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Marent B, Henwood F, Darking M. Ambivalence in digital health: Co-designing an mHealth platform for HIV care. Soc Sci Med 2018; 215:133-141. [PMID: 30232053 DOI: 10.1016/j.socscimed.2018.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/29/2018] [Accepted: 09/03/2018] [Indexed: 11/29/2022]
Abstract
In reaction to polarised views on the benefits or drawbacks of digital health, the notion of 'ambivalence' has recently been proposed as a means to grasp the nuances and complexities at play when digital technologies are embedded within practices of care. This article responds to this proposal by demonstrating how ambivalence can work as a reflexive approach to evaluate the potential implications of digital health. We first outline current theoretical advances in sociology and organisation science and define ambivalence as a relational and multidimensional concept that can increase reflexivity within innovation processes. We then introduce our empirical case and highlight how we engaged with the HIV community to facilitate a co-design space where 97 patients (across five European clinical sites: Antwerp, Barcelona, Brighton, Lisbon, Zagreb) were encouraged to lay out their approaches, imaginations and anticipations towards a prospective mHealth platform for HIV care. Our analysis shows how patients navigated ambivalence within three dimensions of digital health: quantification, connectivity and instantaneity. We provide examples of how potential tensions arising through remote access to quantified data, new connections with care providers or instant health alerts were distinctly approached alongside embodied conditions (e.g. undetectable viral load) and embedded socio-material environments (such as stigma or unemployment). We conclude that ambivalence can counterbalance fatalistic and optimistic accounts of technology and can support social scientists in taking-up their critical role within the configuration of digital health interventions.
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Affiliation(s)
- Benjamin Marent
- School of Applied Social Science, University of Brighton, Mayfield House Falmer, BN1 9PH, United Kingdom.
| | - Flis Henwood
- School of Applied Social Science, University of Brighton, Mayfield House Falmer, BN1 9PH, United Kingdom.
| | - Mary Darking
- School of Applied Social Science, University of Brighton, Mayfield House Falmer, BN1 9PH, United Kingdom.
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- School of Applied Social Science, University of Brighton, Mayfield House Falmer, BN1 9PH, United Kingdom
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Hightow-Weidman L, Muessig K, Knudtson K, Srivatsa M, Lawrence E, LeGrand S, Hotten A, Hosek S. A Gamified Smartphone App to Support Engagement in Care and Medication Adherence for HIV-Positive Young Men Who Have Sex With Men (AllyQuest): Development and Pilot Study. JMIR Public Health Surveill 2018; 4:e34. [PMID: 29712626 PMCID: PMC5952121 DOI: 10.2196/publichealth.8923] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/31/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND HIV disproportionately impacts young men who have sex with men (YMSM) who experience disparities across the HIV care continuum. Addressing antiretroviral therapy (ART) adherence among YMSM is an urgent public health priority. Technology-based interventions-particularly mobile health platforms-can provide tailored adherence interventions and allow YMSM to engage and connect with others. OBJECTIVE The objective of this study was to describe the development of AllyQuest, a novel, theoretically-based, smartphone app designed to improve engagement in care and ART adherence and social support among HIV-positive YMSM. METHODS AllyQuest was built on an established platform for patient engagement that embeds social networking and fundamental game mechanics, such as challenges, points, and rewards. A medication tracker provides reminders to promote ART adherence via personalized adherence strategies that are user and context specific; a calendar allows for reflection on adherence over time. After iterative development with input from two youth advisory boards, usability testing was conducted to assess app functionality, comprehension of the educational content, use of intervention features, and overall impressions of app relevance and appeal. A 28-day pilot trial was conducted with 20 HIV+ YMSM to evaluate intervention feasibility and acceptability. RESULTS Mean age of participants was 21.8 years (range 19-24), and 95% (19/20) of the participants were nonwhite. The mean time of app use was 158.4 min (SD 114.1), with a range of 13 to 441 min. There was a mean of 21.2 days of use (out of a total possible 28 days). There were 222 posts to the daily discussion social wall. Feasibility and acceptability ratings were high. Overall, participants found the app easy to use and navigate, not intrusive, and had few reported technical issues. Higher levels of app usage were positively correlated with HIV self-management outcomes, and there was a statistically significant (P<.05) positive association between the number of days logged into the app and knowledge and confidence in ability to reliably take HIV medications. CONCLUSIONS AllyQuest represents a new, highly scalable solution that is well-suited to meet the specific prevention and care needs of HIV+ YMSM. The development of this intervention is both timely and vital, given the urgency of the ongoing HIV epidemic among YMSM.
