1
|
Son Y, Kim S, Lee W, Won H, Cho JH, Hong J, Choi H, Kim D, Lim A, Kim HM. The effects of a 24-week interactive text message-based mobile health intervention for enhancing self-care behaviours of patients with heart failure: A quasi-experimental study. Nurs Open 2023; 10:6309-6319. [PMID: 37313589 PMCID: PMC10416075 DOI: 10.1002/nop2.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/03/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
AIMS The aim of this study was to identify the effects of a 24-week interactive text message-based mobile health intervention (called) on enhancing the self-care behaviours of patients with heart failure. BACKGROUND Whether text message-based mobile health intervention can be used to improve long-term adherence to self-care behaviours among heart failure patients remains unclear. DESIGN A quasi-experimental study with a pretest-post-test design and repeated measures. METHODS Data from 100 patients (mean age, 58.78 years; 83.0% men) were analysed. The intervention group (n = 50) used the program over 24 weeks, which consisted of weekly goal setting and interactive text messaging, while the control group (n = 50) received usual care. Trained research assistants collected data using self-reported Likert questionnaires. Primary (self-care behaviours) and secondary (health literacy, eHealth literacy, and disease knowledge) outcome variables were measured at baseline and at 1, 3 and 6 months after intervention for follow-up. RESULTS The findings showed that the intervention group demonstrated significantly better self-care behaviours than the control group during the 6 months. Notably, the trajectory of self-care behaviours of the patients in the intervention group showed a steep rise between the first- and third-month follow-up, followed by high stability between the third- and sixth-month follow-up. In addition, the intervention group had significantly higher disease knowledge than the control group at the first- and sixth-month follow-up. CONCLUSIONS We found that the program, as an interactive text messaging service, may be an optimal strategy for improving long-term adherence to self-care behaviours through motivating and providing social support. RELEVANCE TO THE NURSING PRACTICE The WithUs program can help nurses and other healthcare professionals to track patients' health indicators such as symptom severity, diet and physical activity. In addition, nurses can take an important role in evaluating the efficacy of the app in relation to patients' health outcome. PATIENT OR PUBLIC CONTRIBUTION Patients have completed a self-reported questionnaire after providing informed consent.
Collapse
Affiliation(s)
- Youn‐Jung Son
- Red Cross College of Nursing, Chung‐Ang UniversitySeoulSouth Korea
| | - Sang‐Wook Kim
- Heart and Brain Hospital, Chung‐Ang University Gwangmyeong HospitalChung Ang University College of MedicineSeoulSouth Korea
| | - Wang‐Soo Lee
- Division of Cardiology, Chung‐Ang University HospitalChung‐Ang University College of MedicineSeoulSouth Korea
| | - Hoyoun Won
- Division of Cardiology, Chung‐Ang University HospitalChung‐Ang University College of MedicineSeoulSouth Korea
| | - Jun Hwan Cho
- Heart and Brain Hospital, Chung‐Ang University Gwangmyeong HospitalChung Ang University College of MedicineSeoulSouth Korea
| | - Joonhwa Hong
- Department of Thoracic and Cardiovascular Surgery, Chung‐Ang University HospitalChung‐Ang University College of MedicineSeoulSouth Korea
| | - Hong‐Jae Choi
- Graduate School of Nursing, Chung‐Ang UniversitySeoulSouth Korea
| | - Da‐Young Kim
- Graduate School of Nursing, Chung‐Ang UniversitySeoulSouth Korea
| | - Arum Lim
- Johns Hopkins University School of NursingBaltimoreMarylandUSA
| | - Hyue Mee Kim
- Division of Cardiology, Chung‐Ang University HospitalChung‐Ang University College of MedicineSeoulSouth Korea
| |
Collapse
|
2
|
Larson D, Henning J, Burgermaster M. Smartphone Applications (Apps) for Nutrition Education: A Qualitative Analysis of Outpatient Dietitian Perspectives. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:596-603. [PMID: 37354197 DOI: 10.1016/j.jneb.2023.05.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To explore how outpatient dietitians select and use applications (apps) to support nutrition education. METHODS Qualitative analysis of 20 dietitians who participated in semistructured interviews investigating their app use and recommendation processes. Transcripts were analyzed using thematic analysis. RESULTS Four themes described how dietitians perceive apps for nutrition education: (1) nutrition education goals focus on long-term lifestyle behavior change while protecting patients' relationship with food, (2) attitudes toward tracking apps influence app selection, (3) dietitians differentiate among patients who will benefit from tracking vs information apps, and (4) barriers to optimal app use result in adaptations by dietitians. CONCLUSIONS AND IMPLICATIONS Barriers exist to optimal app use for nutrition education. However, accessible app design, app selection guides, and research expounding the effects of apps and their use by dietitians may improve how practitioners incorporate apps into nutrition education.
