A qualitative study of user perceptions of mobile health apps

Insights from user experience and evaluation of a mobile health nutrition intervention for children with autism: A qualitative study

BACKGROUND

Children with autism spectrum disorder (ASD) experience high rates of atypical eating behaviours, such as food neophobia. Mobile health (mHealth) interventions have been found to improve communication, behaviour and social skills for children with ASD. However, there is limited evidence examining mHealth nutrition interventions among children with ASD.

METHODS

The present study comprised a qualitative descriptive study that used qualitative content analysis to explore parent and child experiences with a novel mHealth nutrition intervention. Ten parent-child dyads provided user feedback and evaluation of the intervention. Data collection tools included a semistructured interview guide and a quantitative questionnaire with open-ended questions. Data analysis of the interview transcripts and open-ended questionnaire responses was an iterative process that continued until saturation was achieved. Descriptive statistics were used to analyse quantitative questionnaire data.

RESULTS

Analysis of the qualitative semistructured interviews led to emergence of three themes: (1) positive intervention outcomes; (2) parent suggestions for improvement; and (3) barriers to engagement. Each theme included subthemes. Questionnaire data revealed the ability to pick rewards and the virtual character that reinforced dietary goals ("Nutrition Ninja") were the most liked components of the application. Sending messages within the application and the Nutrition Ninja game were the least liked components of the application.

CONCLUSIONS

Collectively, findings indicated that the app served as an interactive tool prompting dietary change and conversations within families. Yet, for some families, the intervention design, resistance to change or child disinterest hindered use and implementation of the intervention.

Digital tools to support informed decision making among screening invitees in a vulnerable position for population-based cancer screening: A scoping review

BACKGROUND

Individuals in a vulnerable position are generally less inclined to participate in population-based cancer screening. Digital tools, such as educational videos, narratives or decision aids, show promise in reaching and informing these invitees by tailoring information needs based on their preferences. This review aims to provide an overview of design features and reported outcomes of digital tools intended to support informed decision making among screening invitees in a vulnerable position.

METHODS

The review was conducted according to the Preferred Reporting Items for Scoping Reviews guidelines. We searched PubMed, Scopus/MEDLINE and Web of Science and included studies when the effectiveness of the digital tool was assessed and focussed on reaching and/or informing screening invitees in a vulnerable position for breast, cervical or colorectal cancer screening. For each included study, the study population, type of digital tool, the development process, reported design features and reported effects were extracted.

FINDINGS

We found 448 articles, and finally 13 were included in this review after reading full text. Study designs included randomised controlled trials (n = 5), pre-post-test design (n = 7) and experimental design (n = 1). Six different types of digital tools were identified: decision aids (n = 6), educational programs (n = 3), narrative video (n = 1), text-messaging intervention (n = 1), animation video (n = 1), and iPad program (n = 1). A population specific design was applied in 12/13 interventions, such as avoiding jargon and using a voice over function. Reported outcomes measures regarding reaching and informing the target population were: knowledge, attitude, screening intention, self-efficacy, susceptibility, feeling informed, values clarity, and screening uptake. All digital tools reported a significant improvement on at least one of the reported outcome measures.

PRINCIPAL CONCLUSIONS

The use of digital tools seems to contribute to reach or inform screening invitees in a vulnerable position for cancer screening. However, insufficient evidence was found regarding the development process of the tools and their effects on outcome measures related to reaching and informing the screening invitees in a vulnerable position. Future research may look in to combining multiple digital tools and animated visual information in combination with spoken text to improve reaching and informing screening invitees in a vulnerable position.

Tendencies and characteristics of public fitness behavior in the digital era: an Internet ethnography study based on the K Community in China

Introduction

The deep integration of media technologies into fitness activities in the era of digital intelligence has created a new and evolving landscape for public fitness. This transformation significantly impacts the practices and experiences of fitness.

Methods

This study employs Internet ethnography as a qualitative research methodology, focusing on the daily activities of participants in a digital fitness community known as the K-community. Through immersive observation and analysis, the research seeks to uncover the evolving patterns and characteristics of fitness practices in China during the digital era.

Results

As media technology and network culture advance, participants in digital fitness increasingly display fragmented, digitized, entertaining, ritualized, and highly socialized behaviors. These traits reflect the community's desire for varied and complex exercise experiences within the context of modern technology.

Discussion

The evolution of fitness behavior not only reflects the operational principles of contemporary media technologies but also encapsulates the essence of popular culture in the digital age. This study enhances our comprehension of fitness practices in digital environments and their wider cultural ramifications.

Perceptions of the Use of Mobile Technologies for Smoking Cessation: Focus Group Study With Individuals of Low Socioeconomic Status Who Smoke

BACKGROUND

The use of mobile technologies to deliver behavioral health interventions, including smoking cessation support, has grown. Users' perceptions are important determinants of the adoption and use of new technologies. However, little is known about users' perceptions of mobile technologies as smoking cessation aids, particularly among disadvantaged individuals who smoke.

OBJECTIVE

This study aimed to examine the acceptance of mobile technologies for smoking cessation among young adults with low socioeconomic status who smoke.

METHODS

In total, 38 current cigarette smokers, 18 to 29 years old, who wanted to quit and did not have a 4-year college degree nor were enrolled in a 4-year college, participated in 12 semistructured digital focus groups. The moderation guide was guided by the Unified Theory of Acceptance and Use of Technology. Discussions were audio recorded, transcribed verbatim, and coded for the Unified Theory of Acceptance and Use of Technology constructs (ie, effort expectancy, facilitating conditions, performance expectancy, and social influence), sentiment (ie, negative, neutral, and positive), and purpose of using mobile technologies (ie, lifestyle and health management and smoking cessation) following a deductive thematic analysis approach.

RESULTS

Participants had positive experiences using mobile technologies for lifestyle and health management, primarily for fitness and dietary purposes. Salient themes were facilitating conditions of use (44/80, 55%), with prior experiences and costs subthemes, followed by perceived usefulness of mobile technologies in helping users attain health goals (22/80, 27.50%), which were generally positive. Ease of use (11/80, 13.75%) and social influences (3/80, 3.75%) were minimally discussed. Conversely, participants had limited awareness of smoking cessation uses of mobile technologies, which was the primary barrier under facilitating conditions discussed (33/51, 64.70%). Participants expressed skepticism about the usefulness of mobile technologies in helping them quit smoking (14/51, 27.45%). Effort expectancy was not discussed, given participants' limited prior use. Social influences on mobile technology use for smoking cessation were minimally discussed (4/51, 7.84%).

CONCLUSIONS

The use of mobile technologies for smoking cessation was unknown to young adults with low socioeconomic status who smoke. To reduce cigarette smoking and associated health disparities, increasing awareness and use of evidence-based mobile-based smoking cessation interventions are needed. Smoking cessation interventions should incorporate features perceived as useful and easy to use to capitalize on positive user experiences and the acceptability of mobile technologies for lifestyle and health management.

Negotiating pricing and payment terms for insurance covered mHealth apps: a qualitative content analysis and taxonomy development based on a German experience

BACKGROUND

Germany was the first country worldwide to offer mobile digital health applications (mHealth apps, "DiGA") on prescription with full cost coverage by statutory health insurances. Especially statutory health insurances criticize the current pricing and payment regulations in Germany due to "free and non-transparent" pricing in the first year and lack of cost use evidence. The study consists of two parts: The first part evaluates interests of digital health application providers and statutory health insurances in Germany to identify overlaps and divergences of interests. The second part includes the development of a comprehensive pricing and payment taxonomy for reimbursable mHealth apps in general.

METHODS

Both parts of the study used the input from 16 expert interviews with representatives of digital health application providers and statutory health insurances in Germany. In part one the authors conducted a qualitative content analysis and in part two they followed the taxonomy development process according to Nickerson et al. (2013).

RESULTS

A value based care model is expected to bring the greatest benefit for patients while statutory health insurances welcome the idea of usage based pricing. The final pricing and payment taxonomy consists of four design and negotiation steps (price finding, payment prerequisites, payment modalities, composition of negotiation board).

CONCLUSIONS

As healthcare resources are scarce and thus need to be optimally allocated, it is important to implement pricing and payment terms for reimbursable mHealth apps that result in the greatest benefit for patients. To the best of the authors' knowledge, there has been no structured study yet that examines alternative pricing strategies for reimbursable mHealth apps.The developed pricing and payment taxonomy for reimbursable mHealth apps serves as planning and decision basis for developers, health policy makers and payers internationally.

[An application for mobile devices as a decision support for the treatment and prevention of bovine fasciolosis - A survey among organic dairy farms in Bavaria]

SUBJECT AND AIM

Based on health applications used in human medicine for the self-management of chronic diseases, the aim of this study was to evaluate a mobile app in veterinary medicine using the example of a decision-making aid for the control and prevention of bovine fasciolosis on dairy cattle farms.

MATERIAL AND METHOD

The study was carried out on 37 organic dairy cattle farms in Bavaria. The farms were divided into two groups: one group received a mobile app (n=17) as a decision-making aid, while the other group received a printed brochure (n=20) with identical content. At the beginning of the study, all participants were questioned by telephone concerning their farm, among other things. After using the respective tool, the participants were again interviewed by telephone.

RESULTS

At the beginning of the study, the majority of participants were aware of the options for drainage (n=28; 75.7%) and fencing off wet areas (n=36; 97.3%). 37.8% (n=14) stated that they were familiar with a pasture rotation system. After using the respective aid, the majority of participants described the tool as helpful (94.1% app; 80% brochure). Many participants (app group: n=10 (58.8%); brochure group: n=16 (80%)) stated that they wanted to change their approach based on the new knowledge gained, e. g. introducing a pasture rotation system (app group: n=9 (52.9%); brochure group: n=13 (65.0%)).

CONCLUSION

Both study groups enjoyed working with the tool they used. They viewed the knowledge imparted by the mobile app or brochure as helpful and useful. Most participants expressed a desire to continue using these tools in animal health management on farms in the future.

