Comparison of a User-Centered Design, Self-Management App to Existing mHealth Apps for Persons Living With HIV

Exploring patient-centered design solutions of a telehealth app for HIV - A qualitative study

BACKGROUND

The Communication and Tracing App HIV (COMTRAC-HIV) project is developing a mobile health (mHealth) app for integrated care of HIV patients in Germany. The complexity of HIV treatment and continuous care necessitates the need for tailored mHealth solutions. This qualitative study explores design solutions and a prototype to enhance the app's functionality and effectiveness.

METHODS

A total of eight HIV patients and pre-exposure prophylaxis (PrEP) users, recruited at the HIV Center Frankfurt, participated in focus groups and thinking-aloud tests (TA test). In the focus groups, design solutions were discussed for user-interface clarity, leading to the development of an interactive prototype, the usability of which was evaluated with a TA test. Data collection involved video/audio recordings. Qualitative analysis was conducted using a deductive category system, and focused on app design and usage in focus groups, and layout, navigation, interaction, terminology, comprehension, feedback, and level of satisfaction in TA tests.

RESULTS

The app was commended for its simple, clear design, especially its medication reminders and health tracking features. Opinions on the symptom diary varied however, respondents noting it more suitable for HIV users than PrEP users. Privacy concerns suggest avoiding display of HIV-specific information. Suggested improvements include e.g. image uploads, drug interaction checks and prescription tracking. A total of 25 usability issues were identified in the TA test, with most found in the layout (n = 6), navigation (n = 5), interaction (n = 5), and terminology (n = 5) categories. Two examples are non-intuitive controls and illogical button placement. Despite these disadvantages, participants noted positive impressions (n = 5) in the satisfaction category.

CONCLUSION

The study emphasizes the need for patient-centered design in mobile HIV care solutions, highlighting to the app's user-friendliness and potential to enhance care. Further research is necessary to refine the app's functionality and to align it with clinical and patients' privacy needs.

Health service requirements of mHealth app users: evidence from Hangzhou, China

PURPOSE

China's healthcare system is being burdened by the increasing prevalence of chronic diseases. Therefore, this study investigated the health service requirements of mobile health applications (mHealth apps) users in Hangzhou, China. This study aimed to propose suggestions and theoretical references to improve mHealth apps and promote their development, thereby meeting public medical and health needs and creating an efficient medical service system.

DESIGN/METHODOLOGY/APPROACH

We constructed a model of health service demands using a literature review, network survey, and semi-structured interviews. We analyzed the demand attributes using the Kano model and Better-Worse index and obtained the priority ranking of demands.

FINDINGS

The results revealed 25 demand elements in four dimensions: must-be (M), one-dimensional (O), attractive (A), and indifferent (I) requirements. The findings suggest that mHealth app developers can optimize health services by categorizing and managing health services, focusing on middle-aged users, enhancing the professionalism of health service providers, and improving the feedback mechanism.

ORIGINALITY/VALUE

Studies on mHealth apps user demands, particularly on health service needs, remain scarce. This study employed a mixed-methods approach, integrating both qualitative and quantitative research techniques, to establish a priority ranking of user health service needs for mHealth apps. The study offers recommendations and theoretical references to optimize and improve mHealth app services.

HIGHLIGHTS

Construct a better health service requirements model for mHealth app users.Obtain the prioritization of demand elements in the model.Propose some management suggestions to improve mHealth apps.

The Solutions in Health Analytics for Rural Equity Across the Northwest (SHARE-NW) Dashboard for Health Equity in Rural Public Health: Usability Evaluation

BACKGROUND

Given the dearth of resources to support rural public health practice, the solutions in health analytics for rural equity across the northwest dashboard (SHAREdash) was created to support rural county public health departments in northwestern United States with accessible and relevant data to identify and address health disparities in their jurisdictions. To ensure the development of useful dashboards, assessment of usability should occur at multiple stages throughout the system development life cycle. SHAREdash was refined via user-centered design methods, and upon completion, it is critical to evaluate the usability of SHAREdash.

OBJECTIVE

This study aims to evaluate the usability of SHAREdash based on the system development lifecycle stage 3 evaluation goals of efficiency, satisfaction, and validity.

METHODS

Public health professionals from rural health departments from Washington, Idaho, Oregon, and Alaska were enrolled in the usability study from January to April 2022. The web-based evaluation consisted of 2 think-aloud tasks and a semistructured qualitative interview. Think-aloud tasks assessed efficiency and effectiveness, and the interview investigated satisfaction and overall usability. Verbatim transcripts from the tasks and interviews were analyzed using directed content analysis.

RESULTS

Of the 9 participants, all were female and most worked at a local health department (7/9, 78%). A mean of 10.1 (SD 1.4) clicks for task 1 (could be completed in 7 clicks) and 11.4 (SD 2.0) clicks for task 2 (could be completed in 9 clicks) were recorded. For both tasks, most participants required no prompting-89% (n=8) participants for task 1 and 67% (n=6) participants for task 2, respectively. For effectiveness, all participants were able to complete each task accurately and comprehensively. Overall, the participants were highly satisfied with the dashboard with everyone remarking on the utility of using it to support their work, particularly to compare their jurisdiction to others. Finally, half of the participants stated that the ability to share the graphs from the dashboard would be "extremely useful" for their work. The only aspect of the dashboard cited as problematic is the amount of missing data that was present, which was a constraint of the data available about rural jurisdictions.

CONCLUSIONS

Think-aloud tasks showed that the SHAREdash allows users to complete tasks efficiently. Overall, participants reported being very satisfied with the dashboard and provided multiple ways they planned to use it to support their work. The main usability issue identified was the lack of available data indicating the importance of addressing the ongoing issues of missing and fragmented public health data, particularly for rural communities.

Developing an mHealth program to improve HIV care continuum outcomes among young Black gay and bisexual men

BACKGROUND

Young Black gay and bisexual men (YBGBM) in the United States face significant disparities in HIV care outcomes. Mobile health (mHealth) interventions have shown promise with improving outcomes for YBGBM across the HIV care continuum.

METHODS

We developed an mHealth application using human-centered design (HCD) from 2019-2021 in collaboration with YBGBM living with HIV and with HIV service providers. Our HCD process began with six focus groups with 50 YBGBM and interviews with 12 providers. These insights were used to inform rapid prototyping, which involved iterative testing and refining of program features and content, with 31 YBGBM and 12 providers. We then collected user feedback via an online survey with 200 YBGBM nationwide and usability testing of a functional prototype with 21 YBGBM.

RESULTS

Focus groups and interviews illuminated challenges faced by YBGBM living with HIV, including coping with an HIV diagnosis, stigma, need for social support, and a dearth of suitable information sources. YBGBM desired a holistic approach that could meet the needs of those newly diagnosed as well as those who have been living with HIV for many years. Program preferences included video-based content where users could learn from peers and experts, a range of topics, a community of people living with HIV, and tools to support their health and well-being. Providers expressed enthusiasm for an mHealth program to improve HIV care outcomes and help them serve clients. Rapid prototyping resulted in a list of content topics, resources, video characteristics, community features, and mHealth tools to support adherence, retention, goal setting, and laboratory results tracking, as well as tools to help organization staff to support clients. Online survey and usability testing confirmed the feasibility, acceptability, and usability of the content, tools, and features.

CONCLUSIONS

This study demonstrates the potential of a video-based mHealth program to address the unique needs of YBGBM living with HIV, offering support and comprehensive information through a user-friendly interface and videos of peers living with HIV and of experts. The HCD approach allowed for continuous improvements to the concept to maximize cultural appropriateness, utility, and potential effectiveness for both YBGBM and HIV service organizations.

The Feasibility and Acceptability of Using Mobile Applications for HIV Testing, Prevention, and Treatment Among Adolescent Girls and Young Women in Cameroon: A Cross-Sectional Study

ABSTRACT

Adolescent girls and young women (AGYW) are vulnerable populations to HIV/AIDS. We conducted a cross-sectional survey among 637 AGYW in Cameroon to study the feasibility and willingness to use mobile applications (apps) for HIV testing, prevention, and treatment. We found that phone ownership is high among AGYW, where 93.9% ( n = 598) of them (median age: 22 years, interquartile range: 21-24 years) had access to a smartphone, 49.5% ( n = 315) frequently searched for health information, and 48.9% ( n = 312) frequently used health-related apps. AGYW's willingness to use mobile apps for HIV testing, prevention, and treatment were 87.9% ( n = 560), 84.4% ( n = 538), and 84.9% ( n = 541), respectively. The high willingness to use apps was associated with older age, HIV testing, and searching for health information on a phone. Barriers to willingness included having no internet access, concerns about internet cost and privacy, and lack of consistent access to a smartphone.

MyTrack+: Human-centered design of an mHealth app to support long-term weight loss maintenance

A growing body of research has focused on the utility of adaptive intervention models for promoting long-term weight loss maintenance; however, evaluation of these interventions often requires customized smartphone applications. Building such an app from scratch can be resource-intensive. To support a novel clinical trial of an adaptive intervention for weight loss maintenance, we developed a companion app, MyTrack+, to pair with a main commercial app, FatSecret (FS), leveraging a user-centered design process for rapid prototyping and reducing software engineering efforts. MyTrack+ seamlessly integrates data from FS and the BodyTrace smart scale, enabling participants to log and self-monitor their health data, while also incorporating customized questionnaires and timestamps to enhance data collection for the trial. We iteratively refined the app by first developing initial mockups and incorporating feedback from a usability study with 17 university students. We further improved the app based on an in-the-wild pilot study with 33 participants in the target population, emphasizing acceptance, simplicity, customization options, and dual app usage. Our work highlights the potential of using an iterative human-centered design process to build a companion app that complements a commercial app for rapid prototyping, reducing costs, and enabling efficient research progress.

Comparison of evaluation methods for improving the usability of a Spanish mHealth tool

OBJECTIVE

Mobile health (mHealth) technology is now widely used across health conditions and populations. The rigorous development of these tools has yielded improved health outcomes, yet the ideal approach for developing mHealth tools continues to evolve, indicating the need for rigorous usability evaluation methods. This study compares two usability evaluation methods - cognitive interviews and usability assessments employing a think-aloud approach - for adapting an evidence-based mHealth tool from English into Spanish.

