m-Health views and perception among Malaysian: findings from a survey among individuals living in Selangor

Exploring medical students' perceptions of telehealth in Pakistan: a cross-sectional study

INTRODUCTION

This study aimed to investigate medical students' perceptions of telehealth in Pakistan and assess the relationship between students' proficiency in computers and technology, gender, and age.

METHODS

A cross-sectional study was conducted on 330 medical students from various universities in Karachi, Pakistan. Data on demographic characteristics, computer proficiency, and perceptions of telehealth were collected using a self-administered questionnaire. Descriptive statistics, chi-square tests, and Spearman's rank correlation coefficient were utilized for data analysis.

RESULTS

The study included 330 participants, predominantly from public universities (83.3%), with a mean age of 21.40 ± 4.24 years. Most participants were pursuing MBBS (67%). In terms of computer proficiency, 41.8% fell into the middle category. Gender correlated significantly with proficiency (p < 0.05), with females more often in the middle category and males in the not-that-amateur category. Age demonstrated a small positive correlation with proficiency (p < 0.05). A majority (77.6%) expressed a general interest in technology. Regarding healthcare apps, 51.8% had 1-3 apps, and 33.6% had none. Most participants believed telehealth would enhance healthcare (72.1%) and make it cheaper (63.3%). Additionally, 56.7% agreed that Pakistan should invest in telehealth, while only 2.7% disagreed.

CONCLUSION

The study revealed that medical students in Pakistan exhibit an interest in technology and perceive telehealth as beneficial. These findings suggest that telehealth holds the potential to enhance healthcare opportunities in Pakistan. Therefore, investing in and expanding telehealth services may represent a viable solution for improving access to healthcare in the country.

A pilot randomized control trial on the feasibility, acceptability, and initial effects of a digital-assisted parenting intervention for promoting mental health in Malaysian adolescents

Objective

Online parenting interventions for enhancing child development, specifically mental health is relatively new in Malaysia. This pilot study tests the feasibility, acceptability, and initial effects of a universal digital-assisted parenting intervention (DaPI) in promoting mental health in adolescents by improving parental behaviors and self-efficacy.

Methods

A two-arm pilot randomized controlled trial was conducted. Twenty-four mothers of adolescent aged 10 to 14 years from a non-clinical sample were recruited online and randomly allocated into two groups (intervention [DaPI] and waitlist-control [WLC]). Eight weekly sessions were delivered online via technological devices. Feasibility outcomes were based on the participants' engagement in DaPI and study retention. Primary (parental behaviors and self-efficacy) and secondary (adolescent mental health) outcomes were assessed using an online survey at baseline (T0), post-intervention (T1), and 1-month follow-up (T2). Data were analyzed using descriptive and inferential statistics and an intention-to-treat approach.

Results

The DaPI was well received by the mothers. Retention was high (81.8%) in both groups and intervention adherence was excellent (91.6%). Within-group analyses showed a significant decrease in physical control at T2 and an increase in parental self-efficacy at T1 and T2 among the DaPI mothers. No significant differences were observed in adolescents' mental health at any time point. As for the WLC group, there were no significant differences in all the outcome variables across the three assessment moments. Between groups analyses revealed DaPI mothers had significant differences in proactive parenting at T1, and in positive reinforcement and lax control at T2. There were no significant differences in adolescents' mental health between the groups at any time point.

Discussion

The DaPI is feasible and acceptable in the Malaysian context. Findings show promise regarding the initial effects of the DaPI. However, a larger RCT is needed to determine its effectiveness in promoting mental health of adolescents.

Trial registration

https://www.irct.ir/; identifier: IRCT20211129053207N1.

Online Chair Yoga and Digital Learning for Rural Underserved Older Adults at Risk for Alzheimer's Disease and Related Dementias

OBJECTIVES

We evaluated the feasibility and preliminary efficacy of a home-based online chair yoga (OCY) program for racially and ethnically diverse rural community-dwelling older adults.

