Attitudes and preferences on the use of mobile health technology and health games for self-management: interviews with older adults on anticoagulation therapy

Exploring mHealth design opportunities for blind and visually impaired older users

Background

Mobile health (mHealth) applications (apps) are crucial in delivering health information and services to older adults. Despite their importance, blind and visually impaired (BVI) older individuals often face significant challenges in app accessibility and usability. This study delves into the design preferences and expectations of BVI older users and underscores the necessity of user-centered design for inclusive mHealth apps.

Methods

Conducted in September 2023, the study comprised six focus group interviews. Each session involved two to four participants who began with self-introductions, followed by discussions centered on three open-ended interview questions.

Results

The study involved 14 participants: four with severe low vision and 10 totally blind. The primary design principles highlighted were "customizability" and "simplicity". The participants stressed the importance of intuitively designed main pages aligning with user patterns. Further, the participants articulated the following mHealth app feature or menu recommendations: editable profiles, emergency contact access, adaptable data presentation, data exportation, audible color details, customizable colors for varying visual needs, audible error feedback, feasible data input methods, toolbars, and habit-establishing reminders. Discussions also touched on the vital role of clear health data visualizations and comprehensible app-based health information.

Conclusions

The findings illuminate paths for software developers and health scientists working towards more inclusive mHealth solutions. It is essential during the development phase to prioritize app learnability to accommodate a broad range of users, ensuring that even those with disabilities can effectively use technological innovations to address health disparities.

Validity and Reliability of a Smartphone Application for Home Measurement of Four-Meter Gait Speed in Older Adults

The four-meter gait speed (4MGS) is a recommended physical performance test in older adults but is challenging to implement clinically. We developed a smartphone application (App) with a four-meter ribbon for remote 4MGS testing at home. This study aimed to assess the validity and reliability of this smartphone App-based assessment of the home 4MGS. We assessed the validity of the smartphone App by comparing it against a gold standard video assessment of the 4MGS conducted by study staff visiting community-dwelling older adults and against the stopwatch-based measurement. Moreover, we assessed the test-retest reliability in two supervised sessions and three additional sessions performed by the participants independently, without staff supervision. The 4MGS measured by the smartphone App was highly correlated with video-based 4MGS (r = 0.94), with minimal differences (mean = 0.07 m/s, ± 1.96 SD = 0.12) across a range of gait speeds. The test-retest reliability for the smartphone App 4MGS was high (ICC values: 0.75 to 0.93). The home 4MGS in older adults can be measured accurately and reliably using a smartphone in the pants pocket and a four-meter strip of ribbon. Leveraging existing technology carried by a significant portion of the older adult population could overcome barriers in busy clinical settings for this well-established objective mobility test.

Assistive technologies and strategies to support the medication management of individuals with hearing and/or visual impairment: A scoping review

BACKGROUND

Individuals with sensory impairment (visual and/or hearing) experience health inequalities and increased the risk of medication-related iatrogenic disease compared with the general population. Assistive technologies and tailored strategies could support medication management for individuals with sensory impairment to reduce harm and increase the likelihood of therapeutic benefit.

OBJECTIVE

This scoping review identified assistive technologies and strategies to support medication management of/for people with hearing and/or visual impairment.

METHODS

Standard scoping review methodology was used to identify studies that evaluated technologies or strategies designed to support people with sensory impairment with independent medicine management. Electronic databases were searched (MEDLINE, Embase, CINAHL, ACM, Cochrane) from inception to 18/07/22. Independent duplicate screening, selection, and data extraction were undertaken.

RESULTS

Of 1231 publications identified, 18 were included, reporting 17 studies, 16 of which evaluated technologies to assist people with visual impairment and one study to assist people with hearing impairment. The range of technologies and devices included: applications for android phones (n = 6); eyedrop-assistance devices (n = 5); audio-prescription labelling/reading systems (n = 2); touch-to-speech devices (n = 2); continuous glucose monitoring system (n = 1); magnifying technology (n = 1). Ten studies tested early-stage prototypes. Most participants could operate the technologies effectively and deemed them to be useful.

CONCLUSIONS

Despite the increasing number of medicine-related assistive technologies, there has been limited empirical evaluation of their effectiveness for supporting individuals with sensory impairment. Prototypes appear to be useful for people with visual or hearing impairment, however wider 'real-life' testing is needed to confirm the benefits of these technologies.

Preferences of Older Adult Veterans With Heart Failure for Engaging With Mobile Health Technology to Support Self-care: Qualitative Interview Study Among Patients With Heart Failure and Content Analysis

BACKGROUND

Heart failure (HF) affects approximately 6.5 million adults in the United States, disproportionately afflicting older adults. Mobile health (mHealth) has emerged as a promising tool to empower older adults in HF self-care. However, little is known about the use of this approach among older adult veterans.

OBJECTIVE

The goal of this study was to explore which features of an app were prioritized for older adult veterans with HF.

METHODS

Between January and July 2021, we conducted semistructured interviews with patients with heart failure aged 65 years and older at a single facility in an integrated health care system (the Veterans Health Administration). We performed content analysis and derived themes based on the middle-range theory of chronic illness, generating findings both deductively and inductively. The qualitative questions captured data on the 3 key themes of the theory: self-care maintenance, self-care monitoring, and self-care management. Qualitative responses were analyzed using a qualitative data management platform, and descriptive statistics were used to analyze demographic data.

