Mobile Apps for Medication Management: Review and Analysis

Quality Assessment of Smartphone Medication Management Apps in France: Systematic Search

BACKGROUND

Adherence to medication is estimated to be around 50% for chronically ill patients in high-income countries. Improving the effectiveness of adherence interventions could have a far greater impact on population health than any improvement in specific medical treatments. Mobile health (mHealth) is one of the most effective solutions for helping patients improve their medication intake, notably through the use of mobile apps with reminder systems. With more than 327,000 apps available in the mHealth field, it is difficult for health care professionals and patients alike to choose which apps to recommend and use.

OBJECTIVE

We aim to carry out a systematic search of medication management smartphone apps available in France that send reminders to patients and assess their quality using a validated scale.

METHODS

Mobile apps were identified in October and November 2022 after a systematic keyword search on the 2 main app download platforms: App Store (Apple Inc) and Google Play Store. Inclusion criteria were free availability, date of last update, and availability in French. Next, 2 health care professionals independently evaluated the included apps using the French version of the Mobile App Rating Scale (MARS-F), an objective scoring system validated for assessing the overall quality of apps in the mHealth field. An intraclass correlation coefficient was calculated to determine interrater reliability.

RESULTS

In total, 960 apps were identified and 49 were selected (25 from the App Store and 24 from the Google Play Store). Interrater reliability was excellent (intraclass correlation coefficient 0.92; 95% CI 0.87-0.95; P<.001). The average MARS-F score was 3.56 (SD 0.49) for apps on the App Store and 3.51 (SD 0.46) for those on the Google Play Store, with 10 apps scoring above 4 out of 5. Further, 2 apps were tested in at least one randomized controlled trial and showed positive results. The 2 apps with the highest ratings were Mediteo rappel de médicaments (Mediteo GmbH) and TOM rappel medicaments, pilule (Innovation6 GmbH), available on both platforms. Each app's MARS-F score was weakly correlated with user ratings on the App Store and moderately correlated on the Google Play Store.

CONCLUSIONS

To our knowledge, this is the first study that used a validated scoring system to evaluate medication management apps that send medication reminders. The quality of the apps was heterogeneous, with only 2 having been studied in a randomized controlled trial with positive results. The evaluation of apps in real-life conditions by patients is necessary to determine their acceptability and effectiveness. Certification of apps is also essential to help health care professionals and patients identify validated apps.

Using Digital Health Technologies to Monitor Pain, Medication Adherence and Physical Activity in Young People with Juvenile Idiopathic Arthritis: A Feasibility Study

Juvenile idiopathic arthritis can be influenced by pain, medication adherence, and physical activity. A new digital health intervention, InteractiveClinics, aims to monitor these modifiable risk factors. Twelve children, aged 10 to 18 years, received daily notifications on a smartwatch to record their pain levels and take their medications, using a customised mobile app synchronised to a secure web-based platform. Daily physical activity levels were automatically recorded by wearing a smartwatch. Using a quantitative descriptive research design, feasibility and user adoption were evaluated. The web-based data revealed the following: Pain: mean app usage: 68% (SD 30, range: 28.6% to 100%); pain score: 2.9 out of 10 (SD 1.8, range: 0.3 to 6.2 out of 10). Medication adherence: mean app usage: 20.7% (SD, range: 0% to 71.4%), recording 39% (71/182) of the expected daily and 37.5% (3/8) of the weekly medications. Pro-re-nata (PRN) medication monitoring: 33.3% (4/12), one to six additional medications (mean 3.5, SD 2.4) for 2-6 days. Physical activity: watch wearing behaviour: 69.7% (439/630), recording low levels of moderate-to-vigorous physical activity (mean: 11.8, SD: 13.5 min, range: 0-47 min). To conclude, remote monitoring of real-time data is feasible. However, further research is needed to increase adoption rates among children.

Epilepsy self-management mobile health application: A needs assessment in people with epilepsy and caregivers in Viet Nam

OBJECTIVES

This study aimed to determine (1) the needsof Vietnamese people with epilepsy (PWE) and their caregivers for self-management mobile health applications and (2) the self-management features expected to be included in an application.

METHODS

The survey consisted of an anonymous self-administered questionnaire that was distributed to PWE and caregivers from the age of 18 in Vietnam through online platforms and onsite at Nguyen Tri Phuong Hospital and University Medical Center, Ho Chi Minh City, from February 2022 to May 2022. The questionnaire assessed the participants' attitudes toward epilepsy self-management mobile applications, their willingness to use applications, and their expectations of the contents of an application.

RESULTS

Responses from 103 participants were submitted. Eighty-one participants (78.6%) reported using a smartphone, but only 50.6% of those claimed to know about self-management applications. Most respondents (70.9%) thought the applications would be useful for disease self-management, and 68.9% were willing to use epilepsy self-management applications. In addition, the most expected features to be included in self-management applications were epilepsy information, seizure first aid, connecting with medical professionals, and a seizure diary.

CONCLUSION

Most Vietnamese PWE and caregivers had a willingness to use epilepsy self-management applications.The expected features are related to all aspects of self-management, including information, seizure, medication, and safety management.

Digital Solutions Available to Be Used by Informal Caregivers, Contributing to Medication Adherence: A Scoping Review

Medication adherence is essential for managing chronic diseases and achieving optimal health outcomes. However, this process is often challenging, particularly for patients with complex care needs. Informal caregivers play a pivotal role in supporting medication management, but they may face resource limitations and a lack of necessary support. Digital health tools offer a promising avenue to enhance medication adherence by providing reminders, education, and remote monitoring capabilities. This scoping review aimed to identify and evaluate digital solutions available to informal caregivers for improving medication adherence. A systematic search of PubMed and Web of Science was conducted using relevant keywords. Four studies were included in the review, examining a variety of digital tools including mobile apps, SMS messaging, and wearable devices. These tools demonstrated efficacy in improving medication adherence, managing disease symptoms, and enhancing quality of life for patients and caregivers. Digital health interventions hold the potential to revolutionize medication adherence among chronic disease patients. By empowering informal caregivers, these tools can bridge the gaps in medication management and contribute to better health outcomes. Further research is warranted to optimize the design, implementation, and evaluation of digital interventions for medication adherence.

An Online Psychological Program for Adolescents and Young Adults With Headaches: Iterative Design and Rapid Usability Testing

BACKGROUND

Headache disorders are common, debilitating health problems. Cognitive-behavioral therapy (CBT) is recommended but rarely easily available. With the use of the internet and communication technologies among youth and young adults, these individuals could be self-trained in CBT skills. There is an increasing number of internet-based interventions for headaches, but there has been little research into the usability of these interventions because evaluating usability across the intervention development life cycle is costly. We developed an internet-based CBT program, the Specialized Program for Headache Reduction (SPHERE). While developing it, we aimed to improve SPHERE through rapid usability testing cycles.

OBJECTIVE

This study aims to presents a rapid and affordable usability testing approach that can be performed throughout the intervention development life cycle. This paper also provides evidence of the usability of SPHERE.

METHODS

We used the "think aloud" usability testing method based on Krug's approach to test user interaction within a lab setting. This was followed by a short posttest interview. We planned to test SPHERE with 3-5 participants testing the same part of the program each cycle. Both the design and development team and the research team actively participated in the usability testing process. Observers independently identified the top 3 usability issues, rated their severity, and conducted debriefing sessions to come to consensus on major issues and generate potential solutions.

RESULTS

The testing process allowed major usability issues to be identified and rectified rapidly before piloting SPHERE in a real-world context. A total of 2 cycles of testing were conducted. Of the usability issues encountered in cycles 1 and 2, a total of 68% (17/25) and 32% (12/38), respectively, were rated as major, discussed, and fixed.

CONCLUSIONS

This study shows that rapid usability testing is an essential part of the design process that improves program functionality and can be easy and inexpensive to undertake.

Designing personalised mHealth solutions: An overview

INTRODUCTION

Mobile health, or mHealth, is based on mobile information and communication technologies and provides solutions for empowering individuals to participate in healthcare. Personalisation techniques have been used to increase user engagement and adherence to interventions delivered as mHealth solutions. This study aims to explore the current state of personalisation in mHealth, including its current trends and implementation.

MATERIALS AND METHODS

We conducted a review following PRISMA guidelines. Four databases (PubMed, ACM Digital Library, IEEE Xplore, and APA PsycInfo) were searched for studies on mHealth solutions that integrate personalisation. The retrieved papers were assessed for eligibility and useful information regarding integrated personalisation techniques.

RESULTS

Out of the 1,139 retrieved studies, 62 were included in the narrative synthesis. Research interest in the personalisation of mHealth solutions has increased since 2020. mHealth solutions were mainly applied to endocrine, nutritional, and metabolic diseases; mental, behavioural, or neurodevelopmental diseases; or the promotion of healthy lifestyle behaviours. Its main purposes are to support disease self-management and promote healthy lifestyle behaviours. Mobile applications are the most prevalent technological solution. Although several design models, such as user-centred and patient-centred designs, were used, no specific frameworks or models for personalisation were followed. These solutions rely on behaviour change theories, use gamification or motivational messages, and personalise the content rather than functionality. A broad range of data is used for personalisation purposes. There is a lack of studies assessing the efficacy of these solutions; therefore, further evidence is needed.

