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Shiyab W, Rolls K, Ferguson C, Halcomb E. Nurses' Use of mHealth Apps for Chronic Conditions: Cross-Sectional Survey. JMIR Nurs 2024; 7:e57668. [PMID: 38809593 PMCID: PMC11170041 DOI: 10.2196/57668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/07/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) is increasingly used to support public health practice, as it has positive benefits such as enhancing self-efficacy and facilitating chronic disease management. Yet, relatively few studies have explored the use of mHealth apps among nurses, despite their important role in caring for patients with and at risk of chronic conditions. OBJECTIVE The aim of the study is to explore nurses' use of mHealth apps to support adults with or at risk of chronic conditions and understand the factors that influence technology adoption. METHODS A web-based cross-sectional survey was conducted between September 2022 and January 2023. The survey was shared via social media and professional nursing organizations to Australian nurses caring for adults with or at risk of chronic conditions. RESULTS A total of 158 responses were included in the analysis. More than two-thirds (n=108, 68.4%) of respondents reported that they personally used at least 1 mHealth app. Over half (n=83, 52.5% to n=108, 68.4%) reported they use mHealth apps at least a few times a month for clinical purposes. Logistic regression demonstrated that performance expectancy (P=.04), facilitating condition (P=.05), and personal use of mHealth apps (P=.05) were significantly associated with mHealth app recommendation. In contrast, effort expectancy (P=.09) and social influence (P=.46) did not have a significant influence on whether respondents recommended mHealth apps to patients. The inability to identify the quality of mHealth apps and the lack of access to mobile devices or internet were the most common barriers to mHealth app recommendation. CONCLUSIONS While nurses use mHealth apps personally, there is potential to increase their clinical application. Given the challenges reported in appraising and assessing mHealth apps, app regulation and upskilling nurses will help to integrate mHealth apps into usual patient care.
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Affiliation(s)
- Wa'ed Shiyab
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Kaye Rolls
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Caleb Ferguson
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
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2
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Mendoza K, Villalobos-Daniel VE, Jáuregui A, Valero-Morales I, Hernández-Alcaraz C, Zacarías-Alejandro N, Alarcon-Guevara RO, Barquera S. Development of a crowdsourcing- and gamification-based mobile application to collect epidemiological information and promote healthy lifestyles in Mexico. Sci Rep 2024; 14:6174. [PMID: 38486091 PMCID: PMC10940696 DOI: 10.1038/s41598-024-56761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
We developed a mobile application to promote healthy lifestyles and collect non-communicable disease (NCD) data in Mexico. Its theoretical foundations are supported by a framework-guided literature review. With design sprints, Scrum, Model-View-Controller, and Representational State Transfer architecture, we operationalized evidence-based nutrition/physical activity information into a crowdsourcing- and gamification-based application. The application was piloted for three months to monitor the response of 520 adults. Potential improvements were characterized, considering benchmarking, expert guidance, and standards. Salud Activa (English: Active Health) has two crowdsourcing modules: Nutritional scanner, scanning products' bar codes, providing nutritional data, and allowing new product registry feeding our databases; Surveys, comprising gradually-released NCD questions. Three intervention modules were generated: Drinks diary, a beverage assessment component to receive hydration recommendations; Step counter, monitoring users' steps via Google Fit/Health-iOS; Metabolic Avatar, interconnecting modules and changing as a function of beverage and step records. The 3-month median of Salud Activa use was seven days (IQR = 3-12), up to 35% of participants completed a Survey section, and 157 food products were registered through Nutritional scanner. Better customization might benefit usability and user engagement. Quantitative and qualitative data will enhance Salud Activa's design, user uptake, and efficacy in interventions delivered through this platform.
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Affiliation(s)
- Kenny Mendoza
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Víctor Eduardo Villalobos-Daniel
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Alejandra Jáuregui
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Isabel Valero-Morales
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
- Queen Mary University of London, London, UK
| | - César Hernández-Alcaraz
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | | | - Ricardo Omar Alarcon-Guevara
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Simón Barquera
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico.
