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Stutvoet MD, Levelt L, Hrehovcsik MM, Van't Veer J, Visch VT, Bramer WM, Hillegers MHJ, Veltkamp RC, Nijhof SL, Estévez-López F. Gamification in eHealth for Chronic Disease Self-Management in Youth: A Systematic Review. Games Health J 2024. [PMID: 38900649 DOI: 10.1089/g4h.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
This systematic review primarily aims to provide a summary of the game mechanics implemented in eHealth tools supporting young people's self-management of their chronic diseases. This review secondarily investigates the rationale for implementing game mechanics and the effects of these tools. A systematic search was conducted in Embase, Medline, PsycINFO, and Web of Science, from inception until August 30, 2022. Studies were eligible if focus was on the utilization of gamification in eHealth self-management interventions for young people (age = 10-25 years) with chronic diseases. Primary quantitative, qualitative, and mixed-method studies written in English were included. We identified 34 eHealth tools, of which 20 (59%) were gamified tools and 14 (41%) were serious games. We found that 55 unique game mechanics were implemented. The most commonly used were rewards (50%), score (44%), creative control (41%), and social interaction (32%). In comparison with gamified tools, the number and diversity of game mechanics applied were higher in serious games. For most tools (85%), a general rationale was provided for utilizing gamification, which often was to promote engaging experiences. A rationale for using specific game mechanics was less commonly provided (only for 45% of the game mechanics). The limited availability of experimental research precludes to test the effectiveness of using gamification in eHealth to support self-management in young people with chronic diseases. In this study, we highlight the importance of reporting the rationale for utilizing specific game mechanics in eHealth tools to ensure a proper alignment with evidence-based practice and the need of conducting experimental research. PROSPERO: CRD42021293037.
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Affiliation(s)
- Maartje D Stutvoet
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisa Levelt
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Job Van't Veer
- Department of Healthcare, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands
| | - Valentijn T Visch
- Department of Human Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Remco C Veltkamp
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sanne L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Fernando Estévez-López
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024); and CIBIS (Centro de Investigación para el Bienestar y la Inclusión Social) Research Center, University of Almería, Almería, Spain
- Biomedical Research Unit, Torrecárdenas University Hospital, Almería, Spain
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Cordray H, Wright EA, Patel C, Raol N, Prickett KK. A Mobile Application for Child-Focused Tonsillectomy Education: Development and User-Testing. Laryngoscope 2024; 134:2455-2463. [PMID: 37983833 DOI: 10.1002/lary.31198] [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: 08/11/2023] [Revised: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Patient education is central to Enhanced Recovery After Surgery protocols, but child-focused materials are lacking. We developed and piloted a mobile application to support accessible, interactive patient and caregiver education about pediatric tonsillectomy. METHODS Thirty children ages 5-12 who were preparing for tonsillectomy, their caregivers, and six attending otolaryngologists participated in a user-testing trial of a web-based prototype. The trial measured feasibility, fidelity, and patient-centered outcomes. Patients and caregivers rated usability/likeability on the mHealth App Usability Questionnaire. Otolaryngologists rated quality on the Mobile App Rating Scale. The full mobile application, "Ready for Tonsillectomy," was then developed for iOS and Android. RESULTS Enrollment was 88.2%, retention was 90.0%, and use was 96.3%. Mean (SD) patient ratings for usability/likeability were 6.3 (1.1) out of 7; caregiver ratings were 6.5 (1.1). In common themes from open-ended feedback, patients described the application as helpful and appealing, and caregivers described it as informative, easy to understand, calming, and easy to use. Among caregivers who used the application during recovery, 92.3% reported that it helped them manage their child's pain. Providers would recommend the application to many or all of their patients (mean [SD]: 4.7 [0.5] out of 5). Mean provider ratings for domains of engagement, functionality, aesthetics, information quality, subjective quality, and app-specific value ranged from 4.1 to 4.8 out of 5. CONCLUSION Feasibility and fidelity were high. Families and otolaryngologists endorsed the resource as an engaging, informative tool that supports positive coping. Our mobile application offers a patient-centered solution readily scalable to other surgeries. LEVEL OF EVIDENCE NA Laryngoscope, 134:2455-2463, 2024.