METHODS

We conducted cognitive interviews and usability assessments using a think-aloud protocol to evaluate the usability of an HIV mHealth application among 40 Spanish-speaking adults with HIV in New York City, NY, and La Romana, Dominican Republic. The Health IT Usability Evaluation Model (Health-ITUEM) was used to guide the analysis of qualitative data collected from each method.

RESULTS

Participants (N = 40) averaged 43 years old (SD = 12.26; range 20-79), identified primarily Hispanic/Latino (92.5 %), and resided in La Romana (50 %) or New York City (50 %). Both usability evaluation methods yielded similar findings, highlighting learnability and information needs as crucial components of participant feedback for the mHealth application. Cognitive interviews captured participants' perspectives on the app's interface and design. On the other hand, results from usability assessments offered insights into participants' competency while interacting with the mHealth tool.

CONCLUSION

Findings from this study highlight the contributions and limitations of including cognitive interviews and task-based usability assessments using a think-aloud approach in mHealth usability testing. Future research should employ a multi-method approach, incorporating complementary usability evaluation methods and engaging participants in multiple assessments. Using complementary usability evaluation methods may provide a more comprehensive understanding of the usability and participant experience aspects of a mHealth tool compared to using a single usability evaluation method.

Improving asthma control and quality of life via a smartphone self-management app: A randomized controlled trial

BACKGROUND

Mobile phone applications (apps) show promise for enhancing asthma self-management, but their effectiveness varies. This study examined the effect of a smartphone asthma app on asthma control and quality of life.

METHODS

Using block randomization, 60 patients with asthma were allocated to an intervention group (n = 30) or control group (n = 30) for this single-blind randomized controlled trial. At baseline, both groups completed the Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire-Marks (AQLQ-M). The intervention group used a smartphone-based asthma self-management app plus their regular treatment, while the control group received only usual care. Follow-up ACT and AQLQ-M assessments occurred at 3 and 6 months. SPSS version 26 was used for analysis, including descriptive statistics, non-parametric tests (Wilcoxon and Mann-Whitney U), and analysis of variance with repeated measurements.

RESULTS

Both groups showed improved asthma control and quality of life at 3 and 6 months compared to baseline. However, after 6 months the intervention group had significantly greater improvement than controls (p < 0.05). Repeated measures ANOVA revealed divergent changes in ACT and AQLQ-M scores over time, with the intervention group demonstrating greater enhancement of asthma control and quality of life (p < 0.001).

CONCLUSION

This study demonstrated that use of a smartphone-based asthma self-management app improved asthma control and quality of life after 6 months compared to usual care alone. These findings indicate that guideline-based asthma apps can positively impact outcomes.

Evaluation of Chinese HIV Mobile Apps by Researchers and Patients With HIV: Quality Evaluation Study

BACKGROUND

Against the backdrop of globalization, China remains one of the most heavily burdened countries in Asia with regard to AIDS. However, many high-risk groups and patients affected by AIDS may be less likely to actively seek care from medical institutions because of fear of experiencing shame or discrimination. Mobile apps provide a promising avenue for supporting the prevention, diagnosis, and treatment of AIDS. However, a comprehensive systematic evaluation of these mobile apps' functionality and quality has not been conducted yet.

OBJECTIVE

This study aims to identify the available mobile apps for AIDS in China, assess and discuss the functional features and quality of these Chinese AIDS mobile apps, and offer decision support for patients and clinical practitioners in accessing high-quality AIDS mobile apps. Furthermore, based on the evaluation results, recommendations for improvement will be provided.

METHODS

A systematic search was conducted on the Qimai app data platform, the Aladdin WeChat applet data platform, and WeChat to identify mobile apps related to AIDS. A snowball sampling method was used to supplement the potentially overlooked apps. The selected mobile apps underwent a rigorous screening process based on unified criteria. Subsequently, assessments were independently undertaken by 3 separate researchers and 2 patients with HIV, using both the Mobile App Rating Scale (MARS) and the User Mobile App Rating Scale (uMARS). Quantitative interpretations of the data were facilitated by the MedCalc statistical software (version 20.217, MedCalc Software).

RESULTS

A total of 2901 AIDS mobile apps were included in the study, with 2897 identified through information retrieval and an additional 4 added via snowball sampling. After a rigorous selection process, 21 apps were determined to be usable. Among them, the Hong Feng Wan app achieved the highest combined average score, calculated based on the MARS (3.96, SD 0.33) and uMARS (4.47, SD 0.26). Overall, there was no significant correlation between MARS and uMARS (rapp quality total score=0.41; P=.07; rsubjective quality=0.39; P=.08). A notable issue was the widespread lack of user privacy protection, with only 24% (5/21) of the apps offering this feature.

CONCLUSIONS

The number of available Chinese AIDS mobile apps is limited, with WeChat applets dominating the market. Nonetheless, the performance of WeChat mini-apps is generally inferior to that of independent apps, and there may be significant discrepancies between assessments conducted by researchers and those provided by genuine end users, emphasizing the necessity of involving real users in the development and evaluation of HIV mobile apps. In addition, developers of these Chinese HIV mobile apps need to devote attention to improving privacy protection mechanisms, in addition to considering the evaluations of researchers and real users. This will help attract more users and increase user loyalty.

A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol

BACKGROUND

While there is no cure for HIV, adherence to antiretroviral therapy can extend the lifespan and improve the quality of life of people with HIV. Despite the global reduction of HIV infection rates in recent years, New York City and La Romana, Dominican Republic, continue to report high infection rates among Latino populations. Many people with HIV remain virally unsuppressed in these geographic hotspots, suggesting a need for additional interventions to overcome medication adherence barriers. Tailored and culturally appropriate mobile health (mHealth) technology can be an engaging way to improve adherence. The primary objective of this trial is to test the effectiveness of an mHealth tool to improve HIV medication adherence among Spanish-speaking people living in New York City and the Dominican Republic.

METHODS

The WiseApp study is a two-arm randomized controlled trial among 248 people with HIV across the New York and Dominican Republic sites over the course of 12 months. Participants are randomly assigned to either receive a CleverCap pill bottle that is linked to the WiseApp (intervention) or standard of care (control). All participants complete surveys at baseline, 3-month, 6-month, and 12-month follow-up visits and the study team obtains HIV-1 viral load and CD4 count results through blood draw at each study timepoint.

DISCUSSION

The use of mHealth technologies to improve medication adherence among people with HIV has been implemented in recent years. Although some studies have found improvement in adherence to antiretroviral therapy in the short term, there is limited information about how these interventions improve adherence among Spanish-speaking populations. Disproportionate rates of HIV infection among Latinos in New York City suggest an existing inequitable approach in reaching and treating this population. Due to a lack of mHealth studies with Latino populations, and apps tailored to Spanish-speakers, the WiseApp study will not only demonstrate the effectiveness of this particular mHealth app but will also contribute to the mHealth research community as a whole.

TRIAL REGISTRATION

This trial was registered with Clinicaltrials.gov (NCT05398185) on 5/31/2022.

Three cycles of mobile app design to improve HIV self-management: A development and evaluation study

Objective

Employing three cycles of Design Science Research (DSR) to develop a mobile app 'ESSC (Excellent Self Supervised HIV Care)' to improve self-management among people living with HIV (PLWH).

Methods

This study is based on the DSR framework comprising three iterative cycles. In the Relevance cycle, PLWH participated in a survey of mobile health (mHealth) experiences and needs. In the Rigor cycle, the information-motivation-behavioural skills (IMB) model was applied to foundations of the app, and HIV specialists verified the contents. Experts evaluated the heuristic system and the app quality with the Mobile Application Rating Scale (MARS). In the Design cycle, ESSC was built on the findings of the other two cycles, and end-users tested the usability using uMARS.

Results

The contents of the app were developed based on user requirements. The IMB model led ESSC to supplement motivational components for self-management, which built five functions: information contents; health life records including mental and sexual health; interactive counselling with healthcare providers; setting health goals after watching videos; and my page for self-reflection. To reduce social stigma and promote acceptance of the information-driven app, we created animated characters with neutral and bright features. The HIV specialists evaluated content validity as highly appropriate. The MARS score by the overall raters was between 3-acceptable and 4-good: functionality, 4.38; information, 4.12; aesthetics, 3.96; engagement, 3.37; and subjective quality, 3.25.

Conclusions

The DSR approach is effective for implementing usable and useful mHealth. The ESSC app would be feasible and contribute PLWH to retention in care.

Caregivers' Perceptions, Needs, and Data Sharing Concerns in mHealth Research on Pediatric Asthma: Cross-Sectional Survey Study

Background

Pediatric asthma is the most common chronic respiratory disease of childhood. Caregivers often report lacking knowledge in several aspects of asthma management at home. Although the use of mobile health (mHealth) tools, such as mobile apps, could facilitate asthma self-management and, simultaneously, the collection of data for research, few studies have explored the features that caregivers would like to see in such a tool and their perceptions on data sharing.

Objective

This study evaluates caregivers' perceived knowledge gaps in asthma management; their perceptions of certain features and resources that should be included in a potential mobile app; and any concerns that they may have regarding data sharing for research, including privacy and security concerns.

Methods

In this cross-sectional study, we surveyed 200 caregivers of children (aged 1-13 y) with asthma who were followed at a pediatric tertiary care center in Montreal, Canada. Anonymous data were collected through the institutional web-based survey platform. We collected the participants' answers by using a 5-category Likert scale ("completely agree," "agree," "neither agree nor disagree," "disagree," and "completely disagree"), multiple-choice questions, and free-text questions on the abovementioned topics. Descriptive statistics were performed, and answers were compared between caregivers of preschool-aged children and caregivers of school-aged children.

Results

Participating children's mean age was 5.9 (SD 3.4) years, with 54% (108/200) aged ≤5 years and 46% (92/200) aged >6 years. Overall, caregivers reported having adequate knowledge about asthma and asthma self-management. Nonetheless, they identified several desirable features for a mobile app focused on asthma self-management. The most frequently identified features included receiving alerts about environmental triggers of asthma (153/199, 76.9%), having videos that demonstrate symptoms of asthma (133/199, 66.8%), and being able to log children's asthma action plans in the app (133/199, 66.8%). Interestingly, more caregivers of preschool-aged children preferred textual information when compared to caregivers of school-aged children (textual information for explaining asthma: P=.008; textual information for the symptoms of asthma: P=.005). Caregivers were generally highly in favor of sharing data collected through a mobile app for research.

