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Zawati MH, Lang M. Does an App a Day Keep the Doctor Away? AI Symptom Checker Applications, Entrenched Bias, and Professional Responsibility. J Med Internet Res 2024; 26:e50344. [PMID: 38838309 PMCID: PMC11187504 DOI: 10.2196/50344] [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: 06/27/2023] [Revised: 12/01/2023] [Accepted: 04/03/2024] [Indexed: 06/07/2024] Open
Abstract
The growing prominence of artificial intelligence (AI) in mobile health (mHealth) has given rise to a distinct subset of apps that provide users with diagnostic information using their inputted health status and symptom information-AI-powered symptom checker apps (AISympCheck). While these apps may potentially increase access to health care, they raise consequential ethical and legal questions. This paper will highlight notable concerns with AI usage in the health care system, further entrenchment of preexisting biases in the health care system and issues with professional accountability. To provide an in-depth analysis of the issues of bias and complications of professional obligations and liability, we focus on 2 mHealth apps as examples-Babylon and Ada. We selected these 2 apps as they were both widely distributed during the COVID-19 pandemic and make prominent claims about their use of AI for the purpose of assessing user symptoms. First, bias entrenchment often originates from the data used to train AI systems, causing the AI to replicate these inequalities through a "garbage in, garbage out" phenomenon. Users of these apps are also unlikely to be demographically representative of the larger population, leading to distorted results. Second, professional accountability poses a substantial challenge given the vast diversity and lack of regulation surrounding the reliability of AISympCheck apps. It is unclear whether these apps should be subject to safety reviews, who is responsible for app-mediated misdiagnosis, and whether these apps ought to be recommended by physicians. With the rapidly increasing number of apps, there remains little guidance available for health professionals. Professional bodies and advocacy organizations have a particularly important role to play in addressing these ethical and legal gaps. Implementing technical safeguards within these apps could mitigate bias, AIs could be trained with primarily neutral data, and apps could be subject to a system of regulation to allow users to make informed decisions. In our view, it is critical that these legal concerns are considered throughout the design and implementation of these potentially disruptive technologies. Entrenched bias and professional responsibility, while operating in different ways, are ultimately exacerbated by the unregulated nature of mHealth.
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Affiliation(s)
- Ma'n H Zawati
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Michael Lang
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
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2
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Alòs F, Aldon Mínguez D, Cárdenas-Ramos M, Cancio-Trujillo JM, Cánovas Zaldúa Y, Puig-Ribera A. [Mobile health in primary care. New challenges in the development of solutions to promote physical activity and well-being]. Aten Primaria 2024; 56:102900. [PMID: 38479201 PMCID: PMC10944101 DOI: 10.1016/j.aprim.2024.102900] [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: 12/30/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 03/19/2024] Open
Abstract
The use of smart devices such as mobile phones (smartphones) or smart watches (smartwatch) to promote physical activity and well-being has increased in recent years among patients and professionals in primary care. This change is driven by the access of patients and professionals to a large catalog of health applications, which can complement the provision of services and promote the empowerment of patients in their own health and lifestyles. These applications are beginning to be integrated with areas such as Artificial Intelligence (AI), the Internet of Medical Things (IoMT) and data storage in the cloud, among other emerging technological systems, offering a new complementary approach to clinical practice known so far. Despite the great potential, there are numerous limitations and major challenges for its full implementation in clinical practice.
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Affiliation(s)
- Francesc Alòs
- EAP Passeig de Sant Joan, Institut Català de la Salut, Barcelona, España; Tecnocampus Mataró (TCM) - Universitat Pompeu Fabra (UPF), Mataró, Barcelona, España.
| | | | - Marta Cárdenas-Ramos
- EAP Sagrada Família, Consorci Sanitari Integral (CSI), CAP Sagrada Família, Barcelona, España
| | - José Manuel Cancio-Trujillo
- Tecnocampus Mataró (TCM) - Universitat Pompeu Fabra (UPF), Mataró, Barcelona, España; Centro Sociosanitario El Carme, Servicios Asistenciales de Badalona, Badalona, Barcelona, España
| | - Yoseba Cánovas Zaldúa
- EAP Passeig de Sant Joan, Institut Català de la Salut, Barcelona, España; Dirección Asistencial de Atención Primaria y a la Comunidad, Institut Català de la Salut, Barcelona, España
| | - Anna Puig-Ribera
- Sport and Physical Activity Research Group, Centre for Health and Social Care Research, Universitat de Vic - Universitat Central de Catalunya, Vic, Barcelona, España
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Sniderman J, Monarrez R, Drew J, Abdeen A. Mobile Application Use and Patient Engagement in Total Hip and Knee Arthroplasty. JBJS Rev 2024; 12:01874474-202402000-00003. [PMID: 38394327 DOI: 10.2106/jbjs.rvw.23.00208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
» Mobile applications (MAs) are widely available for use during the perioperative period and are associated with increased adherence to rehabilitation plans, increased satisfaction with care, and considerable cost savings when used appropriately.» MAs offer surgeons and health care stakeholders the ability to collect clinical data and quality metrics that are important to value-based reimbursement models and clinical research.» Patients are willing to use wearable technology to assist with data collection as part of MAs but prefer it to be comfortable, easy to apply, and discreet.» Smart implants have been developed as the next step in MA use and data collection, but concerns exist pertaining to patient privacy and cost.» The ongoing challenge of MA standardization, validation, equity, and cost has persisted as concerns regarding widespread use.
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Affiliation(s)
- Jhase Sniderman
- Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts
- Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruben Monarrez
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital, Baltimore, Maryland
| | - Jacob Drew
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ayesha Abdeen
- Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts
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Wall C, Hetherington V, Godfrey A. Beyond the clinic: the rise of wearables and smartphones in decentralising healthcare. NPJ Digit Med 2023; 6:219. [PMID: 38007554 PMCID: PMC10676376 DOI: 10.1038/s41746-023-00971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023] Open
Affiliation(s)
- Conor Wall
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Victoria Hetherington
- Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne, UK.
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Rogers EJ, Reidlinger T, Loria A, Oplinger A, Raza SS, Gestring ML, Vella MA. Medical Information During Trauma Resuscitations: Are Smartphones the Contemporary Medical ID Bracelet? J Surg Res 2023; 291:313-320. [PMID: 37506430 DOI: 10.1016/j.jss.2023.06.024] [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: 02/26/2023] [Revised: 05/17/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Smartphone emergency medical identification (SEMID) applications are built-in health information-storing functions that are accessible without a passcode. The utility of these applications in the real-time resuscitation of trauma patients is unknown. METHODS We prospectively evaluated all trauma activation patients ≥16 y and unable to provide a medical history for any reason for the presence of a smartphone at our urban level I center between October 2020 and September 2021. Available smartphones were queried for SEMID utilization, categories of information contained, and real-time clinical relevance. RESULTS One hundred and forty three patients with a median age of 39 y [interquartile range 28-59] and Injury Severity Score of 16 [2-29] were included. 30 (21%) patients arrived with a smartphone, 27 (90%) of which were accessible. 8 (30%) of those individuals utilized a SEMID application, and SEMID information was relevant for patient care in 6 cases (75%). The extracted information included: identifiers (75%), emergency contacts (50%), height/weight (38%), allergies (38%), age (38%), medications (25%), medical history (13%), and blood type (13%). CONCLUSIONS Approximately one in five altered trauma patients have smartphones present at arrival, some of which contain medical information pertinent for immediate care. There is a pressing need for education and our institution has developed a publicly-facing campaign with shareable materials to improve SEMID awareness and utilization. Other centers are likely to find similar benefit.
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Affiliation(s)
- Eli J Rogers
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Timothy Reidlinger
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Anthony Loria
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Adam Oplinger
- Kessler Trauma Center, University of Rochester Medical Center, Rochester, New York
| | - Shariq S Raza
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark L Gestring
- Division of Acute Care Surgery and Trauma, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael A Vella
- Division of Acute Care Surgery and Trauma, University of Rochester School of Medicine and Dentistry, Rochester, New York.
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van der Storm SL, Jansen M, Meijer HAW, Barsom EZ, Schijven MP. Apps in healthcare and medical research; European legislation and practical tips every healthcare provider should know. Int J Med Inform 2023; 177:105141. [PMID: 37419042 DOI: 10.1016/j.ijmedinf.2023.105141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The use of apps in healthcare and medical research is increasing. Apps in healthcare may be beneficial to patients and healthcare professionals, but their use comes with potential risks. How to use apps in clinical care is not standard part of medical training, resulting in a lack of knowledge. As healthcare professionals and their employers can be held accountable for the wrongful use of medical apps, this situation is undesirable. This article addresses the most important European legislation regarding medical apps from the perspective of healthcare providers. METHODS This review provides an overview of current and changing regulations, focusing on apps used in healthcare and medical research. Three topics are discussed: 1) the relevant European legislation and its enforcement, 2) the responsibilities and liability of the medical professional when using these apps, and 3) an overview of the most practical considerations medical professionals should know when using or building a medical app. RESULTS When using and developing medical apps, data privacy must be guaranteed according to the GDPR guidelines. Several international standards make it easier to comply with the GDPR, such as ISO/IEC 27001 and 27002. Medical Devices Regulation was implemented on May 26, 2021, and as a result, medical apps will more often qualify as medical devices. The important guidelines for manufacturers to comply with Medical Devices Regulation are ISO 13485, ISO 17021, ISO 14971 and ISO/TS 82304-2. CONCLUSION The use of medical apps in healthcare and medical research can be beneficial to patients, medical professionals, and society as a whole. This article provides background information on legislation and a comprehensive checklist for anyone wanting to start using or building medical apps.