RESULTS

Among patients interviewed (n=9), most agreed that a smartphone app for supporting HF self-care was desirable. In addition to 3 a priori themes, we identified 7 subthemes: education on daily HF care, how often to get education on HF, support of medication adherence, dietary restriction support, goal setting for exercises, stress reduction strategies, and prompts of when to call a provider. In addition, we identified 3 inductive themes related to veteran preferences for app components: simplicity, ability to share data with caregivers, and positive framing of HF language.

CONCLUSIONS

We identified educational and tracking app features that can guide the development of HF self-care for an older adult veteran population. Future research needs to be done to extend these findings and assess the feasibility of and test an app with these features.

Benefits of and barriers to telehealth for the informal caregivers of elderly individuals in rural areas: A scoping review

INTRODUCTION

Maintaining care for elderly individuals in rural areas is heavily dependent on support from informal caregivers. Many informal caregivers of the elderly in rural areas feel burdened and urgently require professional support. Interests in telehealth that can provide support irrespective of geographical location have been increasing.

OBJECTIVE

To identify the benefits of and barriers in telehealth engagement for rural caregivers to provide evidence for service improvement.

DESIGN

A scoping review method was used following PRISMA-ScR guidelines and Arksey and O'Malley's five-stage framework. Five databases were searched. The search terms were chosen based on the target intervention (i.e. telehealth), target population (caregivers of elderly individuals) and target context (rural areas). Two authors independently assessed the eligibility of studies and extracted data from eligible studies.

FINDINGS

Of 4220 retrieved studies, 19 articles met the inclusion criteria. This study identified four benefits of and two barriers to telehealth for rural caregivers. Four subthemes were identified as the key benefits in using telehealth for caregivers: decrease in psychological distress, increase in care efficiency, increase in social support and increase in access to resources, while inadequate telehealth infrastructures and caregivers' own reasons were the primary barriers in using telehealth for those populations.

CONCLUSIONS

Telehealth was shown to significantly benefit rural caregivers. Future research can be designed and conducted for overcoming the barriers to telehealth. Additionally, the benefits identified by this review need to be translated from research into practice for rural caregivers' care.

Study on the Types of Elderly Intelligent Health Management Technology and the Influencing Factors of Its Adoption

[Background]: In recent years, aging has become a global social problem. Intelligent health management technology (IHMT) provides solutions for the elderly to deal with various health risks. However, the elderly are facing many difficulties in using IHMT. Studying the application types of IHMT and the influencing factors of the elderly’s acceptance of it will help to improve the use behavior of the elderly. [Methods]: This paper summarizes the application types of IHMT, identifies the influencing factors of the elderly’s adaption of IHMT, and makes a systematic comment on the influencing factors. [Results]: We divide the different functions of IHMT for the elderly into four types: self-monitoring, medical care, remote monitoring, and health education. The influencing factors are divided into three types: individual, social, and technology. [Conclusions]: This study finds that IHMT’s application covers all aspects of the health services of the elderly. Among these applications, self-monitoring is the most used. We divided the influencing factors of the elderly’s acceptance of IHMT into three categories and nine subcategories, having 25 variables.

The Perceptions and Experiences of Mobile Health Technology by Older People in Guangzhou, China: A Qualitative Study

The study explores older people's perceptions and experiences with mobile technology adoption in hospitals. Twenty nine older people were interviewed at a tertiary hospital in Guangzhou from June to December 2020. All the interviews were analyzed using thematic analysis. Older people are a diversified group. Various factors impact their readiness for technology use, including their educational level, age, past experiences, living arrangements, etc. The older people in this study in general expressed a great concern about using the new health technology and many encountered barriers to its successful adoption. Yet, the barriers and difficulties that they encountered are embedded in a changed social context in China. The findings above provide insights into the adoption of health technology, and tailored measures to facilitate older people's technology adoption are suggested.

Smartphone applications managing antithrombotic therapy: a scoping literature review (Preprint)

Background

Antithrombotic therapy is complex and requires informed decisions and high therapy adherence. Several mobile phone apps exist to either support physicians in the management of antithrombotic therapies or to educate and support patients. For the majority of these apps, both their medical evidence and their development background are unknown.

Objective

This review aims to investigate the available literature describing high-quality apps for managing antithrombotic therapy based on professional scientific information.

Methods

Keywords and Medical Subject Heading terms were used to search MEDLINE via PubMed and Ovid between December 2019 and January 2022. Inclusion criteria were the availability of full text and publications in the English language. Apps that solely focused on atrial fibrillation were excluded. Qualitative findings were thematically synthesized and reported narratively.

Results

Out of 149 identified records, 32 were classified as eligible. We identified four groups: (1) apps for patients supporting self-management of vitamin K antagonists, (2) apps for patients increasing therapy adherence, (3) educational apps for patients, and (4) apps for physicians in supporting guideline adherence.