DISCUSSION

Personalisation in mHealth has not been well researched. Although several techniques have been integrated, the effects of using a combination of personalisation techniques remain unclear. Although personalisation is considered a persuasive strategy, many mHealth solutions do not employ it.

CONCLUSIONS

Open research questions concern guidelines for successful personalisation techniques in mHealth, design frameworks, and comprehensive studies on the effects and interactions among multiple personalisation techniques.

The effectiveness of mobile application for monitoring diabetes mellitus and hypertension in the adult and elderly population: systematic review and meta-analysis

CONTEXT

Arterial Hypertension (AH) and Diabetes Mellitus (DM) are diseases that are getting worse all over the world. Linked to this advance, is the growing digital health market with numerous mobile health applications, which aim to help patients and professionals in the proper management of chronic diseases. The aim of this study was to analyze, through a systematic review and meta-analysis, the effectiveness of using mobile health applications in monitoring AH and/or DM in the adult and elderly population.

METHODS

The systematic review and meta-analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Metanalyses guidelines and involved searching five databases - Medline/PubMed, Embase, CINAHL, Virtual Library in Health and Cochrane Library. The review included randomized and cohort clinical trials testing the effects of the intervention on changing biochemical parameters and clinical efficacy in people treated for AH and/or DM. The quality of the selected studies was assessed based on the evaluation criteria of the Joanna Briggs Institute tool. The random effects meta-analysis method was used to explain effect distribution between studies, by Stata® software (version 11.0) and publication bias was examined by visual inspection of graphs and Egger test.

RESULTS

We included 26 studies in the systematic review and 17 in the meta-analysis. These studies were published between 2014 to 2022 in 14 countries. Were reported improvement in knowledge and self-management of AH and DM, social motivation with treatment and behavioral change, reduction in glycated hemoglobin values, fasting glucose and blood pressure, improvement in adherence to drug treatment, among others. The result of the meta-analysis showed that there is evidence that the use of mobile applications can help reduce glycated hemoglobin by 0.39% compared to the usual care group.

CONCLUSIONS

Monitoring and self-monitoring of behaviors and health care related to AH and DM in adults and the elderly through mobile applications, has clinically significant effectiveness in reducing glycated hemoglobin levels. Future studies should provide more evidence and recommendations for best practices and development of digital health interventions.

TRIAL REGISTRATION

PROSPERO. International Prospective Registry of Systematic Reviews. CRD42022361928.

Evaluation of Endo 10 mobile application as diagnostic tool in endodontics

Background

Endodontic diagnosis can be compared to a puzzle, requiring the interpretation of a series of clinical and imaging data. Mobile health, especially mobile application (apps), can assist professionals in endodontic diagnosis. This work aims to evaluate an app - Endo 10 app, designed to assist pulpal and periapical diagnosis based on the patient's signs and symptoms and radiographic data.

Material and Methods

A total of 41 dental students and dentists with different levels of expertise (10 multi-specialty clinic professors, 17 residents in endodontics and 14 dental students) were included. The System Usability Scale (SUS) was used to evaluate usability and the Davis' technology acceptance model was used to evaluate usefulness of Endo 10 app. The Mann-Whitney test was performed to compare SUS scores between professors and undergraduate dental students and to compare questions 6 and 7 of the utility test and verify whether participants who understood that the technology was useful also better understood the concepts of endodontic diagnosis. The agreement between professor's diagnosis with the app and professor without the app, and between professor and residents in endodontics with the app were evaluated.

Results

The SUS score at the 50th percentile was 77.5, graded as acceptable. No significant difference was observed in the SUS scores when analyzing professors and dental students separately (p = 0.442). Usefulness test showed positive responses ranging between 72% - 100%. No statistically significant difference was observed between questions 6 and 7 of the utility test (p = 0.206), indicating that the group of participants who understood that the technology was useful in endodontic diagnosis was associated with the agreement that the application helped to better understand the concepts related. The diagnosis agreement between professor in the common diagnosis process and professor with app was 100% (31) of cases. The concordance between professor and residents in endodontics with the app was 71% (22) of cases. The differences were associated with resident's misinterpreting the patient's data.

Conclusions

The Endo 10 app reached the usability and usefulness requirements. It proved accurate in diagnosing pulpal and periapical pathologies. Key words:Dental education, endodontics, diagnosis, smartphone, dental informatics.

Modeling the Conversation with Digital Health Assistants in Adherence Apps: Some Considerations on the Similarities and Differences with Familiar Medical Encounters

Digital health assistants (DHAs) are conversational agents incorporated into health systems' interfaces, exploiting an intuitive interaction format appreciated by the users. At the same time, however, their conversational format can evoke interactional practices typical of health encounters with human doctors that might misguide the users. Awareness of the similarities and differences between novel mediated encounters and more familiar ones helps designers avoid unintended expectations and leverage suitable ones. Focusing on adherence apps, we analytically discuss the structure of DHA-patient encounters against the literature on physician-patient encounters and the specific affordances of DHAs. We synthesize our discussion into a design checklist and add some considerations about DHA with unconstrained natural language interfaces.

Digital Therapeutics (DTx) Expand Multimodal Treatment Options for Chronic Low Back Pain: The Nexus of Precision Medicine, Patient Education, and Public Health

Digital therapeutics (DTx, software as a medical device) provide personalized treatments for chronic diseases and expand precision medicine beyond pharmacogenomics-based pharmacotherapies. In this perspective article, we describe how DTx for chronic low back pain (CLBP) can be integrated with pharmaceutical drugs (e.g., NSAIDs, opioids), physical therapy (PT), cognitive behavioral therapy (CBT), and patient empowerment. An example of an FDA-authorized DTx for CLBP is RelieVRx, a prescription virtual reality (VR) app that reduces pain severity as an adjunct treatment for moderate to severe low back pain. RelieVRx is an immersive VR system that delivers at-home pain management modalities, including relaxation, self-awareness, pain distraction, guided breathing, and patient education. The mechanism of action of DTx is aligned with recommendations from the American College of Physicians to use non-pharmacological modalities as the first-line therapy for CLBP. Herein, we discuss how DTx can provide multimodal therapy options integrating conventional treatments with exposome-responsive, just-in-time adaptive interventions (JITAI). Given the flexibility of software-based therapies to accommodate diverse digital content, we also suggest that music-induced analgesia can increase the clinical effectiveness of digital interventions for chronic pain. DTx offers opportunities to simultaneously address the chronic pain crisis and opioid epidemic while supporting patients and healthcare providers to improve therapy outcomes.

Evaluation of mobile applications focused on the care of patients with anxiety disorders: A systematic review in app stores in Brazil

OBJECTIVE

To identify and evaluate the quality of mobile apps available in Brazil focused on the care of patients with anxiety disorders.

METHODS

A comprehensive search was conducted until October 2021 on Play Store (Android) and Apple Store (iOS) in Brazil, using the terms "anxiety," "phobia," "panic attack," and "social phobia." Two independent authors identified the apps and performed data extraction and quality assessment using the Mobile App Rating Scale (MARS). Pearson's correlation was used to analyze the relationship between user star rating and the quality defined by the MARS instrument.

RESULTS

A total of 3,278 potential apps were identified, of which 71 fully met the eligibility criteria. Most apps were made available on the Play Store (91.74%), in English (69.01%), and updated in the last two years (90.14%). Approximately half of the apps (50.70%) did not inform the developer's country and most of them did not report the user star rating (70.42%). The target population was indicated as free by most apps (85.92%), with generalized anxiety disorder being the most addressed disorder (74.65%), followed by panic disorder (33.80%). The three main purposes of the apps were education (83.10%), self-assessment (38.03%), and meditation/breathing (32.39%). Only 31 apps (43.66%) had acceptable quality (above 3.0) and the average total MARS quality score of 2.93 (2.20 to 3.90), with the functionality section receiving the highest score (3.90) and the lowest scoring sections being engagement (2.16). The apps that were rated stars by users (29.58%) showed a negative Pearson correlation (ρ = -0.100), evidencing a difference in the user's evaluation and that performed using the MARS instrument.

CONCLUSION

Gaps in the quality of apps focused on the care of patients with anxiety disorders were evidenced since most were classified as having low quality through the MARS instrument. Thus, users are recommended to use these apps with caution.

Immunization of Solid Organ Transplant Candidates and Recipients: A 2022 Update

Immunizations are a relatively safe and cost-effective intervention to prevent morbidity and mortality associated with vaccine preventable infection (VPIs). As such, immunizations are a critical part of the care of pre and posttransplant patients and should be prioritized. New tools are needed to continue to disseminate and implement the most up-to-date vaccine recommendations for the SOT population. These tools will help both primary care providers and multi-disciplinary transplant team members taking care of transplant patients to stay abreast of evidence-based best practices regarding the immunization of the SOT patient.

Features of Cancer mHealth Apps and Evidence for Patient Preferences: Scoping Literature Review

BACKGROUND

Cancer is increasingly being treated as a chronic disease rather than an acute one-time illness. Additionally, oral anticancer therapies, as opposed to intravenous chemotherapy, are now available for an increasing number of cancer indications. Mobile health (mHealth) apps for use on mobile devices (eg, smartphones or tablets) are designed to help patients with medication adherence, symptom tracking, and disease management. Several previous literature reviews have been conducted regarding mHealth apps for cancer. However, these studies did not address patient preferences for the features of cancer mHealth apps.

OBJECTIVE

The primary aim was to review the scientific literature that describes the features and functions of mHealth apps designed for cancer self-management.