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Affiliation(s)
- Sebastiaan L van der Storm
- Amsterdam UMC location University of Amsterdam, Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands.
| | - Marilou Jansen
- Amsterdam UMC location University of Amsterdam, Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Henriëtte A W Meijer
- Amsterdam UMC location University of Amsterdam, Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Esther Z Barsom
- Amsterdam UMC location University of Amsterdam, Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Marlies P Schijven
- Amsterdam UMC location University of Amsterdam, Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands.
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Grimm M, Link E, Albrecht M, Czerwinski F, Baumann E, Suhr R. Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study. J Med Internet Res 2023; 25:e44024. [PMID: 37379058 PMCID: PMC10365627 DOI: 10.2196/44024] [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: 11/03/2022] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one's state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm. OBJECTIVE This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users' perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions. METHODS Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions. RESULTS Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one's state of health, and preventing health problems. In total, 66.62% (1333/2001) of internet users engaged in this behavior. Health care-related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition). CONCLUSIONS Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key.
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Affiliation(s)
| | - Elena Link
- Department of Communication, Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Fabian Czerwinski
- Department of Journalism and Communication Research, University of Music, Drama and Media Hanover, Hanover, Germany
| | - Eva Baumann
- Department of Journalism and Communication Research, University of Music, Drama and Media Hanover, Hanover, Germany
| | - Ralf Suhr
- Stiftung Gesundheitswissen, Berlin, Germany
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Dam R, Mponzi W, Msaky D, Mwandyala T, Kaindoa EW, Sinka ME, Kiskin I, Herreros-Moya E, Messina J, Shah SGS, Roberts S, Willis KJ. What incentives encourage local communities to collect and upload mosquito sound data by using smartphones? A mixed methods study in Tanzania. Glob Health Res Policy 2023; 8:18. [PMID: 37246227 DOI: 10.1186/s41256-023-00298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 04/07/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND To detect and identify mosquitoes using their characteristic high-pitched sound, we have developed a smartphone application, known as the 'HumBug sensor', that records the acoustic signature of this sound, along with the time and location. This data is then sent remotely to a server where algorithms identify the species according to their distinctive acoustic signature. Whilst this system works well, a key question that remains is what mechanisms will lead to effective uptake and use of this mosquito survey tool? We addressed this question by working with local communities in rural Tanzania and providing three alternative incentives: money only, short message service (SMS) reminders and money, and SMS reminders only. We also had a control group with no incentive. METHODS A multi-site, quantitative empirical study was conducted in four villages in Tanzania from April to August 2021. Consenting participants (n = 148) were recruited and placed into one of the three intervention arms: monetary incentives only; SMS reminders with monetary incentives; and SMS reminders only. There was also a control group (no intervention). To test effectiveness of the mechanisms, the number of audio uploads to the server of the four trial groups on their specific dates were compared. Qualitative focus group discussions and feedback surveys were also conducted to explore participants' perspectives on their participation in the study and to capture their experiences of using the HumBug sensor. RESULTS Qualitative data analysis revealed that for many participants (37 out of 81), the main motivation expressed was to learn more about the types of mosquitoes present in their houses. Results from the quantitative empirical study indicate that the participants in the 'control' group switched on their HumBug sensors more over the 14-week period (8 out of 14 weeks) when compared to those belonging to the 'SMS reminders and monetary incentives' trial group. These findings are statistically significant (p < 0.05 or p > 0.95 under a two-sided z-test), revealing that the provision of monetary incentives and sending SMS reminders did not appear to encourage greater number of audio uploads when compared to the control. CONCLUSIONS Knowledge on the presence of harmful mosquitoes was the strongest motive for local communities to collect and upload mosquito sound data via the HumBug sensor in rural Tanzania. This finding suggests that most efforts should be made to improve flow of real-time information back to the communities on types and risks associated with mosquitoes present in their houses.
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Affiliation(s)
- Rinita Dam
- Department of Biology, University of Oxford, Oxford, UK.
- Warwick Medical School, University of Warwick, Warwick, UK.
| | - Winifrida Mponzi
- Environmental Health and Ecological Science Department, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
| | - Dickson Msaky
- Environmental Health and Ecological Science Department, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
| | - Tumpe Mwandyala
- Environmental Health and Ecological Science Department, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
| | - Emmanuel W Kaindoa
- Environmental Health and Ecological Science Department, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
- The Nelson Mandela, African Institution of Science and Technology, School of Life Sciences and Bioengineering, Tengeru, Arusha, Tanzania
| | | | - Ivan Kiskin
- Department of Engineering Science, University of Oxford, Oxford, UK
- Surrey Institute for People-Centred AI, Centre for Vision Speech and Signal Processing, University of Surrey, Guildford, UK
| | | | - Janey Messina
- School of Geography and the Environment and the Oxford School of Global and Area Studies, University of Oxford, Oxford, UK
| | - Syed Ghulam Sarwar Shah
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen Roberts
- Department of Engineering Science, University of Oxford, Oxford, UK
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González-Pérez A, Matey-Sanz M, Granell C, Diaz-Sanahuja L, Bretón-López J, Casteleyn S. AwarNS: A framework for developing context-aware reactive mobile applications for health and mental health. J Biomed Inform 2023; 141:104359. [PMID: 37044134 DOI: 10.1016/j.jbi.2023.104359] [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: 10/21/2022] [Revised: 03/10/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
In recent years, interest and investment in health and mental health smartphone apps have grown significantly. However, this growth has not been followed by an increase in quality and the incorporation of more advanced features in such applications. This can be explained by an expanding fragmentation of existing mobile platforms along with more restrictive privacy and battery consumption policies, with a consequent higher complexity of developing such smartphone applications. To help overcome these barriers, there is a need for robust, well-designed software development frameworks which are designed to be reliable, power-efficient and ethical with respect to data collection practices, and which support the sense-analyse-act paradigm typically employed in reactive mHealth applications. In this article, we present the AwarNS Framework, a context-aware modular software development framework for Android smartphones, which facilitates transparent, reliable, passive and active data sampling running in the background (sense), on-device and server-side data analysis (analyse), and context-aware just-in-time offline and online intervention capabilities (act). It is based on the principles of versatility, reliability, privacy, reusability, and testability. It offers built-in modules for capturing smartphone and associated wearable sensor data (e.g. IMU sensors, geolocation, Wi-Fi and Bluetooth scans, physical activity, battery level, heart rate), analysis modules for data transformation, selection and filtering, performing geofencing analysis and machine learning regression and classification, and act modules for persistence and various notification deliveries. We describe the framework's design principles and architecture design, explain its capabilities and implementation, and demonstrate its use at the hand of real-life case studies implementing various mobile interventions for different mental disorders used in clinical practice.
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Affiliation(s)
- Alberto González-Pérez
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
| | - Miguel Matey-Sanz
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
| | - Carlos Granell
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
| | - Laura Diaz-Sanahuja
- Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Castellon, 12071, Spain.
| | - Juana Bretón-López
- Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Castellon, 12071, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain.
| | - Sven Casteleyn
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
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Malinka C, Dittrich F, Back DA, Ansorg J, von Jan U, Albrecht UV. Orthopaedic and trauma surgeons' prioritisation of app quality principles based on their demographic background. BMC Musculoskelet Disord 2023; 24:146. [PMID: 36823560 PMCID: PMC9948494 DOI: 10.1186/s12891-023-06226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 10/17/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Although apps are becoming increasingly relevant in healthcare, there is limited knowledge about how healthcare professionals perceive "quality" in this context and how quality principles that can aid them in assessing health-related apps may be prioritised. The objective was to investigate physicians' views of predefined (general) quality principles for health apps and to determine whether a ranking algorithm applied to the acquired data can provide stable results against various demographic influences and may thus be appropriate for prioritisation. METHODS Participants of an online survey of members of two German professional orthopaedics associations conducted between 02/12/2019 and 02/01/2020 were asked about their perception of a set of quality principles for health apps (i.e., "practicality," "risk adequacy," "ethical soundness," "legal conformity," "content validity," "technical adequacy," "usability," "resource efficiency," and "transparency"). Structured as a Kano survey, for each principle, there were questions about its perceived relevance and opinions regarding the presence or absence of corresponding characteristics. The available data were evaluated descriptively, and a newly developed method for prioritisation of the principles was applied overall and to different demographic strata (for validation). RESULTS Three hundred eighty-two datasets from 9503 participants were evaluated. Legal conformity, content validity, and risk adequacy filled ranks one to three, followed by practicability, ethical soundness, and usability (ranks 4 to 6). Technical adequacy, transparency, and resource efficiency ranked last (ranks 7 to 9). The ranking based on the proposed method was relatively stable, irrespective of demographic factors. The principles were seen as essential, with one exception ("resource efficiency"). Only those with little to no interest in digitisation (22/382, 5.8%) rated the nine principles indifferently. CONCLUSIONS The specified quality principles and their prioritisation can lay a foundation for future assessments of apps in the medical field. Professional societies build upon this to highlight opportunities for digital transformations in medicine and encourage their members to participate.