Conclusions

Throughout the evaluated data, patients from all age groups receiving antithrombotic drugs expressed the desire for a digital tool that could support their therapy management. In addition, physicians using mobile guideline-based apps may have contributed to decreased adverse event rates among their patients. In general, digital apps encompassing both user-friendly designs and scientific backgrounds may enhance the safety of antithrombotic therapies. However, our evaluation did not identify any apps that addressed all antithrombotic drugs in combination with perioperative stratification strategies. Currently, strict regulations for smartphone apps seem to negatively affect the development of new apps. Therefore, new legal policies for medical digital apps are urgently needed.

Perspectives of older adults with chronic disease on the use of wearable technology and video games for physical activity

BACKGROUND

There is increasing interest in technology to deliver physical rehabilitation and allow clinicians to monitor progress. Examples include wearable activity trackers and active video games (AVGs), where physical activity is required to play the game. However, few studies have explored what may influence the effectiveness of these as technology-based physical activity interventions in older adults with chronic diseases.

OBJECTIVE

This study aimed to explore: 1) perceptions about wearable physical activity trackers; 2) perceptions about using technology to share physical activity information with clinicians; 3) barriers and motivators to playing games, including AVGs for rehabilitation.

METHODS

Qualitative study based on semi-structured interviews with older adults (n = 19) with chronic obstructive pulmonary disease (COPD).

RESULTS

Wearable activity trackers were perceived as useful to quantify activity, facilitate goal-setting, visualize long-term improvements and provide reminders. Participants generally wished to share data with their clinicians to gain greater accountability, receive useful feedback and improve the quality of clinical care. Participants were motivated to play games (including AVGs) by seeking fun, social interaction and health benefits. Some felt that AVGs were of no benefit or were too difficult. Competition was both a motivator and a barrier.

CONCLUSIONS

The findings of the present study seek to inform the design of technology to encourage physical activity in older adults with chronic diseases.

Readiness for Voice Technology in Patients With Cardiovascular Diseases: Cross-Sectional Study

Background

The clinical application of voice technology provides novel opportunities in the field of telehealth. However, patients’ readiness for this solution has not been investigated among patients with cardiovascular diseases (CVD).

Objective

This paper aims to evaluate patients’ anticipated experiences regarding telemedicine, including voice conversational agents combined with provider-driven support delivered by phone.

Methods

A cross-sectional study enrolled patients with chronic CVD who were surveyed using a validated investigator-designed questionnaire combining 19 questions (eg, demographic data, medical history, preferences for using telehealth services). Prior to the survey, respondents were educated on the telemedicine services presented in the questionnaire while being assisted by a medical doctor. Responses were then collected and analyzed, and multivariate logistic regression was used to identify predictors of willingness to use voice technology.

Results

In total, 249 patients (mean age 65.3, SD 13.8 years; 158 [63.5%] men) completed the questionnaire, which showed good repeatability in the validation procedure. Of the 249 total participants, 209 (83.9%) reported high readiness to receive services allowing for remote contact with a cardiologist (176/249, 70.7%) and telemonitoring of vital signs (168/249, 67.5%). The voice conversational agents combined with provider-driven support delivered by phone were shown to be highly anticipated by patients with CVD. The readiness to use telehealth was statistically higher in people with previous difficulties accessing health care (OR 2.920, 95% CI 1.377-6.192) and was most frequent in city residents and individuals reporting a higher education level. The age and sex of the respondents did not impact the intention to use voice technology (P=.20 and P=.50, respectively).

Conclusions

Patients with cardiovascular diseases, including both younger and older individuals, declared high readiness for voice technology.

Patients' Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China

BACKGROUND

As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users' acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China.

OBJECTIVE

This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients' willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology.

METHODS

We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients' sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals.

RESULTS

Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%).

CONCLUSIONS

We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries.

Seniors and mobiles: A qualitative inquiry of mHealth adoption among Singapore seniors

OBJECTIVE

This study examines how seniors in Singapore use mobile devices for healthcare purposes.

METHODS

Semi-structured interviews with 35 mobile phone users aged between 58-82 years old.

RESULTS

Seniors regard mobile phones as important personal devices for socialization, security, and emergency purposes. Most of the seniors consider mobile telephony (voice calls and text messaging) as an accessible platform to access healthcare. Perceived usefulness, ease of use, compatibility, technology anxiety, financial cost, and self-efficacy were identified as factors affecting the use of mHealth among seniors. Although a few adopt mHealth applications and mobile Internet for health-information seeking, some younger seniors show enthusiastic attitudes toward its adoption. Additionally, some seniors also have technology anxiety and resistance toward using mHealth applications.

CONCLUSION

Seniors use mobile phones for healthcare purposes in their daily life, and its use involves several facilitators and barriers. Interpersonal training is likely to reduce their anxiety and increase mHealth literacy and adoption. Theoretical and practical implications are discussed.

Investigating the attitude of patients with chronic diseases about using mobile health

BACKGROUND

Mobile health (mHealth) due to its popularity and accessibility can be widely applied in different health areas such as the management of chronic diseases. However, its success depends on the acceptance of their users. Therefore, the aim of this study was to survey the attitudes of patients with chronic disease toward mHealth technology and their willingness to use it.