CLINICAL RELEVANCE

The use of tools such as mobile apps may improve veterinary advice, e. g. in the management of parasitoses in cattle herds.

mHealth Apps for Hypertension Self-Management: Interview Study Among Patient-Users

BACKGROUND

Hypertension is a major risk factor for cardiovascular disease, affecting over a billion people worldwide. Mobile health (mHealth) apps have emerged as effective tools for managing hypertension, offering capabilities for monitoring blood pressure, fostering lifestyle changes, and improving treatment adherence.

OBJECTIVE

This study aimed to explore patient-users' perspectives on the hypertension care mHealth app Hypertension.APP, focusing on its accessibility, expected benefits, potential risks, and role in hypertension management in Germany.

METHODS

A qualitative study was conducted involving semistructured interviews with 20 patient-users of a hypertension care mHealth app, Hypertension.APP. Participants were recruited between January and June 2023 using purposive sampling. Verbatim transcripts were analyzed using qualitative content analysis.

RESULTS

Participants primarily discovered the app independently, driven by recent hypertension diagnoses and insufficient information from health care professionals regarding effective self-management strategies for their blood pressure. They valued the app for its continuous monitoring and feedback capabilities, aiding in understanding their condition and making lifestyle adjustments. Risks were perceived as minimal, mainly concerning data privacy and potential overreliance on the app. The app became integral to patient-users' hypertension management by offering consistent information and support. The integration into formal health care was limited, as patient-users felt that health care professionals did not accept the use of the technology or might have even felt intimidated to use it.

CONCLUSIONS

Among the sample studied, mHealth apps like Hypertension.APP were valued for their continuous monitoring and educational content, aiding in hypertension management. The findings suggest potential benefits of mHealth apps for effective hypertension care among patients who are health- and digitally literate as well as self-effective. There is a critical need for better integration of these apps into routine health care practices, as perceived by the app users. Given the small and specific sample of this qualitative study, further quantitative research with a broader and more varied participant group is necessary to validate these findings.

TRIAL REGISTRATION

Deutsches Register Klinischer Studien DRKS00029761; https://tinyurl.com/r33ru22s.

Continuous adoption of online healthcare platforms: an extension to the expectation confirmation model and network externalities

BACKGROUND

Online healthcare platforms (OHPs) promote the accessibility of health services while integrating online and offline service delivery. Continuous adoption of these platforms can reduce the information asymmetry between patients and healthcare providers. However, existing study has rarely focused on how the network externalities of these platforms influence patients' continuous adoption. Expectation Confirmation Model (ECM) explains the continuous behavior after initial adoption and reveal the factors influencing satisfaction and continuous adoption intention. Few studies have integrated network externalities with the ECM to understand patients' continuous adoption of OHPs.

OBJECTIVE

This study aims to explore what factors affect the continuous adoption of OHPs based on an extension to the ECM and network externalities. We propose a comprehensive model for the continuous adoption of OHPs by patients with chronic diseases. We extend the conceptual framework by incorporating constructs related to perceived value, habits, and switching costs.

METHODS

This study utilized a web-based survey to collect data from participants in China. We selected a sample of individuals who had experience with OHPs using a random sampling method. This method ensured that participants was randomly chosen from a pool of patients without any regional bias. A total of 568 questionnaires were collected and 518 valid questionnaires were obtained. Structural equation modeling was applied to assess the relationships among the constructs. Hierarchical regression analysis was utilized to examine the moderating effects, while the mediating effects were investigated using the bootstrapping approach.

RESULTS

Direct network externality had significant positive impacts on the confirmation (β = 0.232, p < 0.001) and perceived value (β = 0.167, p < 0.010). Cross network externality had significant positive impacts on confirmation (β = 0.307, p < 0.001) and perceived value (β = 0.120, p < 0.05). Indirect network externality had significant positive impacts on confirmation (β = 0.169, p < 0.010) and perceived value (β = 0.270, p < 0.001). Confirmation had a significant positive impact on perceived value (β = 0.205, p < 0.001) and satisfaction (β = 0.508, p < 0.001). In addition, satisfaction had a significant positive impact on continuous adoption intention (β = 0.579, p < 0.001). Continuous adoption intention had a significant positive impact on continuous adoption behavior (β = 0.547, p < 0.001). Confirmation and perceived value significantly mediate the relationship between network externalities and satisfaction. Moreover, both confirmation and perceived value enhance continuous adoption intention by positively influencing satisfaction, which serves as a mediator. Additionally, confirmation directly influences satisfaction through the mediating role of perceived value. Habits and switching costs positively moderate the relationship between continuous adoption intention and behavior.

CONCLUSIONS

This study contributes by expanding the incorporation of network externalities into the ECM. Results enrich the existing literature on the continuous adoption of professional online platforms.

Conceptualizing Patient as an Organization With the Adoption of Digital Health

The concept of viewing a patient as an organization within the context of digital healthcare is an innovative and evolving concept. Traditionally, the patient-doctor relationship has been centered around the individual patient and their interactions with healthcare providers. However, with the advent of technology and digital healthcare solutions, the dynamics of this relationship are changing. Digital healthcare platforms and technologies enable patients to have more control and active participation in managing their health and healthcare processes. This shift empowers patients to take on a more proactive role, similar to how an organization functions with various stakeholders, goals, and strategies. The prevalence of mobile phones and wearables is regarded as an important factor in the acceptance of digital health.

Objective

This study aimed to identify the factors affecting adoption intention using the TAM (Technology Acceptance Model), HB (Health Belief model), and the UTAUT (Unified Theory of Acceptance and Use of Technology). The argument is made that the adoption of the technology enables patients to create resources (ie, data), transforming patients from mere consumers to producers as well.

Results

PLS analysis showed that health beliefs and perceived ease of use had positive effects on the perceived usefulness of digital healthcare, and system capabilities positively impacted perceived ease of use. Furthermore, perceived service, the customer's willingness to change and reference group influence significantly impacted adoption intention (b > 0.1, t > 1.96, P < .05). However, privacy protection and data security, online healthcare resources, and user guidance were not positively associated with perceived usefulness.

Conclusions

Perceived usefulness, the customer's willingness to change, and the influence of the reference group are decisive variables affecting adoption intention among the general population, whereas privacy protection and data security are indecisive variables. Online resources and user guides do not support adoption intentions.

Health Community 4.0: An Innovative Multidisciplinary Solution for Tailored Healthcare Assistance Management

This paper presents a co-designed solution aimed at improving community healthcare assistance management. To enhance patients' self-awareness of their health status, encouraging active participation in care process, and to support nurses in delivering patient-centered care, we have developed an innovative platform with a highly customized app. This platform was designed using a multi-disciplinary, bottom-up approach. Patient data collection and processing facilitate the automation of care timeline planning, based on real-time patients' needs and the available resources. To achieve this goal, different components have been considered: real-time health data collection and processing, patient care planning, decision support for nurses, secure communication for data transmission, and user-friendly interfaces to ensure easy access to platform functionalities.

The Digital Platform and Its Emerging Role in Decentralized Clinical Trials

Decentralized clinical trials (DCTs) are becoming increasingly popular. Digital clinical trial platforms are software environments where users complete designated clinical trial tasks, providing investigators and trial participants with efficient tools to support trial activities and streamline trial processes. In particular, digital platforms with a modular architecture lend themselves to DCTs, where individual trial activities can correspond to specific platform modules. While design features can allow users to customize their platform experience, the real strengths of digital platforms for DCTs are enabling centralized data capture and remote monitoring of trial participants and in using digital technologies to streamline workflows and improve trial management. When selecting a platform for use in a DCT, sponsors and investigators must consider the specific trial requirements. All digital platforms are limited in their functionality and technical capabilities. Integrating additional functional modules into a central platform may solve these challenges, but few commercial platforms are open to integrating third-party components. The lack of common data standardization protocols for clinical trials will likely limit the development of one-size-fits-all digital platforms for DCTs. This viewpoint summarizes the current role of digital platforms in supporting decentralized trial activities, including a discussion of the potential benefits and challenges of digital platforms for investigators and participants. We will highlight the role of the digital platform in the development of DCTs and emphasize where existing technology is functionally limiting. Finally, we will discuss the concept of the ideal fully integrated and unified DCT and the obstacles developers must address before it can be realized.

Promoting mental health and wellbeing among post-secondary students with the JoyPop™ app: study protocol for a randomized controlled trial

BACKGROUND

Technology use may be one strategy to promote mental health and wellbeing among young adults in post-secondary education settings experiencing increasing distress and mental health difficulties. The JoyPop™ app is mobile mental health tool with a growing evidence base. The objectives of this research are to (1) evaluate the effectiveness of the JoyPop™ app in improving emotion regulation skills (primary outcome), as well as mental health, wellbeing, and resilience (secondary outcomes); (2) evaluate sustained app use once users are no longer reminded and determine whether sustained use is associated with maintained improvements in primary and secondary outcomes; (3) determine whether those in the intervention condition have lower mental health service usage and associated costs compared to those in the control condition; and (4) assess users' perspectives on the quality of the JoyPop™ app.

METHODS

A pragmatic, parallel arm randomized controlled trial will be used. Participants will be randomly allocated using stratified block randomization in a 1:1 ratio to the intervention (JoyPop™) or control (no intervention) condition. Participants allocated to the intervention condition will be asked to use the JoyPop™ app at least twice daily for 4 weeks. Participants will complete outcome measures at four assessment time-points (first [baseline], second [after 2 weeks], third [after 4 weeks], fourth [after 8 weeks; follow-up]). Participants in the control condition will be offered access to the app after the fourth assessment time-point.

DISCUSSION

Results will determine the effectiveness of the JoyPop™ app for promoting mental health and wellbeing among post-secondary students. If effective, this may encourage more widespread adoption of the JoyPop™ app by post-secondary institutions as part of their response to student mental health needs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06154369 . Registered on November 23, 2023.

Behaviour change intervention (education and text) to prevent dental caries in secondary school pupils: BRIGHT RCT, process and economic evaluation

Background

The presence of dental caries impacts on children's daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae.

