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Mendes Pereira C, Matos M, Carvalho D, Macedo P, Calheiros JM, Alves J, Paulino Ferreira L, Dias TL, Neves Madeira R, Jones F. Building Bridges between People with Stroke, Families, and Health Professionals: Development of a Blended Care Program for Self-Management. J Clin Med 2024; 13:300. [PMID: 38202307 PMCID: PMC10779663 DOI: 10.3390/jcm13010300] [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: 12/18/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Evidence-informed interventions for stroke self-management support can influence functional capability and social participation. People with stroke should be offered self-management support after hospital discharge. However, in Portugal, there are no known programs of this nature. This study aimed to develop a person-centered and tailored blended care program for post-stroke self-management, taking into account the existing evidence-informed interventions and the perspectives of Portuguese people with stroke, caregivers, and health professionals. An exploratory sequential mixed methods approach was used, including qualitative methods during stakeholder consultation (stage 1) and co-production (stage 2) and quantitative assessment during prototyping (stage 3). After ethical approval, recruitment occurred in three health units. Results from a literature search led to the adaptation of the Bridges Stroke Self-Management Program. In stage one, 47 participants were interviewed, with two themes emerging: (i) Personalized support and (ii) Building Bridges through small steps. In stage two, the ComVida program was developed, combining in-person and digital approaches, supported by a workbook and a mobile app. In stage three, 56 participants evaluated prototypes, demonstrating a strong level of quality. Understandability and actionability of the developed tools obtained high scores (91-100%). The app also showed good usability (A-grade) and high levels of recommendation (5 stars).
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Affiliation(s)
- Carla Mendes Pereira
- Department of Physiotherapy, School of Health, Polytechnic University of Setúbal, 2910-761 Setúbal, Portugal; (M.M.); (T.L.D.)
- Comprehensive Health Research Centre (CHRC), NOVA University of Lisbon, 1150-082 Lisbon, Portugal
| | - Mara Matos
- Department of Physiotherapy, School of Health, Polytechnic University of Setúbal, 2910-761 Setúbal, Portugal; (M.M.); (T.L.D.)
| | - Daniel Carvalho
- Local Health Unit Litoral Alentejano (ULSLA), 7540-230 Santiago do Cacém, Portugal;
| | - Patricia Macedo
- Research Center for Engineering a Sustainable Development (Sustain.RD), Setúbal School of Technology, Polytechnic University of Setúbal, 2910-761 Setúbal, Portugal; (P.M.); (R.N.M.)
- Center of Technology and Systems (UNINOVA-CTS), NOVA School of Science and Technology, 2829-516 Caparica, Portugal
| | - José M. Calheiros
- Institute for Research, Innovation and Development (FP-I3ID), University Fernando Pessoa, 4249-004 Porto, Portugal;
| | - Janice Alves
- Neurology Department, Setúbal Hospital Centre, 2910-446 Setúbal, Portugal;
| | - Luís Paulino Ferreira
- Department of Psychiatry and Mental Health, Setúbal Hospital Centre, 2910-446 Setúbal, Portugal;
| | - Teresa L. Dias
- Department of Physiotherapy, School of Health, Polytechnic University of Setúbal, 2910-761 Setúbal, Portugal; (M.M.); (T.L.D.)
| | - Rui Neves Madeira
- Research Center for Engineering a Sustainable Development (Sustain.RD), Setúbal School of Technology, Polytechnic University of Setúbal, 2910-761 Setúbal, Portugal; (P.M.); (R.N.M.)