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Affiliation(s)
- Holly Cordray
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emily A Wright
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chhaya Patel
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kara K Prickett
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Sapouna V, Kitixis P, Petrou E, Michailidou T, Dalamarinis P, Kortianou E. Mobile health applications designed for self-management of chronic pulmonary diseases in children and adolescents: a systematic mapping review. J Bras Pneumol 2023; 49:e20230201. [PMID: 37909552 PMCID: PMC10759968 DOI: 10.36416/1806-3756/e20230201] [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: 06/11/2023] [Accepted: 07/24/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Mobile health (mHealth) applications are scarce for children and adolescents with chronic pulmonary diseases (CPDs). This study aimed to map and describe the contents of the mHealth apps available for use in children and adolescents with CPDs. METHODS We performed a systematic mapping review of published scientific literature in PubMed, Scopus, and Cochrane Library by February of 2023, using relevant keywords. Inclusion criteria were as follows: children aged < 18 years with CPDs; and studies published in English on mHealth apps. RESULTS A total number of 353 studies were found, 9 of which met the inclusion criteria. These studies described seven mHealth apps for Android and iOS, designed either for asthma (n = 5) or for cystic fibrosis (n = 2). Five content areas were identified: education/information; pharmacological treatment; emergency; support; and non-pharmacological treatment. The studies (4, 2, and 3, respectively) showed consistent findings using qualitative, quantitative, and mixed methodologies. CONCLUSIONS This mapping review provided a guided selection of the most appropriate mHealth apps for use in children and adolescents with CPDs based on the needs of each target population. However, these mHealth apps have limited capabilities to reinforce disease self-management and provide information related to treatment compliance.
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Affiliation(s)
- Vaia Sapouna
- . Clinical Exercise Physiology and Rehabilitation Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
- . Physical Medicine and Rehabilitation Centre Kentavros, Volos, Greece
| | - Pavlos Kitixis
- . Clinical Exercise Physiology and Rehabilitation Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Elpiniki Petrou
- . Clinical Exercise Physiology and Rehabilitation Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Theano Michailidou
- . Clinical Exercise Physiology and Rehabilitation Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Panagiotis Dalamarinis
- . Clinical Exercise Physiology and Rehabilitation Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Eleni Kortianou
- . Clinical Exercise Physiology and Rehabilitation Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
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Berlot AA, Chen PS, Kaur S, Mowrey W, Mahali LP, Gonzalez JS, Wylie-Rosett J, Golestaneh L, Jariwala SP. Developing and Evaluating the DiabetesXcel Mobile Application for Adult Patients With Type 2 Diabetes. Clin Diabetes 2023; 42:232-242. [PMID: 38694246 PMCID: PMC11060611 DOI: 10.2337/cd23-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The authors trialed a mobile application, DiabetesXcel, which included type 2 diabetes-focused educational videos and modules, in 50 adults of Bronx, NY, a region with a high prevalence of diabetes and diabetes complications. From baseline to 4 months and from baseline to 6 months, there was significantly improved quality of life, self-management, knowledge, self-efficacy, depression, A1C, and LDL cholesterol among those who used DiabetesXcel. There was also a significant decrease in diabetes-related emergency department visits and hospital admissions from baseline to 6 months. This study demonstrates that DiabetesXcel could be beneficial for type 2 diabetes management.
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Affiliation(s)
| | | | | | - Wenzhu Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | - Jeffrey S. Gonzalez
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY
| | - Judith Wylie-Rosett
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY
| | - Ladan Golestaneh
- Albert Einstein College of Medicine, Bronx, NY
- Montefiore Medical Center, Bronx, NY
| | - Sunit P. Jariwala
- Albert Einstein College of Medicine, Bronx, NY
- Montefiore Medical Center, Bronx, NY
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Szylling A, Raciborski F, Wojas O, Furmańczyk K, Krzych‐Fałta E, Bousquet J, Samoliński B. Why the role of mHealth in allergy diagnosis and treatment adherence cannot be overlooked. Clin Transl Allergy 2023; 13:e12298. [PMID: 37876036 PMCID: PMC10580813 DOI: 10.1002/clt2.12298] [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: 05/23/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Allergic diseases-rhinitis and asthma-are the most common chronic conditions affecting adults. Traditional approaches to allergy diagnosis and treatment do not meet the health needs of all patients. Treatment adherence remains a challenge for physicians. The ubiquity of Internet access paired with limited in-person contact with medical personnel in the course of the COVID-19 pandemic demonstrated the potential of mHealth in communicating health information. BODY: The abundance of new applications dedicated to various medical specialties encourages reflection on the informed use of such tools. The paper takes a closer look at the potential of mHealth and presents conclusions of selected studies focusing on the use of good apps. The strength weakness opportunities threats analysis was used to illustrate the strengths of the mHealth strategy, as well as its advantages, limitations and areas in need of further development. CONCLUSION The strength of mHealth depends on the quality and quantity of the collected patient data, its reliable processing, as well as publication of outcomes and conclusions from analyses. Therefore, it is necessary to promote the use of validated applications among patients, physicians and medical staff.