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Affiliation(s)
- Christin Malinka
- grid.10423.340000 0000 9529 9877Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover Medical School, Hannover, Germany
| | - Florian Dittrich
- Joint Centre Bergischland, Sana Fabricius Clinic Remscheid, Remscheid, Germany ,grid.7491.b0000 0001 0944 9128Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - David Alexander Back
- Department for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jörg Ansorg
- Professional Association of Specialists in Orthopaedic and Trauma Surgery, Berlin, Germany
| | - Ute von Jan
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover Medical School, Hannover, Germany.
| | - Urs-Vito Albrecht
- grid.10423.340000 0000 9529 9877Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover Medical School, Hannover, Germany ,grid.7491.b0000 0001 0944 9128Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
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Zahedi FM, Zhao H, Sanvanson P, Walia N, Jain H, Shaker R. My Real Avatar has a Doctor Appointment in the Wepital: A System for Persistent, Efficient, and Ubiquitous Medical Care. INFORMATION & MANAGEMENT 2022. [PMCID: PMC9487169 DOI: 10.1016/j.im.2022.103706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
COVID-19 created a great deal of personal, social, and economic anxiety in the USA and across the globe and exposed the inadequacy of traditional medical systems in handling large-scale emergencies. While telemedicine and virtual visits have become popular as a result, they end once a visit is over, hence lacking data persistence and continuity in caring for patients. Using the design science research approach with support from the theory of affordances, this paper proposes the design of a medical system (called wepital) in which patients receive care through their real avatars, enabling hospitals and other medical centers to provide immediate care that can continue for as long as a patient needs it. Real avatars are digital representations of patients that embody their real-time vital signs and health information. We have created a functional prototype to demonstrate how the proposed design can work. To assess the usability of the design, we have used the prototype in an experiment to provide medical advice to patient volunteers. Based on a theory-based conceptual model, we collected survey data after the experiment to identify factors contributing to the success of such a system, as measured by patient satisfaction. We report the factors that significantly contribute to the patients’ satisfaction. As part of the application and policy implications of our work, we propose a nationwide system that could supplement and expand the capacity of medical systems at the national or even global level.
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Crowdsourcing Operational and Design Flaws of Diabetes Mobile Apps. J Med Syst 2022; 46:101. [PMID: 36418791 DOI: 10.1007/s10916-022-01879-z] [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: 09/06/2020] [Accepted: 10/17/2022] [Indexed: 11/25/2022]
Abstract
Unfortunately, many of the diabetes mobile apps have operational and design flaws that are debarring users from maximizing from the self-management paradigm. We, therefore, aim to identify the markers of operational and design flaws of diabetes mobile apps to facilitate a better user-centred design. e crowdsourced negative user review comments (rating score: 1-3) of 47 diabetes mobile apps from the google play store. A total of 781 negative user comments (rating score 1-3) from the apps are coded to identify and categorize the themes relating to the operational and design flaws. The operational and design flaws account for 50.32% of the challenges faced by the unhappy diabetes mobile apps users. Among them, 44.73% have issues with app crashing, 17.3% are concerned about device compatibility that inhibits seamless operations, 9.67% are worried about the problem of data uploading. Poor design is a worry to 19.29% of the users who complain of the crowded user interface, poor data management, poor analytics, difficulty scheduling doctors' appointments, and transferring data. More patients with diabetes can be encouraged to continue using diabetes mobile apps for self-management of diabetes through improved design and a pace-wise software advancement to match the ever-growing enhancements in android operating systems and telecommunication devices. This will help to counter most of the challenges identified in this study.
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Salem M, Elkaseer A, El-Maddah IAM, Youssef KY, Scholz SG, Mohamed HK. Non-Invasive Data Acquisition and IoT Solution for Human Vital Signs Monitoring: Applications, Limitations and Future Prospects. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22176625. [PMID: 36081081 PMCID: PMC9460364 DOI: 10.3390/s22176625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 05/06/2023]
Abstract
The rapid development of technology has brought about a revolution in healthcare stimulating a wide range of smart and autonomous applications in homes, clinics, surgeries and hospitals. Smart healthcare opens the opportunity for a qualitative advance in the relations between healthcare providers and end-users for the provision of healthcare such as enabling doctors to diagnose remotely while optimizing the accuracy of the diagnosis and maximizing the benefits of treatment by enabling close patient monitoring. This paper presents a comprehensive review of non-invasive vital data acquisition and the Internet of Things in healthcare informatics and thus reports the challenges in healthcare informatics and suggests future work that would lead to solutions to address the open challenges in IoT and non-invasive vital data acquisition. In particular, the conducted review has revealed that there has been a daunting challenge in the development of multi-frequency vital IoT systems, and addressing this issue will help enable the vital IoT node to be reachable by the broker in multiple area ranges. Furthermore, the utilization of multi-camera systems has proven its high potential to increase the accuracy of vital data acquisition, but the implementation of such systems has not been fully developed with unfilled gaps to be bridged. Moreover, the application of deep learning to the real-time analysis of vital data on the node/edge side will enable optimal, instant offline decision making. Finally, the synergistic integration of reliable power management and energy harvesting systems into non-invasive data acquisition has been omitted so far, and the successful implementation of such systems will lead to a smart, robust, sustainable and self-powered healthcare system.
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Affiliation(s)
- Mahmoud Salem
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76344 Eggenstein-Leopoldshafen, Germany
- Correspondence: ; Tel.: +49-0-721-608-25632
| | - Ahmed Elkaseer
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76344 Eggenstein-Leopoldshafen, Germany
- Karlsruhe Nano Micro Facility, Karlsruhe Institute of Technology, 76344 Eggenstein-Leopoldshafen, Germany
- Faculty of Engineering, Port Said University, Port Said 42526, Egypt
| | | | - Khaled Y. Youssef
- Faculty of Navigation Science and Space Technology, Beni-Suef University, Beni-Suef 2731070, Egypt
| | - Steffen G. Scholz
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76344 Eggenstein-Leopoldshafen, Germany
- Karlsruhe Nano Micro Facility, Karlsruhe Institute of Technology, 76344 Eggenstein-Leopoldshafen, Germany
- College of Engineering, Swansea University, Swansea SA2 8PP, UK
| | - Hoda K. Mohamed
- Faculty of Engineering, Ain Shams University, Cairo 11535, Egypt
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King SL, Lebert J, Karpisek LA, Phillips A, Neal T, Kosyluk K. Characterizing User Experiences With an SMS Text Messaging-Based mHealth Intervention: Mixed Methods Study. JMIR Form Res 2022; 6:e35699. [PMID: 35503524 PMCID: PMC9115655 DOI: 10.2196/35699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited access to mental health care services due to provider shortages, geographic limitations, and cost has driven the area of mobile health (mHealth) care to address these access gaps. Reports from the Cohen Veterans Network and National Council for Behavioral Health show that in states where mental health care is more accessible, 38% of people still do not receive the care they need. mHealth strategies help to provide care to individuals experiencing these barriers at lower cost and greater convenience, making mHealth a great resource to bridge the gaps. OBJECTIVE We present a mixed methods study to evaluate user experiences with the mental mHealth service, Cope Notes. Specifically, we aimed to investigate the following research questions: How do users perceive the service in relation to stigma, impact of the intervention, and perceived usefulness? How do users rate the Cope Notes service and SMS text messaging along various dimensions of acceptability? What is the relationship between Cope Notes SMS text message ratings, user personality, and coping strategies? What are user perspectives of leveraging ubiquitous sensing technologies to improve delivery and provide tailored content? METHODS We performed qualitative interviews with Cope Notes users (N=14) who have used the service for at least 30 days to evaluate their experiences and usefulness of the service. These interviews were coded by 2 raters (SLK and JL), and the interrater reliability was calculated with SPSS (IBM Corp) at 61.8%. In addition, participants completed quantitative measures, including a user experiences survey, personality inventory (Big Five Inventory-10), and coping assessment (Brief Coping Orientation to Problems Experienced). RESULTS We derived 7 themes from our qualitative interviews: Likes or Perceived Benefits, Dislikes or Limitations, Suggested Changes, Stigma or Help Seeking, Perceptions of Ubiquitous Sensing, Cultural Sensitivity, and Alternative mHealth Resources. Exploratory analyses between acceptability ratings of Cope Notes and personality factors showed statistically significant positive relationships between seeing oneself as someone who is generally trusting and acceptability items, the most significant being item 7 (I fully understood the sentiment behind Cope Notes Messages) with (rs(10)=0.82, P=.001). We also found statistically significant relationships between acceptability and Brief Coping Orientation to Problems Experienced items, with the strongest positive correlation between participants strongly endorsing coping by accepting the reality that an event has happened and acceptability item 7 (rs(8)=0.86, P=.001). CONCLUSIONS Our study found that Cope Notes subscribers appreciate the service for reframing their mental wellness with statistically significant correlations between personality and acceptability of the service. We found that some users prefer a more personalized experience with neutral to positive reactions to a potential companion app that continuously monitors user behavior via smartphone sensors to provide just-in-time interventions when users need it most.