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Affiliation(s)
- Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Kathryn Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Kelly Knudtson
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | | | | | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Anna Hotten
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, United States
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Mehraeen E, Safdari R, SeyedAlinaghi S, Mohammadzadeh N, Mohraz M. Common elements and features of a mobile-based self-management system for people living with HIV. Electron Physician 2018; 10:6655-6662. [PMID: 29881528 PMCID: PMC5984020 DOI: 10.19082/6655] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/10/2018] [Indexed: 02/05/2023] Open
Abstract
Background In recent years, mobile-based applications have become important technologies to the delivery of healthcare around the world. Mobile-based self-management systems with standard features for providing, evaluating, and improving HIV care are significantly required in developing countries. Objective To determine the common elements of a mobile-based self-management system for people living with HIV (PLWH). Methods This cross-sectional study was done in two main phases in 2017. In the first phase, a review was conducted in relevant databases such as; PubMed, Scopus, Up To Date, and Web of Science. The keywords used to search for resources were as follows; Self-care, Self-management, Data elements, Minimum data set, Mobile application, Mobile health, and HIV/AIDS. In the second phase, the infectious diseases specialists and health information managers affiliated with Tehran University of Medical Sciences were consulted to score identified elements by a questionnaire. Frequency and mean of collected data were calculated using SPSS software (version 19). Results By full-text reviewing of 9 related articles, the identified elements were justified in 3 main categories and 37 subcategories including: clinical data elements (17), technical capabilities (12) and demographic data elements (8). According to the findings, among the clinical category, 11 data elements were selected by the statistical population. Among the identified technical capabilities, 11 features were selected. Moreover, 6 data elements were selected as the demographic category. Conclusion We obtained data elements and technical capabilities of a mobile-based self-management system for people living with HIV. Using these elements and features, designing of self-management system architecture will be possible. Self-management skills of PLWH and their communication with healthcare providers will improve by using this system.
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Affiliation(s)
- Esmaeil Mehraeen
- Ph.D. Candidate of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Ph.D. of Health Information Management, Professor, Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Assistant Professor, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Mohammadzadeh
- Ph.D. of Health Information Management, Assistant Professor, Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Mohraz
- Professor, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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Schnall R, Cho H, Liu J. Health Information Technology Usability Evaluation Scale (Health-ITUES) for Usability Assessment of Mobile Health Technology: Validation Study. JMIR Mhealth Uhealth 2018; 6:e4. [PMID: 29305343 PMCID: PMC5775483 DOI: 10.2196/mhealth.8851] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/28/2017] [Accepted: 11/16/2017] [Indexed: 12/14/2022] Open
Abstract
Background Mobile technology has become a ubiquitous technology and can be particularly useful in the delivery of health interventions. This technology can allow us to deliver interventions to scale, cover broad geographic areas, and deliver technologies in highly tailored ways based on the preferences or characteristics of users. The broad use of mobile technologies supports the need for usability assessments of these tools. Although there have been a number of usability assessment instruments developed, none have been validated for use with mobile technologies. Objective The goal of this work was to validate the Health Information Technology Usability Evaluation Scale (Health-ITUES), a customizable usability assessment instrument in a sample of community-dwelling adults who were testing the use of a new mobile health (mHealth) technology. Methods A sample of 92 community-dwelling adults living with HIV used a new mobile app for symptom self-management and completed the Health-ITUES to assess the usability of the app. They also completed the Post-Study System Usability Questionnaire (PSSUQ), a widely used and well-validated usability assessment tool. Correlations between these scales and each of the subscales were assessed. Results The subscales of the Health-ITUES showed high internal consistency reliability (Cronbach alpha=.85-.92). Each of the Health-ITUES subscales and the overall scale was moderately to strongly correlated with the PSSUQ scales (r=.46-.70), demonstrating the criterion validity of the Health-ITUES. Conclusions The Health-ITUES has demonstrated reliability and validity for use in assessing the usability of mHealth technologies in community-dwelling adults living with a chronic illness.
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Affiliation(s)
- Rebecca Schnall
- School of Nursing, Columbia University, New York, NY, United States
| | - Hwayoung Cho
- School of Nursing, Columbia University, New York, NY, United States
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY, United States
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Stonbraker S, Cho H, Hermosi G, Pichon A, Schnall R. Usability Testing of a mHealth App to Support Self-Management of HIV-Associated Non-AIDS Related Symptoms. Stud Health Technol Inform 2018; 250:106-110. [PMID: 29857399 PMCID: PMC6310175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mobile health (mHealth) applications (apps) are uniquely poised to offer the information that persons living with HIV (PLWH) need to manage the symptoms associated with their chronic condition. The purpose of this study was to assess the usability of a mHealth app designed to help PLWH self-man-age the symptoms associated with their HIV and HIV-associated non-AIDS (HANA) conditions. We conducted a heuristic evaluation with five experts in informatics and end-user testing with 20 PLWH. End-users completed the PSSUQ and Health-ITUES validated measures of system usability. Mean severity scores for the 10-item heuristic checklist com-pleted by experts ranged from 0.4-2.4. End-users gave the system high scores on the PSSUQ and Health-ITUES usability measures (mean 2.23 ± 0.83 and 4.24 ± 0.62 respectively). Results indicated the system is usable and will be ready for future efficacy testing after incorporation of recommended feedback.