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Affiliation(s)
- Anna Szylling
- Department of Allergy and Clinical ImmunologyUniversity Clinical Center of the Medical University of Warsaw Central Clinical HospitalWarszawaMazowieckiePoland
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards, Allergology and ImmunologyMedical University of WarsawWarszawaMazowieckiePoland
| | - Oksana Wojas
- Department of Prevention of Environmental Hazards, Allergology and ImmunologyMedical University of WarsawWarszawaMazowieckiePoland
| | - Konrad Furmańczyk
- Department of Prevention of Environmental Hazards, Allergology and ImmunologyMedical University of WarsawWarszawaMazowieckiePoland
- Institute of Information TechnologyWarsaw University of Life SciencesWarszawaPoland
| | | | - Jean Bousquet
- Institute of AllergologyCharite Universitatsmedizin BerlinBerlinGermany
- University of MontpellierMontpellierFrance
| | - Boleslaw Samoliński
- Department of Allergy and Clinical ImmunologyUniversity Clinical Center of the Medical University of Warsaw Central Clinical HospitalWarszawaMazowieckiePoland
- Department of Prevention of Environmental Hazards, Allergology and ImmunologyMedical University of WarsawWarszawaMazowieckiePoland
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Sapouna V, Dimitriadis Z, Douros K, Kapreli E, Kortianou EA. Technical Factors That May Influence mHealth Adherence in Children With Chronic Pulmonary Diseases: Scoping Review. Pediatr Phys Ther 2023; 35:468-477. [PMID: 37656982 DOI: 10.1097/pep.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE To synthesize the technical factors influencing adherence to nonpharmacological treatment (NPhT) in children with chronic pulmonary diseases (CPDs), using mobile health (mHealth) technology. METHODS Five electronic databases were searched from inception to October 12, 2022, with terms related to pediatrics, CPDs, adherence, NPhT, and mHealth. The methodological quality was assessed using the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool checklist. RESULTS Eleven articles were included. Six major technical themes were supported by the evidence that may influence adherence to NPhT: design and context, technical support/business model, connectivity, free availability, privacy and security, and cultural readiness. CONCLUSIONS The design of mHealth applications (apps) should be done according to the needs of pediatric patients. This may mitigate any barriers and potentially foster adherence to the use of the apps. WHAT THIS ADDS TO THE EVIDENCE Six major technical themes may influence adherence to NPhT in children with chronic respiratory diseases.Video Abstract: Supplemental digital content available at http://links.lww.com/PPT/A487 .
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Affiliation(s)
- Vaia Sapouna
- Clinical Exercise Physiology and Rehabilitation Laboratory (Ms Sapouna and Drs Kapreli and Kortianou) and Health Assessment and Quality of Life Laboratory (Dr Dimitriadis), Physiotherapy Department, University of Thessaly, Lamia, Greece; Pediatric Allergy and Pulmonology Unit (Dr Douros), 3rd Department of Pediatrics, National and Kapodistrian University, Athens, Greece
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7
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Silverstein GD, Styke SC, Kaur S, Singh A, Green S, Jariwala SP, Feldman J. The Relationship Between Depressive Symptoms, eHealth Literacy, and Asthma Outcomes in the Context of a Mobile Health Intervention. Psychosom Med 2023; 85:605-611. [PMID: 36799736 PMCID: PMC10372190 DOI: 10.1097/psy.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE The ASTHMAXcel PRO mobile app provides asthma education and collects asthma outcome data. The objective of this study was to evaluate the associations between health/electronic health literacy (eHealth literacy) and depressive symptoms with app usage and clinical outcomes. METHODS Adults with persistent asthma were recruited to use the app. Participants completed the Patient Health Questionnaire-9 to assess for depressive symptoms, Asthma Control Test, Mini Asthma Quality of Life (QOL) Questionnaire, and the Newest Vital Sign tool to measure health literacy. Data on a subset of participants were available on eHealth literacy ( n = 24) and average number of app logins across 2 months ( n = 40). RESULTS The total study sample included 96 participants (46% non-Hispanic Black, 44.4% Hispanic). The average participant age was 44.0 (standard deviation = 14.9) years, with 74% identifying as female. Increased depressive symptoms were associated with worse asthma control ( β = -0.46, p < .001) and asthma QOL ( β = -0.38, p < .001), but not eHealth literacy. Higher eHealth literacy was associated with worse asthma QOL ( β = -0.48, p = .02) and more app logins ( β = 0.59, p = .04). Newest Vital Sign scores were not associated with any of the other measures. CONCLUSIONS Depressive symptoms were associated with worse asthma outcomes. eHealth literacy was associated with increased patient engagement with the app and worse asthma QOL, which may reflect patients with worse QOL seeking out health information on the Internet (although directionality could not be assessed). Digital health literacy may be key to increasing patient engagement with mobile health interventions.Trial Registration: National Clinical Trial No. 03847142, https://clinicaltrials.gov/ct2/show/NCT03847142 .