METHODS

We randomly assigned participants to OCY or a computer brain game (CBG). After a computer literacy training led by high school students, participants engaged in remotely supervised OCY or CBG in twice-weekly 45-minute sessions for 12 weeks. Outcome data (pain interference, cognitive function, mobility, computer skills) were collected at baseline, post-intervention, and 3-month follow-up.

RESULTS

A total of 32 eligible residents with mean age of 71 years participated in this intervention study. The interventions were feasible (100% recruitment rate, 96.8% retention rate, 100% safety rate). There were significant improvements in pain interference, cognitive function, mobility, and computer skills from baseline to follow-up among participants in both OCY and CBG but no significant differences in outcomes between groups.

CONCLUSIONS

Preliminary results indicated that the CBG was as effective as online OCY in clinical outcomes in these participants. However, this should be confirmed in future studies.

CLINICAL IMPLICATIONS

This telehealth-based intervention is feasible for older adults in rural and digitally underserved communities and could provide a strategy for delivering health-promoting interventions for home-bound older adults at risk for Alzheimer's disease and related dementias (ADRD) and connect caregivers to online resources.

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.

Chronic kidney disease patients' views of readiness and ability to use mHealth apps

BACKGROUND

The use of mobile health (mHealth) applications, which provide opportunities to improve health and lessen health inequalities, is increasing. Studies assessing the readiness and ability of patients in Malaysia with chronic kidney disease (CKD) to use mobile phone apps to manage their health are limited.

AIMS

This study aimed to assess the readiness and ability to use mHealth apps among patients with CKD in north-east Peninsular Malaysia.

METHODS

A cross-sectional study was undertaken, using a convenience sample of 100 CKD medical inpatients in a tertiary teaching hospital. A structured, self-administered questionnaire on readiness and ability to use mHealth apps was adopted.

FINDINGS

Nearly one in five patients (18%) actively used health applications. More than three-quarters (77%) were aged >40 years and a similar proportion were ready to use mHealth apps (78%), and nearly half (46%) were confident about connecting their device to wifi. There was a correlation between ability and readiness to use mHealth apps (r=0.4; P<0.05).

CONCLUSIONS

Fewer than half of participants had a good command of mHealth applications. Therefore, support on the use of these apps is needed, and healthcare managers need to consider this.

Understanding User Requirements for a Senior-Friendly Mobile Health Application

The advancement of mobile technologies has motivated countries around the world to aim for smarter health management to support senior citizens. However, the use of mobile health applications (mHealth apps) among senior citizens appears to be low. Thus, drawing upon user expectations, the present study examined user requirements for a senior-friendly mHealth application. A total of 74 senior citizens were interviewed to explore the difficulties they encounter when using existing mobile apps. This study followed Nielsen’s usability model to identify user requirements from five aspects, namely learnability, efficiency, memorability, error, and satisfaction. Based on the results, a guideline was proposed pertaining to usability and health management features. This guideline offers suggestions for mHealth app issues related to phrasing, menus, simplicity, error messages, icons and buttons, navigation, and layout, among others. The study also found that speech recognition technology can help seniors access information quickly. The proposed guideline and findings offer valuable input for software and app developers in building more engaging and senior-friendly mHealth apps.

An empirical investigation into the altering health perspectives in the internet of health things

Healthcare is on top of the agenda of all governments in the world as it is related to the well-being of the people. Naturally, this domain has attracted the attention of many researchers globally, who have studied the development of its different phases, including E-Health and the Internet of Health Things (IoHT). In this paper, the difference between the recent concepts of healthcare (E-health, M-Health, S-Health, I-Health, U-Health, and IoHT/IoMT) is analyzed based on the main services, applications, and technologies in each concept. The paper has also studied the latest developments in IoHT, which are linked to existing phases of development. A classification of groups of services and constituents of IoHT, linked to the latest technologies, is also provided. In addition, challenges, and future scope of research in this domain concerning the wellbeing of the people in the face of ongoing COVID-19 and future pandemics are explored.