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Affiliation(s)
| | - Hwayoung Cho
- School of Nursing, Columbia University, New York, New York, USA
| | | | - Adrienne Pichon
- School of Nursing, Columbia University, New York, New York, USA
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, New York, USA
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Iribarren S, Siegel K, Hirshfield S, Olender S, Voss J, Krongold J, Luft H, Schnall R. Self-Management Strategies for Coping with Adverse Symptoms in Persons Living with HIV with HIV Associated Non-AIDS Conditions. AIDS Behav 2018; 22:297-307. [PMID: 28488165 DOI: 10.1007/s10461-017-1786-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
People living with HIV (PLWH) are living longer, but many are now affected by HIV-associated non-AIDS (HANA) conditions and their associated adverse symptoms. An online survey was conducted with 769 PLWH with HANA conditions in the US. Information was elicited on symptoms experienced, self-management strategies employed, and the helpfulness of these strategies. Open ended responses were collected for self-management strategies. A qualitative data analytic approach was used to organize the 4036 self-management strategies into thematic categories, with eight main categories emerging, including: taking medication, modifying activity, altering diet, seeking help, waiting, substance use, managing thoughts and attitudes, and altering the physical environment. Of the self-management strategy subcategories, social support was the most helpful self-management strategy with waiting/doing nothing being the least helpful approach. Findings can be used to inform the development of self-management interventions and to support health care professionals in recommending symptom self-management strategies to their patients.
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Bussone A, Stumpf S, Wilson S. The use of online forums by people living with HIV for help in understanding personal health information. Int J Med Inform 2017; 108:64-70. [PMID: 29132633 DOI: 10.1016/j.ijmedinf.2017.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/27/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Effective self-management of the human immunodeficiency virus/acquired immune deficiency virus (HIV/AIDS) requires constant vigilance over personal health information. Little is known about the contribution of online communities to this endeavour. This paper reports a study to investigate how people living with HIV/AIDS use an online community to try to understand their personal health information by analysing how health information is shared and asked about, and how the community responds to questions. METHODS A webscraper was used to gather all messages in the 200 most recently active threads in an online forum for people living with HIV/AIDS, resulting in a total of 2455 messages. These were filtered for all instances of individuals sharing their personal health information and asking the community for help in understanding it. Thematic analysis was used to determine the types of questions asked, the personal health information shared and the information that was asked about. Messages from the community aiming to address the questions were analysed using a framework of social support. RESULTS Approximately 10% of the 2455 messages were found to be involved in this activity: 60 messages contained questions, and 192 messages responded to address the questions. The most frequent type of question was about causation. While users shared a wide variety of information about their health, they most commonly asked about reactions, lab results, and other conditions. Nearly all the messages from the community that aimed to answer the questions provided informational support, which is a type of social support, and the community shared their own personal experiences in these responses. CONCLUSIONS This study demonstrates that online forums are used by people living with HIV to ask specific questions as a means of understanding their personal health information. The analysis provides a better understanding of the questions that people living with HIV have about their health information, and the types of support they receive from the community. The results provide a basis for further research into community support and self-management and will enable improved tools to support self-management.
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Affiliation(s)
- Adrian Bussone
- Centre for HCI Design, School of Mathematics, Computer Science, and Engineering, City, University of London, Northampton Square, London EC1V 0HB, UK.
| | - Simone Stumpf
- Centre for HCI Design, School of Mathematics, Computer Science, and Engineering, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Stephanie Wilson
- Centre for HCI Design, School of Mathematics, Computer Science, and Engineering, City, University of London, Northampton Square, London EC1V 0HB, UK
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Con D, Jackson B, Gray K, De Cruz P. eHealth for inflammatory bowel disease self-management - the patient perspective. Scand J Gastroenterol 2017; 52:973-980. [PMID: 28598210 DOI: 10.1080/00365521.2017.1333625] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Electronic health (eHealth) solutions may help address the growing pressure on IBD outpatient services as they encompass a component of self-management. However, information regarding patients' attitudes towards the use of eHealth solutions in IBD is lacking. OBJECTIVE The aim of this study was to evaluate eHealth technology use and explore the perspectives of IBD patients on what constitutes the ideal eHealth solution to facilitate self-management. METHODS A mixed methods qualitative and quantitative analysis of the outcomes of a discussion forum and an online survey conducted at a tertiary hospital in Melbourne, Australia between November 2015 and January 2016 was undertaken. RESULTS Eighteen IBD patients and parents participated in the discussion forum. IBD patients expressed interest in eHealth tools that are convenient and improve access to care, communication, disease monitoring and adherence. Eighty six patients with IBD responded to the online survey. A majority of patients owned a mobile phone (98.8%), had access to the internet (97.7%), and felt confident entering data onto a phone or computer (73.3%). Most patients (98.8%) were willing to use at least one form of information and communication technology to help manage their IBD. Smartphone apps and internet websites were the two most preferred technologies to facilitate IBD self-management. CONCLUSIONS This study demonstrates the willifngness of patients to engage with eHealth as a potential solution to facilitate IBD self-management. Future development and testing of eHealth solutions should be informed by all major stakeholders including patients to maximise their uptake and efficacy to facilitate IBD self-management.