Collapse
Affiliation(s)
- Dagny Larson
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - Jacqueline Henning
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - Marissa Burgermaster
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX; Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX.
| |
Collapse
|
3
|
Nair US, Kue J, Athilingam P, Rodríguez CS, Menon U. Application of the ConNECT Framework to achieve digital health equity. Nurs Outlook 2023; 71:101991. [PMID: 37302261 DOI: 10.1016/j.outlook.2023.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND The emphasis on digital technology and informatics in health care (digital health) has introduced innovative ways to deliver health care and engage populations in health research. However, inadequate attention to the development and implementation of digital health interventions can exacerbate health disparities. PURPOSE We applied the transdisciplinary ConNECT Framework principles within the context of digital health, with an aim to describe strategies to achieve digital health equity. METHODS We described the five ConNECT principles of (a) integrating context, (b) fostering a norm of inclusion, (c) ensuring equitable diffusion of innovations, (d) harnessing communication technology, and (e) prioritizing specialized training within the framework of achieving digital health equity. FINDINGS AND DISCUSSION We describe proactive, actionable strategies for the systematic application of the ConNECT Framework principles to address digital health equity. Recommendations to reduce the digital health divide in nursing research and practice are also described.
Collapse
Affiliation(s)
- Uma S Nair
- College of Nursing, University of South Florida, Tampa, FL.
| | - Jennifer Kue
- College of Nursing, University of South Florida, Tampa, FL
| | | | | | - Usha Menon
- College of Nursing, University of South Florida, Tampa, FL
| |
Collapse
|
4
|
Odigie E, Andreadis K, Chandra I, Mocchetti V, Rives H, Cox S, Rameau A. Are Mobile Applications in Laryngology Designed for All Patients? Laryngoscope 2023; 133:1540-1549. [PMID: 36317789 PMCID: PMC10149562 DOI: 10.1002/lary.30465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 02/24/2023]
Abstract
OBJECTIVES Mobile applications (apps) are multiplying in laryngology, with little standardization of content, functionality, or accessibility. The purpose of this study is to evaluate the quality, functionality, health literacy, readability, accessibility, and inclusivity of laryngology mobile applications. METHODS Of the 3230 apps identified from the Apple and Google Play stores, 28 patient-facing apps met inclusion criteria. Apps were evaluated using validated scales assessing quality and functionality: the Mobile App Rating Scale (MARS) and the Institute for Healthcare Informatics App Functionality Scale. The Clear Communication Index (CDC) Institute of Medicine Strategies for Creating Health Literate Mobile Applications, and Patient Education Materials Assessment Tool (PEMAT) were used to evaluate apps health literacy level. Readability was assessed using established readability formulas. Apps were evaluated for language, accessibility features, and representation of a diverse population. RESULTS Twenty-six apps (92%) had adequate quality (MARS score > 3). The mean PEMAT score was 89% for actionability and 86% for understandability. On average, apps utilized 25/33 health literate strategies. Twenty-two apps (79%) did not pass the CDC index threshold of 90% for health literacy. Twenty-four app descriptions (86%) were above an 8th grade reading level. Only 4 apps (14%) showed diverse representation, 3 (11%) had non-English language functions, and 2 (7%) offered subtitles. Inter-rater reliability for MARS was adequate (CA-ICC = 0.715). CONCLUSION While most apps scored well in quality and functionality, many laryngology apps did not meet standards for health literacy. Most apps were written at a reading level above the national average, lacked accessibility features, and did not represent diverse populations. Laryngoscope, 133:1540-1549, 2023.
