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Bricker JB, Mull KE, Kientz JA, Vilardaga R, Mercer LD, Akioka KJ, Heffner JL. Randomized, controlled pilot trial of a smartphone app for smoking cessation using acceptance and commitment therapy. Drug Alcohol Depend 2014; 143:87-94. [PMID: 25085225 PMCID: PMC4201179 DOI: 10.1016/j.drugalcdep.2014.07.006] [Citation(s) in RCA: 223] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/08/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is a dual need for (1) innovative theory-based smartphone applications for smoking cessation and (2) controlled trials to evaluate their efficacy. Accordingly, this study tested the feasibility, acceptability, preliminary efficacy, and mechanism of behavioral change of an innovative smartphone-delivered acceptance and commitment therapy (ACT) application for smoking cessation vs. an application following US Clinical Practice Guidelines. METHOD Adult participants were recruited nationally into the double-blind randomized controlled pilot trial (n=196) that compared smartphone-delivered ACT for smoking cessation application (SmartQuit) with the National Cancer Institute's application for smoking cessation (QuitGuide). RESULTS We recruited 196 participants in two months. SmartQuit participants opened their application an average of 37.2 times, as compared to 15.2 times for QuitGuide participants (p<0001). The overall quit rates were 13% in SmartQuit vs. 8% in QuitGuide (OR=2.7; 95% CI=0.8-10.3). Consistent with ACT's theory of change, among those scoring low (below the median) on acceptance of cravings at baseline (n=88), the quit rates were 15% in SmartQuit vs. 8% in QuitGuide (OR=2.9; 95% CI=0.6-20.7). CONCLUSIONS ACT is feasible to deliver by smartphone application and shows higher engagement and promising quit rates compared to an application that follows US Clinical Practice Guidelines. As results were limited by the pilot design (e.g., small sample), a full-scale efficacy trial is now needed.
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA; University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, USA.
| | - Kristin E Mull
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Julie A Kientz
- University of Washington, Department of Human Centered Design and Engineering, Box 352315, Seattle, WA 98195, USA
| | - Roger Vilardaga
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA; University of Washington, Department of Psychiatry and Behavioral Sciences, Box 356560, Seattle, WA 98195, USA
| | - Laina D Mercer
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Katrina J Akioka
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
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5452
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Chandra PS, Sowmya HR, Mehrotra S, Duggal M. 'SMS' for mental health—feasibility and acceptability of using text messages for mental health promotion among young women from urban low income settings in India. Asian J Psychiatr 2014; 11:59-64. [PMID: 25453699 DOI: 10.1016/j.ajp.2014.06.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/11/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The current study assesses the acceptability and feasibility of mobile text messages for promoting positive mental health and as a helpline among young women in urban slums of Bangalore. METHODOLOGY Forty girls in the age range of 16-18 years from urban slums received messages every day for a month. They could call or message back or give a 'missed call' to the same number whenever they had emotional problems or felt like talking to a counselor. The received responses in the form of return texts, missed calls and return phone calls were recorded. Feedback about the feasibility and acceptability of the mobile messages was collected after a month. RESULTS 25 out of 40 (62.5%) participants called back, asking for mental health services and to say they felt good about the messages. 23 of 40 (57.5%) messaged back regarding their feelings. 62% reported that they felt supported with the mental health messages. Male family members of nearly half of the participants called back to check the authenticity of the source. Most women did not face any problems because of the messages. CONCLUSION This pilot qualitative study indicates that mobile text messages are a feasible and culturally acceptable method for mental health promotion and prevention among young women from urban slums in India. Issues such as consent from the woman and family, ensuring confidentiality and providing authentic and reliable support services, need to be taken into account before attempting to scale up such a service, particularly in vulnerable groups.
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Affiliation(s)
- Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
| | - H R Sowmya
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Seema Mehrotra
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mona Duggal
- Policy Center for Biomedical Research, Translational Health Science and Technology Institute, (Under DBT, GoI) National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi 110067, India
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5453
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Allison SM, Adams D, Klindera KC, Poteat T, Wolf RC. Innovative uses of communication technology for HIV programming for men who have sex with men and transgender persons. J Int AIDS Soc 2014; 17:19041. [PMID: 25280864 DOI: 10.7448/IAS.17.1.19041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/05/2014] [Accepted: 09/02/2014] [Indexed: 12/01/2022] Open
Abstract
Globally, overall rates of HIV are on the decline; however, rates among gay men and other men who have sex with men (MSM) and transgender persons are increasing. Meanwhile, there has been exponential growth in access to communication technology over the last decade. More innovative prevention and care technology-based programmes are needed to help address the growing numbers of MSM and transgender persons living with HIV and those at risk for infection. To address this need, a meeting was hosted by the U.S. Agency for International Development (USAID) through the President's Emergency Plan for AIDS Relief (PEPFAR) and co-sponsored by amfAR, The Foundation for AIDS Research and the National Institute of Mental Health (NIMH). The meeting brought together researchers, community implementers, advocates and federal partners to discuss the current landscape of technology-based interventions for MSM and transgender persons and to discuss key considerations. Presentations and discussions focused on the research gaps, facilitators and barriers to programme implementation and public–private partnerships. This article summarizes the meeting proceedings and outlines key considerations for future work in this area.
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5454
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Roth WR, Vilardaga R, Wolfe N, Bricker JB, McDonell MG. Practical considerations in the design and development of smartphone apps for behavior change. J Contextual Behav Sci 2014; 3:269-272. [PMID: 25485231 DOI: 10.1016/j.jcbs.2014.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The fast adoption of smartphone applications (apps) by behavioral scientists pose a new host of opportunities as well as knowledge and interdisciplinary challenges. Therefore, this brief report will discuss the lessons we have learned during the development and testing of smartphone apps for behavior change, and provide the reader with guidance and recommendations about this design and development process. We hope that the guidance and perspectives presented in this brief report will empower behavioral scientists to test the efficacy of smartphone apps for behavior change, further advance the contextual behavioral etiology of behavioral disorders and help move the field towards personalized behavior change technologies.
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Affiliation(s)
| | - Roger Vilardaga
- University of Washington & Fred Hutchinson Cancer Research Center
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5455
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Lewis TL, Wyatt JC. mHealth and mobile medical Apps: a framework to assess risk and promote safer use. J Med Internet Res 2014; 16:e210. [PMID: 25223398 PMCID: PMC4180335 DOI: 10.2196/jmir.3133] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [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: 11/25/2013] [Revised: 02/11/2014] [Accepted: 04/11/2014] [Indexed: 12/16/2022] Open
Abstract
The use of mobile medical apps by clinicians and others has grown considerably since the introduction of mobile phones. Medical apps offer clinicians the ability to access medical knowledge and patient data at the point of care, but several studies have highlighted apps that could compromise patient safety and are potentially dangerous. This article identifies a range of different kinds of risks that medical apps can contribute to and important contextual variables that can modify these risks. We have also developed a simple generic risk framework that app users, developers, and other stakeholders can use to assess the likely risks posed by a specific app in a specific context. This should help app commissioners, developers, and users to manage risks and improve patient safety.
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5456
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Abstract
BACKGROUND The use of mobile devices to deliver healthcare has not yet been exploited in neuropsychological rehabilitation. Smartphones have the potential to serve as multi-functional memory aids. AIMS To investigate whether patients attending a clinic for mixed memory problems own smartphones, to determine whether this could be a widely applicable medium to use as a memory aids device. METHODS A questionnaire on smartphone ownership was given to an opportunity sample of consecutive patients attending a neuropsychiatry and memory disorders outpatient clinic. Data were collected in 2012 and repeated 12 months later in 2013 to assess changes over time. RESULTS Ownership of mobile phones was stable between 2012 (81%) and 2013 (85%), but ownership of smartphones showed a significant increase (from 26% to 40%). Age negatively predicted smartphone ownership. CONCLUSION Despite cognitive or psychiatric problems, our patient group are as likely to own a mobile phone as a member of the general population. Ownership levels are at 40% and likely to increase in the future. Exploring how smartphones and their apps could function as memory aids is likely to be useful for a large enough number of patients to be clinically worthwhile.
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Affiliation(s)
- Ellen M Migo
- a Academic Unit of Neuropsychiatry, Department of Psychological Medicine , Institute of Psychiatry, King's College London , London , UK and
| | - Becky I Haynes
- a Academic Unit of Neuropsychiatry, Department of Psychological Medicine , Institute of Psychiatry, King's College London , London , UK and
| | - Lara Harris
- a Academic Unit of Neuropsychiatry, Department of Psychological Medicine , Institute of Psychiatry, King's College London , London , UK and
| | - Kim Friedner
- a Academic Unit of Neuropsychiatry, Department of Psychological Medicine , Institute of Psychiatry, King's College London , London , UK and
| | - Kate Humphreys
- b Neuropsychiatry and Memory Disorders Clinic, South London and Maudsley NHS Foundation Trust, St Thomas's Hospital , London , UK
| | - Michael D Kopelman
- a Academic Unit of Neuropsychiatry, Department of Psychological Medicine , Institute of Psychiatry, King's College London , London , UK and.,b Neuropsychiatry and Memory Disorders Clinic, South London and Maudsley NHS Foundation Trust, St Thomas's Hospital , London , UK
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5457
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Rodrigues R, Bogg L, Shet A, Kumar DS, De Costa A. Mobile phones to support adherence to antiretroviral therapy: what would it cost the Indian National AIDS Control Programme? J Int AIDS Soc 2014; 17:19036. [PMID: 25186918 DOI: 10.7448/IAS.17.1.19036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 05/26/2014] [Accepted: 06/11/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Adherence to antiretroviral treatment (ART) is critical to maintaining health and good clinical outcomes in people living with HIV/AIDS. To address poor treatment adherence, low-cost interventions using mobile communication technology are being studied. While there are some studies that show an effect of mobile phone reminders on adherence to ART, none has reported on the costs of such reminders for national AIDS programmes. This paper aims to study the costs of mobile phone reminder strategies (mHealth interventions) to support adherence in the context of India's National AIDS Control Program (NACP). METHODS The study was undertaken at two tertiary level teaching hospitals that implement the NACP in Karnataka state, South India. Costs for a mobile phone reminder application to support adherence, implemented at these sites (i.e. weekly calls, messages or both) were studied. Costs were collected based on the concept of avoidable costs specific to the application. The costs that were assessed were one-time costs and recurrent costs that included fixed and variable costs. A sequential procedure for costing was used. Costs were calculated at national-programme level, individual ART-centre level and individual patient level from the NACP's perspective. The assessed costs were pooled to obtain an annual cost per patient. The type of application, number of ART centres and number of patients on ART were varied in a sensitivity analysis of costs. RESULTS The Indian NACP would incur a cost of between 79 and 110 INR (USD 1.27-1.77) per patient per year, based on the type of reminder, the number of patients on ART and the number of functioning ART centres. The total programme costs for a scale-up of the mHealth intervention to reach the one million patients expected to be on treatment by 2017 is estimated to be 0.36% of the total five-year national-programme budget. CONCLUSIONS The cost of the mHealth intervention for ART-adherence support in the context of the Indian NACP is low and is facilitated by the low cost of mobile communication in the country. Extending the use of mobile communication applications beyond adherence support under the national programme could be done relatively inexpensively.