- NOVA Laboratory of Computer Science and Informatics (NOVA LINCS), NOVA School of Science and Technology, NOVA University of Lisbon, 2829-516 Caparica, Portugal
| | - Fiona Jones
- Population Health Research Institute, St George’s, University of London, London SW17 ORE, UK;
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Reimer LM, Nissen L, von Scheidt M, Perl B, Wiehler J, Najem SA, Limbourg FP, Tacke T, Müller A, Jonas S, Schunkert H, Starnecker F. User-centered development of an mHealth app for cardiovascular prevention. Digit Health 2024; 10:20552076241249269. [PMID: 38774157 PMCID: PMC11107323 DOI: 10.1177/20552076241249269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/08/2024] [Indexed: 05/24/2024] Open
Abstract
Background Mobile health (mHealth) apps can be used for cardiovascular disease (CVD) prevention. User-centered design, evidence-based content and user testing can be applied to ensure a high level of usability and adequate app access. Objective To develop and evaluate an mHealth app (HerzFit) for CVD prevention. Methods HerzFit´s development included a user-centered design approach and guideline-based content creation based on the identified requirements of the target group. Beta testing and a preliminary usability evaluation of the HerzFit prototype were performed. For evaluation, German versions of the System Usability Scale (SUS) and the mHealth App Usability Questionnaire (GER-MAUQ) as well as free text feedback were applied. Results User-centered design thinking led to the definition of four personas. Based on their requirements, HerzFit enables users to individually assess, monitor, and optimize their cardiovascular risk profile. Users are also provided with a variety of evidence-based information on CVD and their risk factors. The user interface and system design followed the identified functional requirements. Beta-testers provided feedback on the structure and functionality and rated the usability of HerzFit´s prototype as slightly above average both in SUS and GER-MAUQ rating. Participants positively noted the variety of functions and information presented in HerzFit, while negative feedback mostly concerned wearable synchronization. Conclusions The present study demonstrates the user-centered development of a guideline-based mHealth app for CVD prevention. Beta-testing and a preliminary usability study were used to further improve the HerzFit app until its official release.
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Affiliation(s)
- Lara Marie Reimer
- School for Computation, Information and Technology, Technical University Munich, Munich, Germany
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Leon Nissen
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Moritz von Scheidt
- Department of Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
- German Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Benedikt Perl
- Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
| | - Jens Wiehler
- BioM Biotech Cluster Development GmbH – BioM, Planegg, Germany
| | - Sinann Al Najem
- Deutsche Herzstiftung e.V. (German Heart Foundation), Frankfurt, Germany
| | - Florian P. Limbourg
- Vascular Medicine Research, Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
- Deutsche Hochdruckliga e.V. (German Hypertension League), Heidelberg, Germany
| | - Theodora Tacke
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Angelina Müller
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Heribert Schunkert
- Department of Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
- German Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Deutsche Herzstiftung e.V. (German Heart Foundation), Frankfurt, Germany
- Medical Graduate Center, Technical University Munich, Munich, Germany
| | - Fabian Starnecker
- Department of Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
- German Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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Rivera-Romero O, Gabarron E, Ropero J, Denecke K. Designing personalised mHealth solutions: An overview. J Biomed Inform 2023; 146:104500. [PMID: 37722446 DOI: 10.1016/j.jbi.2023.104500] [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: 02/28/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Mobile health, or mHealth, is based on mobile information and communication technologies and provides solutions for empowering individuals to participate in healthcare. Personalisation techniques have been used to increase user engagement and adherence to interventions delivered as mHealth solutions. This study aims to explore the current state of personalisation in mHealth, including its current trends and implementation. MATERIALS AND METHODS We conducted a review following PRISMA guidelines. Four databases (PubMed, ACM Digital Library, IEEE Xplore, and APA PsycInfo) were searched for studies on mHealth solutions that integrate personalisation. The retrieved papers were assessed for eligibility and useful information regarding integrated personalisation techniques. RESULTS Out of the 1,139 retrieved studies, 62 were included in the narrative synthesis. Research interest in the personalisation of mHealth solutions has increased since 2020. mHealth solutions were mainly applied to endocrine, nutritional, and metabolic diseases; mental, behavioural, or neurodevelopmental diseases; or the promotion of healthy lifestyle behaviours. Its main purposes are to support disease self-management and promote healthy lifestyle behaviours. Mobile applications are the most prevalent technological solution. Although several design models, such as user-centred and patient-centred designs, were used, no specific frameworks or models for personalisation were followed. These solutions rely on behaviour change theories, use gamification or motivational messages, and personalise the content rather than functionality. A broad range of data is used for personalisation purposes. There is a lack of studies assessing the efficacy of these solutions; therefore, further evidence is needed. DISCUSSION Personalisation in mHealth has not been well researched. Although several techniques have been integrated, the effects of using a combination of personalisation techniques remain unclear. Although personalisation is considered a persuasive strategy, many mHealth solutions do not employ it. CONCLUSIONS Open research questions concern guidelines for successful personalisation techniques in mHealth, design frameworks, and comprehensive studies on the effects and interactions among multiple personalisation techniques.