Conclusions

Caregivers of children with asthma in our study identified several desirable educational and interactive features that they wanted to have in a mobile app for asthma self-management. These findings provide a foundation for designing and developing mHealth tools that are relevant to caregivers of children with asthma.

Evaluation of a mobile-application educational intervention on the knowledge, attitude, and practice of patients in postoperative care for lumbar disk herniation surgery: A randomized control trial

Objective

We aimed to evaluate the impact of a mobile-based educational program on patients' postoperative care for lumbar disk herniation surgery.

Methods

A randomized controlled trial was conducted at Fayaz-Bakhsh Hospital, Tehran, Iran. Patients with lumbar disc herniation surgery experience were randomized to the intervention and control groups (learning with the LUmbar CAring Training-app). Participants' knowledge, attitudes, and practices of postoperative care for lumbar disc herniation surgery were assessed using a validated questionnaire at three-time points: pre-test (baseline), post-test one (immediately after program completion), and post-test two (8 weeks after program completion). The primary outcome measures were knowledge, attitudes, and practices scores variations. Secondary outcomes were not considered in our study.

Results

In total, 150 patients were enrolled, with 75 patients in each group. Patients in the intervention group demonstrated increased knowledge, modified attitudes, and practice than those in the control group (p < 0.05). The post-test knowledge, attitudes, and practices scores in the intervention group were significantly higher than those in the control group (p < 0.05).

Conclusion

Mobile-application-based education was a practical and feasible approach to improve patients' postoperative care for lumbar disc herniation surgery in Iran.

Design, development, and usability evaluation of a smartphone-based application for nutrition management in patients with type II diabetes

Purpose

Information technology (IT)-based interventions, especially mobile health (mHealth), possess a great potential for promoting self-management in patients with chronic diseases, including diabetes type II. The present study was aimed to design and develop a smartphone-based application (app) for nutrition management in patients with type II diabetes and evaluation of its usability.

Methods

In this study, a three-phase research approach was followed; (1) To determine the information content and functionalities of the app, a five-point Likert scale checklist including six parts was developed based on reviews of clinical practice guidelines and specialized databases. The checklist was then given to ten experts in endocrinology and metabolism, internal medicine, and nutrition, and those items with a mean score higher than 3.75 were approved. (2) In Android Studio, the app was designed and developed using Java language. (3) The Questionnaire for User Interaction Satisfaction (QUIS) was used to assess the app's usability by 21 patients with type II diabetes, ten IT experts, and seven endocrinologists, internal medicine practitioners, and nutritionists over one month. Mean scores were divided into three levels: weak (0-3), average (3-6), and good (6-9).

Results

According to experts' view, 17 out of 22 educational content and 17 out of 27 functionalities were approved. The app's most important educational content was the timing of meals for insulin patients and the definition of diabetes and its complications. The designed app had the following functionalities: providing educational information, recording information, performing calculations, representing data graphically, setting reminders, and communicating with physicians. The most important features of the app were the insulin dose calculation, reminders for doctors' appointments, setting times for tests and blood glucose measurements, and also tracking weight, blood glucose levels, and blood pressure. In terms of usability evaluation, the app was rated "good" level by diabetic patients (7.83 ± 0.74), IT experts (8.1 ± 0.66), and physicians (8.03 ± 0.95).

Conclusion

Given the desirable evaluation of the app by patients, physicians, and IT experts, it can be concluded that the developed app has the required functionalities for nutrition management of patients with type II diabetes. Smartphone-based apps appear to be able to improve self-management, the quality of care and health in patients with diabetes, and reduce many of their unnecessary visits to healthcare centers, and costs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01140-x.

Efficacy of an mHealth self-management intervention for persons living with HIV: the WiseApp randomized clinical trial

IMPORTANCE

Progression of HIV disease, the transmission of the disease, and premature deaths among persons living with HIV (PLWH) have been attributed foremost to poor adherence to HIV medications. mHealth tools can be used to improve antiretroviral therapy (ART) adherence in PLWH and have the potential to improve therapeutic success.

OBJECTIVE

To determine the efficacy of WiseApp, a user-centered design mHealth intervention to improve ART adherence and viral suppression in PLWH.

DESIGN, SETTING, AND PARTICIPANTS

A randomized (1:1) controlled efficacy trial of the WiseApp intervention arm (n = 99) versus an attention control intervention arm (n = 101) among persons living with HIV who reported poor adherence to their treatment regimen and living in New York City.

INTERVENTIONS

The WiseApp intervention includes the following components: testimonials of lived experiences, push-notification reminders, medication trackers, health surveys, chat rooms, and a "To-Do" list outlining tasks for the day. Both study arms also received the CleverCap pill bottle, with only the intervention group linking the pill bottle to WiseApp.

RESULTS

We found a significant improvement in ART adherence in the intervention arm compared to the attention control arm from day 1 (69.7% vs 48.3%, OR = 2.5, 95% CI 1.4-3.5, P = .002) to day 59 (51.2% vs 37.2%, OR = 1.77, 95% CI 1.0-1.6, P = .05) of the study period. From day 60 to 120, the intervention arm had higher adherence rates, but the difference was not significant. In the secondary analyses, no difference in change from baseline to 3 or 6 months between the 2 arms was observed for all secondary outcomes.

CONCLUSIONS

The WiseApp intervention initially improved ART adherence but did not have a sustained effect on outcomes.

The Development of a Novel mHealth Tool for Obstructive Sleep Apnea: Tracking Continuous Positive Airway Pressure Adherence as a Percentage of Time in Bed

BACKGROUND

Continuous positive airway pressure (CPAP) is the mainstay obstructive sleep apnea (OSA) treatment; however, poor adherence to CPAP is common. Current guidelines specify 4 hours of CPAP use per night as a target to define adequate treatment adherence. However, effective OSA treatment requires CPAP use during the entire time spent in bed to optimally treat respiratory events and prevent adverse health effects associated with the time spent sleeping without wearing a CPAP device. Nightly sleep patterns vary considerably, making it necessary to measure CPAP adherence relative to the time spent in bed. Weight loss is an important goal for patients with OSA. Tools are required to address these clinical challenges in patients with OSA.

OBJECTIVE

This study aimed to develop a mobile health tool that combined weight loss features with novel CPAP adherence tracking (ie, percentage of CPAP wear time relative to objectively assessed time spent in bed) for patients with OSA.

METHODS

We used an iterative, user-centered process to design a new CPAP adherence tracking module that integrated with an existing weight loss app. A total of 37 patients with OSA aged 20 to 65 years were recruited. In phase 1, patients with OSA who were receiving CPAP treatment (n=7) tested the weight loss app to track nutrition, activity, and weight for 10 days. Participants completed a usability and acceptability survey. In phase 2, patients with OSA who were receiving CPAP treatment (n=21) completed a web-based survey about their interpretations and preferences for wireframes of the CPAP tracking module. In phase 3, patients with recently diagnosed OSA who were CPAP naive (n=9) were prescribed a CPAP device (ResMed AirSense10 AutoSet) and tested the integrated app for 3 to 4 weeks. Participants completed a usability survey and provided feedback.

RESULTS

During phase 1, participants found the app to be mostly easy to use, except for some difficulty searching for specific foods. All participants found the connected devices (Fitbit activity tracker and Fitbit Aria scale) easy to use and helpful. During phase 2, participants correctly interpreted CPAP adherence success, expressed as percentage of wear time relative to time spent in bed, and preferred seeing a clearly stated percentage goal ("Goal: 100%"). In phase 3, participants found the integrated app easy to use and requested push notification reminders to wear CPAP before bedtime and to sync Fitbit in the morning.

CONCLUSIONS

We developed a mobile health tool that integrated a new CPAP adherence tracking module into an existing weight loss app. Novel features included addressing OSA-obesity comorbidity, CPAP adherence tracking via percentage of CPAP wear time relative to objectively assessed time spent in bed, and push notifications to foster adherence. Future research on the effectiveness of this tool in improving OSA treatment adherence is warranted.

Evaluating and rating HIV/AIDS mobile apps using the feature-based application rating method and mobile app rating scale

Background

The purpose of this study was to evaluate HIV/AIDS mobile applications using the Mobile App Rating Scale (MARS) and rate the features of these applications using the new tool called the Feature-based Application Rating Method (FARM).

Methods

In this study, all available HIV/AIDS apps in Iran from Cafe Bazaar and Google Play Store due to inclusion criteria were studied. The evaluation of the quality of applications was done using the MARS tool and the FARM tool. The FARM, which was developed in this study, was applied to rank the features of the applications.

Results

In this study, 79 applications were included. The mean score of all apps using both tools was 3.58 (SD = 0.95) out of 5. The overall mean quality score based on the MARS was 3.14 (SD = 0.84), and the mean score of features based on FARM was 3.81 (SD = 1.23). This study showed a higher than moderate correlation between the scores assigned to apps based on the MARS and FARM tools (r > 0.4).

Conclusions

The HIV/AIDS mobile applications available in Iran had the "acceptable" ranking. Also, our study results showed that to evaluate mobile apps, using a single tool may not provide good insight to evaluators about the assessed apps. However, using more than one tool may provide more details about the evaluated apps. To improve the quality of mobile health apps and help users select the most desirable app, we suggested using tools like FARM for ranking apps based on the features of each app in the app stores.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-02029-8.

Integrating Natural Language Processing and Interpretive Thematic Analyses to Gain Human-Centered Design Insights on HIV Mobile Health: Proof-of-Concept Analysis

BACKGROUND

HIV mobile health (mHealth) interventions often incorporate interactive peer-to-peer features. The user-generated content (UGC) created by these features can offer valuable design insights by revealing what topics and life events are most salient for participants, which can serve as targets for subsequent interventions. However, unstructured, textual UGC can be difficult to analyze. Interpretive thematic analyses can preserve rich narratives and latent themes but are labor-intensive and therefore scale poorly. Natural language processing (NLP) methods scale more readily but often produce only coarse descriptive results. Recent calls to advance the field have emphasized the untapped potential of combined NLP and qualitative analyses toward advancing user attunement in next-generation mHealth.