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Affiliation(s)
- Sayde Leya King
- Department of Computer Science and Engineering, College of Engineering, University of South Florida, Tampa, FL, United States
| | - Jana Lebert
- Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa, FL, United States
| | - Lacey Anne Karpisek
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
| | - Amelia Phillips
- Department of Medical Education, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Tempestt Neal
- Department of Computer Science and Engineering, College of Engineering, University of South Florida, Tampa, FL, United States
| | - Kristin Kosyluk
- Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa, FL, United States
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15
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Green J, Leadbitter K, Ainsworth J, Bucci S. An integrated early care pathway for autism. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:335-344. [PMID: 35303486 DOI: 10.1016/s2352-4642(22)00037-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 01/17/2023]
Abstract
In this Viewpoint, we argue for the need to reconceptualise an integrated early-care provision for autistic children in the light of their enduring support needs and relevant new findings from developmental and intervention research. This model goes beyond short-term reactive care to outline an early proactive, evidenced, developmentally phased, and scalable programme of support for autistic children and their families from the earliest opportunity, with timely access to later step-up care when needed. We also integrate this model with emerging opportunities from data science and digital health technologies as a potential facilitator of such a pathway. Building on this work, we argue that the best current autism intervention evidence can be integrated with concepts and evidence gained in the management of other enduring health conditions to support an autistic child and their family through their early development. The aim is to improve those children's social communication abilities, expand their range and flexibility of interests, and mitigate any negative impacts of sensory difficulties and restricted, repetitive behaviours on the child and their family wellbeing. The pathway solutions described could also be adapted for older adolescents and adults and could be used within the health systems of different countries, including within low-income and middle-income contexts.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester, UK; Department of Child and Adolescent Mental Health, Manchester Royal Children's Hospital, Manchester, UK.
| | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester, UK
| | - John Ainsworth
- Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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16
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Adams AT, Mandel I, Gao Y, Heckman BW, Nandakumar R, Choudhury T. Equity-Driven Sensing System for Measuring Skin Tone-Calibrated Peripheral Blood Oxygen Saturation (OptoBeat): Development, Design, and Evaluation Study. JMIR BIOMEDICAL ENGINEERING 2022; 7:e34934. [PMID: 38875699 PMCID: PMC11041433 DOI: 10.2196/34934] [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: 11/13/2021] [Revised: 02/20/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many commodity pulse oximeters are insufficiently calibrated for patients with darker skin. We demonstrate a quantitative measurement of this disparity in peripheral blood oxygen saturation (SpO2) with a controlled experiment. To mitigate this, we present OptoBeat, an ultra-low-cost smartphone-based optical sensing system that captures SpO2 and heart rate while calibrating for differences in skin tone. Our sensing system can be constructed from commodity components and 3D-printed clips for approximately US $1. In our experiments, we demonstrate the efficacy of the OptoBeat system, which can measure SpO2 within 1% of the ground truth in levels as low as 75%. OBJECTIVE The objective of this work is to test the following hypotheses and implement an ultra-low-cost smartphone adapter to measure SpO2: skin tone has a significant effect on pulse oximeter measurements (hypothesis 1), images of skin tone can be used to calibrate pulse oximeter error (hypothesis 2), and SpO2 can be measured with a smartphone camera using the screen as a light source (hypothesis 3). METHODS Synthetic skin with the same optical properties as human skin was used in ex vivo experiments. A skin tone scale was placed in images for calibration and ground truth. To achieve a wide range of SpO2 for measurement, we reoxygenated sheep blood and pumped it through synthetic arteries. A custom optical system was connected from the smartphone screen (flashing red and blue) to the analyte and into the phone's camera for measurement. RESULTS The 3 skin tones were accurately classified according to the Fitzpatrick scale as types 2, 3, and 5. Classification was performed using the Euclidean distance between the measured red, green, and blue values. Traditional pulse oximeter measurements (n=2000) showed significant differences between skin tones in both alternating current and direct current measurements using ANOVA (direct current: F2,5997=3.1170 × 105, P<.01; alternating current: F2,5997=8.07 × 106, P<.01). Continuous SpO2 measurements (n=400; 10-second samples, 67 minutes total) from 95% to 75% were captured using OptoBeat in an ex vivo experiment. The accuracy was measured to be within 1% of the ground truth via quadratic support vector machine regression and 10-fold cross-validation (R2=0.97, root mean square error=0.7, mean square error=0.49, and mean absolute error=0.5). In the human-participant proof-of-concept experiment (N=3; samples=3 × N, duration=20-30 seconds per sample), SpO2 measurements were accurate to within 0.5% of the ground truth, and pulse rate measurements were accurate to within 1.7% of the ground truth. CONCLUSIONS In this work, we demonstrate that skin tone has a significant effect on SpO2 measurements and the design and evaluation of OptoBeat. The ultra-low-cost OptoBeat system enables smartphones to classify skin tone for calibration, reliably measure SpO2 as low as 75%, and normalize to avoid skin tone-based bias.
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Affiliation(s)
- Alexander T Adams
- Information Science, Cornell Tech, New York, NY, United States
- The Center for the Study of Social Determinants of Health, Meharry Medical College, Nashville, TN, United States
| | - Ilan Mandel
- Information Science, Cornell Tech, New York, NY, United States
| | - Yixuan Gao
- Information Science, Cornell Tech, New York, NY, United States
| | - Bryan W Heckman
- The Center for the Study of Social Determinants of Health, Meharry Medical College, Nashville, TN, United States
- Psychiatry and Behavioral Sciences, School of Medicine, Meharry Medical College, Nashville, TN, United States
- Division of Public Health, School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, United States
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17
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Philip BJ, Abdelrazek M, Bonti A, Barnett S, Grundy J. Data Collection Mechanisms in Health and Wellness Apps: Review and Analysis. JMIR Mhealth Uhealth 2022; 10:e30468. [PMID: 35262499 PMCID: PMC8943537 DOI: 10.2196/30468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/10/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background
There has been a steady rise in the availability of health wearables and built-in smartphone sensors that can be used to collect health data reliably and conveniently from end users. Given the feature overlaps and user tendency to use several apps, these are important factors impacting user experience. However, there is limited work on analyzing the data collection aspect of mobile health (mHealth) apps.
Objective
This study aims to analyze what data mHealth apps across different categories usually collect from end users and how these data are collected. This information is important to guide the development of a common data model from current widely adopted apps. This will also inform what built-in sensors and wearables, a comprehensive mHealth platform should support.
Methods
In our empirical investigation of mHealth apps, we identified app categories listed in a curated mHealth app library, which was then used to explore the Google Play Store for health and medical apps that were then filtered using our selection criteria. We downloaded these apps from a mirror site hosting Android apps and analyzed them using a script that we developed around the popular AndroGuard tool. We analyzed the use of Bluetooth peripherals and built-in sensors to understand how a given app collects health data.
Results
We retrieved 3251 apps meeting our criteria, and our analysis showed that 10.74% (349/3251) of these apps requested Bluetooth access. We found that 50.9% (259/509) of the Bluetooth service universally unique identifiers to be known in these apps, with the remainder being vendor specific. The most common health-related Bluetooth Low Energy services using known universally unique identifiers were Heart Rate, Glucose, and Body Composition. App permissions showed the most used device module or sensor to be the camera (669/3251, 20.57%), closely followed by location (598/3251, 18.39%), with the highest occurrence in the staying healthy app category.
Conclusions
We found that not many health apps used built-in sensors or peripherals for collecting health data. The small number of the apps using Bluetooth, with an even smaller number of apps using standard Bluetooth Low Energy services, indicates a wider use of proprietary algorithms and custom services, which restrict the device use. The use of standard profiles could open this ecosystem further and could provide end users more options for apps. The relatively small proportion of apps using built-in sensors along with a high reliance on manual data entry suggests the need for more research into using sensors for data collection in health and fitness apps, which may be more desirable and improve end user experience.
