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Stiles-Shields C, Montague E, Lattie EG, Kwasny MJ, Mohr DC. What might get in the way: Barriers to the use of apps for depression. Digit Health 2017; 3:2055207617713827. [PMID: 29942605 PMCID: PMC6001178 DOI: 10.1177/2055207617713827] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 05/09/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Smartphones are being used with increasing frequency to deliver behavioral interventions for depression via apps. However, barriers specific to using an app for depression are poorly defined. The purpose of the current study is to identify barriers to the use of a mobile app to deliver treatment for depression. Secondarily, design implications will be provided based upon identified barriers. Method A card sorting task that ranked and grouped barriers to the use of apps for depression was completed. Participants first completed a card sorting task identifying barriers to face-to-face treatment, as a primer to identification of treatment barriers. The sample consisted of those above (n = 9) and below (n = 11) the threshold for a referral to psychotherapy, to capture anticipated barriers for likely end users. Cluster analyses were conducted to analyze the card sorting data. Multiple analyses were conducted to identify: 1) the most important barriers, and 2) how consistently barriers were ranked as important. Result The card sorting task identified a number of primary barriers to the use of apps for depression treatment, including concerns over intervention efficacy, app functioning, privacy, cost, and lack of guidance and tailored feedback. The top face-to-face treatment barrier was cost, overlapping with mobile barriers. Conclusion This study identified perceived barriers to the use of mobile treatment apps. Identification of barriers implicates design recommendations for apps for depression.
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Affiliation(s)
- Colleen Stiles-Shields
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, USA
| | - Enid Montague
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA.,College of Computing and Digital Media, DePaul University, Chicago, IL, USA
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - Mary J Kwasny
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
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102
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Privacy and security issues in mobile health: Current research and future directions. HEALTH POLICY AND TECHNOLOGY 2017. [DOI: 10.1016/j.hlpt.2017.01.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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103
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Nicholas J, Boydell K, Christensen H. Beyond symptom monitoring: Consumer needs for bipolar disorder self-management using smartphones. Eur Psychiatry 2017; 44:210-216. [PMID: 28692910 DOI: 10.1016/j.eurpsy.2017.05.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To investigate the potential use of smartphone apps to support self-management in young adults with bipolar disorder. METHODS We recruited 89 young adults (18-30 years) with bipolar disorder to complete a cross-sectional online survey. The survey contained quantitative and qualitative questions regarding technology use, current use of disorder-management apps, types of apps desired for disorder management, and app features that users would consider important when selecting apps. Results were analysed using descriptive statistics and thematic analysis. RESULTS Almost all participants used a smartphone daily and 40% currently used apps for disorder management. Of those not currently using apps, 79% indicated they would like to try them. On average, participants rated 61% of the self-management strategies listed as desirable for app support, with sleep-management, understanding early warning signs and triggers, and stay-well plans the most frequently endorsed. App features considered important during app selection were ease-of-use, scientific quality, flexibility/customisation, and data privacy. CONCLUSIONS The results indicate that young adults with bipolar disorder are interested in a wide range of apps for self-management. Participants were interested in apps to support self-management strategies considered clinically important for disorder management. Many of these app needs are currently unmet. Results suggest diversifying and prioritising app capabilities to ensure evidence-based resources for a broader range of app functions are available to consumers.
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Affiliation(s)
- J Nicholas
- Black Dog institute, UNSW Australia, Sydney, Australia; Faculty of Medicine, School of Psychiatry, UNSW Australia, Sydney, Australia.