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5458
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Kurti AN, Dallery J. INTEGRATING TECHNOLOGICAL ADVANCEMENTS IN BEHAVIORAL INTERVENTIONS TO PROMOTE HEALTH: UNPRECEDENTED OPORTUNITIES FOR BEHAVIOR ANALYSTS. Rev Mex Anal Conducta 2014; 40:106-126. [PMID: 25774070 PMCID: PMC4358800] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The use of mobile devices is growing worldwide in both industrialized and developing nations. Alongside the worldwide penetration of web-enabled devices, the leading causes of morbidity and mortality are increasingly modifiable lifestyle factors (e.g., improving one's diet and exercising more). Behavior analysts have the opportunity to promote health by combining effective behavioral methods with technological advancements. The objectives of this paper are (1) to highlight the public health gains that may be achieved by integrating technology with a behavior analytic approach to developing interventions, and (2) to review some of the currently, under-examined issues related to merging technology and behavior analysis (enhancing sustainability, obtaining frequent measures of behavior, conducting component analyses, evaluating cost-effectiveness, incorporating behavior analysis in the creation of consumer-based applications, and reducing health disparities). Thorough consideration of these issues may inspire the development, implementation, and dissemination of innovative, efficacious interventions that substantially improve global public health.
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5459
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Abstract
Adolescents and young adults use text messaging as their primary mode of communication, thus providing an opportunity to use this mode of communication for mobile health (mHealth) interventions. Youth with diabetes are an important group for these mHealth initiatives, as diabetes management requires an enormous amount of daily effort and this population has difficulty achieving optimal diabetes management. Goal setting and self-efficacy are 2 factors in the management of diabetes. We examined the feasibility of a healthy lifestyle text messaging program targeting self-efficacy and goal setting among adolescents and young adults with diabetes. Participants, ages 16-21, were assigned to either a text messaging group, which received daily motivational messages about nutrition and physical activity, or a control group, which received paper-based information about healthy lifestyle. Both groups set goals for nutrition and physical activity and completed a measure of self-efficacy. Participants' mean age was 18.7 ± 1.6 years old, with diabetes duration of 10.0 ± 4.6 years, and A1c of 8.7 ± 1.7%. The text messaging intervention was rated highly and proved to be acceptable to participants. Self-efficacy, glycemic control, and body mass index did not change over the course of the short, 1-month pilot study. Positive, daily, motivational text messages may be effective in increasing motivation for small goal changes in the areas of nutrition and physical activity. These interventions may be used in the future in youth with diabetes to improve diabetes care. Utilizing more targeted text messages is an area for future research.
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Affiliation(s)
- Jessica T Markowitz
- Department of Pediatrics and Epidemiology, Joslin Diabetes Center, Boston, MA, USA
| | | | - Debra L Franko
- Department of Counseling & Applied Educational Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Alan T Schultz
- Department of Pediatrics and Epidemiology, Joslin Diabetes Center, Boston, MA, USA
| | | | - Rachel Rodgers
- Department of Counseling & Applied Educational Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Lori M B Laffel
- Department of Pediatrics and Epidemiology, Joslin Diabetes Center, Boston, MA, USA
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5460
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Abstract
Modifiable behavioral risk factors such as cigarette smoking, physical inactivity, and obesity contribute to over 40 % of premature deaths in the USA. Advances in digital and information technology are creating unprecedented opportunities for behavior analysts to assess and modify these risk factors. Technological advances include mobile devices, wearable sensors, biomarker detectors, and real-time access to therapeutic support via information technology. Integrating these advances with behavioral technology in the form of conceptually systematic principles and procedures could usher in a new generation of effective and scalable behavioral interventions targeting health behavior. In this selective review of the literature, we discuss how technological tools can assess and modify a range of antecedents and consequences of healthy and unhealthy behavior. We also describe practical, methodological, and conceptual advantages for behavior analysts that stem from the use of technology to assess and treat health behavior.
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Affiliation(s)
- Jesse Dallery
- Department of Psychology, University of Florida, P. O. Box 112250, Gainesville, FL 32611 USA
| | - Allison Kurti
- Department of Psychology, University of Florida, P. O. Box 112250, Gainesville, FL 32611 USA
| | - Philip Erb
- Department of Psychology, University of Florida, P. O. Box 112250, Gainesville, FL 32611 USA
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5461
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Mobasheri MH, Johnston M, King D, Leff D, Thiruchelvam P, Darzi A. Smartphone breast applications - what's the evidence? Breast 2014; 23:683-9. [PMID: 25153432 DOI: 10.1016/j.breast.2014.07.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/30/2014] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION There are around 40,000 healthcare applications (apps) available for smartphones. Apps have been reviewed in many specialties. Breast cancer is the most common malignancy in females with almost 1.38 million new cases a year worldwide. Despite the high prevalence of breast disease, apps in this field have not been reviewed to date. We have evaluated apps relevant to breast disease with an emphasis on their evidence base (EB) and medical professional involvement (MPI). METHODS Searching the major app stores (apple iTunes, Google Play, BlackBerry World, Windows Phone) using the most common breast symptoms and diseases identified relevant apps. Extracted data for each app included target consumer, disease focus, app function, documentation of any EB, documentation of MPI in development, and potential safety concerns. RESULTS One-hundred-and-eighty-five apps were reviewed. The majority focused on breast cancer (n = 139, 75.1%). Educational (n = 94) and self-assessment tools (n = 30) were the most common functions demonstrated. EB and MPI was identified in 14.2% and 12.8% of apps respectively. Potential safety concerns were identified in 29 (15.7%) apps. CONCLUSIONS There is a lack of EB and MPI in the development of current breast apps. Safety concerns highlight the need for regulation, full authorship disclosure and clinical trials. A robust framework for identifying high quality applications is necessary. This will address the current barrier pertaining to a lack of consumer confidence in their use and further aid to promote their widespread implementation within healthcare.
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Affiliation(s)
| | | | - Dominic King
- Institute of Global Health Innovation, Imperial College London, UK.
| | - Daniel Leff
- Institute of Global Health Innovation, Imperial College London, UK.
| | | | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, UK.
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5462
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Hundert AS, Huguet A, McGrath PJ, Stinson JN, Wheaton M. Commercially available mobile phone headache diary apps: a systematic review. JMIR Mhealth Uhealth 2014; 2:e36. [PMID: 25138438 PMCID: PMC4147710 DOI: 10.2196/mhealth.3452] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/07/2014] [Accepted: 07/07/2014] [Indexed: 11/25/2022] Open
Abstract
Background Headache diaries are often used by headache sufferers to self-monitor headaches. With advances in mobile technology, mobile electronic diary apps are becoming increasingly common. Objective This review aims to identify and evaluate all commercially available mobile headache diary apps for the two most popular mobile phone platforms, iOS and Android. Methods The authors developed a priori a set of 7 criteria that define an ideal headache diary app intended to help headache sufferers better understand and manage their headaches, while providing relevant data to health professionals. The app criteria were intended as minimum requirements for an acceptable headache diary app that could be prescribed by health care professionals. Each app was evaluated and scored against each criterion. Results Of the 38 apps identified, none of the apps met all 7 app criteria. The 3 highest scoring apps, meeting 5 of the app criteria, were iHeadache (developed by Better QOL), ecoHeadache (developed by ecoTouchMedia), and Headache Diary Pro (developed by Froggyware). Only 18% of the apps were created with scientific or clinical headache expertise and none of the apps reported on psychometric properties. Conclusions Despite the growing market and demand, there is a concerning lack of scientific expertise and evidence base associated with headache diary apps.
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5463
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Tufts KA, Johnson KF, Shepherd JG, Lee JY, Bait Ajzoon MS, Mahan LB, Kim MT. Novel interventions for HIV self-management in African American women: a systematic review of mHealth interventions. J Assoc Nurses AIDS Care 2015; 26:139-50. [PMID: 25283352 DOI: 10.1016/j.jana.2014.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/04/2014] [Indexed: 01/05/2023]
Abstract
The purpose of this systematic review was to assess the quality of interventions using mobile health (mHealth) technology being developed for and trialed with HIV-infected African American (AA) women. We aimed to assess rigor and to ascertain if these interventions have been expanded to include the broad domain of self-management. After an extensive search using the PRISMA approach and reviewing 450 records (411 published studies and 39 ongoing trials at clinicaltrials.gov), we found little completed research that tested mHealth HIV self-management interventions for AA women. At clinicaltrials.gov, we found several mHealth HIV intervention studies designed for women in general, forecasting a promising future. However, most studies were exploratory in nature and focused on a single narrow outcome, such as medication adherence. Given that cultural adaptation is the key to successfully implementing any effective self-management intervention, culturally relevant, gender-specific mHealth interventions focusing on HIV-infected AA women are warranted for the future.
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5464
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Abstract
Chronic obstructive pulmonary disease (COPD) represents one of the main causes of death worldwide. It affects hundreds of millions of people and is likely to spread further in the coming years. Despite the chronic nature of the disease and the proven efficacy of current therapies, treatment nonadherence is unfortunately common and too often related to treatment failure, disease exacerbations, hospitalizations, and high healthcare costs. At present, studies aimed to assess and improve patients' adherence in chronic respiratory diseases--and especially in COPD--are limited, but a review of the few data available makes it clear that there is a need for an innovative approach that leverages health technology to encourage patients to adhere to prescribed chronic treatments.
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Affiliation(s)
- Francesco Blasi
- 1Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico , Milano , Italy
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5465
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Crutzen R. The behavioral intervention technology model and intervention mapping: the best of both worlds. J Med Internet Res 2014; 16:e188. [PMID: 25095730 PMCID: PMC4129185 DOI: 10.2196/jmir.3620] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/30/2014] [Accepted: 08/04/2014] [Indexed: 01/26/2023] Open
Affiliation(s)
- Rik Crutzen
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands.
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5466
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Nemiroski A, Christodouleas DC, Hennek JW, Kumar AA, Maxwell EJ, Fernández-Abedul MT, Whitesides GM. Universal mobile electrochemical detector designed for use in resource-limited applications. Proc Natl Acad Sci U S A 2014; 111:11984-9. [PMID: 25092346 DOI: 10.1073/pnas.1405679111] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This paper describes an inexpensive, handheld device that couples the most common forms of electrochemical analysis directly to "the cloud" using any mobile phone, for use in resource-limited settings. The device is designed to operate with a wide range of electrode formats, performs on-board mixing of samples by vibration, and transmits data over voice using audio--an approach that guarantees broad compatibility with any available mobile phone (from low-end phones to smartphones) or cellular network (second, third, and fourth generation). The electrochemical methods that we demonstrate enable quantitative, broadly applicable, and inexpensive sensing with flexibility based on a wide variety of important electroanalytical techniques (chronoamperometry, cyclic voltammetry, differential pulse voltammetry, square wave voltammetry, and potentiometry), each with different uses. Four applications demonstrate the analytical performance of the device: these involve the detection of (i) glucose in the blood for personal health, (ii) trace heavy metals (lead, cadmium, and zinc) in water for in-field environmental monitoring, (iii) sodium in urine for clinical analysis, and (iv) a malarial antigen (Plasmodium falciparum histidine-rich protein 2) for clinical research. The combination of these electrochemical capabilities in an affordable, handheld format that is compatible with any mobile phone or network worldwide guarantees that sophisticated diagnostic testing can be performed by users with a broad spectrum of needs, resources, and levels of technical expertise.