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Affiliation(s)
- Octavio Rivera-Romero
- Electronic Technology Department, Universidad de Sevilla, Spain; Instituto de Investigación en Informática de la Universidad de Sevilla, Spain.
| | - Elia Gabarron
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway; Department of Education, ICT and Learning, Østfold University College, Halden, Norway
| | - Jorge Ropero
- Electronic Technology Department, Universidad de Sevilla, Spain
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Martin-Payo R, Leirós-Díaz C, Armes J, Fu MR, Cachero-Rodríguez J, del Mar Fernandez-Alvarez M. The "Breast-4Y" web app for breast cancer prevention at young age: Development, evaluation, and validation. Internet Interv 2023; 33:100651. [PMID: 37555074 PMCID: PMC10404991 DOI: 10.1016/j.invent.2023.100651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Improving knowledge of risk factors, signs and symptoms positively influence an individual's intention to acquire healthy lifestyle behaviors to prevent breast cancer, to identify breast cancer risk early and seek health advice early. The aim of the present study was to develop and to assess the usability and quality of a web-app (Breast-4Y) designed specifically for younger women to improve their knowledge about breast cancer risk factors and symptoms as well as protective behaviors to reduce their risk. METHODS The development of the Breast-4Y web-app, based on Health Belief Model and the Behaviour Change Wheel, comprised four steps: i) analysis of scientific literature regarding breast cancer risk factors, symptoms and preventive lifestyle behaviors; ii) design of web-app; iii) content review by experts; iv) quality and usability assessment by the end-users (n = 20). Web-app usability was evaluated using the Spanish version of the System Usability Scale for the Assessment of Electronic Tools and the quality using the Spanish version of uMARS. RESULTS The contents were rated 4.25 or above, indicating high content quality. The mean usability score was 84.9 (SD 12.4), the mean rating for objective quality and subjective quality dimensions mean were 4.2 (SD 0.4) and 3.4 (0.777) respectively, indicating excellent usability and quality. Positive associations (p < .05) were observed between numbers of app used and attitudes to change (r = 0.479), and intention to change (r = 0.539). Strong positive associations (p < .001) were also observed between usability satisfaction and attitudes to change (r = 0.584), intention to change (r = 0.656), and help-seeking (r = 0.656). CONCLUSIONS This study provided evidence that Breast-4Y has adequate contents, high quality, and usability. Breast-4Y can be tested in pragmatic trials to assess their effectiveness to reduce the risk of breast cancer, raise women's awareness of breast cancer risk factors, increase women's knowledge of breast cancer symptoms, and adopt protective lifestyle behaviors.
