Contribution of mobile health applications to self-management by consumers: review of published evidence

Effectiveness of gamified exercise programs on the level of physical activity in adults with chronic diseases: a systematic review

PURPOSE

to assess the effects of supervised and unsupervised gamified exercise programs on physical activity level, sedentary behavior and quality of life in patients with non-communicable chronic diseases.

MATERIALS AND METHODS

Six database were searched. Methodological quality of included studies, the quality of reporting interventions and the quality of the applications were assessed using the PEDro, TIDieR and MARS, respectively.

RESULTS

Nine studies were included (n = 974; 60.2 ± 5.7 years). Three of them enrolled individuals with cancer, one with stroke, one with multiple sclerosis, one with COPD, two with Diabetes Mellitus, and one with knee and hip osteoarthritis. Gamification was performed via a smartphone application in three studies (MARS = 13.4 ± 9.75pts, ranging from 10.9 to 16.9pts). The intervention was supervised in six studies. The PEDro and TIDIeR scores were 5.5 ± 1.3 (ranging 0-8pts) and 16.11 ± 3.14 (ranging 10-20pts), respectively. Supervised gamified interventions increased the level of physical activity compared to usual supervised exercises. Quality of life was similar between groups. Unsupervised interventions were similar for all outcomes evaluated.

CONCLUSIONS

Supervised gamified exercise programs seem to increase the level of physical activity compared to usual exercises in patients with chronic diseases. However, studies with better methodological qualities and subgroup analyzes are needed.

A Diabetes Education App for People Living With Type 2 Diabetes: Co-Design Study

BACKGROUND

Type 2 diabetes (T2D) is a growing global health concern, including in Singapore. Diabetes education programs have been shown to be effective in improving health outcomes and diabetes self-management skills. Mobile health apps have emerged as useful tools for diabetes education; however, their use and acceptance by the target population remain inconsistent. Therefore, end-user participation in the design and development of a mobile health app is crucial for designing an acceptable app that can improve outcomes for populations with a chronic disease.

OBJECTIVE

The objective of this study was to apply an end-user participatory approach to co-design a diabetes education app prototype for people living with T2D by exploring their perceptions, acceptance, and usability of an app prototype, as well as their diabetes experience and perspectives on digital diabetes education.

METHODS

A total of 8 people with T2D, who were recruited from diabetes management Facebook groups, participated in 4 web-based surveys via Qualtrics and 2 structured interviews via Zoom (Zoom Video Communications, Inc) between August 20, 2021, and January 28, 2022. Descriptive statistics and thematic analyses of the discussion and iterative feedback on the app prototype were used to assess the participants' perceptions of living with T2D, attitudes toward digital diabetes education, and acceptance of the prototype.

RESULTS

Analyses of the surveys and interview data revealed 3 themes: challenges of living with T2D; validation, acceptability, and usability of the diabetes education app prototype; and perspectives on digital diabetes education. In the first theme, participants highlighted the importance of solitary accountability, translating knowledge into practice, and developing pragmatic self-consciousness. The second theme indicated that the diabetes education app prototype was acceptable, with information and appearance being key; revealed ambivalent and polarized opinions toward the chatbot; and confirmed potential impact of the app on diabetes self-management skills and practice. The third theme comprised the necessity of using a variety of information-seeking strategies and recommendations for desired content and app qualities, including accessibility, adaptability, autonomy, evidence-based design and content, gamification, guidance, integration, personalization, and up-to-date content. The findings were used to reiterate the app design.

CONCLUSIONS

Despite a small sample size, the study demonstrated the feasibility of engaging and empowering people living with T2D to consider digital therapeutics for diabetes self-management skills and practice. Participants gave rather positive feedback on the design and content of the app prototype, with some recommendations for improvements. The findings suggest that incorporating end-user feedback into app design can lead to the creation of feasible and acceptable tools for diabetes education, potentially improving outcomes for populations with a chronic disease. Further research is needed to test the impact of the refined diabetes education app prototype on diabetes self-management skills and practice and quality of life.