Health Habits and Wearable Activity Tracker Devices: Analytical Cross-Sectional Study

Wearable activity trackers are electronic devices that facilitate self-monitoring of information related to health. The purpose of this study was to examine the use of tracker devices to record daily activity (calories) and its associations with gender, generation, BMI, and physical activity behavior of United States of America resident adults; a cross-sectional study in 892 subjects recruited to participate in an anonymous online survey was performed. Being female increased the odds of using a tracker device by 2.3 times. Having low cardiovascular disease mortality risk related to time spent sitting increased the odds for using a tracker device by 2.7 times, and having medium risk 1.9 times, with respect to having high risk. For every 1-point increase in BMI, the odds for using a tracker device increased by 5.2%. Conclusions: Subjects who had ever used any tracker device had a higher BMI. The use of tracker devices was related to lower cardiovascular disease mortality risk related to sitting time. The amount of physical activity and the time spent walking were not associated with the usage of tracker devices. It is possible that the user of tracker devices should be supported by professionals to implement deep change in health habits.

A Mobile App for Triangulating Strategies in Phosphate Education Targeting Patients with Chronic Kidney Disease in Malaysia: Development, Validation, and Patient Acceptance

Hyperphosphatemia afflicts end-stage chronic kidney disease (CKD) patients, contributing to comorbidities and mortality. Management strategies are dialysis, phosphate binder, and limiting dietary phosphate intake, but treatment barriers are poor patient compliance and low health literacy arising from low self-efficacy and lack of educational resources. This study describes developing and validating a phosphate mobile application (PMA). The PMA development based on the seven-stage Precaution Adoption Process Model prioritized titrating dietary phosphate intake with phosphate binder dose supported by educational videography. Experts (n = 13) first evaluated the PMA for knowledge-based accuracy, mobile heuristics, and clinical value. Adult HD patients validated the improved PMA using the seven-point mHealth App Usability Questionnaire (MAUQ). Patient feedback (n = 139) indicated agreement for ease of use (69.2%), interface and satisfaction (69.0%), and usefulness (70.1%), while 72.7% said they would recommend this PMA. The expectation confirmation for 25 PMA features ranged from 92.1% (lifestyle) up to 100.0% (language option); and the utilization rate of each feature varied from 21.6% (goal setting and feature-based log) to 91.4% (information on dietary phosphate and phosphate binder). The Conclusions: MyKidneyDiet-Phosphate Tracker PMA was acceptable to adult Malaysian HD patients as part of clinical phosphate management in low-resource settings.

Digital health interventions for gestational diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials

Good blood glucose control is important to reduce the risk of adverse effects on mothers and their offspring in women with gestational diabetes (GDM). This review examined the impact of using digital health interventions on reported glycaemic control among pregnant women with GDM and its impact on maternal and foetal outcomes. Seven databases were searched from database inception to October 31st, 2021 for randomised controlled trials that examined digital health interventions to provide services remotely for women with GDM. Two authors independently screened and assessed the studies for eligibility for inclusion. Risk of bias was independently assessed using the Cochrane Collaboration's tool. Studies were pooled using random effects model and presented as risk ratio or mean difference with 95% confidence intervals. Quality of evidence was assessed using GRADE framework. Twenty-eight randomised controlled trials that examined digital health interventions in 3,228 pregnant women with GDM were included. Moderate certainty of evidence showed that digital health interventions improved glycaemic control among pregnant women, with lower fasting plasma glucose (mean difference -0.33 mmol/L; 95% CI: -0.59 to -0.07), 2-hour post-prandial glucose (-0.49 mmol/L; -0.83 to -0.15) and HbA1c (-0.36%; -0.65 to -0.07). Among those randomised to digital health interventions, there was a lower need for caesarean delivery (Relative risk: 0.81; 0.69 to 0.95; high certainty) and foetal macrosomia (0.67; 0.48 to 0.95; high certainty). Other maternal and foetal outcomes were not significantly different between both groups. Moderate to high certainty evidence support the use of digital health interventions, as these appear to improve glycaemic control and reduce the need for caesarean delivery. However, more robust evidence is needed before it can be offered as a choice to supplement or replace clinic follow up. Systematic review registration: PROSPERO: CRD42016043009.