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5467
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Brian RM, Ben-Zeev D. Mobile health ( mHealth) for mental health in Asia: objectives, strategies, and limitations. Asian J Psychiatr 2014; 10:96-100. [PMID: 25042960 DOI: 10.1016/j.ajp.2014.04.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/15/2014] [Accepted: 04/18/2014] [Indexed: 11/15/2022]
Abstract
Mobile technologies are transforming the way in which we interact with one another, access resources, find information, and conduct business around the world. Harnessing the capabilities of mobile technologies to support health care initiatives worldwide has developed into a new interdisciplinary field called mobile health (mHealth). In the current paper, we review the penetration of mobile technology in Asia, and consider the integration of mobile technologies into the study, diagnoses, and treatment of mental disorders in the region. We outline how mHealth programs could improve mental health literacy, provide greater access to mental health services, extend community-based outreach and engagement, support self-management of illness, and regulate medication distribution. We end with a consideration of the potential barriers and limitations of mHealth for mental health, including funding, language and literacy barriers, power supply considerations, data security, and privacy issues.
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Affiliation(s)
- Rachel M Brian
- Dartmouth Psychiatric Research Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Dror Ben-Zeev
- Dartmouth Psychiatric Research Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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5468
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Ni Mhurchu C, Whittaker R, McRobbie H, Ball K, Crawford D, Michie J, Jiang Y, Maddison R, Waterlander W, Myers K. Feasibility, acceptability and potential effectiveness of a mobile health ( mHealth) weight management programme for New Zealand adults. BMC Obes 2014. [PMID: 26217502 PMCID: PMC4511428 DOI: 10.1186/2052-9538-1-10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Mobile health (mHealth) behaviour change programmes use mobile phones and the internet to deliver health information and behaviour change support to participants. Such programmes offer a potentially cost-effective way to reach many individuals who do not currently access weight loss services. We developed a mHealth weight management programme using proven face-to-face behaviour change techniques and incorporating target population input. Our aim was to evaluate the feasibility, acceptability and potential effectiveness of this programme for ethnically diverse adults with a view to informing a larger trial. Results Fifty three adults who had a BMI of ≥25 kg/m2 and wanted to lose weight (81% female, mean age 42 years, mean BMI 35.7 kg/m2, 26% Maori, 34% Pacific) received the eight-week mHealth weight loss programme. Anthropometric measures were taken at two face-to-face assessments at baseline and 12-weeks (i.e. four weeks after cessation of intervention). Twelve-week follow-up measurements were available for 36/53 participants (68%). Non-completers were younger and more likely to be male and of Pacific ethnicity. Thirty five participants (66%) reported reading ‘all or most’ text messages sent and 96% responded to at least one text data collection question over the eight-week active intervention period. Eighty one per cent of participants logged in to the study website at least once during the eight-week study period. In the intention-to-treat analysis, mean weight change was -1.0 kg (SD 3.1) at 12 weeks (p = 0.024) and change in BMI was -0.34 kg/m2 (SD 1.1) (p = 0.026). In the completers only analysis (n = 36), mean weight change was -1.4 kg (SD 3.6) (p = 0.023) and change in BMI was -0.50 kg/m2 (SD 1.3) (p = 0.025). Conclusions A mHealth weight management programme is feasible to deliver to an ethnically diverse population. Changes in body weight and BMI at 12 weeks indicate that the programme could be effective in supporting people with weight loss. However, the high dropout rate indicates a need for further improvements to the programme. Trial registration ACTRN12612000850875
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Affiliation(s)
- Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Hayden McRobbie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Kylie Ball
- Centre for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - David Crawford
- Centre for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Jo Michie
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Ralph Maddison
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Wilma Waterlander
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Katie Myers
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
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5469
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Lewis TL, Boissaud-Cooke MA, Aungst TD, Eysenbach G. Consensus on use of the term "App" versus "Application" for reporting of mHealth research. J Med Internet Res 2014; 16:e174; discussion e174. [PMID: 25033233 PMCID: PMC4129112 DOI: 10.2196/jmir.3460] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/14/2014] [Indexed: 11/13/2022] Open
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5470
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Jadhav A, Andrews D, Fiksdal A, Kumbamu A, McCormick JB, Misitano A, Nelsen L, Ryu E, Sheth A, Wu S, Pathak J. Comparative analysis of online health queries originating from personal computers and smart devices on a consumer health information portal. J Med Internet Res 2014; 16:e160. [PMID: 25000537 PMCID: PMC4115262 DOI: 10.2196/jmir.3186] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/20/2014] [Accepted: 05/31/2014] [Indexed: 11/18/2022] Open
Abstract
Background The number of people using the Internet and mobile/smart devices for health information seeking is increasing rapidly. Although the user experience for online health information seeking varies with the device used, for example, smart devices (SDs) like smartphones/tablets versus personal computers (PCs) like desktops/laptops, very few studies have investigated how online health information seeking behavior (OHISB) may differ by device. Objective The objective of this study is to examine differences in OHISB between PCs and SDs through a comparative analysis of large-scale health search queries submitted through Web search engines from both types of devices. Methods Using the Web analytics tool, IBM NetInsight OnDemand, and based on the type of devices used (PCs or SDs), we obtained the most frequent health search queries between June 2011 and May 2013 that were submitted on Web search engines and directed users to the Mayo Clinic’s consumer health information website. We performed analyses on “Queries with considering repetition counts (QwR)” and “Queries without considering repetition counts (QwoR)”. The dataset contains (1) 2.74 million and 3.94 million QwoR, respectively for PCs and SDs, and (2) more than 100 million QwR for both PCs and SDs. We analyzed structural properties of the queries (length of the search queries, usage of query operators and special characters in health queries), types of search queries (keyword-based, wh-questions, yes/no questions), categorization of the queries based on health categories and information mentioned in the queries (gender, age-groups, temporal references), misspellings in the health queries, and the linguistic structure of the health queries. Results Query strings used for health information searching via PCs and SDs differ by almost 50%. The most searched health categories are “Symptoms” (1 in 3 search queries), “Causes”, and “Treatments & Drugs”. The distribution of search queries for different health categories differs with the device used for the search. Health queries tend to be longer and more specific than general search queries. Health queries from SDs are longer and have slightly fewer spelling mistakes than those from PCs. Users specify words related to women and children more often than that of men and any other age group. Most of the health queries are formulated using keywords; the second-most common are wh- and yes/no questions. Users ask more health questions using SDs than PCs. Almost all health queries have at least one noun and health queries from SDs are more descriptive than those from PCs. Conclusions This study is a large-scale comparative analysis of health search queries to understand the effects of device type (PCs vs SDs) used on OHISB. The study indicates that the device used for online health information search plays an important role in shaping how health information searches by consumers and patients are executed.
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Affiliation(s)
- Ashutosh Jadhav
- Knoesis Ceneter, Computer Science and Engineering, Wright State University, Dayton, OH, United States
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5471
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Hameed AS, Sauermann S, Schreier G. The impact of adherence on costs and effectiveness of telemedical patient management in heart failure: a systematic review. Appl Clin Inform 2014; 5:612-20. [PMID: 25298802 PMCID: PMC4187079 DOI: 10.4338/aci-2014-04-ra-0037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 04/21/2014] [Accepted: 05/21/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This paper analyzes evidence of the impact of patients' adherence to pharmacological and non-pharmacological recommendations on the treatment costs of heart failure (HF) patients. METHODS A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Papers were searched using various combinations of the following keywords: 'telemedicine', 'telemonitoring', 'telehealth', 'eHealth', 'remote monitoring', 'adherence', 'compliance', 'cost-effectiveness', 'cost-benefit', 'heart failure', 'healthcare costs', 'hospitalization', and 'drug costs'. We included only papers written in English or German, published between 1998 and 2014, and having one of our search terms in the title. RESULTS Initially, 73 papers were selected. After a detailed review, these were narrowed done to 9 that reported an association between adherence and/or compliance and costs. However, none established a quantitative relationship between adherence and total healthcare costs. CONCLUSION A model-based cost-effectiveness analysis that appropriately considers adherence has not been carried out so far, but is needed to fully understand the potential economic benefits of telehealth.
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Affiliation(s)
- A. S. Hameed
- Faculty of Business and Economics, Mendel University, Brno, Czech Republic
- Assistive Healthcare Information Technology, AIT Austrian Institute of Technology GmbH, Graz, Austria
| | - S. Sauermann
- Institute of Biomedical Engineering, University of Applied Sciences Technikum Vienna, Austria
| | - G. Schreier
- Assistive Healthcare Information Technology, AIT Austrian Institute of Technology GmbH, Graz, Austria
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5472
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Abstract
Effective chronic disease management is essential to improve positive health outcomes, and incentive strategies are useful in promoting self-care with longevity. Gamification, applied with mHealth (mobile health) applications, has the potential to better facilitate patient self-management. This review article addresses a knowledge gap around the effective use of gamification design principles, or mechanics, in developing mHealth applications. Badges, leaderboards, points and levels, challenges and quests, social engagement loops, and onboarding are mechanics that comprise gamification. These mechanics are defined and explained from a design and development perspective. Health and fitness applications with gamification mechanics include: bant which uses points, levels, and social engagement, mySugr which uses challenges and quests, RunKeeper which uses leaderboards as well as social engagement loops and onboarding, Fitocracy which uses badges, and Mango Health, which uses points and levels. Specific design considerations are explored, an example of the efficacy of a gamified mHealth implementation in facilitating improved self-management is provided, limitations to this work are discussed, a link between the principles of gaming and gamification in health and wellness technologies is provided, and suggestions for future work are made. We conclude that gamification could be leveraged in developing applications with the potential to better facilitate self-management in persons with chronic conditions.
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Affiliation(s)
- Aaron S Miller
- Centre for Global eHealth Innovation, University Health Network, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Joseph A Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network; Institute of Health Policy, Management and Evaluation, University of Toronto; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Canada
| | - Emily Seto
- Centre for Global eHealth Innovation, Techna Institute, University Health Network; Institute of Health Policy, Management and Evaluation, University of Toronto
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5473
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Eskenazi B, Quirós-Alcalá L, Lipsitt JM, Wu LD, Kruger P, Ntimbane T, Nawn JB, Bornman MSR, Seto E. mSpray: a mobile phone technology to improve malaria control efforts and monitor human exposure to malaria control pesticides in Limpopo, South Africa. Environ Int 2014; 68:219-226. [PMID: 24769412 PMCID: PMC4404295 DOI: 10.1016/j.envint.2014.03.003] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/28/2014] [Accepted: 03/04/2014] [Indexed: 05/30/2023]
Abstract
Recent estimates indicate that malaria has led to over half a million deaths worldwide, mostly to African children. Indoor residual spraying (IRS) of insecticides is one of the primary vector control interventions. However, current reporting systems do not obtain precise location of IRS events in relation to malaria cases, which poses challenges for effective and efficient malaria control. This information is also critical to avoid unnecessary human exposure to IRS insecticides. We developed and piloted a mobile-based application (mSpray) to collect comprehensive information on IRS spray events. We assessed the utility, acceptability and feasibility of using mSpray to gather improved homestead- and chemical-level IRS coverage data. We installed mSpray on 10 cell phones with data bundles, and pilot tested it with 13 users in Limpopo, South Africa. Users completed basic information (number of rooms/shelters sprayed; chemical used, etc.) on spray events. Upon submission, this information as well as geographic positioning system coordinates and time/date stamp were uploaded to a Google Drive Spreadsheet to be viewed in real time. We administered questionnaires, conducted focus groups, and interviewed key informants to evaluate the utility of the app. The low-cost, cell phone-based "mSpray" app was learned quickly by users, well accepted and preferred to the current paper-based method. We recorded 2865 entries (99.1% had a GPS accuracy of 20 m or less) and identified areas of improvement including increased battery life. We also identified a number of logistic and user problems (e.g., cost of cell phones and cellular bundles, battery life, obtaining accurate GPS measures, user errors, etc.) that would need to be overcome before full deployment. Use of cell phone technology could increase the efficiency of IRS malaria control efforts by mapping spray events in relation to malaria cases, resulting in more judicious use of chemicals that are potentially harmful to humans and the environment.