Promoting Self-Management and Independent Living of Older Individuals with Chronic Diseases through Technology: A Study of Self-Reported Needs, Priorities, and Preferences

Background and Objectives: Older patients' needs are rarely examined beforehand, and thus, although technology-based tools can enhance self-management, acceptability rates are still low. This study aimed to examine and compare self-reported needs, priorities, and preferences of older patients with heart failure (HF), diabetes mellitus type II (DM2), and chronic obstructive pulmonary disease (COPD) toward technology use to enhance self-management. Materials and Methods: A convenience sample of 473 participants over 60 s (60.5% females), diagnosed with HF (n= 156), DM2 (n = 164), or COPD (n = 153) was recruited. They were administered a questionnaire about the usefulness of technology in general and in specific areas of disease management. Results: Most participants (84.7%) admitted that technology is needed for better disease management. This was equally recognized across the three groups both for the overall and specific areas of disease management (in order of priority: "Information", "Communication with Physicians and Caregivers", and "Quality of Life and Wellbeing"). Sociodemographic differences were found. Cell phones and PCs were the devices of preference. The four common features prioritized by all three groups were related to 'information about disease management' (i.e., monitoring symptoms, reminders for medication intake, management and prevention of complications), whereas the fifth one was related to 'communication with physicians and caregivers (i.e., in case of abnormal or critical signs). The top disease-specific feature was also monitoring systems (of respiratory rate or blood sugar or blood pressure, and oxygen), whereas other disease-specific features followed (i.e., maintaining normal weight for HF patients, adjusting insulin dose for DM2 patients, and training on breathing exercises for COPD patients). Conclusions: Older individuals in these three groups seem receptive to technology in disease management. mHealth tools, incorporating both common and disease-specific features and addressing different chronic patients, and also being personalized at the same time, could be cost-saving and useful adjuncts in routine clinical care to improve self-management.

Menstrual Tracking Mobile App Review by Consumers and Health Care Providers: Quality Evaluations Study

BACKGROUND

Women's menstrual cycle is an important component of their overall health. Physiological cycles and associated symptoms can be monitored continuously and used as indicators in various fields. Menstrual apps are accessible and can be used to promote overall female health. However, no study has evaluated these apps' functionality from both consumers' and health care providers' perspectives. As such, the evidence indicating whether the menstrual apps available on the market provide user satisfaction is insufficient.

OBJECTIVE

This study was performed to investigate the key content and quality of menstrual apps from the perspectives of health care providers and consumers. We also analyzed the correlations between health care provider and consumer evaluation scores. On the basis of this analysis, we offer technical and policy recommendations that could increase the usability and convenience of future app.

METHODS

We searched the Google Play Store and iOS App Store using the keywords "period" and "menstrual cycle" in English and Korean and identified relevant apps. An app that met the following inclusion criteria was selected as a research app: nonduplicate; with >10,000 reviews; last updated ≤180 days ago; relevant to this topic; written in Korean or English; available free of charge; and currently operational. App quality was evaluated by 6 consumers and 4 health care providers using Mobile Application Rating Scale (MARS) and user version of the Mobile Application Rating Scale (uMARS). We then analyzed the correlations among MARS scores, uMARS scores, star ratings, and the number of reviews.

RESULTS

Of the 34 apps, 31 (91%) apps could be used to predict the menstrual cycle, and 2 (6%) apps provided information pertinent to health screening. All apps that scored highly in the MARS evaluation offer a symptom logging function and provide the user with personalized notifications. The "Bom Calendar" app had the highest MARS (4.51) and uMARS (4.23) scores. The MARS (2.22) and uMARS (4.15) scores for the "Menstrual calendar-ovulation & pregnancy calendar" app were different. In addition, there was no relationship between MARS and uMARS scores (r=0.32; P=.06).

CONCLUSIONS

We compared consumer and health care provider ratings for menstrual apps. Continuous monitoring of app quality from consumer and health care provider perspectives is necessary to guide their development and update content.