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Affiliation(s)
| | - Mohamed Abdelrazek
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Melbourne, Australia
| | - Alessio Bonti
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Melbourne, Australia
| | - Scott Barnett
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Australia
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18
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Siebert JN, Gosetto L, Sauvage M, Bloudeau L, Suppan L, Rodieux F, Haddad K, Hugon F, Gervaix A, Lovis C, Combescure C, Manzano S, Ehrler F. Usability Testing and Technology Acceptance of an mHealth App at the Point of Care During Simulated Pediatric In- and Out-of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials. JMIR Hum Factors 2022; 9:e35399. [PMID: 35230243 PMCID: PMC8924787 DOI: 10.2196/35399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/03/2022] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile apps are increasingly being used in various domains of medicine. Few are evidence-based, and their benefits can only be achieved if end users intend to adopt and use them. To date, only a small fraction of mobile apps have published data on their field usability and end user acceptance results, especially in emergency medicine. OBJECTIVE This study aims to determine the usability and acceptance of an evidence-based mobile app while safely preparing emergency drugs at the point of care during pediatric in- and out-of-hospital cardiopulmonary resuscitations by frontline caregivers. METHODS In 2 multicenter randomized controlled parent trials conducted at 6 pediatric emergency departments from March 1 to December 31, 2017, and 14 emergency medical services from September 3, 2019, to January 21, 2020, the usability and technology acceptance of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app were evaluated among skilled pediatric emergency nurses and advanced paramedics when preparing continuous infusions of vasoactive drugs and direct intravenous emergency drugs at pediatric dosages during standardized, simulation-based, pediatric in- and out-of-hospital cardiac arrest scenarios, respectively. Usability was measured using the 10-item System Usability Scale. A 26-item technology acceptance self-administered survey (5-point Likert-type scales), adapted from the Unified Theory of Acceptance and Use of Technology model, was used to measure app acceptance and intention to use. RESULTS All 100% (128/128) of nurses (crossover trial) and 49.3% (74/150) of paramedics (parallel trial) were assigned to the mobile app. Mean total scores on the System Usability Scale were excellent and reached 89.5 (SD 8.8; 95% CI 88.0-91.1) for nurses and 89.7 (SD 8.7; 95% CI 87.7-91.7) for paramedics. Acceptance of the technology was very good and rated on average >4.5/5 for 5 of the 8 independent constructs evaluated. Only the image construct scored between 3.2 and 3.5 by both participant populations. CONCLUSIONS The results provide evidence that dedicated mobile apps can be easy to use and highly accepted at the point of care during in- and out-of-hospital cardiopulmonary resuscitations by frontline emergency caregivers. These findings can contribute to the implementation and valorization of studies aimed at evaluating the usability and acceptance of mobile apps in the field by caregivers, even in critical situations. TRIAL REGISTRATION ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122. ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-019-3726-4.
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Affiliation(s)
- Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laëtitia Gosetto
- Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - Manon Sauvage
- Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | | | - Laurent Suppan
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédérique Rodieux
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Florence Hugon
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Combescure
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Frederic Ehrler
- Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
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19
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Yu H, He J, Wang X, Yang W, Sun B, Szumilewicz A. A Comparison of Functional Features of Chinese and US Mobile Apps for Pregnancy and Postnatal Care: A Systematic App Store Search and Content Analysis. Front Public Health 2022; 10:826896. [PMID: 35252100 PMCID: PMC8891489 DOI: 10.3389/fpubh.2022.826896] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/24/2022] [Indexed: 12/21/2022] Open
Abstract
Background Pregnancy to postpartum (PtP) applications (apps) are becoming more common tools to document everything from pregnancy and delivery to nutrient allocation, life taboos, and infant medical examinations. However, the dependability, quality, and efficacy of these apps remain unclear. This study examined the features and functions of mobile PtP care apps accessible in China and the United States and to identify the major gaps that need to be addressed. Methods Apps were selected by searching the Apple App Store and Android Markets (in the US and China) for the terms “pregnancy” and “postpartum” in Chinese and English. The apps' security, quality, and effectiveness were investigated, and chi-square tests and analysis of variance were performed to examine the differences in characteristics between apps available in the US and China. Results A total of 84 mobile PtP care apps (45 from the US and 39 from China) were included. A total of 89.7% (35/39) of Chinese mobile apps did not provide safety statements or supporting evidence. The objective app quality ratings for Chinese and US apps were 3.20 ± 0.48 (mean ± standard deviation) and 3.56 ± 0.45, respectively (p > 0.05). A greater number of Chinese apps provided app-based monitoring functions, namely recording fetal size (n = 18, 46.2% in China vs. n = 3, 6.7% in the US), contractions (n = 11, 28.2% in China vs. n = 0, 0% in the US), pregnancy weight (n = 11, 28.2% in China vs. 0, 0% in the US), and pregnancy check-up reminders (n = 10, 25.6% in China vs. n = 0, 0% in the US). Meanwhile, a greater number of US apps provided exercise modules, namely pregnancy yoga (n = 2, 5.1% in China vs. n = 21, 46.7% in the US), pregnancy workouts (n = 2, 5.1% in China vs. n = 13, 28.9% in the US), and pregnancy meditation (n = 0, 0% in China vs. 10, 22.2% in the US) (p < 0.01). A medium security risk was identified for 40% (18/45) of apps in the US and 82.1% (32/39) of apps in China (p < 0.01). Conclusions The functionality and characteristics of in-store mobile apps for PtP care varied between China and the US. Both countries' apps, particularly Chinese apps, encountered issues related to a lack of evidence-based information, acceptable content risk, and program evaluations. Both countries' apps lacked proper mental health care functions. The findings suggest that the design of app features should be enhanced in both countries, and increased interaction between app creators and users is recommended.
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Affiliation(s)
- Hongli Yu
- Department of Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
- Jiuling Primary School, Mianyang, China
- *Correspondence: Hongli Yu
| | - Juan He
- Department of Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Xinghao Wang
- Department of Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Weilin Yang
- Department of Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Bo Sun
- Department of Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Anna Szumilewicz
- Department of Sport, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
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20
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Eis S, Solà-Morales O, Duarte-Díaz A, Vidal-Alaball J, Perestelo-Pérez L, Robles N, Carrion C. Mobile Applications in Mood Disorders and Mental Health: Systematic Search in Apple App Store and Google Play Store and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042186. [PMID: 35206373 PMCID: PMC8871536 DOI: 10.3390/ijerph19042186] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The main objective of this work was to explore and characterize the current landscape of mobile applications available to treat mood disorders such as depression, bipolar disorder, and dysthymia. METHODS We developed a tool that makes both the Apple App Store and the Google Play Store searchable using keywords and that facilitates the extraction of basic app information of the search results. All app results were filtered using various inclusion and exclusion criteria. We characterized all resultant applications according to their technical details. Furthermore, we searched for scientific publications on each app's website and PubMed, to understand whether any of the apps were supported by any type of scientific evidence on their acceptability, validation, use, effectiveness, etc. Results: Thirty apps were identified that fit the inclusion and exclusion criteria. The literature search yielded 27 publications related to the apps. However, these did not exclusively concern mood disorders. 6 were randomized studies and the rest included a protocol, pilot-, feasibility, case-, or qualitative studies, among others. The majority of studies were conducted on relatively small scales and 9 of the 27 studies did not explicitly study the effects of mobile application use on mental wellbeing. CONCLUSION While there exists a wealth of mobile applications aimed at the treatment of mental health disorders, including mood disorders, this study showed that only a handful of these are backed by robust scientific evidence. This result uncovers a need for further clinically oriented and systematic validation and testing of such apps.
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Affiliation(s)
- Sophie Eis
- Fundació HiTT (Health Innovation Technology Transfer), 08015 Barcelona, Spain;
| | - Oriol Solà-Morales
- Fundació HiTT (Health Innovation Technology Transfer), 08015 Barcelona, Spain;
- Correspondence:
| | - Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Barcelona, Spain;
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | | | - Noemí Robles
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain; (N.R.); (C.C.)
| | - Carme Carrion
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain; (N.R.); (C.C.)
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Bond SJ, Parikh N, Majmudar S, Pin S, Wang C, Willis L, Haga SB. A Systematic Review of the Scope of Study of mHealth Interventions for Wellness and Related Challenges in Pediatric and Young Adult Populations. Adolesc Health Med Ther 2022; 13:23-38. [PMID: 35173502 PMCID: PMC8835977 DOI: 10.2147/ahmt.s342811] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite the purported advantages and potential efficacy of mHealth interventions to promote wellness in children, adolescents, and young adults, it is not clear what areas have been explored and the challenges reported in the biomedical literature. Methods We conducted a scoping review of publications between 2015 and 2019. Results We identified 54 papers that met our inclusion criteria. Studies were conducted in 21 countries and ranged in size from six to 9851 participants (median: 184). A total of 41% of studies enrolled adolescents only (n = 19). Of the seven types of mHealth interventions identified, apps were the most common intervention (59%; n = 32) evaluated and 44% of the studies evaluated two or more interventions. The most common topic of the studies reviewed was sexual and reproductive health (24%; n = 13). Conclusion Most pediatric mHealth intervention studies are conducted in adolescents in large part, and sexual and reproductive health is the most commonly studied topic. With the easy and widespread accessibility to smartphone technology, the use of mobile apps for wellness interventions will likely continue to expand to other wellness topics.