Objectives

To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils.

Design

A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations.

Setting

Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school.

Participants

Pupils aged 11-13 years at recruitment, who have their own mobile telephone.

Interventions

Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils' mobile phones about toothbrushing, compared with routine education.

Main outcome measures

Primary outcome: presence of at least one treated or untreated carious lesion using DICDAS4-6MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of DICDAS4-6MFT; presence and number of DICDAS1-6MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children).

Results

Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05). The intervention had higher incremental mean costs (£1.02, 95% confidence interval -1.29 to 3.23) and lower incremental mean quality-adjusted life-years (-0.003, 95% confidence interval -0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging. The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution.

Conclusions

Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility.

Trial registration

This trial is registered as ISRCTN12139369.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/166/08) and is published in full in Health Technology Assessment; Vol. 28, No. 52. See the NIHR Funding and Awards website for further award information.

Development of an mHealth App by Experts for Queer Individuals' Sexual-Reproductive Health Care Services and Needs: Nominal Group Technique Study

BACKGROUND

Queer individuals continue to be marginalized in South Africa; they experience various health care challenges (eg, stigma, discrimination, prejudice, harassment, and humiliation), mental health issues (eg, suicide and depression), and an increased spread of HIV or AIDS and sexually transmitted illnesses (STIs; chlamydia, gonorrhea, and syphilis). Mobile health (mHealth) apps have the potential to resolve the health care deficits experienced by health care providers when managing queer individuals and by queer individuals when accessing sexual-reproductive health care services and needs, thus ensuring inclusivity and the promotion of health and well-being. Studies have proven that the nominal group technique (NGT) could be used to solve different social and health problems and develop innovative solutions. This technique ensures that different voices are represented during decision-making processes and leads to robust results.

OBJECTIVE

This study aims to identify important contents to include in the development of an mHealth app for addressing the sexual-reproductive health care services and needs of queer individuals.

METHODS

We invited a group of 13 experts from different fields, such as researchers, queer activists, sexual and reproductive health experts, private practicing health care providers, innovators, and private health care stakeholders, to take part in a face-to-face NGT. The NGT was conducted in the form of a workshop with 1 moderator, 2 research assistants, and 1 principal investigator. The workshop lasted approximately 2 hours 46 minutes and 55 seconds. We followed and applied 5 NGT steps in the workshop for experts to reach consensus. The main question that experts were expected to answer was as follows: Which content should be included in the mHealth app for addressing sexual-reproductive health care services and needs for queer individuals? This question was guided by user demographics and background, health education and information, privacy and security, accessibility and inclusivity, functionality and menu options, personalization and user engagement, service integration and partnerships, feedback and improvement, cultural sensitivity and ethical considerations, legal and regulatory compliance, and connectivity and data use.

RESULTS

Overall, experts voted and ranked the following main icons: menu options (66 points), privacy and security (39 points), user engagement (27 points), information hub (26 points), user demographics (20 points), connectivity (16 points), service integration and partnerships (10 points), functionalities (10 points), and accessibility and inclusivity (7 points).

CONCLUSIONS

Conducting an NGT with experts from different fields, possessing vast skill sets, knowledge, and expertise, enabled us to obtain targeted data on the development of an mHealth app to address sexual-reproductive health care services and needs for queer individuals. This approach emphasized the usefulness of a multidisciplinary perspective to inform the development of our mHealth app and demonstrated the future need for continuity in using this approach for other digital health care innovations and interventions.

Designing a mobile application to promote physical activity in spousal care partners of persons living with dementia and their care-recipient

Background: Care partners of persons living with dementia and their care-recipient have low levels of physical activity. Mobile applications have demonstrated effectiveness in promoting physical activity among older adults. The purpose of this study was to explore the perceptions of spousal care partners of persons with dementia and their care-recipient on the design and content of a mobile application intended to promote physical activity.Methods: Semi-structured interviews were conducted with 14 care partners and their care-recipient. After the interviews were transcribed verbatim, thematic analysis was performed.Results: Four themes emerged from the participants' responses related to the design and content of a mobile application to promote physical activity: 1) exercise preferences and habits, 2) barriers to exercise, 3) motivations for exercise, and 4) mobile application preferences and supportive features.Conclusion: Findings lay the foundation for designing an effective user-friendly mobile application to promote physical activity that caters to the diverse needs, preferences, and challenges among spousal care partners of persons with dementia and their care-recipient.

Perceptions and Satisfaction of E-Health Applications: An Analytical Cross-Sectional Study in a Rural Health Center at Tiruvallur District, Tamil Nadu

Introduction E-health, defined as the utilization of information and communication technologies for health services, has become integral in enhancing healthcare delivery and accessibility. This study focuses on user satisfaction and perceptions of e-health applications in rural health centers, with special focus on Tamil Nadu, India. E-health technologies have proven to be effective in addressing challenges to healthcare accessibility and improving patient outcomes, at reduced costs. Despite these benefits, there is a need to understand user experiences in rural settings to optimize the implementation of e-health solutions. Methods A cross-sectional study was conducted among 383 patients registered in a non-communicable disease (NCD) clinic and specialty clinic in the rural health center of a tertiary care hospital in Tiruvallur district. Participants were selected using a consecutive sampling method from the NCD and specialty clinic registers. A semi-structured questionnaire was used to collect data on their perception and satisfaction with e-health applications. Data was entered in (Microsoft) MS Excel (Microsoft Corporation, Redmond, Washington, United States) and analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Results The overall mean age was 49.45 ± 7 years. Among the study participants, females constituted 57.3% compared to males who constituted 42.7%. 58.3% of the participants had comorbid conditions. More than half of the study participants were educated up to the high school level. According to BG Prasad's classification, 86.9 % of the participants belonged to middle class and below. Among the study participants, more than half of them use their smartphones as devices for internet access to use e-health applications. The study participants who had no co-morbid conditions were 3.3 times the odds of having poor perception and satisfaction when compared to the other categories (OR = 3.3, CI = 2.1 - 5.1) in using e-health applications, and this difference was found to be statistically significant (p = 0.01). Conclusion This study's findings reveal that gender, socio-economic status, occupation, and the presence of comorbid illnesses play significant roles in shaping users' perceptions and satisfaction levels. This study's findings underscore the importance of tailored e-health interventions to address these barriers and enhance healthcare delivery in rural areas.

Breastfeeding - a survey of fathers' support needs and preferred sources of information

BACKGROUND

Fathers can be a critical source of breastfeeding support for their partner, but little is known about what fathers would like to learn about breastfeeding. Partner's support and encouragement enhances mother's breastfeeding confidence and boost the capacity to address breastfeeding difficulties effectively. The aims of this study were to explore what fathers regard as important to learn around breastfeeding, and their current and preferred sources of information.

METHODS

A structured online survey was conducted, between September 2022 and November 2022, with fathers containing three sections: (1) sociodemographic variables; (2) perceived importance of 26 breastfeeding topics; and (3) sources of breastfeeding information. A convenience sample of expectant and current fathers aged 18 years or older, who were expecting a baby or had a child aged one year or younger, living in Australia, and able to complete survey in English was recruited. Participants were recruited on Facebook advertisement.

RESULTS

A total of 174 fathers participated in the study, majority (75%) were aged 30-39 years, current dads (74%), and university educated (69%). The breastfeeding topics that fathers perceived as the most important/ important to learn about were how to work with their partner to overcome breastfeeding challenges, how fathers can be involved with their breastfed baby, the types of support fathers can provide to breastfeeding mothers, what to expect in the first week and the benefits of breastfeeding. The most preferred health professional sources of breastfeeding information were midwives, child and family nurses and doctors. Among non-health professional sources of support, mobile app, friends and family were most popular.

CONCLUSION

Breastfeeding information to enhance fathers' knowledge and awareness of common breastfeeding challenges, and fathers' role in supporting their breastfeeding partner, appear to be (most) important for fathers. Mobile app appears to be among the most preferred non-health professional ways to provide breastfeeding information to fathers.

mHealth app features that facilitate adolescent use for lifestyle management, and are endorsed by caregivers and health care providers

Background

Mobile health (mHealth) apps are becoming a promising tool to motivate sustainable lifestyle and behavior changes, including modifications to diet and exercise. However, most current mHealth apps do not have meaningful, and sustained user acceptance, particularly, among adolescents. They perceive mHealth apps designed for adults to be tedious and visually unexciting, which discourage adolescent usage. Researchers and adolescent mHealth app developers would benefit from a foundational understanding of which functions and features adolescents feel would most motivate app use. Capturing caregivers' and health care providers' inputs are also important as both groups play an integral role in adolescent health care decision-making. The purpose of the study is to explore and analyze mHealth app features identified by adolescents, caregivers, and health care providers that have the potential to inspire continued use, thereby resulting in sustained health behavior changes in adolescents.

Methods

We used inductive thematic analysis of qualitative data obtained from semi-structured focus groups conducted via Zoom©. Important features of mHealth apps that encourage adoption and continued use were explored with 25 participants, including adolescents, their caregivers, and health care providers.

Results

Common features facilitating continual usage of mHealth apps that were identified as significant by participating adolescents, their caregivers and health care providers were: look and feel of the app, customization, educational information/recommendations, and integration with electronic health record. Features such as gamification and social interaction that are usually lacking in current adolescent mHealth apps were well recognized as meaningful for motivational purposes.

Conclusions

The findings suggest that adolescents and caregivers identify an app as valuable when it is user-friendly and intuitive and appreciate features that are motivating and can engage users in positive behaviors. Health care providers prefer mHealth apps that are user-friendly and can be effectively integrated into the cycle of care, thereby enabling delivery of efficient and value-based health care. Thus, mHealth app designs that are informed by health care providers' clinical experience and needs, in combination with app features that are desired and supported by both adolescents and their caregivers, have the potential to motivate widespread adoption and long-term use, which could result in improved health behaviors and outcomes among adolescents.