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Affiliation(s)
| | - Sarah C. Styke
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Savneet Kaur
- Albert Einstein College of Medicine, Division of Allergy and Immunology, Department of Medicine, Bronx, NY
| | - Anjani Singh
- Albert Einstein College of Medicine, Division of Allergy and Immunology, Department of Medicine, Bronx, NY
| | - Samuel Green
- Albert Einstein College of Medicine, Division of Allergy and Immunology, Department of Medicine, Bronx, NY
| | - Sunit P. Jariwala
- Albert Einstein College of Medicine, Division of Allergy and Immunology, Department of Medicine, Bronx, NY
| | - Jonathan Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Division of Academic General Pediatrics, Department of Pediatrics and Department of Psychiatry and Behavioral Sciences, Bronx, NY
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Wittwer LH, Walters E, Jordan K. Improving Pediatric Asthma Care Through Asthma Apps: A Narrative Review. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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O'Connor A, Tai A, Brinn M, Hoang ANTH, Cataldi D, Carson-Chahhoud K. The Acceptability of Using Augmented Reality as a Mechanism to Engage Children in Asthma Inhaler Technique Training: Qualitative Interview Study With Deductive Thematic Analysis. JMIR Pediatr Parent 2023; 6:e40231. [PMID: 36637889 PMCID: PMC9883739 DOI: 10.2196/40231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Inhaled medications or inhalers provide first-line pharmacotherapeutic treatment for patients with asthma for both acute symptomatic relief and long-term management to keep symptoms under control. A good technique requires only basic instruction and training; however, a recent study identified that 92% of children do not follow all correct steps when using inhalers. There is a growing interest in technology-enhanced asthma education, with evidence demonstrating improvements in knowledge and treatment adherence. Subsequently, there are calls to explore the role of technology-based solutions in improving asthma management and disease outcomes from public health experts, health professionals, and patients with asthma. Augmented reality (AR) technology is an information delivery mechanism with proven efficacy in educational settings. AR displays digital content in a real-world environment using the camera on a smartphone or tablet device to create an immersive learning experience. OBJECTIVE The study aimed to evaluate the acceptability of AR as a mechanism for delivering asthma inhaler technique education from the perspective of children with asthma and their parents and health professionals, examined through the theoretical framework of acceptability (TFA). METHODS An asthma education resource enhanced with AR technology was created to provide inhaler technique education to children. An iterative co-design process was undertaken with target end users for a qualitative evaluation. The participants were 8 to 12 years old with asthma, their caregivers, and health professionals who had experience in managing asthma. Qualitative data were obtained through semistructured one-on-one interviews. Deductive thematic analysis using TFA was undertaken using NVivo software 2020 to assess the acceptability of AR as a delivery modality for asthma inhaler technique education. RESULTS Overall, 6 health care professionals, 5 asthmatic children, and 5 caregivers of children with asthma totaled a sample of 16. The use of AR in the asthma inhaler resource was found to be acceptable when responses were examined in accordance with TFA. Each of the 7 component constructs of TFA was coded throughout the 16 interviews, with perceived effectiveness (157 times) and affective attitude (63 times) coded most frequently. Positive responses included the intervention being accessible, easy to use, interesting, and fitting within the users' value systems. Negative responses included the need to maintain an interest in children and concerns about the loss of face-to-face interaction with health professionals. CONCLUSIONS AR appears to be an acceptable modality for delivering asthma education to children when explored using TFA constructs. Although some challenges were identified with the use of AR, the results were predominantly positive. Future designs of asthma education interventions involving AR should consider the results of this study, and further research should focus on the feasibility, usability, and barriers and facilitators of behavior change to ensure the successful implementation and uptake of AR into clinical settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1177/16094069211042229.