Collapse
Affiliation(s)
- Eseosa Odigie
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
| | - Iyra Chandra
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
| | - Valentina Mocchetti
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
| | - Hal Rives
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
| | - Steven Cox
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, USA
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology, Weill Cornell Medical College, New York, USA
| |
Collapse
|
5
|
Butler J, Petrie MC, Bains M, Bawtinheimer T, Code J, Levitch T, Malvolti E, Monteleone P, Stevens P, Vafeiadou J, Lam CSP. Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post-hospital discharge period. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:23. [PMID: 37046357 PMCID: PMC10097448 DOI: 10.1186/s40900-023-00412-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/25/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND People living with heart failure (HF) are particularly vulnerable after hospital discharge. An alliance between patient authors, clinicians, industry, and co-developers of HF programs can represent an effective way to address the unique concerns and obstacles people living with HF face during this period. The aim of this narrative review article is to discuss challenges and opportunities of this approach, with the goal of improving participation and clinical outcomes of people living with HF. METHODS This article was co-authored by people living with HF, heart transplant recipients, patient advocacy representatives, cardiologists with expertise in HF care, and industry representatives specializing in patient engagement and cardiovascular medicine, and reviews opportunities and challenges for people living with HF in the post-hospital discharge period to be more integrally involved in their care. A literature search was conducted, and the authors collaborated through two virtual roundtables and via email to develop the content for this review article. RESULTS Numerous transitional-care programs exist to ease the transition from the hospital to the home and to provide needed education and support for people living with HF, to avoid rehospitalizations and other adverse outcomes. However, many programs have limitations and do not integrally involve patients in the design and co-development of the intervention. There are thus opportunities for improvement. This can enable patients to better care for themselves with less of the worry and fear that typically accompany the transition from the hospital. We discuss the importance of including people living with HF in the development of such programs and offer suggestions for strategies that can help achieve these goals. An underlying theme of the literature reviewed is that education and engagement of people living with HF after hospitalization are critical. However, while clinical trial evidence on existing approaches to transitions in HF care indicates numerous benefits, such approaches also have limitations. CONCLUSION Numerous challenges continue to affect people living with HF in the post-hospital discharge period. Strategies that involve patients are needed, and should be encouraged, to optimally address these challenges.
Collapse
Affiliation(s)
- Javed Butler
- Department of Medicine (L605), University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
- Baylor Scott and White Research Institute, Dallas, TX, USA.
| | - Mark C Petrie
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Marc Bains
- HeartLife Foundation, Vancouver, BC, Canada
| | | | - Jillianne Code
- HeartLife Foundation, Vancouver, BC, Canada
- Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | | | - Elmas Malvolti
- Global Medical Affairs, BioPharmaceuticals Business Unit, AstraZeneca, Central Cambridge, UK
| | - Pasquale Monteleone
- Global Corporate Affairs, Biopharmaceuticals Business Unit, AstraZeneca, Cambridge, UK
| | - Petrina Stevens
- Global Medical Evidence, BioPharmaceuticals Business Unit, AstraZeneca, Cambridge, UK
| | - Jenny Vafeiadou
- Global Digital Health, Biopharmaceuticals Business Unit, AstraZeneca, Cambridge, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
6
|
Lyles CR, Nguyen OK, Khoong EC, Aguilera A, Sarkar U. Multilevel Determinants of Digital Health Equity: A Literature Synthesis to Advance the Field. Annu Rev Public Health 2023; 44:383-405. [PMID: 36525960 PMCID: PMC10329412 DOI: 10.1146/annurev-publhealth-071521-023913] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Current digital health approaches have not engaged diverse end users or reduced health or health care inequities, despite their promise to deliver more tailored and personalized support to individuals at the right time and the right place. To achieve digital health equity, we must refocus our attention on the current state of digital health uptake and use across the policy, system, community, individual, and intervention levels. We focus here on (a) outlining a multilevel framework underlying digital health equity; (b) summarizingfive types of interventions/programs (with example studies) that hold promise for advancing digital health equity; and (c) recommending future steps for improving policy, practice, and research in this space.