Experiences, Motivations, and Perceived Impact of Participation in a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study

BACKGROUND

Caregivers of children and youth with complex care needs (CCNs) often require considerable support to ensure the well-being of their families. Social media present an opportunity to better support caregivers through computer-mediated communication for social support. Peer-to-peer (P2P) support groups are a way in which caregivers are accessing needed support; however, the experiences of caregivers who use these groups and the perceived impact that participation has on caregivers of children and youth with CCNs are not known.

OBJECTIVE

This study aimed to explore the experiences of caregivers of children and youth with CCNs who use a Facebook-based P2P support group to communicate, understand their motivations to use the group, and investigate its perceived impact on knowledge of programs and services and sense of community belonging among caregivers.

METHODS

A qualitative descriptive design was used to explore the experiences and perceived impact of a Facebook-based (Meta Platforms) P2P support group for caregivers of children and youth with CCNs in New Brunswick, Canada. The group was launched on the web in October 2020, during the COVID-19 pandemic, and resulted in 108 caregivers joining the group. A web-based survey was distributed, and semistructured interviews were conducted in February 2021 with a subsample of members. Thematic analysis was used to identify and report patterns related to caregivers' experiences and perceived impacts of participation.

RESULTS

A subsample of members in the Facebook group completed the web-based survey (39/108, 36.1%) and interviews (14/108, 12.9%). A total of 5 themes emerged from the interviews: safe space, informational support and direction, web-based connection with peers, impact on knowledge of programs and services, and degree of community belonging. Participants reported joining the group to obtain geography-specific information support and connect with peers. Many participants reported an improvement in their knowledge of programs and services and felt connected to the community; however, the short observation period and diversity among the caregiver population were cited as barriers to community belonging.

CONCLUSIONS

Social media present an important opportunity to facilitate the exchange of support between patients and caregivers in an accessible and curated environment. Findings from this study suggest that involvement in web-based, geography-specific P2P support groups can influence perceived knowledge of services and resources and sense of community belonging among caregivers of children and youth with CCNs. Furthermore, this study provides insight into the experiences and motivations of caregivers of children and youth with CCNs who participate in a private social media environment.

Patients' Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study

Background

In a previous study, a prototype mobile health (mHealth) app was co-designed with patients, family physicians, and researchers to enhance self-management and optimize conservative management for patients with mild to moderate knee osteoarthritis (OA).

Objective

This study aims to evaluate the overall usability, quality, and effectiveness of the mHealth app prototype for aiding knee OA self-management from the perspectives of patients with OA and health care providers (HCPs).

Methods

Using methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth app prototype that was codeveloped with patients and HCPs. We recruited adult patients aged ≥20 years with early knee OA (n=18) who experienced knee pain on most days of the month at any time in the past and HCPs (n=7) to participate. In the qualitative assessment, patient and HCP perspectives were elicited on the likeability and usefulness of app features and functionalities and the perceived impact of the app on patient-HCP communication. The quantitative assessment involved evaluating the app using usability, quality, and effectiveness metrics. Patient baseline assessments included a semistructured interview and survey to gather demographics and assess the quality of life (European Quality-of-Life 5-Dimension 5-Level Questionnaire [EQ-5D-5L]) and patient activation (patient activation measure [PAM]). Following the 6-week usability trial period, a follow-up survey assessed patients’ perceptions of app usability and quality and longitudinal changes in quality of life and patient activation. Semistructured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate the usability and quality of the app prototype.

Results

Interviews with patients and HCPs revealed overall positive impressions of the app prototype features and functionalities related to likeability and usefulness. Between the baseline and follow-up patient assessments, the mean EQ-5D-5L scores improved from 0.77 to 0.67 (P=.04), and PAM scores increased from 80.4 to 87.9 (P=.01). Following the 6-week evaluation, patients reported a mean System Usability Scale (SUS) score of 57.8, indicating marginal acceptability according to SUS cutoffs. The mean number of goals set during the usability period was 2.47 (SD 3.08), and the mean number of activities completed for knee OA self-management during the study period was 22.2 (SD 17.8). Spearman rank correlation (r_s) calculations revealed that the follow-up PAM scores were weakly correlated (r_s=−0.32) with the number of goals achieved and the number (r_s=0.19) of activities performed during the 6-week usability period. HCPs reported a mean SUS score of 39.1, indicating unacceptable usability.