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Firdaus MKZH, Jittanoon P, Boonyasopun U, Che Hasan MK. The effect of mHealth program on behavior modification and health outcomes among patients with diabetes: A randomized controlled trial study. BELITUNG NURSING JOURNAL 2023; 9:437-447. [PMID: 37901368 PMCID: PMC10600709 DOI: 10.33546/bnj.2664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/26/2023] [Accepted: 09/23/2023] [Indexed: 10/31/2023] Open
Abstract
Background Mobile health presents a promising alternative in the digital era. Mobile health apps (mHealth), when combined with the concept of self-management, are considered one of the methods for incorporating technology-based interventions into the healthcare system. Objective This study aimed to determine the effect of mHealth (specifically, the Diabetic Care App) on foot care behavior, dietary behavior, foot condition, and fasting blood glucose levels among patients with uncontrolled diabetes mellitus. Methods A single randomized controlled trial was conducted at a government-run primary clinic in Northern Malaysia, involving 58 patients with uncontrolled diabetes who were assigned to two groups. The intervention group received the Diabetic Care App, attended a 2-hour face-to-face session, and was included in a WhatsApp group, while the control group received standard care. Relevant assessments were conducted for both groups in Week 1 and Week 5. The study was conducted from February 2020 to November 2020, and parametric and non-parametric statistics were used for data analysis. Results Pretest-posttest comparisons in both groups revealed significant findings for foot care behavior (p <0.01), dietary behavior (p <0.01), and foot condition (p <0.01), except for fasting blood glucose levels. In inter-group comparisons, a significant difference was observed only in foot care behavior (p <0.01) and dietary behavior (p <0.01). Conclusion The results indicate that technology-based interventions are beneficial for modifying behavior, specifically in terms of foot care and dietary behavior, in this study. The study highlights the applicability of mHealth for nurses in patient education and self-management of chronic conditions. Future research should explore app utilization among patients with chronic conditions. Clinical trial registration number NCT04260100 (registered at https://clinicaltrials.gov/ct2/show/NCT04260100).
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Affiliation(s)
- Mohd Khairul Zul Hasymi Firdaus
- Department of Medical Surgical Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Malaysia
- Faculty of Nursing, Prince of Songkla University, Thailand
| | | | | | - Muhammad Kamil Che Hasan
- Department of Medical Surgical Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Malaysia
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4
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Finn EB, Whang C, Hong PH, Costa SA, Callahan EA, Huang TTK. Strategies to improve the implementation of intensive lifestyle interventions for obesity. Front Public Health 2023; 11:1202545. [PMID: 37559739 PMCID: PMC10407556 DOI: 10.3389/fpubh.2023.1202545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/04/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Emily Benjamin Finn
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Christine Whang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Peter Houlin Hong
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Sergio A. Costa
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | | | - Terry T. -K. Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
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Ahmad MA, Yusof A, Hamid MSA, Zulkifli Amin FH, Kamsan SS, Ag Daud DM, Ajit Singh DK. Effects of Self-management Program as Adjunctive to Usual Rehabilitation Exercise on Pain and Functional Outcomes in Knee Osteoarthritis: A Randomized Controlled Trial. J Res Health Sci 2023; 23:e00569. [PMID: 37571940 PMCID: PMC10422143 DOI: 10.34172/jrhs.2023.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/12/2022] [Accepted: 01/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Home-based exercise (HBE) and patient education (EDU) have been reported as beneficial additions to usual knee osteoarthritis (KOA) rehabilitation. However, previous trials mostly examined the effects of HBE and EDU separately. Thus, this study aimed to evaluate the effects of a structured combined HBE and EDU program in addition to usual KOA rehabilitation on pain score, functional mobility, and disability level. STUDY DESIGN A parallel-group, single-blinded randomized controlled trial. METHODS Eighty adults with KOA were randomly allocated to experimental (n=40) and control (n=40) groups. All participants underwent their usual physiotherapy care weekly for eight weeks. The experimental group received a structured HBE+EDU program to their usual care, while the control group performed home stretching exercises to equate treatment time. The Knee Injury and Osteoarthritis Outcome Score (KOOS) for the disability level, visual analogue scale (VAS) for pain, and timed up-and-go test (TUG) for mobility were measured pre-post intervention. RESULTS After eight weeks, the experimental group demonstrated significant improvements in the KOOS (all subscales), pain VAS, and TUG scores compared to baseline (P<0.001); meanwhile, only KOOS (activities of daily living and sports subscales) was significant in the control group. Relative to the control, the experimental group presented higher improvements (P<0.001) by 22.2%, 44.1%, and 15.7% for KOOS, pain VAS, and TUG, respectively. CONCLUSION Integrating the HBE+EDU program into usual KOA rehabilitation could reduce pain and disability, while it improved functional mobility. The finding of this study suggests a combination of a structured HBE and EDU program to be considered as part of mainstream KOA management.