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Affiliation(s)
- Danny Con
- a Faculty of Medicine, Dentistry and Health Sciences , The University of Melbourne , Melbourne , Australia.,b Department of Gastroenterology , Austin Hospital , Melbourne , Australia
| | - Belinda Jackson
- b Department of Gastroenterology , Austin Hospital , Melbourne , Australia
| | - Kathleen Gray
- c Health and Biomedical Informatics Centre , The University of Melbourne , Melbourne , Australia
| | - Peter De Cruz
- b Department of Gastroenterology , Austin Hospital , Melbourne , Australia.,d Department of Medicine , Austin Academic Centre, The University of Melbourne , Melbourne , Australia
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Daniels J, Lane T, Struthers H, Maleke K, Moges W, McIntyre J, Coates T. Assessing the Feasibility of Smartphone Apps for HIV-Care Research with MSM and Transgender Individuals in Mpumalanga, South Africa. J Int Assoc Provid AIDS Care 2017; 16:433-439. [PMID: 28791915 DOI: 10.1177/2325957417724207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is an urgent need to develop the HIV treatment cascade for men who have sex with men (MSM) and transgender individuals in rural Mpumalanga, South Africa. Mhealth tools such as smartphone applications have the potential to support HIV self-care behaviors. We conducted an exploratory study with HIV-positive community leaders to understand their current uses of cell phones and smartphones and to assess their interest in an HIV research study that utilized a smartphone application for HIV care support. A total of 18 community leaders were recruited to complete a questionnaire and focus group. We found that a large proportion of participants had smartphone access and were interested in a research study that utilized a smartphone application with secure access measures. We conclude that smartphone applications for HIV care research are feasible based on access and interest by MSM and transgender individuals in this rural setting.
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Affiliation(s)
- Joseph Daniels
- 1 Department of Health Sciences, Lehman College, The City University of New York, USA
| | - Tim Lane
- 2 Center for AIDS Prevention Studies, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Kabelo Maleke
- 3 Anova Health Institute, Johannesburg, South Africa
| | - Winta Moges
- 4 Program in Public Health, University of California at Irvine, Irvine, USA
| | - James McIntyre
- 5 School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Thomas Coates
- 6 Center for World Health, David Geffen School of Medicine, Los Angeles, USA
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Brown EL, Ruggiano N, Li J, Clarke PJ, Kay ES, Hristidis V. Smartphone-Based Health Technologies for Dementia Care: Opportunities, Challenges, and Current Practices. J Appl Gerontol 2017; 38:73-91. [DOI: 10.1177/0733464817723088] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Most of the 5.4 million people affected by Alzheimer’s disease and other forms of dementia (AD) are noninstitutionalized, receiving care by unpaid family caregivers and medically managed by a primary care provider (PCP). Health Information Technology has been recognized for its potential in improving efficiency and quality of AD care and support for AD caregivers. Simultaneously, smartphone technologies have become an increasingly common way to deliver physical and behavioral health care. However, little is known about how smartphone technologies have been used to support AD caregiving and care. This article highlights the current need for smartphone-based interventions for AD and systematically identified and appraised current smartphone apps targeting and available for AD caregivers. Findings indicate that individual available apps have limited functions (compared with the complex needs of caregivers) and little has been done to extend AD caregiving apps to Hispanic populations. Implications for research, practice, and policy are discussed.
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Affiliation(s)
| | | | - Juanjuan Li
- Florida International University, Miami, USA
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Cho H, Iribarren S, Schnall R. Technology-Mediated Interventions and Quality of Life for Persons Living with HIV/AIDS. A Systematic Review. Appl Clin Inform 2017; 8:348-368. [PMID: 28401246 PMCID: PMC6241739 DOI: 10.4338/aci-2016-10-r-0175] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/27/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND As HIV/AIDS is considered a chronic disease; quality of life (QoL) has become an important focus for researchers and healthcare providers. Technology-mediated interventions have demonstrated improved clinical effectiveness in outcomes, such as viral suppression, for persons living with HIV/AIDS (PLWH). However, the evidence to support the impact of these interventions on QoL is lacking. OBJECTIVES The aim of this paper was to assess the impact of technology-mediated interventions on QoL and to identify the instruments used to measure the QoL of PLWH. METHODS For this review we followed the PRISMA guidelines. A literature search was conducted in PubMed, CINAHL, Cochrane, and EMBASE databases in April 2016. Inclusion criteria limited articles to those with technology-mediated interventions as compared to usual care; articles with the population defined as HIV-infected patients; and articles with QoL measured as a health outcome in randomized controlled trials. The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. RESULTS Of the 1,554 peer-reviewed articles returned in the searches, 10 met the inclusion criteria. This systematic review identified four types of technology-mediated interventions and two types of QoL instruments used to examine the impact of technology-mediated interventions on PLWH. Four studies of technology-mediated interventions resulted in improvement in QoL. Four studies considered QoL as a secondary outcome and resulted in a negative or neutral impact on QoL. Overall, four studies had a low risk of bias, one study had a moderate risk of bias, and the other five studies had a high risk of bias. CONCLUSIONS The evidence to support the improvement of QoL using technology-mediated interventions is insufficient. This lack of research highlights the need for increased study of QoL as an outcome measure and the need for consistent measures to better understand the role of technology-mediated interventions in improving QoL for PLWH.