OBJECTIVE

In this proof-of-concept analysis, we gain human-centered design insights by applying hybrid consecutive NLP-qualitative methods to UGC from an HIV mHealth forum.

METHODS

UGC was extracted from Thrive With Me, a web app intervention for men living with HIV that includes an unstructured peer-to-peer support forum. In Python, topics were modeled by latent Dirichlet allocation. Rule-based sentiment analysis scored interactions by emotional valence. Using a novel ranking standard, the experientially richest and most emotionally polarized segments of UGC were condensed and then analyzed thematically in Dedoose. Design insights were then distilled from these themes.

RESULTS

The refined topic model detected K=3 topics: A: disease coping; B: social adversities; C: salutations and check-ins. Strong intratopic themes included HIV medication adherence, survivorship, and relationship challenges. Negative UGC often involved strong negative reactions to external media events. Positive UGC often focused on gratitude for survival, well-being, and fellow users' support.

CONCLUSIONS

With routinization, hybrid NLP-qualitative methods may be viable to rapidly characterize UGC in mHealth environments. Design principles point toward opportunities to align mHealth intervention features with the organically occurring uses captured in these analyses, for example, by foregrounding inspiring personal narratives and expressions of gratitude, or de-emphasizing anger-inducing media.

Smartphone-Based mHealth and Internet of Things for Diabetes Control and Self-Management

In patients with chronic diseases condition, mobile health monitoring facility proves to play a significant role in providing significant assistance toward personal management. This research examined the use of smartphones by diabetes patients and their intentions to apply them for self-care and monitoring as well as management. This cross-sectional survey-based study was conducted in Jul-Aug 2021 with 200 diabetic patients (especially type 2) who were visiting specialized clinics and hospitals of Gujrat state, India. A validated questionnaire survey was designed to collect data, which included questions about demographics, information pertaining to other, use of cellphones, the Internet, and the intention to implement smartphones for diabetes monitoring, self-care, and self-management. A highest number of studied participants have mobile phone (97.5%) and smartphones (87%) and access the Internet on daily basis (83.5%). Younger participants were more inclined to use smartphone apps and have also shown more interest for continuous use in the future (p < 0.01). The majority of participants used apps for nutritional planning (85.5%), to monitor glucose control (76.5%), and for scheduling of diabetes appointments on the calendar (90.5%). Recommendations to use mobile app by doctors or healthcare profession were reported by 20.5% of the participants and attitude and future intention to use mobile apps were reported by the majority of participants. The majority of type 2 diabetes patients choose to use their cellphones and the internet or mobile phone reminder system for medication as well as to plan their diets, monitor their blood sugar levels, and communicate with their doctors. The findings of this research can be used to develop strategies and implement mHealth-based therapies to assist patients with type 2 diabetes to efficiently manage their health and might contribute to reducing patients' out-of-pocket expenditure as well as reducing disability-adjusted life years (DAILY) attributed by DM.

Toward understanding the impact of mHealth features for people with HIV: a latent class analysis of PositiveLinks usage

PositiveLinks (PL) is a multi-feature smartphone-based platform to improve engagement-in-care and viral suppression (VS) among clinic patients living with HIV. Features include medication reminders, mood/stress check-ins, a community board, and secure provider messaging. Our goal was to examine how PL users interact with the app and determine whether usage patterns correlate with clinical outcomes. Patients (N = 83) at a university-based Ryan White clinic enrolled in PL from June 2016 to March 2017 and were followed for up to 12 months. A subset (N = 49) completed interviews after 3 weeks of enrollment to explore their experiences with and opinions of PL. We differentiated PL members based on 6-month usage of app features using latent class analysis. We explored characteristics associated with class membership, compared reported needs and preferences by class, and examined association between class and VS. The sample of 83 PL members fell into four classes. "Maximizers" used all app features frequently (27%); "Check-in Users" tended to interact only with daily queries (22%); "Moderate All-Feature Users" used all features occasionally (33%); and "As-Needed Communicators" interacted with the app minimally (19%). VS improved or remained high among all classes after 6 months. VS remained high at 12 months among Maximizers (baseline and 12-month VS: 100%, 94%), Check-in Users (82%, 100%), and Moderate All-Feature Users (73%, 94%) but not among As-Needed Communicators (69%, 60%). This mixed-methods study identified four classes based on PL usage patterns that were distinct in characteristics and clinical outcomes. Identifying and characterizing mHealth user classes offers opportunities to tailor interventions appropriately based on patient needs and preferences as well as to provide targeted alternative support to achieve clinical goals.

The Development of a Personalized Symptom Management Mobile Health Application for Persons Living with HIV in China

Persons living with HIV (PLWH) continuously experience symptom burdens. Their symptom prevalence and severity are also quite different. Mobile health (mHealth) applications (apps) offer exceptional opportunities for using personalized interventions when and where PLWH are needed. This study aimed to demonstrate the development process of the symptom management (SM) app and the structure and content of it. Our research team systematically searched for evidence-based resources and summarized up-to-date evidence for symptom management and health education. Our multidisciplinary research team that included physicians, nurses, software engineers, and nursing professors, evaluated the structure and content of the drafted app. Both quantitative data and qualitative results were collected at a group discussion meeting. Quantitative data were scores of sufficient evidence, situational suitability, practicability, cost-effectiveness, and understandability (ranged from one to four) for 119 items of the app contents, including the health tracking module, the self-assessment module, coping strategies for 18 symptoms (80 items), medication management, complementary therapy, diet management, exercise, relaxation techniques, and the obtaining support module. The SM app was comprised of eight modules and provided several personalized symptom management functions, including assessing symptoms and receiving different symptom management strategies, tracking health indicators, and communicating with medical staff. The SM app was a promising and flexible tool for HIV symptom management. It provided PLWH with personalized symptom management strategies and facilitated the case management for medical staff. Future studies are needed to further test the app's usability among PLWH users and its effects on symptom management.

Evaluation of HIV/AIDS-related mobile health applications content using an evidence-based content rating tool

Background

Despite the increasing number of mobile health applications, the validity of their content is understudied. The objective of this study was to rate the content of HIV/AIDS-related mobile applications and to determine the extent to which evidence-based medicine is being incorporated into their content using a new tool called the Evidence-based content rating tool of mobile health applications (EBCRT-mHealth).

Methods

All available HIV/AIDS-related applications in Iran from Cafe Bazaar and Google Play Store were evaluated. This study was first conducted in 2018, then after almost two years in 2021 was done again. In this study, researchers developed the EBCRT-mHealth tool to rate the content of applications based on the evidence-based medicine pyramid. Its reliability was calculated (α = 0.78), and five specialists confirmed its validity. Two reviewers independently reviewed all HIV/AIDS applications directly downloaded and installed from the Google Play Store and Cafe Bazaar.

Results

Out of 980 retrieved applications, in 2018, 85, and in 2021, 78 applications were included in the study. Only in 17 (28%) out of the 60 in 2018, and 25 (51%) in 2021 Google Play store applications the source of content information was mentioned. All Cafe Bazaar mobile applications mentioned the source of information. The mean rating of all application content in 2018 was 2.38 (SD = 0.74), and in 2021 was 2.90 (SD = 1.35) out of 5. The mean rating of the content of Cafe Bazaar applications in 2018 was 2.10 (SD = 0.49), and in 2021 was 1.94 (SD = 0.29). The mean content rating of Google Play store applications in 2018 was 2.50 (SD = 0.80) and in 2021 was 3.86 (SD = 1.18).

Conclusion

After two years, the rating of the content of HIV/AIDS-related applications available in Iran that existed in Cafe Bazaar decreased from "poor" to "inappropriate". Also, the content score of the Google Play Store applications increased from "poor" to "good". It is critical to ensure the credibility of the sources used in developing their content and removing applications with inappropriate and unreliable content from the App Stores. Also, mobile health application developers should use the highest quality information in their applications.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-021-01498-7.

Designing the Optimal Digital Health Intervention for Patients' Use Before and After Elective Orthopedic Surgery: Qualitative Study

Background

Health behavior changes made by patients during the perioperative period can impact the outcomes and success of elective surgeries. However, there remains a limited understanding of how best to support patients during this time, particularly through the use of digital health interventions. Recognizing and understanding the potential unmet needs of elective orthopedic surgery patients is central to motivating healthier behavior change, improving recovery, and optimizing overall surgical success in the short and long term.

Objective

The aim of this study is to explore patient perspectives on technology features that would help support them to change their lifestyle behaviors during the pre- and postoperative periods, and that could potentially maintain long-term healthy lifestyles following recovery.

Methods

Semistructured interviews with pre- and postoperative elective orthopedic patients were conducted between May and June 2020 using telephone and video call–based software. Patient perspectives on the use of digital technologies to complement current surgical care and support with lifestyle behavior changes were discussed. Interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data, with QSR NVivo software (version 12) facilitating data management. Ethical approval was obtained from the National Health Service Health Research Authority.

Results

A total of 18 participants were interviewed. Four themes were developed from the data regarding the design and functionality of digital technologies to best support the perioperative journey. These center around an intervention’s ability to incorporate interactive, user-centered features; direct a descriptive and structured recovery; enable customizable, patient-controlled settings; and deliver both general and specific surgical advice in a timely manner. Interventions that are initiated preoperatively and continued postoperatively were perceived as beneficial. Interventions designed with personalized milestones were found to better guide patients through a structured recovery. Individualized tailoring of preparatory and recovery information was desired by patients with previously high levels of physical activity before surgery. The use of personalized progression-based exercises further encouraged physical recovery; game-like rewards and incentives were regarded as motivational for making and sustaining health behavior change. In-built video calling and messaging features offered connectivity with peers and clinicians for supported care delivery.

Conclusions

Specific intervention design and functionality features can provide better, structured support for elective orthopedic patients across the entire surgical journey and beyond. This study provides much-needed evidence relating to the optimal design and timing of digital interventions for elective orthopedic surgical patients. Findings from this study suggest a desire for personalized perioperative care, in turn, supporting patients to make health behavior changes to optimize surgical success. These findings should be used to influence future co-design projects to enable the design and implementation of patient-focused, tailored, and targeted digital health technologies within modern health care settings.

