117). RESULTS The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D̄=1.11; t311=5.73, P<.001; PMS or PMDD: D̄=1.20; t115=3.76, P<.001) and menstrual health awareness (D̄=3.97; t311=7.71, P<.001), health and well-being (D̄=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D̄=-7.08; t115=-5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D̄=1.01; t311=5.08, P<.001), communication about health (D̄=0.93; t311=2.41, P=.002), menstrual cycle stigma (D̄=-0.61; t311=-2.73, P=.007), and fear of unplanned pregnancies (D̄=-0.22; t311=-2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D̄=-1.67; t144=-2.49, P=.01). CONCLUSIONS These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health. TRIAL REGISTRATION OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq.
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Affiliation(s)
| | | | - Kimberly Peven
- Flo Health UK Limited, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Tara Radovic
- Flo Health UK Limited, London, United Kingdom
- Department of Psychology and Ergonomics, Technische Universitaet Berlin, Berlin, Germany
| | | | - Maria Fomina
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Katja Cunningham
- Department of Psychology, Texas Christian University, Fort Worth, TX, United States
| | - Sarah Hill
- Department of Psychology, Texas Christian University, Fort Worth, TX, United States
| | - Liisa Hantsoo
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Jennifer Payne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
| | | | - Sonia Ponzo
- Flo Health UK Limited, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
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Zhu D, Zhao J, Wang M, Cao B, Zhang W, Li Y, Zhang C, Han T. Rehabilitation Applications Based on Behavioral Therapy for People With Knee Osteoarthritis: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e53798. [PMID: 38696250 PMCID: PMC11099817 DOI: 10.2196/53798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND The development of digital applications based on behavioral therapies to support patients with knee osteoarthritis (KOA) has attracted increasing attention in the field of rehabilitation. This paper presents a systematic review of research on digital applications based on behavioral therapies for people with KOA. OBJECTIVE This review aims to describe the characteristics of relevant digital applications, with a special focus on the current state of behavioral therapies, digital interaction technologies, and user participation in design. The secondary aim is to summarize intervention outcomes and user evaluations of digital applications. METHODS A systematic literature search was conducted using the keywords "Knee Osteoarthritis," "Behavior Therapy," and "Digitization" in the following databases (from January 2013 to July 2023): Web of Science, Embase, Science Direct, Ovid, and PubMed. The Mixed Methods Assessment Tool (MMAT) was used to assess the quality of evidence. Two researchers independently screened and extracted the data. RESULTS A total of 36 studies met the inclusion criteria and were further analyzed. Behavioral change techniques (BCTs) and cognitive behavioral therapy (CBT) were frequently combined when developing digital applications. The most prevalent areas were goals and planning (n=31) and repetition and substitution (n=27), which were frequently used to develop physical activity (PA) goals and adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email (n=12), which has tremendous potential. This area of application design offers notable advantages, primarily manifesting in pain mitigation (n=24), reduction of physical dysfunction (n=21), and augmentation of PA levels (n=12). Additionally, when formulating design strategies, it is imperative to consider the perspectives of stakeholders, especially in response to the identified shortcomings in application design elucidated within the study. CONCLUSIONS The results demonstrate that "goals and planning" and "repetition and substitution" are frequently used to develop PA goals and PA behavior adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email, which has tremendous potential. Moreover, incorporating several stakeholders in the design and development stages might enhance user experience, considering the distinct variations in their requirements. To improve the efficacy and availability of digital applications, we have several proposals. First, comprehensive care for patients should be ensured by integrating multiple behavioral therapies that encompass various aspects of the rehabilitation process, such as rehabilitation exercises and status monitoring. Second, therapists could benefit from more precise recommendations by incorporating additional intelligent algorithms to analyze patient data. Third, the implementation scope should be expanded from the home environment to a broader social community rehabilitation setting.
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Affiliation(s)
- Dian Zhu
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Jianan Zhao
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Mingxuan Wang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Bochen Cao
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Zhang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Yunlong Li
- Department of Design, Jiangxi Science and Technology Normal University, Shanghai, China
| | - Chenqi Zhang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Han
- School of Design, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
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Wang JW, Zhu Z, Shuling Z, Fan J, Jin Y, Gao ZL, Chen WD, Li X. Effectiveness of mHealth App-Based Interventions for Increasing Physical Activity and Improving Physical Fitness in Children and Adolescents: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2024; 12:e51478. [PMID: 38687568 PMCID: PMC11094610 DOI: 10.2196/51478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/11/2024] [Accepted: 03/14/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly reduced physical activity (PA) levels and increased sedentary behavior (SB), which can lead to worsening physical fitness (PF). Children and adolescents may benefit from mobile health (mHealth) apps to increase PA and improve PF. However, the effectiveness of mHealth app-based interventions and potential moderators in this population are not yet fully understood. OBJECTIVE This study aims to review and analyze the effectiveness of mHealth app-based interventions in promoting PA and improving PF and identify potential moderators of the efficacy of mHealth app-based interventions in children and adolescents. METHODS We searched for randomized controlled trials (RCTs) published in the PubMed, Web of Science, EBSCO, and Cochrane Library databases until December 25, 2023, to conduct this meta-analysis. We included articles with intervention groups that investigated the effects of mHealth-based apps on PA and PF among children and adolescents. Due to high heterogeneity, a meta-analysis was conducted using a random effects model. The Cochrane Risk of Bias Assessment Tool was used to evaluate the risk of bias. Subgroup analysis and meta-regression analyses were performed to identify potential influences impacting effect sizes. RESULTS We included 28 RCTs with a total of 5643 participants. In general, the risk of bias of included studies was low. Our findings showed that mHealth app-based interventions significantly increased total PA (TPA; standardized mean difference [SMD] 0.29, 95% CI 0.13-0.45; P<.001), reduced SB (SMD -0.97, 95% CI -1.67 to -0.28; P=.006) and BMI (weighted mean difference -0.31 kg/m2, 95% CI -0.60 to -0.01 kg/m2; P=.12), and improved muscle strength (SMD 1.97, 95% CI 0.09-3.86; P=.04) and agility (SMD -0.35, 95% CI -0.61 to -0.10; P=.006). However, mHealth app-based interventions insignificantly affected moderate to vigorous PA (MVPA; SMD 0.11, 95% CI -0.04 to 0.25; P<.001), waist circumference (weighted mean difference 0.38 cm, 95% CI -1.28 to 2.04 cm; P=.65), muscular power (SMD 0.01, 95% CI -0.08 to 0.10; P=.81), cardiorespiratory fitness (SMD -0.20, 95% CI -0.45 to 0.05; P=.11), muscular endurance (SMD 0.47, 95% CI -0.08 to 1.02; P=.10), and flexibility (SMD 0.09, 95% CI -0.23 to 0.41; P=.58). Subgroup analyses and meta-regression showed that intervention duration was associated with TPA and MVPA, and age and types of intervention was associated with BMI. CONCLUSIONS Our meta-analysis suggests that mHealth app-based interventions may yield small-to-large beneficial effects on TPA, SB, BMI, agility, and muscle strength in children and adolescents. Furthermore, age and intervention duration may correlate with the higher effectiveness of mHealth app-based interventions. However, due to the limited number and quality of included studies, the aforementioned conclusions require validation through additional high-quality research. TRIAL REGISTRATION PROSPERO CRD42023426532; https://tinyurl.com/25jm4kmf.
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Affiliation(s)
- Jun-Wei Wang
- School of Sport Medicine and Health, Chengdu Sport University, Chengdu, China
- School of Sports Science, Beijing Sport University, Beijing, China
| | - Zhicheng Zhu
- Physical education institute, Xinyu University, Xinyu, China
| | - Zhang Shuling
- School of Sport Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Jia Fan
- School of Sport Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Yu Jin
- School of Sport Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Zhan-Le Gao
- School of Sport Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Wan-Di Chen
- Academic Administration, Chengdu Sport University, Chengdu, China
| | - Xue Li
- School of Sport Medicine and Health, Chengdu Sport University, Chengdu, China
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Wunsch K, Fiedler J, Hubenschmid S, Reiterer H, Renner B, Woll A. An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e51201. [PMID: 38669071 PMCID: PMC11087865 DOI: 10.2196/51201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/27/2023] [Accepted: 02/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps. OBJECTIVE The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family-based setting. METHODS A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2). RESULTS Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30). CONCLUSIONS Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts. TRIAL REGISTRATION German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/20534.
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Affiliation(s)
- Kathrin Wunsch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Janis Fiedler
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Sebastian Hubenschmid
- Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Harald Reiterer
- Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Britta Renner
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Bernal-Jiménez MÁ, Calle G, Gutiérrez Barrios A, Gheorghe LL, Cruz-Cobo C, Trujillo-Garrido N, Rodríguez-Martín A, Tur JA, Vázquez-García R, Santi-Cano MJ. Effectiveness of an Interactive mHealth App (EVITE) in Improving Lifestyle After a Coronary Event: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e48756. [PMID: 38648103 DOI: 10.2196/48756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/27/2023] [Accepted: 01/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Coronary heart disease is one of the leading causes of mortality worldwide. Secondary prevention is essential, as it reduces the risk of further coronary events. Mobile health (mHealth) technology could become a useful tool to improve lifestyles. OBJECTIVE This study aimed to evaluate the effect of an mHealth intervention on people with coronary heart disease who received percutaneous coronary intervention. Improvements in lifestyle regarding diet, physical activity, and smoking; level of knowledge of a healthy lifestyle and the control of cardiovascular risk factors (CVRFs); and therapeutic adherence and quality of life were analyzed. METHODS This was a randomized controlled trial with a parallel group design assigned 1:1 to either an intervention involving a smartphone app (mHealth group) or to standard health care (control group). The app was used for setting aims, the self-monitoring of lifestyle and CVRFs using measurements and records, educating people with access to information on their screens about healthy lifestyles and adhering to treatment, and giving motivation through feedback about achievements and aspects to improve. Both groups were assessed after 9 months. The primary outcome variables were adherence to the Mediterranean diet, frequency of food consumed, patient-reported physical activity, smoking, knowledge of healthy lifestyles and the control of CVRFs, adherence to treatment, quality of life, well-being, and satisfaction. RESULTS The study analyzed 128 patients, 67 in the mHealth group and 61 in the control group; most were male (92/128, 71.9%), with a mean age of 59.49 (SD 8.97) years. Significant improvements were observed in the mHealth group compared with the control group regarding adherence to the Mediterranean diet (mean 11.83, SD 1.74 points vs mean 10.14, SD 2.02 points; P<.001), frequency of food consumption, patient-reported physical activity (mean 619.14, SD 318.21 min/week vs mean 471.70, SD 261.43 min/week; P=.007), giving up smoking (25/67, 75% vs 11/61, 42%; P=.01), level of knowledge of healthy lifestyles and the control of CVRFs (mean 118.70, SD 2.65 points vs mean 111.25, SD 9.05 points; P<.001), and the physical component of the quality of life 12-item Short Form survey (SF-12; mean 45.80, SD 10.79 points vs mean 41.40, SD 10.78 points; P=.02). Overall satisfaction was higher in the mHealth group (mean 48.22, SD 3.89 vs mean 46.00, SD 4.82 points; P=.002) and app satisfaction and usability were high (mean 44.38, SD 6.18 out of 50 points and mean 95.22, SD 7.37 out of 100). CONCLUSIONS The EVITE app was effective in improving the lifestyle of patients in terms of adherence to the Mediterranean diet, frequency of healthy food consumption, physical activity, giving up smoking, knowledge of healthy lifestyles and controlling CVRFs, quality of life, and overall satisfaction. The app satisfaction and usability were excellent. TRIAL REGISTRATION Clinicaltrials.gov NCT04118504; https://clinicaltrials.gov/study/NCT04118504.