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Affiliation(s)
- Hwayoung Cho
- Hwayoung Cho, MPhil, MSN, RN, Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032, United States,
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ANI Emerging Leaders Project: Point-of-Care Technology for HIV Prevention and Management. Comput Inform Nurs 2017; 34:193-5. [PMID: 27153226 DOI: 10.1097/cin.0000000000000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Anand T, Nitpolprasert C, Kerr SJ, Muessig KE, Promthong S, Chomchey N, Hightow-Weidman LB, Chaiyahong P, Phanuphak P, Ananworanich J, Phanuphak N. A qualitative study of Thai HIV-positive young men who have sex with men and transgender women demonstrates the need for eHealth interventions to optimize the HIV care continuum. AIDS Care 2017; 29:870-875. [PMID: 28158952 DOI: 10.1080/09540121.2017.1286288] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In Thailand, young men who have sex with men (YMSM) and transgender women (TG) are disproportionately affected by HIV and have suboptimal care continuum outcomes. Although Thai YMSM and young TG are early adopters of emerging technologies and have high Internet and technology access and utilization, the potential of technology has not been harnessed to optimize the HIV treatment cascade. We interviewed 18 behaviorally HIV-infected YMSM and young TG regarding care challenges, identified how eHealth could address care needs, and elicited preferences for eHealth interventions. Participants reported struggling with individual and societal-level stigma which negatively impacted linkage to and retention in care, and antiretroviral therapy adherence. YMSM and young TG described inadequate in-person support services and heavily relied on random online resources to fill information and support gaps, but sometimes viewed them as untrustworthy or inconsistent. Participants universally endorsed the development of eHealth resources and proposed how they could ameliorate individual-level fears over stigma and improve public perceptions about HIV. Personalized and integrated eHealth interventions with interactive, user-driven structures, credible content, rewards for engagement, real-time counseling and reminder support could help overcome barriers YMSM and young TG face in traditional HIV healthcare systems and have the potential to improve care outcomes.
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Affiliation(s)
- Tarandeep Anand
- a The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,b SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | - Chattiya Nitpolprasert
- a The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,b SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | - Stephen J Kerr
- c HIV-NAT, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,d The Kirby Institute, University of New South Wales , Sydney , Australia.,e Department of Global Health, Academic Medical Center , Amsterdam Institute for Global Health and Development, University of Amsterdam , Amsterdam , The Netherlands
| | - Kathryn E Muessig
- f Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA
| | | | - Nitiya Chomchey
- b SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | - Lisa B Hightow-Weidman
- g Division of Infectious Diseases, School of Medicine , University of North Carolina , Chapel Hill , NC , USA
| | | | - Praphan Phanuphak
- a The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,c HIV-NAT, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | - Jintanat Ananworanich
- b SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,h US Military HIV Research Program , Walter Reed Army Institute of Research , Silver Spring , MD , USA.,i Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda , MD , USA
| | - Nittaya Phanuphak
- a The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,b SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
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Predictors of willingness to use a smartphone for research in underserved persons living with HIV. Int J Med Inform 2017; 99:53-59. [PMID: 28118922 DOI: 10.1016/j.ijmedinf.2017.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The burden of HIV/AIDS is borne disproportionally by a growing number of racial and ethnic minorities and socioeconomically disadvantaged individuals. Developing mHealth interventions for the everyday self-management needs of persons living with HIV (PLWH) can be challenging given the current constraints of the U.S. healthcare system, especially for those from underserved communities. In order to develop effective, evidence-based mHealth self-management interventions, we need a better understanding of the factors associated with mHealth research. The purpose of this study was to assess factors associated with PLWH's for participation in research using smartphones. METHODS We conducted a prospective cohort study (parent study) to examine the relationships among HIV self-management, age, gender and mental wellness. Relevant to this study, we analyzed the relationship between self-reported use of smartphones, willingness to use a smartphone for research, and other predictor variables including: HIV stigma, social isolation, social integration functions, and depression. We selected these variables because previous work indicated they may influence smartphone or mHealth use and because they also tend to be elevated in PLWH. RESULTS We found increased age, HIV stigma and social isolation were negatively associated with smartphone use, which supports the use of smartphones for conducting research with PLWH but also suggests that age, stigma, social integration functions and social isolation need to be considered in research involving PLWH. CONCLUSIONS Findings here support smartphone use in research involving PLWH. However, future mHealth interventions targeting PLWH should take into account the inverse relationship between smartphone use and age, HIV stigma, and social isolation, and other predictor variables.
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Fulford H, McSwiggan L, Kroll T, MacGillivray S. Exploring the Use of Information and Communication Technology by People With Mood Disorder: A Systematic Review and Metasynthesis. JMIR Ment Health 2016; 3:e30. [PMID: 27370327 PMCID: PMC4947190 DOI: 10.2196/mental.5966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/05/2016] [Accepted: 06/06/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a growing body of evidence relating to how information and communication technology (ICT) can be used to support people with physical health conditions. Less is known regarding mental health, and in particular, mood disorder. OBJECTIVE To conduct a metasynthesis of all qualitative studies exploring the use of ICTs by people with mood disorder. METHODS Searches were run in eight electronic databases using a systematic search strategy. Qualitative and mixed-method studies published in English between 2007 and 2014 were included. Thematic synthesis was used to interpret and synthesis the results of the included studies. RESULTS Thirty-four studies were included in the synthesis. The methodological design of the studies was qualitative or mixed-methods. A global assessment of study quality identified 22 studies as strong and 12 weak with most having a typology of findings either at topical or thematic survey levels of data transformation. A typology of ICT use by people with mood disorder was created as a result of synthesis. CONCLUSIONS The systematic review and metasynthesis clearly identified a gap in the research literature as no studies were identified, which specifically researched how people with mood disorder use mobile ICT. Further qualitative research is recommended to understand the meaning this type of technology holds for people. Such research might provide valuable information on how people use mobile technology in their lives in general and also, more specifically, how they are being used to help with their mood disorders.