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Affiliation(s)
- Mohd Azzuan Ahmad
- Physiotherapy Program, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ashril Yusof
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mohamad Shariff A Hamid
- Sports Medicine Unit, Faculty of Medicine, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Faizul Hafiz Zulkifli Amin
- Physiotherapy Program, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Siti Salwana Kamsan
- Department of Physical Rehabilitation Sciences, Faculty of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia
| | - D Maryama Ag Daud
- HEAL Research Unit, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Sabah, Malaysia
| | - Devinder Kaur Ajit Singh
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Kruse CS, Mileski M, Heinemann K, Huynh H, Leafblad A, Moreno E. Analyzing the Effectiveness of mHealth to Manage Diabetes Mellitus Among Adults Over 50: A Systematic Literature Review. J Multidiscip Healthc 2023; 16:101-117. [PMID: 36660039 PMCID: PMC9842522 DOI: 10.2147/jmdh.s392693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023] Open
Abstract
Purpose A total of 537 million suffered from diabetes mellitus in 2021, and the aging of the population will not abate this number in the future. Diabetes predisposes people to ailments and doubles the risk of COVID-19 mortality. mHealth has shown promise to help manage diabetes. The aim of this review is to objectively analyze research from the last 2.5 years to assess effectiveness where mHealth has been used as an intervention to help manage diabetes in older patients. We also analyzed patient satisfaction, quality, and barriers to adoption of mHealth to manage diabetes. Patients and Methods No human subjects were involved in this review. We queried four research databases for mHealth to manage diabetes in older adults. We conducted the review based on the Kruse Protocol for writing as systematic review and we reported our findings in accordance with PRISMA (2020). Results Thirty research articles from 11 countries were analyzed. Five interventions of mHealth were identified. Of these mHealth Short Message service (SMS) helped change behavior and encouraged self-care. mHealth SMS coupled with telemedicine for coaching showed positive effects on weight loss, BMI, diet, exercise, HbA1C, disease awareness, blood pressure, cholesterol, medication adherence, and foot care. Conclusion mHealth SMS coupled with telemedicine for coaching shows the greatest promise for educating, changing behavior, and realizing positive outcomes across a broad spectrum of health factors. The largest drawback is the cost of acquiring equipment and training users.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Michael Mileski
- School of Health Administration, Texas State University, San Marcos, TX, USA,Correspondence: Michael Mileski, Texas State University, School of Health Administration, 601 University Drive, Encino Hall—250, San Marcos, TX, 78666, USA, Tel +1 512 245 3556, Email
| | - Katharine Heinemann
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Hung Huynh
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Abigail Leafblad
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Emmanuel Moreno
- School of Health Administration, Texas State University, San Marcos, TX, USA
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7
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Daud MH, Yusoff FH, Abdul-Razak S, Baharudin N, Mohamed-Yassin MS, Badlishah-Sham SF, Nikmat AW, Isa MR, Jamil N, Nawawi H, Ramli AS. Design, development, utility and usability testing of the EMPOWER-SUSTAIN Self-Management Mobile App © among primary care physicians and patients with metabolic syndrome. Digit Health 2023; 9:20552076231176645. [PMID: 37312957 PMCID: PMC10259157 DOI: 10.1177/20552076231176645] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/02/2023] [Indexed: 06/15/2023] Open
Abstract