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Affiliation(s)
- María Ángeles Bernal-Jiménez
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - German Calle
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Alejandro Gutiérrez Barrios
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Livia Luciana Gheorghe
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Celia Cruz-Cobo
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - Nuria Trujillo-Garrido
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - Amelia Rodríguez-Martín
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Biomedicine, Biotechnology and Public Health Department, University of Cádiz, Cádiz, Spain
| | - Josep A Tur
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain
- Network Biomedical Research Center "Pathophysiology of Obesity and Nutrition", Carlos III Health Institute, Madrid, Spain
| | - Rafael Vázquez-García
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - María José Santi-Cano
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
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Liu P, Li X, Zhang XM. Healthcare professionals' and patients' assessments of listed mobile health apps in China: a qualitative study. Front Public Health 2023; 11:1220160. [PMID: 37780445 PMCID: PMC10538635 DOI: 10.3389/fpubh.2023.1220160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background In recent years, mobile health (mHealth) has gradually developed in China, and intelligent medicine has become an important research topic. However, there are still significant problems in mHealth applications (apps). Although healthcare professionals and patients are the main users, few studies have focused on their perceptions of the quality of mHealth apps. Objective This study aimed to (1) understand the respective perceptions of healthcare professionals and patients regarding mHealth apps, (2) assess what barriers exist that influence the user experience, and (3) explore how to improve the quality of mHealth apps and the development of the mHealth market in China. The study aims to promote the standardization of mHealth apps and provide effective information for the improvement and development of mHealth apps in the future. Methods Semistructured interviews with 9 patients and 14 healthcare professionals were conducted from January 2022 to April 2022 in the Affiliated Hospital of Xuzhou Medical University. The participants used mHealth apps for more than 3 months, including the "Good Mood" and "Peace and Safe Doctors" apps and apps developed by the hospital that were popular in China. Interview transcripts were analysed using thematic analysis. Results The following five themes were extracted: different concerns, hidden medical dangers, distance and insecurity, barriers for older people, and having positive perceptions of mHealth apps. Healthcare professionals prioritized simplicity in regard to mHealth apps, whereas patients rated effectiveness as the most crucial factor. The study also revealed several problems with mHealth apps, including insufficient information about physician qualifications, inaccurate medical content, nonstandard treatment processes, and unclear accountability, which led to a sense of distance and insecurity among participants. Older individuals faced additional obstacles when using mHealth apps. Despite these issues, the participants remained optimistic about the future of mHealth app development. Conclusion The utilization, advantages, and obstacles of mHealth applications for healthcare professionals and patients were explored through semistructured interviews. Despite the promising prospects for mHealth apps in China, numerous issues still need to be addressed. Enhancing the safety monitoring system and developing user-friendly mHealth apps for older adult patients are essential steps to bridge the gap between healthcare providers and patients.
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Affiliation(s)
- PeiYu Liu
- Department of Anesthesia and Operation Room, Nanjing Drum Tower Hospital, Nanjing, China
| | - XueYun Li
- Department of Anesthesia and Operation Room, Nanjing Drum Tower Hospital, Nanjing, China
| | - Xiao Man Zhang
- Department of Nursing, Xuzhou Medical University, Xuzhou, China
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10
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Muñoz K, Markle K, San Miguel GG, Twohig MP. Increasing Pediatric Hearing Aid Use: Considerations for Clinical Practice. Am J Audiol 2023; 32:665-670. [PMID: 37566885 DOI: 10.1044/2023_aja-23-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Hearing aid use can be variable for young children, and inconsistent wear time can undermine spoken language development. This study explored the effectiveness of hearing aid data logging (DL) awareness and coaching sessions on increasing hours of hearing aid use. We also collected qualitative data on challenges participants experienced managing hearing aid use. METHOD We used a single-subject design that included three conditions, during a 6-week period, in the same order for each participant. Condition A was baseline, Condition B was DL monitoring alone, and Condition C was remote coaching calls plus DL monitoring. RESULTS Hours of hearing aid use increased for each child from baseline to the end of the study, ranging from 1.19 to 4.4 hr. Mothers reported that the coaching calls were beneficial and helped them identify and problem-solve issues. CONCLUSIONS Parents were able to increase hours of hearing aid use with DL awareness and coaching support. Tele-audiology offers an opportunity to provide parents with more frequent support that can be individualized based on their situation, challenges, and family needs.
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Affiliation(s)
- Karen Muñoz
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Kali Markle
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
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Abstract
IMPORTANCE It is unclear whether mobile technology hypertension self-management programs are associated with blood pressure (BP) control. OBJECTIVE To examine whether engagement with a hypertension self-management program with a BP monitor and connected smartphone application with clinically based digital coaching was associated with BP control during a follow-up period of as long as 3 years. DESIGN, SETTING, AND PARTICIPANTS This cohort study enrolled US adults with elevated BP or hypertension between January 1, 2015, and July 1, 2020. The hypertension self-management program was provided through the participant's (or their spouse's) employer health plan. EXPOSURES Program engagement, defined by average number of application sessions. MAIN OUTCOMES AND MEASURES Systolic and diastolic BP measured by a US Food and Drug Administration-cleared BP monitor, with categories defined as normal (systolic BP, <120 mm Hg), elevated (systolic BP, 120-129 mm Hg), stage 1 hypertension (systolic BP, 130-139 mm Hg), and stage 2 hypertension (systolic BP ≥140 mm Hg). Other measures included age, gender, depression, anxiety, diabetes, high cholesterol, smoking, geographic region, area deprivation index, self-reported weight, and device-measured physical activity (steps per day). RESULTS Among 28 189 participants (median [IQR] age, 51 [43-58] years; 9424 women [40.4%]; 13 902 men [59.6%]), median (IQR) baseline systolic BP was 129.5 mm Hg (120.5-139.6 mm Hg) and diastolic BP was 81.7 mm Hg (75.7-88.4 mm Hg). Median systolic BP at 1 year improved at least 1 category for 495 of 934 participants (53.0%) with baseline elevated BP, 673 of 966 (69.7%) with baseline stage 1 hypertension, and 920 of 1075 (85.7%) with baseline stage 2 hypertension. Participants in the program for 3 years had a mean (SEM) systolic BP reduction of 7.2 (0.4), 12.2 (0.7), and 20.9 (1.7) mm Hg compared with baseline for those starting with elevated, stage 1 hypertension, and stage 2 hypertension, respectively. Greater engagement was associated with lower systolic BP over time (high-engagement group: 131.2 mm Hg; 95% CI, 115.5-155.8 mm Hg; medium-engagement group: 133.4 mm Hg; 95% CI 116.3-159.5 mm Hg; low-engagement group: 135.5 mm Hg; 95% CI, 117.3-164.8 mm Hg; P < .001); these results persisted after adjusting for age, gender, depression, anxiety, diabetes, high cholesterol, smoking, area deprivation index rank, and US region, which was partially mediated by greater physical activity. A very high BP (systolic BP >180 mm Hg) was observed 11 637 times from 3778 participants. Greater engagement was associated with lower risk of very high BP; the estimated probability of a very high BP was greater in the low-engagement group (1.42%; 95% CI, 1.26%-1.59%) compared with the medium-engagement group (0.79%; 95% CI, 0.71%-0.87%; P < .001) and the high-engagement group (0.53%; 95% CI, 0.45%-0.60%; P < .001 for comparison with both groups). CONCLUSIONS AND RELEVANCE The findings of this study suggest that a mobile technology hypertension self-management program can support long-term BP control and very high BP detection. Such programs may improve real-world BP monitoring and control.
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Affiliation(s)
| | | | - Alexis L. Beatty
- Department of Epidemiology & Biostatistics and Division of Cardiology, University of California, San Francisco
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12
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San Giovanni CB, Dawley E, Pope C, Steffen M, Roberts J. The Doctor Will "Friend" You Now: A Qualitative Study on Adolescents' Preferences for Weight Management App Features. South Med J 2021; 114:373-379. [PMID: 34215886 PMCID: PMC8284848 DOI: 10.14423/smj.0000000000001273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Primary care providers report a lack of resources as a barrier to managing adolescent obesity. Mobile health applications (apps) may be helpful in weight management; however, adolescents' preferences for weight management app features are unknown. Our objectives were to provide insight into adolescents' preferred weight management app features and elicit facilitators and barriers to app use. METHODS Using the qualitative content analysis method, 14 interviews with adolescents with overweight/obesity were conducted in rural and urban pediatric offices in South Carolina. Eligibility criteria included being 13 to 17 years old, having a body mass index at or above the 85th percentile for age and sex, and having access to a smartphone or tablet. Semistructured key informant interviews were conducted from May to October 2017. Participants were presented with three popular mobile health apps and asked to complete tasks and comment on their various features and usability. Summative content analysis coding was performed on interview transcripts, and interviews were conducted until thematic saturation was reached. RESULTS Seventy-one percent of participants were from a rural practice, 64% were White, and 86% had a body mass index higher than the 95th percentile. Familiarity with similar apps and accessibility of apps on their smartphones promoted app use. The need for wireless Internet, operating difficulties, or privacy concerns were barriers. Nutritional education, physical activity tracking, and social connection were desirable app features. CONCLUSIONS Adolescents have expressed preferred app features to help them manage weight; however, further work is needed to see whether these features are effective.
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Affiliation(s)
| | - Erin Dawley
- From the University of South Carolina, Charleston
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Affiliation(s)
- Quinn Grundy
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lindsay Jibb
- Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | | | - Geoffrey Fang
- Hospital for Sick Children (SickKids), Toronto, ON, Canada
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Abstract
OBJECTIVES To investigate whether and what user data are collected by health related mobile applications (mHealth apps), to characterise the privacy conduct of all the available mHealth apps on Google Play, and to gauge the associated risks to privacy. DESIGN Cross sectional study SETTING: Health related apps developed for the Android mobile platform, available in the Google Play store in Australia and belonging to the medical and health and fitness categories. PARTICIPANTS Users of 20 991 mHealth apps (8074 medical and 12 917 health and fitness found in the Google Play store: in-depth analysis was done on 15 838 apps that did not require a download or subscription fee compared with 8468 baseline non-mHealth apps. MAIN OUTCOME MEASURES Primary outcomes were characterisation of the data collection operations in the apps code and of the data transmissions in the apps traffic; analysis of the primary recipients for each type of user data; presence of adverts and trackers in the app traffic; audit of the app privacy policy and compliance of the privacy conduct with the policy; and analysis of complaints in negative app reviews. RESULTS 88.0% (n=18 472) of mHealth apps included code that could potentially collect user data. 3.9% (n=616) of apps transmitted user information in their traffic. Most data collection operations in apps code and data transmissions in apps traffic involved external service providers (third parties). The top 50 third parties were responsible for most of the data collection operations in app code and data transmissions in app traffic (68.0% (2140), collectively). 23.0% (724) of user data transmissions occurred on insecure communication protocols. 28.1% (5903) of apps provided no privacy policies, whereas 47.0% (1479) of user data transmissions complied with the privacy policy. 1.3% (3609) of user reviews raised concerns about privacy. CONCLUSIONS This analysis found serious problems with privacy and inconsistent privacy practices in mHealth apps. Clinicians should be aware of these and articulate them to patients when determining the benefits and risks of mHealth apps.