Development and validation of a progressive web application to educate partial denture wearers

Effective delivery of post-insertion instructions is essential for denture care and oral health. This study aimed to develop a progressive web application (PWA) to educate patients' chairside and serve as a reference material. A need analysis was conducted before prototype development. Subsequently, the prototype was subjected to content verification, design appraisal and usability testing. The results of usability testing revealed a user task success rate of 94.4%, with an adjusted Wald 95% confidence interval of 83-100%. User satisfaction assessed using the Single Ease Questionnaire and System Usability Score reported a mean score of 6.13 (95% CI: 5.69-6.55) and 85.9 (95% CI: 82.2-89.6), respectively, indicating good usability. This study highlights the systematic approach of developing an evidence-based educational PWA to meet the usability standards for mobile applications. This PWA is useful in clinical studies to explore mobile technologies' potential in educating denture wearers, especially in the older population.

The Mediating Influence of the Unified Theory of Acceptance and Use of Technology on the Relationship Between Internal Health Locus of Control and Mobile Health Adoption: Cross-sectional Study

Background

Mobile health (mHealth) as an innovative form of information and communications technology can efficiently deliver high-quality health care by enhancing communication and health management, reducing costs, and increasing access to health services. An individual’s internal health locus of control (HLOC) is found to be associated with the behavioral intent to adopt mHealth. However, little is known about the underlying mechanism of this association.

Objective

The primary objective of this study was to test the mediation influence of the Unified Theory of Acceptance and Use of Technology (UTAUT) on the relationship between internal HLOC and the behavioral intention to use mHealth.

Methods

A total of 374 responses were collected from Malaysian adult users of mHealth, using convenience and snowball sampling methods. Partial least squares structural equation modeling was used to analyze the data. Data were collected for variables, including demographics, internal HLOC, and modified UTAUT constructs (ie, performance expectancy, effort expectancy, and social influence).

Results

The results showed that there was no direct relationship between internal HLOC and the behavioral intention to use mHealth (β=−0.039, P=.32). The indirect relationship between internal HLOC and the intent to adopt mHealth was supported, indicating that the UTAUT constructs performance expectancy (β=0.104, P<.001), effort expectancy (β=0.056, P=.02), and social influence (β=0.057, P=.002) mediated this relationship. The results showed full mediation, with total variance explained at 47.2%.

Conclusions

This study developed an integrative model, where a health-related disposition (internal HLOC), mHealth-related beliefs (performance expectancy and effort expectancy), and normative pressure (social influence) were combined to explain the underlying mechanism of the behavioral intent to adopt mHealth. The results showed that the intention to adopt mHealth is mediated by the influence of UTAUT factors, while HLOC has no direct effect on adoption intention. The findings provide insights into augmenting mHealth adoption among the public by enhancing the perceived benefits of mHealth, helping design more effective and user-friendly mHealth tools, and capitalizing on social normative influence to adopt mHealth. This study utilized the constructs of the UTAUT model to determine the intention to use mHealth. Future research should focus on other health- and technology-related theories to ascertain other possible factors influencing the behavioral intent of mHealth adoption.