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Affiliation(s)
| | | | | | | | | | | | - Susanne B Haga
- Duke University, Durham, NC, 27708, USA
- Duke University School of Medicine, Durham, NC, 27708, USA
- Correspondence: Susanne B Haga, Duke University, 101 Science Drive, Box 3382, Durham, NC, 27708, USA, Tel +1 919 684 0325, Fax +1 919 681 8973, Email
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Vaidyam A, Halamka J, Torous J. Enabling Research and Clinical Use of Patient-Generated Health Data (the mindLAMP Platform): Digital Phenotyping Study. JMIR Mhealth Uhealth 2022; 10:e30557. [PMID: 34994710 PMCID: PMC8783287 DOI: 10.2196/30557] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/18/2021] [Accepted: 11/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a growing need for the integration of patient-generated health data (PGHD) into research and clinical care to enable personalized, preventive, and interactive care, but technical and organizational challenges, such as the lack of standards and easy-to-use tools, preclude the effective use of PGHD generated from consumer devices, such as smartphones and wearables. OBJECTIVE This study outlines how we used mobile apps and semantic web standards such as HTTP 2.0, Representational State Transfer, JSON (JavaScript Object Notation), JSON Schema, Transport Layer Security (version 1.3), Advanced Encryption Standard-256, OpenAPI, HTML5, and Vega, in conjunction with patient and provider feedback to completely update a previous version of mindLAMP. METHODS The Learn, Assess, Manage, and Prevent (LAMP) platform addresses the abovementioned challenges in enhancing clinical insight by supporting research, data analysis, and implementation efforts around PGHD as an open-source solution with freely accessible and shared code. RESULTS With a simplified programming interface and novel data representation that captures additional metadata, the LAMP platform enables interoperability with existing Fast Healthcare Interoperability Resources-based health care systems as well as consumer wearables and services such as Apple HealthKit and Google Fit. The companion Cortex data analysis and machine learning toolkit offer robust support for artificial intelligence, behavioral feature extraction, interactive visualizations, and high-performance data processing through parallelization and vectorization techniques. CONCLUSIONS The LAMP platform incorporates feedback from patients and clinicians alongside a standards-based approach to address these needs and functions across a wide range of use cases through its customizable and flexible components. These range from simple survey-based research to international consortiums capturing multimodal data to simple delivery of mindfulness exercises through personalized, just-in-time adaptive interventions.
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Affiliation(s)
- Aditya Vaidyam
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | | | - John Torous
- Beth Israel Deaconess Medical Center, Boston, MA, United States
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23
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Khadjesari Z, Brown T, Naughton F. Regulation and accreditation of addictive behaviour applications-navigating the landscape. Addiction 2021; 116:3276-3283. [PMID: 33739480 DOI: 10.1111/add.15484] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/24/2020] [Accepted: 03/02/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND mHealth applications (apps) for addictive behaviours offer widespread provision of digital support, with particular benefits for stigmatized groups and those with poor access to treatment services. Regulation and accreditation may encourage the uptake and use of evidence-based addictive behaviour apps, yet this is a complex and confusing landscape. We navigate international regulatory and accreditation guidance, explore some of the implementation challenges and provide implications for app developers, health-care professionals and app users. ANALYSIS We explore the classification of health and wellbeing, blended support and clinical therapy apps as medical devices by country to help readers navigate the complexity of the guidance. We describe an addictive behaviour app classified as a medical device and explore the innovative approaches to regulation that are currently emerging. We discuss the use of curated on-line app libraries that adhere to thresholds for characteristics such as quality, user satisfaction or effectiveness, which we hope will become the starting-point in the search for suitable apps, rather than commercial app stores. We also explore the ethical concerns associated with apps and how curated libraries address these. CONCLUSIONS International regulation of applications as medical devices varies across countries and would benefit from standardization in a simple, usable and transparent format. Efforts to provide accreditation of non-medical device applications are also variable, and public bodies provide mixed messages concerning endorsement. Health-care professionals and users are encouraged to use accredited applications for addictive behaviours where they exist, or explore other forms of digital intervention with a stronger evidence base.
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Affiliation(s)
- Zarnie Khadjesari
- Behavioural and Implementation Science Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Tracey Brown
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Felix Naughton
- Behavioural and Implementation Science Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
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24
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Marley G, Fu G, Zhang Y, Li J, Tucker JD, Tang W, Yu R. Willingness of Chinese Men Who Have Sex With Men to Use Smartphone-Based Electronic Readers for HIV Self-testing: Web-Based Cross-sectional Study. J Med Internet Res 2021; 23:e26480. [PMID: 34806988 PMCID: PMC8663451 DOI: 10.2196/26480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/21/2021] [Accepted: 10/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The need for strategies to encourage user-initiated reporting of results after HIV self-testing (HIVST) persists. Smartphone-based electronic readers (SERs) have been shown capable of reading diagnostics results accurately in point-of-care diagnostics and could bridge the current gaps between HIVST and linkage to care. OBJECTIVE Our study aimed to assess the willingness of Chinese men who have sex with men (MSM) in the Jiangsu province to use an SER for HIVST through a web-based cross-sectional study. METHODS From February to April 2020, we conducted a convenience web-based survey among Chinese MSM by using a pretested structured questionnaire. Survey items were adapted from previous HIVST feasibility studies and modified as required. Prior to answering reader-related questions, participants watched a video showcasing a prototype SER. Statistical analysis included descriptive analysis, chi-squared test, and multivariable logistic regression. P values less than .05 were deemed statistically significant. RESULTS Of 692 participants, 369 (53.3%) were aged 26-40 years, 456 (65.9%) had ever self-tested for HIV, and 493 (71.2%) were willing to use an SER for HIVST. Approximately 98% (483/493) of the willing participants, 85.3% (459/538) of ever self-tested and never self-tested, and 40% (46/115) of unwilling participants reported that SERs would increase their HIVST frequency. Engaging in unprotected anal intercourse with regular partners compared to consistently using condoms (adjusted odds ratio [AOR] 3.04, 95% CI 1.19-7.74) increased the odds of willingness to use an SER for HIVST. Participants who had ever considered HIVST at home with a partner right before sex compared to those who had not (AOR 2.99, 95% CI 1.13-7.90) were also more willing to use an SER for HIVST. Playing receptive roles during anal intercourse compared to playing insertive roles (AOR 0.05, 95% CI 0.02-0.14) was associated with decreased odds of being willing to use an SER for HIVST. The majority of the participants (447/608, 73.5%) preferred to purchase readers from local Centers of Disease Control and Prevention offices and 51.2% (311/608) of the participants were willing to pay less than US $4.70 for a reader device. CONCLUSIONS The majority of the Chinese MSM, especially those with high sexual risk behaviors, were willing to use an SER for HIVST. Many MSM were also willing to self-test more frequently for HIV with an SER. Further research is needed to ascertain the diagnostic and real-time data-capturing capacity of prototype SERs during HIVST.