Conclusions

This evidence-based and patient-centered app prototype represents a potential use of mHealth for improving outcomes and enhancing conservative care by promoting patient activation and patient-HCP communication regarding OA management. However, future iterations of the app prototype are required to address the limitations related to usability and quality.

Risk factor management of atrial fibrillation using mHealth: The Atrial Fibrillation – Helping Address Care with Remote Technology (AF-HEART) Pilot Study

Background

Personalized treatment of atrial fibrillation (AF) risk factors using mHealth and telehealth may improve patient outcomes.

Objective

The purpose of this study was to assess the feasibility of the Atrial Fibrillation Helping Address Care with Remote Technology (AF-HEART) intervention on the following patient outcomes: (1) heart rhythm tracking; (2) weight, alcohol, blood pressure (BP), and sleep apnea reduction; (3) AF symptom reduction; and (4) quality-of-life (QOL) improvement.

Methods

A total of 20 patients with AF undergoing antiarrhythmic therapy, cardioversion, and/or catheter ablation were enrolled and followed for 6 months. The AF-HEART intervention included remote heart rhythm, weight, and BP tracking; televisits with a dietician focusing on AF risk factors; and referrals for sleep apnea and hypertension treatment.

Results

Patients transmitted a median of 181 rhythm recordings during the 6-month follow-up period. Patients lost an average of 3.5 kilograms at 6 months (P = .005). Patients had improved SF-12 scores (P = .01), AFSS score (P = .01), EQ-5D score (P = .006), and AFEQT Global Score (P = .03). There was significant correlation between weight loss and decrease in symptom severity (r = -0.45, P = .05), and between % weight loss and decrease in symptom severity (r = -0.49, P = .03).

Conclusion

This study described the feasibility of the AF-HEART intervention for (1) consistent remote tracking of heart rhythm, weight, and BP; (2) achievement of weight loss; (3) reduction of symptoms; and (4) improvement in QOL. Expansion to a larger randomized study is planned.

Effectiveness of mobile applications in diabetic patients' healthy lifestyles: A review of systematic reviews

OBJECTIVE

(1) Examine the mobile applications that address lifestyles to improve the metabolic control of adult patients with diabetes mellitus. (2) Describe the characteristics of the used mobile applications, identify the healthy lifestyles they target, and describe any of their adverse effects.

METHODS

Review systematic reviews. We included studies that used any mobile application to help patients improve diabetes mellitus self-management by focusing on healthy lifestyles. Studies needed to include a control group receiving regular care with no mobile devices. In May 2018, Medline, Embase, Cochrane, LILACS, PsychINFO, Cinahl and Science Direct were searched, updated in June 2021. The methodological quality of the studies was assessed by the Amstar-2 tool.

RESULTS

First 804 articles were analyzed to select 17 systematic reviews, of which the methodological quality of seven was high or moderate. Interventions lasted 1-12 months. Twenty-three different mobile applications were identified that were all related to eating and physical activity. Significant changes were noted in HbA1c values. No clear improvement was observed for weight/BMI, lipid profile, quality of life or blood pressure. No adverse effects were found.

CONCLUSIONS

Managing the lifestyle of patients with diabetes using mobile applications improves short-term glycemic control, but the long-term results are not conclusive. The identified mobile applications focus on food and physical activity. Most are free. No adverse effects caused by using them were identified.

PROSPERO REGISTER

CRD42019133685.

"BRUSH UP": AN INNOVATIVE TECHNOLOGICAL AID FOR PARENTS TO KEEP A CHECK OF THEIR CHILDREN'S ORAL HYGIENE BEHAVIOUR

OBJECTIVE

To investigate the impact of "Brush Up" - a mobile application, on oral hygiene behaviours of 4-6-year-old children in Bangalore city.

METHODS

In this experimental study, 247 children aged 4-6, were randomly divided into three groups. Considering "Brush Up" is a mobile application, parents of the children in Group 1 (n=82) downloaded the application on their smartphones. Children in Group 2 (n=83) and Group 3 (n=82) received tooth brushing instructions by an educative video and manual demonstration, respectively. Effectiveness of tooth brushing was assessed with plaque scores, which were recorded for all the groups at baseline and one month using Visible Biofilm Index.