| | - K Boydell
- Black Dog institute, UNSW Australia, Sydney, Australia
| | - H Christensen
- Black Dog institute, UNSW Australia, Sydney, Australia
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Crosby LE, Ware RE, Joffe NE, Britto MT. Reply to iManage: A novel self-management app for sickle cell disease. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26358. [PMID: 28342302 PMCID: PMC7323363 DOI: 10.1002/pbc.26358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/13/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Lori E. Crosby
- Division of Behavioral Medicine, Cincinnati
Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College
of Medicine, Cincinnati, OH,James M. Anderson Center for Health Systems Excellence,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Russell E. Ware
- Department of Pediatrics, University of Cincinnati College
of Medicine, Cincinnati, OH,Division of Hematology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH
| | - Naomi E. Joffe
- Division of Behavioral Medicine, Cincinnati
Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College
of Medicine, Cincinnati, OH
| | - Maria T. Britto
- Department of Pediatrics, University of Cincinnati College
of Medicine, Cincinnati, OH,Division of Adolescent Medicine, Cincinnati
Children’s Hospital Medical Center, Cincinnati, OH,James M. Anderson Center for Health Systems Excellence,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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105
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Badawy SM. iManage: A novel self-management app for sickle cell disease. Pediatr Blood Cancer 2017; 64. [PMID: 27696691 DOI: 10.1002/pbc.26289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 09/08/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Hematology/Oncology, Department of Pediatrics, Faculty of Medicine at Zagazig University, Zagazig, Egypt
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106
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Salzwedel A, Rabe S, Zahn T, Neuwirth J, Eichler S, Haubold K, Wachholz A, Reibis R, Völler H. User Interest in Digital Health Technologies to Encourage Physical Activity: Results of a Survey in Students and Staff of a German University. JMIR Mhealth Uhealth 2017; 5:e51. [PMID: 28428156 PMCID: PMC5415655 DOI: 10.2196/mhealth.7192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/07/2017] [Indexed: 11/24/2022] Open
Abstract
Background Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users. Objective The aim of this study was the explorative, nuanced determination of the interest in mHealth apps with respect to PA among students and staff of a university. Methods We conducted a Web-based survey from June to July 2015 in which students and employees from the University of Potsdam were asked about their activity level, interest in mHealth fitness apps, chronic diseases, and sociodemographic parameters. Results A total of 1217 students (67.30%, 819/1217; female; 26.0 years [SD 4.9]) and 485 employees (67.5%, 327/485; female; 42.7 years [SD 11.7]) participated in the survey. The recommendation for PA (3 times per week) was not met by 70.1% (340/485) of employees and 52.67% (641/1217) of students. Within these groups, 53.2% (341/641 students) and 44.2% (150/340 employees)—independent of age, sex, body mass index (BMI), and level of education or professional qualification—indicated an interest in mHealth fitness apps. Conclusions Even in a younger, highly educated population, the majority of respondents reported an insufficient level of PA. About half of them indicated their interest in training support. This suggests that the use of personalized mobile fitness apps may become increasingly significant for a positive change of lifestyle.
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Affiliation(s)
- Annett Salzwedel
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Sophie Rabe
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Thomas Zahn
- GeWINO - Health Research Institute, AOK Nordost - Die Gesundheitskasse, Berlin, Germany
| | - Julia Neuwirth
- GeWINO - Health Research Institute, AOK Nordost - Die Gesundheitskasse, Berlin, Germany
| | - Sarah Eichler
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Kathrin Haubold
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Anne Wachholz
- GeWINO - Health Research Institute, AOK Nordost - Die Gesundheitskasse, Berlin, Germany
| | - Rona Reibis
- Cardiological Outpatient Clinic Am Park Sanssouci Potsdam, Potsdam, Germany
| | - Heinz Völler
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
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Zamora A, Carrion C, Aymerich M, Castells X, Blanco L, Martin-Urda A, Paluzie G, Capella D, Elosua R, Group V. Evaluation of a Clinical Decision Support System for Dyslipidemia Treatment (HTE-DLPR) by QoE questionnaire. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2017. [DOI: 10.21859/ijcp-020105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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108
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Prochaska JJ, Coughlin SS, Lyons EJ. Social Media and Mobile Technology for Cancer Prevention and Treatment. Am Soc Clin Oncol Educ Book 2017; 37:128-137. [PMID: 28561647 PMCID: PMC5788572 DOI: 10.1200/edbk_173841] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Given the number of lives affected by cancer and the great potential for optimizing well-being via lifestyle changes, patients, providers, health care systems, advocacy groups, and entrepreneurs are looking to digital solutions to enhance patient care and broaden prevention efforts. Thousands of health-oriented mobile websites and apps have been developed, with a majority focused upon lifestyle behaviors (e.g., exercise, diet, smoking). In this review, we consider the use and potential of social media and mHealth technologies for cancer prevention, cancer treatment, and survivorship. We identify key principles in research and practice, summarize prior reviews, and highlight notable case studies and patient resources. Further, with the potential for scaled delivery and broad reach, we consider application of social media and mHealth technologies in low-resource settings. With clear advantages for reach, social media and mHealth technologies offer the ability to scale and engage entire populations at low cost, develop supportive social networks, connect patients and providers, encourage adherence with cancer care, and collect vast quantities of data for advancing cancer research. Development efforts have been rapid and numerous, yet evaluation of intervention effects on behavior change and health outcomes are sorely needed, and regulation around data security issues is notably lacking. Attention to broader audiences is also needed, with targeted development for culturally diverse groups and non-English speakers. Further investment in research to build the evidence base and identify best practices will help delineate and actualize the potential of social media and mHealth technologies for cancer prevention and treatment.