Systematic content analysis of self-help smokeless tobacco cessation smartphone applications available in India

Background

The content of smartphone applications (apps) that offer smoking cessation interventions has been appraised in the past. Considering the high prevalence of smokeless tobacco (SLT) use in Southeast Asia, identifying high-quality and credible apps for SLT cessation would be more helpful.

Objective

This study evaluated the technical quality of apps for SLT cessation and their content adherence with the standard tobacco cessation guidelines.

Materials and methods

A systematic search of SLT cessation smartphone apps freely available in the Google PlayStore was conducted using nine relevant search terms, and the first fifty apps under each search term were identified. The technical quality of the apps was rated using the Mobile App Rating Scale (MARS). Adherence of the app content to the standard tobacco cessation guidelines was also determined.

Results

Three apps were found to be relevant for SLT cessation. However, none of the apps was high-quality or incorporated existing evidence on SLT cessation.

Conclusion

Adherence of these apps to the tobacco cessation guidelines by the National Tobacco Control Program (NTCP), India and the National Institute for Health and Care Excellence (NICE), U.K., was limited only to a few checklist parameters.

Factors influencing the use of an artificial intelligence-based app (selfBACK) for tailored self-management support among adults with neck and/or low back pain

PURPOSE

Tailored self-management support is recommended as first-line treatment for neck and low back pain, for which mHealth applications could be promising. However, there is limited knowledge about factors influencing the engagement with such apps. The aim of this study was to assess barriers and facilitators for engaging with a self-management mHealth app among adults suffering from neck and/or low back pain.

MATERIALS AND METHODS

We carried out a qualitative descriptive study among adults with neck and/or low back pain. The artificial intelligence-based selfBACK app supports tailored self-management of neck and low back pain and was used for 6 weeks. After these 6 weeks, participants were interviewed by phone.

RESULTS

Thirty-two adults (17 males) with neck and/or low back pain participated (mean age = 54.9 (SD = 15.8)). Our results show that the mode of delivery and the novelty of the selfBACK app were perceived most often as a barrier to use the app. The action plans of the app and health-related factors were perceived most often as facilitating factors.

CONCLUSIONS

This study provides insight into possible strategies to improve an mHealth service. Furthermore, it shows that adults with neck and/or low back pain are willing and ready to receive blended treatment.

Barriers and facilitators to engaging with a digital self-management programme for painful distal upper limb musculoskeletal disorders: A qualitative exploratory study

INTRODUCTION

People living with a painful distal upper limb musculoskeletal disorder (DUL-MSD) often experience pain, difficulty in doing everyday tasks and a reduced quality of life. Currently, there are challenges in the treatment of DUL-MSDs, highlighting the need to develop innovative approaches to rehabilitation. A potential solution is to develop and implement a digital self-management rehabilitation programme focussing on optimising recovery, improving function and reducing pain. Before developing this programme, we aimed to identify the barriers and facilitators to using a digital health intervention (DHI) for self-management of DUL-MSDs.

OBJECTIVE

This study aimed to investigate the potential barriers and facilitators to using a DHI with people living with DUL-MSDs and healthcare professionals (HCPs).

METHODS

A qualitative exploratory study was carried out with purposely selected participants consisting of 15 participants with DUL-MSDs and 13 HCPs. Three focus groups (FGs) and four semistructured interviews with DUL-MSD participants and semistructured interviews with 13 HCPs were conducted. FGs and interviews were digitally recorded, transcribed and analysed using reflexive thematic analysis.

RESULTS

To address challenges in the care and management of DUL-MSDs, both HCPs and people living with a DUL-MSD welcomed the development of a DHI. This study identified several barriers and facilitators that would influence engagement with a digital intervention. Findings suggest that in developing a DHI, attention needs to be paid to digital design features, usability, tailoring, personalisation and consideration of how well usual care could be replicated digitally without direct HCP involvement.

CONCLUSION

The identified digital design features of importance to participants will inform the design of a digital self-management rehabilitation programme for people living with DUL-MSDs. Addressing the barriers and facilitators to engagement with a DHI is essential in ensuring its relevance and acceptability to those who will use it.

PATIENT OR PUBLIC CONTRIBUTION

Patient and Public Involvement and Engagement (PPIE) was integral throughout the study. PPIE members contributed to the development and planning of this study, checked and confirmed the relevance of the findings and are involved in the dissemination plans.

Feasibility and Acceptability of a Health App Platform Providing Individuals With a Budget to Purchase Preselected Apps to Work on Their Health and Well-Being: Quantitative Evaluation Study

BACKGROUND

The potential of health apps for health promotion and disease prevention is widely recognized. However, uptake is limited due to barriers individuals face in finding suitable and trustworthy apps, such as the overwhelming amount of available health apps. Therefore, the health app platform "FitKnip" was developed, enabling individuals to purchase preselected, trustworthy health apps with a budget of 100 euros (a currency exchange rate of EUR €1=US $1.0831 is applicable). The platform aimed to empower individuals to improve their health and vitality, ultimately supporting a more healthy society.

OBJECTIVE

The primary aim of this study was to evaluate the health app platform in terms of feasibility and acceptability. Potential effects on health empowerment and health outcomes were secondarily explored.

METHODS

This quantitative study was part of a mixed methods study with a prospective pre-post interventional design. We collected web-based user data, and self-reported web-based questionnaires were collected over 5 measurements over an 8-month period. Use statistics were tracked on the platform, including the number of purchased apps and euros spent per user registered within the health app platform. We measured the user-friendliness of the health app platform using the System Usability Scale (SUS) and satisfaction using the Client Satisfaction Questionnaire-8 (CSQ-8) and several 10-point Likert items. We asked participants to indicate, on a scale from 1 (not at all) to 10 (completely), how much the health app platform contributed to various areas related to health empowerment. We assessed health-related quality of life by the 12-item Short-Form Health Survey (SF-12) and one's perceived level of stress by the 10-item Perceived Stress Scale (PSS-10).

RESULTS

A total of 1650 participants were included, of whom 42% (685/1650) bought at least 1 app. The majority of those purchased one app (244/685, 35.6%). The health app platform was rated as user-friendly (SUS mean 66.5, SD 20.7; range 66.5-70.0), and the acceptability of the health app platform was moderate (CSQ-8 mean 20.0, SD 1.5; range 19.6-20.0). Results furthermore showed that participants were generally satisfied to highly satisfied with the ease of the payment system to purchase apps on the platform (median 8, IQR 7-10), the look and feel of the platform (median 7, IQR 6-8), as well as the provided budget of 100 euros (median 9, IQR 7-10). Participants were less satisfied with the amount (median 6, IQR 4-7) and diversity (median 6, IQR 4-7) of apps offered on the platform.

CONCLUSIONS

A health app platform is a promising initiative to enhance public health. Feasibility and acceptability are critical for success, as they ensure that such a platform is accessible, user-friendly, and meets end users' needs and preferences. This can help to increase uptake, engagement, and ultimately the platform's adoption and effectiveness.

Development of oral health resources and a mobile app for caregivers and autistic children through consensus building

LAY ABSTRACT

Caregivers of autistic children often lack knowledge regarding oral homecare and when and where to see the dentist. To address this need, we developed a series of information on oral health. An autistic child assisted in developing two social stories to showcase a dental visit. A mobile app was developed to deliver the above mentioned. Other features include creation of customised social stories and visual schedule and an inbox to allow dentists to send messages to parents. The developed information and social stories were reviewed by experts and parents. The app also underwent anonymous and independent testing by parents. Overall the information and app were well received by the experts and parents.

Assessing the Quality and Behavior Change Potential of Vaping Cessation Apps: Systematic Search and Assessment

Background

An increasing number of people are using vapes (e-cigarettes), and with growing evidence of associated harms, there is a need for acceptable cessation support and interventions. Smartphone apps for health and well-being have increased in popularity and use. Limited published literature assesses the potential of apps to support vaping cessation.

Objective

A systematic search of vaping cessation apps currently available in Australia for iOS and Android platforms was conducted. Apps were assessed against established health app assessment tools for quality and behavior change potential.

Methods

A systematic search through the Australian Apple iTunes and Google Play stores was conducted using the search terms "vape"; "vaping"; "e-cigarette"; and "cessation," "quit," or "quitting" in May 2023. Only apps that encouraged the cessation of vaping were included. App descriptions were reviewed to determine if they were relevant for inclusion in this study, and relevant apps were downloaded onto the appropriate mobile device for review. The Mobile App Rating Scale (MARS) was used to rate the quality (engagement, functionality, aesthetics, and information) of the apps using an overall score out of 5. The App Behavior Change Scale (ABACUS) was used to assess the behavior change potential of each app using a score out of 21.

Results

An initial search of the app stores yielded 220 Android apps and 124 iOS apps. Screening against the inclusion criteria left 20 iOS apps and 10 Android apps for review. Six apps were available on both operating systems, and these were downloaded, reviewed, and reported separately for each operating system. The average MARS score for all apps assessed in this review was 3.1 (SD 0.41) out of 5. The reviewed apps overall performed well for the MARS elements relating to functionality, such as ease of use and navigation, but had the lowest scores for information-related elements, such as credibility. The number of ABACUS behavior change features per app ranged from 0 to 19 out of 21, with a mean of 8.9 (SD 4.51). The apps commonly included information-related features, such as requesting baseline information. The least common behavior change features were those relating to goal-setting, such as asking about the user's willingness for behavior change and providing feedback on current actions in comparison to future goals.

Conclusions

The identified vaping cessation apps had moderate levels of quality and some behavior change components. Future vaping cessation apps could benefit from including more features that are known to support behavior change, such as goal-setting, to improve the potential benefit of these apps to support people to stop vaping. As guidelines for vaping cessation continue to be established, future apps need to reference these in their development.

An mHealth Intervention to Address Depression and Improve Antiretroviral Therapy Adherence Among Youths Living With HIV in Uganda: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

People living with HIV often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. There is growing evidence that depression treatment may improve ART adherence and result in improved HIV outcomes. Given that mental health services are severely underequipped in low-resource settings, including in Uganda, new solutions to increase access to mental health care and close the treatment gap are urgently needed. This protocol paper presents the Suubi-Mhealth study, which proposed to develop a mobile health (mHealth) intervention for use among Ugandan youths (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs.