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Affiliation(s)
- Antonia O'Connor
- Respiratory and Sleep Department, Women's and Children's Hospital, South Australia, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Andrew Tai
- Respiratory and Sleep Department, Women's and Children's Hospital, South Australia, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Malcolm Brinn
- Translational Medicine and Technology Research Group, University of South Australia, Adelaide, Australia.,Australian Centre for Precision Health, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Daniele Cataldi
- Paediatric Medicine, The Women's and Children's Hospital, Adelaide, Australia
| | - Kristin Carson-Chahhoud
- School of Medicine, The University of Adelaide, Adelaide, Australia.,Translational Medicine and Technology Research Group, University of South Australia, Adelaide, Australia.,Australian Centre for Precision Health, South Australian Health and Medical Research Institute, Adelaide, Australia
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Dauletbaev N, Oftring ZS, Akik W, Michaelis-Braun L, Korel J, Lands LC, Waldmann S, Müller BS, Dreher M, Rohde G, Vogelmeier CF, Kuhn S. A scoping review of mHealth monitoring of pediatric bronchial asthma before and during COVID-19 pandemic. Paediatr Respir Rev 2022; 43:67-77. [PMID: 35131174 PMCID: PMC8761580 DOI: 10.1016/j.prrv.2022.01.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 12/02/2022]
Abstract
Mobile (m) Health technology is well-suited for Remote Patient Monitoring (RPM) in a patient's habitual environment. In recent years there have been fast-paced developments in mHealth-enabled pediatric RPM, especially during the COVID-19 pandemic, necessitating evidence synthesis. To this end, we conducted a scoping review of clinical trials that had utilized mHealth-enabled RPM of pediatric asthma. MEDLINE, Embase and Web of Science were searched from September 1, 2016 through August 31, 2021. Our scoping review identified 25 publications that utilized synchronous and asynchronous mHealth-enabled RPM in pediatric asthma, either involving mobile applications or via individual devices. The last three years has seen the development of evidence-based, multidisciplinary, and participatory mHealth interventions. The quality of the studies has been improving, such that 40% of included study reports were randomized controlled trials. In conclusion, there exists high-quality evidence on mHealth-enabled RPM in pediatric asthma, warranting future systematic reviews and/or meta-analyses of the benefits of such RPM.
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Affiliation(s)
- Nurlan Dauletbaev
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany; Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; The Research Institute of McGill University Health Centre, Montreal, QC, Canada; al-Farabi Kazakh National University, Almaty, Kazakhstan.
| | - Zoe S. Oftring
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Wided Akik
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Lukas Michaelis-Braun
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Julia Korel
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Larry C. Lands
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada,The Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Susanne Waldmann
- Central Medical Library, Philipps University of Marburg, Marburg, Germany
| | - Beate S. Müller
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Gernot Rohde
- Medical Clinic 1, Department of Respiratory Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Claus F. Vogelmeier
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Sebastian Kuhn
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
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Stake M, Heinrichs B. Ethical Implications of e-Health Applications in Early Preventive Healthcare. Front Genet 2022; 13:902631. [PMID: 35899190 PMCID: PMC9309263 DOI: 10.3389/fgene.2022.902631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/17/2022] [Indexed: 11/24/2022] Open
Abstract
As a means of preventive medicine early detection and prevention examinations can identify and treat possible health disorders or abnormalities from an early age onwards. However, pediatric examinations are often widely spaced, and thus only snapshots of the children’s and adolescents’ developments are obtained. With e-health applications parents and adolescents could record developmental parameters much more frequently and regularly and transmit data directly for ongoing evaluation. AI technologies could be used to search for new and previously unknown patterns. Although e-health applications could improve preventive healthcare, there are serious concerns about the unlimited use of big data in medicine. Such concerns range from general skepticism about big data in medicine to specific challenges and risks in certain medical areas. In this paper, we will focus on preventive health care in pediatrics and explore ethical implications of e-health applications. Specifically, we will address opportunities and risks of app-based data collection and AI-based data evaluation for complementing established early detection and prevention examinations. To this end, we will explore the principle of the best interest of the child. Furthermore, we shall argue that difficult trade-offs need to be made between group benefit on the one hand and individual autonomy and privacy on the other.