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Affiliation(s)
- Judith J Prochaska
- From the Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA; Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA; Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Steven S Coughlin
- From the Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA; Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA; Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Elizabeth J Lyons
- From the Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA; Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA; Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
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109
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The Interactive Mobile App Review Toolkit (IMART): a Clinical Practice-Oriented System. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s41347-016-0005-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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110
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Grindrod K, Boersema J, Waked K, Smith V, Yang J, Gebotys C. Locking it down: The privacy and security of mobile medication apps. Can Pharm J (Ott) 2016; 150:60-66. [PMID: 28286594 DOI: 10.1177/1715163516680226] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore the privacy and security of free medication applications (apps) available to Canadian consumers. METHODS The authors searched the Canadian iTunes store for iOS apps and the Canadian Google Play store for Android apps related to medication use and management. Using an Apple iPad Air 2 and a Google Nexus 7 tablet, 2 reviewers generated a list of apps that met the following inclusion criteria: free, available in English, intended for consumer use and related to medication management. Using a standard data collection form, 2 reviewers independently coded each app for the presence/absence of passwords, the storage of personal health information, a privacy statement, encryption, remote wipe and third-party sharing. A Cohen's Kappa statistic was used to measure interrater agreement. RESULTS Of the 184 apps evaluated, 70.1% had no password protection or sign-in system. Personal information, including name, date of birth and gender, was requested by 41.8% (77/184) of apps. Contact information, such as address, phone number and email, was requested by 25% (46/184) of apps. Finally, personal health information, other than medication name, was requested by 89.1% (164/184) of apps. Only 34.2% (63/184) of apps had a privacy policy in place. CONCLUSION Most free medication apps offer very limited authentication and privacy protocols. As a result, the onus currently falls on patients to input information in these apps selectively and to be aware of the potential privacy issues. Until more secure systems are built, health care practitioners cannot fully support patients wanting to use such apps.
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Affiliation(s)
- Kelly Grindrod
- School of Pharmacy (Grindrod, Boersema, Waked, Yang), University of Waterloo, Waterloo, Ontario
| | - Jonathan Boersema
- School of Pharmacy (Grindrod, Boersema, Waked, Yang), University of Waterloo, Waterloo, Ontario
| | - Khrystine Waked
- School of Pharmacy (Grindrod, Boersema, Waked, Yang), University of Waterloo, Waterloo, Ontario
| | - Vivian Smith
- School of Pharmacy (Grindrod, Boersema, Waked, Yang), University of Waterloo, Waterloo, Ontario
| | - Jilan Yang
- School of Pharmacy (Grindrod, Boersema, Waked, Yang), University of Waterloo, Waterloo, Ontario
| | - Catherine Gebotys
- School of Pharmacy (Grindrod, Boersema, Waked, Yang), University of Waterloo, Waterloo, Ontario
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111
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Wellbeloved-Stone CA, Weppner JL, Valdez RS. A Systematic Review of Telerehabilitation and mHealth Interventions for Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0138-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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112
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Bacchus LJ, Bullock L, Sharps P, Burnett C, Schminkey DL, Buller AM, Campbell J. Infusing Technology Into Perinatal Home Visitation in the United States for Women Experiencing Intimate Partner Violence: Exploring the Interpretive Flexibility of an mHealth Intervention. J Med Internet Res 2016; 18:e302. [PMID: 27856405 PMCID: PMC5133433 DOI: 10.2196/jmir.6251] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/17/2016] [Accepted: 10/28/2016] [Indexed: 11/13/2022] Open
Abstract
Background Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored. Objective Our objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors’ and women’s perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method. Methods We used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the 2 DOVE program designers. Nonparticipant observations of home visits with trial participants who chose not to participate in semistructured interviews were undertaken. Results We conducted 51 interviews with 26 women, 23 home visiting staff at rural and urban sites, and the 2 DOVE program designers. We conducted 4 nonparticipant observations. Among 18 IPV-positive women, 7 used the computer tablet and 11 used the home visitor method. Among 8 IPV-negative women, 7 used the home visitor method. The computer tablet was viewed as a safe and confidential way for abused women to disclose their experiences without fear of being judged. The meanings that the DOVE technology held for home visitors and women led to its construction as either an impersonal artifact that was an impediment to discussion of IPV or a conduit through which interpersonal connection could be deepened, thereby facilitating discussion about IPV. Women’s and home visitors’ comfort with either method of screening was positively influenced by factors such as having established trust and