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Affiliation(s)
- Hamish Fulford
- School of Nursing and Health Sciences, University of Dundee, Dundee, United Kingdom
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Iribarren SJ, Schnall R, Stone PW, Carballo-Diéguez A. Smartphone Applications to Support Tuberculosis Prevention and Treatment: Review and Evaluation. JMIR Mhealth Uhealth 2016; 4:e25. [PMID: 27177591 PMCID: PMC4884267 DOI: 10.2196/mhealth.5022] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/23/2015] [Accepted: 10/31/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a major global health problem and is the leading killer due to a single infectious disease. Mobile health (mHealth)-based tools such as smartphone apps have been suggested as tools to support TB control efforts (eg, identification, contact tracing, case management including patient support). OBJECTIVE The purpose of this review was to identify and assess the functionalities of mobile apps focused on prevention and treatment of TB. METHODS We searched 3 online mobile app stores. Apps were included if they were focused on TB and were in English, Spanish, or Portuguese. For each included app, 11 functionalities were assessed (eg, inform, instruct, record), and searches were conducted to identify peer-review publications of rigorous testing of the available apps. RESULTS A total of 1332 potentially relevant apps were identified, with 24 meeting our inclusion criteria. All of the apps were free to download, but 7 required login and password and were developed for specific clinics, regional sites, or research studies. Targeted users were mainly clinicians (n=17); few (n=4) apps were patient focused. Most apps (n=17) had 4 or fewer functions out of 11 (range 1-6). The most common functionalities were inform and record (n=15). Although a number of apps were identified with various functionalities to support TB efforts, some had issues such as incorrect spelling and grammar, inconsistent responses to data entry, problems with crashing, or links to features that had no data. Of more concern, some apps provided potentially harmful information to patients, such as links to natural remedies for TB and natural healers. One-third of the apps (8/24) had not been updated for more than a year and may no longer be supported. Peer-reviewed publications were identified for only two of the included apps. In the gray literature (not found in the app stores), three TB-related apps were identified as in progress, being launched, or tested. CONCLUSIONS Apps identified for TB prevention and treatment had minimal functionality, primarily targeted frontline health care workers, and focused on TB information (eg, general information, guidelines, and news) or data collection (eg, replace paper-based notification or tracking). Few apps were developed for use by patients and none were developed to support TB patient involvement and management in their care (eg, follow-up alerts/reminders, side effects monitoring) or improve interaction with their health care providers, limiting the potential of these apps to facilitate patient-centered care. Our evaluation shows that more refined work is needed to be done in the area of apps to support patients with active TB. Involving TB patients in treatment in the design of these apps is recommended.
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Affiliation(s)
- Sarah J Iribarren
- Columbia University, School of Nursing, New York, NY, United States.
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Ramirez V, Johnson E, Gonzalez C, Ramirez V, Rubino B, Rossetti G. Assessing the Use of Mobile Health Technology by Patients: An Observational Study in Primary Care Clinics. JMIR Mhealth Uhealth 2016; 4:e41. [PMID: 27095507 PMCID: PMC4858592 DOI: 10.2196/mhealth.4928] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/14/2015] [Accepted: 01/04/2016] [Indexed: 12/03/2022] Open
Abstract
Background There is significant potential for mobile health technology to improve health outcomes for patients with chronic diseases. However, there is a need for further development of mobile health technology that would help to improve the health of lower-income communities. Objective The study objective was to assess mobile phone and app usage among a culturally diverse patient population, and to determine whether patients would be interested in using mobile health technology to help manage their chronic diseases. Methods An observational study was conducted with patients of the Internal Medicine resident primary care clinics of Los Angeles County and University of Southern California (LAC+USC) Medical Center. Self-reported information regarding demographics, current mobile phone usage, current mobile health app and social media usage, barriers to using mobile phones or mobile health apps, and interest in using a mobile health app was collected. Results Ninety-one percent of patients owned a mobile phone, with 76% (169/223) of these reporting having a mobile phone with Internet capability. Fifty-seven percent of subjects used mobile apps on their mobile phones, and 32% (41/130) of these used mobile apps related to their health. Eighty-six percent (207/241) of respondents voiced interest in using a mobile app to improve their health, and 40% (88/221) stated they would use such an app daily. Patients stated they would find the mobile health app most useful for nutrition, exercise, and obtaining general information on medical conditions. Conclusions Despite the fact that the majority of our primary care patients were of lower socioeconomic status, they utilized mobile phones with Internet and mobile app capabilities to a great extent. There was substantial interest among our patients in using mobile health technology to both manage chronic disease and improve overall health. Given that cultural, educational, and socioeconomic disparities strongly correlate with higher rates of chronic diseases such as obesity, diabetes and hypertension, access to culturally relevant mobile health tools may empower patients in these populations to improve health outcomes.