Collapse
Affiliation(s)
- Courtney R Lyles
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Public Health, University of California-Berkeley, Berkeley, California, USA
| | - Oanh Kieu Nguyen
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Elaine C Khoong
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
| | - Adrian Aguilera
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Social Welfare, University of California-Berkeley, Berkeley, California, USA
- Department of Psychiatry, University of California-San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
| |
Collapse
|
7
|
Fernández-Gutiérrez M, Bas-Sarmiento P, Jesús Marín-Paz A, Castro-Yuste C, Sánchez-Sánchez E, Hernández-Encuentra E, Jesus Vinolo-Gil M, Carmona-Barrientos I, Poza-Méndez M. Self-management in heart failure using mHealth: A content validation. Int J Med Inform 2023; 171:104986. [PMID: 36638582 DOI: 10.1016/j.ijmedinf.2023.104986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
AIM To describe the development of a mobile health application -mICardiApp- designed by a multidisciplinary professional team and patients with heart failure and to evaluate its content validity. METHODS Critical reviews of the literature, semi-structured interviews with patients, and user stories guided the development of the content of the mobile application. These contents were refined and validated through a modified Delphi process. An expert panel of healthcare and social care professionals together with patients and academics evaluated the content through two content validity indicators, relevance, and adequacy, and provided narrative feedback. The content validity of the app and each screen was determined by calculating the Content Validity Index (CVI). Similarly, the Adequacy Index (AI) was analyzed. RESULTS The developed app is composed by 8 topics: (1) available resources, (2) cardiac rehabilitation, (3) control of signs and symptoms, (4) emotional support, (5) learning and having fun, (6) medication, (7) nutrition, and (8) physical activity. The results demonstrated high CVI of the screens and the full app. 57 of the 59 screens in the app reached an excellent CVI ≥ 0.70 for both relevance and adequacy, except for 2 screens. The CVI Average Method of the app was 0.851. CONCLUSIONS mICardiApp is presented as an application to improve health literacy and self-management of patients with multimorbidity and heart failure, with proven validation.
Collapse
Affiliation(s)
- Martina Fernández-Gutiérrez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Pilar Bas-Sarmiento
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain.
| | - Antonio Jesús Marín-Paz
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; The University Research Institute for Sustainable Social Development, INDESS, Spain
| | - Cristina Castro-Yuste
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Eduardo Sánchez-Sánchez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | | | - Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Inés Carmona-Barrientos
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Miriam Poza-Méndez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; The University Research Institute for Sustainable Social Development, INDESS, Spain
| |
Collapse
|
8
|
Shaw G, Nadkarni D, Phann E, Sielaty R, Ledenyi M, Abnowf R, Xu Q, Arredondo P, Chen S. Separating Features From Functionality in Vaccination Apps: Computational Analysis. JMIR Form Res 2022; 6:e36818. [PMID: 36222791 PMCID: PMC9597419 DOI: 10.2196/36818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Some latest estimates show that approximately 95% of Americans own a smartphone with numerous functions such as SMS text messaging, the ability to take high-resolution pictures, and mobile software apps. Mobile health apps focusing on vaccination and immunization have proliferated in the digital health information technology market. Mobile health apps have the potential to positively affect vaccination coverage. However, their general functionality, user and disease coverage, and exchange of information have not been comprehensively studied or evaluated computationally. OBJECTIVE The primary aim of this study is to develop a computational method to explore the descriptive, usability, information exchange, and privacy features of vaccination apps, which can inform vaccination app design. Furthermore, we sought to identify potential limitations and drawbacks in the apps' design, readability, and information exchange abilities. METHODS A comprehensive codebook was developed to conduct a content analysis on vaccination apps' descriptive, usability, information exchange, and privacy features. The search and selection process for vaccination-related apps was conducted from March to May 2019. We identified a total of 211 apps across both platforms, with iOS and Android representing 62.1% (131/211) and 37.9% (80/211) of the apps, respectively. Of the 211 apps, 119 (56.4%) were included in the final study analysis, with 42 features evaluated according to the developed codebook. The apps selected were a mix of apps used in the United States and internationally. Principal component analysis was used to reduce the dimensionality of the data. Furthermore, cluster analysis was used with unsupervised machine learning to determine patterns within the data to group the apps based on preselected features. RESULTS The results indicated that readability and information exchange were highly correlated features based on principal component analysis. Of the 119 apps, 53 (44.5%) were iOS apps, 55 (46.2%) were for the Android operating system, and 11 (9.2%) could be found on both platforms. Cluster 1 of the k-means analysis contained 22.7% (27/119) of the apps; these were shown to have the highest percentage of features represented among the selected features. CONCLUSIONS We conclude that our computational method was able to identify important features of vaccination apps correlating with end user experience and categorize those apps through cluster analysis. Collaborating with clinical health providers and public health officials during design and development can improve the overall functionality of the apps.