OBJECTIVE

The proposed study is guided by the following objectives: (1) to develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand the needs of youths living with HIV; (2) to explore the feasibility and acceptability of Suubi-Mhealth on a small scale to inform subsequent refinement; (3) to test the preliminary impact of Suubi-Mhealth versus a waitlist control group on youths' outcomes, including depression and treatment adherence; and (4) to examine barriers and facilitators for integrating Suubi-Mhealth into health care settings.

METHODS

Youths will be eligible to participate in the study if they are (1) 14-17 years of age, (2) HIV-positive and aware of their status, (3) receiving care and ART from one of the participating clinics, and (4) living within a family. The study will be conducted in 2 phases. In phase 1, we will conduct focus group discussions with youths and health care providers, for feedback on the proposed intervention content and methods, and explore the feasibility and acceptability of the intervention. In phase II, we will pilot-test the preliminary impact of the intervention on reducing depression and improving ART adherence. Assessments will be conducted at baseline, 1-, 2-, and 6-months post intervention completion.

RESULTS

Participant recruitment for phase 1 is completed. Youths and health care providers participated in focus group discussions to share their feedback on the proposed Suubi-Mhealth intervention content, methods, design, and format. Transcription and translation of focus group discussions have been completed. The team is currently developing Suubi-Mhealth content based on participants' feedback.

CONCLUSIONS

This study will lay important groundwork for several initiatives at the intersection of digital therapeutics, HIV treatment, and mental health, especially among sub-Saharan African youths, as they transition through adolescence and into adult HIV care settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05965245; https://clinicaltrials.gov/study/NCT05965245.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54635.

The self-help app My Grief: Bereaved parents' experiences of helpfulness, satisfaction and usability

Mobile health (mHealth) apps have been shown to be useful to monitor and reduce mental health problems across a variety of stress-related and affective disorders, yet research on the value of apps for prolonged grief is scarce. Therefore, the main aim of this study was to elucidate bereaved parents' experiences of using the self-help app My Grief with a focus on helpfulness, satisfaction, and usability. Data were derived from closed-ended and open-ended questions administered at the 3-month post-assessment of the intervention group (n = 67) within a randomized controlled trial testing the effects of access to the My Grief app. The sample consisted of 88 % women, with a mean age of 47 years, who predominantly lost their child to cancer (41 %), on average 4.8 years ago. Participating parents indicated that the My Grief app helped them increase their knowledge about prolonged grief and track their grief over time. The app was experienced as easy to navigate and around half of the parents used the app more than one day a week. Almost all parents were satisfied with the app and would recommend it to other parents in similar situations. The findings add to the knowledge base justifying mHealth within support systems for bereaved adults.

Mobile health applications for epilepsy in Indian app stores: A systematic review and content analysis using the mobile app rating scale

OBJECTIVE

The growing prevalence of smartphones may prompt individuals with epilepsy to pursue unfulfilled healthcare requirements through mobile health (mHealth) apps, but the content and quality of these mHealth apps are rarely analysed. Hence, this study aimed to identify and assess the quality of epilepsy apps for patients with epilepsy (PWE), their caregivers, and healthcare practitioners (HCPs) available in the Play Store and App Store of India.

METHODS

We performed a systematic search on the Google Play Store and Apple App Store of India to identify the mHealth apps for epilepsy which were released and updated till May 2023. The identified applications were downloaded and the quality was assessed using a Mobile app rating scale (MARS) for the overall quality, Aesthetics, Engagement, Functionality, and Information by three independent reviewers. The intraclass correlation coefficient (ICC) was calculated to assess the interrater reliability between the reviewers. An unpaired t-test was calculated to analyse the difference in mean scores for Android and iOS applications.

RESULTS

The systematic search yielded a total of 2518 apps, out of which 26 were selected for inclusion in the study. Among these, 9 apps were compatible with Android, 11 with iOS, and 6 on both platforms. The mean (SD) MARS score of the apps was 3.5 (0.6) and the ICC for the overall app quality was 0.90 (95% CI: 0.82-0.96). Overall, apps scored highest in functionality (3.9), followed by aesthetics (3.6), information (3.3), and engagement (3.2). Among the included apps, the overall quality score was found to be higher for iOS apps than Android (MD = 0.54; 95% CI: 0.02 - 1.07; p-value: 0.042).

CONCLUSION

Our study identified twenty-six mHealth applications for epilepsy that integrated various aspects of epilepsy self-management. The results of this study emphasize the importance of ensuring that current and future applications offer evidence-based information, integrate features that align with patient preferences, and generate evidence regarding the effectiveness of application usage.

Cross-sectional Analysis of Health Behavior Tracking, Perceived Health, Fitness, and Health Literacy Among Active-Duty Air Force Personnel

There is a paucity of evidence connecting health literacy, perceived wellness, self-reported fitness activity, or military readiness to wearable devices. Moreover, we do not currently know the prevalence and impact of health tracker device use in the active-duty Air Force population. This prospective cross-sectional survey assessed self-reported fitness activity, health-related quality of life, health literacy, and health behavior tracking practices and preferences among active-duty Air Force service members. Four hundred twenty-eight respondents completed an online survey, with 247 selecting tracking a health behavior and 181 selecting that they did not track a health behavior. Demographic characteristics of the sample showed no significant differences in age, sex distribution, or mode of service. We found that there were no significant differences in self-reported aerobic and strength training frequency, health literacy, or health-related quality of life. More than half of nontracking respondents either had not considered or had no interest in tracking health behaviors. Nearly three-quarters of tracking respondents tracked more than one health behavior. Further research could explore the extent to which these technologies improve fitness, health outcomes, and overall readiness in the military, involving longitudinal studies tracking fitness improvements and health outcomes among service members using wearable devices.

Digital Health in Diabetes and Cardiovascular Disease

BACKGROUND

Digital health technologies are rapidly evolving and transforming the care of diabetes and cardiovascular disease (CVD).

PURPOSE OF THE REVIEW

In this review, we discuss emerging approaches incorporating digital health technologies to improve patient outcomes through a more continuous, accessible, proactive, and patient-centered approach. We discuss various mechanisms of potential benefit ranging from early detection to enhanced physiologic monitoring over time to helping shape important management decisions and engaging patients in their care. Furthermore, we discuss the potential for better individualization of management, which is particularly important in diseases with heterogeneous and complex manifestations, such as diabetes and cardiovascular disease. This narrative review explores ways to leverage digital health technology to better extend the reach of clinicians beyond the physical hospital and clinic spaces to address disparities in the diagnosis, treatment, and prevention of diabetes and cardiovascular disease.

CONCLUSION

We are at the early stages of the shift to digital medicine, which holds substantial promise not only to improve patient outcomes but also to lower the costs of care. The review concludes by recognizing the challenges and limitations that need to be addressed for optimal implementation and impact. We present recommendations on how to navigate these challenges as well as goals and opportunities in utilizing digital health technology in the management of diabetes and prevention of adverse cardiovascular outcomes.

Exploring the relevance of a psychology-based resilience app (JoyPop™) for Indigenous youth

BACKGROUND

Despite facing challenges to mental wellness from ongoing multifold trauma, Indigenous youth continue to galvanize their resilience. One pathway undertaken is embracing technology. The JoyPop™ youth resilience mobile application (app) was invited by Six Nations of the Grand River (SN) leadership to consider its use with their reserve youth.

OBJECTIVE

This study explored the feasibility of JoyPop™ research from the SN community adult perspective for appropriateness and relevance to SN youth, as a precursor to a user-experience study with community youth.

METHODS

Semi-structured, online interviews with 19 adult community members (26 % male) about JoyPop™ were conducted with nominated stakeholders from SN. Based on a standard presentation of the app, comments were solicited about app features, design, and relevance to Haudenosaunee culture. Interviews were transcribed, coded in a double-blind fashion, and analyzed for themes.

RESULTS

Most offered positive feedback, with some level of support for each feature of JoyPop™. Themes were identified (Need for Indigenous Design, Incorporation of Indigenous Culture, Appreciation of Ease, Flexibility and Personalization), stemming from comments of appraisal and suggestions for adaptations (e.g., incorporating more cultural elements, localized resources, simplification of app).

CONCLUSIONS

The JoyPop™ app was viewed as positive and relevant, based on feedback from adults within SN. Adaptations were identified by adults to better fit SN youth needs, and research with SN youth is pending before implementation of adaptations. Research with other communities is encouraged to expand the reach of technology interventions, to holistically support Indigenous youth mental health in a culturally relevant way.

Smartphone-Based Cognitive Telerehabilitation: A Usability and Feasibility Study Focusing on Mild Cognitive Impairment

The implementation of cognitive health apps in patients with mild cognitive impairment (MCI) is challenging because of their cognitive, age, and other clinical characteristics. In this project, we aimed to evaluate the usability and feasibility of the Rehastart app tested in MCI patients. Eighteen subjects affected by MCI due to neurodegenerative disorders (including Parkinson's disease, multiple sclerosis, and amnestic/multidomain MCI) and eighteen healthcare professionals were recruited to this study. Patients were registered on the app by clinicians and they were assigned a protocol of specific cognitive exercises. The recruitment was conducted in the period between March and June 2023. The trial testing of the app consisted of three sessions per week for three weeks, with each session lasting about 30 min. After three weeks, the participants as well as medical personnel were invited to rate the usability and feasibility of the Rehastart mobile application. The instruments employed to evaluate the usability and feasibility of the app were the System Usability Scale (SUS), The Intrinsic Motivation Inventory (IMI) and the Client Satisfaction Questionnaire (CSQ). We did not find statistically significant differences on the SUS (p = 0.07) between healthcare professionals and patients. In addition, we found promising results on subscales of the Intrinsic Motivation Inventory, suggesting high levels of interest and enjoyment when using the Rehastart app. Our study demonstrated that smartphone-based telerehabilitation could be a suitable tool for people with MCI due to neurodegenerative disorders, since the Rehastart app was easy to use and motivating for both patients and healthy people.