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Affiliation(s)
| | - Muhammad Ikram
- Department of Computing, Macquarie University, Sydney, NSW, Australia
| | - Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | | | - Shlomo Berkovsky
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Mouter N, Collewet M, de Wit GA, Rotteveel A, Lambooij MS, Kessels R. Societal Effects Are a Major Factor for the Uptake of the Coronavirus Disease 2019 (COVID-19) Digital Contact Tracing App in The Netherlands. Value Health 2021; 24:658-667. [PMID: 33933234 PMCID: PMC7943373 DOI: 10.1016/j.jval.2021.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/09/2020] [Accepted: 01/01/2021] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Our study investigates the extent to which uptake of a COVID-19 digital contact-tracing (DCT) app among the Dutch population is affected by its configurations, its societal effects, and government policies toward such an app. METHODS We performed a discrete choice experiment among Dutch adults including 7 attributes, that is, who gets a notification, waiting time for testing, possibility for shops to refuse customers who have not installed the app, stopping condition for contact tracing, number of people unjustifiably quarantined, number of deaths prevented, and number of households with financial problems prevented. The data were analyzed by means of panel mixed logit models. RESULTS The prevention of deaths and financial problems of households had a very strong influence on the uptake of the app. Predicted app uptake rates ranged from 24% to 78% for the worst and best possible app for these societal effects. We found a strong positive relationship between people's trust in government and people's propensity to install the DCT app. CONCLUSIONS The uptake levels we find are much more volatile than the uptake levels predicted in comparable studies that did not include societal effects in their discrete choice experiments. Our finding that the societal effects are a major factor in the uptake of the DCT app results in a chicken-or-the-egg causality dilemma. That is, the societal effects of the app are severely influenced by the uptake of the app, but the uptake of the app is severely influenced by its societal effects.
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Affiliation(s)
- Niek Mouter
- Delft University of Technology, Faculty of Technology, Policy and Management, Transport and Logistics Group, Delft, The Netherlands.
| | - Marion Collewet
- Maastricht University, Department of Data Analytics and Digitalization, Maastricht, The Netherlands
| | - G Ardine de Wit
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands; Utrecht University, University Medical Center Utrecht, Juliuscenter for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Adrienne Rotteveel
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands
| | - Mattijs S Lambooij
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands
| | - Roselinde Kessels
- Leiden University, Department of Economics, Institute of Tax Law and Economics, Leiden Law School, The Netherlands; University of Antwerp, Department of Economics, Antwerp, Belgium
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Matin RN, Dinnes J. AI-based smartphone apps for risk assessment of skin cancer need more evaluation and better regulation. Br J Cancer 2021; 124:1749-1750. [PMID: 33742148 PMCID: PMC8144419 DOI: 10.1038/s41416-021-01302-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 01/26/2021] [Accepted: 02/03/2021] [Indexed: 11/08/2022] Open
Abstract
Smartphone applications ("apps") with artificial intelligence (AI) algorithms are increasingly used in healthcare. Widespread adoption of these apps must be supported by a robust evidence-base and app manufacturers' claims appropriately regulated. Current CE marking assessment processes inadequately protect the public against the risks created by using smartphone diagnostic apps.
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Affiliation(s)
- Rubeta N Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jacqueline Dinnes
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK.
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.
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Tucker L, Villagomez AC, Krishnamurti T. Comprehensively addressing postpartum maternal health: a content and image review of commercially available mobile health apps. BMC Pregnancy Childbirth 2021; 21:311. [PMID: 33879089 PMCID: PMC8059182 DOI: 10.1186/s12884-021-03785-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The United States is currently facing a maternal morbidity and mortality crisis, with the highest rates of any resource-rich nation. In efforts to address this, new guidelines for postpartum care suggest that mobile health (mHealth) apps can help provide complementary clinical support for new mothers during the postpartum period. However, to date no study has evaluated the quality of existing mHealth tools targeted to this time period in terms of sufficiency of maternal health information, inclusivity of people of color, and app usability. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to review the peripartum apps from the Apple and Google Play stores in either the Health/Fitness, Medical, or Education categories. Apps were evaluated for extent and quality of maternal health information and inclusivity of people of color using an a priori coding scheme. App usability was evaluated using the Mobile Application Rating Scale (MARS) score. RESULTS Of the 301 apps from the Apple and Google Play stores, 25 met criteria for final evaluation. Of the 30 maternal health topics coded for, the median number addressed by apps was 19.5 (65%). Peripartum behaviors were more frequently addressed than peripartum outpatient care topics and peripartum acute health risks. The coverage of maternal health information and inclusivity of people of color in app imagery both correlated positively with the MARS usability score of the app. Only 8 apps (32%) portrayed greater than 24% images of people of color- the percent of non-white Americans according to 2019 census estimates. There was no correlation between MARS usability score and number of app users, as estimated by number of ratings for the app available on the app store. In addition, apps with evidence-based maternal health information had greater MARS engagement, information, and aesthetics scores. However, presence of evidence-based information did not correlate with greater numbers of app users. CONCLUSIONS Current commercially available peripartum apps range widely in quality. Overall current app offerings generally do not provide adequate maternal health information and are not optimally accessible to the target users in terms of inclusivity of women of color or app usability. Apps delivering evidence-based information and more usable design are more likely to meet these standards but are not more likely to be downloaded by users.
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Affiliation(s)
- Laura Tucker
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA.
| | - Alan Cuevas Villagomez
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Tamar Krishnamurti
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
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Earle S, Marston HR, Hadley R, Banks D. Use of menstruation and fertility app trackers: a scoping review of the evidence. BMJ Sex Reprod Health 2021; 47:90-101. [PMID: 32253280 DOI: 10.1136/bmjsrh-2019-200488] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 05/23/2023]
Abstract
INTRODUCTION There has been a phenomenal worldwide increase in the development and use of mobile health applications (mHealth apps) that monitor menstruation and fertility. Critics argue that many of the apps are inaccurate and lack evidence from either clinical trials or user experience. The aim of this scoping review is to provide an overview of the research literature on mHealth apps that track menstruation and fertility. METHODS This project followed the PRISMA Extension for Scoping Reviews. The ACM, CINAHL, Google Scholar, PubMed and Scopus databases were searched for material published between 1 January 2010 and 30 April 2019. Data summary and synthesis were used to chart and analyse the data. RESULTS In total 654 records were reviewed. Subsequently, 135 duplicate records and 501 records that did not meet the inclusion criteria were removed. Eighteen records from 13 countries form the basis of this review. The papers reviewed cover a variety of disciplinary and methodological frameworks. Three main themes were identified: fertility and reproductive health tracking, pregnancy planning, and pregnancy prevention. CONCLUSIONS Motivations for fertility app use are varied, overlap and change over time, although women want apps that are accurate and evidence-based regardless of whether they are tracking their fertility, planning a pregnancy or using the app as a form of contraception. There is a lack of critical debate and engagement in the development, evaluation, usage and regulation of fertility and menstruation apps. The paucity of evidence-based research and absence of fertility, health professionals and users in studies is raised.
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Affiliation(s)
- Sarah Earle
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Hannah R Marston
- Health and Wellbeing Priority Research Area, The Open University, Milton Keynes, UK
| | | | - Duncan Banks
- School of Life, Health & Chemical Sciences, The Open University, Milton Keynes, Buckinghamshire, UK
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Noblin A, Hewitt B, Moqbel M, Sittig S, Kinnerson L, Rulon V. Can caregivers trust information technology in the care of their patients? A systematic review. Inform Health Soc Care 2021; 46:29-41. [PMID: 33256469 DOI: 10.1080/17538157.2020.1834399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that healthcare providers allow patients to engage in their healthcare by allowing access to their health records. Often patients need informal caregivers including family members or others to help them with their care. This paper explores whether trust is a key factor for informal caregivers' decision to use health information technologies (HIT) including electronic health records (EHR), patient portals, mobile apps, or other devices to care for their patient. Six reviewers conducted a comprehensive search of four literature databases using terms that pertained to a caregiver and trust to investigate the role trust plays when caregivers use HIT. While trust is a key factor for the use of HIT, it the researchers only identified ten articles that met the research question thresholds. Four main topics of trust surfaced including perceived confidentiality, perceived security, technological malfunction, and trustworthiness of the information. Trust is a critical factor for informal caregivers when using HIT to assist in the care of their patient (child, loved one, parent, or acquaintance). Based on the findings, it is clear that more research on the use of HIT by caregivers is needed.
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Affiliation(s)
- Alice Noblin
- Health Management & Informatics, University of Central Florida , Orlando, FL, USA
| | - Barbara Hewitt
- Health Information Management, Texas State University , San Marcos, TX, USA
| | - Murad Moqbel
- Information Systems, University of Texas Rio Grande Valley , Brownsville, TX, USA
| | - Scott Sittig
- Information Systems and Technology, University of South Alabama , Mobile, AL, USA
| | - Lakesha Kinnerson
- Health Informatics and Information Management, Samford University , Birmingham, AL, USA
| | - Vera Rulon
- CEO of TIR, Tir Health Advisors LLC , Nyack, NY, USA
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Ciapponi A, Donato M, Gülmezoglu AM, Alconada T, Bardach A. Mobile apps for detecting falsified and substandard drugs: A systematic review. PLoS One 2021; 16:e0246061. [PMID: 33539433 PMCID: PMC7861418 DOI: 10.1371/journal.pone.0246061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
The use of substandard and counterfeit medicines (SCM) leads to significant health and economic consequences, like treatment failure, rise of antimicrobial resistance, extra expenditures of individuals or households and serious adverse drug reactions including death. Our objective was to systematically search, identify and compare relevant available mobile applications (apps) for smartphones and tablets, which use could potentially affect clinical and public health outcomes. We carried out a systematic review of the literature in January 2020, including major medical databases, and app stores. We used the validated Mobile App Rating Scale (MARS) to assess the quality of apps, (1 worst score, 3 acceptable score, and 5 best score). We planned to evaluate the accuracy of the mobile apps to detect SCM. We retrieved 335 references through medical databases and 42 from Apple, Google stores and Google Scholar. We finally included two studies of the medical database, 25 apps (eight from the App Store, eight from Google Play, eight from both stores, and one from Google Scholar), and 16 websites. We only found one report on the accuracy of a mobile apps detecting SCMs. Most apps use the imprint, color or shape for pill identification, and only a few offer pill detection through photographs or bar code. The MARS mean score for the apps was 3.17 (acceptable), with a maximum of 4.9 and a minimum of 1.1. The 'functionality' dimension resulted in the highest mean score (3.4), while the 'engagement' and 'information' dimensions showed the lowest one (3.0). In conclusion, we found a remarkable evidence gap about the accuracy of mobile apps in detecting SCMs. However, mobile apps could potentially be useful to screen for SCM by assessing the physical characteristics of pills, although this should still be assessed in properly designed research studies.