Adapting an m-Health Intervention for Spanish-Speaking Latinx People Living with HIV in the Nonurban Southern United States

Background: Latinx people in the United States are disproportionately diagnosed with HIV and are more likely to experience worse HIV-related health outcomes. Although m-health has demonstrated success in improving HIV care, a gap remains in the development of m-health platforms tailored to Latinx populations. Methods: We conducted formative study to guide the adaptation of an evidence-based m-health intervention, PositiveLinks (PL), for Spanish-speaking Latinx people living with HIV (PLWH). Spanish-speaking Latinx PLWH in the nonurban Southern United States completed semistructured interviews and viewed a demo version of the m-health intervention. Qualitative analysis was performed using a grounded theory approach. Emerging themes were identified in four topic areas: (1) prior experiences with technology, (2) desired m-health features, (3) experiences with prototype app, and (4) iteration of prototype. Results: All PLWH who participated (n = 22) were born outside the continental United States. Participants included 10 men, 10 women, and 2 transgender participants. Mean age was 41.1 years (standard deviation 11.6 years). Participants expressed concerns about privacy, a need for reliable information, and interest in practical m-health features such as appointment and medication reminders. After trialing the Spanish-language PL prototype, participants reported that peer support and positive reinforcement were strong motivators to use the app. The ability to individualize the app to meet one's own needs was also considered important. Conclusion: This formative study provides baseline attitudes about m-health among Latinx PLWH as well as desired m-health features. m-Health interventions are acceptable to Spanish-speaking PLWH and involving the target population in a user-centered formative process led to improvements in app accessibility and usability.

The use of mobile phone functionalities by patients with asthma and their desire to use for self-care purposes

Background

Mobile health (mHealth) has good potential for promoting self-care in patients suffering from chronic diseases. The patients' positive attitude toward this technology is a key factor for the successful implementation. The present study was conducted to investigate the asthma patients' use of mobile phone functionalities and their desire to receive self-care services through this technology.

Methods

This survey study was conducted in Iran in 2018. The study population consisted of 146 patients suffering from asthma. The data collection tool was a questionnaire containing items on the demographic characteristics of patients, current use of mobile phone functionalities, and desire to use them for receiving self-care services. Data were analyzed using descriptive and analytical statistics.

Results

Out of the 160 questionnaires distributed, 146 (91.25%) were completed. The majority of the participants had smartphones (84.9%). Less than half of the participants occasionally used mobile phone functionalities including mobile phone calls (42.5%) and mobile Internet (40.4%) to receive asthma-related information. A significant number of the participants had never used smartphone applications (72.6%) and E-mail (66.4%) to receive asthma-related information. The participants had their greatest use of Internet search, followed by social media, to receive information about asthma symptoms, allergenic and irritating substances, medicinal therapy, and how to use therapy aids. The participants were most willing to use social media for receiving asthma information, communicating with other patients, receiving reminders about doctor's appointment, and receiving warnings about the lack of asthma control.

Conclusion

In Iran as a developing country, asthma patients use Internet search mostly to receive instructional information and are willing to use social media rather than other mobile phone functionalities to receive self-care services. These patients believe that mobile phones are appropriate for receiving instructional information and reminders.

Theme Trends and Knowledge Structure on Mobile Health Apps: Bibliometric Analysis

Background

Due to the widespread and unprecedented popularity of mobile phones, the use of digital medicine and mobile health apps has seen significant growth. Mobile health apps have tremendous potential for monitoring and treating diseases, improving patient care, and promoting health.

Objective

This paper aims to explore research trends, coauthorship networks, and the research hot spots of mobile health app research.

Methods

Publications related to mobile health apps were retrieved and extracted from the Web of Science database with no language restrictions. Bibliographic Item Co-Occurrence Matrix Builder was employed to extract bibliographic information (publication year and journal source) and perform a descriptive analysis. We then used the VOSviewer (Leiden University) tool to construct and visualize the co-occurrence networks of researchers, research institutions, countries/regions, citations, and keywords.

Results

We retrieved 2802 research papers on mobile health apps published from 2000 to 2019. The number of annual publications increased over the past 19 years. JMIR mHealth and uHealth (323/2802, 11.53%), Journal of Medical Internet Research (106/2802, 3.78%), and JMIR Research Protocols (82/2802, 2.93%) were the most common journals for these publications. The United States (1186/2802, 42.33%), England (235/2802, 8.39%), Australia (215/2802, 7.67%), and Canada (112/2802, 4.00%) were the most productive countries of origin. The University of California San Francisco, the University of Washington, and the University of Toronto were the most productive institutions. As for the authors’ contributions, Schnall R, Kuhn E, Lopez-Coronado M, and Kim J were the most active researchers. The co-occurrence cluster analysis of the top 100 keywords forms 5 clusters: (1) the technology and system development of mobile health apps; (2) mobile health apps for mental health; (3) mobile health apps in telemedicine, chronic disease, and medication adherence management; (4) mobile health apps in health behavior and health promotion; and (5) mobile health apps in disease prevention via the internet.

Conclusions

We summarize the recent advances in mobile health app research and shed light on their research frontier, trends, and hot topics through bibliometric analysis and network visualization. These findings may provide valuable guidance on future research directions and perspectives in this rapidly developing field.

Usability of Mobile Health Apps for Postoperative Care: Systematic Review

BACKGROUND

Mobile health (mHealth) apps are increasingly used postoperatively to monitor, educate, and rehabilitate. The usability of mHealth apps is critical to their implementation.

OBJECTIVE

This systematic review evaluates the (1) methodology of usability analyses, (2) domains of usability being assessed, and (3) results of usability analyses.

METHODS

The A Measurement Tool to Assess Systematic Reviews checklist was consulted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was adhered to. Screening was undertaken by 2 independent reviewers. All included studies were assessed for risk of bias. Domains of usability were compared with the gold-standard mHealth App Usability Questionnaire (MAUQ).

RESULTS

A total of 33 of 720 identified studies were included for data extraction. Of the 5 included randomized controlled trials (RCTs), usability was never the primary end point. Methodology of usability analyses included interview (10/33), self-created questionnaire (18/33), and validated questionnaire (9/33). Of the 3 domains of usability proposed in the MAUQ, satisfaction was assessed in 28 of the 33 studies, system information arrangement was assessed in 11 of the 33 studies, and usefulness was assessed in 18 of the 33 studies. Usability of mHealth apps was above industry average, with median System Usability Scale scores ranging from 76 to 95 out of 100.

CONCLUSIONS

Current analyses of mHealth app usability are substandard. RCTs are rare, and validated questionnaires are infrequently consulted. Of the 3 domains of usability, only satisfaction is regularly assessed. There is significant bias throughout the literature, particularly with regards to conflicts of interest. Future studies should adhere to the MAUQ to assess usability and improve the utility of mHealth apps.

A Specific Mobile Health Application for Older HIV-Infected Patients: Usability and Patient's Satisfaction

Background: HIV infection is an increasingly complex chronic disease associated with numerous medical, psychological, and social problems. The life expectancy of affected patients has increased considerably. Medical apps could also play a role in prevention and management of comorbid conditions in the HIV-infected population. Objectives: To determine the usefulness of an app designed specifically for HIV-infected patients aged 60 years or older and to assess changes in patient satisfaction, adherence to treatment, and quality of health care. Methods: A randomized clinical trial was conducted, including 100 patients (50 per group): (1) an experimental group comprising patients using the app + routine medical care (app group) and (2) with routine medical care (control group). The usability of the app and patient satisfaction were evaluated in the app group at week 48. Quality of life, adherence to treatment, and clinical parameters were compared between both groups at 48 weeks, as well as the number of face-to-face visits. Results: We found that 52.2% and 73.8% of patients in the app group used the app at weeks 24 and 48, respectively. Patients used the app for a mean of 23.7 (±2.84) days over the 48 weeks. The most visited screens were health counseling and medical records (24.8% and 22.2%, respectively). At week 48, 85.2% of patients thought that the app was useful and 91.4% would recommend the app to friends or relatives. The app was well valued by participants (4.79 [±0.21] of 5.00) and 64.6% thought that the app improved their health care.

A Systematic Review of Behavioral Intervention Technologies for Youth With Chronic Health Conditions and Physical and Intellectual Disabilities: Implications for Adolescents and Young Adults With Spina Bifida

OBJECTIVE

Behavioral intervention technologies (BITs) stand as a promising delivery mechanism that overcomes multiple condition-specific and access barriers for self-management interventions for adolescents and young adults with spina bifida (AYA-SB). The purpose of the current review was to synthesize the behavioral and self-management intervention literature in conditions that have overlapping symptoms with youth with SB and to develop a model of likely user needs for AYA-SB that promotes self-management.

METHOD

The search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) databases. The review was based on a systematic narrative synthesis framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092342).

RESULTS

In total, 18 articles were included in the current BIT review. The majority of included studies (1) targeted the management of chronic health conditions, (2) were informed by evidence-based approaches, (3) relied on content delivery, (4) were Web-based, (5) used linear or user-driven workflows, (6) included professional human support, and (7) included a control condition.

CONCLUSIONS

Many of the evaluated BITs resulted in acceptable usage and maintained or improved targeted symptoms. A user needs model for AYA-SB is proposed with the intention that future research will promote further refinement and ultimate deployment of a BIT for AYA-SB to promote self-management.

Converting and expanding mobile support tools for tuberculosis treatment support: Design recommendations from domain and design experts

Background

Tuberculosis (TB) remains one of the top ten causes of death globally despite it being largely treatable. Poor adherence to treatment directly contributes to poor outcomes, such as, prolonged infectivity and the development of drug resistance. Mobile phone-based interventions have the potential to improve treatment outcomes.

Objective

The purpose of this study was to solicit design and domain expert feedback of a previously developed TB support intervention converted to a mobile application.

Methods

We used prototyping in iterative cycles that included integrating findings from prior formative research with endusers and soliciting feedback from design and content experts. In this project, we used low-fidelity prototype evaluation to inform the design of high-fidelity prototypes for further testing and iterative refinement.

Results

We received 12 survey results. Overall, the participants agreed that the functions would be easy to learn/use. Recommendations for improvement included: simplify the reporting by offering broad categories; split complex screens to be more intuitive and user friendly; modify feedback graphics to display data more clearly; incorporate instructions for each task/function to guide users and collapse the information once users had viewed it; display navigation icons on each screen and add a main menu button; have medication tracker be homepage and limit redundancies. Several potential functionalities were suggested, such as adding a notes/journal and a social feature. We were able to easily incorporate recommendations and feedback into the high-fidelity prototypes and continue testing and refinement. After we came to a stable prototype through testing, we gave the interactive prototype to our developers to program a base functioning model.