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Affiliation(s)
- Brenda Eskenazi
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, 1995 University Ave, Suite 265, Berkeley, CA 94704, USA.
| | - Lesliam Quirós-Alcalá
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, 1995 University Ave, Suite 265, Berkeley, CA 94704, USA.
| | - Jonah M Lipsitt
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, 1995 University Ave, Suite 265, Berkeley, CA 94704, USA.
| | - Lemuel D Wu
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, 1995 University Ave, Suite 265, Berkeley, CA 94704, USA.
| | - Philip Kruger
- Malaria Control Programme, Limpopo Department of Health, Voortrekker Street, Tzaneen, Limpopo 0850, South Africa.
| | - Tzundzukani Ntimbane
- Malaria Control Programme, Limpopo Department of Health, Voortrekker Street, Tzaneen, Limpopo 0850, South Africa.
| | - John Burns Nawn
- Malaria Control Programme, National Department of Health, Johannesburg, South Africa.
| | - M S Riana Bornman
- Center for Sustainable Malaria Control, Department of Urology, University of Pretoria, Pretoria, South Africa.
| | - Edmund Seto
- Center for Information Technology in the Interest of Society (CITRIS) Health Care Initiative, University of California, Sutardja Dai Hall, Room 330E, Berkeley CA 94720, USA; University of Washington, Environmental & Occupational Health Sciences Department, 1959 NE Pacific Street, Campus Box 357234, Seattle, WA 98195, USA.
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5474
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Tsui I, Drexler A, Stanton AL, Kageyama J, Ngo E, Straatsma BR. Pilot study using mobile health to coordinate the diabetic patient, diabetologist, and ophthalmologist. J Diabetes Sci Technol 2014; 8:845-9. [PMID: 24876413 PMCID: PMC4764215 DOI: 10.1177/1932296814529637] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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] [Indexed: 12/16/2022]
Abstract
In the United States, more than 25 million adults have diabetes, 40% of diabetics have diabetic retinopathy, and diabetes is the leading cause of blindness in people 20 to 74 years of age. Clinical trials have shown that strict control of blood glucose level and other risk factors delays diabetic retinopathy onset, progression, and vision loss. Patients with Type 1 or Type 2 diabetes mellitus, access to an Apple iPhone or iPad, and no psychological or medical condition that would interfere with the study participated in a nonrandomized clinical trial using SightBook™, a free mobile app that enables self-measurement of visual function and creates a password-protected web account for each patient. Sixty patients enrolled in the clinical trial over a 6 month period. Twenty-six participants were men and 34 were women, with ages from 23 to 72 years (mean 45 ± 15) and diabetes duration of 1.5 to 50 years (mean 15.5 ± 11.5). Thirty-nine (65%) patients reported Type 1 diabetes and 21 (35%) patients reported Type 2 diabetes. Every patient established a personal web account on SightBook and invited participation of treating physicians; 51 (85%) patients completed the validated self-reported outcome assessments. Diabetologist examinations of 49 (82%) patients demonstrated systolic hypertension (≥140 mgHg) in 20% and hemoglobin A1c ≥ 7.0% in 56%. Ophthalmology examinations of 45 patients showed visual acuity in the worse-seeing eye of < 20/40 in 18% and diabetic retinopathy in 42% of patients. This clinical trial used a mobile health app to incorporate diabetic patient self-measurement of vision and coordinate the diabetic patient, diabetologist, and ophthalmologist for control of diabetes and diabetic retinopathy risk factors.
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Affiliation(s)
- Irena Tsui
- Department of Ophthalmology and Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Andrew Drexler
- Department of Medicine and the Gonda Diabetes Center, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, Center for Cancer Prevention and Control Research, University of California, Los Angeles, CA, USA
| | - Jennie Kageyama
- Department of Ophthalmology and Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Elaine Ngo
- Department of Ophthalmology and Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Bradley R Straatsma
- Department of Ophthalmology and Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
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5475
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Surka S, Edirippulige S, Steyn K, Gaziano T, Puoane T, Levitt N. Evaluating the use of mobile phone technology to enhance cardiovascular disease screening by community health workers. Int J Med Inform 2014; 83:648-54. [PMID: 25002305 DOI: 10.1016/j.ijmedinf.2014.06.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/12/2014] [Accepted: 06/14/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary prevention of cardiovascular disease (CVD),by identifying individuals at risk is a well-established, but costly strategy when based on measurements that depend on laboratory analyses. A non-laboratory, paper-based CVD risk assessment chart tool has previously been developed to make screening more affordable in developing countries. Task shifting to community health workers (CHWs) is being investigated to further scale CVD risk screening. This study aimed to develop a mobile phone CVD risk assessment application and to evaluate its impact on CHW training and the duration of screening for CVD in the community by CHWs. METHODS A feature phone application was developed using the open source online platform, CommCare(©). CHWs (n=24) were trained to use both paper-based and mobile phone CVD risk assessment tools. They were randomly allocated to using one of the risk tools to screen 10-20 community members and then crossed over to screen the same number, using the alternate risk tool. The impact on CHW training time, screening time and margin of error in calculating risk scores was recorded. A focus group discussion evaluated experiences of CHWs using the two tools. RESULTS The training time was 12.3h for the paper-based chart tool and 3h for the mobile phone application. 537 people were screened. The mean screening time was 36 min (SD=12.6) using the paper-base chart tool and 21 min (SD=8.71) using the mobile phone application, p=<0.0001. Incorrect calculations (4.3% of average systolic BP measurements, 10.4% of BMI and 3.8% of CVD risk score) were found when using the paper-based chart tool while all the mobile phone calculations were correct. Qualitative findings from the focus group discussion corresponded with the findings of the pilot study. CONCLUSION The reduction in CHW training time, CVD risk screening time, lack of errors in calculation of a CVD risk score and end user satisfaction when using a mobile phone application, has implications in terms of adoption and sustainability of this primary prevention strategy to identify people with high CVD risk who can be referred for appropriate diagnoses and treatment.
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5476
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Castelnuovo G, Manzoni GM, Pietrabissa G, Corti S, Giusti EM, Molinari E, Simpson S. Obesity and outpatient rehabilitation using mobile technologies: the potential mHealth approach. Front Psychol 2014; 5:559. [PMID: 24959157 PMCID: PMC4051130 DOI: 10.3389/fpsyg.2014.00559] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/20/2014] [Indexed: 11/22/2022] Open
Abstract
Obesity is currently an important public health problem of epidemic proportions (globesity). Inpatient rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach by enhancing the steps specified by psychological and medical treatment protocols. These outcomes may be augmented further by the mHealth approach, through creating new treatment delivery methods to increase compliance and engagement. mHealth (m-health, mobile health) can be defined as the practice of medicine and public health, supported by mobile communication devices for health services and information. mHealth applications which can be implemented in weight loss protocols and obesity rehabilitation are discussed, taking into account future research directions in this promising area.
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Affiliation(s)
- Gianluca Castelnuovo
- Department of Psychology, Catholic University of MilanMilan, Italy
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
| | - Gian Mauro Manzoni
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
- Faculty of Psychology, eCampus UniversityComo, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of MilanMilan, Italy
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
| | - Stefania Corti
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
- Department of Psychology, University of BergamoBergamo, Italy
| | | | - Enrico Molinari
- Department of Psychology, Catholic University of MilanMilan, Italy
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
| | - Susan Simpson
- School of Psychology, Social Work and Social Policy, University of South AustraliaAdelaide, SA, Australia
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5477
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Montoya JL, Georges S, Poquette A, Depp CA, Atkinson JH, Moore DJ. Refining a personalized mHealth intervention to promote medication adherence among HIV+ methamphetamine users. AIDS Care 2014; 26:1477-81. [PMID: 24911433 DOI: 10.1080/09540121.2014.924213] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Mobile health (mHealth) interventions to promote antiretroviral therapy (ART) adherence have shown promise; however, among persons living with HIV who abuse methamphetamine (MA), effective tailoring of content to match the expressed needs of this patient population may be necessary. This study aimed (1) to understand patient perspectives of barriers and facilitators of ART adherence among people with HIV who use MA, and (2) to obtain feedback on the thematic content of an mHealth intervention in order to tailor the intervention to this subgroup. Two separate focus groups, each with 10 HIV+/MA+ individuals, were conducted. Transcribed audio recordings were qualitatively analyzed to identify emergent themes. Inter-rater reliability of themes was high (mean Kappa = .97). Adherence barriers included MA use, misguided beliefs about ART adherence, memory and planning difficulties, social barriers and perceived stigma, and mental heath issues. Facilitators of effective ART adherence were cognitive compensatory strategies, promotion of well-being, health-care supports, adherence education, and social support. Additionally, the focus groups generated content for reminder text messages to be used in the medication adherence intervention. This qualitative study demonstrates the feasibility of using focus groups to derive patient-centered intervention content to address the health challenge at hand in targeted populations.
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Affiliation(s)
- Jessica L Montoya
- a SDSU/UCSD Joint Doctoral Program in Clinical Psychology , San Diego , CA , USA
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5478
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Mallow JA, Theeke LA, Barnes ER, Whetsel T, Mallow BK. Using mHealth Tools to Improve Rural Diabetes Care Guided by the Chronic Care Model. Online J Rural Nurs Health Care 2014; 14:43-65. [PMID: 26029005 DOI: 10.14574/ojrnhc.v14i1.276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Used as an integrated tool, mHealth may improve the ability of healthcare providers in rural areas to provide care, improve access to care for underserved populations, and improve biophysical outcomes of care for persons with diabetes in rural, underserved populations. Our objective in this paper is to present an integrated review of the impact of mHealth interventions for community dwelling individuals with type two diabetes. MATERIALS AND METHODS A literature search was performed using keywords in PubMed to identify research studies which mHealth technology was used as the intervention. RESULTS AND DISCUSSION Interventions using mHealth have been found to improve outcomes, be cost effective, and culturally relevant. mHealth technology that has been used to improve outcomes include: seeking out health information via the web, access to appointment scheduling and medication refills, secure messaging, computerized interventions to manage a chronic condition, use of a personal health record, use of remote monitoring devices, and seeking support from others with similar health concerns through social networks. CONCLUSION Using the validated Chronic Care Model to translate what is known about mHealth technology to clinical practice has the potential to improve the ability of healthcare providers in rural areas to provide care, improve access to care for underserved populations, and improve biophysical outcomes of care for persons with diabetes in rural underserved populations. While these approaches were effective in improving some outcomes, they have not resulted in the establishment of the necessary electronic infrastructure for a sustainable mobile healthcare delivery model.