Patients' Technology Readiness and eHealth Literacy: Implications for Adoption and Deployment of eHealth in the COVID-19 Era and Beyond

The COVID-19 pandemic has rerouted the healthcare ecosystem by accelerating digital health, and rapid adoption of eHealth is partly influenced by eHealth literacy (eHL). This study aims to examine patients' eHL in relation to their "technology readiness"-an innate attitude that is underexplored in clinical research. A total of 276 adult inpatients with hypertension, diabetes mellitus, and coronary heart disease were surveyed cross-sectionally in 2019 using self-reported questionnaires: eHealth Literacy Scale and Technology Readiness Index (2.0). The study found moderate eHL (mean, 27.38) and moderate technology readiness (mean, 3.03) among patients. The hierarchical regression model shows that lower eHL scores were associated with patients of minor ethnicity (Malaysian Chinese), with an unemployed status, and having >1 cardiovascular risk (β = -0.136 to -0.215, R2 = 0.283, Ps < .005). Technology readiness is a strong determinant of eHL (ΔR2 = 0.295, P < .001) with its subdomains (optimism, innovativeness, and discomfort) significantly influencing eHL (|β| = 0.28-0.40, Ps < .001), except for the insecurity subdomain. Deployment of eHealth interventions that incorporate assessment of patients' eHL and technology readiness will enable targeted strategies, especially in resource-limited settings hit hard by the pandemic crisis.

Perception of telemedicine among medical practitioners in Malaysia during COVID-19

The novel Coronavirus Disease 2019 (COVID-19) has brought unprecedented changes in the way conventional health care is delivered. This study examined if clinicians' perceptions regarding telemedicine and its barriers to implementation in Malaysia have changed during this pandemic. A cross-sectional survey was conducted among Malaysian medical doctors of various specialties in four urban healthcare facilities between June 2020 and July 2020. A total of 146 (41.7%) out of 350 responses were obtained. 62% of doctors reported a reduction greater than 50% in outpatient visits during the COVID-19 pandemic. The majority of doctors either found telemedicine useful in situations similar to COVID-19 (34.2%) or that it is essential to their daily practice (42.5%). However, only 22% reported using telemedicine for consultation during the COVID-19 pandemic. 74% of doctors felt that telemedicine would only benefit up to 30% of their patient population. Significantly more female doctors (80%) felt that telemedicine would benefit their patients compared to male doctors (45.8%) (P=0.03). Physicians (51.3%) were more inclined to adopt telemedicine in comparison to surgeons (32.4%) (P=0.03). The majority cited medico-legal issues and consent (80.6%), billing and charges (66.7%) and insurance reimbursement (62.5%), technical difficulties (62.5%) as their barrier to the adoption of telemedicine. Female doctors and physicians were more willing to adopt telemedicine when compared to male doctors and surgeons. Although the COVID-19 pandemic appeared to improve the perception, significant barriers should be resolved before many can incorporate it into their practice.

Privacy Concerns About Health Information Disclosure in Mobile Health: Questionnaire Study Investigating the Moderation Effect of Social Support

Background

Mobile health (mHealth) provides a new opportunity for disease prediction and patient health self-management. However, privacy problems in mHealth have drawn significant attention to patients’ online health information disclosure and to the possibility that privacy concerns may hinder mHealth development.

Objective

Privacy calculus theory (PCT) has been widely used to understand personal information disclosure behaviors with the basic assumption of a rational and linear decision-making process. However, cognitive behavior processes are complex and mutual. In an attempt to gain a fuller understanding of information disclosure behavior, we further optimize a PCT-based information disclosure model by identifying the mutual relationship between costs (privacy concerns) and benefits. Social support, which has been proven to be a distinct and significant disclosure benefit of mHealth, was chosen as the representative benefit of information disclosure.

Methods

We examine a structural equation model that incorporates privacy concerns, health information disclosure intention in mHealth, and social support from mHealth, all at the individual level.