Using science as a differentiator in a crowded digital mental health market

The digital mental health industry has seen remarkable growth in recent years. However, within this crowded landscape, many companies overlook a critical factor for gaining a competitive edge: the integration of science. In this context, "science" refers to the strategic collection and analysis of information (i.e., data) at digital mental health companies, aimed at guiding business decisions and achieving business objectives. This paper demonstrates that science is integral, yet underutilized in the digital mental health industry, with common misconceptions about its role. When science is integrated within a company, it enables them to (1) innovate, (2) understand customers, (3) make informed decisions, and (4) drive revenue. Digital mental health companies recognizing the multifaceted value of science may be better equipped for sustainable growth and success amid the crowded digital health market.

Barriers to using eHealth/mHealth platforms and perceived beneficial eHealth/mHealth platform features among informal carers of persons living with dementia: a qualitative study

BACKGROUND

New technologies have brought about a new age of technology-enabled aids that can equip informal carers with the relevant resources for better care. These include but are not limited to facilitating access to healthcare providers, knowledge of caring for persons living with dementia, and sources of support for carers' well-being. This qualitative study explores barriers to using eHealth/mHealth platforms and perceived beneficial eHealth/mHealth platform features among informal carers of persons living with dementia.

METHODS

An exploratory qualitative study design was employed. Semi-structured interviews were conducted among 29 informal carers of persons living with dementia in Singapore recruited via convenience and snowball sampling. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data.

RESULTS

The participants in this study identified several barriers to using eHealth/mHealth platforms, including personal preference, apprehension, poor user experience and lack of skills. On the other hand, knowledge of dementia, caring for persons living with dementia and self-care, a list of resources, social support, location monitoring and alert systems, and the ability to manage appointments and transactions were valuable features for eHealth/mHealth platforms.

CONCLUSIONS

Despite the underutilisation of eHealth/mHealth platforms, carers expressed a keen interest in using them if they are functional and capable of reducing their care burden. The findings from this study can contribute to developing content and features for eHealth/mHealth interventions aimed at lightening carers' burden in their day-to-day caring routine.

Sleep well, worry less: A co-design study for the development of the SMILE app

Objective

With the coronavirus disease 2019 pandemic exacerbating mental health concerns, the prevalence rates of anxiety and sleep problems have increased alarmingly among youth. Although 90% of patients with anxiety experience sleep problems, current interventions for anxiety often do not target sleep problems in youth. Given this lack, we designed the SMILE app, an intervention that addresses both anxiety and sleep problems simultaneously.

Methods

As users' perspectives are essential to ensure app engagement and uptake, the features, designs, and functions of the SMILE app were evaluated using a participatory app design approach. Participants (N = 17) were youth aged 15 to 25 who reported co-morbid anxiety and sleep issues above clinical thresholds. After completing an online screening survey assessing demographics, anxiety, and sleep problems, participants shared app feedback through group-based, semi-structured co-design sessions. Qualitative analyses were conducted to identify common themes from participants' feedback.

Results

While participants expressed enthusiasm for the SMILE app's features, particularly the Visualization, Journaling, and Psychoeducation features, and their variety, they criticized the design aspects of the app, such as the font and text amount. Most participants stated they would use the SMILE app or recommend it to a friend.

Conclusion

By actively involving the target population in the design process, the SMILE app has the potential to notably improve the mental well-being of youth, though further research and development are required to realize this potential fully.

'Better see a doctor?' Status quo of symptom checker apps in Germany: A cross-sectional survey with a mixed-methods design (CHECK.APP)

Background

Symptom checker apps (SCAs) offer symptom classification and low-threshold self-triage for laypeople. They are already in use despite their poor accuracy and concerns that they may negatively affect primary care. This study assesses the extent to which SCAs are used by medical laypeople in Germany and which software is most popular. We examined associations between satisfaction with the general practitioner (GP) and SCA use as well as the number of GP visits and SCA use. Furthermore, we assessed the reasons for intentional non-use.

Methods

We conducted a survey comprising standardised and open-ended questions. Quantitative data were weighted, and open-ended responses were examined using thematic analysis.

Results

This study included 850 participants. The SCA usage rate was 8%, and approximately 50% of SCA non-users were uninterested in trying SCAs. The most commonly used SCAs were NetDoktor and Ada. Surprisingly, SCAs were most frequently used in the age group of 51-55 years. No significant associations were found between SCA usage and satisfaction with the GP or the number of GP visits and SCA usage. Thematic analysis revealed skepticism regarding the results and recommendations of SCAs and discrepancies between users' requirements and the features of apps.

Conclusion

SCAs are still widely unknown in the German population and have been sparsely used so far. Many participants were not interested in trying SCAs, and we found no positive or negative associations of SCAs and primary care.

The acceptability, usability, engagement and optimisation of a mHealth service promoting healthy lifestyle behaviours: A mixed method feasibility study

Objective

Mobile health (mHealth) services suffer from high attrition rates yet represent a viable strategy for adults to improve their health. There is a need to develop evidence-based mHealth services and to constantly evaluate their feasibility. This study explored the acceptability, usability, engagement and optimisation of a co-developed mHealth service, aiming to promote healthy lifestyle behaviours.

Methods

The service LongLife Active® (LLA) is a mobile app with coaching. Adults were recruited from the general population. Quantitative results and qualitative findings guided the reasoning for the acceptability, usability, engagement and optimisation of LLA. Data from: questionnaires, log data, eight semi-structured interviews with users, feedback comments from users and two focus groups with product developers and coaches were collected. Inductive content analysis was used to analyse the qualitative data. A mixed method approach was used to interpret the findings.

Results

The final sample was 55 users (82% female), who signed up to use the service for 12 weeks. Engagement data was available for 43 (78%). The action plan was the most popular function engaged with by users. The mean scores for acceptability and usability were 3.3/5.0 and 50/100, respectively, rated by 15 users. Users expressed that the service's health focus was unique, and the service gave them a 'kickstart' in their behaviour change. Many ways to optimise the service were identified, including to increase personalisation, promote motivation and improve usability.

Conclusion

By incorporating suggestions for optimisation, this service has the potential to support peoples' healthy lifestyle behaviours.

Exploring Generation Z and Young Millennials' Perspectives of a Spiritual Self-Care App and Their Spiritual Identity (Skylight): Qualitative Semistructured Interview Study

BACKGROUND

Generation Z and young millennials (ages 18-35 years), collectively referred to as GenZennials, are connected to technology and the internet like no other generation before them. This has mental health implications, such as increased rates of anxiety and stress. Recent research has shown that app-based mental health interventions can be useful to address such mental health concerns. However, spirituality is an untapped resource, especially since GenZennials largely identify as spiritual and already integrate spiritual practices into their self-care.

OBJECTIVE

There were four objectives to this study: (1) comprehensively explore reasons why GenZennials use a spiritual self-care app (ie, Skylight; Radiant Foundation), (2) understand how GenZennials identify spiritually, (3) understand the app's relevance to GenZennials, and (4) gather feedback and suggestions to improve the app.

METHODS

Semistructured interviews were conducted with 23 GenZennials (ages 18-35 years; mean 28.7, SD 5.0 years; n=20, 87% female) who used the Skylight app. Interviews were 30 to 60 minutes and conducted on Zoom. Thematic analysis was used to analyze interviews.

RESULTS

Five major categories emerged from the analysis, each encompassing one to several themes: (1) reasons for using the Skylight app, (2) content favorites, (3) defining spiritual identity, (4) relevance to GenZennials, and (5) overall improvement recommendations. Participants used the app for various reasons including to relax, escape, or ground themselves; improve mood; and enhance overall health and wellness. Participants also cited the app's variety of content offerings and its free accessibility as their primary reasons for using it. Most participants identified themselves as solely spiritual (8/23/35%) among the options provided (ie, spiritual or religious or both), and they appreciated the app's inclusive content. Participants felt that the app was relevant to their generation as it offered modern content (eg, spiritual self-care activities and short content). Participants recommended adding more personalization capabilities, content, and representation to the app.

CONCLUSIONS

This is the first study to qualitatively explore GenZennials' perspectives and the use of a spiritual self-care app. Our findings should inform the future creation and improvement of spiritual self-care apps aimed at cultivating GenZennials' spiritual and mental well-being. Future research is warranted to examine the effects of using a spiritual self-care app on GenZennial mental health.

Factors Influencing Telehealth Service Use and Health Outcomes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Cross-Sectional Study

BACKGROUND

Several studies have demonstrated the efficacy and user acceptance of telehealth in managing patients with chronic conditions, including continuous ambulatory peritoneal dialysis (CAPD). However, the rates of telehealth service use in various patient groups have been low and have declined over time, which may affect important health outcomes. Telehealth service use in patients undergoing CAPD has been recognized as a key challenge that needs to be examined further.

OBJECTIVE

This study aimed to explore the rates of telehealth service use over 4 months, identify factors influencing its use, and examine the relationship between telehealth service use and health outcomes in Thai people undergoing CAPD.

METHODS

This cross-sectional study, which was a part of a pragmatic randomized controlled trial study, was conducted at a dialysis center in Bangkok, Thailand. The study included patients who were undergoing CAPD. These patients were randomly enrolled in the intervention group to receive telehealth service and additional standard care for 4 months. Data were collected using self-reported questionnaires, including a demographic form, Functional, Communicative, and Critical Health Literacy Scale, Perceived Usefulness Questionnaire, Brief Illness Perception Questionnaire, Patient-Doctor Relationship Questionnaire, and Kidney Disease Quality of Life 36 Questionnaire. Additionally, Google Analytics was used to obtain data on the actual use of the telehealth service. These data were analyzed using descriptive statistics, repeated-measures ANOVA, and regression analyses.