Objective This study aimed to design, develop, assess and refine the EMPOWER-SUSTAIN Self-Management Mobile App© among primary care physicians (PCP) and patients with metabolic syndrome (MetS) in primary care. Methodology Using the software-development-life-cycle (SDLC) iterative model, storyboard and wireframe were drafted; and a mock prototype was designed to illustrate the content and function graphically. Subsequently, a working prototype was developed. Qualitative studies using the 'think-aloud' and cognitive-task-analysis methods were conducted for the utility and usability testing. Topic guide was based on the 10-Nielsen's-Heuristic-Principles. Utility testing was conducted among PCP in which they 'thought-aloud' while performing tasks using the mobile app. Usability testing was conducted among MetS patients after they were given the app for 3 weeks. They 'thought-aloud' while performing tasks using the app. Interviews were audio- and video-recorded, and transcribed verbatim. Thematic content analysis was performed. Result Seven PCP and nine patients participated in the utility and usability testing, respectively. Six themes (efficiency of use, user control and freedom, appearance and aesthetic features, clinical content, error prevention, and help and documentation) emerged. PCP found the mobile app attractive and relevant sections were easy to find. They suggested adding 'zoom/swipe' functions and some parts needed bigger fonts. Patients commented that the app was user-friendly, has nice interface, and straightforward language. It helped them understand their health better. Based on these findings, the mobile app was refined. Conclusion This app was produced using a robust SDLC method to increase users' satisfaction and sustainability of its use. It could potentially improve self-management behaviour among MetS patients in primary care.
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Affiliation(s)
- Maryam Hannah Daud
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | | | - Suraya Abdul-Razak
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
- Cardio Vascular and Lungs Research Institute (CaVaLRI), Hospital Al-Sultan Abdullah (HASA), Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Noorhida Baharudin
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Mohamed-Syarif Mohamed-Yassin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Siti Fatimah Badlishah-Sham
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Azlina Wati Nikmat
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Mohamad Rodi Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Nursuriati Jamil
- Computing Centre of Studies, College of Computing, Informatics and Media, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Hapizah Nawawi
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Anis Safura Ramli
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
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Gupta K, Roy S, Altameem A, Kumar R, Saudagar AKJ, Poonia RC. Usability Evaluation and Classification of mHealth Applications for Type 2 Diabetes Mellitus Using MARS and ID3 Algorithm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19126999. [PMID: 35742248 PMCID: PMC9222518 DOI: 10.3390/ijerph19126999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022]
Abstract
The rapid growth of mHealth applications for Type 2 Diabetes Mellitus (T2DM) patients’ self-management has motivated the evaluation of these applications from both the usability and user point of view. The objective of this study was to identify mHealth applications that focus on T2DM from the Android store and rate them from the usability perspective using the MARS tool. Additionally, a classification of these mHealth applications was conducted using the ID3 algorithm to identify the most preferred application. The usability of the applications was assessed by two experts using MARS. A total of 11 mHealth applications were identified from the initial search, which fulfilled our inclusion criteria. The usability of the applications was rated using the MARS scale, from 1 (inadequate) to 5 (excellent). The Functionality (3.23) and Aesthetics (3.22) attributes had the highest score, whereas Information (3.1) had the lowest score. Among the 11 applications, “mySugr” had the highest average MARS score for both Application Quality (4.1/5) as well as Application Subjective Quality (4.5/5). Moreover, from the classification conducted using the ID3 algorithm, it was observed that 6 out of 11 mHealth applications were preferred for the self-management of T2DM.
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Affiliation(s)
- Kamaldeep Gupta
- Faculty of Computing and Information Technology, Usha Martin University, Ranchi 835103, India; (K.G.); (S.R.)
| | - Sharmistha Roy
- Faculty of Computing and Information Technology, Usha Martin University, Ranchi 835103, India; (K.G.); (S.R.)