rapport, as well as good interpersonal communication. The technology helped reduce the anticipated stigma associated with disclosing abuse. The didactic intervention video was a limiting feature, as the content could not be tailored to accommodate the fluidity of women’s circumstances. Conclusions Users and developers of technology-based IPV interventions need to consider the context in which they are being embedded and the importance of the patient-provider relationship in promoting behavior change in order to realize the full benefits. An mHealth approach can and should be used as a tool for initiating discussion about IPV, assisting women in enhancing their safety and exploring help-seeking options. However, training for home visitors is required to ensure that a computer tablet is used to complement and enhance the therapeutic relationship. ClinicalTrial Clinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitation.org/6limSWdZP)
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Affiliation(s)
- Loraine J Bacchus
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.,School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Linda Bullock
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Phyllis Sharps
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Camille Burnett
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Donna L Schminkey
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Ana Maria Buller
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jacquelyn Campbell
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
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Coughlin S, Thind H, Liu B, Champagne N, Jacobs M, Massey RI. Mobile Phone Apps for Preventing Cancer Through Educational and Behavioral Interventions: State of the Art and Remaining Challenges. JMIR Mhealth Uhealth 2016; 4:e69. [PMID: 27242162 PMCID: PMC4925121 DOI: 10.2196/mhealth.5361] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/21/2016] [Accepted: 04/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rapid developments in technology have encouraged the use of mobile phones in smoking cessation, promoting healthy diet, nutrition, and physical activity, sun safety, and cancer screening. Although many apps relating to the prevention of cancer and other chronic diseases are available from major mobile phone platforms, relatively few have been tested in research studies to determine their efficacy. OBJECTIVE In this paper, we discuss issues related to the development and testing of new apps for preventing cancer through smoking cessation, sun safety, and other healthy behaviors, including key methodologic issues and outstanding challenges. METHODS An exploratory literature review was conducted using bibliographic searches in PubMed and CINAHL with relevant search terms (eg, smartphones, smoking cessation, cancer prevention, cancer screening, and carcinogens) to identify papers published in English through October 2015. RESULTS Only 4 randomized controlled trials of the use of mobile phone apps for smoking cessation and 2 trials of apps for sun safety were identified, indicating that it is premature to conduct a systematic search and meta-analysis of the published literature on this topic. CONCLUSIONS Future studies should utilize randomized controlled trial research designs, larger sample sizes, and longer study periods to better establish the cancer prevention and control capabilities of mobile phone apps. In developing new and refined apps for cancer prevention and control, both health literacy and eHealth literacy should be taken into account. There is a need for culturally appropriate, tailored health messages to increase knowledge and awareness of health behaviors such as smoking cessation, cancer screening, and sun safety. Mobile phone apps are likely to be a useful and low-cost intervention for preventing cancer through behavioral changes.
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Affiliation(s)
- Steven Coughlin
- University of Massachusetts Lowell, Department of Community Health and Sustainability, Lowell, MA, United States.
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Filkins BL, Kim JY, Roberts B, Armstrong W, Miller MA, Hultner ML, Castillo AP, Ducom JC, Topol EJ, Steinhubl SR. Privacy and security in the era of digital health: what should translational researchers know and do about it? Am J Transl Res 2016; 8:1560-1580. [PMID: 27186282 PMCID: PMC4859641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
The rapid growth in the availability and incorporation of digital technologies in almost every aspect of our lives creates extraordinary opportunities but brings with it unique challenges. This is especially true for the translational researcher, whose work has been markedly enhanced through the capabilities of big data aggregation and analytics, wireless sensors, online study enrollment, mobile engagement, and much more. At the same time each of these tools brings distinctive security and privacy issues that most translational researchers are inadequately prepared to deal with despite accepting overall responsibility for them. For the researcher, the solution for addressing these challenges is both simple and complex. Cyber-situational awareness is no longer a luxury-it is fundamental in combating both the elite and highly organized adversaries on the Internet as well as taking proactive steps to avoid a careless turn down the wrong digital dark alley. The researcher, now responsible for elements that may/may not be beyond his or her direct control, needs an additional level of cyber literacy to understand the responsibilities imposed on them as data owner. Responsibility lies with knowing what you can do about the things you can control and those you can't. The objective of this paper is to describe the data privacy and security concerns that translational researchers need to be aware of, and discuss the tools and techniques available to them to help minimize that risk.
