Potential for mobile health (mHealth) prevention of cardiovascular diseases in Kerala: A population-based survey

Improving medication adherence among persons with cardiovascular disease through m-health and community health worker-led interventions in Kerala; protocol for a type II effectiveness-implementation research-(SHRADDHA-ENDIRA)

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and at present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). A key reason for poor outcomes is non-adherence to medication.

METHODS

The intervention is a 2 × 2 factorial design trial applying two interventions individually and in combination with 1:1 allocation ratio: (i) ASHA-led medication adherence initiative comprising of home visits and (ii) m-health intervention using reminders and self-reporting of medication use. This design will lead to four potential experimental conditions: (i) ASHA-led intervention, (ii) m-health intervention, (iii) ASHA and m-health intervention combination, (iv) standard of care. The cluster randomized trial has been chosen as it randomizes communities instead of individuals, avoiding contamination between participants. Subcenters are a natural subset of the health system, and they will be considered as the cluster/unit. The factorial cluster randomized controlled trial (cRCT) will also incorporate a nested health economic evaluation to assess the cost-effectiveness and return on investment (ROI) of the interventions on medication adherence among patients with CVDs. The sample size has been calculated to be 393 individuals per arm with 4-5 subcenters in each arm. A process evaluation to understand the effect of the intervention in terms of acceptability, adoption (uptake), appropriateness, costs, feasibility, fidelity, penetration (integration of a practice within a specific setting), and sustainability will be done.

DISCUSSION

The effect of different types of intervention alone and in combination will be assessed using a cluster randomized design involving 18 subcenter areas. The trial will explore local knowledge and perceptions and empower people by shifting the onus onto themselves for their medication adherence. The proposal is aligned to the WHO-NCD aims of improving the availability of the affordable basic technologies and essential medicines, training the health workforce and strengthening the capacity of at the primary care level, to address the control of NCDs. The proposal also helps expand the use of digital technologies to increase health service access and efficacy for NCD treatment and may help reduce cost of treatment.

TRIAL REGISTRATION

The trial has been registered with the Clinical Trial Registry of India (CTRI), reference number CTRI/2023/10/059095.

A randomized controlled trial of medication adherence and management of risk factors for secondary prevention of stroke (MaMoRS) using a smartphone-based application

BACKGROUND

There are little data on the use of smartphone-based applications for medication adherence and risk-factor control for the secondary prevention of stroke in low-and-middle-income countries (LMICs).

AIMS

The aim was to determine whether a smartphone-based app improved medication adherence, risk-factor control, and provided health education to stroke survivors for lifestyle and behavioral modifications.

METHODS

An unblinded, single-center randomized controlled double arm trial with 1:1 allocation among stroke survivors was performed in South India. The primary outcome was medication adherence, with co-primary outcomes of lifestyle and behavioral factors and control of vascular risk factors, at 3 and 6 months.

RESULTS

Among 351 stroke survivors screened, 209 were recruited. The mean (standard deviation (SD)) age of the intervention (n = 105) group was 60 (12) years and that of the control (n = 104) group was 60 (10) years. In the primary outcome, mean medication adherence significantly improved in the intervention group with a between group difference of 0.735 (95% confidence interval (CI) = 0.419 to 1.050), p < 0.001. Being in intervention group (OR = 4.5; 95% CI = 2.3 to 8.9), stroke recurrence (OR = 3.3 (95% CI = 1.9 to 7.8)), and regular physician visits (OR = 2.1; 95% CI = 1.0 to 4.4) were significant predictors of good medication adherence. Considering the co-primary outcomes, compared to the control group, participants in the intervention group had a greater improvement in self-reported healthy diet intake (p = 0.003), intake of fruits (p = 0.005), and were physically more active (p = 0.001). At 6 months, mean fasting blood sugar (p = 0.005) and high-density lipoprotein cholesterol higher (p = 0.024) in the intervention group.

CONCLUSIONS

The use of a mobile app is an effective method to improve medication adherence and risk-factor control in stroke survivors and is feasible in LMICs like India.

DATA ACCESS STATEMENT

Data used during the study are available from the corresponding author on request.