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5479
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Al Ayubi SU, Parmanto B, Branch R, Ding D. A Persuasive and Social mHealth Application for Physical Activity: A Usability and Feasibility Study. JMIR Mhealth Uhealth 2014; 2:e25. [PMID: 25099928 PMCID: PMC4114463 DOI: 10.2196/mhealth.2902] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/17/2013] [Accepted: 03/30/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Advances in smartphones and the wide usage of social networking systems offer opportunities for the development of innovative interventions to promote physical activity. To that end, we developed a persuasive and social mHealth application designed to monitor and motivate users to walk more every day. OBJECTIVE The objectives of this project were to conduct a focused review on the fundamental characteristics of mHealth for physical activity promotion, to develop an mHealth application that meets such characteristics, and to conduct a feasibility study to deploy the application in everyday life. METHODS This project started as an analytical study to review the fundamental characteristics of the technologies used in physical activity monitoring and promotion. Then, it was followed by a technical development of the application. Next, a 4 week deployment was conducted where participants used the application as part of their daily life. A think-aloud method and in-depth semistructured interviews were conducted following the deployment. A qualitative description method was used to thematically analyze the interviews. Feasibility measures included, adherence to the program, user-system interactions, motivation to use, and experience with physical activity and online social interactions. RESULTS There were seven fundamental characteristics of physical activity monitoring and promotion that were identified, which were then used as a foundation to develop the application. There were fourteen participants that enrolled in the application evaluation. The age range was from 24 to 45; body mass index ranged from 18.5 to 42.98, with 4 of the subjects falling into the category "obese". Half of them were experienced with smartphones, and all were familiar with a social network system. There were thirteen participants that completed the study; one was excluded. Overall, participants gave high scores to almost all of the usability factors examined, with averages of 4.52 out of a 5.00 maximum. Over 29 days, participants used the application for a total of 119,380 minutes (average=7.57 hours/day/participant; SD 1.56). CONCLUSIONS Based on the fundamental characteristics, the application was successfully developed. The usability results suggest that the system is usable and user satisfaction was high. Deploying the application was shown to be feasible for the promotion of daily physical activity.
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Affiliation(s)
- Soleh U Al Ayubi
- Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
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5480
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Shaw RJ, Steinberg DM, Zullig LL, Bosworth HB, Johnson CM, Davis LL. mHealth interventions for weight loss: a guide for achieving treatment fidelity. J Am Med Inform Assoc 2014; 21:959-63. [PMID: 24853065 DOI: 10.1136/amiajnl-2013-002610] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
UNLABELLED mHealth interventions have shown promise for helping people sustain healthy behaviors such as weight loss. However, few have assessed treatment fidelity, that is, the accurate delivery, receipt, and enactment of the intervention. Treatment fidelity is critical because the valid interpretation and translation of intervention studies depend on treatment fidelity assessments. We describe strategies used to assess treatment fidelity in mobile health (mHealth) interventions aimed at sustaining healthy behaviors in weight loss. We reviewed treatment fidelity recommendations for mHealth-based behavioral interventions and described how these recommendations were applied in three recent weight loss studies. We illustrate how treatment fidelity can be supported during study design, training of providers, treatment delivery, receipt of treatment, and enactment of treatment skills. Pre-planned strategies to ensure the treatment fidelity of mHealth interventions will help counter doubts concerning valid conclusions about their effectiveness and allow investigators and clinicians to implement robustly efficacious mobile health programs. TRIAL REGISTRATION NUMBER 1F31 NR012599.
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Affiliation(s)
- Ryan J Shaw
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Dori M Steinberg
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Hayden B Bosworth
- Duke University School of Nursing, Durham, North Carolina, USA Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | | | - Linda L Davis
- Duke University School of Nursing, Durham, North Carolina, USA
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5481
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Becker S, Miron-Shatz T, Schumacher N, Krocza J, Diamantidis C, Albrecht UV. mHealth 2.0: Experiences, Possibilities, and Perspectives. JMIR Mhealth Uhealth 2014; 2:e24. [PMID: 25099752 PMCID: PMC4114478 DOI: 10.2196/mhealth.3328] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/03/2014] [Accepted: 05/02/2014] [Indexed: 11/13/2022] Open
Abstract
With more than 1 billion users having access to mobile broadband Internet and a rapidly growing mobile app market, all stakeholders involved have high hopes that this technology may improve health care. Expectations range from overcoming structural barriers to access in low-income countries to more effective, interactive treatment of chronic conditions. Before medical health practice supported by mobile devices ("mHealth") can scale up, a number of challenges need to be adequately addressed. From a psychological perspective, high attrition rates, digital divide of society, and intellectual capabilities of the users are key issues when implementing such technologies. Furthermore, apps addressing behavior change often lack a comprehensive concept, which is essential for an ongoing impact. From a clinical point of view, there is insufficient evidence to allow scaling up of mHealth interventions. In addition, new concepts are required to assess the efficacy and efficiency of interventions. Regarding technology interoperability, open standards and low-energy wireless protocols appear to be vital for successful implementation. There is an ongoing discussion in how far health care-related apps require a conformity assessment and how to best communicate quality standards to consumers. "Apps Peer-Review" and standard reporting via an "App synopsis" appear to be promising approaches to increase transparency for end users. With respect to development, more emphasis must be placed on context analysis to identify what generic functions of mobile information technology best meet the needs of stakeholders involved. Hence, interdisciplinary alliances and collaborative strategies are vital to achieve sustainable growth for "mHealth 2.0," the next generation mobile technology to support patient care.
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Affiliation(s)
- Stefan Becker
- Institute for Drug Safety, Department of Nephrology, University Hospital Essen, Essen, Germany
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5482
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Wu YP, Steele RG, Connelly MA, Palermo TM, Ritterband LM. Commentary: pediatric eHealth interventions: common challenges during development, implementation, and dissemination. J Pediatr Psychol 2014; 39:612-23. [PMID: 24816766 DOI: 10.1093/jpepsy/jsu022] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. METHODS The article draws on the existing eHealth literature and the authors' collective experience in pediatric eHealth research. RESULTS AND CONCLUSIONS The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination.
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Affiliation(s)
- Yelena P Wu
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Clinical Child Psychology Program, University of Kansas, University of Missouri-Kansas City School of Medicine and Children's Mercy Hospitals and Clinics, University of Washington, Seattle Children's Research Institute, and Behavioral Health and Technology, University of Virginia Health System
| | - Ric G Steele
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Clinical Child Psychology Program, University of Kansas, University of Missouri-Kansas City School of Medicine and Children's Mercy Hospitals and Clinics, University of Washington, Seattle Children's Research Institute, and Behavioral Health and Technology, University of Virginia Health System
| | - Mark A Connelly
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Clinical Child Psychology Program, University of Kansas, University of Missouri-Kansas City School of Medicine and Children's Mercy Hospitals and Clinics, University of Washington, Seattle Children's Research Institute, and Behavioral Health and Technology, University of Virginia Health System
| | - Tonya M Palermo
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Clinical Child Psychology Program, University of Kansas, University of Missouri-Kansas City School of Medicine and Children's Mercy Hospitals and Clinics, University of Washington, Seattle Children's Research Institute, and Behavioral Health and Technology, University of Virginia Health SystemDivision of Public Health, Department of Family and Preventive Medicine, University of Utah, Clinical Child Psychology Program, University of Kansas, University of Missouri-Kansas City School of Medicine and Children's Mercy Hospitals and Clinics, University of Washington, Seattle Children's Research Institute, and Behavioral Health and Technology, University of Virginia Health System
| | - Lee M Ritterband
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Clinical Child Psychology Program, University of Kansas, University of Missouri-Kansas City School of Medicine and Children's Mercy Hospitals and Clinics, University of Washington, Seattle Children's Research Institute, and Behavioral Health and Technology, University of Virginia Health System
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Poorman E, Gazmararian J, Elon L, Parker R. Is health literacy related to health behaviors and cell phone usage patterns among the text4baby target population? Arch Public Health 2014; 72:13. [PMID: 24872883 PMCID: PMC4036492 DOI: 10.1186/2049-3258-72-13] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 02/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Text4baby provides educational text messages to pregnant and postpartum women and targets underserved women. The primary purpose of this study is to examine the health behaviors and cell phone usage patterns of a text4baby target population and the associations with health literacy. METHODS Pregnant and postpartum women were recruited from two Women, Infant and Children clinics in Atlanta. Women were asked about their demographics, selected pregnancy or postpartum health behaviors, and cell phone usage patterns. Health literacy skills were measured with the English version of the Newest Vital Sign. Multivariable logistic regression was used to examine health behaviors and cell usage patterns by health literacy classification, controlling for commonly accepted confounders. RESULTS Four hundred sixty-eight women were recruited, and 445 completed the Newest Vital Sign. Of these, 22% had inadequate health literacy, 50% had intermediate health literacy, and 28% had adequate health literacy skills. Compared to adequate health literacy, limited literacy was independently associated with not taking a daily vitamin during pregnancy (OR 3.6, 95% CI: 1.6, 8.5) and never breastfeeding their infant (OR 1.4, 95% CI: 1.1, 1.8). The majority (69.4%) of respondents received nine or more text messages a day prior to enrollment, one in four participants (24.6%) had changed their number within the last six months, and 7.0% of study participants shared a cell phone. Controlling for potentially confounding factors, those with limited health literacy were more likely to share a cell phone than those with adequate health literacy (OR 2.57, 95% CI: 1.79, 3.69). CONCLUSIONS Text4baby messages should be appropriate for low health literacy levels, especially as this population may have higher prevalence of targeted unhealthy behaviors. Text4baby and other mhealth programs targetting low health literacy populations should also be aware of the different ways that these populations use their cell phones, including: sharing cell phones, which may mean participants will not receive messages or have special privacy concerns; frequently changing cell phone numbers which could lead to higher drop-off rates; and the penetrance of text messages in a population that receives many messages daily.