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Affiliation(s)
| | - Ju Young Kim
- Scripps Translational Science InstituteUSA
- Seoul National University Bundang HospitalKorea
| | | | | | | | | | | | | | - Eric J Topol
- Scripps Translational Science InstituteUSA
- The Scripps Research InstituteUSA
| | - Steven R Steinhubl
- Scripps Translational Science InstituteUSA
- The Scripps Research InstituteUSA
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115
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Chen J, Bauman A, Allman-Farinelli M. A Study to Determine the Most Popular Lifestyle Smartphone Applications and Willingness of the Public to Share Their Personal Data for Health Research. Telemed J E Health 2016; 22:655-65. [PMID: 26958742 DOI: 10.1089/tmj.2015.0159] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Smartphone lifestyle applications (apps) and wearable fitness-tracking devices collect a wealth of data that could provide research insights to support prevention and treatment of obesity and chronic diseases. The aim of this study was to pilot a survey to explore patterns of behavioral tracking using smartphone lifestyle apps and individuals' willingness to share their app-generated data. METHODS A cross-sectional Web-based survey was conducted within a university setting. The 35-item survey asked participants about their self-tracking patterns; use of lifestyle apps and wearable devices; how their self-tracked health data could be useful to them; and any restrictions they would impose on sharing personal data. Responses were tabulated and analyzed for trends. RESULTS The survey was completed by 101 participants. On average, 3.1 (standard deviation [SD] ±1.9) health and fitness apps were installed by current app users (n = 85), with MyFitnessPal, MapMyRun, Nike+, and Fitbit being most popular. Most participants were willing to share their personal health data for research (77%). Those who did not normally share their health-tracking data were more likely than sharers to be concerned about privacy (odds ratio [OR] = 5.93; 95% confidence interval [95% CI] = 2.09-16.78), as were those not identifying with the quantified-self movement compared with those who were (OR = 5.04; 95% CI = 1.64-15.50). DISCUSSION Participants were generally willing to share personal data, thus increasing the potential for these data to inform public health research and for use in targeted personalized program and intervention development. CONCLUSIONS Opportunities for partnerships between researchers and commercial app developers or industry could improve public health research and practice.
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Affiliation(s)
- Juliana Chen
- 1 School of Molecular Bioscience, Charles Perkins Centre, The University of Sydney , Sydney, Australia
| | - Adrian Bauman
- 2 School of Public Health, Charles Perkins Centre, The University of Sydney , Sydney, Australia
| | - Margaret Allman-Farinelli
- 1 School of Molecular Bioscience, Charles Perkins Centre, The University of Sydney , Sydney, Australia
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116
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Gay V, Leijdekkers P. Bringing Health and Fitness Data Together for Connected Health Care: Mobile Apps as Enablers of Interoperability. J Med Internet Res 2015; 17:e260. [PMID: 26581920 PMCID: PMC4704968 DOI: 10.2196/jmir.5094] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/14/2015] [Accepted: 10/20/2015] [Indexed: 11/22/2022] Open
Abstract
Background A transformation is underway regarding how we deal with our health. Mobile devices make it possible to have continuous access to personal health information. Wearable devices, such as Fitbit and Apple’s smartwatch, can collect data continuously and provide insights into our health and fitness. However, lack of interoperability and the presence of data silos prevent users and health professionals from getting an integrated view of health and fitness data. To provide better health outcomes, a complete picture is needed which combines informal health and fitness data collected by the user together with official health records collected by health professionals. Mobile apps are well positioned to play an important role in the aggregation since they can tap into these official and informal health and data silos. Objective The objective of this paper is to demonstrate that a mobile app can be used to aggregate health and fitness data and can enable interoperability. It discusses various technical interoperability challenges encountered while integrating data into one place. Methods For 8 years, we have worked with third-party partners, including wearable device manufacturers, electronic health record providers, and app developers, to connect an Android app to their (wearable) devices, back-end servers, and systems. Results The result of this research is a health and fitness app called myFitnessCompanion, which enables users to aggregate their data in one place. Over 6000 users use the app worldwide to aggregate their health and fitness data. It demonstrates that mobile apps can be used to enable interoperability. Challenges encountered in the research process included the different wireless protocols and standards used to communicate with wireless devices, the diversity of security and authorization protocols used to be able to exchange data with servers, and lack of standards usage, such as Health Level Seven, for medical information exchange. Conclusions By limiting the negative effects of health data silos, mobile apps can offer a better holistic view of health and fitness data. Data can then be analyzed to offer better and more personalized advice and care.