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Affiliation(s)
- Ruben Martin-Payo
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Spain
- PRECAM Research Group, Instituto de Investigación Sanitaria del Principado de Asturias, Spain
| | - Claudia Leirós-Díaz
- PRECAM Research Group, Instituto de Investigación Sanitaria del Principado de Asturias, Spain
- Área Sanitaria 3, Servicio de Salud del Principado de Asturias, Spain
| | - Jo Armes
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, United Kingdom
| | - Mei Rosemary Fu
- The Dorothy and Dale Thompson School of Nursing, University of Missouri-Kansas, United States of America
| | - Judit Cachero-Rodríguez
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Spain
- PRECAM Research Group, Instituto de Investigación Sanitaria del Principado de Asturias, Spain
| | - María del Mar Fernandez-Alvarez
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Spain
- PRECAM Research Group, Instituto de Investigación Sanitaria del Principado de Asturias, Spain
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von Kalckreuth N, Feufel MA. Extending the Privacy Calculus to the mHealth Domain: Survey Study on the Intention to Use mHealth Apps in Germany. JMIR Hum Factors 2023; 10:e45503. [PMID: 37585259 PMCID: PMC10468710 DOI: 10.2196/45503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/13/2023] [Accepted: 06/21/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND With the increasing digitalization of the health sector, more and more mobile health (mHealth) apps are coming to the market to continuously collect and process sensitive health data for the benefit of patients and providers. These technologies open up new opportunities to make the health care system more efficient and save costs but also pose potential threats such as loss of data or finances. OBJECTIVE This study aims to present an empirical review and adaptation of the extended privacy calculus model to the mHealth domain and to understand what factors influence the intended usage of mHealth technologies. METHODS A survey study was conducted to empirically validate our model, using a case vignette as cover story. Data were collected from 250 German participants and analyzed using a covariance-based structural equation model. RESULTS The model explains R2=79.3% of the variance in intention to use. The 3 main factors (social norms, attitude to privacy, and perceived control over personal data) influenced the intention to use mHealth apps, albeit partially indirectly. The intention to use mHealth apps is driven by the perceived benefits of the technology, trust in the provider, and social norms. Privacy concerns have no bearing on the intention to use. The attitude to privacy has a large inhibiting effect on perceived benefits, as well as on trust in the provider. Perceived control over personal data clearly dispels privacy concerns and supports the relationship of trust between the user and the provider. CONCLUSIONS Based on the privacy calculus, our domain-specific model explains the intention to use mHealth apps better than previous, more general models. The findings allow health care providers to improve their products and to increase usage by targeting specific user groups.
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Affiliation(s)
- Niklas von Kalckreuth
- Division of Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Berlin, Germany
| | - Markus A Feufel
- Division of Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Berlin, Germany
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Chen ZF, Kusuma JD, Shiao SYPK. Validating Healthy Eating Index, Glycemic Index, and Glycemic Load with Modern Diets for E-Health Era. Nutrients 2023; 15:nu15051263. [PMID: 36904261 PMCID: PMC10005628 DOI: 10.3390/nu15051263] [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: 01/17/2023] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Predictors of healthy eating parameters, including the Healthy Eating Index (HEI), Glycemic Index (GI), and Glycemic Load (GL), were examined using various modern diets (n = 131) in preparation for personalized nutrition in the e-health era. Using Nutrition Data Systems for Research computerized software and artificial intelligence machine-learning-based predictive validation analyses, we included domains of HEI, caloric source, and various diets as the potentially modifiable factors. HEI predictors included whole fruits and whole grains, and empty calories. Carbohydrates were the common predictor for both GI and GL, with total fruits and Mexican diets being additional predictors for GI. The median amount of carbohydrates to reach an acceptable GL < 20 was predicted as 33.95 g per meal (median: 3.59 meals daily) with a regression coefficient of 37.33 across all daily diets. Diets with greater carbohydrates and more meals needed to reach acceptable GL < 20 included smoothies, convenient diets, and liquids. Mexican diets were the common predictor for GI and carbohydrates per meal to reach acceptable GL < 20; with smoothies (12.04), high-school (5.75), fast-food (4.48), Korean (4.30), Chinese (3.93), and liquid diets (3.71) presenting a higher median number of meals. These findings could be used to manage diets for various populations in the precision-based e-health era.
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Affiliation(s)
- Zhao-Feng Chen
- Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Correspondence: (Z.-F.C.); (S.-Y.P.K.S.); Tel.: +1-(818)-233-6112 (S.-Y.P.K.S.)
| | | | - Shyang-Yun Pamela K. Shiao
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence: (Z.-F.C.); (S.-Y.P.K.S.); Tel.: +1-(818)-233-6112 (S.-Y.P.K.S.)