Collapse
Affiliation(s)
- George Shaw
- Public Health Sciences, School of Data Science, University of North Carolina, Charlotte, NC, United States
| | - Devaki Nadkarni
- Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Eric Phann
- Department of Computer Science, University of North Carolina at Charlotte, Charlotte, NC, United States
- Department of Language and Culture Studies, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Rachel Sielaty
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Madeleine Ledenyi
- Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Razaan Abnowf
- Department of Global Studies, Belk College of Business, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Qian Xu
- School of Communications, Elon University, Elon, NC, United States
| | - Paul Arredondo
- School of Data Science, University of North Carolina, Charlotte, NC, United States
| | - Shi Chen
- Public Health Sciences, School of Data Science, University of North Carolina, Charlotte, NC, United States
| |
Collapse
|
9
|
Son YJ, Kim EY. The effectiveness and usability of a novel mobile phone-based self-care intervention for patients with heart failure: A mixed-methods pilot study. Eur J Cardiovasc Nurs 2022; 22:254-263. [PMID: 35997293 DOI: 10.1093/eurjcn/zvac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/12/2022]
Abstract
AIM To evaluate the preliminary effectiveness and usability of a novel mobile phone-based self-care intervention (named WithUs) for patients with heart failure (HF). METHODS AND RESULTS We conducted a mixed-methods pilot study with group pretest-posttest design and usability testing. Participants were 26 Korean HF patients (20 men; median age 62 years) who took part in this study after hospital discharge. Data were collected at baseline and after the 24-week intervention, using questionnaires and interviews. The outcome variables were eHealth literacy, disease knowledge, and self-care behaviours. The Wilcoxon signed-rank test was used to compare the pre- and post-intervention results. Thematic analysis was used for analysing qualitative data. The WithUs programme improved the eHealth literacy (p = .005), disease knowledge (p < .001), and self-care behaviours (p < .001) of patients with HF. The median score of total app usability was 4.1 out of 5 (interquartile range = 4.0-5.0). Four themes were identified which complemented the quantitative results. These were increased awareness of the importance of routine self-care behaviours, enhanced motivation toward self-care behaviours, challenges adapting to the new app, and suggestions for improving app adoption. CONCLUSION The app was effective in improving adherence to self-care behaviours, eHealth literacy, and disease knowledge in patients with HF. The usability evaluation results showed that the app is usable and has the potential to support HF patients in self-care. However, the app needs to be modified to improve its adoption.