METHODS

This study was conducted within a 2-year period (2016-2018) to determine and compare the attitude and willingness of patients with asthma, diabetes, and multiple sclerosis (MS) toward using mHealth technology in a province in Iran.

RESULTS

In total, 222 patients participated in this study. More than 93 percent of the patients with diabetes and MS, and 65 percent of the asthmatic patients preferred using mHealth services rather than consulting a physician (p < .0001). About 98, 94, and 49 percent of the MS, diabetic, and asthmatic patients, respectively felt comfortable if their health conditions checked by physicians through mHealth technology (p < .0001).

CONCLUSIONS

Our results showed that the majority of the patients felt comfortable and preferred using mHealth technology rather than consulting the physicians. The attitudes of diabetic and MS patients toward mHealth technology were rather more positive compared to asthmatic patient attitude. These results may be helpful for the developers of mHealth technology, and researchers who design mHelath interventions for patients with chronic disease.

Perceptions and experiences of using mobile technology for medication adherence among older adults with coronary heart disease: A qualitative study

OBJECTIVE

Medication non-adherence is linked to adverse clinical outcomes (i.e. rehospitalization, mortality) among patients with coronary heart disease. Given its global adoption and growing popularity among older adults, mobile technology may be an effective strategy to improve medication adherence. The aim of this article is to present the perceptions, attitudes, and beliefs of individuals with coronary heart disease about using text messaging and mobile phone applications for medication adherence.

METHODS

We recruited 28 participants (veterans and non-veterans) with a history of coronary heart disease and antiplatelet medication use in Northern California. We formed six focus groups of individuals who participated in three sessions (total 18 sessions). We analyzed our data using grounded theory.

RESULTS

The median age was 69.5 ± 10.8 years for non-veterans (50% male) and 70 ± 8.6 years for veterans (100% male). In the first session, we found that participants perceived text message reminders as a convenient, easy, and flexible tool to establish a routine for taking medications. In the second session, participants were eager to use applications for their greater interactivity, individualized health monitoring, and personalized medication information. The third session, participants shared preferred features (i.e. drug interactions, tracking symptoms) after using two applications at home for 2 weeks.

CONCLUSIONS

Older adults are engaged and can be proficient mobile technology users. Text messaging and mobile phone applications are perceived as helpful tools for medication adherence. Future research should include rigorous clinical trials to test the efficacy of mobile health technology to promote medication adherence in populations that require strict medication adherence.

Characteristics Associated With Facebook Use and Interest in Digital Disease Support Among Older Adults With Atrial Fibrillation: Cross-Sectional Analysis of Baseline Data From the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) Cohort

BACKGROUND

Online support groups for atrial fibrillation (AF) and apps to detect and manage AF exist, but the scientific literature does not describe which patients are interested in digital disease support.

OBJECTIVE

The objective of this study was to describe characteristics associated with Facebook use and interest in digital disease support among older patients with AF who used the internet.

METHODS

We used baseline data from the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF), a prospective cohort of older adults (≥65 years) with AF at high stroke risk. Participants self-reported demographics, clinical characteristics, and Facebook and technology use. Online patients (internet use in the past 4 weeks) were asked whether they would be interested in participating in an online support AF community. Mobile users (owns smartphone and/or tablet) were asked about interest in communicating with their health care team about their AF-related health using a secure app. Logistic regression models identified crude and multivariable predictors of Facebook use and interest in digital disease support.

RESULTS

Online patients (N=816) were aged 74.2 (SD 6.6) years, 47.8% (390/816) were female, and 91.1% (743/816) were non-Hispanic white. Roughly half (52.5%; 428/816) used Facebook. Facebook use was more common among women (adjusted odds ratio [aOR] 2.21, 95% CI 1.66-2.95) and patients with mild to severe depressive symptoms (aOR 1.50, 95% CI 1.08-2.10) and less common among patients aged ≥85 years (aOR 0.27, 95% CI 0.15-0.48). Forty percent (40.4%; 330/816) reported interest in an online AF patient community. Interest in an online AF patient community was more common among online patients with some college/trade school or Bachelors/graduate school (aOR 1.70, 95% CI 1.10-2.61 and aOR 1.82, 95% CI 1.13-2.92, respectively), obesity (aOR 1.65, 95% CI 1.08-2.52), online health information seeking at most weekly or multiple times per week (aOR 1.84, 95% CI 1.32-2.56 and aOR 2.78, 95% CI 1.86-4.16, respectively), and daily Facebook use (aOR 1.76, 95% CI 1.26-2.46). Among mobile users, 51.8% (324/626) reported interest in communicating with their health care team via a mobile app. Interest in app-mediated communication was less likely among women (aOR 0.48, 95% CI 0.34-0.68) and more common among online patients who had completed trade school/some college versus high school/General Educational Development (aOR 1.95, 95% CI 1.17-3.22), sought online health information at most weekly or multiple times per week (aOR 1.86, 95% CI 1.27-2.74 and aOR 2.24, 95% CI 1.39-3.62, respectively), and had health-related apps (aOR 3.92, 95% CI 2.62-5.86).

CONCLUSIONS

Among older adults with AF who use the internet, technology use and demographics are associated with interest in digital disease support. Clinics and health care providers may wish to encourage patients to join an existing online support community for AF and explore opportunities for app-mediated patient-provider communication.