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Affiliation(s)
- Gifty Marley
- School of Public Health, Nanjing Medical University, Nanjing, China.,The Social Entrepreneurship to Spur Health Project, The University of North Carolina Project-China, Guangzhou, China
| | - Gengfeng Fu
- Section of STD/AIDS Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ye Zhang
- Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Jianjun Li
- Section of STD/AIDS Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Joseph D Tucker
- The Social Entrepreneurship to Spur Health Project, The University of North Carolina Project-China, Guangzhou, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Weiming Tang
- The Social Entrepreneurship to Spur Health Project, The University of North Carolina Project-China, Guangzhou, China.,Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Rongbin Yu
- School of Public Health, Nanjing Medical University, Nanjing, China
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25
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Ryan S, Ní Chasaide N, O' Hanrahan S, Corcoran D, Caulfield B, Argent R. mHealth Apps for Musculoskeletal Rehabilitation: State of the Practice Review (Preprint). JMIR Rehabil Assist Technol 2021; 9:e34355. [PMID: 35916688 PMCID: PMC9379789 DOI: 10.2196/34355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Background The number of mobile health (mHealth) apps released for musculoskeletal (MSK) injury treatment and self-management with home exercise programs (HEPs) has risen rapidly in recent years as digital health interventions are explored and researched in more detail. As this number grows, it is becoming increasingly difficult for users to navigate the market and select the most appropriate app for their use case. It is also unclear what features the developers of these apps are harnessing to support patient self-management and how they fit into clinical care pathways. Objective The objective of this study was to scope the current market of mHealth apps for MSK rehabilitation and to report on their features, claims, evidence base, and functionalities. Methods A cross-sectional study of apps for MSK rehabilitation was performed across the iTunes App Store and Google Play Store. Four search terms were used, namely, physiotherapy rehabilitation, physical therapy rehabilitation, rehabilitation exercise, and therapeutic exercise to identify apps, which were then cross-referenced against set selection criteria by 4 reviewers. Each reviewer, where possible, downloaded the app and accessed supplementary literature available on the product to assist in data extraction. Results A total of 1322 apps were identified. After applying the inclusion and exclusion criteria and removing duplicates, 144 apps were included in the study. Over half (n=81, 56.3%) of the included apps had been released within the past 3 years. Three quarters (n=107, 74.3%) of the apps made no reference to evidence supporting the design or efficacy of the app, with only 11.1% (n=16) providing direct citations to research. Most of the apps did utilize exercise pictures (n=138, 95.8%) or videos (n=97, 67.4%); however, comparatively few harnessed additional features to encourage engagement and support self-management, such as an adherence log (n=66, 45.8%), communication portal (n=32, 22.2%), patient-reported outcome capture (n=36, 25%), or direct feedback (n=57, 39.6%). Of note and concern, many of these apps prescribed generic exercises (n=93, 64.6%) in the absence of individualized input to the user, with few providing specific patient education (n=43, 34%) and safety advice or disclaimers (n=38, 26.4%). Conclusions The cohort of apps included in this study contained a large heterogeneity of features, so it is difficult for users to identify the most appropriate or effective app. Many apps are missing the opportunity to offer key features that could promote exercise adherence and encourage self-management in MSK rehabilitation. Furthermore, very few developers currently offering products on the market are providing evidence to support the design and efficacy of their technologies.
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Affiliation(s)
- Shíofra Ryan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Noirín Ní Chasaide
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Shane O' Hanrahan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Darragh Corcoran
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Brian Caulfield
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Rob Argent
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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Torous J, Bucci S, Bell IH, Kessing LV, Faurholt-Jepsen M, Whelan P, Carvalho AF, Keshavan M, Linardon J, Firth J. The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry 2021; 20:318-335. [PMID: 34505369 PMCID: PMC8429349 DOI: 10.1002/wps.20883] [Citation(s) in RCA: 239] [Impact Index Per Article: 79.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies - such as smartphone apps, vir-tual reality, chatbots, and social media - have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions - including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders - as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.
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Affiliation(s)
- John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sandra Bucci
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Imogen H Bell
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lars V Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Pauline Whelan
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Matcheri Keshavan
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jake Linardon
- Deakin University, Centre for Social and Early Emotional Development and School of Psychology, Burwood, VIC, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
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Seeking Inspiration: Examining the Validity and Reliability of a New Smartphone Respiratory Therapy Exergame App. SENSORS 2021; 21:s21196472. [PMID: 34640793 PMCID: PMC8513019 DOI: 10.3390/s21196472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 12/23/2022]
Abstract
Background: Clinically valid and reliable simulated inspiratory sounds were required for the development and evaluation of a new therapeutic respiratory exergame application (i.e., QUT Inspire). This smartphone application virtualises incentive spirometry, a longstanding respiratory therapy technique. Objectives: Inspiratory flows were simulated using a 3 litre calibration syringe and validated using clinical reference devices. Syringe flow nozzles of decreasing diameter were applied to model the influence of mouth shape on audible sound levels generated. Methods: A library of calibrated audio inspiratory sounds was created to determine the reliability and range of inspiratory sound detection at increasing distances separating the sound source and smartphones running the app. Results: Simulated inspiratory sounds were reliably detected by the new application at higher air inflows (high, medium), using smaller mouth diameters (<25 mm) and where smartphones were held proximal (≤5 cm) to the mouth (or at distances up to 50 cm for higher airflows). Performance was comparable for popular smartphone types and using different phone orientations (i.e., held horizontally, at 45° or 90°). Conclusions: These observations inform future application refinements, including prompts to reduce mouth diameter, increase inspiratory flow and maintain proximity to the phone to optimise sound detection. This library of calibrated inspiratory sounds offers reproducible non-human reference data suitable for development, evaluation and regression testing of a therapeutic respiratory exergame application for smartphones.
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Ossai CI, Wickramasinghe N. Text Mining and Grounded Theory for Appraising the Self-Management Indicators of Diabetes Mobile Apps. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Moses JC, Adibi S, Shariful Islam SM, Wickramasinghe N, Nguyen L. Application of Smartphone Technologies in Disease Monitoring: A Systematic Review. Healthcare (Basel) 2021; 9:889. [PMID: 34356267 PMCID: PMC8303662 DOI: 10.3390/healthcare9070889] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 12/21/2022] Open
Abstract
Technologies play an essential role in monitoring, managing, and self-management of chronic diseases. Since chronic patients rely on life-long healthcare systems and the current COVID-19 pandemic has placed limits on hospital care, there is a need to explore disease monitoring and management technologies and examine their acceptance by chronic patients. We systematically examined the use of smartphone applications (apps) in chronic disease monitoring and management in databases, namely, Medline, Web of Science, Embase, and Proquest, published from 2010 to 2020. Results showed that app-based weight management programs had a significant effect on healthy eating and physical activity (p = 0.002), eating behaviours (p < 0.001) and dietary intake pattern (p < 0.001), decreased mean body weight (p = 0.008), mean Body Mass Index (BMI) (p = 0.002) and mean waist circumference (p < 0.001). App intervention assisted in decreasing the stress levels (paired t-test = 3.18; p < 0.05). Among cancer patients, we observed a high acceptance of technology (76%) and a moderately positive correlation between non-invasive electronic monitoring data and questionnaire (r = 0.6, p < 0.0001). We found a significant relationship between app use and standard clinical evaluation and high acceptance of the use of apps to monitor the disease. Our findings provide insights into critical issues, including technology acceptance along with regulatory guidelines to be considered when designing, developing, and deploying smartphone solutions targeted for chronic patients.
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Affiliation(s)
- Jeban Chandir Moses
- School of Information Technology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia;
| | - Sasan Adibi
- School of Information Technology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia;
| | | | - Nilmini Wickramasinghe
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC 3122, Australia;
| | - Lemai Nguyen
- Department of Information Systems and Business Analytics, Deakin Business School, 221 Burwood Highway, Burwood, VIC 3125, Australia;
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Patient Engagement Technologies in Orthopaedics: What They Are, What They Offer, and Impact. J Am Acad Orthop Surg 2021; 29:e584-e592. [PMID: 33826580 DOI: 10.5435/jaaos-d-20-00585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/06/2020] [Indexed: 02/01/2023] Open
Abstract
The modern era is an increasingly digital and connected world. Most of the Americans now use a smartphone irrespective of age or income level. As smartphone technologies become ubiquitous, there is tremendous interest and growth in mobile health applications. One segment of these new technologies are the so-called patient engagement platforms. These technologies present a host of features that may improve care. This article provides an introduction to this growing technology sector, offers insight into what they may offer patients and surgeons, and discusses how to evaluate various platforms.
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31
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Szinay D, Perski O, Jones A, Chadborn T, Brown J, Naughton F. Influences on the Uptake of Health and Well-being Apps and Curated App Portals: Think-Aloud and Interview Study. JMIR Mhealth Uhealth 2021; 9:e27173. [PMID: 33904827 PMCID: PMC8114158 DOI: 10.2196/27173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Health and well-being smartphone apps can provide a cost-effective solution to addressing unhealthy behaviors. The selection of these apps tends to occur in commercial app stores, where thousands of health apps are available. Their uptake is often influenced by popularity indicators. However, these indicators are not necessarily associated with app effectiveness or evidence-based content. Alternative routes to app selection are increasingly available, such as via curated app portals, but little is known about people's experiences of them. OBJECTIVE The aim of this study is to explore how people select health apps on the internet and their views on curated app portals. METHODS A total of 18 UK-based adults were recruited through social media and asked during an in-person meeting to verbalize their thoughts while searching for a health or well-being app on the internet on a platform of their choice. The search was then repeated on 2 curated health app portals: the National Health Service Apps Library and the Public Health England One You App portal. This was followed by semistructured interviews. Data were analyzed using framework analysis, informed by the Capability, Opportunity, Motivation-Behavior model and the Theoretical Domains Framework. RESULTS Searching for health and well-being apps on the internet was described as a minefield. App uptake appeared to be influenced by participants' capabilities such as app literacy skills and health and app awareness, and opportunities including the availability of apps, app esthetics, the price of an app, and social influences. Motivation factors that seemed to affect the uptake were perceived competence, time efficiency, perceived utility and accuracy of an app, transparency about data protection, commitment and social identity, and a wide range of emotions. Social influences and the perceived utility of an app were highlighted as particularly important. Participants were not previously aware of curated portals but found the concept appealing. Curated health app portals appeared to engender trust and alleviate data protection concerns. Although apps listed on these were perceived as more trustworthy, their presentation was considered disappointing. This disappointment seemed to stem from the functionality of the portals, lack of user guidance, and lack of tailored content to an individual's needs. CONCLUSIONS The uptake of health and well-being apps appears to be primarily affected by social influences and the perceived utility of an app. App uptake via curated health app portals perceived as credible may mitigate concerns related to data protection and accuracy, but their implementation must better meet user needs and expectations.