| | - Ayman Altameem
- Department of Computer Science and Engineering, College of Applied Studies and Community Services, King Saud University, Riyadh 11533, Saudi Arabia;
| | - Raghvendra Kumar
- Department of Computer Science and Engineering, GIET University, Rayagada 765022, India;
| | - Abdul Khader Jilani Saudagar
- Information Systems Department, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia
- Correspondence:
| | - Ramesh Chandra Poonia
- Department of Computer Science, CHRIST (Deemed to be University), Bangalore 560029, India;
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Jakob R, Harperink S, Rudolf AM, Fleisch E, Haug S, Mair JL, Salamanca-Sanabria A, Kowatsch T. Factors Influencing Adherence to mHealth Apps for Prevention or Management of Noncommunicable Diseases: Systematic Review. J Med Internet Res 2022; 24:e35371. [PMID: 35612886 PMCID: PMC9178451 DOI: 10.2196/35371] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/31/2022] [Accepted: 04/09/2022] [Indexed: 12/14/2022] Open
Abstract
Background Mobile health (mHealth) apps show vast potential in supporting patients and health care systems with the increasing prevalence and economic costs of noncommunicable diseases (NCDs) worldwide. However, despite the availability of evidence-based mHealth apps, a substantial proportion of users do not adhere to them as intended and may consequently not receive treatment. Therefore, understanding the factors that act as barriers to or facilitators of adherence is a fundamental concern in preventing intervention dropouts and increasing the effectiveness of digital health interventions. Objective This review aimed to help stakeholders develop more effective digital health interventions by identifying factors influencing the continued use of mHealth apps targeting NCDs. We further derived quantified adherence scores for various health domains to validate the qualitative findings and explore adherence benchmarks. Methods A comprehensive systematic literature search (January 2007 to December 2020) was conducted on MEDLINE, Embase, Web of Science, Scopus, and ACM Digital Library. Data on intended use, actual use, and factors influencing adherence were extracted. Intervention-related and patient-related factors with a positive or negative influence on adherence are presented separately for the health domains of NCD self-management, mental health, substance use, nutrition, physical activity, weight loss, multicomponent lifestyle interventions, mindfulness, and other NCDs. Quantified adherence measures, calculated as the ratio between the estimated intended use and actual use, were derived for each study and compared with the qualitative findings. Results The literature search yielded 2862 potentially relevant articles, of which 99 (3.46%) were included as part of the inclusion criteria. A total of 4 intervention-related factors indicated positive effects on adherence across all health domains: personalization or tailoring of the content of mHealth apps to the individual needs of the user, reminders in the form of individualized push notifications, user-friendly and technically stable app design, and personal support complementary to the digital intervention. Social and gamification features were also identified as drivers of app adherence across several health domains. A wide variety of patient-related factors such as user characteristics or recruitment channels further affects adherence. The derived adherence scores of the included mHealth apps averaged 56.0% (SD 24.4%). Conclusions This study contributes to the scarce scientific evidence on factors that positively or negatively influence adherence to mHealth apps and is the first to quantitatively compare adherence relative to the intended use of various health domains. As underlying studies mostly have a pilot character with short study durations, research on factors influencing adherence to mHealth apps is still limited. To facilitate future research on mHealth app adherence, researchers should clearly outline and justify the app’s intended use; report objective data on actual use relative to the intended use; and, ideally, provide long-term use and retention data.