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Affiliation(s)
- Veronica Ramirez
- Department of Internal Medicine, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States.
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Horvath KJ, Alemu D, Danh T, Baker JV, Carrico AW. Creating Effective Mobile Phone Apps to Optimize Antiretroviral Therapy Adherence: Perspectives From Stimulant-Using HIV-Positive Men Who Have Sex With Men. JMIR Mhealth Uhealth 2016; 4:e48. [PMID: 27084049 PMCID: PMC4851721 DOI: 10.2196/mhealth.5287] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/25/2015] [Accepted: 01/30/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of stimulant drugs among men who have sex with men (MSM) with human immunodeficiency virus (HIV) is associated with decreased odds of antiretroviral therapy (ART) adherence and elevated risk of forward HIV transmission. Advancing tailored and innovative mobile phone-based ART adherence app interventions for stimulant-using HIV-positive MSM requires greater understanding of their needs and preferences in this emerging area. OBJECTIVE The purpose of this study is to (1) assess reasons that stimulant-using HIV-positive MSM download and sustain their use of mobile phone apps in general, and (2) obtain feedback on features and functions that these men prefer in a mobile phone app to optimize their ART adherence. METHODS Focus groups were conducted with stimulant-using HIV-positive MSM (24-57 years of age; mostly non-Hispanic white; 42% once a week or more frequent stimulant drug use) in San Francisco and Minneapolis. Our aim was to explore the mobile phone app features and functions that they considered when deciding to download and sustain their use of general apps over time, as well as specific features and functions that they would like to see incorporated into an ART adherence mobile app. Focus groups were audiorecorded and transcribed verbatim. Thematic analysis was applied to transcripts using line-by-line open coding and organizing codes into meaningful themes. RESULTS Men reported that they currently had a variety of health and wellness, social media and networking, gaming and entertainment, and utility apps on their mobile phones. Downloading apps to their mobile phones was influenced by the cost of the app, recommendations by a trusted source, and the time it takes to download. In addition, downloading and sustained use of apps was more likely to occur when men had control over most features of the app and apps were perceived to be useful, engaging, secure, and credible. Participants suggested that ART adherence mobile phone apps include social networking features, connections to local resources and their medical chart, and breaking HIV news and updates. Although some men expressed concerns about daily self-monitoring of HIV medication doses, many appreciated receiving a summary of their medication adherence over time and suggested that feedback about missed doses be delivered in an encouraging and humorous manner. CONCLUSIONS In this study, we were able to recruit a relatively high proportion (42%) of HIV-positive MSM reporting weekly or more stimulant use. These results suggest critical design elements that may need to be considered during development of ART adherence-related mobile phone apps for this, and possibly other, high-risk groups. In particular, finding the optimal balance of security, engagement, usefulness, control capabilities, and credibility will be critical to sustained used of HIV treatment apps.
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Affiliation(s)
- Keith J Horvath
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States.
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SCHNALL R, BAKKEN S, BROWN W, CARBALLO-DIEGUEZ A, IRIBARREN S. Usabilty Evaluation of a Prototype Mobile App for Health Management for Persons Living with HIV. Stud Health Technol Inform 2016; 225:481-485. [PMID: 27332247 PMCID: PMC5588855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mobile health (mHealth) applications (apps) have the potential to support self-management and improve health outcomes in persons living with HIV (PLWH). In this paper, we report on the final step in a three-stage user-centered design process for the development of a mHealth app for PLWH. We conducted a usability evaluation with 10 targeted end-users and a heuristic evaluation with 5 persons with informatics expertise to assess the usability of a prototype mHealth app for PLWH to manage their health. At the end of our usability evaluation, we finalized a Design Document that included the user interface design and functional specifications of the mHealth app. The functional areas which were identified at the end of our iterative process included: Communication, Reminders, Medication Logs, Lab Reports, Pharmacy Info, Nutrition and Fitness, Resources and Settings.