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Affiliation(s)
- Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
- * E-mail:
| | - Manuel Donato
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - A. Metin Gülmezoglu
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Tomás Alconada
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
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Lopez KD, Chae S, Michele G, Fraczkowski D, Habibi P, Chattopadhyay D, Donevant SB. Improved readability and functions needed for mHealth apps targeting patients with heart failure: An app store review. Res Nurs Health 2021; 44:71-80. [PMID: 33107056 PMCID: PMC8270757 DOI: 10.1002/nur.22078] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/28/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Abstract
To maintain their quality of life and avoid hospitalization and early mortality, patients with heart failure must recognize and respond to symptoms of exacerbation. A promising method for engaging patients in their self-care is through mobile health applications (mHealth apps). However, for mHealth to have its greatest chance for improving patient outcomes, the app content must be readable, provide useful functions and be based in evidence. The study aimed to determine: (1) readability, (2) types of functions, and (3) linkage to authoritative sources of evidence for self-care focused mHealth apps targeting heart failure patients that are available in the Apple and Google Play Stores. We systematically searched for mHealth apps targeting patients with heart failure in the Apple and Google Play Stores and applied selection criteria. Readability of randomly selected informational paragraphs were determined using Flesch-Kincaid grade level test tool in Microsoft Word. Ten mHealth apps met our criteria. Only one had a reading grade level at or below the recommended 6th grade reading level (average 9.35). The most common functions were tracking, clinical data feedback, and non-data-based reminders and alerts. Only three had statements that clearly linked the mHealth app content to trustworthy, evidence-based sources. Only two had interoperability with the electronic health record and only one had a communication feature with clinicians. Future mHealth designs that are tailored to patients' literacy level and have advanced functions may hold greater potential for improving patient outcomes.
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Affiliation(s)
| | - Sena Chae
- The University of Iowa College of Nursing, Iowa City, Iowa, USA
| | - Girgis Michele
- Creighton University College of Nursing, Omaha, Nebraska
| | - Dan Fraczkowski
- University of Illinois at Chicago, College of Nursing, Chicago, Illinois, USA
| | - Pantea Habibi
- University of Illinois at Chicago, College of Engineering, Chicago, Illinois, USA
| | | | - Sara B. Donevant
- University of South Carolina, College of Nursing, Columbia, South Carolina, USA
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von Wyl V, Höglinger M, Sieber C, Kaufmann M, Moser A, Serra-Burriel M, Ballouz T, Menges D, Frei A, Puhan MA. Drivers of Acceptance of COVID-19 Proximity Tracing Apps in Switzerland: Panel Survey Analysis. JMIR Public Health Surveill 2021; 7:e25701. [PMID: 33326411 PMCID: PMC7790736 DOI: 10.2196/25701] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Digital proximity tracing apps have been released to mitigate the transmission of SARS-CoV-2, the virus known to cause COVID-19. However, it remains unclear how the acceptance and uptake of these apps can be improved. OBJECTIVE This study aimed to investigate the coverage of the SwissCovid app and the reasons for its nonuse in Switzerland during a period of increasing incidence of COVID-19 cases. METHODS We collected data between September 28 and October 8, 2020, via a nationwide online panel survey (COVID-19 Social Monitor, N=1511). We examined sociodemographic and behavioral factors associated with app use by using multivariable logistic regression, whereas reasons for app nonuse were analyzed descriptively. RESULTS Overall, 46.5% (703/1511) of the survey participants reported they used the SwissCovid app, which was an increase from 43.9% (662/1508) reported in the previous study wave conducted in July 2020. A higher monthly household income (ie, income >CHF 10,000 or >US $11,000 vs income ≤CHF 6000 or CONCLUSIONS Eliminating technical hurdles and communicating the benefits of digital proximity tracing apps are crucial to promote further uptake and adherence of such apps and, ultimately, enhance their effectiveness to aid pandemic mitigation strategies.
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Affiliation(s)
- Viktor von Wyl
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zürich, Switzerland
| | - Marc Höglinger
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Chloé Sieber
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Marco Kaufmann
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - André Moser
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Miquel Serra-Burriel
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Tala Ballouz
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Dominik Menges
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Anja Frei
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Milo Alan Puhan
- Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Zürich, Switzerland
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Karaismailoğlu B, Erkuş S, Bacaksız T, Ercan N, Kendirci AŞ, Küçükdurmaz F, Kalenderer Ö, Öztürk İ. Instant messaging application usage for clinical consultation among orthopedic surgery residents in Turkey: A survey study. Acta Orthop Traumatol Turc 2021; 55:5-8. [PMID: 33650503 DOI: 10.5152/j.aott.2021.20041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to determine the characteristics of instant messaging application (IMA) usage for clinical consultation among orthopedic residents in Turkey and to explore their experiences and opinions concerning potential legal problems. METHODS A questionnaire titled "Instant messaging for consultation among orthopedic surgeons" consisting of 21 questions was applied to orthopedic surgery residents, and the results were analyzed. The questions were designed to obtain information on 4 categories: 1) demographics and professional experience, 2) attitudes on the use of cellular phones, 3) IMA usage for clinical consultation purposes, and 4) problems and comments on smartphone application usage for clinical consultation purposes. The participants who had no experience with a smartphone or IMA usage were excluded at the final analysis. RESULTS A total of 860 orthopedic residents (849 males [98.7%]; mean age=28.6 years; age range=22-44 years) participated in the survey (participation rate: 97.3%). The distribution of residency years was as follows: 1st year, 27%; 2nd year, 21.4%; 3rd year, 18.4%; 4th year, 17.4%; and 5th year, 49.9%. The most frequently used IMAs were WhatsApp (99.3%), Facebook Messenger (14.8%), Viber (8%), and Tango (1.3%). The rate of IMA usage for consultation was 95.3%. The most common reasons to prefer IMAs for consultation were being "fast" and "easy," but only 26.3% of the residents reported that they prefer the use of IMAs because they find them "reliable." Moreover, 41.7% of the respondents reported that they had an experience of misdiagnosis owing to the use of IMAs; 81.2% of the participants used the personal information of the patients during the consultation; 57.6% of the respondents considered that legal problems may arise because of the use of IMAs during the consultation; and 51.4% believed that an electronic platform, solely for consultation purposes, is required. CONCLUSION This survey has shown that it is necessary to make some legal regulations regarding the use of IMAs for consultation purposes and to develop applications only for medical consultation purposes. Most of the trainees make decisions using IMAs without a proper examination, putting the patients at the risk of misdiagnosis. Moreover, the confidentiality of the patient's personal information appears to be in danger when IMAs are used. LEVEL OF EVIDENCE Level IV, Diagnostic Study.
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Affiliation(s)
| | - Serkan Erkuş
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Tayfun Bacaksız
- Clinic of Orthopaedics and Traumatology, Akçakale State Hospital, Şanlıurfa, Turkey
| | - Niyazi Ercan
- Department of Orthopaedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Alper Şükrü Kendirci
- Department of Orthopaedics and Traumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Fatih Küçükdurmaz
- Department of Orthopaedics and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey
| | - Önder Kalenderer
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - İrfan Öztürk
- Department of Orthopaedics and Traumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
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Li WY, Chiu FC, Zeng JK, Li YW, Huang SH, Yeh HC, Cheng BW, Yang FJ. Mobile Health App With Social Media to Support Self-Management for Patients With Chronic Kidney Disease: Prospective Randomized Controlled Study. J Med Internet Res 2020; 22:e19452. [PMID: 33320101 PMCID: PMC7772070 DOI: 10.2196/19452] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/12/2020] [Accepted: 11/11/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global health burden. Self-management plays a key role in improving modifiable risk factors. OBJECTIVE The aim of this study was to evaluate the effectiveness of wearable devices, a health management platform, and social media at improving the self-management of CKD, with the goal of establishing a new self-management intervention model. METHODS In a 90-day prospective experimental study, a total of 60 people with CKD at stages 1-4 were enrolled in the intervention group (n=30) and control group (n=30). All participants were provided with wearable devices that collected exercise-related data. All participants maintained dietary diaries using a smartphone app. All dietary and exercise information was then uploaded to a health management platform. Suggestions about diet and exercise were provided to the intervention group only, and a social media group was created to inspire the participants in the intervention group. Participants' self-efficacy and self-management questionnaire scores, Kidney Disease Quality of Life scores, body composition, and laboratory examinations before and after the intervention were compared between the intervention and control groups. RESULTS A total of 49 participants completed the study (25 in the intervention group and 24 in the control group); 74% of the participants were men and the mean age was 51.22 years. There were no differences in measured baseline characteristics between the groups except for educational background. After the intervention, the intervention group showed significantly higher scores for self-efficacy (mean 171.28, SD 22.92 vs mean 142.21, SD 26.36; P<.001) and self-management (mean 54.16, SD 6.71 vs mean 47.58, SD 6.42; P=.001). Kidney Disease Quality of Life scores were also higher in the intervention group (mean 293.16, SD 34.21 vs mean 276.37, SD 32.21; P=.02). The number of steps per day increased in the intervention group (9768.56 in week 1 and 11,389.12 in week 12). The estimated glomerular filtration rate (eGFR) of the intervention group was higher than that of the control group (mean 72.47, SD 24.28 vs mean 59.69, SD 22.25 mL/min/1.73m2; P=.03) and the decline in eGFR was significantly slower in the intervention group (-0.56 vs -4.58 mL/min/1.73m2). There were no differences in body composition between groups postintervention. CONCLUSIONS The use of wearable devices, a health management platform, and social media support not only strengthened self-efficacy and self-management but also improved quality of life and a slower eGFR decline in people with CKD at stages 1-4. These results outline a new self-management model to promote healthy lifestyle behaviors for patients with CKD. TRIAL REGISTRATION ClinicalTrials.gov NCT04617431; https://www.clinicaltrials.gov/ct2/show/NCT04617431.
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Affiliation(s)
- Wen-Yi Li
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fu-Chun Chiu
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
| | - Jyun-Kai Zeng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Yao-Wei Li
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Su-Hua Huang
- Department of Dietetics, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
| | - Hui-Chin Yeh
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
- Department of Applied Foreign Languages, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Bor-Wen Cheng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Feng-Jung Yang
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Ćirković A. Evaluation of Four Artificial Intelligence-Assisted Self-Diagnosis Apps on Three Diagnoses: Two-Year Follow-Up Study. J Med Internet Res 2020; 22:e18097. [PMID: 33275113 PMCID: PMC7748958 DOI: 10.2196/18097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background Consumer-oriented mobile self-diagnosis apps have been developed using undisclosed algorithms, presumably based on machine learning and other artificial intelligence (AI) technologies. The US Food and Drug Administration now discerns apps with learning AI algorithms from those with stable ones and treats the former as medical devices. To the author’s knowledge, no self-diagnosis app testing has been performed in the field of ophthalmology so far. Objective The objective of this study was to test apps that were previously mentioned in the scientific literature on a set of diagnoses in a deliberate time interval, comparing the results and looking for differences that hint at “nonlocked” learning algorithms. Methods Four apps from the literature were chosen (Ada, Babylon, Buoy, and Your.MD). A set of three ophthalmology diagnoses (glaucoma, retinal tear, dry eye syndrome) representing three levels of urgency was used to simultaneously test the apps’ diagnostic efficiency and treatment recommendations in this specialty. Two years was the chosen time interval between the tests (2018 and 2020). Scores were awarded by one evaluating physician using a defined scheme. Results Two apps (Ada and Your.MD) received significantly higher scores than the other two. All apps either worsened in their results between 2018 and 2020 or remained unchanged at a low level. The variation in the results over time indicates “nonlocked” learning algorithms using AI technologies. None of the apps provided correct diagnoses and treatment recommendations for all three diagnoses in 2020. Two apps (Babylon and Your.MD) asked significantly fewer questions than the other two (P<.001). Conclusions “Nonlocked” algorithms are used by self-diagnosis apps. The diagnostic efficiency of the tested apps seems to worsen over time, with some apps being more capable than others. Systematic studies on a wider scale are necessary for health care providers and patients to correctly assess the safety and efficacy of such apps and for correct classification by health care regulating authorities.