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Affiliation(s)
- Robert Jakob
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Samira Harperink
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Aaron Maria Rudolf
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, Zurich University, Zurich, Switzerland
| | - Jacqueline Louise Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
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10
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Taylor L, Ranaldi H, Amirova A, Zhang L, Ahmed AA, Dibb B. Using virtual representations in mHealth application interventions for health-related behaviour change: A systematic review. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2069906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Lauren Taylor
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Hannah Ranaldi
- Department of Psychology, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Aliya Amirova
- Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Louisa Zhang
- Department of Psychology, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Ayan A Ahmed
- Department of Psychology, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Bridget Dibb
- Department of Psychology, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
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Sittig S, Hauff C, Williams SG, Graves RJ, Fruh S. A Qualitative Exploration of Desired mHealth App Mechanisms Related to Daily Life Influences for College Nursing Students. RESEARCH DIRECTS IN HEALTH SCIENCES 2022; 2:7. [PMID: 36569223 PMCID: PMC9782965 DOI: 10.53520/rdhs2022.10441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction Mobile health (mHealth) apps are digital health tools that allow for the delivery and access to vital health information, support, and encouragement needed to foster positive behavior change. Designing and developing mHealth solutions based on daily life influences for nursing students is imperative to establishing healthier physical and mental health habits. Methods Multiple focus groups (n=10) were conducted, and a questionnaire (n=11) was administered to undergraduate students in the professional nursing component. Themed analysis of focus-group data was conducted along with descriptive analysis of the questionnaire. Results All participants stated it has been more difficult to maintain a healthy lifestyle since beginning the nursing program. This deterioration can be attributed to three key areas: mental health needs/support, rigor of nursing school, and decline in positive health choices. Participants stated they would use an mHealth app designed specifically for nursing students to combat deterioration of their health. Conclusions The results of this study (100% positive response rate) reveal mHealth applications might be a powerful tool in helping nursing students transform their physical and mental health. It appears that if an mHealth application is created with the specific "must-haves" of nursing students then we might experience a positive shift in health behaviors for nursing students, which will hopefully transcend into their careers as nurses.
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Affiliation(s)
- Scott Sittig
- Department of Health Science, University of Louisiana at Lafayette, Lafayette, Louisiana
| | - Caitlyn Hauff
- Departemnt of Health, Kinesiology and Sport, University of South Alabama, Mobile, Alabama
| | | | - Rebecca J Graves
- College of Nursing, University of South Alabama, Mobile, Alabama
| | - Sharon Fruh
- College of Nursing, University of South Alabama, Mobile, Alabama
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Amagai S, Pila S, Kaat AJ, Nowinski CJ, Gershon RC. Challenges in Participant Engagement and Retention using Mobile Health Apps: A Literature Review (Preprint). J Med Internet Res 2021; 24:e35120. [PMID: 35471414 PMCID: PMC9092233 DOI: 10.2196/35120] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps are revolutionizing the way clinicians and researchers monitor and manage the health of their participants. However, many studies using mHealth apps are hampered by substantial participant dropout or attrition, which may impact the representativeness of the sample and the effectiveness of the study. Therefore, it is imperative for researchers to understand what makes participants stay with mHealth apps or studies using mHealth apps. Objective This study aimed to review the current peer-reviewed research literature to identify the notable factors and strategies used in adult participant engagement and retention. Methods We conducted a systematic search of PubMed, MEDLINE, and PsycINFO databases for mHealth studies that evaluated and assessed issues or strategies to improve the engagement and retention of adults from 2015 to 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Notable themes were identified and narratively compared among different studies. A binomial regression model was generated to examine the factors affecting retention. Results Of the 389 identified studies, 62 (15.9%) were included in this review. Overall, most studies were partially successful in maintaining participant engagement. Factors related to particular elements of the app (eg, feedback, appropriate reminders, and in-app support from peers or coaches) and research strategies (eg, compensation and niche samples) that promote retention were identified. Factors that obstructed retention were also identified (eg, lack of support features, technical difficulties, and usefulness of the app). The regression model results showed that a participant is more likely to drop out than to be retained. Conclusions Retaining participants is an omnipresent challenge in mHealth studies. The insights from this review can help inform future studies about the factors and strategies to improve participant retention.