TRIAL REGISTRATION

The study is registered in Clinical Trial Registry of India (CTRI/2022/06/042980).

Assessment of Heart Failure Post-discharge Management Strategies, Needs and Acceptance of Mobile Application-based Remote Patient Management in South India

The demand for digital platforms in managing heart failure (HF) is expected to increase with promising effects on readmission and health expenditure. The study aims to explore current post-discharge management strategies and identify the need and acceptance of digital platforms, to ensure the development of a user-friendly mobile application for HF patients. Using a cross-sectional analytical research design, 90 consecutive patients diagnosed with HF who were discharged from a Tertiary Care Center were enrolled. Tele-interview was conducted using a self-developed and validated tool. The mean age of participants was 55.54 ± 10.33 years. The participants' adherence to HF management strategies was low in terms of physical exercise and weight monitoring. More than one-third were willing to self-record their measurements and use a mobile application. The common mobile application features requested were medication information/reminder (88.6%), health education (84.3%), chat with nurses (84.3%), physical activity (81.4%), symptoms (78.6%), diet (78.6%) and weight management (72.9%). The findings from this initial phase of mobile development are expected to help leverage better development of digital interventions for HF patients.

Preferences, Acceptability and Usage of Mobile Health Applications Among Undergraduate Nursing Students: A Multisite, Cross-Sectional Survey

Introduction and objective

Mobile health applications (mHealth) can bring revolutionary changes to health care by making it more accessible, cost-effective, and efficient. The successful adoption of mHealth is largely determined by its acceptance by providers and end users. The acceptance of mHealth among nursing students, who are the future nurses, needs to be understood. This study aimed to determine the preferences, acceptability, and usage of mHealth applications among undergraduate nursing students.

Methods

A descriptive cross-sectional study was conducted in two selected universities in southern and northern India. A convenience sample of 567 undergraduate nursing students was recruited for the study. The data were collected using a structured questionnaire via Google Forms.

Results

mHealth applications were presently used by 32.9% of the students. The most common types of mHealth applications used were diet related (27.6%) and lifestyle related (23.4%). The majority of nursing students were willing to use mobile phones for consulting health professionals (78.8%) for prevention and management of health and disease. (83.1%), and for emergencies (73.3%). While more than half of the students were willing to recommend mHealth applications for patients, those students who were using two or more mHealth apps were more likely to recommend the same for the patients.

Conclusion

The results of the study highlight about the usage of mobile health applications among the nursing students. The students consider mHealth applications to be useful for delivering health-related services to end users. The study underscores the need to sensitize students about the possible usage of mHealth in healthcare delivery.

Medication-Adherence and Management of Risk Factors for Secondary Prevention of Stroke Using Smartphone-Based Application: Protocol for MAMORs-Randomized Controlled Trial

Background

In LMICs, the medication adherence and risk factor control are suboptimal in the post-stroke follow-up period. With shortage of physicians, smartphone-based interventions can help stroke survivors in secondary stroke prevention.

Objectives

We aim to validate a digital innovative technology-based intervention to improve the awareness, medication adherence, control of risk factors through timely intervention of physician among the stroke survivors.

Methods

MAMOR is a smartphone-based application to improve the stroke awareness by heath education materials, reminders to timely adherence of medication, alerts on control of risk factors, video files, and timely physician intervention. The study will involve development of the app using contextual research (Delphi qualitative method) followed by a randomized, single center, double arm-controlled trial with 1:1 assignment. The app will be evaluated over a period of 6 months with a target to enroll 192 participants. Process evaluation will be conducted. The sample size was calculated as 192, considering medication adherence of 43.8%, 20% increase in medication adherence by app, power of 80%, and 10% loss to follow-up.

Results

The primary outcome will be medication adherence, changes in the lifestyle and behavioral and control of vascular risk factors. The secondary outcome will include vascular events and functional outcome.

Conclusion

This study will be one among the few studies for secondary prevention of stroke through digital technology innovation in LMICs with resource constraints. The evidences generated from this study will provide translational evidence for other similar settings for stroke survivors.