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Tsopra R, Peiffer-Smadja N, Charlier C, Campeotto F, Lemogne C, Ruszniewski P, Vivien B, Burgun A. Putting undergraduate medical students in AI-CDSS designers' shoes: An innovative teaching method to develop digital health critical thinking. Int J Med Inform 2023; 171:104980. [PMID: 36681042 DOI: 10.1016/j.ijmedinf.2022.104980] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Digital health programs are urgently needed to accelerate the adoption of Artificial Intelligence and Clinical Decision Support Systems (AI-CDSS) in clinical settings. However, such programs are still lacking for undergraduate medical students, and new approaches are required to prepare them for the arrival of new and unknown technologies. At University Paris Cité medical school, we designed an innovative program to develop the digital health critical thinking of undergraduate medical students that consisted of putting medical students in AI-CDSS designers' shoes. METHODS We followed the six steps of Kern's approach for curriculum development: identification of needs, definition of objectives, design of an educational strategy, implementation, development of an assessment and design of program evaluation. RESULTS A stand-alone and elective AI-CDSS program was implemented for fourth-year medical students. Each session was designed from an AI-CDSS designer viewpoint, with theoretical and practical teaching and brainstorming time on a project that consisted of designing an AI-CDSS in small groups. From 2021 to 2022, 15 students were enrolled: they rated the program 4.4/5, and 80% recommended it. Seventy-four percent considered that they had acquired new skills useful for clinical practice, and 66% felt more confident with technologies. The AI-CDSS program aroused great enthusiasm and strong engagement of students: 8 designed an AI-CDSS and wrote two scientific 5-page articles presented at the Medical Informatics Europe conference; 4 students were involved in a CDSS research project; 2 students asked for a hospital internship in digital health; and 1 decided to pursue PhD training. DISCUSSION Putting students in AI-CDSS designers' shoes seemed to be a fruitful and innovative strategy to develop digital health skills and critical thinking toward AI technologies. We expect that such programs could help future doctors work in rapidly evolving digitalized environments and position themselves as key leaders in digital health.
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Affiliation(s)
- Rosy Tsopra
- Université Paris Cité, UFR de Médecine, Digital Health Program, Paris, France; Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France; Inria, HeKA, PariSanté Campus Paris, France; Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou, F-75015 Paris, France
| | - Nathan Peiffer-Smadja
- Université Paris Cité, UFR de Médecine, Paris, France; Université Paris Cité, INSERM, IAME, F-75018 Paris, France; Infectious Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, F-75018 Paris, France
| | - Caroline Charlier
- Université Paris Cité, UFR de Médecine, Paris, France; Cochin University Hospital, Division of Infectious Diseases and Tropical Medicine, AP-HP, Paris, France; Institut Pasteur, National Reference Center and WHO Collaborating Center Listeria, Paris, France; Institut Pasteur, Inserm U1117, Biology of Infection Unit, Paris, France
| | - Florence Campeotto
- Université Paris Cité, UFR de Médecine, Paris, France; Régulation Régionale Pédiatrique, SAMU de Paris, AP-HP, Hôpital Necker - Enfants Malades, Paris, France; Gastro-entérologie pédiatrique, AP-HP, Hôpital Necker - Enfants Malades, Paris, France; Faculté de Pharmacie, Université Paris Cité, Inserm UMR S1139, Paris, France
| | - Cédric Lemogne
- Université Paris Cité, UFR de Médecine, Paris, France; Université Paris Cité, INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, F-75014 Paris, France; Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, F-75004 Paris, France
| | - Philippe Ruszniewski
- Université Paris Cité, UFR de Médecine, Paris, France; Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, France; Service de gastro-entérologie et pancréatologie, Hôpital Beaujon AP-HP, Paris, France
| | - Benoît Vivien
- Université Paris Cité, UFR de Médecine, Paris, France; Régulation Régionale Pédiatrique, SAMU de Paris, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Anita Burgun
- Université Paris Cité, UFR de Médecine, Digital Health Program, Paris, France; Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France; Inria, HeKA, PariSanté Campus Paris, France; Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou, F-75015 Paris, France