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Affiliation(s)
- Elisabeth Poorman
- Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, USA
| | - Julie Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton RdNE, Atlanta, Georgia
| | - Lisa Elon
- Department of Biostatistics, Rollins School of Public Health, Emory University, 1518 Clifton RdNE, Atlanta, Georgia
| | - Ruth Parker
- School of Medicine, Emory University, 1648 Pierce DrNE, Atlanta, Georgia
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5484
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Brath H, Morak J, Kästenbauer T, Modre-Osprian R, Strohner-Kästenbauer H, Schwarz M, Kort W, Schreier G. Mobile health ( mHealth) based medication adherence measurement - a pilot trial using electronic blisters in diabetes patients. Br J Clin Pharmacol 2014; 76 Suppl 1:47-55. [PMID: 24007452 DOI: 10.1111/bcp.12184] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 05/16/2013] [Indexed: 11/29/2022] Open
Abstract
AIMS The aim of the present study was to evaluate a mobile health (mHealth) based remote medication adherence measurement system (mAMS) in elderly patients with increased cardiovascular risk treated for diabetes, high cholesterol and hypertension. Cardiovascular risk was defined as the presence of at least two out of the three risk factors: type 2 diabetes, hypercholesterolaemia and hypertension. METHODS For treatment of diabetes, hypercholesterolaemia and hypertension, four predefined routinely used drugs were selected. Drug adherence was investigated in a controlled randomized doctor blinded study with crossover design. The mAMS was used to measure and improve objectively the adherence by means of closed-loop interactions. RESULTS The mean age of the 53 patients (30 female) was 69.4 ± 4.8 years. A total of 1654 electronic blisters were handed out. A statistically significant difference (P = 0.04) between the monitoring and the control phase was observed for the diabetes medication only. In a post-study questionnaire twenty-nine patients appreciated that their physician knew if and when they had taken their medications and 13 asked for more or automated communication with their physicians. Only one subject withdrew from the study because of technical complexity. CONCLUSIONS The results indicate that mHealth based adherence management is feasible and well accepted by patients with increased cardiovascular risk. It may help to increase adherence, even in patients with high baseline adherence and, subsequently, lead to improved control of indicators including blood pressure and cholesterol concentrations. Electronic blisters can be used in a multi-medication regimen but need to be carefully designed for day-to-day application.
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Affiliation(s)
- Helmut Brath
- Diabetes Outpatient Clinic, Health Centre South, Vienna, Austria.
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5485
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Arnhold M, Quade M, Kirch W. Mobile applications for diabetics: a systematic review and expert-based usability evaluation considering the special requirements of diabetes patients age 50 years or older. J Med Internet Res 2014; 16:e104. [PMID: 24718852 PMCID: PMC4004144 DOI: 10.2196/jmir.2968] [Citation(s) in RCA: 314] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 02/24/2014] [Accepted: 03/13/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A multitude of mhealth (mobile health) apps have been developed in recent years to support effective self-management of patients with diabetes mellitus type 1 or 2. OBJECTIVE We carried out a systematic review of all currently available diabetes apps for the operating systems iOS and Android. We considered the number of newly released diabetes apps, range of functions, target user groups, languages, acquisition costs, user ratings, available interfaces, and the connection between acquisition costs and user ratings. Additionally, we examined whether the available applications serve the special needs of diabetes patients aged 50 or older by performing an expert-based usability evaluation. METHODS We identified relevant keywords, comparative categories, and their specifications. Subsequently, we performed the app review based on the information given in the Google Play Store, the Apple App Store, and the apps themselves. In addition, we carried out an expert-based usability evaluation based on a representative 10% sample of diabetes apps. RESULTS In total, we analyzed 656 apps finding that 355 (54.1%) offered just one function and 348 (53.0%) provided a documentation function. The dominating app language was English (85.4%, 560/656), patients represented the main user group (96.0%, 630/656), and the analysis of the costs revealed a trend toward free apps (53.7%, 352/656). The median price of paid apps was €1.90. The average user rating was 3.6 stars (maximum 5). Our analyses indicated no clear differences in the user rating between free and paid apps. Only 30 (4.6%) of the 656 available diabetes apps offered an interface to a measurement device. We evaluated 66 apps within the usability evaluation. On average, apps were rated best regarding the criterion "comprehensibility" (4.0 out of 5.0), while showing a lack of "fault tolerance" (2.8 out of 5.0). Of the 66 apps, 48 (72.7%) offered the ability to read the screen content aloud. The number of functions was significantly negative correlated with usability. The presence of documentation and analysis functions reduced the usability score significantly by 0.36 and 0.21 points. CONCLUSIONS A vast number of diabetes apps already exist, but the majority offer similar functionalities and combine only one to two functions in one app. Patients and physicians alike should be involved in the app development process to a greater extent. We expect that the data transmission of health parameters to physicians will gain more importance in future applications. The usability of diabetes apps for patients aged 50 or older was moderate to good. But this result applied mainly to apps offering a small range of functions. Multifunctional apps performed considerably worse in terms of usability. Moreover, the presence of a documentation or analysis function resulted in significantly lower usability scores. The operability of accessibility features for diabetes apps was quite limited, except for the feature "screen reader".
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Affiliation(s)
- Madlen Arnhold
- Research Association Public Health Saxony and Saxony-Anhalt, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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5486
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Abstract
This commentary aims to create initial recommendations to guide researchers' decisions on the development and use of mobile technologies for public health research. We recommend that mobile technologies for public health research should be scalable and sustainable; draw on social, psychological and/or behavioral theoretical models; be able to be integrated with multiple communication devices; incorporate social network and/or geographic metrics and take a community-based participatory approach to development and implementation. All of these approaches are discussed.
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Affiliation(s)
- Sean D Young
- Department of Family Medicine, University of California, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - Dallas Swendeman
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, and Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), University of California, Los Angeles, CA, USA
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5487
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Wen KY, Miller SM, Kilby L, Fleisher L, Belton TD, Roy G, Hernandez E. Preventing postpartum smoking relapse among inner city women: development of a theory-based and evidence-guided text messaging intervention. JMIR Res Protoc 2014; 3:e20. [PMID: 24698804 PMCID: PMC4004157 DOI: 10.2196/resprot.3059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/27/2014] [Accepted: 02/20/2014] [Indexed: 11/15/2022] Open
Abstract
Background Underserved women are at high risk for smoking relapse after childbirth due to their unique socioeconomic and postpartum stressors and barriers. Mobile text messaging technology allows delivery of relapse prevention programs targeted to their personal needs over time. Objective To describe the development of a social-cognitive theory-based and evidence-guided text messaging intervention for preventing postpartum smoking relapse among inner city women. Methods Guided by the cognitive-social health information processing framework, user-centered design, and health communication best practices, the intervention was developed through a systematic process that included needs assessment, followed by an iterative cycling through message drafting, health literacy evaluation and rewriting, review by target community members and a scientific advisory panel, and message revision, concluding with usability testing. Results All message content was theory-grounded, derived by needs assessment analysis and evidence-based materials, reviewed and revised by the target population, health literacy experts, and scientific advisors. The final program, “Txt2Commit,” was developed as a fully automated system, designed to deliver 3 proactive messages per day for a 1-month postpartum smoking relapse intervention, with crave and lapse user-initiated message functions available when needed. Conclusions The developmental process suggests that the application of theory and best practices in the design of text messaging smoking cessation interventions is not only feasible but necessary for ensuring that the interventions are evidence based and user-centered.
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Affiliation(s)
- Kuang-Yi Wen
- Fox Chase Cancer Center/Temple University Health System, Cancer Prevention and Control, Philadelphia, PA, United States
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5488
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Forjuoh SN, Ory MG, Wang S, des Bordes JK, Hong Y. Using the iPod Touch for Patient Health Behavior Assessment and Health Promotion in Primary Care. JMIR Mhealth Uhealth 2014; 2:e14. [PMID: 25100308 PMCID: PMC4114460 DOI: 10.2196/mhealth.2927] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/29/2014] [Accepted: 02/27/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a growing recognition of the importance of lifestyle behavior change for health promotion and disease prevention, as well as the concomitant influence of patient-physician communication on effective behavior change. Mobile technology is increasingly being recognized as an important and efficient tool to collect patients' health behavior data and facilitate patient-physician communication. OBJECTIVE The aim of this study was to assess the feasibility of an iPod touch-based health behavior assessment (HBA) tool in enhancing patient-physician collaborative goal-setting for health promotion in primary care. METHODS A total of 109 patients from three primary care clinics in central Texas completed a brief HBA, which was programmed on an iPod touch device. An instant feedback report was generated for the patient and their physician simultaneously to facilitate collaborative goal-setting. Within approximately 7 days of the HBA, the patients were phoned for a follow-up survey for their feedback on the iPod touch-based HBA and resultant patient-physician communication. RESULTS Patients were able to complete an HBA on the iPod touch with ease. Among those who completed the follow-up survey (n=83), 30% (25/83) reported that their physicians discussed the HBA report with them, while 29% (24/83) established behavior change goals with them. More than 90% (75/83) of the patients reported positive experiences with the iPod touch-based HBA. CONCLUSIONS It is feasible to use mobile tools for HBA in the primary care setting. The HBA also facilitated patient-physician communication on behavior change. However, more research is needed on the effectiveness of large scale dissemination of mobile-based HBA technology on health communication and behavior change for preventing or managing lifestyle-related chronic conditions, such as obesity, diabetes, cancer, or heart diseases.
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Affiliation(s)
- Samuel N Forjuoh
- Department of Family & Community Medicine, Scott & White Healthcare, Temple, TX, United States
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5489
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Munro ML, Lori JR, Boyd CJ, Andreatta P. Knowledge and skill retention of a mobile phone data collection protocol in rural Liberia. J Midwifery Womens Health 2014; 59:176-83. [PMID: 24655593 DOI: 10.1111/jmwh.12155] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION With a large number of births occurring outside the formal health system, it is difficult to determine the number of pregnant women in rural regions of Liberia. The exponential growth of mobile phone use in developing countries provides a potential avenue for data collection on maternal and child health in such rural, remote regions. METHODS A pre-, post-, and one-year posttest design was used to collect data on knowledge and skill retention for 7 essential items required for mobile phone use among traditional birth attendants (TBAs) trained in a short message service (SMS) texting data collection protocol (N = 99) in rural Liberia. RESULTS Sixty-three participants (63.6% retention) completed the one-year posttest and displayed evidence of statistically significant knowledge and skill retention in 6 of the 7 tasks (P < .005), including the ability to: 1) turn on the phone, 2) use the mobile phone to make a call, 3) recognize that they have coverage, 4) recognize that the mobile phone is charged, 5) create a SMS text message without help, and 6) send a SMS text message without help. The TBAs continued to have difficulty with more complex tasks such as adding minutes to a phone. DISCUSSION The mobile phone data-collection protocol proved feasible with TBAs demonstrating knowledge retention in a one-year posttest; however, clinical significance needs further investigation. The protocol increased communication and collaboration among TBAs, certified midwives, and clinic staff.