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Affiliation(s)
- Mandy Stake
- Institute for Neuroscience and Medicine: Brain and Behaviour (INM-7), Jülich Research Center, Jülich, Germany
- *Correspondence: Mandy Stake,
| | - Bert Heinrichs
- Institute for Neuroscience and Medicine: Brain and Behaviour (INM-7), Jülich Research Center, Jülich, Germany
- Institute of Science and Ethics (IWE), University of Bonn, Bonn, Germany
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12
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Karataş N, Kaya A, İşler Dalgıç A. The effectiveness of user-focused mobile health applications in paediatric chronic disease management: A systematic review. J Pediatr Nurs 2022; 63:e149-e156. [PMID: 34598848 DOI: 10.1016/j.pedn.2021.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022]
Abstract
PROBLEM This systematic review aims to evaluate the effectiveness of user-focused mobile health (mHealth) applications in paediatric chronic disease management. ELIGIBILITY CRITERIA Articles were included under the Population Intervention Comparator Outcome Study (PICOS) design framework for (P) children with a chronic disease, (I) mHealth user-focused apps, (C) usual care/control groups, (O) health outcomes related to chronic diseases, and (S) randomised controlled trials. This study followed the guidelines provided by Cochrane, Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and Mobile Health Evidence Reporting and Assessment. SAMPLE A comprehensive literature search screening was conducted via CINAHL, PubMed, CENTRAL, ELSEVIER, SAGE, Science Direct, Scopus, Taylor Francis, WoS, and IEEE XPLORE from inception to November 15, 2020. RESULTS The review included seven articles, which combined provided data for a total of 755 children. The effects of the mHealth applications on the investigated 31 unique outcomes of five chronic paediatric diseases were mixed, ranging from effective to no effect. The risk of bias in the included studies was mostly either high or concerning according to Risk of Bias tool 2.0. The mobile apps that were evaluated were not standalone apps but were designed to interact with and provide data to healthcare providers. CONCLUSION Some mHealth interventions in this systematic review produced clinically meaningful and statistically relevant reductions in health outcomes related to chronic disease management. However, based on the available data, it is not possible to make definitive conclusions concerning the preferred target population of the interventions. IMPLICATION mHealth apps may be beneficial in improving selected patient outcomes in chronic disease management. Our results may assist the digital health services of hospitals, paediatric nurses who are interested in mHealth, and children who have a chronic disease.
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Affiliation(s)
- Nimet Karataş
- Pediatric Nursing Department, Faculty of Nursing, Akdeniz University Antalya, Turkey.
| | - Ayla Kaya
- Pediatric Nursing Department, Faculty of Nursing, Akdeniz University Antalya, Turkey.
| | - Ayşegül İşler Dalgıç
- Pediatric Nursing Department, Faculty of Nursing, Akdeniz University Antalya, Turkey.
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Kruse C, Heinemann K. Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review. J Med Internet Res 2022; 24:e31752. [PMID: 34854815 PMCID: PMC8729874 DOI: 10.2196/31752] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/23/2021] [Accepted: 11/22/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The virulent and unpredictable nature of COVID-19 combined with a change in reimbursement mechanisms both forced and enabled the rapid adoption of telemedicine around the world. Thus, it is important to now assess the effects of this rapid adoption and to determine whether the barriers to such adoption are the same today as they were under prepandemic conditions. OBJECTIVE The objective of this systematic literature review was to examine the research literature published during the COVID-19 pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine, and to determine if changes have occurred in the industry during this time. METHODS The systematic review was performed in accordance with the Kruse protocol and the results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed 46 research articles from five continents published during the first year of the COVID-19 pandemic that were retrieved from searches in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. RESULTS Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, and 14 results (compared to a control group) themes and observations. Overall, 22% of the articles analyzed reported strong satisfaction or satisfaction (zero reported a decline in satisfaction), 27% reported an improvement in administrative or efficiency results (as compared with a control group), 14% reported no statistically significant difference from the control group, and 40% and 10% reported an improvement or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. CONCLUSIONS The pandemic encouraged rapid adoption of telemedicine, which also encouraged practices to adopt the modality regardless of the challenges identified in previous research. Several barriers remain for health policymakers to address; however, health care administrators can feel confident in the modality as the evidence largely shows that it is safe, effective, and widely accepted.