Ease of Use and Usefulness of Medication Reminder Apps among Rural Aging Adults

Older adults manage multiple medications for chronic disease and those living in rural areas are impacted by health care disparities due to health provider shortages and fewer pharmacies. The use of downloadable medication reminder apps on smartphones may serve as a strategy for medication self-management of chronic diseases. In this feasibility study, thirteen rural older adult participants downloaded Medisafe® and used the app to manage their daily medications. The community-dwelling aging adults in this pilot perceived the Medisafe® as not difficult to use, useful for medication tracking and providing reminders for the self-management of multiple medications.

By the numbers: ratings and utilization of behavioral health mobile applications

Although >10,000 behavioral health applications ("apps") are currently available on the Apple and Google Play marketplaces, they have been minimally evaluated or regulated and little is known about "real world" usage patterns. This investigation combined data from online behavioral health app rating frameworks and a mobile health market research firm to identify the most downloaded apps as well as determine rating and ranking concordance between frameworks. Findings demonstrated that the most commonly downloaded apps focus on relaxation, mindfulness, and meditation skills and that they often have notably discordant reviews across rating frameworks. Our results suggest that there is a growing need for: (1) standardized behavioral health app quality and effectiveness measures, (2) up-to-date behavioral health app guidance for clinicians and consumers, and (3) evidence-based apps that incorporate revealed consumer preferences.

"Call a Teenager… That's What I Do!" - Grandchildren Help Older Adults Use New Technologies: Qualitative Study

Background

Although family technical support seems intuitive, there is very little research exploring this topic.

Objective

The objective of this study was to conduct a subanalysis of data collected from a large-scale qualitative project regarding older adults’ experiences in using health information technology. Specifically, the subanalysis explored older adults’ experiences with technology support from family members to inform strategies for promoting older adults’ engagement with new health technologies. Although the primary analysis of the original study was theoretically driven, this paper reports results from an inductive, open-coding analysis.

Methods

This is a subanalysis of a major code identified unexpectedly from a qualitative study investigating older adults’ use experience of a widespread health technology, the patient portal. A total of 24 older patients (≥65 years) with multiple chronic conditions (Charlson Comorbidity Index >2) participated in focus groups conducted at the patients’ primary clinic. While conducting the primary theoretically driven analysis, coders utilized an open-coding approach to ensure important ideas not reflected in the theoretical code book were captured. Open coding resulted in 1 code: family support. This subanalysis further categorized family support by who provided tech support, how tech support was offered, and the opinions of older participants about receiving family tech support.

Results

The participants were not specifically asked about family support, yet themes around family assistance and encouragement for technology emerged from every focus group. Participants repeatedly mentioned that they called their grandchildren and adult children if they needed help with technology. Participants also reported that family members experienced difficulty when teaching technology use. Family members struggled to explain simple technology tasks and were frustrated by the slow teaching process.

Conclusions

The results suggest that older adults ask their family members, particularly grandchildren, to support them in the use of new technologies. However, family may experience difficulties in providing this support. Older adults will be increasingly expected to use health technologies, and family members may help with tech support. Providers and health systems should consider potential family support and engagement strategies to foster adoption and use among older patients.

Characteristics of software used in self-management of vitamin K antagonist therapy: A systematic review

INTRODUCTION AND GOAL

Currently, 1-2% of the population in developed countries are under treatment with oral anticoagulants. An appropriate strategy to deal with this increase in demand of treatment with oral anticoagulants and to manage the costs is the transfer of part or all of the responsibility for managing treatment to the patients. The use of information technology, particularly electronic health software, can be an appropriate method to improve the quality of self-management of treatment with these drugs. Therefore, this systematic review investigated studies that discuss the characteristics of electronic health software in self-management of oral anticoagulation therapy.

METHOD

A systematic review based on PRISMA protocol was conducted. In this study, articles were investigated that were in English. Articles existing in Cochrane, EMBASE and PubMed databases were searched up to 14 May 2017. Then, articles searched through Google Scholar were added to this study.

FINDINGS

The common characteristics used in most software included 'encryption in exchanging information', having an 'instruction module' and 'being Android-based'. In terms of functionality, 'communication between the patient and healthcare team' existed in most of the software.

CONCLUSION

The results of the study showed that the accuracy of administration of the dose of the drug using computer to reach a target international normalized ratio level was not less than those administered with experienced medical staff. In addition, the results indicated that important characteristics of the software include encryption in exchanging information, instruction module and Android-based instruction module. The most important characteristic was the interaction between the patient and the healthcare team.

Perceptions and Acceptance of mHealth in Patients With Cardiovascular Diseases: A Cross-Sectional Study

Background

Mobile health (mHealth)—a method of assisting long-term care in patients with chronic cardiovascular diseases (CVDs)—is gaining popularity in China, mainly owing to the large number of patients and limited clinical resources. Patients of different ages have varying needs for CVD management. However, evidence regarding how age influences Chinese CVD patients’ use and perceptions of mHealth is limited.

Objective

This study aimed to explore age-related differences among Chinese patients with CVD regarding their use and perceptions of mHealth and to determine the factors that influence this population’s willingness to use mHealth technologies.