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Nakamoto I, Jiang M, Zhang J, Zhuang W, Guo Y, Jin MH, Huang Y, Tang K. Evaluation of the Design and Implementation of a Peer-To-Peer COVID-19 Contact Tracing Mobile App (COCOA) in Japan. JMIR Mhealth Uhealth 2020; 8:e22098. [PMID: 33170801 PMCID: PMC7710388 DOI: 10.2196/22098] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 12/23/2022] Open
Abstract
We evaluate a Bluetooth-based mobile contact-confirming app, COVID-19 Contact-Confirming Application (COCOA), which is being used in Japan to contain the spread of COVID-19, the disease caused by the novel virus termed SARS-COV-2. The app prioritizes the protection of users' privacy from a variety of parties (eg, other users, potential attackers, and public authorities), enhances the capacity to balance the current load of excessive pressure on health care systems (eg, local triage of exposure risk and reduction of in-person hospital visits), increases the speed of responses to the pandemic (eg, automated recording of close contact based on proximity), and reduces operation errors and population mobility. The peer-to-peer framework of COCOA is intended to provide the public with dynamic and credible updates on the COVID-19 pandemic without sacrificing the privacy of their information. However, cautions must be exercised to address critical concerns, such as the rate of participation and delays in data sharing. The results of a simulation imply that the participation rate in Japan needs to be close 90% to effectively control the spread of COVID-19.
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Affiliation(s)
- Ichiro Nakamoto
- School of Internet Economics and Business, Fujian University of Technology, Fuzhou, China
| | - Ming Jiang
- School of Internet Economics and Business, Fujian University of Technology, Fuzhou, China
| | - Jilin Zhang
- School of Internet Economics and Business, Fujian University of Technology, Fuzhou, China
| | - Weiqing Zhuang
- School of Internet Economics and Business, Fujian University of Technology, Fuzhou, China
| | - Yan Guo
- School of Internet Economics and Business, Fujian University of Technology, Fuzhou, China
| | - Ming-Hui Jin
- School of Internet Economics and Business, Fujian University of Technology, Fuzhou, China
| | - Yi Huang
- School of Internet Economics and Business, Fujian University of Technology, Fuzhou, China
| | - Kuotai Tang
- School of Internet Economics and Business, Fujian University of Technology, Fuzhou, China
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Kanstrup AM, Bertelsen PS, Knudsen C. Changing Health Behavior with Social Technology? A Pilot Test of a Mobile App Designed for Social Support of Physical Activity. Int J Environ Res Public Health 2020; 17:E8383. [PMID: 33198364 PMCID: PMC7696553 DOI: 10.3390/ijerph17228383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022]
Abstract
Mobile applications targeting people engaged in physical activity have increased. However, while research has identified social support as a key factor for people's engagement in physical activity, most mobile health (mHealth) applications are designed for individual use. In this paper, we report on a research study exploring opportunities for designing mHealth to facilitate social support around physical activity. A mHealth application was designed, and pilot tested for eight weeks with healthcare professionals (n = 3) and two groups of citizens (n = 20) who were motivated but challenged physically due to various health conditions. Data was collected via online monitoring of the use of the mHealth application during the pilot test and via qualitative interviews with the participants before and after. The results support the idea that designing for social health support is important but so is identifying key challenges related to (i) the facilitation of technology-mediated social health support, especially to a target group that is living with health challenges, and (ii) finding a balance between social and health agendas that bring social support to the foreground for the participants.
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Affiliation(s)
- Anne Marie Kanstrup
- Department of Planning, Aalborg University, 9000 Aalborg, Denmark; (P.S.B.); (C.K.)
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Terhorst Y, Philippi P, Sander LB, Schultchen D, Paganini S, Bardus M, Santo K, Knitza J, Machado GC, Schoeppe S, Bauereiß N, Portenhauser A, Domhardt M, Walter B, Krusche M, Baumeister H, Messner EM. Validation of the Mobile Application Rating Scale (MARS). PLoS One 2020; 15:e0241480. [PMID: 33137123 PMCID: PMC7605637 DOI: 10.1371/journal.pone.0241480] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mobile health apps (MHA) have the potential to improve health care. The commercial MHA market is rapidly growing, but the content and quality of available MHA are unknown. Instruments for the assessment of the quality and content of MHA are highly needed. The Mobile Application Rating Scale (MARS) is one of the most widely used tools to evaluate the quality of MHA. Only few validation studies investigated its metric quality. No study has evaluated the construct validity and concurrent validity. OBJECTIVE This study evaluates the construct validity, concurrent validity, reliability, and objectivity, of the MARS. METHODS Data was pooled from 15 international app quality reviews to evaluate the metric properties of the MARS. The MARS measures app quality across four dimensions: engagement, functionality, aesthetics and information quality. Construct validity was evaluated by assessing related competing confirmatory models by confirmatory factor analysis (CFA). Non-centrality (RMSEA), incremental (CFI, TLI) and residual (SRMR) fit indices were used to evaluate the goodness of fit. As a measure of concurrent validity, the correlations to another quality assessment tool (ENLIGHT) were investigated. Reliability was determined using Omega. Objectivity was assessed by intra-class correlation. RESULTS In total, MARS ratings from 1,299 MHA covering 15 different health domains were included. Confirmatory factor analysis confirmed a bifactor model with a general factor and a factor for each dimension (RMSEA = 0.074, TLI = 0.922, CFI = 0.940, SRMR = 0.059). Reliability was good to excellent (Omega 0.79 to 0.93). Objectivity was high (ICC = 0.82). MARS correlated with ENLIGHT (ps<.05). CONCLUSION The metric evaluation of the MARS demonstrated its suitability for the quality assessment. As such, the MARS could be used to make the quality of MHA transparent to health care stakeholders and patients. Future studies could extend the present findings by investigating the re-test reliability and predictive validity of the MARS.
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Affiliation(s)
- Yannik Terhorst
- Department of Research Methods, Institute of Psychology and Education, University Ulm, Ulm, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Paula Philippi
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Lasse B. Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Freiburg im Breisgau, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Sarah Paganini
- Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Freiburg, Germany
| | - Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Karla Santo
- Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Cardiovascular Division, The George Institute for Global Health, Sydney, Australia
| | - Johannes Knitza
- Department of Internal Medicine 3 – Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Gustavo C. Machado
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Schoeppe
- School of Health, Medical and Applied Sciences, Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, Queensland, Australia
| | - Natalie Bauereiß
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Alexandra Portenhauser
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Benjamin Walter
- Department of Internal Medicine I, Gastroenterology, University Hospital Ulm, Ulm, Germany
| | - Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
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Carlisle N, Watson HA, Seed PT, Carter J, Kuhrt K, Tribe RM, Shennan AH. Impact of a medical mobile phone app (QUiPP) for predicting preterm birth on the anxiety and decisional conflicts faced by women in threatened preterm labour. Midwifery 2020; 92:102864. [PMID: 33137547 DOI: 10.1016/j.midw.2020.102864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The QUiPP app is a free, validated mobile phone application (app) that supports clinical decision-making for women in threatened preterm labour by providing an individualised risk of delivery within clinically important time points. Alongside generating a percentage risk score, the QUiPP app also provides the risk score in an infographic donut chart, allowing the clinician to communicate with the woman in an easy to understand format. Informing women of their risk status using the QUIPP app may help to reduce anxiety in women and decrease decisional conflict. METHOD A subset of participants from the EQUIPTT study [REC Ref. 17/LO/1802] were asked to complete a questionnaire booklet which was used to evaluate decisional conflict and anxiety. Seven sites were randomised to the QUiPP app intervention (to use as a decision and communication tool) and six sites were randomised to the control (continued their normal practice). The first section of the questionnaire booklet was completed by the woman before her assessment, and the second section after. The pre and postassessment anxiety scores utilised the Visual Analogue Scale for Anxiety (Hornblow and Kidson, 1976). The Decisional Conflict Scale (O'Connor, 1995) measured decisional conflict post assessment. The data were then analysed to determine the impact of the QUiPP App on the anxiety and decisional conflicts faced by women in threatened preterm labour. RESULTS Questionnaires were completed by 221 women from 12 of the potential 13 sites. After exclusions 202 questionnaires were included in the analysis. There was a significant reduction in difference between anxiety scores before and after clinical assessment. While there were reductions in anxiety and decisional conflict for women who were aware of the QUiPP app use, this failed to reach statistical significance. CONCLUSIONS The QUiPP app has potential to reduce anxiety and decisional conflict in women who are aware that it is being used in their care. Additional work is required to ensure clinicians are aware of the QUiPP app and optimise using it as a communication tool when counselling women.
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Affiliation(s)
- N Carlisle
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH.
| | - H A Watson
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
| | - P T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
| | - J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
| | - K Kuhrt
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
| | - R M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
| | - A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
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Kilic M, Karadağ A. Developing and Evaluating a Mobile Foot Care Application for Persons With Diabetes Mellitus: A Randomized Pilot Study. Wound Manag Prev 2020; 66:29-40. [PMID: 33048829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
UNLABELLED Ulceration of the foot is a major complication of diabetes mellitus, and optimal self-care may help prevent its development. Research suggests that mobile applications (apps) may affect behavioral change. OBJECTIVE The purpose of this study was to develop the Mobile Diabetic Foot Personal Care System (m-DAKBAS) and evaluate its effectiveness for patients with diabetes. METHOD During Phase 1, a mobile app that included communication features, remote patient monitoring, and information was developed and pilot-tested among 10 patients. The Phase 2 study, conducted from June 2017 to April 2018, used a 2-group, pre-test/post-test design to evaluate the effect of the app on patients' knowledge, behavior, and self-efficacy scores when used for 6 months. Both the experimental (app) and control groups participated in 1 education session at the start of the study. RESULTS Of 106 patients who enrolled, 88 completed the study (44 in the experimental group and 44 in the control group). Only 6 patients had received education about foot care previously. The average age of all participants was 51.63 years (SD = 8.08). There were significantly more women in the experimental group than in the control group (65% vs. 45.5%; P = 0.5). Each participant used the app for 24 weeks, and the data entry rate was 72.9%. Throughout the study, participants had 1977 data entries (blood glucose and foot observation) in total. Differences between pre- and post-intervention test scores were significantly higher for knowledge, behavior, and self-efficacy in both groups, but the difference was greater in the experimental group (P < .05). Only post-test knowledge scores were significantly higher in the experimental compared with the control group (P < .05). Compared to the start of the study, the proportion of participants with cracked/dry skin and inappropriate footwear was significantly lower in the experimental group but not in the control group. CONCLUSION In this study, education and follow-up via the mobile app and verbal-only instruction increased the knowledge, behavior, and self-efficacy scores of patients in both groups. Post-study knowledge scores were significantly higher in the experimental group than in the control group. Patient education remains a crucial component of optimal care, and further development, refinement, and testing of mobile applications to improve self-efficacy and reduce the risk of diabetic foot are warranted.