METHODS

As the purpose of this review was to explore the depth and breadth of research on mHealth app features for cancer self-management, a scoping review methodology was adopted. Four databases were used for this review: PubMed/MEDLINE, Embase, CINAHL, and PsycINFO. Citation and reference searches were conducted for manuscripts meeting the inclusion criteria. A gray literature search was also conducted. Data extracted from manuscripts included author, title, publication date, study type, sampling type, cancer type, treatment, age of participants, features, availability (free or subscription), design input, and patient preferences. Finally, the features listed for each app were compared, highlighting similarities across platforms as well as features unique to each app.

RESULTS

After the removal of duplicates, 522 manuscripts remained for the title and abstract review, with 51 undergoing full-text review. A total of 7 manuscripts (referred to as studies hereafter) were included in the final scoping review. App features described in each study varied from 2 to 11, with a median of 4 features per app. The most reported feature was a symptom or side effect tracker, which was reported in 6 studies. Two apps specified the inclusion of patients and health care providers during the design, while 1 app noted that IT and communications experts provided design input. The utility of the apps for end users was measured in several ways, including acceptability (measuring the end users' experience), usability (assessing the functionality and performance by observing real users completing tasks), or qualitative data (reports from end users collected from interviews or focus groups).

CONCLUSIONS

This review explored the literature on cancer mHealth apps. Popular features within these mHealth apps include symptom trackers, cancer education, and medication trackers. However, these apps and features are often developed with little input from patients. Additionally, there is little information regarding patient preferences for the features of existing apps. While the number of cancer-related apps available for download continues to increase, further exploration of patient preferences for app features could result in apps that better meet patient disease self-management needs.

Evaluation criteria for health apps supporting medication adherence in early-stage technology development - a scoping review

Introduction

Health apps offer an approach to improve the patients' management of their medication. Although the Digital Healthcare Act (DVG) has created a claim in the statutory health insurance (SHI), the large number of health apps available and their varying quality make it difficult for service providers and especially for medical laypersons to select an adequate high-quality medication app. Manufacturers need guidance for the development of high-quality apps right from the start. Various general evaluation concepts for health apps have been available to date. However, the requirements that should be met by healthcare depend largely on the field of application and the type of apps. This article aims to provide an overview of the international evidence on specific criteria for the evaluation of medication apps.

Methods

Within the framework of a scoping review, a systematic search was conducted in PubMed and EMBASE on January 29, 2020. The search was limited to publications from 2007 onwards as well as to English and German articles. Additionally, a semi-systematic research of reference lists of the previously included articles as well as a structured search of websites of relevant stakeholders were conducted. Inclusion criteria were the following: the publication deals with health apps that can be used on smartphones and focus on supporting medication intake; the publication does not refer to evaluation criteria for a single app exclusively. The included publications were examined in a qualitative content analysis searching for evaluation criteria and categorizing them according to the framework criteria of the DVG and the Digital Health Applications Ordinance (DiGAV).

Results

2,542 articles were identified in the systematic search (999 in PubMed, 1,543 in EMBASE, 560 duplicates). A total of 16 studies met the inclusion criteria. The semi-systematic research and the structured search identified one further study. A catalog of criteria was developed based on the included 17 studies. This catalog covers the general topics "patient orientation" (data protection and security, consumer protection, user friendliness) and "quality/core functions of medication apps" (reminder, self-monitoring, (drug) information, motivation to change behavior, drug/patient safety, robustness) as well as "interoperability/cooperation". Due to its specific importance for medication apps, the subcategory "motivation for behavioral change" stands out beneath the general topic "quality/core functions of medication apps". This category aims to evaluate the design of individual functions with regard to their potential to actually change the behavior of app users.

Discussion

The criteria for the evaluation of health apps mentioned in the DiGAV intersected with the criteria identified in the literature research. However, the area of positive health care effects was hardly covered by the included studies. In the development of the criteria catalog, it was not possible to weight the identified criteria. Therefore, the catalog should be understood as a supporting checklist for service providers, manufacturers, and/or users.

Conclusions

A large variety of possible evaluation criteria for medication apps could be shown. Future research should focus on the possibilities of weighting these diverse evaluation criteria, using not only clinical studies but also methods to identify preferences.

Mobile Apps to Improve Brace-Wearing Compliance in Patients with Idiopathic Scoliosis: A Quality Analysis, Functionality Review and Future Directions

This study was performed to review which mHealth apps that improve brace-wearing compliance are currently available, and to carry out their quality assessments by listing their functionalities. We found ten mHealth apps in the literature review and commercial mHealth apps market (Google Play and App store). Then, the quality of these apps was evaluated by their transparency, health content, excellent technical content, security/privacy, issues of usability, and subjective ratings (THESIS) scale, and the functionalities of the included apps were reviewed. Regarding these functionalities, four categories (data acquisition, compliance enhancement, educational components, and additional functionalities) and twelve subcategories were identified. The mean overall quality of the apps was 3.00 out of 5. Although four of the apps achieved a score of 3.0 or more for their overall quality, indicating an acceptable quality, none of the apps scored higher than 4.0, which indicated a high or excellent quality. According to the sections, the transparency section had the highest rating (3.92) and the security/privacy section received the lowest rating (2.02). Given that the overall quality of current mHealth apps was not high, and their potential to motivate patients with idiopathic scoliosis to adhere to their bracing treatment, it is necessary to develop high-quality apps with appropriate functionalities for supporting brace treatment.

A Comparison of Innovative App-Based Prescriptions With Conventional Prescriptions for Children by General Dentists: A Mixed Methods Study

Introduction Writing drug prescriptions for children with accurate drug dosages and clear instructions is a must for general dentists. A digital tool in the form of a software application (app) to write, save and share prescriptions can potentially overcome the possible limitations of handwritten prescriptions such as handwriting illegibility, errors in calculations, and incomplete descriptions. However, it is also important to assess the satisfaction of dentists with making prescriptions using a digital tool such as an android application. A mixed methods study comparing an innovative "app-based" and handwritten prescriptions in dental settings is presented. Methodology An indigenously developed and piloted app "PREscribing children made EASY (PREASY)" was used in this study. Based on the preliminary study, a sample size of 20 was found to be adequate. Twenty-two dentists participated in the study. The conventional handwritten and an Android app PREASY-based prescriptions were compared in terms of the time taken, precision of writing, and satisfaction of the dentists. Qualitative feedback regarding the PREASY app was obtained in Google Forms (Google, Inc., Mountain View, CA, USA). Results A study sample of 20 subjects was calculated based on a pilot study, and 22 dentists were recruited. The mean time taken in seconds for handwritten prescriptions (199.14 (+ 59.18)) was almost four times higher than that for app-based prescriptions (52.05 (+ 23.89)) (t-test, P < 0.00001). The accuracy of handwritten prescriptions versus app-based prescriptions was compared by two examiners independently using analysis of variance (ANOVA) in three domains: dosage accuracy, legible handwriting, and completeness of instructions, the differences (Domain 1 mean + SD: 1.04 + 0.89, Domain 2 mean + SD: 1.38 + 0.40, Domain 3 mean + SD: 0.88 + 0.58) being statistically significant (P < 0.05). The differences in the percentages of the three domains (dosage accuracy: 40.9%, legibility of handwriting: 63.6%, completeness of instructions: 18.1%) were found to be statistically significant (P < 0.05; chi-squared statistic, 9.4017). Of the participants, 59% were very satisfied, 36.3% were satisfied, and 4.5% were neutral (chi-squared test, P < 0.00001). Participants' feedback/comments were categorized under technical suggestions, dosage suggestions, criticism, and positive remarks and were thematically analyzed. Conclusion App-based prescriptions proved to be more instantaneous and detailed than handwritten ones with the majority of dentists satisfied. Valuable feedback pertaining to the limitations of the tool was obtained for improving the app. PREASY-based prescriptions could be recommended for prescribing to pediatric dental patients.

A pilot project investigating the use of ONCOpatient®-An electronic patient-reported outcomes app for oncology patients

Purpose

To investigate the feasibility of implementing a remote patient monitoring system using an electronic patient-reported outcomes (ePROs) platform in a tertiary cancer center in the Republic of Ireland.

Methods

Patients receiving oral chemotherapy and oncology clinicians were invited to participate in the study. Patients were asked to submit weekly symptom questionnaires through an ePRO mobile phone application (app)-ONCOpatient®. Clinical staff were invited to use the ONCOpatient® clinician interface. After 8 weeks all participants submitted evaluation questionnaires.

Results

Thirteen patients and five staff were enrolled in the study. The majority of patients were female (85%) with a median age of 48 years (range 22-73). Most (92%) were enrolled over telephone requiring on average 16 minutes. Compliance with the weekly assessments was 91%. Alerts were triggered by 40% of patients who then required phone calls to aid with symptom management. At the end of study, 87% of patients reported they would use the app frequently, 75% reported that the platform met their expectations, and 25% that it exceeded their expectations. Similarly, 100% of staff reported they would use the app frequently, 60% reported that it met their expectations, and 40% that it exceeded their expectations.

Conclusions

Our pilot study showed that it is feasible to implement ePRO platforms in the Irish clinical setting. Small sample bias was recognized as a limitation, and we plan to confirm our findings on a larger cohort of patients. In the next phase we will integrate wearables including remote blood pressure monitoring.

Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study

BACKGROUND

Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors.

OBJECTIVE

With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy.

METHODS

The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform.

RESULTS

The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users.

CONCLUSIONS

Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population.

A smartphone app to improve the safety of patients undergoing treatment with oral antineoplastic agents: 4 years of experience in a university hospital

Objective

This study aims to analyze the impact of the eOncosalud app on the management and follow-up of adverse effects (AE) in patients receiving oral antineoplastic agents.

Material and methods

We performed an observational, prospective study of cancer outpatients treated with oral antineoplastic agents (OAA), monitored by the eOncosalud app between August 2017 and October 2021. Safety variables were collected from eOncosalud: the number of AE; severity of the AE according to CTCAE, version 4.03; timelapse from app installation to first recorded AE; automatic recommendations issued; and the patient's acceptance of the recommendations made. To assess the impact of the recommendations generated by the algorithm, we calculated the positive predictive value (PPV) as the number of recommendations accepted out of the total number of recommendations generated. Safety-related patient messages were also analyzed (AE, drug-drug interactions, drug administration).

Result

The app was downloaded and used by 186 patients (58.0% women), with a mean age of 59.0 years. A total of 1,368 AE were recorded, the most frequent being fatigue (19.37%), diarrhea (18.20%), and skin changes (9.21%). Regarding the recommendations issued by the app algorithm, 102 patients received 344 information brochures, 39 patients received 51 recommendations for supportive care to control AE, 60 patients received 240 recommendations to visit their primary care doctor, 14 patients received 16 recommendations to contact their specialist pharmacist or oncologist-hematologist, and 34 patients received 73 recommendations to go to the emergency room. The suggestion to go to the emergency room and contact the specialist pharmacist or oncologist-hematologist had a PPV of 0.51 and 0.35, respectively. Half of the patients (50.4%) used the messaging module. A total of 1,668 messages were sent. Of these, 47.8% were related to treatment safety: AE, 22.7%; drug-drug interactions, 20.6%; drug administration, 3.6%; and missing a dose, 1.0%.

Conclusions

The eOncosalud app enables close, real-time monitoring of patients treated with OAA. The automatic recommendations through the app's algorithm have optimized available healthcare resources. The app facilitated early detection of AE, thus enabling patients themselves to improve the safety of their treatment.

The effects of information platform-based nursing on preventing venous thromboembolism in patients with hip fractures

PURPOSE

Venous thromboembolism (VTE) is a major health issue among hip fracture patients. This study aimed to develop an information platform based on a mobile application and then evaluate whether information platform-based nursing could improve patient's drug compliance and reduce the incidence of VTE in hip fracture patients.

METHODS

This study retrospectively analyzed hip fracture patients who were treated with conventional prevention and intervention methods for VTE (control group) between January 2008 and November 2012, and prospectively analyzed hip fracture patients who were treated with nursing intervention based on the information platform (study group) between January 2016 and September 2017. All the patients included in the both groups were hip fracture patients who had an age over 50 years, treated with surgery, and hospitalized ≥ 48 h. Patients were excluded if they admitted to hospital due to old fractures, had a severe bleeding after 72 h of admission, diagnosed with any type of VTE, or refused to participate in the study. The information platform was divided into medical, nursing, and patient interface. Based on the information platform, medical practitioners and nurses could perform risk assessments, monitoring management and early warnings, preventions and treatments, health educations, follow-up, and other aspects of nursing interventions for patients. This study compared essential characteristics, drug compliance, VTE occurrence, and mean length of hospitalization between the two groups. Besides, a subgroup analysis was performed in the study group according to different drug compliances. SPSS 18.0 software (IBM Corp., NY, and USA) was used for statistical analysis.

RESULTS

Altogether 1177 patients were included in the control group, and 491 patients in the study group. Regarding baseline data, patients in the study group had more morbidities than those in the control group (p < 0.05). The difference of drug compliance between the two groups was statistically significant (p < 0.001): 761 (64.7%) of the patients in the control group and only 30 (6.1%) patients in the study group had poor drug compliance. In terms of VTE, 10.7% patients (126/1177) in the control group had VTE, and the rate in the study group was 7.1% (35/491), showing a statistically significant difference (p = 0.02). Moreover, the average length of hospitalization in the study group was also significantly lower than that in the control group (10.4 days vs. 13.7 days, p < 0.001). Subgroup analyses of the study group showed that the incidence of VTE in patients with poor, partial, and good compliances were 56.7% (17/30), 5.8% (10/171), and 2.8% (8/290), respectively, revealing a significantly huge difference (p < 0.001).

CONCLUSIONS

Poor drug compliance leads to higher VTE occurrence. The information platform-based nursing can effectively improve the compliance of hip fracture patients and thus considerably reduce the incidence of VTE. The mobile application may be an effective tool to prevent VTE in hip fracture patients.

Separating Features From Functionality in Vaccination Apps: Computational Analysis

BACKGROUND

Some latest estimates show that approximately 95% of Americans own a smartphone with numerous functions such as SMS text messaging, the ability to take high-resolution pictures, and mobile software apps. Mobile health apps focusing on vaccination and immunization have proliferated in the digital health information technology market. Mobile health apps have the potential to positively affect vaccination coverage. However, their general functionality, user and disease coverage, and exchange of information have not been comprehensively studied or evaluated computationally.

OBJECTIVE

The primary aim of this study is to develop a computational method to explore the descriptive, usability, information exchange, and privacy features of vaccination apps, which can inform vaccination app design. Furthermore, we sought to identify potential limitations and drawbacks in the apps' design, readability, and information exchange abilities.

METHODS

A comprehensive codebook was developed to conduct a content analysis on vaccination apps' descriptive, usability, information exchange, and privacy features. The search and selection process for vaccination-related apps was conducted from March to May 2019. We identified a total of 211 apps across both platforms, with iOS and Android representing 62.1% (131/211) and 37.9% (80/211) of the apps, respectively. Of the 211 apps, 119 (56.4%) were included in the final study analysis, with 42 features evaluated according to the developed codebook. The apps selected were a mix of apps used in the United States and internationally. Principal component analysis was used to reduce the dimensionality of the data. Furthermore, cluster analysis was used with unsupervised machine learning to determine patterns within the data to group the apps based on preselected features.

RESULTS

The results indicated that readability and information exchange were highly correlated features based on principal component analysis. Of the 119 apps, 53 (44.5%) were iOS apps, 55 (46.2%) were for the Android operating system, and 11 (9.2%) could be found on both platforms. Cluster 1 of the k-means analysis contained 22.7% (27/119) of the apps; these were shown to have the highest percentage of features represented among the selected features.

CONCLUSIONS

We conclude that our computational method was able to identify important features of vaccination apps correlating with end user experience and categorize those apps through cluster analysis. Collaborating with clinical health providers and public health officials during design and development can improve the overall functionality of the apps.

The Effect of Mobile Health (m-Health) Education Based on WANTER Application on Knowledge, Attitude, and Practice (KAP) Regarding Anemia among Female Students in a Rural Area of Indonesia

Female students, as adolescent girls, are more at risk of anemia because of high nutritional requirements. Health education through mobile applications influences the knowledge, attitude, and practice (KAP) of anemia in adolescent girls. Based on our previous study, several adolescents experienced anemia. This study aims to analyze the effect of health education through mobile applications, namely the WANTER application, on increasing KAP. This study was quasi-experimental with a pretest−posttest design; the sample was divided into an intervention (WANTER application) and a control group (booklet). The study was conducted in a rural area of Indonesia. There were 162 adolescent girls included in the intervention group and as many as 115 adolescent girls in the control group. Our study showed that adolescents’ knowledge and attitude increased significantly in three months after the intervention of WANTER and booklets toward preventing anemia with p < 0.001; however, there was no significant difference in KAP between the control and intervention groups. In addition, there was no improvement in practice, either in the control or intervention groups. Knowledge, attitudes, and practices to prevent anemia need to be continuously improved. Health education through appropriate media for adolescents is very important to make interventions more effective.

A smartphone application to improve adherence to vitamin and mineral supplementation after bariatric surgery

OBJECTIVE

This trial evaluated a smartphone application's effectiveness in improving adherence to vitamin and mineral supplementation postoperatively.

METHODS

This study was a randomized controlled trial comprising 140 patients undergoing bariatric surgery (gastric bypass or sleeve gastrectomy). Participants were randomized 1:1 to the 12-week intervention, using the smartphone application PromMera, or to standard care. The primary end point was adherence to vitamin and mineral supplementation.

RESULTS

Initiation rate and overall adherence to supplementation were high in both groups. Change in objectively measured adherence rate from before the intervention to 1 year post surgery, measured with pharmacy refill data, did not differ between groups for vitamin B₁₂ (-9.6% [SD = 27%] vs. -9.3% [SD = 30%]; p = 0.48) or calcium/vitamin D (-12.3% [SD = 29%] vs. -11.5% [SD = 32%]; p = 0.44). A modest effect on the secondary end point (subjectively measured adherence, using the Medication Adherence Report Scale-5) was seen immediately after the intervention (intervention group 0.00 [SD = 1.3] vs. control group -1.2 [SD = 3.5]; p = 0.021), but this effect did not persist 1 year post surgery. No differences were detected in the prevalence of biochemical deficiencies.

CONCLUSIONS

The use of the smartphone application PromMera did not obtain a lasting improvement in adherence to vitamin and mineral supplementation 1 year post bariatric surgery.