Methods

We conducted a cross-sectional study of patients with chronic CVDs in a tertiary hospital in Beijing using a new questionnaire designed by the investigators. Participants were sourced using nonproportional quota-sampling methods, being recruited consecutively in each sampling category (age 18-49, 50-64, 65-74, and ≥75 years, with at least 25 men and 25 women in each age group). The survey consisted of 5 parts, including sociodemographic profile and medical history; current disease management situation; self-evaluation of disease management; current usage of mobile and internet technology (IT); and willingness to use an mHealth solution to perform disease self-management. Responses were compared among the 4 age groups as well as between patients who were willing to use mHealth solutions and those who were not. Multivariate logistic regression model was used to identify predictors of willingness to use mHealth for self-management.

Results

Overall, 231 patients (124 men) completed the questionnaire; of these, 53 were aged 18-49 years, 66 were aged 50-64 years, 54 were aged 65-74 years, and 58 were aged ≥75 years. Patients in the older cohorts visited hospitals more often than did those in the younger cohorts (P<.001), and they also showed lower technology skills regarding the use of mobile or internet devices (P<.001) and searched for health-related information on the internet less often (P<.001). In addition, 68.0% (157/231) of the patients showed interest in using mHealth solution to manage their disease; of these, 40.8% (64/157) were aged ≥65 years. Patients who were more willing to use mHealth solution to manage their diseases were younger (P<.001), more educated (P<.001), still working (P=.001), possessed higher skill regarding mobile or internet device use (P<.001), and more frequently searched for health information on the internet (P<.001). Finally, multivariate logistic regression showed that IT skill was the single indicator (P=.003) of willingness to use mHealth, not age.

Conclusions

Although age is associated with the use of mobile or internet devices, the sole indicator of mHealth use for self-management was participants’ IT skills. Education regarding the use of mobile devices and development of easy-to-use software might improve the acceptance of mHealth solutions among older patient populations.

Older Adult Preferences of Mobile Application Functionality Supporting Medication Self-Management

Health systems and insurers alike are increasingly interested in leveraging mHealth (mobile health) tools to support patient health-related behaviors including medication adherence. However, these tools are not widely used by older patients. This study explores patient preferences for functionality in a smartphone application (app) that supports medication self-management among older adults with multiple chronic conditions. We conducted six discussion groups in Chicago, Miami, and Denver (N = 46). English-speaking older adults (55 and older) who owned smartphones and took five or more prescription medicines were invited to participate. Discussions covered familiarity with and use of current apps and challenges with taking multidrug regimens. Participants reviewed a range of possible mobile app functions and were asked to give feedback regarding the acceptability and desirability of each to support medication management. Very few participants (n = 3) reported current use of a mobile app for medication support, although all were receptive. Challenges to medication use were forgetfulness, fear of adverse events, and managing medication information from multiple sources. Desired features included (1) a list and consolidated schedule of medications, (2) identification and warning of unsafe medication interactions, (3) reminder alerts to take medicine, and (4) the ability record when medications were taken. Features relating to refill ordering, pharmacy information, and comparing costs for medication were not considered to be as important for an app.

Investigating the Enduring Impact of a Community-Based Health Education Program to Promote African American Elders' Use of Technology Designed to Support Chronic Disease Self-Management

Elders experience chronic disease disparities and barriers to access technology designed to support recommended self-management behaviors. Elders from racial minority groups are among those who experience particular disparities in chronic disease incidence, outcomes, and barriers to technology use. In order to investigate strategies to address barriers, the study team recruited elder African Americans with diabetes and young adults connected to the elders through naturally occurring familial or social networks. Participants attended a community-based health education session focused on enhancing self-efficacy for recommended self-management and using consumer-oriented technology accessible on their smartphones for self-management support. To assess enduring impact, the study team conducted a pilot study to investigate perceptions and use one month following the health education session. Both elders and young adults offered perspectives on what was effective in teaching elders how to use technology. Both age groups stressed that having patience was crucial, as is providing encouragement for the elders to try tasks on their own. Both elders and young adults also showed a statistically significant increase in aspirations to work together for additional intergenerational health and technology knowledge exchange. Several elder participants continued using technology that they first used during the session. This novel, pilot study describes how to promote self-management and technology use for individuals plagued by persistent chronic disease and technology use disparities.

Facilitators and barriers to using physical activity smartphone apps among Chinese patients with chronic diseases

Background

Smartphones and their applications (apps) impact society and health care. With the growth of smartphone users and app downloads in China, patients with chronic diseases have access to a self-management strategy for physical activity. Although studies report physical activity apps improve the physical activity of patients, data is limited concerning their use of these apps. Therefore, this study investigated the current usage, willingness to use, and barriers to using physical activity apps of Chinese patients with chronic diseases.

Methods

We designed a questionnaire to collect data from chronic disease patients in a tertiary hospital in Beijing, which was sent to 250 patients in four departments.