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Affiliation(s)
- Clemens Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Katharine Heinemann
- School of Health Administration, Texas State University, San Marcos, TX, United States
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14
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Cherrez‐Ojeda I, Vanegas E, Cherrez A, Felix M, Weller K, Magerl M, Maurer RR, Mata VL, Kasperska‐Zajac A, Sikora A, Fomina D, Kovalkova E, Godse K, Rao ND, Khoshkhui M, Rastgoo S, Criado RFJ, Abuzakouk M, Grandon D, Van Doorn MBA, Rodrigues Valle SO, De Souza Lima EM, Thomsen SF, Ramón GD, Matos Benavides EE, Bauer A, Giménez‐Arnau AM, Kocatürk E, Guillet C, Larco JI, Zhao Z, Makris M, Ritchie C, Xepapadaki P, Ensina LF, Cherrez S, Maurer M. Chronic urticaria patients are interested in apps to monitor their disease activity and control: A UCARE CURICT analysis. Clin Transl Allergy 2021; 11:e12089. [PMID: 34962721 PMCID: PMC8684305 DOI: 10.1002/clt2.12089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Information/communication technologies such as mobile phone applications (apps) would enable chronic urticaria (CU) patients to self-evaluate their disease activity and control. Yet, recently Antó et al (2021) reported a global paucity of such apps for patients with CU. In this analysis, we assessed patient interest in using apps to monitor CU disease activity and control using questions from the chronic urticaria information and communication technologies (CURICT) study. METHODS The methodology for CURICT has been reported. Briefly, a 23-item questionnaire was completed by 1841 CU patients from 17 UCAREs across 17 countries. Here, we analyzed patient responses to the CURICT questions on the use of apps for urticaria-related purposes. RESULTS As previously published, the majority of respondents had chronic spontaneous urticaria (CSU; 63%; 18% chronic inducible urticaria (CIndU) [CIndu]; 19% with both), were female (70%) and in urban areas (75%). Over half of patients were very/extremely interested in an app to monitor disease activity (51%) and control (53%), while only ∼1/10 were not. Patients with both urticaria types versus those with CSU only (odds ratio [OR], 1.36 [1.03-1.79]) and females versus males (OR [95% CI], 1.47 [1.17-1.85]) were more likely to be very to extremely interested in an app to assess disease control. CONCLUSIONS Overall, half of the patients with CU were very to extremely interested in using an app to assess their disease activity and control. Development of well-designed apps, specific to disease types (CSU, CIndU, CSU + CIndU, etc), validated by experts across platforms would help improve the management and possibly outcomes of CU treatment while providing important patient information to be used in future research.
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Affiliation(s)
- Ivan Cherrez‐Ojeda
- Universidad Espíritu SantoSamborondónEcuador
- RespiralabRespiralab Research GroupGuayaquilEcuador
| | - Emanuel Vanegas
- Universidad Espíritu SantoSamborondónEcuador
- RespiralabRespiralab Research GroupGuayaquilEcuador
| | - Annia Cherrez
- RespiralabRespiralab Research GroupGuayaquilEcuador
- Clinic and Policlinic for Dermatology and VenereologyUniversity Medical Center RostockRostockGermany
| | - Miguel Felix
- Universidad Espíritu SantoSamborondónEcuador
- RespiralabRespiralab Research GroupGuayaquilEcuador
| | - Karsten Weller
- Institute for Allergology, Charité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and ImmunologyBerlinGermany
| | - Markus Magerl
- Institute for Allergology, Charité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and ImmunologyBerlinGermany
| | - Rasmus Robin Maurer
- Institute for Allergology, Charité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and ImmunologyBerlinGermany
| | - Valeria L. Mata
- Universidad Espíritu SantoSamborondónEcuador
- RespiralabRespiralab Research GroupGuayaquilEcuador
| | - Alicja Kasperska‐Zajac
- European Center for Diagnosis and Treatment of UrticariaMedical University of SilesiaKatowicePoland
| | - Agnieszka Sikora
- European Center for Diagnosis and Treatment of UrticariaMedical University of SilesiaKatowicePoland
| | - Daria Fomina
- City Center of Allergy and ImmunologyClinical City Hospital #52MoscowRussia
- Department of Allergology and Clinical ImmunologyI.M. Sechenov First Moscow State Medical UniversityMoscowRussian Federation