Conclusion

The proposed design recommendations provide valuable insight to inform initial conversion of an interactive intervention to customize patient support, which include a smartphone app and a direct drug metabolite test reengineered for home use. We argue that iteratively developing low- and high-fidelity prototypes with content and design experts to guide initial programming of a functional beta app paves the way to better explore further refinement needs and recommendations with endusers rather than using hypothetical scenarios.

Mobile phone usage in patients with type II diabetes and their intention to use it for self-management: a cross-sectional study in Iran

BACKGROUND

Mobile health has potential for promotion of self-management in patients with chronic diseases. This study was conducted to investigate smartphone usage in patients with type II diabetes and their intention to use it for self-management.

METHODS

This cross-sectional study was conducted in 2018 with 176 patients with type II diabetes visiting a specialized diabetes clinic or one of two endocrinology and metabolism specialists in north of Iran. Data were collected using a validated questionnaire containing items on demographic characteristics, disease information, use of mobile phones, smartphones and the internet, and intention to use mobile phones for diabetes self-management.

RESULTS

The majority of the participants had mobile phones (94.9%), smartphones (61.1%), and daily access to the internet (81.3%), and used phones two hours per day on average (80.1%). They mostly used mobile phones to contact friends (89.2%) and search for information (50.6%), and their greatest intention for using smartphones and the internet for self-management was related to dietary planning (96%), checking blood glucose (90.9%), and contacting specialists (87.5%). Younger participants were more interested in using smartphone applications (apps) (P < 0.001). About half of the participants argued that using apps can be interesting (54%) and useful (50%) for diabetes management, and intended to use apps much more in future (48.3%).

CONCLUSIONS

The majority of patients with type II diabetes are inclined to use mobile phone and the Internet, especially to plan their diet, check blood glucose, and contact their doctors. The present study provides valuable information for designing and implementing interventions based on mHealth to promote self-management in type II diabetes.

Converting and expanding a mobile support intervention: Focus group and field-testing findings from individuals in active tuberculosis treatment

BACKGROUND

Non-adherence to tuberculosis (TB) treatment jeopardizes the individual's health and contributes to disease transmission and drug resistance. New patient-centered strategies are needed to improve TB treatment outcomes.

PURPOSE

To convert and expand a texting-based intervention into a mobile optimized application (app), evaluate the feasibility of an added self-administered paper-based drug metabolite test, and identify needs and preferences to inform their iterative design.

METHODS

Qualitative methods using focus groups and field testing with patients in active TB treatment were used to gather initial input on the converted intervention design, content and issues using at home test strips to report medication adherence. Seven participants were recruited from an outpatient clinic within a regional public reference hospital specialized in respiratory diseases in Argentina. Thematic analyses were conducted on the transcripts and session notes.

RESULTS

Participants considered interactive communication, access to answers to frequently asked questions, and tracking of progress in treatment as important. Participants reported having many questions and uncertainties at initiation of treatment and emphasized a need for reliable information, assurance and support from both providers and peers. Other suggestions included streamlining the graphical user interface for easier and shorter data entry times and usability.

CONCLUSIONS

Overall feedback from the participants regarding the intervention was positive, reporting that it was useful and relevant, and they were eager to contribute their ideas for improvement and additional functionality. Valuable feedback to improve functionality and meet the needs of end-users were obtained to inform the generation of new design ideas for refinement and testing in a pilot study.

A Review on the Mobile Applications Developed for COVID-19: An Exploratory Analysis

The objective of this research is to explore the existing mobile applications developed for the COVID-19 pandemic. To obtain this research objective, firstly the related applications were selected through the systematic search technique in the popular application stores. Secondly, data related to the app objectives, functionalities provided by the app, user ratings, and user reviews were extracted. Thirdly, the extracted data were analyzed through the affinity diagram, noticing-collecting-thinking, and descriptive analysis. As outcomes, the review provides a state-of-the-art view of mobile apps developed for COVID-19 by revealing nine functionalities or features. It revealed ten factors related to information systems design characteristics that can guide future app design. The review outcome highlights the need for new development and further refinement of the existing applications considering not only the revealed objectives and their associated functionalities, but also revealed design characteristics such as reliability, performance, usefulness, supportive, security, privacy, flexibility, responsiveness, ease of use, and cultural sensitivity.

Use of the FITT framework to understand patients' experiences using a real-time medication monitoring pill bottle linked to a mobile-based HIV self-management app: A qualitative study

OBJECTIVE

The purpose of this work was to conduct an in-depth analysis to understand patients' experiences using a real-time medication monitoring pill bottle linked to an HIV self-management app.

METHODS

A descriptive qualitative study design was used. In-depth interviews were conducted using a semi-structured interview guide at the 3-month follow-up visit during a trial of the app for improving medication adherence which began in January 2018. Eligibility criteria were HIV-positive, over the age of 18, ownership of a smartphone, able to speak and understand English and self-report less than 80% adherence to medications in the past 30 days or a viral load of over 20 copies/mL (detectable). All interviews were audio-recorded and transcribed. Using thematic analysis, we explored emerging themes with similar patterns across interviews and organized the themes according to the constructs of the Fit between Individuals, Task and Technology (FITT) framework.

RESULTS

Thirty-eight persons living with HIV (PLWH), who were randomized to the intervention arm of the study trial, participated in the interviews. 79.0% of participants reported their race as African American/Black, 63.2% had completed some high school or less, and 79.0% reported an annual median income of less than $20,000. Data was collected until saturation was reached. A total of nine major themes organized by the FITT framework were identified. Three themes related to the fit between individuals and task were: motivation for strict medication adherence, self-efficacy for overall health management, and engagement with medication reminders. Four themes related to the fit between individual and technology were: ease of use, HIV-related stigma and disclosure of HIV status, customized alert of medication time windows based on individual routine set-up, and preference for device design. Two themes related to the fit between task and technology were: system functionality of data transfer from the electronic pill bottle to the app and self-awareness of system syncing signals.

CONCLUSIONS

This study demonstrated that tracking medication adherence and receiving push-notification medication reminders through the electronic pill bottle connected to the app encourages and supports PLWH in adhering to their medication regimens. Findings from this work highlight the importance of adequate consideration of the needs of intended users in designing customizable mobile health technology, including HIV-related stigma, disclosure of HIV status and antiretroviral therapy regimens.

Attitudes, Beliefs, and Willingness Toward the Use of mHealth Tools for Medication Adherence in the Florida mHealth Adherence Project for People Living With HIV (FL-mAPP): Pilot Questionnaire Study

BACKGROUND

Antiretroviral (ART) adherence among people living with HIV (PLWH) continues to be a challenge despite advances in HIV prevention and treatment. Mobile health (mHealth) interventions are increasingly deployed as tools for ART adherence. However, little is known about the uptake and attitudes toward commercially available, biprogrammatic mobile apps (ie, designed for both smartphone and short message service [SMS] messaging) among demographically diverse PLWH.

OBJECTIVES

The Florida mHealth Adherence Project for PLWH (FL-mAPP) is an innovative pilot study that aimed to determine the acceptability of a commercially available, biprogrammatic mHealth intervention platform to ensure medication adherence and gauge the current attitudes of PLWH toward current and future mHealth apps.

METHODS

A predeveloped, commercially available, biprogrammatic mHealth platform (Care4Today Mobile Health Manager, Johnson & Johnson, New Brunswick, NJ) was deployed, with self-reported ART adherence recorded in the app and paper survey at both short term (30-day) or long-term (90-day) follow-ups. Consented participants completed baseline surveys on sociodemographics and attitudes, beliefs, and willingness toward the use of mHealth interventions for HIV care using a 5-point Likert scale. Chi-square tests and multivariate logistic regression analyses identified correlations with successful uptake of the mHealth platform.

RESULTS

Among 132 PLWH, 66% (n=87) initially agreed to use the mHealth platform, of which 54% (n=47) successfully connected to the platform. Of the 87 agreeing to use the mHealth platform, we found an approximate 2:1 ratio of persons agreeing to try the smartphone app (n=59) versus the SMS text messages (n=28). Factors correlating with mHealth uptake were above high school level education (adjusted odds ratio 2.65; P=.05), confidence that a clinical staff member would assist with mHealth app use (adjusted odds ratio 2.92, P=.048), belief that PLWH would use such an mHealth app (adjusted odds ratio 2.89; P=.02), and ownership of a smartphone in contrast to a "flip-phone" model (adjusted odds ratio 2.80; P=.05). Of the sample, 70.2% (n=92) reported daily interest in receiving medication adherence reminders via an app (80.4% users versus 64.7% nonusers), although not significantly different among the user groups (P=.06). In addition, 34.8% (n=16) of mHealth users reported a theoretical "daily" interest and 68.2% (n=58) of non-mHealth users reported no interest in using an mHealth app for potentially tracking alcohol or drug intake (P=.002).

CONCLUSIONS

This commercially available, biprogrammatic mHealth platform showed feasibility and efficacy for enhanced ART and medication adherence within public health clinics and successfully included older age groups. Successful use of the platform among demographically diverse PLWH is important for HIV implementation science and promising for uptake on a larger scale.

Development of PositiveLinks: A Mobile Phone App to Promote Linkage and Retention in Care for People With HIV

Background

Linkage to and retention in HIV care are challenging, especially in the Southeastern United States. The rise in mobile phone app use and the potential for an app to deliver just in time messaging provides a new opportunity to improve linkage and retention among people living with HIV (PLWH).

Objective

This study aimed to develop an app to engage, link, and retain people in care. We evaluated the acceptability, feasibility, and impact of the app among users.

Methods

App development was informed by principles of chronic disease self-management and formative interviews with PLWH. Once developed, the app was distributed among participants, and usability feedback was incorporated in subsequent iterations. We interviewed app users after 3 weeks to identify usability issues, need for training on the phone or app, and to assess acceptability. We tracked and analyzed usage of app features for the cohort over 2 years.

Results

A total of 77 participants used the app during the pilot study. The query response rate for the first 2 years was 47.7%. Query response declined at a rate of 0.67% per month. The community message board was the most popular feature, and 77.9% (60/77) of users posted on the board at least once during the 2 years.