Results

A validated questionnaire was completed by 253 randomly selected participants. The result indicated that perceived health information sensitivity positively enhances patients’ privacy concern (beta path coefficient 0.505, P<.001), and higher privacy concern levels will decrease their health information disclosure intention (beta path coefficient –0.338, P<.001). Various individual characteristics influence perceived health information sensitivity in different ways. One dimension of social support, informational support, negatively moderates the effect of the relationship between perceived health information sensitivity and privacy concerns (beta path coefficient –0.171, P=.092) and the effect of the relationship between privacy concerns and health information disclosure intention (beta path coefficient –0.105, P=.092). However, another dimension, emotional support, has no direct moderation effect on the relationship between privacy concerns and health information disclosure intention.

Conclusions

The results indicate that social support can be regarded as a disutility reducer. That is, on the one hand, it reduces patients’ privacy concerns; on the other hand, it also reduces the negative impact of privacy concerns on information disclosure intention. Moreover, the moderation effect of social support is partially supported. Informational support, one dimension of social support, is significant (beta path coefficient –0.171, P=.092), while the other dimension, emotional support, is not significant (beta path coefficient –0.137, P=.146), in mHealth. Furthermore, the results are different among patients with different individual characteristics. This study also provides specific theoretical and practical implications to enhance the development of mHealth.

The Types and Pattern of Use of Mobile Health Applications Among the General Population: A Cross-Sectional Study from Selangor, Malaysia

PURPOSE

The aims of this study are to explore the types and patterns of use of health mobile apps among pharmacy clients in Selangor, Malaysia, and to explore the users' experiences and views regarding the benefits of and issues with the use of the health apps.

PATIENTS AND METHODS

A cross-sectional survey was conducted with 278 pharmacy clients who were using health apps on their smartphones. A survey was developed, piloted, and rolled out, comprised of socio-demographic characteristics, information regarding the common types and the pattern of health app use, the benefits of health apps, and issues that users faced while using these apps. Statistical analysis was performed using IBM SPSS version 21.

RESULTS

The mean (±SD) age of health app users was 29.8 (±11.74) years old, and over half of them (51.8%) were male, while less than half were female (48.2%). There were 48 different types of mobile health apps used by the participants in this study. The two most common were multi-purpose general health apps (53.6%) and fitness apps (38.1%). In terms of pattern of use, 33.5% of the participants reported using their health apps daily, 36.7% at least once weekly, and 25.2% monthly. The main benefits reported by the users were tracking of health status (47%), motivation (41%), and knowledge about health and fitness (9%). The main issues reported by the participants included inaccuracy of the app (24%), inconvenience (20.7%), and not being user-friendly (18.5%).

CONCLUSION

The study showed that the participants used many different types of mobile health apps for several purposes, including general health, wellness, fitness, and self-management of diseases. These apps helped the participants to track their health-related activities and motivated them to maintain their wellness and fitness. Further areas of improvement were identified to ensure evidence-based and effective utilization of apps to achieve required health outcomes.

Health information seeking behaviour using mobile devices among people with diabetes: A comparison between Middle and high income country

Objective

The internet has become a primary source of information for many individuals especially those with chronic diseases. This study aims to understand and compare the health seeking behaviour using mobile devices among individuals with diabetes and between a high (Singapore) and middle (Malaysia) income country.

Methods

A cross sectional survey was conducted among people with diabetes in Malaysia and Singapore. Participants attending the primary health clinic for the treatment of diabetes were approached to participate in this survey. Data on demographics, health status and beliefs to health were collected and compared.

Results

A total of 673 respondents were included in the study. Most of the respondents reported to have access to the Internet, with a high ownership of mobile phones (99.3%). However, only one in every three respondents sought information online. Younger individuals (≤50 years) and those with higher education more likely to seek information using mobile devices. Respondents in Singapore reported to be more likely to use mobile devices to monitor their health as compared to respondents in Malaysia. However, most respondents would seek health information from their healthcare professionals’ especially physicians.

Conclusion

There was limited differences in the health-seeking behaviour among the respondents from both countries, suggesting for a need to identify for more effective means of distribution of health related information.