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Affiliation(s)
- Meryem Kilic
- Department of Nursing, Sanko University, Gaziantep, Turkey
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Abstract
Android is the most widely used mobile operating system (OS). A large number of third-party Android application (app) markets have emerged. The absence of third-party market regulation has prompted research institutions to propose different malware detection techniques. However, due to improvements of malware itself and Android system, it is difficult to design a detection method that can efficiently and effectively detect malicious apps for a long time. Meanwhile, adopting more features will increase the complexity of the model and the computational cost of the system. Permissions play a vital role in the security of the Android apps. Term Frequency—Inverse Document Frequency (TF-IDF) is used to assess the importance of a word for a file set in a corpus. The static analysis method does not need to run the app. It can efficiently and accurately extract the permissions from an app. Based on this cognition and perspective, in this paper, a new static detection method based on TF-IDF and Machine Learning is proposed. The system permissions are extracted in Android application package’s (Apk’s) manifest file. TF-IDF algorithm is used to calculate the permission value (PV) of each permission and the sensitivity value of apk (SVOA) of each app. The SVOA and the number of the used permissions are learned and tested by machine learning. 6070 benign apps and 9419 malware are used to evaluate the proposed approach. The experiment results show that only use dangerous permissions or the number of used permissions can’t accurately distinguish whether an app is malicious or benign. For malware detection, the proposed approach achieve up to 99.5% accuracy and the learning and training time only needs 0.05s. For malware families detection, the accuracy is 99.6%. The results indicate that the method for unknown/new sample’s detection accuracy is 92.71%. Compared against other state-of-the-art approaches, the proposed approach is more effective by detecting malware and malware families.
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Affiliation(s)
- Hongli Yuan
- Institute of information engineering, Anhui Xinhua University, Hefei, Anhui, China
- * E-mail: ; (HT) (YT)
| | - Yongchuan Tang
- School of Big Data & Software Engineering, Chongqing University, Chongqing, China
- * E-mail: ; (HT) (YT)
| | - Wenjuan Sun
- Institute of information engineering, Anhui Xinhua University, Hefei, Anhui, China
- Department of Modern Mechanics, University of Science and Technology of China, Hefei, Anhui, China
| | - Li Liu
- Institute of information engineering, Anhui Xinhua University, Hefei, Anhui, China
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Camacho E, Hoffman L, Lagan S, Rodriguez-Villa E, Rauseo-Ricupero N, Wisniewski H, Henson P, Torous J. Technology Evaluation and Assessment Criteria for Health Apps (TEACH-Apps): Pilot Study. J Med Internet Res 2020; 22:e18346. [PMID: 32535548 PMCID: PMC7484774 DOI: 10.2196/18346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/17/2020] [Accepted: 06/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Despite the emergence of app evaluation tools, there remains no well-defined process receptive to diverse local needs, rigorous standards, and current content. The need for such a process to assist in the implementation of app evaluation across all medical fields is evident. Such a process has the potential to increase stakeholder engagement and catalyze interest and engagement with present-day app evaluation models. OBJECTIVE This study aimed to develop and pilot test the Technology Evaluation and Assessment Criteria for Health apps (TEACH-apps). METHODS Tailoring a well-known implementation framework, Replicating Effective Programs, we present a new process to approach the challenges faced in implementing app evaluation tools today. As a culmination of our experience implementing this process and feedback from stakeholders, we present the four-part process to aid the implementation of mobile health technology. This paper outlines the theory, evidence, and initial versions of the process. RESULTS The TEACH-apps process is designed to be broadly usable and widely applicable across all fields of health. The process comprises four parts: (1) preconditions (eg, gathering apps and considering local needs), (2) preimplementation (eg, customizing criteria and offering digital skills training), (3) implementation (eg, evaluating apps and creating educational handouts), and (4) maintenance and evolution (eg, repeating the process every 90 days and updating content). TEACH-apps has been tested internally at our hospital, and there is growing interest in partnering health care facilities to test the system at their sites. CONCLUSIONS This implementation framework introduces a process that equips stakeholders, clinicians, and users with the foundational tools to make informed decisions around app use and increase app evaluation engagement. The application of this process may lead to the selection of more culturally appropriate and clinically relevant tools in health care.
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Affiliation(s)
- Erica Camacho
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Liza Hoffman
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Bicycle Health, Boston, MA, United States
| | - Sarah Lagan
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Elena Rodriguez-Villa
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Natali Rauseo-Ricupero
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Hannah Wisniewski
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Philip Henson
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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Young JQ, Sugarman R, Schwartz J, McClure M, O'Sullivan PS. A mobile app to capture EPA assessment data: Utilizing the consolidated framework for implementation research to identify enablers and barriers to engagement. Perspect Med Educ 2020; 9:210-219. [PMID: 32504446 PMCID: PMC7459074 DOI: 10.1007/s40037-020-00587-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Mobile apps that utilize the framework of entrustable professional activities (EPAs) to capture and deliver feedback are being implemented. If EPA apps are to be successfully incorporated into programmatic assessment, a better understanding of how they are experienced by the end-users will be necessary. The authors conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to identify enablers and barriers to engagement with an EPA app. METHODS Structured interviews of faculty and residents were conducted with an interview guide based on the CFIR. Transcripts were independently coded by two study authors using directed content analysis. Differences were resolved via consensus. The study team then organized codes into themes relevant to the domains of the CFIR. RESULTS Eight faculty and 10 residents chose to participate in the study. Both faculty and residents found the app easy to use and effective in facilitating feedback immediately after the observed patient encounter. Faculty appreciated how the EPA app forced brief, distilled feedback. Both faculty and residents expressed positive attitudes and perceived the app as aligned with the department's philosophy. Barriers to engagement included faculty not understanding the EPA framework and scale, competing clinical demands, residents preferring more detailed feedback and both faculty and residents noting that the app's feedback should be complemented by a tool that generates more systematic, nuanced, and comprehensive feedback. Residents rarely if ever returned to the feedback after initial receipt. DISCUSSION This study identified key enablers and barriers to engagement with the EPA app. The findings provide guidance for future research and implementation efforts focused on the use of mobile platforms to capture direct observation feedback.
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Affiliation(s)
- John Q Young
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Zucker Hillside Hospital at Northwell Health, Hempstead, NY, USA.
| | - Rebekah Sugarman
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Zucker Hillside Hospital at Northwell Health, Hempstead, NY, USA
| | - Jessica Schwartz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Zucker Hillside Hospital at Northwell Health, Hempstead, NY, USA
| | - Matthew McClure
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Zucker Hillside Hospital at Northwell Health, Hempstead, NY, USA
| | - Patricia S O'Sullivan
- Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, USA
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Fiador F, Poyade M, Bennett L. The Use of Augmented Reality to Raise Awareness of the Differences Between Osteoarthritis and Rheumatoid Arthritis. Adv Exp Med Biol 2020; 1262:115-147. [PMID: 32613582 DOI: 10.1007/978-3-030-43961-3_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Arthritis is one of the most common disease states worldwide but is still publicly misunderstood and lacks engaging public awareness materials. Within the UK, the most prevalent types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). The two are commonly mistaken as the same disease but, in fact, have very different pathogenesis, symptoms and treatments. This chapter describes a study which aimed to assess whether an augmented reality (AR) application could be used to raise awareness about the difference between OA and RA.An application was created for Android tablets that included labelled 3D models, animations and AR scenes triggered from a poster. In total 11 adult participants tested the application taking part in a pretest and posttest which aim to measure the usability of the application and the acquisition of knowledge on OA and RA. A T-test was performed to assess the effectiveness of the application from the pretest and posttest questionnaire outcomes. Overall results were encouraging reporting a very significant acquisition of knowledge and a highly satisfactory user experience.
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Affiliation(s)
- Florina Fiador
- School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Matthieu Poyade
- School of Simulation and Visualisation, The Glasgow School of Art, Glasgow, UK
| | - Louise Bennett
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Lee JS, Kang MA, Lee SK. Effects of the e-Motivate4Change Program on Metabolic Syndrome in Young Adults Using Health Apps and Wearable Devices: Quasi-Experimental Study. J Med Internet Res 2020; 22:e17031. [PMID: 32729838 PMCID: PMC7426802 DOI: 10.2196/17031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 05/22/2020] [Accepted: 06/14/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The health behaviors of young adults lag behind those of other age groups, and active health management is needed to improve health behaviors and prevent chronic diseases. In addition, developing good lifestyle habits earlier in life could reduce the risk of metabolic syndrome (MetS) later on. OBJECTIVE The aim of this study is to investigate the effects of the e-Motivate4Change program, for which health apps and wearable devices were selected based on user needs. The program was developed for the prevention and management of MetS in young adults. METHODS This experimental study used a nonequivalent control group. In total, 59 students from 2 universities in Daegu, Korea participated in the study (experimental group n=30; control group n=29). Data were collected over 4 months, from June 1 to September 30, 2018. The experimental group received a 12-week e-Motivate4Change program intervention, and the control group received MetS education and booklets without the e-Motivate4Change program intervention. RESULTS After the program, the experimental group had significantly higher scores for health-related lifestyle (t=3.86; P<.001) and self-efficacy (t=6.00; P<.001) than did the control group. Concerning BMI, there were significant effects by group (F=1.01; P<.001) and for the group × time interaction (F=4.71; P=.034). Concerning cholesterol, there were significant main effects for group (F=4.32; P=.042) and time (F=9.73; P<.001). CONCLUSIONS The e-Motivate4Change program effectively improved participants' health-related lifestyle scores and self-efficacy, and significantly reduced their BMI and cholesterol levels. The program can be used to identify and prevent MetS among young adults.
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Affiliation(s)
- Ji-Soo Lee
- Keimyung University, Daegu, Republic of Korea
| | - Min-Ah Kang
- Keimyung University, Daegu, Republic of Korea
- Gyeongnam Center for Infectious Disease Control and Prevention, Changwon, Republic of Korea
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Menni C, Valdes AM, Freidin MB, Sudre CH, Nguyen LH, Drew DA, Ganesh S, Varsavsky T, Cardoso MJ, El-Sayed Moustafa JS, Visconti A, Hysi P, Bowyer RCE, Mangino M, Falchi M, Wolf J, Ourselin S, Chan AT, Steves CJ, Spector TD. Real-time tracking of self-reported symptoms to predict potential COVID-19. Nat Med 2020; 26:1037-1040. [PMID: 32393804 PMCID: PMC7751267 DOI: 10.1038/s41591-020-0916-2] [Citation(s) in RCA: 829] [Impact Index Per Article: 207.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023]
Abstract
A total of 2,618,862 participants reported their potential symptoms of COVID-19 on a smartphone-based app. Among the 18,401 who had undergone a SARS-CoV-2 test, the proportion of participants who reported loss of smell and taste was higher in those with a positive test result (4,668 of 7,178 individuals; 65.03%) than in those with a negative test result (2,436 of 11,223 participants; 21.71%) (odds ratio = 6.74; 95% confidence interval = 6.31-7.21). A model combining symptoms to predict probable infection was applied to the data from all app users who reported symptoms (805,753) and predicted that 140,312 (17.42%) participants are likely to have COVID-19.