RESULTS

Wilcoxon signed rank test showed a significant improvement in the tooth brushing behaviour for the Brush Up group, which was indicated by a lower plaque score after a follow-up of one month. Kruskal-Wallis test followed by post-hoc test showed that the mean ranks of plaque scores of Brush Up group are consistently lower than those of video demonstration group and manual demonstration group.

CONCLUSIONS

The lower plaque score in subsequent follow-up in Brush Up group suggests that using a smart system can enhance learning a correct tooth brushing method in young children and can also help in implementing the required reinforcement and motivation to brush and aid in better plaque control.

Assessment of Mobile Health Apps Using Built-In Smartphone Sensors for Diagnosis and Treatment: Systematic Survey of Apps Listed in International Curated Health App Libraries

Background

More than a million health and well-being apps are available from the Apple and Google app stores. Some apps use built-in mobile phone sensors to generate health data. Clinicians and patients can find information regarding safe and effective mobile health (mHealth) apps in third party–curated mHealth app libraries.

Objective

These independent Web-based repositories guide app selection from trusted lists, but do they offer apps using ubiquitous, low-cost smartphone sensors to improve health? This study aimed to identify the types of built-in mobile phone sensors used in apps listed on curated health app libraries, the range of health conditions these apps address, and the cross-platform availability of the apps.

Methods

This systematic survey reviewed three such repositories (National Health Service Apps Library, AppScript, and MyHealthApps), assessing the availability of apps using built-in mobile phone sensors for the diagnosis or treatment of health conditions.

Results

A total of 18 such apps were identified and included in this survey, representing 1.1% (8/699) to 3% (2/76) of all apps offered by the respective libraries examined. About one-third (7/18, 39%) of the identified apps offered cross-platform Apple and Android versions, with a further 50% (9/18) only dedicated to Apple and 11% (2/18) to Android. About one-fourth (4/18, 22%) of the identified apps offered dedicated diagnostic functions, with a majority featuring therapeutic (9/18, 50%) or combined functionality (5/18, 28%). Cameras, touch screens, and microphones were the most frequently used built-in sensors. Health concerns addressed by these apps included respiratory, dermatological, neurological, and anxiety conditions.

Conclusions

Diligent mHealth app library curation, medical device regulation constraints, and cross-platform differences in mobile phone sensor architectures may all contribute to the observed limited availability of mHealth apps using built-in phone sensors in curated mHealth app libraries. However, more efforts are needed to increase the number of such apps on curated lists, as they offer easily accessible low-cost options to assist people in managing clinical conditions.

Older adults' experiences with a tablet-based self-management intervention for diabetes mellitus type II: A qualitative study

Technological interventions to support self-management can potentially help older adults manage their health, live active lives, and maintain their independence. The objective of this study was to assess individuals' experiences and perceptions of using a tablet-based application for 30 days as a component of routine diabetes self-management care in older adults with type 2 diabetes mellitus (T2DM) in the context of daily living. A qualitative research design using semi-structured interviews was used. The participants found the tablet-based application to be a beneficial and valuable component of their routine self-management activities. Five themes emerged from the interviews, namely self-dependence, awareness, positive impact on attitude and behavior, support, and balance. Findings from the individual interviews indicate that technological applications have a unique potential to support the foundations for attitude and behavioral changes toward self-management behaviors and activities, thus improving clinical outcomes.

Evaluation of Child-Friendly Augmented Reality Tool for Patient-Centered Education in Radiology and Bone Reconstruction