Mobile medical applications’ state quo and underlying barriers: review of literature†

Objective

To explore the current development and challenges regarding mobile medical applications (mmAPPs), so as to provide reference for application function elevation and quality improvement.

Methods

We retrieved literature databases like Web of Science, PubMed, China National Knowledge Infrastructure, Wanfang, China Biomedical Network, time limit was from January 1, 2010 to December 31, 2021, and restricted to the Chinese or English language.

Results

This study concluded with the following six aspects: Domestic and foreign development of mmAPP, reminder function, barriers and challenges (low quality; slow update rate; lack of standard evaluation tool or criterion), privacy and safety concerns, adverse drug event report state (low report rate-related reasons, different countries’ report policies), and current hindrances in the progression (economic worries; personal education level; acceptance and study of technology; rural districts, and low-income countries).

Conclusions

We should focus on the application's quality elevation rather than quantity, pay more attention to patients’ adverse drug event reports, privacy and safety, and place emphasis on rural districts and low-income countries.

Attitude and Needs Toward MTM Applications of Chronic Disease in China: A Questionnaire Survey

Objective

Chronic diseases are characterized by high incidence, long-term medication, and complex types of medication. There are also many corresponding medication therapy management (MTM) applications on the market, such as iCarea, and Medisafe. However, the existing research mainly focuses on how to choose high-quality MTM applications, and few researchers consider the expectations of MTM applications from potential users. The aims of this study were to investigate the demand, attitude, and expectations of the Chinese patients for the MTM applications to support.

Methods

From August 2019 to December 2019, we created a questionnaire to have knowledge of user needs, preferences, and expectations for MTM applications among 302 chronic patients in Hunan, Guangdong, and other provinces in China. Logistic regression analysis was performed to analyze the risk factors of affecting patients' attitudes toward MTM applications. Then, respondents' expectations and preferences for MTM applications were statistically analyzed. The survey data were merged to provide information for the design of targeted chronic disease MTM applications.

Results

A total of 260 (86.09%) out of 302 patients the respondents were willing to use the MTM applications of chronic disease. The independent influencing factors for using the MTM applications were long-term medication history (OR = 4.45, P &lt; 0.001), willing to learn about medicine knowledge (OR = 3.01, P = 0.04), and wanting to get more professional medication knowledge via Internet (OR = 2.86, P = 0.005). It was worth noting that among those willing to use MTM applications, 55.00% of respondents were willing to use the WeChat applet for MTM, while only 23.46% of respondents preferred other applications. As to the more prevalent WeChat applet for MTM, the majority of participants expected the inclusion of useful modules, such as medication log (62.81%), medication reminder (62.81%), and medication recommendations (57.79%).

Conclusion

The participants are willing to use MTM applications of chronic disease, with a preference for the WeChat applet. Patients tended to use MTM applications if they had a long-term medication history or a desire for medical knowledge, especially if they want to get more professional medication knowledge via the Internet. Participants are expected to include in the WeChat applet as medication logs, medication reminders, and medication recommendations which should be taken into serious account for the further development of MTM applications.

Design and implementation of a mobile app for the pharmacotherapeutic follow-up of patients diagnosed with immune-mediated inflammatory diseases: eMidCare

Background

Pharmacotherapeutic management of immune-mediated inflammatory diseases (IMID) has become more complex due to the development of new treatments, such as biological therapies. Mobile health, especially apps, can provide IMID patients with greater autonomy and facilitate communication with healthcare professionals. Our objective was to design and implement an app for remote monitoring and communication with IMID patients.

Methods

A multidisciplinary group was created to design and develop an app for IMID patients in a tertiary hospital. The app functionalities were identified through a focus group with IMID patients and through an observational, descriptive study of available apps for IMID patients at App Store and Play Store platforms. Once the app was designed and developed, we offered the app to IMID patients who initiated a new biological therapy. The inclusion period was from December 2020 to August 2021. We performed an observational, longitudinal study to assess the app’s impact on medication safety, communication, satisfaction, and usability.

Results

We designed an app (eMidCare®) with the following modules: My Medication, My Questionnaires, Adverse Events, Useful Information, Messages, and Patient Profile. A total of 85 patients were installed with the app. The median (range) follow-up time for app use was 123 (5-270) days. In the My Medication module, 100% of patients registered their biological therapy and 25.9% also used this module to record each dose of medication administered. A total of 82 adverse events (AEs) were registered. Thirty-two percent of the patients registered at least 1 AE. The most frequent AEs were fatigue, injection site reaction, headache, and nausea. Fifty-two percent of patients used the Messages module to communicate with healthcare professionals. The most frequent messages concerned doubts about managing AEs (26.2%) and drug interactions (18.9%). The satisfaction survey yielded a median (range) score of 9.1 (7-10) out of 10.

Conclusions

We developed an app, eMidCare®, which reminds patients to take their medication, enables them to record AEs, and helps them communicate with healthcare professionals. Approximately one-third of the patients registered the administration of the biological therapies and registered at least 1 AE. The most used and most satisfactory functionality was communication with health professionals.

Co-created Mobile Apps for Palliative Care Using Community-Partnered Participatory Research: Development and Usability Study

Background

Open design formats for mobile apps help clinicians and stakeholders bring their needs to direct, co-creative solutions. Palliative care for patients with advanced cancers requires intensive monitoring and support and remains an area in high need for innovation.

Objective

This study aims to use community-partnered participatory research to co-design and pretest a mobile app that focuses on palliative care priorities of clinicians and patients with advanced cancer.

Methods

In-person and teleconference workshops were held with patient and family stakeholders, researchers, and clinicians in palliative care and oncology. Question prompts, written feedback, semistructured interviews, and facilitated group discussions identified the core palliative care needs. Using Chorus, a no-code app-building platform, a mobile app was co-designed with the stakeholders. A pretest with 11 patients was conducted, with semistructured interviews of clinician and patient users for feedback.

Results

Key themes identified from the focus groups included needs for patient advocacy and encouragement, access to vetted information, patient-clinician communication support, and symptom management. The initial prototype, My Wellness App, contained a weekly wellness journal to track patient-reported symptoms, goals, and medication use; information on self-management of symptoms; community resources; and patient and caregiver testimonial videos. Initial pretesting identified value in app-based communication for clinicians, patients, and caregivers, with suggestions for improving user interface, feedback and presentation of symptom reports, and gamification and staff coordinators to support patient app engagement.

Conclusions

The development of a mobile app using community-partnered participatory research is a low-technology and feasible intervention for palliative care. Iterative redesign and user interface expertise may improve implementation.

Oral-Hygiene-Related Mobile Apps in the French App Stores: Assessment of Functionality and Quality

Mobile health apps can contribute to increased quality of individual oral hygiene behaviors. This study provides an overview and an evaluation of quality of oral-hygiene-related mobile apps currently available in Google Play Store and the French Apple App. A shortlist of nine apps was assessed by 10 oral health professionals using the Mobile App Rating Scale. Intraclass correlation was used to evaluate interrater agreement. Best quality scores were obtained by Oral-B (3.4 ± 0.97), Colgate Connect (3.20 ± 0.63), and Preventeeth (3.10 ± 1.1) and worst ones by Mimizaur se brosse les dents (1.80 ± 0.79) and Kolibree (2.30 ± 0.82). The subjective quality scores ranged from 2.62 ± 0.61 (Oral-B) to 1.5 ± 0.61 (MSD). Specificity of the content ranged from 3.46 ± 0.84 (Preventeeth) to 1.78 ± 0.47 (Mimizaur se brosse les dents). Thus, even if oral health professionals positively evaluated the quality of oral-hygiene-related mobile apps, they are less assertive concerning their impact on the user's knowledge, attitudes, and intentions to change, as well as the likelihood of actual change in the oral hygiene behavior. Further investigations are needed to assess whether information from these apps is consistent with oral hygiene recommendations and to determine the long-term impacts of these apps.

Adopting wearables to customize health insurance contributions: a ranking-type Delphi

Background

Wearables, as small portable computer systems worn on the body, can track user fitness and health data, which can be used to customize health insurance contributions individually. In particular, insured individuals with a healthy lifestyle can receive a reduction of their contributions to be paid. However, this potential is hardly used in practice.

Objective

This study aims to identify which barrier factors impede the usage of wearables for assessing individual risk scores for health insurances, despite its technological feasibility, and to rank these barriers according to their relevance.

Methods

To reach these goals, we conduct a ranking-type Delphi study with the following three stages. First, we collected possible barrier factors from a panel of 16 experts and consolidated them to a list of 11 barrier categories. Second, the panel was asked to rank them regarding their relevance. Third, to enhance the panel consensus, the ranking was revealed to the experts, who were then asked to re-rank the barriers.

Results

The results suggest that regulation is the most important barrier. Other relevant barriers are false or inaccurate measurements and application errors caused by the users. Additionally, insurers could lack the required technological competence to use the wearable data appropriately.

Conclusion

A wider use of wearables and health apps could be achieved through regulatory modifications, especially regarding privacy issues. Even after assuring stricter regulations, users’ privacy concerns could partly remain, if the data exchange between wearables manufacturers, health app providers, and health insurers does not become more transparent.

Mobile Health Apps Providing Information on Drugs for Adult Emergency Care: Systematic Search on App Stores and Content Analysis

Background

Drug-referencing apps are among the most frequently used by emergency health professionals. To date, no study has analyzed the quantity and quality of apps that provide information on emergency drugs.