Conclusions

The PositiveLinks app was feasible and acceptable among nonurban PLWH. High participation on the community message board suggests that social support from peers is important for people recently diagnosed with or returning to care for HIV.

The Effectiveness and Safety of Utilizing Mobile Phone-Based Programs for Rehabilitation After Lumbar Spinal Surgery: Multicenter, Prospective Randomized Controlled Trial

Background

Rehabilitation is crucial for postoperative patients with low back pain (LBP). However, the implementation of traditional clinic-based programs is limited in developing countries, such as China, because of the maldistribution of medical resources. Mobile phone–based programs may be a potential substitute for those who have no access to traditional rehabilitation.

Objective

The aim of this study was to examine the efficacy of mobile phone–based rehabilitation systems in patients who underwent lumbar spinal surgery.

Methods

Patients who accepted spinal surgeries were recruited and randomized into 2 groups of rehabilitation treatments: (1) a mobile phone–based eHealth (electronic health) program (EH) or (2) usual care treatment (UC). The primary outcomes were (1) function and pain status assessed by the Oswestry Disability Index (ODI) and (2) the visual analog scale (VAS). Secondary outcomes were (1) general mental health and (2) quality of life (Likert scales, EuroQol-5 Dimension health questionnaire, and 36-item Short-Form Health Survey). All the patients were assessed preoperatively and then at 3, 6, 12, and 24 months postoperatively.

Results

A total of 168 of the 863 eligible patients were included and randomized in this study. Our analysis showed that the improvement of primary outcomes in the EH group was superior to the UC group at 24 months postoperatively (ODI mean 7.02, SD 3.10, P<.05; VAS mean 7.59, SD 3.42, P<.05). No significant difference of primary outcomes was found at other time points.

A subgroup analysis showed that the improvements of the primary outcomes were more significant in those who completed 6 or more training sessions each week throughout the trial (the highest compliance group) compared with the UC group at 6 months (ODI mean 17.94, SD 5.24, P<.05; VAS mean 19.56, SD 5.27, P<.05), 12 months (ODI mean 13.39, SD 5.32, P<.05; VAS mean 14.35, SD 5.23, P<.05), and 24 months (ODI mean 18.80, SD 5.22, P<.05; VAS mean 21.56, SD 5.28, P<.05).

Conclusions

This research demonstrated that a mobile phone–based telerehabilitation system is effective in self-managed rehabilitation for postoperative patients with LBP. The effectiveness of eHealth was more evident in participants with higher compliance. Future research should focus on improving patients’ compliance.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-TRC-13003314; http://www.chictr.org.cn/showproj.aspx?proj=6245 (Archived by WebCite at http://www.webcitation.org/766RAIDNc)

A Multi-step Usability Evaluation of a Self-Management App to Support Medication Adherence in Persons Living with HIV

PURPOSE

Adherence to antiretroviral therapy is essential to HIV management and sustaining viral suppression. Despite simplified regimens, adherence remains difficult for certain persons living with HIV (PLWH). There is evidence to support the use of mHealth apps for effective self-management in PLWH; however, a medication adherence app with real-time monitoring for this population has not been developed and rigorously evaluated by PLWH. We developed a mHealth app (WiseApp) for HIV self-management to help PLWH self-manage their health. The purpose of this study was to evaluate the usability of the WiseApp.

METHODS

We conducted a three-step usability evaluation using 1) a traditional think-aloud protocol with end-users, 2) a heuristic evaluation with experts in informatics, and 3) a cognitive walkthrough with end-users. During the cognitive walkthrough, we tested two devices (fitness tracker and medication tracking bottle) that were linked to the WiseApp.

RESULTS

The think-aloud protocol informed iterative updates to the app, specifically to make it easier to see different sections of the app. The heuristic evaluation confirmed the necessity of these design changes. The cognitive walkthrough informed additional updates and confirmed that overall, the app and the linked devices were usable for the end-users.

CONCLUSION

The results of the cognitive walkthrough with both experts and end-users informed iterative refinements to the WiseApp and finalization of a mHealth app for PLWH to better self-manage their health.

Addressing Stigma Through a Virtual Community for People Living with HIV: A Mixed Methods Study of the PositiveLinks Mobile Health Intervention

Stigma has negative consequences for quality of life and HIV care outcomes. PositiveLinks is a mobile health intervention that includes a secure anonymous community message board (CMB). We investigated discussion of stigma and changes in stigma scores. Of 77 participants in our pilot, 63% were male, 49% Black, and 72% had incomes below the federal poverty level. Twenty-one percent of CMB posts (394/1834) contained stigma-related content including negative (experiencing stigma) and positive (overcoming stigma) posts addressing intrapersonal and interpersonal stigma. Higher baseline stigma was positively correlated with stress and negatively correlated with HIV care self-efficacy. 12-month data showed a trend toward more improved stigma scores for posters on the CMB versus non-posters (- 4.5 vs - 0.63) and for posters of stigma-related content versus other content (- 5.1 vs - 3.3). Preliminary evidence suggests that a supportive virtual community, accessed through a clinic-affiliated smartphone app, can help people living with HIV to address stigma.

Mobile Health Technology for Improving Symptom Management in Low Income Persons Living with HIV

Persons living with HIV (PLWH) are living longer but experiencing more adverse symptoms associated with the disease and its treatment. This study aimed to examine the impact of a mHealth application (app) comprised of evidence-based self-care strategies on the symptom experience of PLWH. We conducted a 12-week feasibility study with 80 PLWH who were randomized (1:1) to a mHealth app, mobile Video Information Provider (mVIP), with self-care strategies for improving 13 commonly experienced symptoms in PLWH or to a control app. Intervention group participants showed a significantly greater improvement than the control group in 5 symptoms: anxiety (p = 0.001), depression (p = 0.001), neuropathy (p = 0.002), fever/chills/sweat (p = 0.037), and weight loss/wasting (p = 0.020). Participants in the intervention group showed greater improvement in adherence to their antiretroviral medications (p = 0.017) as compared to those in the control group. In this 12-week trial, mVIP was associated with improved symptom burden and increased medication adherence in PLWH.

SUITABILITY OF CURRENT EVALUATION FRAMEWORKS FOR USE IN THE HEALTH TECHNOLOGY ASSESSMENT OF MOBILE MEDICAL APPLICATIONS: A SYSTEMATIC REVIEW

OBJECTIVES

To identify and appraise existing evaluation frameworks for mobile medical applications (MMA) and determine their suitability for use in health technology assessment (HTA) of these technologies.

METHODS

Systematic searches were conducted of seven bibliographic databases to identify literature published between 2008 and 2016 on MMA evaluation frameworks. Frameworks were eligible if they were used to evaluate at least one of the HTA domains of effectiveness, safety, and/or cost and cost-effectiveness of an MMA. After inclusion, the frameworks were reviewed to determine the number and extent to which other elements of an HTA were addressed by the framework.

RESULTS

A total of forty-five frameworks were identified that assessed MMAs. All frameworks assessed whether the app was effective. Of the thirty-four frameworks that examined safety, only seven overtly evaluated potential harms from the MMA (e.g., the impact of inaccurate information). Only one framework explicitly considered a comparator. Technology specific domains were sporadically addressed.

CONCLUSION

None of the evaluation frameworks could be used, unaltered, to guide the HTA of MMAs. To use these frameworks in HTA they would need to identify relevant comparators, improve assessments of harms and consider the ongoing effect of software updates on the safety and effectiveness of MMAs. Attention should also be paid to ethical issues, such as data privacy, and technology specific characteristics.

IMPLICATIONS

Existing MMA evaluation frameworks are not suitable for use in HTA. Further research is needed before an MMA evaluation framework can be developed that will adequately inform policy makers.

A Mobile Health Intervention for HIV Prevention Among Racially and Ethnically Diverse Young Men: Usability Evaluation

BACKGROUND

Mobile health (mHealth) apps have the potential to be a useful mode of delivering HIV prevention information, particularly for young men (13-24 years) who account for 21% of new HIV diagnoses in the United States. We translated an existing evidence-based, face-to-face HIV prevention curriculum into a portable platform and developed a mobile Web app: MyPEEPS Mobile.

OBJECTIVE

The purpose of this study was to assess the usability of MyPEEPS Mobile from both expert and end user perspectives.

METHODS

We conducted a heuristic evaluation with five experts in informatics to identify violations of usability principles and end user usability testing with 20 young men aged 15 to 18 years in New York, NY, Birmingham, AL, and Chicago, IL to identify potential obstacles to their use of the app.

RESULTS

Mean scores of the overall severity of the identified heuristic violations rated by experts ranged from 0.4 and 2.6 (0=no usability problem to 4=usability catastrophe). Overall, our end users successfully completed the tasks associated with use case scenarios and provided comments/recommendations on improving usability of MyPEEPS Mobile. The mean of the overall Post-Study System Usability Questionnaire scores rated by the end users was 1.63 (SD 0.65), reflecting strong user acceptance of the app.

CONCLUSIONS

The comments made by experts and end users will be used to refine MyPEEPS Mobile prior to a pilot study assessing the acceptability of the app across diverse sexual minority young men in their everyday lives.

mHealth Tools for the Self-Management of Patients With Multimorbidity in Primary Care Settings: Pilot Study to Explore User Experience

Background

Given the complex and evolving needs of individuals with multimorbidity, the adoption of mHealth tools to support self-management efforts is increasingly being explored, particularly in primary care settings. The electronic patient-reported outcomes (ePRO) tool was codeveloped with patients and providers in an interdisciplinary primary care team in Toronto, Canada, to help facilitate self-management in community-dwelling adults with multiple chronic conditions.

Objective

The objective of study is to explore the experience and expectations of patients with multimorbidity and their providers around the use of the ePRO tool in supporting self-management efforts.

Methods

We conducted a 4-week pilot study of the ePRO tool. Patients’ and providers’ experiences and expectations were explored through focus groups that were conducted at the end of the study. In addition, thematic analyses were used to assess the shared and contrasting perspectives of patients and providers on the role of the ePRO tool in facilitating self-management. Coded data were then mapped onto the Individual and Family Self-Management Theory using the framework method.