The use of augmented reality (AR) has a rich history and is used in a number of fields. Its application in healthcare and anatomy education is developing considerable interest. However, although its popularity is on the rise, its use as an educational and practical tool has not been sufficiently evaluated, especially with children. Therefore, this study presents the design, development and evaluation of an educational tablet-based application with AR functionality for children. A distal radius fracture was chosen, as it is one of the more common fractures in the younger age group. Following a standardized software engineering methodology, we identified functional and non-functional requirements, creating a child-friendly tablet based AR application. This used industry standard software and incorporated three-dimensional models of a buckle fracture, object and image target marker recognition, interactivity and educational elements. In addition, we surveyed children at the Glasgow Science Centre on its usability, design and educational effectiveness. Seventy-one children completed a questionnaire (25 also underwent a short structured interview). Overall, the feedback was positive relating to entertainment value, graphic design, usability and educational scope of the application. Notably, it was shown to increase user understanding of radiology across all age groups following a trial of the application. This study shows the great potential of using digital technologies, and more particularly augmented information, in engaging future generations in science from a young age. Creation of educational materials using digital technologies, and evaluating its effectiveness, highlights the great scope novel technology could have in anatomical education and training.

Design of a Consumer Mobile Health App for Heart Failure: Findings From the Nurse-Led Co-Design of Care4myHeart

Background

Consumer health care technology shows potential to improve outcomes for community-dwelling persons with chronic conditions, yet health app quality varies considerably. In partnership with patients and family caregivers, hospital clinicians developed Care4myHeart, a mobile health (mHealth) app for heart failure (HF) self-management.

Objective

The aim of this paper was to report the outcomes of the nurse-led design process in the form of the features and functions of the developed app, Care4myHeart.

Methods

Seven patients, four family caregivers, and seven multidisciplinary hospital clinicians collaborated in a design thinking process of innovation. The co-design process, involving interviews, design workshops, and prototype feedback sessions, incorporated the lived experience of stakeholders and evidence-based literature in a design that would be relevant and developed with rigor.

Results

The home screen displays the priority HF self-management components with a reminder summary, general information on the condition, and a settings tab. The health management section allows patients to list health care team member’s contact details, schedule medical appointments, and store documents. The My Plan section contains nine important self-management components with a combination of information and advice pages, graphical representation of patient data, feedback, and more. The greatest strength of the co-design process to achieve the design outcomes was the involvement of local patients, family caregivers, and clinicians. Moreover, incorporating the literature, guidelines, and current practices into the design strengthened the relevance of the app to the health care context. However, the strength of context specificity is also a limitation to portability, and the final design is limited to the stakeholders involved in its development.

Conclusions

We recommend health app development teams strategically incorporate relevant stakeholders and literature to design mHealth solutions that are rigorously designed from a solid evidence base and are relevant to those who will use or recommend their use.

Evaluating the Development Processes of Consumer mHealth Interventions for Chronic Condition Self-management: A Scoping Review

Innovative, patient-centered mHealth interventions have the potential to help with the burden of chronic conditions. This review aims to describe the development of consumer mHealth interventions for chronic condition self-management. A scoping review methodology was used to search medical databases for eligible reports, published between January 1, 2010, and December 31, 2017, that provided information on consumer mHealth interventions for respiratory disease, cancer, diabetes, and cardiovascular disease. Twenty-one reports were included, representing the development of 14 mHealth interventions. Most were developed collaboratively, using user-centered and participatory design processes. Predesign work involved a thorough needs assessment, and redesign processes were described as iterative, engaging with usability testing and design improvements. Tensions from competing priorities between patients and healthcare professionals were uncovered, with the intention to develop a useful product for the patient while ensuring clinical relevance. This review provides clear evidence that consumer mHealth interventions are developed inconsistently even when engaging with participatory or user-centered design principles, sometimes without direct involvement of patients themselves. Further, the incomplete description of the development processes presents challenges to furthering the knowledge base as healthcare professionals need timely access to quality information on mHealth products in order to recommend safe, effective consumer mHealth interventions.

Combining Technology and Research to Prevent Scald Injuries (the Cool Runnings Intervention): Randomized Controlled Trial

Background

New technologies, internet accessibility, social media, and increased smartphone ownership provide new opportunities for health researchers to communicate and engage target audiences. An innovative burn prevention intervention was developed using these channels.

Objective

The aim of this study was to evaluate the efficacy of Cool Runnings, an app-based intervention to increase knowledge of childhood burn risk (specifically hot beverage scalds) and correct burn first aid among mothers of young children.