Objective

This study aimed to identify apps designed to assist emergency professionals in managing drugs and to describe and analyze their characteristics.

Methods

We performed an observational, cross-sectional, descriptive study of apps that provide information on drugs for adult emergency care. The iOS and Android platforms were searched in February 2021. The apps were independently evaluated by 2 hospital clinical pharmacists. We analyzed developer affiliation, cost, updates, user ratings, and number of downloads. We also evaluated the main topic (emergency drugs or emergency medicine), the number of drugs described, the inclusion of bibliographic references, and the presence of the following drug information: commercial presentations, usual dosage, dose adjustment for renal failure, mechanism of action, therapeutic indications, contraindications, interactions with other medicinal products, use in pregnancy and breastfeeding, adverse reactions, method of preparation and administration, stability data, incompatibilities, identification of high-alert medications, positioning in treatment algorithms, information about medication reconciliation, and cost.

Results

Overall, 49 apps were identified. Of these 49 apps, 32 (65%) were found on both digital platforms; 11 (22%) were available only for Android, and 6 (12%) were available only for iOS. In total, 41% (20/49) of the apps required payment (ranging from €0.59 [US $0.64] to €179.99 [US $196.10]) and 22% (11/49) of the apps were developed by non–health care professionals. The mean weighted user rating was 4.023 of 5 (SD 0.71). Overall, 45% (22/49) of the apps focused on emergency drugs, and 55% (27/49) focused on emergency medicine. More than half (29/47, 62%) did not include bibliographic references or had not been updated for more than a year (29/49, 59%). The median number of drugs was 66 (range 4 to >5000). Contraindications (26/47, 55%) and adverse reactions (24/47, 51%) were found in only half of the apps. Less than half of the apps addressed dose adjustment for renal failure (15/47, 32%), interactions (10/47, 21%), and use during pregnancy and breastfeeding (15/47, 32%). Only 6% (3/47) identified high-alert medications, and 2% (1/47) included information about medication reconciliation. Health-related developer, main topic, and greater amount of drug information were not statistically associated with higher user ratings (P=.99, P=.09, and P=.31, respectively).

Conclusions

We provide a comprehensive review of apps with information on emergency drugs for adults. Information on authorship, drug characteristics, and bibliographic references is frequently scarce; therefore, we propose recommendations to consider when developing an app of these characteristics. Future efforts should be made to increase the regulation of drug-referencing apps and to conduct a more frequent and documented review of their clinical content.

A large-scale group decision making method to select the ideal mobile health application for the hospital

Mobile health, which is not limited by time and space, can effectively alleviate the imbalance of medical resources. Currently, more and more hospitals begin to pay attention to online medical care and actively expand their mobile channels. Among of which, the cooperation with the third-party platform is an effective way to expand the online services of most hospitals. With the increasing number of mobile health applications (mHealth apps), it is difficult to select the ideal application. Most of the existing studies on mHealth app selection are conducted from the perspective of users who have health needs, which is insufficient. The views of multiple stakeholders should be taken into account. mHealth app selection can be regarded as a large-scale group decision making (LSGDM) problem. In this paper, a hybrid LSGDM method is proposed to select the mHealth app with the highest user satisfaction. First, the weights of criteria are obtained based on quality function deployment and 2-additive measure. Furthermore, a consensus model that considers cooperative and non-cooperative behaviors of decision makers is applied to select the ideal mHealth app. Finally, an illustrative example is implemented to exhibit the utility and validity of the proposed model.

The Characteristics and Functionalities of Mobile Apps Aimed at Patients Diagnosed With Immune-Mediated Inflammatory Diseases: Systematic App Search

Background

Immune-mediated inflammatory diseases (IMIDs) are systemic conditions associated with a high social and health impact. New treatments have changed the prognosis of IMIDs and have increased patient autonomy in disease management. Mobile apps have enormous potential to improve health outcomes in patients with IMIDs. Although a large number of IMID apps are available, the app market is not regulated, and functionality and reliability remain uncertain.

Objective

Our aims are to review available apps for patients with IMIDs or caregivers and to describe the main characteristics and functionalities of these apps.

Methods

We performed an observational, cross-sectional, descriptive study of all apps for patients with IMIDs. Between April 5 and 14, 2021, we conducted a search of the App Store (iOS) and Play Store (Android) platforms. We used the names of the different IMIDs as search terms. The inclusion criteria were as follows: content related to IMIDs, English or Spanish language, and user population consisting of patients and health care consumers, including family and caregivers. The variables analyzed were as follows: app name, type of IMID, platform (Android or iOS), country of origin, language, category of the app, cost, date of the last update, size, downloads, author affiliation, and functionalities.

Results

We identified 713 apps in the initial search, and 243 apps met the criteria and were analyzed. Of these, 37% (n=90) were on Android, 27.2% (n=66) on iOS, and 35.8% (n=87) on both platforms. The most frequent categories were health and well-being/fitness apps (n=188, 48.5%) and medicine (n=82, 37.9%). A total of 211 (82.3%) apps were free. The mean time between the date of the analysis and the date of the most recent update was 18.5 (SD 19.3) months. Health care professionals were involved in the development of 100 (41.1%) apps. We found differences between Android and iOS in the mean time since the last update (16.2, SD 14.7 months vs 30.3, SD 25.7 months) and free apps (85.6% vs 75.8%; respectively). The functionalities were as follows: general information about lifestyles, nutrition, or exercises (n=135, 55.6%); specific information about the disease or treatment (n=102, 42%); recording of symptoms or adverse events (n=51, 21%); agenda/calendar (n=44, 18.1%); reminder medication (n=41, 16.9%); and recording of patient-reported outcomes (n=41, 16.9%). A total of 147 (60.5%) apps had more than one functionality.

Conclusions

IMID-related apps are heterogeneous in terms of functionality and reliability. Apps may be a useful complement to IMID care, especially inpatient education (their most frequent functionality). However, more than half of the IMID apps had not been developed by health care professionals or updated in the last year.

The Impact of Using mHealth Apps on Improving Public Health Satisfaction during the COVID-19 Pandemic: A Digital Content Value Chain Perspective

The use of mobile technology and equipment has been found to be successful in the governance of public health. In the context of the coronavirus disease 2019 (COVID-19) pandemic, mobile health (mhealth) apps are expected to play an important role in the governance of public health. This study establishes a structural equation model based on the digital content value chain framework, identifies the main values created by mhealth apps in the prevention and control of COVID-19, and surveys 500 citizens of China. The data were analyzed using an independent t-test and partial least squares structural equations (PLS-SEM). The results showed that people who use mhealth apps are more satisfied with public health governance than those who do not; the healthcare assurance value of mhealth apps and healthcare confidence positively influence the interaction between users and mhealth app functions, the interaction with information, and the interaction with doctors to improve users’ satisfaction with public health governance; and the parasocial relationships between doctors and users of mhealth apps positively affect the interactions between users and doctors to improve users’ satisfaction with public health governance. This study confirms the potential of mhealth apps toward improving public health governance during the COVID-19 pandemic from a new perspective and provides a new theoretical basis whereby mobile technology can contribute toward improving public health governance.

Supporting Management of Noncommunicable Diseases With Mobile Health (mHealth) Apps: Experimental Study

Background

Noncommunicable diseases (NCDs) are the leading global health problem in this century and are the principal causes of death and health care spending worldwide. Mobile health (mHealth) apps can help manage and prevent NCDs if people are willing to use them as supportive tools. Still, many people are reluctant to adopt these technologies. Implementing new apps could result in earlier intervention for many health conditions, preventing more serious complications.

Objective

This research project aimed to test the factors that facilitate the adoption of mHealth apps by users with NCDs. We focused on determining, first, what user interface (UI) qualities and complexity levels appeal to users in evaluating mHealth apps. We also wanted to determine whether people prefer that the data collected by an mHealth app be analyzed using a physician or an artificial intelligence (AI) algorithm. The contribution of this work is both theoretical and practical. We examined users’ considerations when adopting mHealth apps that promote healthy lifestyles and helped them manage their NCDs. Our results can also help direct mHealth app UI designers to focus on the most appealing aspects of our findings.

Methods

A total of 347 respondents volunteered to rate 3 models of mHealth apps based on 16 items that measured instrumentality, aesthetics, and symbolism. Respondents rated each model after reading 1 of 2 different scenarios. In one scenario, a physician analyzed the data, whereas, in the other, the data were analyzed by an AI algorithm. These scenarios tested the degree of trust people placed in AI algorithms versus the “human touch” of a human physician regarding analyzing data collected by an mHealth app.

Results

As shown by the responses, the involvement of a human physician in the application had a significant effect (P<.001) on the perceived instrumentality of the simple model. The complex model with more controls was rated significantly more aesthetic when associated with a physician performing data analysis rather than an AI algorithm (P=.03).

Conclusions

Generally, when participants found a human touch in the mHealth app (connection to a human physician who they assumed would analyze their data), they judged the app more favorably. Simple models were evaluated more positively than complex ones, and aesthetics and symbolism were salient predictors of preference. These trends suggest that designers and developers of mHealth apps should keep the designs simple and pay special attention to aesthetics and symbolic value.