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Affiliation(s)
- Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
| | - Ana M Valdes
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Academic Rheumatology, Clinical Sciences, Nottingham City Hospital, Nottingham, UK
| | - Maxim B Freidin
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Thomas Varsavsky
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - M Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | - Alessia Visconti
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Pirro Hysi
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Ruth C E Bowyer
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' Foundation Trust, London, UK
| | - Mario Falchi
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | | | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
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Floryan M, Chow PI, Schueller SM, Ritterband LM. The Model of Gamification Principles for Digital Health Interventions: Evaluation of Validity and Potential Utility. J Med Internet Res 2020; 22:e16506. [PMID: 32519965 PMCID: PMC7315368 DOI: 10.2196/16506] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/22/2020] [Accepted: 02/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although gamification continues to be a popular approach to increase engagement, motivation, and adherence to behavioral interventions, empirical studies have rarely focused on this topic. There is a need to empirically evaluate gamification models to increase the understanding of how to integrate gamification into interventions. OBJECTIVE The model of gamification principles for digital health interventions proposes a set of five independent yet interrelated gamification principles. This study aimed to examine the validity and reliability of this model to inform its use in Web- and mobile-based apps. METHODS A total of 17 digital health interventions were selected from a curated website of mobile- and Web-based apps (PsyberGuide), which makes independent and unbiased ratings on various metrics. A total of 133 independent raters trained in gamification evaluation techniques were instructed to evaluate the apps and rate the degree to which gamification principles are present. Multiple ratings (n≥20) were collected for each of the five gamification principles within each app. Existing measures, including the PsyberGuide credibility score, mobile app rating scale (MARS), and the app store rating of each app were collected, and their relationship with the gamification principle scores was investigated. RESULTS Apps varied widely in the degree of gamification implemented (ie, the mean gamification rating ranged from 0.17≤m≤4.65 out of 5). Inter-rater reliability of gamification scores for each app was acceptable (κ≥0.5). There was no significant correlation between any of the five gamification principles and the PsyberGuide credibility score (P≥.49 in all cases). Three gamification principles (supporting player archetypes, feedback, and visibility) were significantly correlated with the MARS score, whereas three principles (meaningful purpose, meaningful choice, and supporting player archetypes) were significantly correlated with the app store rating. One gamification principle was statistically significant with both the MARS and the app store rating (supporting player archetypes). CONCLUSIONS Overall, the results support the validity and potential utility of the model of gamification principles for digital health interventions. As expected, there was some overlap between several gamification principles and existing app measures (eg, MARS). However, the results indicate that the gamification principles are not redundant with existing measures and highlight the potential utility of a 5-factor gamification model structure in digital behavioral health interventions. These gamification principles may be used to improve user experience and enhance engagement with digital health programs.
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Affiliation(s)
- Mark Floryan
- Department of Computer Science, University of Virginia, Charlottesville, VA, United States
| | - Philip I Chow
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | | | - Lee M Ritterband
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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Liu YS, Lu NH, Shieh PC, Sun CK. Combination of a Self-Regulation Module and Mobile Application to Enhance Treatment Outcome for Patients with Acne. Medicina (Kaunas) 2020; 56:E276. [PMID: 32512875 PMCID: PMC7353865 DOI: 10.3390/medicina56060276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 01/30/2023]
Abstract
Background and Objectives: Acne, an inflammatory disorder of the pilosebaceous unit associated with both physiological and psychological morbidities, should be considered a chronic disease. The application of self-regulation theory and therapeutic patient education has been widely utilized in different health-related areas to help patient with a chronic disease to attain better behavioral modification. The present study aims at investigating the treatment efficacy of combining a self-regulation-based patient education module with mobile application in acne patients. Materials and Methods: This was one-grouped pretest-posttest design at a single tertiary referral center with the enrollment of 30 subjects diagnosed with acne vulgaris. Relevant information was collected before (week 0) and after (week 4) treatment in the present study, including the Acne Self-Regulation Inventory (ASRI), Cardiff Acne Disability Index (CADI), and Dermatology Life Quality Index (DLQI) that involved a questionnaire-based subjective evaluation of the patient's ability in self-regulation and quality of life as well as clinical Acne Grading Scores (AGS) that objectively assessed changes in disease severity. To reinforce availability and feasibility, an individualized platform was accessible through mobile devices for real-time problem solving between hospital visits. Results: Thirty subjects completed the designed experiment. An analysis of the differences between scores of pretest and posttest of ASRI demonstrated substantial elevations (p < 0.001). The questionnaire survey of CADI and DLQI dropped significantly after the application of a self-regulation-based patient education module with a mobile application, revealing substantial reductions in both parameters (p < 0.001). The sign test demonstrated a remarkably significant difference in AGS (Z = -7.38, p < 0.001), indicating notable improvement in the clinical severity of acne after treatment. Conclusions: After incorporating modern mobile application, a self-regulation-based therapeutic patient education module could significantly improve treatment outcomes among acne patients.
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Affiliation(s)
- Yi-Shan Liu
- Department of Pharmacy, Tajen University, Pingtung 907391, Taiwan;
- School of Chinese Medicine for Post-Baccalaureate, College of Medicine, I-Shou University & Department of Dermatology, E-Da Hospital, Kaohsiung 824410, Taiwan
| | - Nan-Han Lu
- School of Medicine, College of Medicine, I-Shou University & Department of Radiology, E-Da Hospital, Kaohsiung 824410, Taiwan;
| | - Po-Chuen Shieh
- Department of Pharmacy, Tajen University, Pingtung 907391, Taiwan;
| | - Cheuk-Kwan Sun
- School of Medicine, College of Medicine, I-Shou University & Department of Emergency Medicine, E-Da Hospital, Kaohsiung 824410, Taiwan;
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Choi SK, Yelton B, Ezeanya VK, Kannaley K, Friedman DB. Review of the Content and Quality of Mobile Applications About Alzheimer's Disease and Related Dementias. J Appl Gerontol 2020; 39:601-608. [PMID: 30049239 PMCID: PMC6348031 DOI: 10.1177/0733464818790187] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This study reviewed the content of mobile applications (apps) providing Alzheimer's disease or related dementias (ADRD) information and assessed quality of the apps. Characteristics, content, and technical aspects of 36 apps in the U.S. Google Play Store and App Store were coded, and quality of the apps was evaluated using the Mobile Application Rating Scale. Caregiving (62.1%) and disease management (55.6%) content was frequently provided. Few apps had an app community (8.3%) or a reminder function (8.3%). Overall, quality of the apps was acceptable; apps by health care-related developers had higher quality scores than those by non-health care-related developers. This analysis showed that ADRD-related apps provide a range of content and have potential to benefit caregivers, individuals with ADRD, health care providers, and the general public. Collaboration of ADRD experts and technology experts is needed to provide evidence-based information using effective technical functions that make apps to meet users' needs.
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Affiliation(s)
- Seul Ki Choi
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208 USA
| | - Brooks Yelton
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208 USA
| | - Victor K. Ezeanya
- Department of Mathematics and Natural Science, Allen University, 1530 Harden Street, Columbia, SC 29204 USA
| | - Kristie Kannaley
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, SC 29208 USA
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior & Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208 USA
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Szinay D, Jones A, Chadborn T, Brown J, Naughton F. Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review. J Med Internet Res 2020; 22:e17572. [PMID: 32348255 PMCID: PMC7293059 DOI: 10.2196/17572] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools. OBJECTIVE This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults. METHODS We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF). RESULTS Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E). CONCLUSIONS Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps.
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Affiliation(s)
- Dorothy Szinay
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Andy Jones
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Tim Chadborn
- Behavioural Insights, Public Health England, London, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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Abstract
AIMS Many websites giving first aid advice are disappointingly inaccurate and at times dangerous in regard to burn injuries. With more patients relying on their smart phones to obtain online information the aim of this study was to compare first aid applications (apps) burn advice against those guidelines set by the British Burns Association (BBA). METHOD A content analysis of all freely available English written first aid apps from Google Play and the Apple Store was performed. The information was compared against BBA guidance which was split into 12 domains and scored appropriately. RESULTS 61 of the 103 first aid apps included in the study, had information on the treatment of burn injuries. The mean score for all apps was 3.3 out of 12. 85% of apps postulated the need to cool the burn. However, only 11% of apps stipulated the need for 20min of cooling, while 3% suggested the burn can be cooled up to 3h post injury. Disappointingly even apps produced by reputable first aid charities scored poorly. CONCLUSION Burns first aid is documented as being poorly given in the community. With easy access to the internet and specifically smart device apps, more needs to be done to improve burn first aid information online.
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Affiliation(s)
- Andrew David Kilshaw
- Department of Burns, Plastic and Reconstructive Surgery, Pinderfields General Hospital, Aberford Road, Wakefield WF14DG, UK.
| | - Sharmila Jivan
- Department of Burns, Plastic and Reconstructive Surgery, Pinderfields General Hospital, Aberford Road, Wakefield WF14DG, UK
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McCaig D, Elliott MT, Prnjak K, Walasek L, Meyer C. Engagement with MyFitnessPal in eating disorders: Qualitative insights from online forums. Int J Eat Disord 2020; 53:404-411. [PMID: 31762064 DOI: 10.1002/eat.23205] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Using calorie-counting and fitness-tracking technologies is concerning in relation to eating disorders. While studies in this area typically assess one aspect of use (e.g., frequency), engagement with a device or application is more complex. Consequently, important relationships between the use of these technologies and the eating disorder symptomatology might remain undetected. The current study therefore used comments from online eating disorder-related forums to generate comprehensive qualitative insights into engagement with a popular calorie-counting and fitness-tracking application, MyFitnessPal. METHOD First, we extracted every comment mentioning MyFitnessPal made on three eating disorder-related forums between May 2015 and January 2018 (1,695 comments from 920 commenters). Then, we conducted an inductive thematic analysis using these comments to identify important aspects of engagement with MyFitnessPal. RESULTS The analyses resulted in three themes: Preventing misuse, describing ways in which MyFitnessPal attempts to prevent pathological use and actions taken by users to circumvent its interventions; Accuracy, outlining distrust of MyFitnessPal's accuracy and ways in which perceived inaccuracy is reduced or compensated for; and Psychosocial factors, comprising cognitive, behavioral, and social factors that influence, or are influenced by, engagement with MyFitnessPal. DISCUSSION The qualitative insights provide a detailed overview of how people with high levels of eating disorder symptomatology likely engage with MyFitnessPal. The insights can be used as a basis to develop valid, quantitative assessment of pathological patterns of engagement with calorie-counting and fitness-tracking technologies. The findings can also provide clinicians with insight into how their patients likely engage with, and are affected by, these devices and applications.
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Affiliation(s)
| | | | - Katarina Prnjak
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Lukasz Walasek
- Department of Psychology, University of Warwick, Coventry, UK
| | - Caroline Meyer
- WMG, University of Warwick, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire NHS Partnership Trust, Coventry, UK
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Cai X, Qiu S, Luo D, Wang L, Lu Y, Li M. Mobile Application Interventions and Weight Loss in Type 2 Diabetes: A Meta-Analysis. Obesity (Silver Spring) 2020; 28:502-509. [PMID: 31965748 DOI: 10.1002/oby.22715] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/20/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This meta-analysis aimed to assess the effect of mobile application (app) interventions on weight loss in patients with type 2 diabetes. METHODS Electronic databases were searched for randomized controlled trials examining the use of mobile app interventions with outcomes on weight loss evaluated by body weight or other measures such as BMI or waist circumference. A random-effects model was applied to obtain weight mean differences and 95% CIs. RESULTS Fourteen studies enrolling 2,129 patients with type 2 diabetes were included. Mobile app interventions could significantly reduce body weight (weight mean difference, -0.84 kg; 95% CI: -1.51 to -0.17 kg) and lower waist circumference (-1.35 cm; 95% CI: -2.16 to -0.55 cm) but may not decrease BMI (-0.08 kg/m2 ; 95% CI: -0.41 to 0.25 kg/m2 ). The reductions appeared to be more pronounced in patients with obesity or among studies using mobile app interventions combined with other behavior components. However, weight loss was not moderated by the functionalities of the mobile apps (all Pinteraction > 0.05) or by the intervention duration (all P > 0.87). CONCLUSIONS Mobile app interventions lead to weight loss in patients with type 2 diabetes and are worth recommending for weight loss promotion.