| | - Elena Kovalkova
- City Center of Allergy and ImmunologyClinical City Hospital #52MoscowRussia
| | - Kiran Godse
- Department of DermatologyD Y, Patil University School of Medicine and HospitalMumbaiIndia
| | - Nimmagadda Dheeraj Rao
- Department of DermatologyD Y, Patil University School of Medicine and HospitalMumbaiIndia
| | - Maryam Khoshkhui
- Allergy Research CenterMashhad University of Medical SciencesMashhadIran
- Department of Allergy and ImmunologyMashhad University of Medical SciencesMashhadIran
| | - Sahar Rastgoo
- Department of Allergy and ImmunologyMashhad University of Medical SciencesMashhadIran
| | | | - Mohamed Abuzakouk
- Allergy and Immunology DepartmentCleveland Clinic Abu DhabiAbu DhabiUAE
| | - Deepa Grandon
- Allergy and Immunology DepartmentCleveland Clinic Abu DhabiAbu DhabiUAE
| | | | | | | | - Simon Francis Thomsen
- Department of DermatologyBispebjerg HospitalUniversity of Copenhagen, Biomedical SciencesCopenhagenDenmark
| | - German D. Ramón
- Instituto de Alergia e Inmunología del Sur, Bahía BlancaBuenos AiresArgentina
| | | | - Andrea Bauer
- Department of DermatologyUniversity Allergy CenterUniversity Hospital Carl Gustav CarusTechnical UniversityDresdenGermany
| | - Ana M. Giménez‐Arnau
- Department of DermatologyHospital del MarIMIM, Universitat AutònomaBarcelonaSpain
| | - Emek Kocatürk
- Department of DermatologyKoç University School of MedicineIstanbulTurkey
| | - Carole Guillet
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland
| | | | - Zuo‐Tao Zhao
- Department of Dermatology and VenereologyPeking University First HospitalBeijingChina
| | - Michael Makris
- Allergy Unit2nd Department of Dermatology and VenereologyNational and Kapodistrian University of Athens“Attikon” University HospitalAthensGreece
| | - Carla Ritchie
- Allergy DivisionHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Paraskevi Xepapadaki
- Allergy Department2nd Pediatric ClinicNational and Kapodistrian University of AthensAthensGreece
| | | | - Sofia Cherrez
- RespiralabRespiralab Research GroupGuayaquilEcuador
- Department of DermatologySRH Zentralklinikum SuhlSuhlGermany
| | - Marcus Maurer
- Institute for Allergology, Charité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and ImmunologyBerlinGermany
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Abstract
Patient Generated Health Data (PGHD) is defined as data generated by and from patients.1 The use of PGHD has rapidly increased with the widespread availability of smart phone mobile health applications (mHealth apps) and wearable devices. Currently, the vast majority of PGHD is generated via the use of mHealth apps and wearables like "Fitbit" or medical devices such as a continuous glucose monitoring device. There are many benefits of PGHD including increased monitoring of children's chronic health conditions outside clinical care to supplement ambulatory clinic visits, improved health outcomes, increased patient awareness and engagement and improved patient-provider communication. When leveraged properly, PGHD can be a powerful tool in delivering safe, effective, patient centered, efficient and equitable care as outlined by the Institute of Medicine (IOM).2 The challenges that limit collection, use and acceptance of PGHD include limited access to the internet, inability to incorporate PGHD into clinical workflows, data privacy and security concerns and apprehension about accuracy and safety of mHealth apps. These issues can lead to a lack of use or compliance with devices or apps associated with PGHD. To ensure optimal health benefits, agreement to leverage PGHD should be a joint decision between the clinician and the patient/caregiver. Future steps to ensure safety and clinical relevance of PGHD include involving regulatory authorities, device manufacturers and professional bodies to develop standards for mHealth apps and wearables to promote uncomplicated PGHD integration into workflows, easy and secure sharing of PGHD. Wearable technology, medical devices and smart phone apps become more advanced and widespread among the population, there will be an increasing potential for PGHD to facilitate personalized, efficient, and collaborative care resulting in improved health outcomes for children and adolescent and young adult. More research and innovation is needed to facilitate this transition.
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