Methods

This was a 2-group, parallel, single-blinded randomized controlled trial (RCT). Participants were women aged 18 years and above, living in Queensland, Australia, with at least 1 child aged 5-12 months at time of enrollment. The primary outcome measures were change in knowledge about risk of burns and correct burn first aid assessed via 2 methods: (1) overall score and (2) categorized as adequate (score=4) versus inadequate (score<4). Efficacy of gamification techniques was also assessed.

Results

In total, 498 participants were recruited via social media and enrolled. At the 6-month follow-up, 244 participants completed the posttest questionnaire. Attrition rates in both groups were similar. Participants who remained in the study did not differ from those lost to follow-up on any characteristics except education level. Although similar at baseline, intervention group participants achieved significantly greater improvement in overall knowledge posttest than control group participants on both primary outcome measures (overall knowledge intervention: mean [SD] of overall knowledge 2.68 [SD 1.00] for intervention vs 2.13 [SD 1.03] for control; 20.7% [25/121] adequate in intervention vs 7.3% [2/123] in control). Consequently, the number needed to treat was 7.46. Logistic regression showed participants exposed to the highest level of disadvantage had 7.3 times higher odds of improved overall knowledge scores than participants in other levels of disadvantage. There were also significant correlations between gamification techniques and knowledge change (P<.001). In addition, odds of knowledge improvement between baseline and 6-month follow-up was higher in participants with low-moderate app activity compared with no app activity (odds ratio [OR] 8.59, 95% CI 2.9-25.02) and much higher in participants with high app activity (OR 18.26, 95% CI 7.1-46.8).

Conclusions

Despite substantial loss to follow-up, this RCT demonstrates the Cool Runnings app was an effective intervention for improving knowledge about risks of hot beverage scalds and burn first aid in mothers of young children. The benefits of combining gamification elements in the intervention were also highlighted. Given the low cost and large reach of smartphone apps to deliver content to and engage with targeted populations, the results from this RCT provide important information on how smartphone apps can be used for widespread injury prevention campaigns and public health campaigns generally.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12616000019404; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369745&showOriginal=true&isReview=true (Archived by WebCite at http://www.webcitation.org/72b1E8gTW)

Developing the Medication Reminder Mobile Application "Seeb"

Introduction:

Today, the structure of comprehensive health care emphasizes self-care more than therapy. Medication therapy is a strong instrument for therapy received through the health setting, especially in medication area. Error in medication administration has produced different problems and they cost billions of dollars every year. Regarding mobile phone extensions, we developed a local medication reminder mobile application called “Seeb” as a suitable solution for decreasing medication errors for Iranians.

Methods:

We conducted a mixed methods study in three Phases: 1) Comparative study of existing mobile applications; 2) developed its object-oriented model; 3) Developed the initial version of “Seeb” that was approved for production.

Results:

This application was designed for the appropriate medication administration including time and dosages through: recording patient and medication data; scheduling patients’ medication; and reporting medication administration on progress.

Conclusion:

“Seeb” has been designed in compliance with Iranian health information technologists and pharmacists requirements. It is expected to reduce medication error and improve patient adherence to medical prescriptions.

Acceptance and Use of eHealth/mHealth Applications for Self-Management Among Cancer Survivors

Cancer survivors' acceptance and use of eHealth/mHealth applications for self-management can be unique and are not fully understood. We used data from the Health Information National Trends Survey 4 Cycle 4 to examine cancer survivors' acceptance and use of eHealth/mHea applications for key self-management processes, and conducted logistic regression and Rao-Scott design-adjusted Chi-square tests to assess bivariate associations between potential predictors and actual use. Potential factors were selected based on the Individual and Family Self-Management theory. High acceptance of eHealth applictions was identified, and adoption of mHealth was relatively low. Younger, higher educated, married, employed, and higher income survivors tended to use eHealth/mHealth applications for self-management. Survivors who were newly diagnosed or still on treatment were more likely to look for cancer information online or communicate with health providers electronically. BMI and rural residency were associated with use of mHealth apps to achieve a health-related goal and treatment decision-making.