A Systematic Review of Personalized Health Applications through Human–Computer Interactions (HCI) on Cardiovascular Health Optimization

Introduction: Currently, the deployment of human–computer interactive technologies to provide personalized care has grown and immensely taken shape in most healthcare settings. With the increasing growth of the internet and technology, personalized health interventions including smartphones, associated apps, and other interventions demonstrate prowess in various health fields, including cardiovascular management. This systematic review thus examines the effectiveness of various human–computer interactions technologies through telehealth (mainly eHealth) towards optimizing the outcomes in cardiovascular treatment. Methods: A comprehensive search of MEDLINE, EMBASE, and CINAHL databases using key terms was conducted from 2000 to November 2021 to identify suitable studies that explored the use of human–computer interaction technologies to provide a personalized care approach to facilitate bolstered outcomes for cardiovascular patients, including the elderly. The included studies were assessed for quality and risk of bias, and the authors undertook a data extraction task. Results: Ten studies describing the use of a mix of personalized health app (mHealth) interventions were identified and included in the study. Among the included studies, nine of them were randomized trials. All of the studies demonstrated the effectiveness of various personalized health interventions in maximizing the benefits of cardiovascular disease treatment. Conclusions: Personalized health application interventions through precision medicine has great potential to boost cardiovascular disease management outcomes, including rehabilitation. Fundamentally, since each intervention’s focus might differ based on the disease and outcome preference, it is recommended that more research be done to tailor the interventions to specific disease and patient outcome expectations.

Coverage and Acceptability of Mobile Phone Messages for Cancer Prevention: a Population-Based Study in a Latin American Country

Mobile health (m-health) has shown positive effects on disease prevention; however, several factors might influence its effectiveness, particularly in low- and middle-income countries. Randomized trials provide data with high internal validity but no major information on population impact. We conducted a pilot population-based study to assess the feasibility of cancer prevention through m-health in a Latin American population. A sample of affiliates to a health insurance company in Colombia was randomly selected and assigned to receive a short message service (SMS) or voice messages (VMS) during 4 weeks; weekly frequencies 2 and 7. Baseline and post-intervention surveys were conducted. Overall, 797 affiliates were contacted (SMS 393, VMS 404) but only 15.3% and 24.8% enrolled, respectively. Over 80% acceptability was observed among participants for all items evaluated (usefulness, understandability, timing, and frequency); however, 2-VMS per week was the only frequency consistent with the declared number of messages received and listened. Other frequencies resulted in high reception recall but low willingness to read/listen the messages. The willingness to be part of future programs was 20.0%. The gap between declared acceptability and practice, low participation rates, and low willingness to read/listen messages indicate m-health should be part of multicomponent interventions and should not be conceived as the sole intervention.

Protecting Mental Health Data Privacy in India: The Case of Data Linkage With Aadhaar

In an underprepared and under-resourced digital mental health system, the linkage of health and personal data with Aadhaar, a biometric system that provides a unique identification number to all Indian residents, poses significant privacy risks to individuals seeking mental health care. We discuss the challenges in protecting mental health data privacy due to these emerging digital health technologies.

“Through their eyes, I can work” – rural physicians' perceptions about mobile phone use among community health workers – a qualitative analysis

Purpose

Physicians who are primary care providers in rural communities form an essential stakeholder group in rural mobile health (mHealth) delivery. This study was exploratory in nature and was conducted in Udupi district of Karnataka, India. The purpose of this study is to examine the perceptions of rural medical officers (MOs) (rural physicians) regarding the benefits and challenges of mobile phone use by community health workers (CHWs).

Design/methodology/approach

In-depth interviews were conducted among 15 MOs belonging to different primary health centers of the district. Only MOs with a minimum five years of experience were recruited in the study using purposive and snowball sampling. This was followed by thematic analysis of the data collected.

Findings

The perceptions of MOs regarding the CHWs' use of mobile phones were largely positive. However, they reported the existence of some challenges that limits the potential of its full use. The findings were categorized under four themes namely, benefits of mobile phone use to CHWs, benefits of mobile phone-equipped CHWs, current mobile phone use by CHWs and barriers to CHWs' mobile phone use. The significant barriers reported in the CHWs' mobile phone use were poor mobile network coverage, technical illiteracy, lack of consistent technical training and call and data expense of the CHWs. The participants recommend an increased number of mobile towers, frequent training in mobile phone use and basic English language for the CHWs as possible solutions to the barriers.