Results

Two hundred eighteen questionnaires were returned (87.2% response rate). Most (92.7%) respondents owned a smartphone, 34.9% had used a physical activity app, and 18.8% were current users. Additionally, 53.7% were willing to use a physical activity app designed for them. Respondents more likely to use physical activity apps were younger (i.e., ≤ 44 years), more educated, current smartphone users, and previous users of physical activity apps; moreover, they believed they needed exercise, their disease required exercise instruction and support, and their physical status needed monitored when exercising (p < 0.05). Main barriers to using apps reported were insufficient function, difficulty of use, extra cost, and security issues.

Conclusions

Our results indicate sizeable smartphone ownership among Chinese patients with chronic diseases; moreover, over half of our participants report they would use a physical activity app designed for them. This information can be leveraged by healthcare workers managing patients with chronic diseases.

Electronic supplementary material

The online version of this article (doi:10.1186/s12911-017-0446-0) contains supplementary material, which is available to authorized users.

The Use and Effectiveness of Mobile Apps for Depression: Results From a Fully Remote Clinical Trial

Background

Mobile apps for mental health have the potential to overcome access barriers to mental health care, but there is little information on whether patients use the interventions as intended and the impact they have on mental health outcomes.

Objective

The objective of our study was to document and compare use patterns and clinical outcomes across the United States between 3 different self-guided mobile apps for depression.

Methods

Participants were recruited through Web-based advertisements and social media and were randomly assigned to 1 of 3 mood apps. Treatment and assessment were conducted remotely on each participant’s smartphone or tablet with minimal contact with study staff. We enrolled 626 English-speaking adults (≥18 years old) with mild to moderate depression as determined by a 9-item Patient Health Questionnaire (PHQ-9) score ≥5, or if their score on item 10 was ≥2. The apps were (1) Project: EVO, a cognitive training app theorized to mitigate depressive symptoms by improving cognitive control, (2) iPST, an app based on an evidence-based psychotherapy for depression, and (3) Health Tips, a treatment control. Outcomes were scores on the PHQ-9 and the Sheehan Disability Scale. Adherence to treatment was measured as number of times participants opened and used the apps as instructed.

Results

We randomly assigned 211 participants to iPST, 209 to Project: EVO, and 206 to Health Tips. Among the participants, 77.0% (482/626) had a PHQ-9 score >10 (moderately depressed). Among the participants using the 2 active apps, 57.9% (243/420) did not download their assigned intervention app but did not differ demographically from those who did. Differential treatment effects were present in participants with baseline PHQ-9 score >10, with the cognitive training and problem-solving apps resulting in greater effects on mood than the information control app (χ22=6.46, P=.04).

Conclusions

Mobile apps for depression appear to have their greatest impact on people with more moderate levels of depression. In particular, an app that is designed to engage cognitive correlates of depression had the strongest effect on depressed mood in this sample. This study suggests that mobile apps reach many people and are useful for more moderate levels of depression.

ClinicalTrial

Clinicaltrials.gov NCT00540865; https://www.clinicaltrials.gov/ct2/show/NCT00540865 (Archived by WebCite at http://www.webcitation.org/6mj8IPqQr)

Predicting adherence to use of remote health monitoring systems in a cohort of patients with chronic heart failure

BACKGROUND

It is unclear whether subgroups of patients may benefit from remote monitoring systems (RMS) and what user characteristics and contextual factors determine effective use of RMS in patients with heart failure (HF).

OBJECTIVE

The study was conducted to determine whether certain user characteristics (i.e. personal and clinical variables) predict use of RMS using advanced machine learning software algorithms in patients with HF.

METHODS

This pilot study was a single-arm experimental study with a pre- (baseline) and post- (3 months) design; data from the baseline measures were used for the current data analyses. Sixteen patients provided consent; only 7 patients (mean age 65.8 ± 6.1, range 58-83) accessed the RMS and transmitted daily data (e.g. weight, blood pressure) as instructed during the 12 week study duration.

RESULTS

Baseline demographic and clinical characteristics of users and non-users were comparable for a majority of factors. However, users were more likely to have no HF specialty based care or an automatic internal cardioverter defibrillator. The precision accuracy of decision tree, multilayer perceptron (MLP) and k-Nearest Neighbor (k-NN) classifiers for predicting access to RMS was 87.5%, 90.3%, and 94.5% respectively.

CONCLUSION

Our preliminary data show that a small set of baseline attributes is sufficient to predict subgroups of patients who had a higher likelihood of using RMS. While our findings shed light on potential end-users more likely to benefit from RMS-based interventions, additional research in a larger sample is warranted to explicate the impact of user characteristics on actual use of these technologies.

Feasibility Study of a Mobile Health Intervention for Older Adults on Oral Anticoagulation Therapy

Background: Oral anticoagulation treatment (OAT) such as warfarin therapy is recommended for older adults with atrial fibrillation, heart failure, or who are at risk for venous thromboembolism. Despite its proven benefits, older adults report both dissatisfaction with OAT and reduced quality of life that can potentially lead to low adherence to OAT and decreased treatment efficacy. Objective: To test the feasibility of Mobile Applications for Seniors to enhance Safe anticoagulation therapy (MASS), a mobile-based health technology intervention designed to promote independence and self-care. Methods: This pilot study used a single-arm experimental pre–post design to test the feasibility of a 3-month intervention using MASS in 18 older adults (male: n = 14; White: n = 9; Hispanic: n = 7; Other: n = 2; M age = 67). MASS was available in English or Spanish. Participants completed surveys about their OAT knowledge, attitudes, quality of life with OAT, and adherence at baseline and at a 3-month follow-up. Satisfaction with the MASS intervention was also assessed at follow-up. Results: Anticoagulation knowledge significantly improved from baseline to follow-up (M_base = 12.5 ± 5.51, M_follow-up = 14.78 ± 3.93, p = .007). Other outcomes were not different, pre- and post-tests. Participants reported they were generally satisfied with MASS, its ease of use and its usefulness. Conclusion: The results showed use of MASS improved older adults’ knowledge of OAT. Using mHealth apps may enhance self-care among older adults with chronic conditions who are also taking oral anticoagulants.