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Affiliation(s)
- Valerie Gay
- Faculty of Engineering and Information Technology, University of Technology Sydney, Broadway NSW, Australia.
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Yuan S, Chang S, Uyeno K, Almquist G, Wang S. Blood donation mobile applications: are donors ready? Transfusion 2015; 56:614-21. [DOI: 10.1111/trf.13387] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/11/2015] [Accepted: 09/12/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Shan Yuan
- Division of Transfusion Medicine Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte California
| | - Shelley Chang
- Division of Transfusion Medicine Department of Pathology and Laboratory Medicine; UCLA School of Medicine; Los Angeles California
| | - Kasie Uyeno
- Division of Transfusion Medicine Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte California
| | - Gay Almquist
- Division of Transfusion Medicine Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte California
| | - Shirong Wang
- Division of Transfusion Medicine Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte California
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Richardson JE, Ancker JS. Public Perspectives of Mobile Phones' Effects on Healthcare Quality and Medical Data Security and Privacy: A 2-Year Nationwide Survey. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:1076-1082. [PMID: 26958246 PMCID: PMC4765572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Given growing interest in mobile phones for health management (mHealth), we surveyed consumer perceptions of mHealth in security, privacy, and healthcare quality using national random-digit-dial telephone surveys in 2013 and 2014. In 2013, 48% thought that using a mobile phone to communicate data with a physician's electronic health record (EHR) would improve the quality of health care. By 2014, the proportion rose to 57% (p < .001). There were no similar changes in privacy concerns yet nearly two-thirds expressed privacy concerns. In 2013 alone, respondents were more likely to express privacy concerns about medical data on mobile phones than they were to endorse similar concerns with EHRs or health information exchange (HIE). Consumers increasingly believe that mHealth improves healthcare quality, but security and privacy concerns need to be addressed for quality improvement to be fully realized.
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Affiliation(s)
- Joshua E Richardson
- Department of Healthcare Policy and ResearchWeill Cornell Medical College, New York, NY
| | - Jessica S Ancker
- Department of Healthcare Policy and ResearchWeill Cornell Medical College, New York, NY
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Huckvale K, Prieto JT, Tilney M, Benghozi PJ, Car J. Unaddressed privacy risks in accredited health and wellness apps: a cross-sectional systematic assessment. BMC Med 2015; 13:214. [PMID: 26404673 PMCID: PMC4582624 DOI: 10.1186/s12916-015-0444-y] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 08/07/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Poor information privacy practices have been identified in health apps. Medical app accreditation programs offer a mechanism for assuring the quality of apps; however, little is known about their ability to control information privacy risks. We aimed to assess the extent to which already-certified apps complied with data protection principles mandated by the largest national accreditation program. METHODS Cross-sectional, systematic, 6-month assessment of 79 apps certified as clinically safe and trustworthy by the UK NHS Health Apps Library. Protocol-based testing was used to characterize personal information collection, local-device storage and information transmission. Observed information handling practices were compared against privacy policy commitments. RESULTS The study revealed that 89% (n = 70/79) of apps transmitted information to online services. No app encrypted personal information stored locally. Furthermore, 66% (23/35) of apps sending identifying information over the Internet did not use encryption and 20% (7/35) did not have a privacy policy. Overall, 67% (53/79) of apps had some form of privacy policy. No app collected or transmitted information that a policy explicitly stated it would not; however, 78% (38/49) of information-transmitting apps with a policy did not describe the nature of personal information included in transmissions. Four apps sent both identifying and health information without encryption. Although the study was not designed to examine data handling after transmission to online services, security problems appeared to place users at risk of data theft in two cases. CONCLUSIONS Systematic gaps in compliance with data protection principles in accredited health apps question whether certification programs relying substantially on developer disclosures can provide a trusted resource for patients and clinicians. Accreditation programs should, as a minimum, provide consistent and reliable warnings about possible threats and, ideally, require publishers to rectify vulnerabilities before apps are released.