Results

In this pilot study, 12 patients and 6 providers participated. Both patients and providers emphasized the need for a more explicit recognition of self-management context, including greater customizability of content to better adapt to the complexity and fluidity of self-management in this particular patient population. Patients and providers highlighted gaps in the extent to which the tool enables self-management processes, including how limited progress toward self-management goals and the absence of direct provider engagement through the ePRO tool inhibited patients from meeting their self-management goals. Providers highlighted proximal outcomes based on their experience of the tool and specifically, they indicated that the tool offered valuable insights into the broader patient context, which helps to inform the self-management approach and activities they recommend to patients, whereas patients recognized the tool’s potential in helping to improve access to different providers in a team-based primary care setting.

Conclusions

This study identifies a more explicit recognition of the contextual factors that influence patients’ ability to self-manage and greater adaptability to accommodate patient complexity and provider workflow as next steps in refining the ePRO tool to better support self-management efforts in primary care ahead of its application in a full-scale randomized pragmatic trial.

A multi-level usability evaluation of mobile health applications: A case study

OBJECTIVE

To report a methodological approach for the development of a usable mHealth application (app).

MATERIALS AND METHODS

This work was guided by a 3-level stratified view of health information technology (IT) usability evaluation framework. We first describe a number of methodologies for operationalizing each level of the framework. Following the description of each methodology, we present a case study which illustrates the use of our preferred methodologies for the development of a mHealth app. At level 1 (user-task), we applied a card sorting technique to guide the information architecture of a mobile HIV symptom self-management app, entitled mVIP. At level 2 (user-task-system), we conducted a usability evaluation of mVIP in a laboratory setting through end-user usability testing and heuristic evaluation with informatics experts. At level 3 (user-task-system-environment), usability of mVIP was evaluated in a real-world setting following the use of the app during a 3-month trial.

RESULTS

The 3-level usability evaluation guided our work exploring in-depth interactions between the user, task, system, and environment. Integral to the findings from the 3-level usability evaluation, we iteratively refined the app's content, functionality, and interface to meet the needs of our intended end-users.

DISCUSSION AND CONCLUSION

The stratified view of the health IT usability evaluation framework is a useful methodological approach for the design, development, and evaluation of mHealth apps. The methodological recommendations for using the theoretical framework can inform future usability studies of mHealth apps.

PositiveLinks: A Mobile Health Intervention for Retention in HIV Care and Clinical Outcomes with 12-Month Follow-Up

Mobile health interventions may help People Living with HIV (PLWH) improve engagement in care. We designed and piloted PositiveLinks, a clinic-affiliated mobile intervention for PLWH, and assessed longitudinal impact on retention in care and viral suppression. The program was based at an academic Ryan White Clinic serving a nonurban population in Central Virginia. The PL intervention included a smartphone app that connected participants to clinic staff and provided educational resources, daily queries of stress, mood and medication adherence, weekly quizzes, appointment reminders, and a virtual support group. Outcomes were analyzed using McNemar's tests for HRSA-1, visit constancy, and viral suppression and nonparametric Wilcoxon signed-rank tests for CD4 counts and viral loads. Of 77 participants, 63% were male, 49% black non-Hispanic, and 72% below the federal poverty level. Participants' achievement of a retention in care benchmark (HRSA-1) increased from 51% at baseline to 88% at 6 months (p < 0.0001) and 81% at 12 months (p = 0.0003). Visit constancy improved from baseline to 6 months (p = 0.016) and 12 months (p = 0.0004). Participants' mean CD4 counts increased from baseline to 6 months (p = 0.0007) and 12 months (p = 0.0005). The percentage of participants with suppressed viral loads increased from 47% at baseline to 87% at 6 months (p < 0.0001) and 79% at 12 months (p = 0.0007). This study is one of the first to demonstrate that a mobile health intervention can have a positive impact on retention in care and clinical outcomes for vulnerable PLWH. Next steps include integration with clinical practice and dissemination.

A Gamified Smartphone App to Support Engagement in Care and Medication Adherence for HIV-Positive Young Men Who Have Sex With Men (AllyQuest): Development and Pilot Study

BACKGROUND

HIV disproportionately impacts young men who have sex with men (YMSM) who experience disparities across the HIV care continuum. Addressing antiretroviral therapy (ART) adherence among YMSM is an urgent public health priority. Technology-based interventions-particularly mobile health platforms-can provide tailored adherence interventions and allow YMSM to engage and connect with others.

OBJECTIVE

The objective of this study was to describe the development of AllyQuest, a novel, theoretically-based, smartphone app designed to improve engagement in care and ART adherence and social support among HIV-positive YMSM.

METHODS

AllyQuest was built on an established platform for patient engagement that embeds social networking and fundamental game mechanics, such as challenges, points, and rewards. A medication tracker provides reminders to promote ART adherence via personalized adherence strategies that are user and context specific; a calendar allows for reflection on adherence over time. After iterative development with input from two youth advisory boards, usability testing was conducted to assess app functionality, comprehension of the educational content, use of intervention features, and overall impressions of app relevance and appeal. A 28-day pilot trial was conducted with 20 HIV+ YMSM to evaluate intervention feasibility and acceptability.

RESULTS

Mean age of participants was 21.8 years (range 19-24), and 95% (19/20) of the participants were nonwhite. The mean time of app use was 158.4 min (SD 114.1), with a range of 13 to 441 min. There was a mean of 21.2 days of use (out of a total possible 28 days). There were 222 posts to the daily discussion social wall. Feasibility and acceptability ratings were high. Overall, participants found the app easy to use and navigate, not intrusive, and had few reported technical issues. Higher levels of app usage were positively correlated with HIV self-management outcomes, and there was a statistically significant (P<.05) positive association between the number of days logged into the app and knowledge and confidence in ability to reliably take HIV medications.

CONCLUSIONS

AllyQuest represents a new, highly scalable solution that is well-suited to meet the specific prevention and care needs of HIV+ YMSM. The development of this intervention is both timely and vital, given the urgency of the ongoing HIV epidemic among YMSM.

mHealth Interventions To Support Self-Management In HIV: A Systematic Review

Background:

Self-management is an important aspect of long-term HIV treatment. Mobile technologies offer the potential to efficiently deliver interventions to facilitate HIV self-management. The last comprehensive review of such mHealth interventions was conducted in 2011. Given the rapidly evolving field, a need was identified for an updated review of the literature.

Objective:

The study aimed to describe and evaluate current evidence-based mHealth interventions to support self-management in HIV.

Method:

Eight online databases (Medline, Scopus, Embase, PsycINFO, Cochrane, Global Health CAB, IEEE explore, Web of Science) were systematically searched for papers describing and evaluating mHealth HIV self-management interventions. Reference lists of relevant papers were also searched. Data on intervention content and evaluation methodology were extracted and appraised by two researchers.

Results:

41 papers were identified evaluating 28 interventions. The majority of these interventions (n=20, 71%) had a single focus of either improving adherence (n=16), increasing engagement in care (n=3) or supporting smoking cessation (n=1), while just 8 (29%) were more complex self-management interventions, targeting a range of health-related behaviours. Interventions were predominantly delivered through SMS messaging. They significantly impacted on a range of outcomes including adherence, viral load, mental health and social support.

Conclusion:

Since the last major review of mHealth interventions in HIV, there has been a shift from exploratory acceptability/feasibility studies to impact evaluations. While overall the interventions impacted on a range of outcomes, they were generally limited in scope, failing to encompass many functions identified as desirable by people living with HIV. Participant incentives may limit the generalizability of findings.

Patient Self-Management of Asthma Using Mobile Health Applications: A Systematic Review of the Functionalities and Effects

Objective The aim of this systematic review was to summarize the evidence regarding the effects of mobile health applications (mHealth apps) for self-management outcomes in patients with asthma and to assess the functionalities of effective interventions. Methods We systematically searched Medline, Scopus, and the Cochrane Central Register of Controlled Trials. We included English-language studies that evaluated the effects of smartphone or tablet computer apps on self-management outcomes in asthmatic patients. The characteristics of these studies, effects of interventions, and features of mHealth apps were extracted. Results A total of 10 studies met all the inclusion criteria. Outcomes that were assessed in the included studies were categorized into three groups (clinical, patient-reported, and economic). mHealth apps improved asthma control (five studies) and lung function (two studies) from the clinical outcomes. From the patient-reported outcomes, quality of life (three studies) was statistically significantly improved, while there was no significant impact on self-efficacy scores (two studies). Effects on economic outcomes were equivocal, so that the number of visits (in two studies) and admission and hospitalization-relevant outcomes (in one study) statistically significantly improved; and in four other studies, these outcomes did not improve significantly. mHealth apps features were categorized into seven categories (inform, instruct, record, display, guide, remind/alert, and communicate). Eight of the 10 mHealth apps included more than one functionality. Nearly all interventions had the functionality of recording user-entered data and half of them had the functionality of providing educational information and reminders to patients. Conclusion Multifunctional mHealth apps have good potential in the control of asthma and in improving the quality of life in such patients compared with traditional interventions. Further studies are needed to identify the effectiveness of these interventions on outcomes related to medication adherence and costs.

What might get in the way: Barriers to the use of apps for depression

Objective

Smartphones are being used with increasing frequency to deliver behavioral interventions for depression via apps. However, barriers specific to using an app for depression are poorly defined. The purpose of the current study is to identify barriers to the use of a mobile app to deliver treatment for depression. Secondarily, design implications will be provided based upon identified barriers.

Method

A card sorting task that ranked and grouped barriers to the use of apps for depression was completed. Participants first completed a card sorting task identifying barriers to face-to-face treatment, as a primer to identification of treatment barriers. The sample consisted of those above (n = 9) and below (n = 11) the threshold for a referral to psychotherapy, to capture anticipated barriers for likely end users. Cluster analyses were conducted to analyze the card sorting data. Multiple analyses were conducted to identify: 1) the most important barriers, and 2) how consistently barriers were ranked as important.

Result

The card sorting task identified a number of primary barriers to the use of apps for depression treatment, including concerns over intervention efficacy, app functioning, privacy, cost, and lack of guidance and tailored feedback. The top face-to-face treatment barrier was cost, overlapping with mobile barriers.

Conclusion

This study identified perceived barriers to the use of mobile treatment apps. Identification of barriers implicates design recommendations for apps for depression.