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Affiliation(s)
- Saki Amagai
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah Pila
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Aaron J Kaat
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Cindy J Nowinski
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Richard C Gershon
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Alrige M, Bitar H, Meccawy M. Promoting precautionary behavior during the COVID-19 pandemic: Development and validation of a behavior-change messaging campaign. J Infect Public Health 2021; 14:1727-1732. [PMID: 34710783 PMCID: PMC8491996 DOI: 10.1016/j.jiph.2021.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/22/2021] [Accepted: 09/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background Designing a health promotion campaign is never an easy task, especially during a pandemic of a highly infectious disease such as COVID-19. In Saudi Arabia, many attempts have been made to raise public awareness about COVID-19 infection and precautionary health measures. However, most of the health information delivered through the national dashboard and the COVID-19 awareness campaigns are generic and do not necessarily make the impact needed to be seen on individuals’ behavior. Health messages need to be applicable and reverent to the individual in the audience. Objective In light of Fogg-Behavior model, this research aims to build and validate a behavior-change-based messaging campaign to promote precautionary health behavior in individuals during the COVID-19 pandemic. Intervention messages can then be targeted appropriately during the pandemic. Methods An initial library of 32 text-based and video-based messages were developed and validated based on Fogg behavior model for behavior change. Based on this model, three groups of messages were created to reflect the model’s three theoretical concepts of motivation, ability and triggers. Each group of messages is designed to target different segment of the audience. The content of the messages was developed based on resources from the World Health Organization and the Ministry of Health in Saudi Arabia. The validity of this content was evaluated by domain experts through the content validity index. Results Fogg-Behavior Model was used to segment the audience into three different groups based on their perceived ability and motivation. The three groups of messages designed for those groups were found relevant to Fogg theoretical concepts. Thirteen professional health care workers (n = 13) evaluated the content of the message libraries in Arabic and English. Thirty-two messages were found to have acceptable content validity (I-CVI = 0.87). Conclusions This research introduced Fogg Behavior Model as a behavior change model to develop targeted messages for three groups of the audience based on their motivation and ability level toward maintaining precautionary behavior during the pandemic. This targeted awareness messaging campaign can be utilized by health authorities to raise individuals’ awareness about the precautionary measures that should be taken, maintain these measures and hence help in reducing the number of positive cases in the city of Jeddah.
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Affiliation(s)
- Mayda Alrige
- Information Systems Department, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Hind Bitar
- Information Systems Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maram Meccawy
- Information Systems Department, King Abdulaziz University, Jeddah, Saudi Arabia
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Analysis of Effectiveness and Psychological Techniques Implemented in mHealth Solutions for Middle-Aged and Elderly Adults with Type 2 Diabetes: A Narrative Review of the Literature. J Clin Med 2021; 10:jcm10122701. [PMID: 34207402 PMCID: PMC8235068 DOI: 10.3390/jcm10122701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND in diabetes, multiple mHealth solutions were produced and implemented for self-management behaviors. However, little research on the effectiveness of psychological techniques implemented within these mHealth solutions was carried out, and even less with the elderly population where technological barriers might exist. Reliable evidence generated through a comprehensive evaluation of mHealth interventions may accelerate its growth for successful long-term implementation and to help to experience mHealth benefits in an enhanced way in all ages. OBJECTIVE this study aimed to review mHealth solutions for diabetes self-management in older adults (adherence to treatments and glycemic control) by analyzing the effectiveness of specific psychological techniques implemented. METHODS a narrative review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed (Medline) and American Psychological Association (APA) PsycInfo databases were searched for published papers that addressed eHealth solutions' effectiveness for diabetes self-management. Studies in English, Spanish, and/or German of any design were screened, with no time constraints regarding the year of publication. A qualitative analysis of the selected papers was conducted in several steps. RESULTS this review found 38 studies setting up and analyzing mHealth solutions for older adults. Most research showed improvements in HbA1c, self-management behaviors, and medication adherence in T2DM patients post intervention. However, different mid-to-long term effects were found across studies, specifically concerning the maintenance and adherence to healthy behaviors. The most employed psychological framework was CBT, including techniques such as self-monitoring of outcome behaviors (mostly targeting glycemia measurements and healthy habits as physical activity and/or diet), tailored motivational feedback from medical staff, and psychoeducation or health coaches. The most successful mHealth intervention combined the feature of tailored feedback messages, interactive communication with healthcare professionals, and multifaceted functions. CONCLUSIONS there is a lack of elaborate and detailed information in the literature regarding the factors considered in the design and development of mHealth solutions used as interventions for T2DM self-management in the elderly. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of useful and user-friendly self-management apps that can enhance the quality of life for diabetes patients. Further research adapting mHealth solutions to older adults' sensory deficits is necessary.