RESULTS

A total of 159 patients were included in this study. The mean rate of telehealth service use throughout the period of 4 months was 62.06 (SD 49.71) times. The rate of telehealth service use was the highest in the first month (mean 23.48, SD 16.28 times) and the lowest in the third month (mean 11.09, SD 11.48 times). Independent variables explained 27.6% of the sample variances in telehealth service use. Older age (β=.221; P=.002), higher perceived usefulness (β=.414; P<.001), unemployment (β=-.155; P=.03), and positive illness perception (β=-.205; P=.004) were associated with a significantly higher rate of telehealth service use. Regarding the relationship between telehealth service use and health outcomes, higher rates of telehealth service use were linked to better quality of life (β=.241; P=.002) and lower peritonitis (odds ratio 0.980, 95% CI 0.962-0.997; P=.03).

CONCLUSIONS

This study provides valuable insights into factors impacting telehealth service use, which in turn affect health outcomes in patients undergoing CAPD.

Use Patterns of Smartphone Apps and Wearable Devices Supporting Physical Activity and Exercise: Large-Scale Cross-Sectional Survey

Background

Physical inactivity is a global health issue, and mobile health (mHealth) apps are expected to play an important role in promoting physical activity. Empirical studies have demonstrated the efficacy and efficiency of app-based interventions, and an increasing number of apps with more functions and richer content have been released. Regardless of the success of mHealth apps, there are important evidence gaps in the literature; that is, it is largely unknown who uses what app functions and which functions are associated with physical activity.

Objective

This study aims to investigate the use patterns of apps and wearables supporting physical activity and exercise in a Japanese-speaking community sample.

Methods

We recruited 20,573 web-based panelists who completed questionnaires concerning demographics, regular physical activity levels, and use of apps and wearables supporting physical activity. Participants who indicated that they were using a physical activity app or wearable were presented with a list of app functions (eg, sensor information, goal setting, journaling, and reward), among which they selected any functions they used.

Results

Approximately one-quarter (n=4465) of the sample was identified as app users and showed similar demographic characteristics to samples documented in the literature; that is, compared with app nonusers, app users were younger (odds ratio [OR] 0.57, 95% CI 0.50-0.65), were more likely to be men (OR 0.83, 95% CI 0.77-0.90), had higher BMI scores (OR 1.02, 95% CI 1.01-1.03), had higher levels of education (university or above; OR 1.528, 95% CI 1.19-1.99), were more likely to have a child (OR 1.16, 95% CI 1.05-1.28) and job (OR 1.28, 95% CI 1.17-1.40), and had a higher household income (OR 1.40, 95% CI 1.21-1.62). Our results revealed unique associations between demographic variables and specific app functions. For example, sensor information, journaling, and GPS were more frequently used by men than women (ORs <0.84). Another important finding is that people used a median of 2 (IQR 1-4) different functions within an app, and the most common pattern was to use sensor information (ie, self-monitoring) and one other function such as goal setting or reminders.

Conclusions

Regardless of the current trend in app development toward multifunctionality, our findings highlight the importance of app simplicity. A set of two functions (more precisely, self-monitoring and one other function) might be the minimum that can be accepted by most users. In addition, the identified individual differences will help developers and stakeholders pave the way for the personalization of app functions.

Healthy adults' views and experiences on behavior change strategies in mobile applications for diet monitoring: A single centre qualitative study

Mobile diet apps assist in tracking nutritional intake and managing healthy eating diets. Effective diet apps incorporate specific population-tailored behavior change strategies (BCS) for user engagement and adherence to healthy diets. Malaysians have their unique behaviors and customs surrounding food and diet. This study aims to explore the perceptions, views, and experiences of healthy Malaysian adults with diet monitoring apps, by focusing on the BCS that engages users to use diet mobile apps and adhere to a healthy diet. A qualitative approach utilizing semi-structured in-depth interviews was conducted using a topic guide based on the Theory of Planned Behavior and trigger materials. Twenty interviews were audio-recorded and transcribed verbatim. Five themes emerged from the data, which are; instilling self-awareness, closed online group support, shaping knowledge, personalization, and user-friendly design. Influence by one's social circle and attractiveness of app features may initiate users' interest and help them engage with mobile diet apps, but the app's ability to raise awareness of progress and impart useful knowledge help them adhere and comply to a healthier diet in the long run. The results from this study may help improve the behavior change strategy features of mobile diet apps for Malaysian adults.

Facilitators and barriers of mHealth interventions during the Covid-19 pandemic: systematic review

BACKGROUND

With the spread of Covid-19 disease, health interventions related to the control, prevention, and treatment of this disease and other diseases were given real attention. The purpose of this systematic review is to express facilitators and barriers of using mobile health (mHealth) interventions during the Covid-19 pandemic.

METHODS

In this systematic review, original studies were searched using keywords in the electronic database of PubMed until August 2022. The objectives and outcomes of these studies were extracted. Finally, to identify the facilitators and barriers of mHealth interventions, a qualitative content analysis was conducted based on the strengths, weaknesses, opportunities, and threats (SWOT) analysis method with Atlas.ti 8 software. We evaluated the studies using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

In total, 1598 articles were identified and 55 articles were included in this study. Most of the studies used mobile applications to provide and receive health services during the Covid-19 pandemic (96.4%). The purpose of the applications was to help prevention (17), follow-up (15), treatment (12), and diagnosis (8). Using SWOT analysis, 13 facilitators and 18 barriers to patients' use of mHealth services were identified.

CONCLUSION

Mobile applications are very flexible technologies that can be customized for each person, patient, and population. During the Covid-19 pandemic, the applications designed due to lack of interaction, lack of time, lack of attention to privacy, and non-academic nature have not met their expectations of them.

Evaluating the Impact of an mHealth Platform for Managing Acute Postoperative Dental Pain: Randomized Controlled Trial

Background

Postoperative dental pain is pervasive and can affect a patient's quality of life. Adopting a patient-centric approach to pain management involves having contemporaneous information about the patient's experience of pain and using it to personalize care.

Objective

In this study, we evaluated the use of a mobile health (mHealth) platform to collect pain-related patient-reported outcomes over 7 days after the patients underwent pain-inducing dental procedures; we then relayed the information to the dentist and determined its impact on the patient's pain experience.

Methods

The study used a cluster-randomized experimental study design with an intervention arm where patients were prompted to complete a series of questions relating to their pain experience after receiving automated text notifications on their smartphone on days 1, 3, 5, and 7, with the resulting information fed back to dentists, and a control arm where patients received usual care. Providers were randomized, and patients subsequently assumed the enrollment status of their providers. Providers or their staff identified eligible patients and invited them to participate in the study. Provider interviews and surveys were conducted to evaluate acceptance of the mHealth platform.

Results

A total of 42 providers and 1525 patients participated. For the primary outcome (pain intensity on a 1 to 10 scale, with 10 being the most painful), intervention group patients reported an average pain intensity of 4.8 (SD 2.6), while those in the control group reported an average pain intensity of 4.7 (SD 2.8). These differences were not significant. There were also no significant differences in secondary outcomes, including pain interference with activity or sleep, patient satisfaction with pain management, or opioid prescribing. Patient surveys revealed reluctance to use the app was mostly due to technological challenges, data privacy concerns, and a preference for phone calls over texting. Providers had high satisfaction with the app and suggested integrating additional features, such as an in-system camera for patients to upload pictures and videos of the procedural site, and integration with the electronic health record system.

Conclusions

While the mHealth platform did not have a significant impact on acute postoperative pain experience, patients and providers indicated improvement in patient-provider communication, patient-provider relationship, postoperative complication management, and ability to manage pain medication prescribing. Expanded collaboration between mHealth developers and frontline health care providers can facilitate the applicability of these platforms, further help improve its integration with the normal clinic workflow, and assist in moving toward a more patient-centric approach to pain management.

A survey of the adoption and perception of mobile health applications among community pharmacists in Malaysia

OBJECTIVES

To determine the adoption and perception of mobile health (mHealth) applications among community pharmacists in Malaysia.

METHODS

A cross-sectional survey using a self-administered questionnaire was conducted with 300 community pharmacists in the Klang Valley, Malaysia using a stratified sampling approach. The questionnaire consisted of 36 questions with three sections: demographic data, adoption of mHealth applications and perception towards mHealth applications. Descriptive and inferential tests as well as exploratory factor analysis were used to analyse the data.

KEY FINDINGS

Adoption of mHealth applications by community pharmacists for both professional and personal use was relatively high at 79.7%. Utilised mHealth applications were primarily from the medical references category, while applications for patient monitoring, personal care and fitness were used to a lesser degree. Among mHealth application users, only 65.7% recommended them to their patients. Overall perception towards mHealth applications was positive, but perception towards the benefits and favour of mHealth applications for their patients was lower. This was corroborated by the factor analysis, which identified four main factors explaining 59.9% of variance in the dataset. These factors were perception towards use in their own professional practice, perception on benefits and use in their patients, perception on specific features of mHealth applications, and reliability of mHealth applications.

CONCLUSIONS

Adoption of mHealth applications among community pharmacists in Malaysia is high. Community pharmacists are more likely to use mHealth applications professionally and personally but less likely to recommend them to patients due to less favourable perceptions on how patients will benefit from mHealth applications.

A Health App Platform Providing a Budget to Purchase Preselected Apps as an Innovative Way to Support Public Health: Qualitative Study With End Users and Other Stakeholders

BACKGROUND

eHealth has the potential to improve health outcomes. However, this potential is largely untapped. Individuals face an overload of apps and have difficulties choosing suitable apps for themselves. In the FitKnip experiment, individuals were given access to a health app platform, where they could purchase reliable preselected health apps with a personal budget of €100 (US $107.35). By conducting a prospective study, we aimed to scientifically evaluate the FitKnip experiment as an innovative way to improve population health.

OBJECTIVE

The aim of the experiment was to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. More specifically, we conducted an in-depth qualitative evaluation of the concept and acceptability of FitKnip, its perceived impact on health empowerment, as well as the roles of stakeholders for the future implementation of a health app platform through focus group interviews.