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5490
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Grindrod KA, Li M, Gates A. Evaluating user perceptions of mobile medication management applications with older adults: a usability study. JMIR Mhealth Uhealth 2014; 2:e11. [PMID: 25099993 PMCID: PMC4114457 DOI: 10.2196/mhealth.3048] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/30/2014] [Accepted: 02/17/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Medication nonadherence has a significant impact on the health and wellbeing of individuals with chronic disease. Several mobile medication management applications are available to help users track, remember, and read about their medication therapy. OBJECTIVE The objective of this study was to explore the usability and usefulness of existing medication management applications for older adults. METHODS We recruited 35 participants aged 50 and over to participate in a 2-hour usability session. The average age ranged from 52-78 years (mean 67 years) and 71% (25/35) of participants were female. Each participant was provided with an iPad loaded with four medication management applications: MyMedRec, DrugHub, Pillboxie, and PocketPharmacist. These applications were evaluated using the 10 item System Usability Scale (SUS) and visual analog scale. An investigator-moderated 30-minute discussion followed, and was recorded. We used a grounded theory (GT) approach to analyze qualitative data. RESULTS When assessing mobile medication management applications, participants struggled to think of a need for the applications in their own lives. Many were satisfied with their current management system and proposed future use only if cognition and health declined. Most participants felt capable of using the applications after a period of time and training, but were frustrated by their initial experiences with the applications. The early experiences of participants highlighted the benefits of linear navigation and clear wording (eg, "undo" vs "cancel") when designing for older users. While there was no order effect, participants attributed their poor performance to the order in which they tried the applications. They also described being a part of a technology generation that did not encounter the computer until adulthood. Of the four applications, PocketPharmacist was found to be the least usable with a score of 42/100 (P<.0001) though it offered a drug interaction feature that was among the favorite features of participants. The usability scores for MyMedRec (56/100), DrugHub (57/100), and Pillboxie (52/100) were not significantly different and participants preferred MyMedRec and DrugHub for their simple, linear interfaces. CONCLUSIONS With training, adults aged 50 and over can be capable and interested in using mHealth applications for their medication management. However, in order to adopt such technology, they must find a need that their current medication management system cannot fill. Interface diversity and multimodal reminder methods should be considered to increase usability for older adults. Lastly, regulation or the involvement of older adults in development may help to alleviate generation bias and mistrust for applications.
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Affiliation(s)
- Kelly Anne Grindrod
- School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON, Canada.
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5491
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Liddle J, Ireland D, McBride SJ, Brauer SG, Hall LM, Ding H, Karunanithi M, Hodges PW, Theodoros D, Silburn PA, Chenery HJ. Measuring the lifespace of people with Parkinson's disease using smartphones: proof of principle. JMIR Mhealth Uhealth 2014; 2:e13. [PMID: 25100206 PMCID: PMC4114414 DOI: 10.2196/mhealth.2799] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 01/21/2014] [Accepted: 02/07/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Lifespace is a multidimensional construct that describes the geographic area in which a person lives and conducts their activities, and reflects mobility, health, and well-being. Traditionally, it has been measured by asking older people to self-report the length and frequency of trips taken and assistance required. Global Positioning System (GPS) sensors on smartphones have been used to measure Lifespace of older people, but not with people with Parkinson's disease (PD). OBJECTIVE The objective of this study was to investigate whether GPS data collected via smartphones could be used to indicate the Lifespace of people with PD. METHODS The dataset was supplied via the Michael J Fox Foundation Data Challenge and included 9 people with PD and 7 approximately matched controls. Participants carried smartphones with GPS sensors over two months. Data analysis compared the PD group and the control group. The impact of symptom severity on Lifespace was also investigated. RESULTS Visualization methods for comparing Lifespace were developed including scatterplots and heatmaps. Lifespace metrics for comparison included average daily distance, percentage of time spent at home, and number of trips into the community. There were no significant differences between the PD and the control groups on Lifespace metrics. Visual representations of Lifespace were organized based on the self-reported severity of symptoms, suggesting a trend of decreasing Lifespace with increasing PD symptoms. CONCLUSIONS Lifespace measured by GPS-enabled smartphones may be a useful concept to measure the progression of PD and the impact of various therapies and rehabilitation programs. Directions for future use of GPS-based Lifespace are provided.
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Affiliation(s)
- Jacki Liddle
- UQ Centre for Clinical Research, Asia-Pacific Centre for Neuromodulation, The University of Queensland, Herston, QLD, Australia.
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5492
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Weinstein RS, Lopez AM, Joseph BA, Erps KA, Holcomb M, Barker GP, Krupinski EA. Telemedicine, telehealth, and mobile health applications that work: opportunities and barriers. Am J Med 2014; 127:183-7. [PMID: 24384059 DOI: 10.1016/j.amjmed.2013.09.032] [Citation(s) in RCA: 301] [Impact Index Per Article: 30.1] [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: 09/18/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 01/17/2023]
Abstract
There has been a spike in interest and use of telehealth, catalyzed recently by the anticipated implementation of the Affordable Care Act, which rewards efficiency in healthcare delivery. Advances in telehealth services are in many areas, including gap service coverage (eg, night-time radiology coverage), urgent services (eg, telestroke services and teleburn services), mandated services (eg, the delivery of health care services to prison inmates), and the proliferation of video-enabled multisite group chart rounds (eg, Extension for Community Healthcare Outcomes programs). Progress has been made in confronting traditional barriers to the proliferation of telehealth. Reimbursement by third-party payers has been addressed in 19 states that passed parity legislation to guarantee payment for telehealth services. Medicare lags behind Medicaid, in some states, in reimbursement. Interstate medical licensure rules remain problematic. Mobile health is currently undergoing explosive growth and could be a disruptive innovation that will change the face of healthcare in the future.
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Affiliation(s)
- Ronald S Weinstein
- Department of Pathology, College of Medicine-Tucson, Tucson, Ariz; Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz; College of Medicine-Phoenix, Phoenix, Ariz.
| | - Ana Maria Lopez
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz; College of Medicine-Phoenix, Phoenix, Ariz; Department of Medicine, University of Arizona College of Medicine-Tucson, Tucson, Ariz
| | - Bellal A Joseph
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz; Department of Surgery, University of Arizona College of Medicine-Tucson, Tucson, Ariz
| | - Kristine A Erps
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz
| | - Michael Holcomb
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz
| | - Gail P Barker
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz; College of Medicine-Phoenix, Phoenix, Ariz
| | - Elizabeth A Krupinski
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz; Department of Medical Imaging, University of Arizona College of Medicine-Tucson, Tucson, Ariz
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5493
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Aikens JE, Zivin K, Trivedi R, Piette JD. Diabetes self-management support using mHealth and enhanced informal caregiving. J Diabetes Complications 2014; 28:171-6. [PMID: 24374137 PMCID: PMC3943823 DOI: 10.1016/j.jdiacomp.2013.11.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/13/2013] [Accepted: 11/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To characterize diabetes patient engagement and clinician notifications for an mHealth interactive voice response (IVR) service. DESIGN Observational study. METHODS For three to six months, VA patients with diabetes received weekly IVR calls assessing health status and self-care along with tailored education. Patients could enroll with an informal caregiver who received suggestions on self-management support. Notifications were issued to clinicians when patients reported significant problems. RESULTS Patients (n = 303) participated for a total of 5684 patient-weeks, during which 84% of calls were completed. The odds of call completion decreased over time (AOR = 0.96, p < 0.001), and were lower among unmarried patients (AOR = 0.67, p = 0.038) and those who had difficulties with health literacy (AOR = 0.67, p = 0.039), diabetes-related distress (AOR = 0.30, p = 0.018), or medication nonadherence (AOR = 0.57, p = 0.002). Twenty-one clinician notifications were triggered per 100 patient-weeks. The odds of notification were higher during the early weeks of the program (AOR = 0.95, p < 0.001) and among patients who were older (AOR = 1.03, p = 0.004) or more physically impaired (AOR = 0.97, p < 0.001). CONCLUSIONS By providing information that is reliable, valid, and actionable, IVR-based mHealth services may increase access to between-visit monitoring and diabetes self-management support. The system detects abnormal glycemia and blood pressure levels that might otherwise go unreported, although thresholds for clinician notifications might require adjustment to avoid overloading clinicians. Patient engagement might be enhanced by addressing health literacy and psychological distress.
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Affiliation(s)
- James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Kara Zivin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Ranak Trivedi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Dept of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - John D Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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5494
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Wang A, An N, Lu X, Chen H, Li C, Levkoff S. A classification scheme for analyzing mobile apps used to prevent and manage disease in late life. JMIR Mhealth Uhealth 2014; 2:e6. [PMID: 25098687 PMCID: PMC4114434 DOI: 10.2196/mhealth.2877] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/29/2013] [Accepted: 11/12/2013] [Indexed: 12/31/2022] Open
Abstract
Background There are several mobile apps that offer tools for disease prevention and management among older adults, and promote health behaviors that could potentially reduce or delay the onset of disease. A classification scheme that categorizes apps could be useful to both older adult app users and app developers. Objective The objective of our study was to build and evaluate the effectiveness of a classification scheme that classifies mobile apps available for older adults in the “Health & Fitness” category of the iTunes App Store. Methods We constructed a classification scheme for mobile apps according to three dimensions: (1) the Precede-Proceed Model (PPM), which classifies mobile apps in terms of predisposing, enabling, and reinforcing factors for behavior change; (2) health care process, specifically prevention versus management of disease; and (3) health conditions, including physical health and mental health. Content analysis was conducted by the research team on health and fitness apps designed specifically for older adults, as well as those applicable to older adults, released during the months of June and August 2011 and August 2012. Face validity was assessed by a different group of individuals, who were not related to the study. A reliability analysis was conducted to confirm the accuracy of the coding scheme of the sample apps in this study. Results After applying sample inclusion and exclusion criteria, a total of 119 apps were included in the study sample, of which 26/119 (21.8%) were released in June 2011, 45/119 (37.8%) in August 2011, and 48/119 (40.3%) in August 2012. Face validity was determined by interviewing 11 people, who agreed that this scheme accurately reflected the nature of this application. The entire study sample was successfully coded, demonstrating satisfactory inter-rater reliability by two independent coders (95.8% initial concordance and 100% concordance after consensus was reached). The apps included in the study sample were more likely to be used for the management of disease than prevention of disease (109/119, 91.6% vs 15/119, 12.6%). More apps contributed to physical health rather than mental health (81/119, 68.1% vs 47/119, 39.5%). Enabling apps (114/119, 95.8%) were more common than reinforcing (20/119, 16.8%) or predisposing apps (10/119, 8.4%). Conclusions The findings, including face validity and inter-rater reliability, support the integrity of the proposed classification scheme for categorizing mobile apps for older adults in the “Health and Fitness” category available in the iTunes App Store. Using the proposed classification system, older adult app users would be better positioned to identify apps appropriate for their needs, and app developers would be able to obtain the distributions of available mobile apps for health-related concerns of older adults more easily.