Originality/value

Studies examining the perceptions of doctors who are a primary stakeholder group in mHealth as well as in the public health system scenario are limited. To the authors’ knowledge, this is one of the first studies to examine the perception of rural doctors regarding CHWs' mobile phone use for work in India.

A bibliometric analysis of medical informatics and telemedicine in sub-Saharan Africa and BRICS nations

The advances in eHealth have dramatically changed the face of healthcare delivery around the world, with Sub-Saharan Africa being no exception. It is essential to identify the prominent, emerging researchers, successful areas of research within the field of health informatics (HI) and telemedicine (TM) to be duplicated where there is a need. This study gives a bibliometric overview of original research articles on medical informatics and telemedicine indexed in Scopus, PubMed, and Science Direct over the last 20 years in sub-Saharan Africa. Keywords related to health informatics and telemedicine were used to retrieve relevant literature. We specifically analyzed the evolution, standard metrics, domains of medical informatics (MI) and TM in sub-Saharan Africa (SSA) and Brazil, Russia, India, China, and South Africa (BRIC) nations. Our results identified mhealth as the main field of research in telemedicine that has seen significant growth in both BRIC and SSA nations and is poised to be the focus of research activity in the near future. Research production in mhealth and telemedicine showed a considerable increase from 1999-2018. The production was dominated by articles from South Africa in Africa and China from the BRIC nations. Most prolific authors have resources and are leaders of health informatics projects. The production came from 26 sub-Saharan African countries, denoting this field's devotion in different areas around sub-Sahara. Research in mhealth needs to be encouraged, mostly in the fight against infectious and non-infectious diseases in sub-Saharan Africa, where technology can improve health services and decrease disease burden.

Bibliometric Analysis and Methodological Review of Mobile Health Services and Applications in India

PURPOSE

The purpose of this research is to analyze the literature published on mobile health (mHealth) in the Indian context. It also reviews the most important research works and presents various methodologies adopted by the researchers in this domain.

DESIGN/METHODOLOGY/APPROACH

The SciVerse SCOPUS database was used for extracting the literature on mobile health. The study used articles published between January 2008 to 28^th June 2019. The keyword used is 'mHealth' and journal articles with studies or interventions carried out in India were selected for bibliometric analysis and methodological review.

FINDINGS

For the keyword search, a total of 7,874 documents have been extracted, of which only 158 have been considered for the analysis. There is an exponential increase in the number of publications from the year 2015 to 2019. The keywords used for representing their articles have been grouped as mobile health devices, gender and age groups, system and software, health and disease condition, management, evidence-based practices (outcome), methods, and importance of the study. The journal PLOS One (87) has the highest number of citations, followed by The Lancet (63). The bibliometric analysis of the literature revealed seven clusters classified as individual's individual's mobile health applications adoption characteristics, need for mobile health and its governance, mobile phone application with the internet of things based framework for healthcare monitoring, mobile health for primary healthcare systems, authentication and security protocol for mobile healthcare, development and experimentation of mobile health application, and development and mobile health for adherence support intervention.

ORIGINALITY/VALUE

The study contributes in analyzing the bibliometrics and provides a methodological review for the journal articles published on mobile health. Previous articles considered systematic analysis of the bibliometric for mHealth, and mobile technology but less adequately discussed specifically towards Indian context which this study has embraced.

Developments in Privacy and Data Ownership in Mobile Health Technologies, 2016-2019

OBJECTIVES

To survey international regulatory frameworks that serve to protect privacy of personal data as a human right as well as to review the literature regarding privacy protections and data ownership in mobile health (mHealth) technologies between January 1, 2016 and June 1, 2019 in order to identify common themes.

METHODS

We performed a review of relevant literature available in English published between January 1, 2016 and June 1, 2019 from databases including PubMed, Google Scholar, and Web of Science, as well as relevant legislative background material. Articles out of scope (as detailed below) were eliminated. We categorized the remaining pool of articles and discrete themes were identified, specifically: concerns around data transmission and storage, including data ownership and the ability to re-identify previously de-identified data; issues with user consent (including the availability of appropriate privacy policies) and access control; and the changing culture and variable global attitudes toward privacy of health data.