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Affiliation(s)
- Dorothy Szinay
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Olga Perski
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Andy Jones
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Tim Chadborn
- Behavioural Insights, Public Health England, London, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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32
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Mehdi M, Dode A, Pryss R, Schlee W, Reichert M, Hauck FJ. Contemporary Review of Smartphone Apps for Tinnitus Management and Treatment. Brain Sci 2020; 10:brainsci10110867. [PMID: 33212928 PMCID: PMC7698350 DOI: 10.3390/brainsci10110867] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022] Open
Abstract
Tinnitus is a complex and heterogeneous psycho-physiological disorder responsible for causing a phantom ringing or buzzing sound albeit the absence of an external sound source. It has a direct influence on affecting the quality of life of its sufferers. Despite being around for a while, there has not been a cure for tinnitus, and the usual course of action for its treatment involves use of tinnitus retaining and sound therapy, or Cognitive Behavioral Therapy (CBT). One positive aspect about these therapies is that they can be administered face-to-face as well as delivered via internet or smartphone. Smartphones are especially helpful as they are highly personalized devices, and offer a well-established ecosystem of apps, accessible via respective marketplaces of differing mobile platforms. Note that current therapeutic treatments such as CBT have shown to be effective in suppressing the tinnitus symptoms when administered face-to-face, their effectiveness when being delivered using smartphones is not known so far. A quick search on the prominent market places of popular mobile platforms (Android and iOS) yielded roughly 250 smartphone apps offering tinnitus-related therapies and tinnitus management. As this number is expected to steadily increase due to high interest in smartphone app development, a contemporary review of such apps is crucial. In this paper, we aim to review scientific studies validating the smartphone apps, particularly to test their effectiveness in tinnitus management and treatment. We use the PRISMA guidelines for identification of studies on major scientific literature sources and delineate the outcomes of identified studies.
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Affiliation(s)
- Muntazir Mehdi
- Institute of Distributed Systems, Ulm University, 89081 Ulm, Germany
- Correspondence: (M.M.); (F.J.H.)
| | - Albi Dode
- Institute of Databases and Information Systems, Ulm University, 89081 Ulm, Germany; (A.D.); (M.R.)
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany;
| | - Winfried Schlee
- Clinic and Polyclinic for Psychiatry and Psychotherapy, 93053 Regensburg, Germany;
| | - Manfred Reichert
- Institute of Databases and Information Systems, Ulm University, 89081 Ulm, Germany; (A.D.); (M.R.)
| | - Franz J. Hauck
- Institute of Distributed Systems, Ulm University, 89081 Ulm, Germany
- Correspondence: (M.M.); (F.J.H.)
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Mehdi M, Stach M, Riha C, Neff P, Dode A, Pryss R, Schlee W, Reichert M, Hauck FJ. Smartphone and Mobile Health Apps for Tinnitus: Systematic Identification, Analysis, and Assessment. JMIR Mhealth Uhealth 2020; 8:e21767. [PMID: 32808939 PMCID: PMC7463412 DOI: 10.2196/21767] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023] Open
Abstract
Background Modern smartphones contain sophisticated high-end hardware features, offering high computational capabilities at extremely manageable costs and have undoubtedly become an integral part in users' daily life. Additionally, smartphones offer a well-established ecosystem that is easily discoverable and accessible via the marketplaces of differing mobile platforms, thus encouraging the development of many smartphone apps. Such apps are not exclusively used for entertainment purposes but are also commonplace in health care and medical use. A variety of those health and medical apps exist within the context of tinnitus, a phantom sound perception in the absence of any physical external source. Objective In this paper, we shed light on existing smartphone apps addressing tinnitus by providing an up-to-date overview. Methods Based on PRISMA guidelines, we systematically searched and identified existing smartphone apps on the most prominent app markets, namely Google Play Store and Apple App Store. In addition, we applied the Mobile App Rating Scale (MARS) to evaluate and assess the apps in terms of their general quality and in-depth user experience. Results Our systematic search and screening of smartphone apps yielded a total of 34 apps (34 Android apps, 26 iOS apps). The mean MARS scores (out of 5) ranged between 2.65-4.60. The Tinnitus Peace smartphone app had the lowest score (mean 2.65, SD 0.20), and Sanvello—Stress and Anxiety Help had the highest MARS score (mean 4.60, SD 0.10). The interrater agreement was substantial (Fleiss κ=0.74), the internal consistency was excellent (Cronbach α=.95), and the interrater reliability was found to be both high and excellent—Guttman λ6=0.94 and intraclass correlation, ICC(2,k) 0.94 (95% CI 0.91-0.97), respectively. Conclusions This work demonstrated that there exists a plethora of smartphone apps for tinnitus. All of the apps received MARS scores higher than 2, suggesting that they all have some technical functional value. However, nearly all identified apps were lacking in terms of scientific evidence, suggesting the need for stringent clinical validation of smartphone apps in future. To the best of our knowledge, this work is the first to systematically identify and evaluate smartphone apps within the context of tinnitus.
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Affiliation(s)
- Muntazir Mehdi
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Michael Stach
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Constanze Riha
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Patrick Neff
- Clinic and Policlinic for Psychiatry and Psychotherapy, Regensburg, Germany.,URPP Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Albi Dode
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Winfried Schlee
- Clinic and Policlinic for Psychiatry and Psychotherapy, Regensburg, Germany
| | - Manfred Reichert
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Franz J Hauck
- Institute of Distributed Systems, Ulm University, Ulm, Germany
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Kernebeck S, Busse TS, Böttcher MD, Weitz J, Ehlers J, Bork U. Impact of mobile health and medical applications on clinical practice in gastroenterology. World J Gastroenterol 2020; 26:4182-4197. [PMID: 32848328 PMCID: PMC7422538 DOI: 10.3748/wjg.v26.i29.4182] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/09/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
Mobile health apps (MHAs) and medical apps (MAs) are becoming increasingly popular as digital interventions in a wide range of health-related applications in almost all sectors of healthcare. The surge in demand for digital medical solutions has been accelerated by the need for new diagnostic and therapeutic methods in the current coronavirus disease 2019 pandemic. This also applies to clinical practice in gastroenterology, which has, in many respects, undergone a recent digital transformation with numerous consequences that will impact patients and health care professionals in the near future. MHAs and MAs are considered to have great potential, especially for chronic diseases, as they can support the self-management of patients in many ways. Despite the great potential associated with the application of MHAs and MAs in gastroenterology and health care in general, there are numerous challenges to be met in the future, including both the ethical and legal aspects of applying this technology. The aim of this article is to provide an overview of the current status of MHA and MA use in the field of gastroenterology, describe the future perspectives in this field and point out some of the challenges that need to be addressed.
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Affiliation(s)
- Sven Kernebeck
- Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten 58455, Germany
| | - Theresa S Busse
- Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten 58455, Germany
| | - Maximilian D Böttcher
- Department of GI-, Thoracic- and Vascular Surgery, Dresden Technical University, University Hospital Dresden, Dresden 01307, Germany
| | - Jürgen Weitz
- Department of GI-, Thoracic- and Vascular Surgery, Dresden Technical University, University Hospital Dresden, Dresden 01307, Germany
| | - Jan Ehlers
- Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten 58455, Germany
| | - Ulrich Bork
- Department of GI-, Thoracic- and Vascular Surgery, Dresden Technical University, University Hospital Dresden, Dresden 01307, Germany
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Huckvale K, Nicholas J, Torous J, Larsen ME. Smartphone apps for the treatment of mental health conditions: status and considerations. Curr Opin Psychol 2020; 36:65-70. [PMID: 32553848 DOI: 10.1016/j.copsyc.2020.04.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022]
Abstract
Clinical and research interest in the potential of mobile health apps for the management of mental health conditions has recently been given added impetus by growing evidence of consumer adoption. In parallel, there is now a developing evidence base that includes meta-analyses demonstrating reductions in symptoms of depression and anxiety, and reduction in suicidal ideation. While these findings are encouraging, recent research continues to identify a number of potential barriers to the widespread adoption of mental health apps. These challenges include poor data governance and data sharing practices; questions of clinical safety relating to the management of adverse events and potentially harmful content; low levels of user engagement and the possibility of 'digital placebo' effects; and workforce barriers to integration with clinical practice. Current efforts to address these include the development of new models of care, such as 'digital clinics' that integrate health apps. Other contemporary innovations in the field such as digital sensing and just-in-time adaptive interventions are showing early promise for providing accessible and personalised care.
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Affiliation(s)
| | - Jennifer Nicholas
- Orygen, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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