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Buis L, Galyean S, Alcorn M, Childress A. Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e41235. [PMID: 36637888 PMCID: PMC9883741 DOI: 10.2196/41235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cardiovascular disease, cancer, diabetes mellitus, and obesity are common chronic diseases, and their prevalence is reaching an epidemic level worldwide. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mobile health (mHealth) to access clinical information, collaborate with care teams, communicate over long distances with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved in the disease state. Hence, available evidence on the effectiveness of mHealth apps toward behavior change to improve chronic disease outcomes is limited. OBJECTIVE The objective of this scoping review was to provide an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (ie, cardiovascular disease, diabetes mellitus, cancer, and obesity). We further evaluated the behavior change techniques and theories or models used for behavior change, if any. METHODS A scoping review was conducted through a systematic literature search in the MEDLINE, EBSCO, PubMed, ScienceDirect, and Scopus databases. Studies were excluded from the review if they did not involve an app or nutrition intervention, were written in a language other than English, were duplicates from other database searches, or were literature reviews. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, the systematic review process included 4 steps: identification of records through the database search, screening of duplicate and excluded records, eligibility assessment of full-text records, and final analysis of included records. RESULTS In total, 46 studies comprising 256,430 patients were included. There was diversity in the chronic disease state, study design, number of participants, in-app features, behavior change techniques, and behavior models used in the studies. In addition, our review found that less than half (19/46, 41%) of the studies based their nutrition apps on a behavioral theory or its constructs. Of the 46 studies, 11 (24%) measured maintenance of health behavior change, of which 7 (64%) sustained behavior change for approximately 6 to 12 months and 4 (36%) showed a decline in behavior change or discontinued app use. CONCLUSIONS The results suggest that mHealth apps involving nutrition can significantly improve health outcomes in people with chronic diseases. Tailoring nutrition apps to specific populations is recommended for effective behavior change and improvement of health outcomes. In addition, some studies (7/46, 15%) showed sustained health behavior change, and some (4/46, 9%) showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of the health behavior change effectiveness of disease-specific nutrition apps.
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Affiliation(s)
| | - Shannon Galyean
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Michelle Alcorn
- Department of Hospitality & Retail Management, Texas Tech University, Lubbock, TX, United States
| | - Allison Childress
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
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Ghaben SJ, Mat Ludin AF, Mohamad Ali N, Beng Gan K, Singh DKA. A framework for design and usability testing of telerehabilitation system for adults with chronic diseases: A panoramic scoping review. Digit Health 2023; 9:20552076231191014. [PMID: 37599901 PMCID: PMC10437210 DOI: 10.1177/20552076231191014] [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: 02/25/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Objective This scoping review aimed to identify the design and usability testing of a telerehabilitation (TR) system, and its characteristics and functionalities that are best-suited for rehabilitating adults with chronic diseases. Methods Searches were conducted in PubMed, EBSCO, Web of Science, and Cochrane library for studies published between January 2017 and December 2022. We followed the Joanna Briggs Institute guidelines and the framework by Arksey and O'Malley. Screening was undertaken by two reviewers, and data extraction was undertaken by the first author. Then, the data were further reviewed and discussed thoroughly with the team members. Results A total of 31 results were identified, with the core criteria of developing and testing a telerehabilitation system, including a mobile app for cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders. All developed systems resulted from multidisciplinary teams and employed mixed-methods research. We proposed the "input-process-output" framework that identified phases of both system design and usability testing. Through system design, we reported the use of user-centered design, iterative design, users' needs and characteristics, theory underpinning development, and the expert panel in 64%, 75%, 86%, 82%, and 71% of the studies, respectively. We recorded the application of moderated usability testing, unmoderated testing (1), and unmoderated testing (2) in 74%, 63%, and 15% of the studies, respectively. The identified design and testing activities produced a matured system, a high-fidelity prototype, and a released system in 81.5%, 15%, and 3.5%, respectively. Conclusion This review provides a framework for TR system design and testing for a wide range of chronic diseases that require prolonged management through remote monitoring using a mobile app. The identified "input-process-output" framework highlights the inputs, design, development, and improvement as components of the system design. It also identifies the "moderated-unmoderated" model for conducting usability testing. This review illustrates characteristics and functionalities of the TR systems and healthcare professional roles.