RESULTS

Recent literature demonstrates that the security of mHealth data storage and transmission remains of wide concern, and aggregated data that were previously considered "de-identified" have now been demonstrated to be re-identifiable. Consumer-informed consent may be lacking with regard to mHealth applications due to the absence of a privacy policy and/or to text that is too complex and lengthy for most users to comprehend. The literature surveyed emphasizes improved access control strategies. This survey also illustrates a wide variety of global user perceptions regarding health data privacy.

CONCLUSION

The international regulatory framework that serves to protect privacy of personal data as a human right is diverse. Given the challenges legislators face to keep up with rapidly advancing technology, we introduce the concept of a "healthcare fiduciary" to serve the best interest of data subjects in the current environment.

Mobile applications addressing violence against women: a systematic review

Introduction

Violence against women is a pressing global health problem that is being met with a new intervention strategy—mobile applications. With this systematic review, we provide an initial analysis and functional categorisation of apps addressing violence against women.

Methods

We conducted a systematic online search conforming with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify apps addressing violence against women in five World Bank regions (Europe and Central Asia; North America, Latin America and the Caribbean; Middle East and North Africa; South Asia; and sub-Saharan Africa). Applications with location of initiation in mentioned regions and ≥100 downloads were included. Data on sector, target group(s), year of release, location of initiation and implementation were extracted. By means of a structured qualitative content analysis, applications were then categorised according to their main functions.

Results

Of 327 relevant applications, 171 were included into the systematic review and assigned to one of five identified categories of main functions, respectively: emergency, avoidance, education, reporting and evidence building, and supporting apps. The largest proportion (46.78%) consisted of emergency apps, followed by education, reporting and evidence building, supporting and avoidance apps in descending order. With regards to the geographical distribution of app categories, significant (χ²(20)=58.172; p=0.000) differences among the included regions were found.

Conclusion

A vast proportion of apps addressing violence against women primarily draw on one-time emergency or avoidance solutions, as opposed to more preventative approaches. Further research is necessary, critically considering questions of data security, personal safety and efficacy of such mobile health interventions.

Effectiveness of information technology-enabled 'SMART Eating' health promotion intervention: A cluster randomized controlled trial

BACKGROUND

Unhealthy dietary behaviour-high intake of fat, sugar, and salt, and low intake of fruits and vegetables-is a major risk factor for chronic diseases. There is a lack of evidence-based interventions to promote healthy dietary intake among Indian populations. Therefore, we tested the effectiveness of an information technology-enabled 'SMART Eating' intervention to reduce the intake of fat, sugar and salt, and to increase the intake of fruits and vegetables.

METHODS

In Chandigarh, a North Indian city, a cluster randomized controlled trial was implemented in twelve geographical clusters, based on the type of housing (i.e., LIG: Low-income group; MIG; Middle-income group, and HIG: High-income group-a proxy for socio-economic status). Computer-generated randomization was used to allocate clusters to intervention and comparison arms after pairing on the basis of socioeconomic status and geographical distance between clusters. The sample size was 366 families per arm (N = 732). One adult per family was randomly selected as an index case to measure the change in the outcomes. For behaviour change, a multi-channel communication approach was used, which included information technology-short message service (SMS), email, social networking app and 'SMART Eating' website, and interpersonal communication along with distribution of a 'SMART Eating' kit-kitchen calendar, dining table mat, and measuring spoons. The intervention was implemented at the family level over a period of six months. The comparison group received pamphlets on nutrition education. Outcome measurements were made at 0 and 6 months post-intervention at the individual level. Primary outcomes were changes in mean dietary intakes of fat, sugar, salt, and fruit and vegetables. Secondary outcomes included changes in body mass index (BMI), blood pressure, haemoglobin, fasting plasma glucose (FPG), and serum lipids. Mixed-effects linear regression models were used to determine the net change in the outcomes in the intervention group relative to the comparison group.