App Chronic Disease Checklist: Protocol to Evaluate Mobile Apps for Chronic Disease Self-Management

Background

The availability of mobile health apps for self-care continues to increase. While little evidence of their clinical impact has been published, there is general agreement among health authorities and authors that consumers’ use of health apps assist in self-management and potentially clinical decision making. A consumer’s sustained engagement with a health app is dependent on the usability and functionality of the app. While numerous studies have attempted to evaluate health apps, there is a paucity of published methods that adequately recognize client experiences in the academic evaluation of apps for chronic conditions.

Objective

This paper reports (1) a protocol to shortlist health apps for academic evaluation, (2) synthesis of a checklist to screen health apps for quality and reliability, and (3) a proposed method to theoretically evaluate usability of health apps, with a view towards identifying one or more apps suitable for clinical assessment.

Methods

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was developed to guide the selection of the apps to be assessed. The screening checklist was thematically synthesized with reference to recurring constructs in published checklists and related materials for the assessment of health apps. The checklist was evaluated by the authors for face and construct validity. The proposed method for evaluation of health apps required the design of procedures for raters of apps, dummy data entry to test the apps, and analysis of raters’ scores.

Results

The PRISMA flow diagram comprises 5 steps: filtering of duplicate apps; eliminating non-English apps; removing apps requiring purchase, filtering apps not updated within the past year; and separation of apps into their core functionality. The screening checklist to evaluate the selected apps was named the App Chronic Disease Checklist, and comprises 4 sections with 6 questions in each section. The validity check verified classification of, and ambiguity in, wording of questions within constructs. The proposed method to evaluate shortlisted and downloaded apps comprises instructions to attempt set-up of a dummy user profile, and dummy data entry to represent in-range and out-of-range clinical measures simulating a range of user behaviors. A minimum score of 80% by consensus (using the Intraclass Correlation Coefficient) between raters is proposed to identify apps suitable for clinical trials.

Conclusions

The flow diagram allows researchers to shortlist health apps that are potentially suitable for formal evaluation. The evaluation checklist enables quantitative comparison of shortlisted apps based on constructs reported in the literature. The use of multiple raters, and comparison of their scores, is proposed to manage inherent subjectivity in assessing user experiences. Initial trial of the combined protocol is planned for apps pertaining to the self-monitoring of asthma; these results will be reported elsewhere.

Mobile Health Apps to Facilitate Self-Care: A Qualitative Study of User Experiences

OBJECTIVE

Consumers are living longer, creating more pressure on the health system and increasing their requirement for self-care of chronic conditions. Despite rapidly-increasing numbers of mobile health applications ('apps') for consumers' self-care, there is a paucity of research into consumer engagement with electronic self-monitoring. This paper presents a qualitative exploration of how health consumers use apps for health monitoring, their perceived benefits from use of health apps, and suggestions for improvement of health apps.

MATERIALS AND METHODS

'Health app' was defined as any commercially-available health or fitness app with capacity for self-monitoring. English-speaking consumers aged 18 years and older using any health app for self-monitoring were recruited for interview from the metropolitan area of Perth, Australia. The semi-structured interview guide comprised questions based on the Technology Acceptance Model, Health Information Technology Acceptance Model, and the Mobile Application Rating Scale, and is the only study to do so. These models also facilitated deductive thematic analysis of interview transcripts. Implicit and explicit responses not aligned to these models were analyzed inductively.

RESULTS

Twenty-two consumers (15 female, seven male) participated, 13 of whom were aged 26-35 years. Eighteen participants reported on apps used on iPhones. Apps were used to monitor diabetes, asthma, depression, celiac disease, blood pressure, chronic migraine, pain management, menstrual cycle irregularity, and fitness. Most were used approximately weekly for several minutes per session, and prior to meeting initial milestones, with significantly decreased usage thereafter. Deductive and inductive thematic analysis reduced the data to four dominant themes: engagement in use of the app; technical functionality of the app; ease of use and design features; and management of consumers' data.

CONCLUSIONS

The semi-structured interviews provided insight into usage, benefits and challenges of health monitoring using apps. Understanding the range of consumer experiences and expectations can inform design of health apps to encourage persistence in self-monitoring.