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Affiliation(s)
- Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Shanhu Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Dan Luo
- School of Nursing, Peking University, Beijing, China
| | - Limin Wang
- School of Nursing, Peking University, Beijing, China
| | - Yanhu Lu
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
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Abstract
This article examines the privacy and security issues associated with mobile application-mediated health research, concentrating in particular on research conducted or participated in by independent scientists, citizen scientists, and patient researchers. Building on other articles in this issue that examine state research laws and state data protection laws as possible sources of privacy and security protections for mobile research participants, this article focuses on the lack of application of federal standards to mobile application-mediated health research. As discussed in more detail below, the voluminous and diverse data collected by some independent scientists who use mobile applications to conduct health research may be at risk for unregulated privacy and security breaches, leading to dignitary, psychological, and economic harms for which participants have few legally enforceable rights or remedies under current federal law. Federal lawmakers may wish to consider enacting new legislation that would require otherwise unregulated health data holders to implement reasonable data privacy, security, and breach notification measures.
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Affiliation(s)
- Stacey A Tovino
- Stacey A. Tovino, J.D., Ph.D., is the Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
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Khanh TQ, Hao PN, Roitman E, Raz I, Marganitt B, Cahn A. Digital Diabetes Care System Observations from a Pilot Evaluation Study in Vietnam. Int J Environ Res Public Health 2020; 17:ijerph17030937. [PMID: 32028707 PMCID: PMC7037177 DOI: 10.3390/ijerph17030937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 11/29/2022]
Abstract
Digital technologies are gaining an important role in the management of patients with diabetes. We assessed clinical outcomes and user satisfaction of incorporating a digital diabetes care system in diabetes clinics of a developing country. The system integrated a wireless blood glucose monitor that communicates data to any smartphone utilizing a patented acoustic data transfer method, a mobile-app, and cloud-based software that stores, analyzes, and presents data. Five hospital endocrinology clinics in Vietnam sequentially recruited all patients willing to join the study, providing they had a smartphone and access to internet connectivity. Face-to-face visits were conducted at baseline and at 12 weeks, with monthly digital visits scheduled in the interim and additional digital visits performed as needed. HbA1c levels were measured at baseline and at 12 weeks (±20 days). The study included 300 patients of whom 279 completed the evaluation. Average glucose levels declined from 170.4 ± 64.6 mg/dL in the first 2 weeks to 150.8 ± 53.2 mg/dL in the last 2 weeks (n = 221; p < 0.001). HbA1c levels at baseline and 12 weeks declined from 8.3% ± 1.9% to 7.6% ± 1.3% (n = 126; p < 0.001). The digital solution was broadly accepted by both patients and healthcare professionals and improved glycemic outcomes. The durability, scalability, and cost-effectiveness of this approach merits further study.
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Affiliation(s)
- Tran Quang Khanh
- Head of Endocrinology Department, University of Medicine and Pharmacy, Ho Chi Minh City 72000, Vietnam;
| | - Pham Nhu Hao
- Department of Endocrinology, University of Medicine and Pharmacy, Ho Chi Minh City 72000, Vietnam;
| | - Eytan Roitman
- Head Diabetes Technologies Clinic, Diabetes consultant to the Clalit Health Services, Tel Aviv 6209804, Israel;
| | - Itamar Raz
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel;
| | | | - Avivit Cahn
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel;
- Correspondence: ; Tel.: 97-226-776-498; Fax: 97-226-437-940
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Stone TE, Jia Y, Kunaviktikul W. Mobile apps: An effective, inclusive and equitable way of delivering patient and nurse education? Nurse Educ Today 2020; 85:104308. [PMID: 31785570 DOI: 10.1016/j.nedt.2019.104308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/04/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Teresa E Stone
- The Dean's Office, Building 4, Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, SriPhum District, Chiang Mai 50200, Thailand..
| | - Yue Jia
- The Dean's Office, Building 4, Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, SriPhum District, Chiang Mai 50200, Thailand
| | - Wipada Kunaviktikul
- The Dean's Office, Building 4, Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, SriPhum District, Chiang Mai 50200, Thailand..
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Goodday SM, Atkinson L, Goodwin G, Saunders K, South M, Mackay C, Denis M, Hinds C, Attenburrow MJ, Davies J, Welch J, Stevens W, Mansfield K, Suvilehto J, Geddes J. The True Colours Remote Symptom Monitoring System: A Decade of Evolution. J Med Internet Res 2020; 22:e15188. [PMID: 31939746 PMCID: PMC6996723 DOI: 10.2196/15188] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/25/2019] [Accepted: 10/22/2019] [Indexed: 01/04/2023] Open
Abstract
The True Colours remote mood monitoring system was developed over a decade ago by researchers, psychiatrists, and software engineers at the University of Oxford to allow patients to report on a range of symptoms via text messages, Web interfaces, or mobile phone apps. The system has evolved to encompass a wide range of measures, including psychiatric symptoms, quality of life, and medication. Patients are prompted to provide data according to an agreed personal schedule: weekly, daily, or at specific times during the day. The system has been applied across a number of different populations, for the reporting of mood, anxiety, substance use, eating and personality disorders, psychosis, self-harm, and inflammatory bowel disease, and it has shown good compliance. Over the past decade, there have been over 36,000 registered True Colours patients and participants in the United Kingdom, with more than 20 deployments of the system supporting clinical service and research delivery. The system has been adopted for routine clinical care in mental health services, supporting more than 3000 adult patients in secondary care, and 27,263 adolescent patients are currently registered within Oxfordshire and Buckinghamshire. The system has also proven to be an invaluable scientific resource as a platform for research into mood instability and as an electronic outcome measure in randomized controlled trials. This paper aimed to report on the existing applications of the system, setting out lessons learned, and to discuss the implications for tailored symptom monitoring, as well as the barriers to implementation at a larger scale.
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Affiliation(s)
- Sarah M Goodday
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- 4YouandMe, Seattle, WA, United States
| | - Lauren Atkinson
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Center for Human Brain Activity, University of Oxford, Oxford, United Kingdom
| | - Guy Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Matthew South
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Clare Mackay
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Mike Denis
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Chris Hinds
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Mary-Jane Attenburrow
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Jim Davies
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - James Welch
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - William Stevens
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Karen Mansfield
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Juulia Suvilehto
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Renfrew ME, Morton DP, Morton JK, Hinze JS, Beamish PJ, Przybylko G, Craig BA. A Web- and Mobile App-Based Mental Health Promotion Intervention Comparing Email, Short Message Service, and Videoconferencing Support for a Healthy Cohort: Randomized Comparative Study. J Med Internet Res 2020; 22:e15592. [PMID: 31904578 PMCID: PMC6971514 DOI: 10.2196/15592] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/14/2019] [Accepted: 10/20/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The rapid increase in mental health disorders has prompted a call for greater focus on mental health promotion and primary prevention. Web- and mobile app-based interventions present a scalable opportunity. Little is known about the influence of human support on the outcomes of these interventions. OBJECTIVE This study aimed to compare the influence of 3 modes of human support on the outcomes (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing) of a 10-week, Web- and mobile app-based, lifestyle-focused mental health promotion intervention among a healthy adult cohort. METHODS Participants were recruited voluntarily using a combination of online and offline advertising. They were randomized, unblinded into 3 groups differentiated by human support mode: Group 1 (n=201): standard-fully automated emails (S); Group 2 (n=202): standard plus personalized SMS (S+pSMS); and Group 3 (n=202): standard plus weekly videoconferencing support (S+VCS), hosted by 1 trained facilitator. Participants accessed the intervention, including the questionnaire, on a Web-based learning management system or through a mobile app. The questionnaire, administered at pre- and postintervention, contained self-reported measures of mental well-being, including the "mental health" and "vitality" subscales from the Short Form Health Survey-36, Depression Anxiety and Stress Scale-21, Diener Satisfaction With Life Scale (SWLS), and Diener Flourishing Scale. RESULTS Of 605 potential participants, 458 (S: n=157, S+pSMS: n=163, and S+VCS: n=138) entered the study by completing registration and the preintervention questionnaire. At post intervention, 320 out of 458 participants (69.9%; S: n=103, S+pSMS: n=114, and S+VCS: n=103) completed the questionnaire. Significant within-group improvements were recorded from pre- to postintervention in all groups and in every outcome measure (P≤.001). No significant between-group differences were observed for outcomes in any measure: mental health (P=.77), vitality (P=.65), depression (P=.93), anxiety (P=.25), stress (P.57), SWLS (P=.65), and Flourishing Scale (P=.99). Adherence was not significantly different between groups for mean videos watched (P=.42) and practical activity engagement (P=.71). Participation in videoconference support sessions (VCSSs) was low; 37 out of 103 (35.9%) participants did not attend any VCSSs, and only 19 out of 103 (18.4%) attended 7 or more out of 10 sessions. Stratification within the S+VCS group revealed that those who attended 7 or more VCSSs experienced significantly greater improvements in the domains of mental health (P=.006; d=0.71), vitality (P=.005; d=0.73), depression (P=.04; d=0.54), and life satisfaction (P=.046; d=0.50) compared with participants who attended less than 7. CONCLUSIONS A Web- and mobile app-based mental health promotion intervention enhanced domains of mental well-being among a healthy cohort, irrespective of human support. Low attendance at VCSSs hindered the ability to make meaningful between-group comparisons. Supplementing the intervention with VCSSs might improve outcomes when attendance is optimized. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx.
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Affiliation(s)
- Melanie Elise Renfrew
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Darren Peter Morton
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Jason Kyle Morton
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Jason Scott Hinze
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Peter James Beamish
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Geraldine Przybylko
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Bevan Adrian Craig
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
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Abstract
BACKGROUND Timely communication of critical laboratory results is important yet cumbersome. OBJECTIVE To assess the impact of a new technology on the process of reporting critical laboratory results at our 480-bed, adult/children, tertiary-care, medical school-affiliated health center in the southeastern region of the United States. METHODS We changed the process of reporting critical values by telephone only to reporting via telephone and a secure messaging app. Physician order entry, an online on-call roster for availability, and support from the C-suite (executive branch of the organization) were instrumental in implementation. RESULTS Consistently, before our process changes, more than 95% of the critical laboratory results were reported in less than 30 minutes. Use of the app reduced the time taken for reporting results. The need to involve pathology residents and attending physicians in reporting has been eliminated by this process. DISCUSSION Secure messaging has facilitated the reporting of critical laboratory values, making it more efficient and providing a reliable record of the process. This process meets or exceeds the standards of the accrediting agencies. The method is suitable for activating rapid-response teams in case of hypercritical values.
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Affiliation(s)
- Alex Clavijo
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, GA
| | - David Fallaw
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, GA
| | - Philip Coule
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, GA
| | - Gurmukh Singh
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, GA
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