The attitudes of pharmacists, students and the general public on mHealth applications for medication adherence

BACKGROUND

During recent years mobile technology has developed tremendously and has infiltrated the healthcare field. Mobile healthcare (mHealth) applications, or apps, may be used to support patient adherence to medication thus promoting optimal treatment outcomes and reducing medication wastage.

OBJECTIVE

This study shall consider the opinions of United Kingdom (UK) based pharmacists, pharmacy undergraduates and members of the general public towards the use of mHealth apps to promote adherence to prescribed medication regimens.

METHODS

On Liverpool John Moores University (LJMU) ethical approval, the 25 item questionnaire was distributed to UK registered pharmacists within inner city Liverpool and Manchester (n=500), pharmacy undergraduates studying at LJMU (n=420) and members of the general public within Liverpool City Centre (n=400). The questions were formatted as multiple choice, Likert scales or the open answer type. The data were analysed using simple frequencies, cross tabulations and non-parametric techniques in the SPSS v22 program.

RESULTS

The number of completed questionnaires from the pharmacist, student and general public cohorts were 245, 333 and 400; respectively. The data indicated that the general public rely heavily upon daily routine to take medication as prescribed (54.1%) with mHealth app use being extremely low (1.5%); a similar trend was noted for the pharmacist / student cohorts. The age of the individual is an important consideration, with the younger generation likely to engage with mHealth apps and the older generation less so. Here, education and training are important. Pharmacists (82.3%) would be happy to deliver training packages to the public who would in turn happily receive such training (84%). Key barriers precluding mHealth app use include data reliability, security and technical difficulties.

CONCLUSION

Adherence apps hold great promise to support the patient and their healthcare needs. In order to increase acceptance and uptake simple, user-friendly designs must be considered and constructed. In addition, such technology requires effective promotion and end user training in order to reach its full potential. Furthermore, the regulation of mobile adherence apps will be essential in order to overcome underlying patient concerns.

Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps: A Systematic Review

BACKGROUND

Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether or not app contents adhere to current medical evidence.

OBJECTIVE

To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps.

METHODS

We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed.

RESULTS

Based on inclusion criteria, 52 studies were included in this review. These studies assessed a total of 6520 apps. Studies dealt with a variety of medical specialties and topics. As much as 28 studies assessed expert involvement, which was found in 9-67% of the assessed apps. Thirty studies (including 6 studies that also assessed expert involvement) assessed adherence of app content to current medical evidence. Thirteen studies found that 10-87% of the assessed apps adhered fully to the compared evidence (published studies, recommendations, and guidelines). Seventeen studies found that none of the assessed apps (n=2237) adhered fully to the compared evidence.

CONCLUSIONS

Most medical mobile phone apps lack expert involvement and do not adhere to relevant medical evidence.

Feasibility study of an attention training application for older adults

BACKGROUND

Technology-based attention training has demonstrated promise in its potential to improve cognitive functioning in older people. Developing mobile applications, with older users specifically in mind, may support future dissemination of these interventions and integration into daily life.

AIMS AND OBJECTIVES

The purpose of this pilot study was to test the feasibility of an Attention Training Application (ATA) for community-dwelling older adults using mobile technology.

DESIGN

A descriptive, mixed-methods design was used to capture older adults' feedback on the usability and acceptability of the ATA.

METHODS

A convenience sample of older adults (n = 9) from two independent living facilities participated in a 2-hour training and practice session with the ATA. Participants were given personally tailored instructions for using the mobile device and the ATA specifically. Following a practice session, participants provided ratings on multiple components of the ATA and completed an audio-recorded, semi-structured interview to provide detailed descriptions of their experience and perceptions. An iterative process of content analysis was used to characterise the open-ended responses.

RESULTS

Participants rated the ATA favourably overall on several 0-10 scales including likeability [8.5 (1.6)], interest [8.8 (2.3)] and satisfaction [8.2 (1.9)]. The qualitative analyses revealed several issues relevant to the feasibility of the ATA among older people including the importance of the technological background of the user, limiting negative feedback, challenges with the touch screen interface, personal preferences for challenge, extending the practice period and the difficulty of the dual-task condition.

CONCLUSIONS

The use of the ATA is feasible in the older adult population. Future development should specifically consider personal characteristics as well as preferences to maximise usability and acceptability among older people.

IMPLICATIONS FOR PRACTICE

Older adults enjoyed the ATA. This opens doors to user-friendly technological interventions that may be effective in assisting older adults maintain and possibly even improve their cognitive function.