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Affiliation(s)
- Aiguo Wang
- Gerontechnology Lab, Hefei University of Technology, Hefei, China
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5495
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de Tolly KM, Constant D. Integrating mobile phones into medical abortion provision: intervention development, use, and lessons learned from a randomized controlled trial. JMIR Mhealth Uhealth 2014; 2:e5. [PMID: 25098569 PMCID: PMC4114479 DOI: 10.2196/mhealth.3165] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/15/2014] [Accepted: 01/19/2014] [Indexed: 11/13/2022] Open
Abstract
Background Medical abortion is legal in South Africa but access and acceptability are hampered by the current protocol requiring a follow-up visit to assess abortion completion. Objective To assess the feasibility and efficacy of information and follow-up provided via mobile phone after medical abortion in a randomized controlled trial (RCT). Methods Mobile phones were used in three ways in the study: (1) coaching women through medical abortion using short message service (SMS; text messages); (2) a questionnaire to assess abortion completion via unstructured supplementary service data (USSD, a protocol used by GSM mobile telephones that allows the user to interact with a server via text-based menus) and the South African mobile instant message and social networking application Mxit; and (3) family planning information via SMS, mobisite and Mxit. A needs and context assessment was done to learn about women’s experiences undergoing medical abortion and their use of mobile phones. After development, the mobile interventions were piloted. Recruitment was done by field workers at the clinics. In the RCT, women were interviewed at baseline and exit. Computer logs were also analyzed. All study participants received standard of care at the clinics. Results In the RCT, 234 women were randomized to the intervention group. Eight did not receive the intervention due to invalid numbers, mis-registration, system failure, or opt-out, leaving 226 participants receiving the full intervention. Of the 226, 190 returned and were interviewed at their clinic follow-up visit. The SMSs were highly acceptable, with 97.9% (186/190) saying that the SMSs helped them through the medical abortion. In terms of mobile phone privacy, 86.3% (202/234) said that it was not likely or possible that someone would see SMSs on their phone, although at exit, 20% (38/190) indicated that they had worried about phone privacy. Having been given training at baseline and subsequently asked via SMS to complete the self-assessment questionnaire, 90.3% (204/226) attempted it, and of those, 86.3% (176/204) reached an endpoint of the questionnaire. For the family planning information, a preference for SMS was indicated by study clients, although the publicly available Mxit/mobisite was heavily used (813,375 pages were viewed) over the study duration. Conclusions SMS provided a good medium for timed, "push" information that guided and supported women through medical abortion. Women were able to perform a self-assessment questionnaire via mobile phones if provided training and prompted by SMS. Phone privacy needs to be protected in similar settings. This study may contribute to the successful expansion of medical abortion provision aided by mobile phones. Trial Registration Pan African Clinical Trials Registry (PACTR): PACTR201302000427144; http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201302000427144 (Archived by WebCite at http://www.webcitation.org/6N0fnZfzm).
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5496
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Muench F, van Stolk-Cooke K, Morgenstern J, Kuerbis AN, Markle K. Understanding messaging preferences to inform development of mobile goal-directed behavioral interventions. J Med Internet Res 2014; 16:e14. [PMID: 24500775 PMCID: PMC3936297 DOI: 10.2196/jmir.2945] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/19/2013] [Accepted: 11/21/2013] [Indexed: 11/13/2022] Open
Abstract
Background Mobile messaging interventions have been shown to improve outcomes across a number of mental health and health-related conditions, but there are still significant gaps in our knowledge of how to construct and deliver the most effective brief messaging interventions. Little is known about the ways in which subtle linguistic variations in message content can affect user receptivity and preferences. Objective The aim of this study was to determine whether any global messaging preferences existed for different types of language content, and how certain characteristics moderate those preferences, in an effort to inform the development of mobile messaging interventions. Methods This study examined user preferences for messages within 22 content groupings. Groupings were presented online in dyads of short messages that were identical in their subject matter, but structurally or linguistically varied. Participants were 277 individuals residing in the United States who were recruited and compensated through Amazon’s Mechanical Turk (MTurk) system. Participants were instructed to select the message in each dyad that they would prefer to receive to help them achieve a personal goal of their choosing. Results Results indicate global preferences of more than 75% of subjects for certain types of messages, such as those that were grammatically correct, free of textese, benefit-oriented, polite, nonaggressive, and directive as opposed to passive, among others. For several classes of messages, few or no clear global preferences were found. There were few personality- and trait-based moderators of message preferences, but subtle manipulations of message structure, such as changing “Try to…” to “You might want to try to…” affected message choice. Conclusions The results indicate that individuals are sensitive to variations in the linguistic content of text messages designed to help them achieve a personal goal and, in some cases, have clear preferences for one type of message over another. Global preferences were indicated for messages that contained accurate spelling and grammar, as well as messages that emphasize the positive over the negative. Research implications and a guide for developing short messages for goal-directed behaviors are presented in this paper.
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Affiliation(s)
- Frederick Muench
- CASPIR, Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, United States.
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5497
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Lwin MO, Vijaykumar S, Fernando ONN, Cheong SA, Rathnayake VS, Lim G, Theng YL, Chaudhuri S, Foo S. A 21st century approach to tackling dengue: Crowdsourced surveillance, predictive mapping and tailored communication. Acta Trop 2014; 130:100-7. [PMID: 24161879 DOI: 10.1016/j.actatropica.2013.09.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 05/17/2013] [Revised: 09/21/2013] [Accepted: 09/29/2013] [Indexed: 11/17/2022]
Abstract
This paper describes a social media system to prevent dengue in Sri Lanka and potentially in the rest of the South and Southeast Asia regions. The system integrates three concepts of public health prevention that have thus far been implemented only in silos. First, the predictive surveillance component uses a computer simulation to forewarn health authorities and the general public about impending disease outbreaks. The civic engagement component allows the general public to use social media tools to interact and engage with health authorities by aiding them in surveillance efforts by reporting symptoms, mosquito bites and breeding sites using smartphone technologies. The health communication component utilizes citizen data gathered from the first two components to disseminate customized health awareness messages to enhance knowledge and increase preventive behaviors among citizens. The system, known as "Mo-Buzz," will be made available on a host of digital platforms like simple mobile phones, smart phones and a website. We present challenges and lessons learnt including content validation, stakeholder collaborations and applied trans-disciplinary research.
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Affiliation(s)
- May O Lwin
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, HSS-06-16D, 14 Nanyang Drive, 637332 Singapore.
| | - Santosh Vijaykumar
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, HSS-06-15, 14 Nanyang Drive, 637332 Singapore.
| | - Owen Noel Newton Fernando
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, HSS-06-15, 14 Nanyang Drive, 637332 Singapore.
| | - Siew Ann Cheong
- School of Physical and Mathematical Sciences, Nanyang Technological University, SPMS-PA-04-03, 21 Nanyang Link, 637371 Singapore.
| | - Vajira Sampath Rathnayake
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, HSS-06-15, 14 Nanyang Drive, 637332 Singapore.
| | - Gentatsu Lim
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, HSS-06-15, 14 Nanyang Drive, 637332 Singapore.
| | - Yin-Leng Theng
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, HSS-06-15, 14 Nanyang Drive, 637332 Singapore.
| | - Subhasis Chaudhuri
- Department of Electrical Engineering, Indian Institute of Technology Bombay, Powai, Mumbai 400076, India.
| | - Schubert Foo
- Center of Social Media Innovations for Communities (COSMIC), Nanyang Technological University, HSS-06-16E, 14 Nanyang Drive, 637332 Singapore.
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5498
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Abstract
INTRODUCTION Midwives in rural Ghana work at the frontline of the health care system, where they have access to essential data about the patient population. However, current methods of data capture, primarily pen and paper, make the data neither accessible nor usable for monitoring patient care or program evaluation. Electronic health (eHealth) systems present a potential mechanism for enhancing the roles of midwives by providing tools for collecting, exchanging, and viewing patient data as well as offering midwives the possibility for receiving information and decision support. Introducing such technology in low-resource settings has been challenging because of low levels of user acceptance, software design that does not match the end-user environment, and/or unforeseen challenges such as irregular power availability. These challenges are often attributable to a lack of understanding by the software developers of the end users' needs and work environment. METHODS A mobile health (mHealth) application known as mClinic was designed to support midwife access to the Millennium Village-Global Network, an eHealth delivery platform that captures data for managing patient care as well as program evaluation and monitoring, decision making, and management. We conducted a descriptive usability study composed of 3 phases to evaluate an mClinic prototype: 1) hybrid lab-live software evaluation of mClinic to identify usability issues; 2) completion of a usability questionnaire; and 3) interviews that included low-fidelity prototyping of new functionality proposed by midwives. RESULTS The heuristic evaluation identified usability problems related to 4 of 8 usability categories. Analysis of usability questionnaire data indicated that the midwives perceived mClinic as useful but were more neutral about the ease of use. Analysis of midwives' reactions to low-fidelity prototypes during the interview process supported the applicability of mClinic to midwives' work and identified the need for additional functionality. DISCUSSION User acceptance is essential for the success of any mHealth implementation. Usability testing identified mClinic development flaws and needed software enhancements.
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5499
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Bravo C, O'Donoghue C, Kaplan CP, Luce J, Ozanne E. Can mHealth Improve Risk Assessment in Underserved Populations? Acceptability of a Breast Health Questionnaire App in Ethnically Diverse, Older, Low-Income Women. J Health Dispar Res Pract 2014; 7:6. [PMID: 25705576 PMCID: PMC4335717] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Use of mobile health (mHealth) tools has expanded rapidly but little research has been done on its acceptability by low-income, diverse, older patient populations. OBJECTIVE To assess the attitudes of a diverse group of underserved women on the acceptability and usability of mHealth tools in a clinical setting using a breast health questionnaire application (app) at a public hospital mammography clinic. METHODS Semi-structured interviews were conducted in a breast-imaging center of an urban safety net institution from July-August 2012. Interviews included pre- and post-questions. Women completed the Athena breast health questionnaire app on an iPad and were asked about their experience and ways to improve the tool. RESULTS Fifteen women age 45-79 years from diverse ethnic and educational backgrounds were interviewed. The majority of women, 11 of 15, preferred the Athena app over a paper version and all the women thought the app was easy to use. Two Spanish-speaking Latinas preferred paper; and two women, with limited mobile phone use, did not have a preference. Many women indicated that it would be necessary to have staff available for instruction and assistance if the app were to be implemented. CONCLUSIONS mHealth tools are an acceptable, if not preferred, method of collecting health information for diverse, older, low-income women. Further studies are required to evaluate the reliability and accuracy of data collection using mHealth tools in underserved populations. mHealth tools should be explored as a novel way to engage diverse populations to improve clinical care and bridge gaps in health disparities.
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Affiliation(s)
- Carolina Bravo
- University of California, San Francisco, San Francisco General Hospital
| | | | | | | | - Elissa Ozanne
- The Dartmouth Institute for Health Policy and Clinical Practice; University of California, San Francisco; University of California, San Francisco
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5500
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Muessig KE, Baltierra NB, Pike EC, LeGrand S, Hightow-Weidman LB. Achieving HIV risk reduction through HealthMpowerment.org, a user-driven eHealth intervention for young Black men who have sex with men and transgender women who have sex with men. Digit Cult Educ 2014; 6:164-182. [PMID: 25593616 PMCID: PMC4292870] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Young, Black men who have sex with men and transgender women who have sex with men (YBMSM/TW) are at disproportionate risk for HIV and other sexually transmitted infections (HIV/STI). HealthMpowerment.org (HMP) is a mobile phone optimised online intervention that utilises behaviour change and gaming theories to reduce risky sexual behaviours and build community among HIV-positive and negative YBMSM/TW. The intervention is user-driven, provides social support, and utilises a point reward system. A four-week pilot trial was conducted with a diverse group of 15 YBMSM/TW. During exit interviews, participants described how HMP components led to behaviour changes such as asking partners' sexual history, increased condom use, and HIV/STI testing. The user-driven structure, interactivity, and rewards appeared to facilitate sustained user engagement and the mobile platform provided relevant information in real-time. Participants described the reward elements of exceeding their previous scores and earning points toward prizes as highly motivating. HMP showed promise for being able to deliver a sufficient intervention dose and we found a trend toward higher dose received and more advanced stages of behaviour change. In this pilot trial, HMP was well accepted and demonstrates promise for translating virtual intervention engagement into actual behaviour change to reduce HIV risk behaviours.
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Affiliation(s)
- Kathryn E Muessig
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA ; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nina B Baltierra
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily C Pike
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Lisa B Hightow-Weidman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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