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Wu HHL, Nixon AC, Dhaygude AP, Jayanti A, Mitra S. Is home hemodialysis a practical option for older people? Hemodial Int 2021; 25:416-423. [PMID: 34133069 DOI: 10.1111/hdi.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/23/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
An increasing demand for in-center dialysis services has been largely driven by a rapid growth of the older population progressing to end-stage kidney disease. Since the onset of the COVID-19 pandemic, efforts to encourage home-based dialysis options have increased due to risks of infective transmission for patients receiving hemodialysis in center-based units. There are various practical and clinical advantages for patients receiving hemodialysis at home. However, the lack of caregiver support, cognitive and physical impairment, challenges of vascular access, and preparation and training for home hemodialysis (HHD) initiation may present as barriers to successful implementation of HHD in the older dialysis population. Assessment of an older patient's frailty status may help clinicians guide patients when making decisions about HHD. The development of an assisted HHD care delivery model and advancement of telehealth and technology in provision of HHD care may increase accessibility of HHD services for older patients. This review examines these factors and explores current unmet needs and barriers to increasing access, inclusion, and opportunities of HHD for the older dialysis population.
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Affiliation(s)
- Henry H L Wu
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK.,Faculty of Medical and Human Sciences, Manchester Academy of Health Sciences Centre, University of Manchester, Manchester, UK
| | - Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK.,Faculty of Medical and Human Sciences, Manchester Academy of Health Sciences Centre, University of Manchester, Manchester, UK.,Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ajay P Dhaygude
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK.,Faculty of Medical and Human Sciences, Manchester Academy of Health Sciences Centre, University of Manchester, Manchester, UK
| | - Anu Jayanti
- Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sandip Mitra
- Faculty of Medical and Human Sciences, Manchester Academy of Health Sciences Centre, University of Manchester, Manchester, UK.,Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester, UK
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Ahmad MA, A Hamid MS, Yusof A. Effects of low-level and high-intensity laser therapy as adjunctive to rehabilitation exercise on pain, stiffness and function in knee osteoarthritis: a systematic review and meta-analysis. Physiotherapy 2021; 114:85-95. [PMID: 34654554 DOI: 10.1016/j.physio.2021.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND When treating knee osteoarthritis (KOA), rehabilitation exercise is often combined with low-level (LLLT) or high-intensity laser therapy (HILT). However, the effectiveness of these combinations is still uncertain. OBJECTIVE To examine the effects of LLLT or HILT combined with rehabilitation exercise (LLLT+E or HILT+E) on pain, stiffness and function in KOA. DATA SOURCES Five databases (PubMed, Web of Science, CINAHL, PEDro and SPORTDiscus) were searched for relevant studies published up to 31 December 2019. STUDY SELECTION KOA randomised controlled trials, LLLT+E or HILT+E against exercise alone with or without placebo laser, reported clinical outcomes, human studies and English language. DATA SYNTHESIS Methodological quality was assessed by the PEDro and Cochrane risk-of-bias scales, and the meta-analysis was undertaken using RevMan 5.3. RESULTS Of the 10 retrieved studies, six investigated LLLT+E, three on HILT+E, and one evaluated both. All the studies had high PEDro scores. However, as most of the studies employed a single type of laser therapy, only indirect comparison of LLLT+E and HILT+E was possible. This study found all treatment modalities were effective in reducing KOA symptoms. Interestingly, relative to control, the meta-analysis showed significant improvements in knee pain, stiffness and function for the HILT+E. CONCLUSION Both LLLT and HILT are beneficial as adjuncts to rehabilitation exercise in the management of KOA. Based on an indirect comparison, the HILT+E seems to have higher efficacy in reducing knee pain and stiffness, and in increasing function. To confirm this finding, a direct comparative investigation of the two types of laser therapy may be necessary. Systematic review registration PROSPERO ID CRD42020206228.
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Affiliation(s)
- Mohd Azzuan Ahmad
- Centre for Sport and Exercise Sciences, University of Malaya, 50603, Kuala Lumpur, Malaysia; Physiotherapy Programme, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia.
| | - Mohamad Shariff A Hamid
- Sports Medicine Unit, Faculty of Medicine, University of Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia.
| | - Ashril Yusof
- Centre for Sport and Exercise Sciences, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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