METHODS

This study followed a phenomenological research design and included 7 focus group interviews with end users and 1 with stakeholders, held between July and December 2020. End users were recruited through various institutions in the Netherlands, for example, insurance companies and local governments. All focus groups were semistructured using interview guides and were held via videoconferencing due to the COVID-19 pandemic measures. Each participant received access to a health app platform where they were enabled to purchase reliable, preselected health apps with a budget of €100 (US $107.35). The budget was valid for the entire research period. The health app platform offered 38 apps. A third party, a health care coalition, selected the apps to be included in FitKnip. The analyses were conducted according to the principles of the Framework Method.

RESULTS

A priori formulated themes were concept, acceptability, health empowerment, and outcomes, and the roles of stakeholders for the future implementation of a health app platform. Both end users (n=31) and stakeholders (n=5) were enthusiastic about the concept of a health app platform. End users indicated missing apps regarding physical health and lifestyle and needing more guidance toward suitable apps. End users saw health empowerment as a precondition to using a health app platform and achieving health outcomes depending on the purchased mobile apps. End users and stakeholders identified potential providers and financing parties of FitKnip. Stakeholders recommended the establishment of a reputable national or international quality guidelines or certification for health and wellbeing apps, that can demonstrate the quality and reliability of mobile health applications.

CONCLUSIONS

This study showed the need for a personalized and flexible platform. Next to this, a deeper understanding of the roles of stakeholders in such initiatives is needed especially on financing and reimbursement of health promotion and digital health services. A personalized, flexible health app platform is a promising initiative to support individuals in their health.

Female youth and mental health service providers' perspectives on the JoyPop™ app: a qualitative study

Introduction

Mobile health (mHealth) apps are a promising adjunct to traditional mental health services, especially in underserviced areas. Developed to foster resilience in youth, the JoyPop™ app has a growing evidence base showing improvement in emotion regulation and mental health symptoms among youth. However, whether this novel technology will be accepted among those using or providing mental health services remains unknown. This study aimed to evaluate the JoyPop™ app's acceptance among (a) a clinical sample of youth and (b) mental health service providers.

Method

A qualitative descriptive approach involving one-on-one semi-structured interviews was conducted. Interviews were guided by the Technology Acceptance Model and were analyzed using a deductive-inductive content analysis approach.

Results

All youth (n = 6 females; Mage = 14.60, range 12-17) found the app easy to learn and use and expressed positive feelings towards using the app. Youth found the app useful because it facilitated accessibility to helpful coping skills (e.g., journaling to express their emotions; breathing exercises to increase calmness) and positive mental health outcomes (e.g., increased relaxation and reduced stress). All service providers (n = 7 females; Mage = 43.75, range 32-60) perceived the app to be useful and easy to use by youth within their services and expressed positive feelings about integrating the app into usual care. Service providers also highlighted various organizational factors affecting the app's acceptance. Youth and service providers raised some concerns about apps in general and provided recommendations to improve the JoyPop™ app.

Discussion

Results support youth and service providers' acceptance of the JoyPop™ app and lend support for it as an adjunctive resource to traditional mental health services for youth with emotion regulation difficulties.

Health Lifestyle Theory in a Changing Society: The Rise of Infectious Diseases and Digitalization

Social change produces alterations in society that necessitate changes in sociological theories. Two significant changes affecting health lifestyle theory are the behaviors associated with the COVID-19 pandemic and the digitalization of society. The health-protective practices emerging from the ongoing pandemic and the recent parade of other newly emerging infectious diseases need to be included in the theory's framework. Moreover, the extensive digitalization of today's society leads to the addition of connectivities (electronic networks) as a structural variable. Connectivities serve as a computational authority influencing health lifestyle practices through health apps and other digital resources in contrast to collectivities (human social networks) as a normative authority. The recent literature supporting these features in an updated and expanded model of health lifestyle theory is discussed.

Identification of the Needs and Preferences of Patients With Cancer for the Development of a Clinic App: Qualitative Study

BACKGROUND

Mobile health (mHealth) tools were developed during the past decades and are increasingly used by patients in cancer care too. Scientific research in the development of mHealth services is required in order to meet the various needs of patients and test usability.

OBJECTIVE

The aim of this study is to assess patients' needs, preferences, and usability of an app (My University Clinic [MUC] app) developed by the Comprehensive Cancer Center Freiburg (CCCF) Germany.

METHODS

Based on a qualitative cross-sectional approach, we conducted semistructured interviews with patients with cancer, addressing their needs, preferences, and usability of the designed MUC app. Patients treated by the CCCF were recruited based on a purposive sampling technique focusing on age, sex, cancer diagnoses, and treatment setting (inpatient, outpatient). Data analysis followed the qualitative content analysis according to Kuckartz and was performed using computer-assisted software (MAXQDA).

RESULTS

For the interviews, 17 patients with cancer were selected, covering a broad range of sampling parameters. The results showed that patients expect benefits in terms of improved information about the disease and communication with the clinic staff. Demands for additional features were identified (eg, a list of contact persons and medication management). The most important concerns referred to data security and the potential restriction of personal contacts with health care professionals of the clinical departments of the CCCF. In addition, some features for improving the design of the MUC app with respect to usability or for inclusion of interacting tools were suggested by the patients.

CONCLUSIONS

The results of this qualitative study were discussed within the multidisciplinary team and the MUC app providers. Patients' perspectives and needs will be included in further development of the MUC app. There will be a second study phase in which patients will receive a test version of the MUC app and will be asked about their experiences with it.

TRIAL REGISTRATION

Deutsches Register Klinischer Studien DRKS00022162; https://drks.de/search/de/trial/DRKS00022162.

User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study

BACKGROUND

Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams.

OBJECTIVE

This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, PathwayPlatform, intended to enhance patient engagement, MBC, and SDM.

METHODS

Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project.

RESULTS

In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the Pathway app while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the Pathway app.

CONCLUSIONS

Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the Pathway Platform. Key insights led to further development of the patient-facing and care team-facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey.

Improving Predictability and Effectiveness in Preventive Digital Health Interventions: Scoping Review

BACKGROUND

Lifestyle-related diseases caused by inadequate diet and physical activity cause premature death, loss of healthy life years, and increased health care costs. Randomized controlled trial (RCT) studies indicate that preventive digital health interventions (P-DHIs) can be effective in preventing these health problems, but the results of these studies are mixed. Adoption studies have identified multiple factors related to individuals and the context in which they live that complicate the transfer of positive results from RCT studies to practical use. Implementation studies have revealed barriers to the large-scale implementation of mobile health (mHealth) solutions in general. Consequently, there is no clear path to delivering predictable outcomes from P-DHIs and achieving effectiveness when scaling up interventions to reduce health problems in society.

OBJECTIVE

This research aimed to expand our understanding of how to increase the outcome predictability of P-DHIs by focusing on physical activity and diet behaviors and amplify our understanding of how to improve effectiveness in large-scale implementations.

METHODS

The research objective was pursued through a multidisciplinary scoping review. This scoping review used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) as a guide. A comprehensive search of Web of Science and PubMed limited to English-language journal articles published before January 2022 was conducted. Google Scholar was used for hand searches. Information systems theory was used to identify key constructs influencing outcomes of IT in general. Public health and mHealth literature were used to identify factors influencing the adoption of, outcomes from, and implementation of P-DHIs. Finally, the P-DHI investment model was developed based on information systems constructs and factors from the public health and mHealth literature.

RESULTS

In total, 203 articles met the eligibility criteria. The included studies used a variety of methodologies, including literature reviews, interviews, surveys, and RCT studies. The P-DHI investment model suggests which constructs and related factors should be emphasized to increase the predictability of P-DHI outcomes and improve the effectiveness of large-scale implementations.

CONCLUSIONS

The research suggests that outcome predictability could be improved by including descriptions of the constructs and factors in the P-DHI investment model when reporting from empirical studies. Doing so would increase our understanding of when and why P-DHIs succeed or fail. The effectiveness of large-scale implementations may be improved by using the P-DHI investment model to evaluate potential difficulties and possibilities in implementing P-DHIs to create better environments for their use before investing in them and when designing and implementing them. The cost-effectiveness of large-scale implementations is unknown; implementations are far more complicated than just downloading and using apps, and there is uncertainty accompanying implementations given the lack of coordinated control over the constructs and factors that influence the outcome.

A mobile health application for patients eligible for statin therapy: app development and qualitative feedback on design and usability

BACKGROUND

Cardiovascular disease is the leading cause of death in the United States (US). Despite the well-recognized efficacy of statins, statin discontinuation rates remain high. Statin intolerance is a major cause of statin discontinuation. To accurately diagnose statin intolerance, healthcare professionals must distinguish between statin-associated and non-statin-associated muscle symptoms, because many muscle symptoms can be unrelated to statin therapy. Patients' feedback on muscle-related symptoms would help providers make decisions about statin treatment. Given the potential benefits and feasibility of existing apps for cardiovascular disease (CVD) management and the unmet need for an app specifically addressing statin intolerance management, the objectives of the study were 1) to describe the developmental process of a novel app designed for patients who are eligible for statin therapy to lower the risk of CVD; 2) to explore healthcare providers' feedback of the app; and 3) to explore patients' app usage experience.

METHODS

The app was developed by an interdisciplinary team. Healthcare provider participants and patient participants were recruited in the study. Providers were interviewed to provide their feedback about the app based on screenshots of the app. Patients were interviewed after a 30 days of app usage.

RESULTS

The basic features of the app included symptom logging, vitals tracking, patient education, and push notifications. Overall, both parties provided positive feedback about the app. Areas to be improved mentioned by both parties included: the pain question asked in symptom tracking and the patient education section. Both parties agreed that it was essential to add the trend report of the logged symptoms.

CONCLUSIONS

The results indicated that providers were willing to use patient-reported data for disease management and perceived that the app had the potential to facilitate doctor-patient communication. Results also indicated that user engagement is the key to the success of app efficacy. To promote app engagement, app features should be tailored to individual patient's needs and goals. In the future, after it is upgraded, we plan to test the app usability and feasibility among a more diverse sample.