Collapse
Affiliation(s)
- Youn Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Eun Young Kim
- Soonchunhyang University, Cheonan, South Korea, Dongnamgu, Soonchunhyang 6Gil 31
| |
Collapse
|
10
|
Woulfe F, Fadahunsi KP, O'Grady M, Chirambo GB, Mawkin M, Majeed A, Smith S, Henn P, O'Donoghue J. Modification and Validation of an mHealth App Quality Assessment Methodology for International Use: Cross-sectional and eDelphi Studies. JMIR Form Res 2022; 6:e36912. [PMID: 35984688 PMCID: PMC9497647 DOI: 10.2196/36912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/28/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background Over 325,000 mobile health (mHealth) apps are available to download across various app stores. However, quality assurance in this field of medicine remains relatively undefined. Globally, around 84% of the population have access to mobile broadband networks. Given the potential for mHealth app use in health promotion and disease prevention, their role in patient care worldwide is ever apparent. Quality assurance regulations both nationally and internationally will take time to develop. Frameworks such as the Mobile App Rating Scale and Enlight Suite have demonstrated potential for use in the interim. However, these frameworks require adaptation to be suitable for international use. Objective This study aims to modify the Enlight Suite, a comprehensive app quality assessment methodology, to improve its applicability internationally and to assess the preliminary validity and reliability of this modified tool in practice. Methods A two-round Delphi study involving 7 international mHealth experts with varied backgrounds in health, technology, and clinical psychology was conducted to modify the Enlight Suite for international use and to improve its content validity. The Modified Enlight Suite (MES) was then used by 800 health care professionals and health care students in Ireland to assess a COVID-19 tracker app in an online survey. The reliability of the MES was assessed using Cronbach alpha, while the construct validity was evaluated using confirmatory factor analysis. Results The final version of the MES has 7 sections with 32 evaluating items. Of these items, 5 were novel and based on consensus for inclusion by Delphi panel members. The MES has satisfactory reliability with a Cronbach alpha score of .925. The subscales also demonstrated acceptable internal consistency. Similarly, the confirmatory factor analysis demonstrated a positive and significant factor loading for all 32 items in the MES with a modestly acceptable model fit, thus indicating the construct validity of the MES. Conclusions The Enlight Suite was modified to improve its international relevance to app quality assessment by introducing new items relating to cultural appropriateness, accessibility, and readability of mHealth app content. This study indicates both the reliability and validity of the MES for assessing the quality of mHealth apps in a high-income country, with further studies being planned to extrapolate these findings to low- and middle-income countries.
Collapse
Affiliation(s)
- Fionn Woulfe
- School of Medicine, University College Cork, Cork, Ireland
| | - Kayode Philip Fadahunsi
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Michael O'Grady
- School of Computer Science, University College Dublin, Dublin, Ireland
| | | | - Mala Mawkin
- School of Medicine, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Simon Smith
- School of Medicine, University College Cork, Cork, Ireland
| | - Patrick Henn
- ASSERT Research Centre, School of Medicine, University College Cork, Cork, Ireland
| | - John O'Donoghue
- ASSERT Research Centre, School of Medicine, University College Cork, Cork, Ireland
- Malawi eHealth Research Centre, University College Cork, Cork, Ireland
| |
Collapse
|
11
|
Agnew JMR, Nugent C, Hanratty CE, Martin E, Kerr DP, McVeigh JG. Rating the Quality of Smartphone Apps Related to Shoulder Pain: Systematic Search and Evaluation Using the Mobile App Rating Scale. JMIR Form Res 2022; 6:e34339. [PMID: 35617008 PMCID: PMC9185331 DOI: 10.2196/34339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/31/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background The successful rehabilitation of musculoskeletal pain requires more than medical input alone. Conservative treatment, including physiotherapy and exercise therapy, can be an effective way of decreasing pain associated with musculoskeletal pain. However, face-to-face appointments are currently not feasible. New mobile technologies, such as mobile health technologies in the form of an app for smartphones, can be a solution to this problem. In many cases, these apps are not backed by scientific literature. Therefore, it is important that they are reviewed and quality assessed. Objective The aim is to evaluate and measure the quality of apps related to shoulder pain by using the Mobile App Rating Scale. Methods This study included 25 free and paid apps—8 from the Apple Store and 17 from the Google Play Store. A total of 5 reviewers were involved in the evaluation process. A descriptive analysis of the Mobile App Rating Scale results provided a general overview of the quality of the apps. Results Overall, app quality was generally low, with an average star rating of 1.97 out of 5. The best scores were in the “Functionality” and “Aesthetics” sections, and apps were scored poorer in the “Engagement” and “Information” sections. The apps were also rated poorly in the “Subjective Quality” section. Conclusions In general, the apps were well built technically and were aesthetically pleasing. However, the apps failed to provide quality information to users, which resulted in a lack of engagement. Most of the apps were not backed by scientific literature (24/25, 96%), and those that contained scientific references were vastly out-of-date. Future apps would need to address these concerns while taking simple measures to ensure quality control.
