Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic

Patients' Perspectives on the Data Confidentiality, Privacy, and Security of mHealth Apps: Systematic Review

BACKGROUND

Mobile health (mHealth) apps have the potential to enhance health care service delivery. However, concerns regarding patients' confidentiality, privacy, and security consistently affect the adoption of mHealth apps. Despite this, no review has comprehensively summarized the findings of studies on this subject matter.

OBJECTIVE

This systematic review aims to investigate patients' perspectives and awareness of the confidentiality, privacy, and security of the data collected through mHealth apps.

METHODS

Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted in 3 electronic databases: PubMed, Ovid, and ScienceDirect. All the retrieved articles were screened according to specific inclusion criteria to select relevant articles published between 2014 and 2022.

RESULTS

A total of 33 articles exploring mHealth patients' perspectives and awareness of data privacy, security, and confidentiality issues and the associated factors were included in this systematic review. Thematic analyses of the retrieved data led to the synthesis of 4 themes: concerns about data privacy, confidentiality, and security; awareness; facilitators and enablers; and associated factors. Patients showed discordant and concordant perspectives regarding data privacy, security, and confidentiality, as well as suggesting approaches to improve the use of mHealth apps (facilitators), such as protection of personal data, ensuring that health status or medical conditions are not mentioned, brief training or education on data security, and assuring data confidentiality and privacy. Similarly, awareness of the subject matter differed across the studies, suggesting the need to improve patients' awareness of data security and privacy. Older patients, those with a history of experiencing data breaches, and those belonging to the higher-income class were more likely to raise concerns about the data security and privacy of mHealth apps. These concerns were not frequent among patients with higher satisfaction levels and those who perceived the data type to be less sensitive.

CONCLUSIONS

Patients expressed diverse views on mHealth apps' privacy, security, and confidentiality, with some of the issues raised affecting technology use. These findings may assist mHealth app developers and other stakeholders in improving patients' awareness and adjusting current privacy and security features in mHealth apps to enhance their adoption and use.

TRIAL REGISTRATION

PROSPERO CRD42023456658; https://tinyurl.com/ytnjtmca.

A lifestyle screening tool for young children in the community: needs and wishes of parents and youth healthcare professionals

BACKGROUND

Youth healthcare has an important role in promoting a healthy lifestyle in young children in order to prevent lifestyle-related health problems. To aid youth healthcare in this task, a new lifestyle screening tool will be developed. The aim of this study was to explore how youth healthcare professionals (YHCP) could best support parents in improving their children's lifestyle using a new lifestyle screening tool for young children.

METHODS

We conducted four and seven focus groups among parents (N = 25) and YHCP (N = 25), respectively. Two main topics were addressed: the experiences with current practice of youth healthcare regarding lifestyle in young children, and the requirements for the lifestyle screening tool to be developed. The focus groups were recorded, transcribed verbatim and analysed using an inductive approach.

RESULTS

Both parents and YHCP indicated that young children's lifestyles are often discussed during youth healthcare appointments. While parents felt that this discussion could be more in-depth, YHCP mainly needed clues to continue the discussion. According to parents and YHCP, a new lifestyle screening tool for young children should be easy to use, take little time and provide courses of action. Moreover, it should be attractive to complete and align with the family concerned.

CONCLUSIONS

According to parents and YHCP, a new lifestyle screening tool for young children could be useful to discuss specific lifestyle topics in more detail and to provide targeted advice.

Analysis of the virtual healthcare model in Latin America: a systematic review of current challenges and barriers

Background

The virtual care model can be used in all aspects of healthcare, such as prevention, diagnosis, treatment, and follow-up of most medical and surgical conditions. The objective of this study was to identify the current barriers to implementing and consolidating the virtual healthcare model, of "telemedicine", in Latin American countries.

Methods

A systematic review was conducted through four databases: PubMed, Scopus, Web of Science, and Virtual Health, including articles in Spanish, Portuguese, and English. A combination of Boolean operators was used with the terms "telemedicine", "telehealth", "telecare", "home care services", "remote care" and the name of each Latin American country. Articles published from January 2020 to January 2023 that reported on the barriers and challenges of using the virtual care model were included.

Results

Nineteen articles were included. Brazil (n=5) and Argentina (n=4) were the countries where there was the greatest interest to explore barriers to virtual care. The barriers identified were categorized into five main themes: (I) technological and technical issues; (II) absence of a physical examination; (III) patient's negative perceptions; (IV) negative perceptions among healthcare professionals; and (V) structural obstacles and those associated with the healthcare system. The main obstacles reported were connectivity problems, lack of a complete physical examination, issues of privacy, high risk of medical malpractice, and absence of local regulation.

Conclusions

The virtual care model is a safe and cost-effective alternative for the delivery of health services, with multiple benefits for patients and their families. The indication for the use of virtual care should be based on a risk model for patient prioritization. Likewise, the analysis of the main barriers and benefits is fundamental to consolidating this model of care and ensuring its expansion in the region.

A meta-Ethnography on Parents' Experiences of the Internet As a Source of Health Information

The Internet is increasingly being used as a health information resource. This meta-ethnography aimed to synthesize the literature on how parents of children aged below 5 years' experienced using the Internet for health information purposes. We employed an interpretive meta-synthesis approach-meta-ethnography-according to Noblit & Hare's seven phases. A total of 22 articles met the inclusion criteria, representing four continents and with 650 participants, mainly mothers. We analysed and synthesized the primary studies into the following lines-of-argument synthesis representing a novel conceptual understanding of the phenomenon: Parents experience the Internet as "A cyber partner for child caring" being a 24/7 available "go-to" among other confined sources. Parents find ways of "patching together" trustworthy information in solicitude for their child's health while navigating between trust and anxiety. They relate online and share their experiences and secrets without being rejected. Clinicians and parents may benefit from "partnering" with this resource.