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Affiliation(s)
- Suad J Ghaben
- Faculty of Health Sciences, Physiotherapy Programme & Center for Healthy Ageing & Wellness, (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Al Azhar University, Gaza, Palestine
| | - Arimi Fitri Mat Ludin
- Faculty of Health Sciences, Biomedical Science Programme & Center for Healthy Ageing and Wellness (H=CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nazlena Mohamad Ali
- Institute of Visual Informatics (IVI), Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Kok Beng Gan
- Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Devinder Kaur Ajit Singh
- Faculty of Health Sciences, Physiotherapy Programme & Center for Healthy Ageing & Wellness, (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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10
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Vilasi A, Panuccio VA, Morante S, Villa A, Versace MC, Mezzatesta S, Mercuri S, Inguanta R, Aiello G, Cutrupi D, Puglisi R, Capria S, Li Vigni M, Tripepi G, Torino C. Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2022; 3:e36766. [PMID: 38935948 PMCID: PMC11135230 DOI: 10.2196/36766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 06/29/2024]
Abstract
BACKGROUND Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors. OBJECTIVE With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy. METHODS The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform. RESULTS The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users. CONCLUSIONS Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population.
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Affiliation(s)
- Antonio Vilasi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | | | | | | | - Sabrina Mezzatesta
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | | | - Giuseppe Aiello
- Department of Engineering, University of Palermo, Palermo, Italy
| | - Demetrio Cutrupi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | - Salvatore Capria
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | - Giovanni Tripepi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | - Claudia Torino
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
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11
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Fenton A, Cooper-Ryan AM, Hardey M(M, Ahmed W. Football Fandom as a Platform for Digital Health Promotion and Behaviour Change: A Mobile App Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148417. [PMID: 35886270 PMCID: PMC9317557 DOI: 10.3390/ijerph19148417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 02/07/2023]
Abstract
Background: The last decade has seen a dramatic shift toward the study of fitness surveillance, thanks in part to the emergence of mobile health (mHealth) apps that allow users to track their health through a variety of data-driven insights. This study examines the adoption trends and community mediation of the mobile fitness application ‘FanFit’, a platform aimed at promoting physical activity among sports fans by creating a fitness app branded to their favourite team for health promotion. Objective: Our study looked at the impact of a specially designed mobile app (FanFit) as a digital health intervention for initiating and maintaining physical activity as part of football club membership. Our analysis indicates that app users will adopt healthier behaviours as a result of the app’s sense of fan community and behaviour change. Methods: The findings reported here are based on an implementation of the FanFit app and, in particular, on those who participated in a more in-depth study (n = 30). These participants were Rangers FC supporters with a mix of genders (n = 19 males and n = 11 females). Focus groups and interviews were conducted with participants to ascertain users’ perspectives on the most effective methods for nudging users toward adopting and maintaining a pattern of fitness behaviours. Results: The findings show that the user community was interested in fitness and wanted to live a ‘healthy lifestyle,’ which was augmented and fuelled by the app’s competitive architecture design. Furthermore, the data reveal a new fan-health discourse about a person’s developing wants, talents, and identities as embodied beings. Conclusions: We have developed and presented valid links between the use of sports club apps and health programmes. The app could be useful for sports programmes and club providers looking for mHealth applications that provide community support through fan discourse with opportunities for both male and female fans.
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Affiliation(s)
- Alex Fenton
- Business School, University of Chester, Chester CH1 4BJ, UK;
| | | | | | - Wasim Ahmed
- Stirling Management School, University of Stirling, Stirling FK9 4LA, UK
- Correspondence: ; Tel.: +44-(0)1786-467333
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