Collapse
Affiliation(s)
- Jonathon M R Agnew
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Chris Nugent
- Discipline in Computing, School of Computing, University of Ulster, Newtownabbey, United Kingdom
| | - Catherine E Hanratty
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Elizabeth Martin
- Discipline in Computing, School of Computing, University of Ulster, Newtownabbey, United Kingdom
| | - Daniel P Kerr
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Joseph G McVeigh
- Discipline in Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| |
Collapse
|
12
|
Emerson MR, Buckland S, Lawlor MA, Dinkel D, Johnson DJ, Mickles MS, Fok L, Watanabe-Galloway S. Addressing and evaluating health literacy in mHealth: a scoping review. Mhealth 2022; 8:33. [PMID: 36338314 PMCID: PMC9634204 DOI: 10.21037/mhealth-22-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/23/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Recent surveys have revealed many adults have basic or below basic health literacy, which is linked to medical errors, increased illness, and compromised public health. Health literacy as a concept is multi-faceted extending beyond the individual to include social structures and the context in which health information is being accessed. Delivering health information via mobile devices (mHealth) expands the amount of information available while presenting challenges to ensuring these materials are suitable for a variety of literacy needs. The aims of this study are to discover how health literacy is addressed and evaluated in mHealth app development. METHODS A scoping review of 5 peer-reviewed databases was conducted. Eligible articles were written in English, addressed general literacy or mHealth/digital/eHealth literacy, and collected literacy information in order to incorporate literacy into the design and/or modification of an app or collected literacy information to describe the population being studied. The "Health Literacy Online" (HLO) United States (U.S.) government guide was used as a framework. RESULTS Thirty-two articles were reviewed. Articles included health literacy recommendations for all HLO categories and some recommendations not aligned with these categories. Most articles addressed health literacy using specific HLO categories though none incorporated every HLO category. The most common categories addressed engagement and testing of mHealth content. Though several studies addressed health literacy through a formal assessment tool, most did not. Evaluation of health literacy in mHealth was end-user focused and did not extensively evaluate content for fit to a variety of individuals with limited health literacy. CONCLUSIONS The recommendations seen consistently in our results in conjunction with formal HLO categories can act as beginning steps towards development of a health literacy evaluation tool for mHealth apps themselves. It is clear efforts are being made to reduce barriers to using mHealth for those with literacy deficits, however, it was also clear that this space has room to be more pragmatic in evaluation of mHealth tools for literacy. End user engagement in design and testing is necessary in future mHealth literacy tool development.
Collapse
Affiliation(s)
| | - Sydney Buckland
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Maxwell A. Lawlor
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Danae Dinkel
- College of Education Health and Human Sciences, University of Nebraska, Omaha, NE, USA
| | - David J. Johnson
- Department of Psychiatry & Behavioral Science, Mercer University School of Medicine, Atlanta, GA, USA
| | - Maria S. Mickles
- College of Public Health University of Nebraska Medical Center, Omaha, NE, USA
| | - Louis Fok
- College of Public Health University of Nebraska Medical Center, Omaha, NE, USA
| | | |
Collapse
|
13
|
Shang S, Du C, Wu J. Comparison on effect mechanism of continuance usage between entertainment and knowledge apps: a qualitative analysis of online reviews. ELECTRONIC LIBRARY 2021. [DOI: 10.1108/el-07-2021-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Continuance usage of mobile applications (apps) has attracted much attention from scholars and enterprises, while the extant research mainly focuses on continuance intention. The inner effect mechanism of the characteristics of apps is still unclear. Under the tenet of continuance usage behaviour, through analysis of characteristics derived from online reviews, this paper aims to establish an effective model and discloses the commonalities and differences between two mainstream apps, which are entertainment and knowledge apps.