Mobile Apps for Hematological Conditions: Review and Content Analysis Using the Mobile App Rating Scale

Background

Hematological conditions are prevalent disorders that are associated with significant comorbidities and have a major impact on patient care. Concerning new tools for the care of these patients, the number of health apps aimed at hematological patients is growing. Currently, there are no quality analyses or classifications of apps for patients diagnosed with hematological conditions.

Objective

The aim of this study is to analyze the characteristics and quality of apps designed for patients diagnosed with hematological conditions by using the Mobile App Rating Scale (MARS).

Methods

We performed an observational, cross-sectional descriptive study of all smartphone apps for patients diagnosed with hematological conditions. A search was conducted in March 2021 using the following terms: anemia, blood cancer, blood disorder, hematological cancer, hematological malignancy, hematological tumor, hematology, hemophilia, hemorrhage, lymphoma, leukemia, multiple myeloma, thalassemia, thrombocytopenia, and thrombosis. The apps identified were downloaded and evaluated by 2 independent researchers. General characteristics were registered, and quality was analyzed using MARS scores. Interrater reliability was measured by using the Cohen κ coefficient.

Results

We identified 2100 apps in the initial search, and 4.19% (88/2100) of apps met the inclusion criteria and were analyzed. Of the 88 apps, 61% (54/88) were available on Android, 30% (26/88) were available on iOS, and 9% (8/88) were available on both platforms. Moreover, 7% (6/88) required payment, and 49% (43/88) were updated in the last year. Only 26% (23/88) of the apps were developed with the participation of health professionals. Most apps were informative (60/88, 68%), followed by preventive (23/88, 26%) and diagnostic (5/88, 6%). Most of the apps were intended for patients with anemia (23/88, 26%). The mean MARS score for the overall quality of the 88 apps was 3.03 (SD 1.14), ranging from 1.19 (lowest-rated app) to 4.86 (highest-rated app). Only 47% (41/88) of the apps obtained a MARS score of over 3 points (acceptable quality). Functionality was the best-rated section, followed by aesthetics, engagement, information, and app subjective quality. The five apps with the highest MARS score were the following: Multiple Myeloma Manager, Hodgkin Lymphoma Manager, Focus On Lymphoma, ALL Manager, and CLL Manager. The analysis by operating system, developer, and cost revealed statistically significant differences in MARS scores (P<.001, P<.001, and P=.049, respectively). The interrater agreement between the 2 reviewers was substantial (k=0.78).

Conclusions

There is great heterogeneity in the quality of apps for patients with hematological conditions. More than half of the apps do not meet acceptable criteria for quality and content. Most of them only provide information about the pathology, lacking interactivity and personalization options. The participation of health professionals in the development of these apps is low, although it is narrowly related to better quality.

Medical Data Acquisition and Internet of Things Technology-Based Cerebral Stroke Disease Prevention and Rehabilitation Nursing Mobile Medical Management System

This research was aimed at exploring the application value of a mobile medical management system based on Internet of Things technology and medical data collection in stroke disease prevention and rehabilitation nursing. In this study, on the basis of radio frequency identification (RFID) technology, the signals collected by the sensor were filtered by the optimized median filtering algorithm, and a rehabilitation nursing evaluation model was established based on the backpropagation (BP) neural network. The performance of the medical management system was verified in 32 rehabilitation patients with hemiplegia after stroke and 6 healthy medical staff in the rehabilitation medical center of the hospital. The results showed that the mean square error (MSE) and peak signal-to-noise ratio (PSNR) of the median filtering algorithm after optimization were significantly higher than those before optimization (P < 0.05). When the number of neurons was 23, the prediction accuracy of the test set reached a maximum of 89.83%. Using traingda as the training function, the model had the lowest training time and root mean squared error (RMSE) value of 2.5 s and 0.29, respectively, which were significantly lower than the traingd and traingdm functions (P < 0.01). The error percentage and RMSE of the model reached a minimum of 7.56% and 0.25, respectively, when the transfer functions of both the hidden and input layers were tansig. The prediction accuracy in stages III~VI was 90.63%. It indicated that the mobile medical management system established based on Internet of Things technology and medical data collection has certain application value for the prevention and rehabilitation nursing of stroke patients, which provides a new idea for the diagnosis, treatment, and rehabilitation of stroke patients.

A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study

Background

Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group.

Objective

The aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population.

Methods

We used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app.

Results

A new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant.

Conclusions

Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant.

Smartphone Application to Improve Oral Anticoagulation Adherence in Patients with Atrial Fibrillation: Prospective Observational Study

BACKGROUND

Poor adherence to oral anticoagulants (OACs) in elderly patients with atrial fibrillation (AF) has been shown to negatively impact healthcare costs, morbidity, and mortality. Although various methods such as automated reminders, counseling, telephone support, and patient education have been effective in improving medication adherence, the burden on healthcare providers has been considerable. Recently, an attempt has been made to improve medication adherence without burdening healthcare providers by using smartphone applications (i.e., app), but the use of the app for elderly patients with AF is still limited.

OBJECTIVE

The purpose of this study was to determine whether the new-developed smartphone application for AF patients (The Smart AF app) that integrates education, automatic reminder and patient engagement strategies with a simple user interface (UI) can improve medication adherence in elderly patients with AF.

METHODS

Patient enrollment was done by obtaining informed consent from AF patients attending Kyoto Prefectural University of Medicine hospitals between May 2019 and September 2020. Follow-up was planned at 1, 3, and 6 months after enrollment, and questionnaire reminders were automatically sent to patient applications at designated follow-up time points. A questionnaire-based survey of medication adherence was performed electronically using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) as the survey tool.

RESULTS

A total of 136 patients with AF were enrolled in this study. During the follow-up period, 112 patients underwent follow-up at 1 month, 107 at 3 months, and 96 at 6 months. The mean age of the enrolled patients was 64.3 years, and males accounted for 79.4% (108/136) of the study population. The mean CHADS2 score was 1.2, with hypertension being the most common comorbidity. At the time of enrollment, 126 and 10 patients were taking direct oral anticoagulants (DOACs) and warfarin, respectively. For medication adherence as measured according to the MMAS-8, MMAS scores at 1 month, 3 months, and 6 months were significantly improved compared with baseline MMAS scores. (all p values<0.01). The overall improvement in medication adherence achieved by the 6-month intervention was as follows. 77.8% (14/18) of patients in the high adherence group (score=8) at baseline remained, 45.3% (24/53) of patients in the medium adherence group (score=6 to <8) at baseline moved to the high adherence group, and 72% (18/25) of patients in the low adherence group (score<6) moved to either the medium or high adherence group.

CONCLUSIONS

The Smart AF app improved medication adherence among elderly patients with AF. In the realm of medication management, an approach using mobile health technology that emphasizes education, automatic reminder and patient engagement, may be helpful.

A Multidimensional Analysis of Released COVID-19 Location-Based Mobile Applications

The spread of coronavirus disease (COVID-19) has triggered a series of responses worldwide ranging from traveling restrictions and shelter-in-place orders to lockdowns, contact tracing, social distancing, and other mitigation measures. To assist with contact tracing and ensure the safety of citizens, a significant number of mobile applications has been developed, utilizing geospatial information and proximity sensing. We perform a thorough research on seven digital databases (Appbrain, e-Health Hub, GDPRhub, “fs0c131y”, News Sites, Appstore, and Google Play), identifying a total of 160 apps regarding COVID-19 related to our research questions. The aim of this research is to identify the main categories of apps and analyze their functions based on a proposed framework of by mapping aspects that affect their functionalities regarding Services, Technology, Societal & Business, and Legal aspects. As the world comes to the new normal, the utilization of these apps might become more essential for more mobile users and developers. The new encryption protocols that are established are also in favor of this argument. Future work can utilize our framework to further examine the development, design, and adoption of such mobile applications.

Mobile applications for prematurity: a systematic review protocol

Background

Premature birth is a global epidemic of significant public health concern. Counselling and education of pregnant women at risk of preterm birth or mothers with premature infants are essential to improve mother and infant health. Mobile applications are an increasingly popular tool among parents to receive health information and education. This study aims to evaluate the usages and the effects of a mobile application designed for premature births in order to improve health outcomes.

Methods

This review will include all studies of different designs which evaluated the use and impact of interventions provided via mobile applications on pregnant women at risk of preterm birth or mothers with premature infants in order to address all health outcomes. A combination of keywords and MeSH(Medical Subject Headings) terms is used in the search strategy. Literature databases including Scopus, PubMed, ISI Web of Science, ProQuest, CINAHL and Cochrane Library will be searched to May 2021. Furthermore, eligible studies will be chosen from the reference list of retrieved papers. Two researchers will independently review the retrieved citations to decide whether they meet the inclusion criteria. Mixed Methods Appraisal Tool (MMAT) V.2018 will be used to assess the quality of studies. Relevant data are collected in a data extraction form and analysed. Results are reported under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Discussion

This systematic review will recognize and combine evidence about the usages and impact of mobile application interventions on the health improvement of pregnant women at risk of preterm birth or mothers with premature infants.