RESULTS

Participants' mean age was 53 years, a majority were women (76%), most were married (90%) and 51% had completed a college degree. All families had mobile phones, and more than 90% of these families had access to Internet through mobile phones. The intervention group had significant net mean changes of -12.5 g/day (p<0.001), -11.4 g/day (p<0.001), -0.5 g/day (p<0.001), and +71.6 g/day (p<0.001) in the intake of fat, sugar, salt, and fruit and vegetables, respectively. Similarly, significant net changes occurred for secondary outcomes: BMI -0.25 kg/m2, diastolic blood pressure -2.77 mm Hg, FPG -5.7 mg/dl, and triglycerides -24.2mg/dl. The intervention had no effect on haemoglobin, systolic blood pressure, low-density lipoprotein cholesterol, or high-density lipoprotein cholesterol.

CONCLUSION

The IT-enabled 'SMART Eating' intervention was found to be effective in reducing fat, sugar, and salt intake, and increasing fruit and vegetable consumption among urban adults from diverse socio-economic backgrounds.

TRIAL REGISTRATION

Clinical Trial Registry of India CTRI/2016/11/007457.

Evaluation of mHealth Applications Related to Cardiovascular Diseases: a Systematic Review

Introduction:

Currently, with the widespread penetration of mobile devices with Internet access, including smartphones, they can allow specific and/or complementary activities in the health field as well as in other commercial sectors.

Aim:

This systematic review examined the impact of mHealth-based for cardiovascular research. The specific aims of the systematic review are to (1) classification of the studies according to the type of research (scientific articles and master’s and doctoral theses) and (2) relationship of studies with topics associated with cardiovascular diseases.

Results:

This review corresponds to information in scientific journals of high impact. This review intends to respond to the following question: How these research works have evaluated the performance of health mobile applications, with a special interest in cardiac issues? This review of these searches corresponds to an analysis by 14 categories, being these: 1) Scientific paper; 2) Doctoral Thesis; 3) Master thesis; 4) Telemedicine; 5) m-sssshealth, e-health; 6) cardiovascular, coronary diseases, heart failures, cardiopulmonary, cardiac rehabilitation; 7) rural health; 8) prevention and control, protection; 9) wearables; 10) mobile, web applications, app, smartphone, software, platform; 11) mhealth education, training, promotion, formative process; 12) self-management; 13) Multiple Vital Sign Monitoring, medical device, heart rate measurement, health care information systems; 14) health regulatory. It provides evidence of how some apps have been evaluated, and in some cases, the effectiveness of the estimated accuracy is not in line with the real situation.

Conclusion:

The analysis of these studies allows us to locate the sources of the development of mobile health projects. It also guides us to discover some needs that require new technology implementations.

A qualitative study of facilitators and barriers to cardiovascular risk factor control in a semiurban population in India

Cardiovascular (CV) risk factors like diabetes and hypertension are poorly controlled in both rural and urban India. This study was designed to identify the reasons for suboptimal control in a semiurban population in India. A total of 70 participants from the Study to Expand Heart Associated Treatments (SEHAT) trial, conducted in West Bengal, India. We qualitatively examined perspectives regarding CV risk factor control using focus group discussions based on the theory of reasoned action. Qualitative content analysis was used to analyze prevailing themes. Participants demonstrated a generalized knowledge of healthy lifestyle practices but lacked insight into disease-specific prevention methods. We further noticed significant gaps in the translation of existing knowledge into behavior. While personal and systemic barriers exist, factors like high patient motivation and a deep sense of trust in providers can potentially be harnessed to improve risk factor control in the community. We identified key facilitators and barriers to CV risk factor control in the community using a knowledge attitude behavior approach. Our findings provide direction for the development of community-based CV risk reduction models.