Decoding early childhood caries: an in-depth analysis of YouTube videos for effective parental education

PURPOSE

To assess the coverage of information about early childhood caries (ECC) available on YouTube videos in three different languages, regarding technical characteristics of videos and interaction metrics.

METHODS

Search strategies were developed in English, Spanish, and Portuguese to make a comprehensive collection of videos from YouTube, encompassing 60 samples for each language, regarding all video types. The videos were assessed by a thematic checklist regarding 17 items on ECC. Videos were dichotomized according to the median of the thematic score and the nature of their authorship (health and non-health authors) to compare groups. The statistical analysis was performed using the Statistical Package for Social Science (version 25.0), applying Spearman's rank correlation coefficient and Mann-Whitney U test. P < 0.05 values were considered significant.

RESULTS

Among 120 videos meeting inclusion criteria, ECC aetiology and prevention information proved incomplete, with a median score of 5 (Q1-Q3 = 3-7). No correlation emerged between this score and other video characteristics. However, interaction metrics like views, likes, dislikes, and viewing rates displayed significant correlations. Health authors primarily created these videos, yet non-health author channels had more subscribers. Surprisingly, videos focused on the impact of regular sugary food and beverage consumption on ECC progression received the most attention.

CONCLUSIONS

Videos that presented information about the aetiology and prevention of ECC invariably focused on partial aspects of the disease. This highlights the need for better-quality educational videos and the importance of dental professionals in guiding patients toward reliable sources of information.

Factors Associated With Initiating Breastfeeding and Continuing it for At Least 4 Months in Consuelo, a Rural Town in the Dominican Republic

Objective. We assessed the proportion of and factors associated with mothers initiating and continuing breastfeeding (BF) for ≥4 months in a rural town of the Dominican Republic. Methods. A survey was administered to 190 mothers of children cared for at a free clinic in Consuelo. Modified bivariate and multivariable Poisson regressions were utilized in data analysis. Results. BF was initiated in 89.5% of cases and continued ≥4 months in 81.7% of cases. Maternal education beyond secondary school [adjusted RR = 1.13, 95% CI: (1.04-1.24), 0.010], and visiting both public and private antenatal clinics [adjusted RR = 1.25; 95% CI: (1.10-1.37), 0.010] were associated with BF initiation. Public and private antenatal clinic attendance [adjusted RR = 1.01, 95% CI: (0.45-2.23), 0.020], Cesarean section [adjusted RR = 0.81, 95% CI: (0.68-0.98), 0.026], number of biological children [adjusted RR = 0.95, 95% CI: (0.90-1.00), 0.032] and maternal employment [adjusted RR = 0.89, 95% CI: (0.79-0.99), 0.048] were associated with BF continuation. Conclusions. These results provide valuable insights for targeting specific populations in future breastfeeding education interventions.

"Hey Siri, Help Me Take Care of My Child": A Feasibility Study With Caregivers of Children With Special Healthcare Needs Using Voice Interaction and Automatic Speech Recognition in Remote Care Management

Background

About 23% of households in the United States have at least one child who has special healthcare needs. As most care activities occur at home, there is often a disconnect and lack of communication between families, home care nurses, and healthcare providers. Digital health technologies may help bridge this gap.

Objective

We conducted a pre-post study with a voice-enabled medical note taking (diary) app (SpeakHealth) in a real world setting with caregivers (parents, family members) of children with special healthcare needs (CSHCN) to understand feasibility of voice interaction and automatic speech recognition (ASR) for medical note taking at home.

Methods

In total, 41 parents of CSHCN were recruited. Participants completed a pre-study survey collecting demographic details, technology and care management preferences. Out of 41, 24 participants completed the study, using the app for 2 weeks and completing an exit survey. The app facilitated caregiver note-taking using voice interaction and ASR. An exit survey was conducted to collect feedback on technology adoption and changes in technology preferences in care management. We assessed the feasibility of the app by descriptively analyzing survey responses and user data following the key focus areas of acceptability, demand, implementation and integration, adaptation and expansion. In addition, perceived effectiveness of the app was assessed by comparing perceived changes in mobile app preferences among participants. In addition, the voice data, notes, and transcriptions were descriptively analyzed for understanding the feasibility of the app.

Results

The majority of the recruited parents were 35–44 years old (22, 53.7%), part of a two-parent household (30, 73.2%), white (37, 90.2%), had more than one child (31, 75.6%), lived in Ohio (37, 90.2%), used mobile health apps, mobile note taking apps or calendar apps (28, 68.3%) and patient portal apps (22, 53.7%) to track symptoms and health events at home. Caregivers had experience with voice technology as well (32, 78%). Among those completed the post-study survey (in Likert Scale 1–5), ~80% of the caregivers agreed or strongly agreed that using the app would enhance their performance in completing tasks (perceived usefulness; mean = 3.4, SD = 0.8), the app is free of effort (perceived ease of use; mean = 3.2, SD = 0.9), and they would use the app in the future (behavioral intention; mean = 3.1, SD = 0.9). In total, 88 voice interactive patient notes were generated with the majority of the voice recordings being less than 20 s in length (66%). Most noted symptoms and conditions, medications, treatment and therapies, and patient behaviors. More than half of the caregivers reported that voice interaction with the app and using transcribed notes positively changed their preference of technology to use and methods for tracking symptoms and health events at home.

Conclusions

Our findings suggested that voice interaction and ASR use in mobile apps are feasible and effective in keeping track of symptoms and health events at home. Future work is suggested toward using integrated and intelligent systems with voice interactions with broader populations.