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Affiliation(s)
- Kit Huckvale
- Global eHealth Unit, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
| | - José Tomás Prieto
- CRG, Ecole polytechnique CNRS, Bâtiment Ensta, 828 boulevard des Maréchaux, Palaiseau, Cedex, 91762, France.
| | - Myra Tilney
- Global eHealth Unit, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
| | - Pierre-Jean Benghozi
- CRG, Ecole polytechnique CNRS, Bâtiment Ensta, 828 boulevard des Maréchaux, Palaiseau, Cedex, 91762, France.
| | - Josip Car
- Global eHealth Unit, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
- Health Services and Outcomes Research Programme, LKC Medicine, Imperial College, Nanyang Technological University, Singapore, Singapore.
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Nicholas J, Larsen ME, Proudfoot J, Christensen H. Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality. J Med Internet Res 2015; 17:e198. [PMID: 26283290 PMCID: PMC4642376 DOI: 10.2196/jmir.4581] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/08/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND With continued increases in smartphone ownership, researchers and clinicians are investigating the use of this technology to enhance the management of chronic illnesses such as bipolar disorder (BD). Smartphones can be used to deliver interventions and psychoeducation, supplement treatment, and enhance therapeutic reach in BD, as apps are cost-effective, accessible, anonymous, and convenient. While the evidence-based development of BD apps is in its infancy, there has been an explosion of publicly available apps. However, the opportunity for mHealth to assist in the self-management of BD is only feasible if apps are of appropriate quality. OBJECTIVE Our aim was to identify the types of apps currently available for BD in the Google Play and iOS stores and to assess their features and the quality of their content. METHODS A systematic review framework was applied to the search, screening, and assessment of apps. We searched the Australian Google Play and iOS stores for English-language apps developed for people with BD. The comprehensiveness and quality of information was assessed against core psychoeducation principles and current BD treatment guidelines. Management tools were evaluated with reference to the best-practice resources for the specific area. General app features, and privacy and security were also assessed. RESULTS Of the 571 apps identified, 82 were included in the review. Of these, 32 apps provided information and the remaining 50 were management tools including screening and assessment (n=10), symptom monitoring (n=35), community support (n=4), and treatment (n=1). Not even a quarter of apps (18/82, 22%) addressed privacy and security by providing a privacy policy. Overall, apps providing information covered a third (4/11, 36%) of the core psychoeducation principles and even fewer (2/13, 15%) best-practice guidelines. Only a third (10/32, 31%) cited their information source. Neither comprehensiveness of psychoeducation information (r=-.11, P=.80) nor adherence to best-practice guidelines (r=-.02, P=.96) were significantly correlated with average user ratings. Symptom monitoring apps generally failed to monitor critical information such as medication (20/35, 57%) and sleep (18/35, 51%), and the majority of self-assessment apps did not use validated screening measures (6/10, 60%). CONCLUSIONS In general, the content of currently available apps for BD is not in line with practice guidelines or established self-management principles. Apps also fail to provide important information to help users assess their quality, with most lacking source citation and a privacy policy. Therefore, both consumers and clinicians should exercise caution with app selection. While mHealth offers great opportunities for the development of quality evidence-based mobile interventions, new frameworks for mobile mental health research are needed to ensure the timely availability of evidence-based apps to the public.
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Affiliation(s)
- Jennifer Nicholas
- Black Dog Institute, University of New South Wales, Sydney, Australia.
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Simpao AF, Lingappan AM, Ahumada LM, Rehman MA, Gálvez JA. Perioperative Smartphone Apps and Devices for Patient-Centered Care. J Med Syst 2015; 39:102. [PMID: 26265239 DOI: 10.1007/s10916-015-0310-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/04/2015] [Indexed: 12/19/2022]
Abstract
Smartphones have grown in ubiquity and computing power, and they play an ever-increasing role in patient-centered health care. The "medicalized smartphone" not only enables web-based access to patient health resources, but also can run patient-oriented software applications and be connected to health-related peripheral devices. A variety of patient-oriented smartphone apps and devices are available for use to facilitate patient-centered care throughout the continuum of perioperative care. Ongoing advances in smartphone technology and health care apps and devices should expand their utility for enhancing patient-centered care in the future.
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Affiliation(s)
- Allan F Simpao
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Suite 9329, Philadelphia, PA, 19104-4399, USA,
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