Design/methodology/approach
The authors collected reviews of TikTok and Zhihu, which are typical representatives of entertainment and knowledge apps, respectively, from 2018 to 2020. They then derive effect factors and establish the effect model using grounded theory. A deep comparison is then conducted. They analysed the similarities and differences in the general effect model, internal effect mechanism and detailed characteristics of the two types of apps.
Findings
Entertainment app and knowledge apps share the same general effect mechanism; that is, the effect chain of characteristics to perceived value then finally to continuance usage behaviour. However, obvious differences also exist in detailed and specific effects between the two apps.
Originality/value
The present research is among the first to have a deep analysis of the comparison of entertainment apps and knowledge apps under the context of continuance usage behaviour. The findings contribute to understanding continuance usage behaviours. Suggestions are proposed on how to promote apps, which may benefit app managers.
Collapse
|
14
|
Woulfe F, Fadahunsi KP, Smith S, Chirambo GB, Larsson E, Henn P, Mawkin M, O' Donoghue J. Identification and Evaluation of Methodologies to Assess the Quality of Mobile Health Apps in High-, Low-, and Middle-Income Countries: Rapid Review. JMIR Mhealth Uhealth 2021; 9:e28384. [PMID: 34636737 PMCID: PMC8548973 DOI: 10.2196/28384] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/22/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In recent years, there has been rapid growth in the availability and use of mobile health (mHealth) apps around the world. A consensus regarding an accepted standard to assess the quality of such apps has yet to be reached. A factor that exacerbates the challenge of mHealth app quality assessment is variations in the interpretation of quality and its subdimensions. Consequently, it has become increasingly difficult for health care professionals worldwide to distinguish apps of high quality from those of lower quality. This exposes both patients and health care professionals to unnecessary risks. Despite progress, limited understanding of the contributions of researchers in low- and middle-income countries (LMICs) exists on this topic. Furthermore, the applicability of quality assessment methodologies in LMIC settings remains relatively unexplored. OBJECTIVE This rapid review aims to identify current methodologies in the literature to assess the quality of mHealth apps, understand what aspects of quality these methodologies address, determine what input has been made by authors from LMICs, and examine the applicability of such methodologies in LMICs. METHODS This review was registered with PROSPERO (International Prospective Register of Systematic Reviews). A search of PubMed, EMBASE, Web of Science, and Scopus was performed for papers related to mHealth app quality assessment methodologies, which were published in English between 2005 and 2020. By taking a rapid review approach, a thematic and descriptive analysis of the papers was performed. RESULTS Electronic database searches identified 841 papers. After the screening process, 52 papers remained for inclusion. Of the 52 papers, 5 (10%) proposed novel methodologies that could be used to evaluate mHealth apps of diverse medical areas of interest, 8 (15%) proposed methodologies that could be used to assess apps concerned with a specific medical focus, and 39 (75%) used methodologies developed by other published authors to evaluate the quality of various groups of mHealth apps. The authors in 6% (3/52) of papers were solely affiliated to institutes in LMICs. A further 15% (8/52) of papers had at least one coauthor affiliated to an institute in an LMIC. CONCLUSIONS Quality assessment of mHealth apps is complex in nature and at times subjective. Despite growing research on this topic, to date, an all-encompassing appropriate means for evaluating the quality of mHealth apps does not exist. There has been engagement with authors affiliated to institutes across LMICs; however, limited consideration of current generic methodologies for application in LMIC settings has been identified. TRIAL REGISTRATION PROSPERO CRD42020205149; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205149.
Collapse
Affiliation(s)
- Fionn Woulfe
- School of Medicine, University College Cork, Cork, Ireland
| | - Kayode Philip Fadahunsi
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Simon Smith
- School of Medicine, University College Cork, Cork, Ireland
| | | | - Emma Larsson
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, United Kingdom
| | - Patrick Henn
- Assert Centre, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Mala Mawkin
- School of Medicine, Imperial College London, London, United Kingdom
| | - John O' Donoghue
- Malawi eHealth Research Centre, University College Cork, College Road, Cork, Ireland
| |
Collapse
|