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Affiliation(s)
| | - Suzanne BAKKEN
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - William BROWN
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- HIV Center, Division of Gender, Sexuality and Health, New York State Psychiatric Institute, New York, NY, USA
| | - Alex CARBALLO-DIEGUEZ
- HIV Center, Division of Gender, Sexuality and Health, New York State Psychiatric Institute, New York, NY, USA
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Schnall R, Mosley JP, Iribarren SJ, Bakken S, Carballo-Diéguez A, Brown Iii W. Comparison of a User-Centered Design, Self-Management App to Existing mHealth Apps for Persons Living With HIV. JMIR Mhealth Uhealth 2015; 3:e91. [PMID: 26385783 PMCID: PMC4704937 DOI: 10.2196/mhealth.4882] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/07/2015] [Accepted: 08/18/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is preliminary evidence that mobile health (mHealth) apps are feasible, attractive, and an effective platform for the creation of self-management tools for persons living with HIV (PLWH). As a foundation for the current study, we conducted formative research using focus groups, participatory design sessions, and usability evaluation methods to inform the development of a health management app for PLWH. The formative research resulted in identification of the following functional requirements of a mHealth app for self-management: (1) communication between providers and peers, (2) medication reminders, (3) medication log, (4) lab reports, (5) pharmacy information, (6) nutrition and fitness, (7) resources (eg, social services, substance use, video testimonials), (8) settings, and (9) search function. OBJECTIVE The purpose of this study was to conduct an ecological review of the existing apps for PLWH and to compare the functionality of existing apps with the app specifications identified in our formative work. METHODS We searched two mobile app stores (Google Play and iTunes) and found a total of 5606 apps. We reviewed the apps, narrowed our search terms, and found a total of 112 apps. Of these, we excluded 97 (86.6%) apps that were either not in English (10/112, 8.9%), not HIV focused (32/112, 28.9%), or focused only on HIV prevention (2/112, 7.8%); targeted health care providers (26/112, 23.2%); provided information only on conference schedules and events (7/112, 6.3%), fundraisers (7/112, 6.3%), specific clinics (7/112, 6.3%), international or narrow local resources (3/112, 2.7%); or were identified in the first search but were no longer on the market at the next review (4/112, 3.6%). The 15 apps meeting inclusion criteria were then evaluated for inclusion of the nine functionalities identified in our earlier work. RESULTS Of the 15 apps that we included in our final review, none had all of the functionalities that were identified in our formative work. The apps that we identified included the following functionalities: communication with providers and/or peers (4/15, 27%), medication reminders (6/15, 40%), medication logs (7/15, 47%), lab reports (5/15, 33%), pharmacy information (4/15, 27%), resources (7/15, 47%), settings (11/15, 73%), and search function (6/15, 40%). No apps included nutrition or fitness information. CONCLUSIONS Currently, there are only a small number of apps that have been designed for PLWH to manage their health. Of the apps that are currently available, none have all of the desired functionalities identified by PLWH and experts in our formative research. Findings from this work elucidate the need to develop and evaluate mobile apps that meet PLWH's desired functional specifications.
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Affiliation(s)
- Rebecca Schnall
- Columbia University, School of Nursing, New York, NY, United States.
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Schnall R, Iribarren SJ. Review and analysis of existing mobile phone applications for health care-associated infection prevention. Am J Infect Control 2015; 43:572-6. [PMID: 25748924 DOI: 10.1016/j.ajic.2015.01.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The expanding number of mobile health applications (apps) holds potential to reduce and eliminate health care-associated infections (HAIs) in clinical practice. The purpose of this review was to identify and provide an overview of the apps available to support prevention of HAIs and to assess their functionality and potential uses in clinical care. METHODS We searched 3 online mobile app stores using the following terms: infection prevention, prevention, hand hygiene, hand washing, and specific HAI terms (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infections, surgical site infection, and ventilator associated pneumonia [VAP]). RESULTS Search queries yielded a total of 2,646 potentially relevant apps, of which 17 met our final inclusion criteria. The areas of focus were CAUTI (n = 1, 5.9%), VAP (n = 1, 5.9%), environmental monitoring (n = 2, 11.8%), and hand hygiene (n = 2, 11.8%); the remainder (n = 11, 64.7%) were focused on >1 area (eg, multiple infection prevention bundles, infection prevention guidelines). Almost all of the apps (70.6%) had a maximum of two functions. CONCLUSION Mobile apps may help reduce HAI by providing easy access to guidelines, hand hygiene monitoring support, or step-by-step procedures aimed at reducing infections at the point of clinical care. Given the dearth of available apps and the lack of functionality with those that are available, there is a need for further development of mobile apps for HAI prevention at the point of care.
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Schnall R, Higgins T, Brown W, Carballo-Dieguez A, Bakken S. Trust, Perceived Risk, Perceived Ease of Use and Perceived Usefulness as Factors Related to mHealth Technology Use. Stud Health Technol Inform 2015; 216:467-471. [PMID: 26262094 PMCID: PMC5588863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mobile technology use is nearly ubiquitous which affords the opportunity for using these technologies for modifying health related behaviors. At the same time, use of mobile health (mHealth) technology raises privacy and security concerns of consumers. The goal of this analysis was to understand the perceived ease of use, usefulness, risk and trust that contribute to behavioral intention to use a mobile application for meeting the healthcare needs of persons living with HIV (PLWH). To understand these issues, we conducted focus group sessions with 50 persons living with HIV and 30 HIV healthcare providers. We used the e-commerce acceptance model to analyze our focus group data. Findings from the study demonstrated the need for mHealth to be perceived as useful, easy to use, with little perceived risk accompanied by a measure of trust in the creators of the technology. Findings from this work can inform future work on patients and providers' perceptions of risk, trust, ease of use and usefulness of mHealth technology.
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Affiliation(s)
| | - Tracy Higgins
- Columbia University School of Nursing, New York, NY, USA
| | - William Brown
- Columbia University Department of Biomedical Informatics, New York, NY, USA
| | - Alex Carballo-Dieguez
- HIV center, Division of Gender, Sexuality and Health NYS Psychiatric Institute and Columbia University, New York, NY, USA
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
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