Personalized and Self-Management: Systematic Search and Evaluation Quality Factors and User Preference of Drug Reference Apps in Taiwan

Background: Drug reference apps promote self-management and improve the efficiency and quality of work for physicians, nurses, pharmacists, and patients. This study aimed to describe a systematic and stepwise process to identify drug reference apps in Taiwan, assess the quality of these apps, and analyze the influential factors for user ratings. Methods: A two-step algorithm (KESS) consisting of keyword growing and systematic search was proposed. Seven independent reviewers were trained to evaluate these apps using Mobile App Rating Scale (MARS). A logistic regression model was fitted and average marginal effects (AME) were calculated to identify the effects of factors for higher user ratings. Results: A total of 23 drug reference apps in Taiwan were identified and analyzed. Generally, these drug reference apps were evaluated as acceptable quality with an average MARS score of 3.23. Higher user engagement, more functionality, better aesthetics, and more information associated with higher user ratings. Navigation is the most influential factor on higher user ratings (AME: 13.15%) followed by performance (AME: 11.03%), visual appeal (AME: 10.87%), credibility (AME: 10.67%), and quantity of information (AME: 10.42%). Conclusions: User experience and information clearly affect user ratings of drug reference apps. Five key factors should be considered when designing drug reference apps.

Development and use of mobile messaging for individuals with musculoskeletal pain conditions: a scoping review protocol

INTRODUCTION

Previous reviews of mobile messaging for individuals with musculoskeletal pain have shown positive effects on pain and disability. However, the configuration of digital content, method of presentation and interaction, dose and frequency needed for optimal results remain unclear. Patient preferences concerning such systems are also unclear. Addressing these knowledge gaps, incorporating evidence from both experimental and observational studies, may be useful to understand the extent of the relevant literature, and to influence the design and outcomes of future messaging systems. We aim to map information that could be influential in the design of future mobile messaging systems for individuals with musculoskeletal pain conditions, and to summarise the findings of efficacy, effectiveness, and economics derived from both experimental and observational studies.

METHODS AND ANALYSIS

We will include studies describing the development and/or use of mobile messaging to support adults (≥18 years) with acute or chronic musculoskeletal pain. We will exclude digital health studies that lack a mobile messaging component, or those targeted at other health conditions unrelated to the bones, muscles and connective tissues, or involving surgical or patients with cancer, or studies involving solely healthy individuals. Our sources of information will be online databases and reference lists of relevant papers. We will include papers published in English in the last 10 years. Two pairs of independent reviewers will screen, select and extract the data, with any disagreements mediated by a third reviewer. We will report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. We will synthesise the findings in a tabular format and provide a descriptive summary.

ETHICS AND DISSEMINATION

Formal ethical approval is not required. We will disseminate the findings through publication in a peer-reviewed journal, relevant conferences, and relevant consumer forums.

TRIAL REGISTRATION

Open Science Framework https://osf.io/8mzya; DOI: 10.17605/OSF.IO/8MZYA.

Impact of mobile health application on data collection and self-management of epilepsy

Recent advances in mobile health have enabled health data collection, which includes seizure and medication tracking and epilepsy self-management. We developed a mobile epilepsy management application, integrated with a hospital electronic health record (EHR). In this prospective clinical trial, we assessed whether the mobile application provides quality healthcare data compared to conventional clinic visits, and enhances epilepsy self-management for patients with epilepsy. The study population includes patients with epilepsy (ages 15 years and older) and caregivers for children with epilepsy. Participants were provided access to the application for 90 days. We compared healthcare data collected from the mobile application with data obtained from clinic visits. The healthcare data included seizure records, seizure triggering factors, medication adherence rate, profiles of adverse events resulting from anti-seizure medication (ASM), and comorbidity screenings. In addition, we conducted baseline and follow-up questionnaires after the 90-day period to evaluate how this mobile application improved epilepsy knowledge and self-efficacy in seizure management. Data of 99 participants (18 patients with epilepsy and 81 caregivers) were analyzed. Among 24 individuals who had seizures, we obtained detailed seizure records from 13 individuals through clinic visits and for 18 from the application. Aside from the 6 individuals who reported their medication adherence during clinic visitation, half of the study participants had adherence rates of over 70%, as monitored through the application. However, the adherence rates were not reliable due to high variability. Twenty-three individuals reported 59 adverse reactions on the application, whereas 21 individuals reported 24 adverse reactions during clinic visits. We collected comorbidity data from 4 individuals during clinic visits. In comparison, 64 participants underwent comorbidity self-screening on the application, and 2 of them were referred to neuropsychiatric services. Compared to rare/non-users, app users demonstrated significant improvement in epilepsy knowledge score (p < 0.001) and self-efficacy score (p = 0.038). In conclusion, mobile health technology would help patients and caregivers to record their healthcare data and aid in self-management. Mobile health technology would provide an influential clinical validity in epilepsy care when users engage and actively maintain records on the application.

A framework to lower the risk of medication prescribing and dispensing errors: A usability study of an NFC-based mobile application

BACKGROUND

Wrong medication and wrong dosage are major risks in the pharmaceutical industry, as many medication errors occur when dispensing medication. The dispensing process in its current form is limited in verifying the patient's identity before dispensing the medication. Furthermore, this process does not offer a robust method for providing accurate medication intake instructions. Therefore, we have developed a framework to accurately and securely overcome issues associated with transferring patient credentials and prescription information. The long-term goal of this research is to develop a framework to mitigate medication dispensing errors. One of the framework components is the mobile application that uses near-field communication (NFC) to transfer information. Therefore, in this paper, we designed a user study to assess the proposed NFC-based mobile application in terms of usefulness and ease of use compared with the traditional method of picking up a prescribed medication.

METHODS

We conducted a usability study with 21 participants to perform four tasks to simulate the process of picking up a prescribed medication using the proposed NFC application method and the traditional method of picking up medication. Then, we asked the participants to complete two post-questionnaires after using each method to evaluate the participants' experience of the process. Next, we asked the participants to complete an additional questionnaire about the usefulness of the NFC application method. Finally, we conducted semi-structured interviews with the participants to get more evidence to back up the questionnaire answers.

RESULTS

Our findings show that 91% of the participants believe using the NFC application method will improve patient safety during the medication pickup process. Nearly 97% of participants found the NFC application method easy to use. Our findings show that the participants scored lower when using the NFC application method compared with the traditional method when trying to identify the wrong medication after dispensing. In addition, 90% of the participants successfully identified the wrong medication when using the NFC application method, compared to only 38% when using the traditional method. Finally, the results show that the participants preferred using the NFC application method in terms of information availability, security, and privacy.

CONCLUSIONS

The study findings show that the proposed NFC application for managing patients' prescriptions and picking up medication might improve patient safety. The results show that the participants believe the NFC application will mitigate medication dispensing errors, at least from their end. The participants believe the application will provide a fast and accurate method of verifying dispensed medication from the patient end. Moreover, the application will help the patient to track their current prescription, which also helps them remember the medication intake instructions. Finally, the study indicates that the application will provide a secure, private, and accurate method to help verify the patient's identity, thus minimizing medication errors during the medication dispensing process.

Building MedVenture - A mobile health application to improve adolescent medication adherence - Using a multidisciplinary approach and academic-industry collaboration

Objective

Mobile health (mHealth) tools are increasingly used to support medication adherence yet few have been designed specifically for the pediatric population. This paper describes the development of a medication adherence application (MedVenture) using the integration of patient and healthcare provider input, health behavior theory, and user engagement strategies for adolescents with chronic gastrointestinal disease.

Methods

MedVenture was created by a multidisciplinary research team consisting of a gastroenterologist, a social health psychologist, software developers, and digital health researchers. Healthcare providers and adolescent patients were interviewed to identify barriers to medication adherence, explore ways that technologies could best support medication adherence for both patients and providers, and determine user requirements and core design features for a digital health tool. Intervention mapping was used to match themes from qualitative content analysis to known efficacious adherence strategies, according to a conceptual framework based on self-determination theory. Iterative design with review by the research team and two rounds of user testing informed the final prototype.

Results

Three themes were identified from content analysis: 1) lack of routine contributes to nonadherence, 2) adolescents sometimes purposefully forgo medications, and 3) healthcare providers would prefer a tool that promotes patient self-management rather than one that involves patient-provider interaction. These findings, combined with evidence-based adherence and user engagement strategies, resulted in the development of MedVenture – a game-based application to improve planning and habit formation.

Conclusions

Academic-industry collaboration incorporating stakeholders can facilitate the development of mobile health tools designed specifically for adolescents with chronic disease.

Usability Evaluation of a Smartphone Medication Reminder Application in Patients Treated With Short-term Antibiotic

Medication adherence is poor in persons with chronic disease, especially in those with multiple chronic diseases, one of which is a psychological disorder. Social support, medication education, and external reminders have been identified as facilitators of adherence. Mobile health applications have the potential to enhance adherence; however, it is unknown if publicly available applications are user-friendly and useful. We aimed to examine the usability and feasibility of the "MediSafe" medication reminder application in adults with diarrhea-predominant irritable bowel syndrome undergoing short-term antibiotic therapy and a "Medfriend" from their social support network (N = 14). A mixed-methods study was conducted. All patient participants used the MediSafe application daily for 14 days. Ease of use, ease of learning, and satisfaction scales were rated highest by both patient participants and Medfriends, whereas usefulness was rated lowest by both groups, with Medfriends' usefulness rating significantly lower than that of patient participants. Telephone interviews identified patient participants found the application instrumental in facilitating medication adherence, and Medfriends viewed themselves as active participants in the patient participants' care. The MediSafe medication reminder application is easy to use and accepted by both patients and their designated Medfriend. The MediSafe is instrumental in facilitating short-term antibiotic adherence and social support engagement.