Health systems readiness for adopting mhealth interventions for addressing non-communicable diseases in low- and middle-income countries: a current debate

In low-and-middle-income countries, epidemiologic transition is taking place very rapidly from communicable diseases to non-communicable diseases. NCDs mortality rates are increasing faster and nearly 80% of NCDs deaths occur in LMICs. Existing weak health systems of LMICs are undergoing a devastating human and economic toll as a result of increasing treatment costs and losses to productivity from NCDs. At the same time, the increasing penetration of mobile phone technology and the spread of cellular network and infrastructure have led to the introduction of the mHealth field. While mHealth field offers a great promise to prevent and control non-communicable diseases in low-and-middle-income countries: there is a great debate going on to explore health systems readiness for adopting mHealth technology to address NCDs in LMICs. There are a number of factors which determine health systems readiness and response for adoption of mHealth technology including preparedness of healthcare institutions, availability of the resources, willingness of healthcare providers and communities. We have discussed these factors to understand health systems preparedness to adopt mHealth field for prevention and control of NCDs. To adequately integrate mobile-phone-based health interventions into existing health systems, these factors should be dealt up-front through constant effort to improve health systems response for NCDs. Currently, there is insufficient empirical and policy evidence on this research area and therefore future research and policy dialogue should be directed to assess the health systems willingness for mHealth adoption principally to address NCDs in the context of LMICs.

Is India ready for mental health apps (MHApps)? A quantitative-qualitative exploration of caregivers' perspective on smartphone-based solutions for managing severe mental illnesses in low resource settings

Background

Mobile application based delivery of psycho-social interventions may help reduce the treatment gap for severe mental illnesses (SMIs) and decrease the burden on caregivers. Apps developed in high income settings show effectiveness, but they suffer from lack of applicability in low resource scenarios due to the difference in technology penetration, affordability, and acceptance.

Objective

This study aimed to understand health technology usage, perceived needs, and acceptability of app based interventions in patients with SMIs to improve illness management and reduce caregiver burden.

Methods

The study was conducted in inpatient and outpatient settings of a tertiary care center in North India. A cross-sectional survey assessed smartphone and health app usage. Further, three focus group discussions evaluated the needs and apprehensions in using apps in management of SMIs.

Results

A total of 176 participants including 88 patients and 88 caregivers completed the survey. Smartphone ownership was similar to the national average (30%) in both caregivers (38.6%) and in patients (31.8%). Although subjects regularly used a third party app, health app usage was very low. Cost, unfamiliarity, and language were significant barriers to adoption. The focus group discussions provided insight into the various apprehensions of caregivers in using and in allowing patients to use smartphones and such apps. Caregivers wanted mobile apps for accessing information regarding services and resources available for people with SMI, and they felt such apps can be helpful if they could automate some of their routine caregiving activities. However, the significant difficulty was perceived in regards to the cost of the device, language of the medium, and unfamiliarity in using technology. Apprehensions that SMI patients might misuse technology, or damage the device were also prevalent.

Conclusions

The study systematically looks into the scope, design considerations and limitations of implementing a mobile technology based intervention for low resource settings. With only one-third of the patients and caregivers having access to smartphones and internet, parallel outreach strategies like IVRS should be actively considered while designing interventions. The difficulty of understanding and searching in a non-native language needs to be addressed. Hand holding of caregivers and frequent encouragement from treating doctors might significantly help in technology adoption and in surmounting the apprehensions related to using technology. To make the solution acceptable and useful to the already over-burdened caregivers, developers need to work closely with patients’ family members and follow a ground-up collaborative approach to app development. The scope of delivering mental health services through technology is immense in resource constrained settings like India, provided we, researchers, appreciate and accept the fact that in the varied landscape of a divergent economic, educational, and cultural milieu, a single solution will never suffice for all, and intervention modality matching with end user capacity will be of paramount importance in determining the success of the endeavor.

Mobile health apps preferences and practice among ambulatory cardiovascular patients

Aim: To determine if patients in cardiology practices would be interested in or willing to use mobile health technologies. Methods: Patients seen at an ambulatory cardiology clinic for any indication were included. A paper survey was administered during pre-intake that assessed frequency of use, familiarity with and interest in mobile health applications. Data were analyzed using an exploratory logistic regression analysis to determine demographic predictors for technology utilization. Results: A total of 306 patients were included (a plurality, 39.3%, in age group 50–69; 62.7% male). Those from median household incomes between US$30,000 and US$74,999 and those 18–29 years old were more likely to have used a health app (0.53 and 1.21, respectively). Those between 18 and 29 years were less interested in virtual visits with their healthcare provider (-0.92) and those over age 70 were less comfortable using their phone apps (-0.80). Conclusion: Age and income are important predictors of mobile health app adoption.