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Stutvoet MD, Levelt L, Hrehovcsik MM, Van't Veer J, Visch VT, Bramer WM, Hillegers MHJ, Veltkamp RC, Nijhof SL, Estévez-López F. Gamification in eHealth for Chronic Disease Self-Management in Youth: A Systematic Review. Games Health J 2024. [PMID: 38900649 DOI: 10.1089/g4h.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
This systematic review primarily aims to provide a summary of the game mechanics implemented in eHealth tools supporting young people's self-management of their chronic diseases. This review secondarily investigates the rationale for implementing game mechanics and the effects of these tools. A systematic search was conducted in Embase, Medline, PsycINFO, and Web of Science, from inception until August 30, 2022. Studies were eligible if focus was on the utilization of gamification in eHealth self-management interventions for young people (age = 10-25 years) with chronic diseases. Primary quantitative, qualitative, and mixed-method studies written in English were included. We identified 34 eHealth tools, of which 20 (59%) were gamified tools and 14 (41%) were serious games. We found that 55 unique game mechanics were implemented. The most commonly used were rewards (50%), score (44%), creative control (41%), and social interaction (32%). In comparison with gamified tools, the number and diversity of game mechanics applied were higher in serious games. For most tools (85%), a general rationale was provided for utilizing gamification, which often was to promote engaging experiences. A rationale for using specific game mechanics was less commonly provided (only for 45% of the game mechanics). The limited availability of experimental research precludes to test the effectiveness of using gamification in eHealth to support self-management in young people with chronic diseases. In this study, we highlight the importance of reporting the rationale for utilizing specific game mechanics in eHealth tools to ensure a proper alignment with evidence-based practice and the need of conducting experimental research. PROSPERO: CRD42021293037.
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Affiliation(s)
- Maartje D Stutvoet
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisa Levelt
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Job Van't Veer
- Department of Healthcare, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands
| | - Valentijn T Visch
- Department of Human Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Remco C Veltkamp
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sanne L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Fernando Estévez-López
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024); and CIBIS (Centro de Investigación para el Bienestar y la Inclusión Social) Research Center, University of Almería, Almería, Spain
- Biomedical Research Unit, Torrecárdenas University Hospital, Almería, Spain
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Gudjonsdottir B, Oskarsdottir SA, Kristjansdottir A, Gudmundsdottir JA, Kamban SW, Licina ZA, Gudmundsdottir DB. Impact of Musculoskeletal Pain on Functioning and Disability in Children with Juvenile Idiopathic Arthritis in Iceland. Phys Occup Ther Pediatr 2024; 44:554-571. [PMID: 38178574 DOI: 10.1080/01942638.2023.2299028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
AIMS 1) to map questions of pain from a survey to the International Classification of Functioning, Disability and Health (ICF) 2) to compare the impact of musculoskeletal pain on functioning based on the different components of the ICF in children with juvenile idiopathic arthritis (JIA) and age-matched peers. METHOD A cross-sectional case-control survey. A total of 28 children with JIA and 36 age-matched children participated. The survey included questions on the child's sex and age, about pain experienced, number of painful body areas, pain frequency and three short forms of Patient-Reported Outcome Measurement Information System (PROMIS) pain questionnaires. Sixteen children with JIA (57%) and 10 peers (28%) reported pain during past seven days. Their responses were used in the description of impact of pain. RESULTS After the mapping of the questions to ICF, a comparison between the two groups indicated that a higher number of children with JIA described effects of pain on mental function, mobility, general tasks and demands, than their peers. More children with JIA expressed to others that they had pain, non-verbally and verbally. CONCLUSION The findings provide important information about the impacts of pain on daily life in children with JIA and about their intervention needs.
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Affiliation(s)
- Bjorg Gudjonsdottir
- Department of Physical Therapy, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Audur Kristjansdottir
- Department of Physical Therapy, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Solrun W Kamban
- Landspitali - The National University Hospital of Iceland, Children's Medical Center, Reykjavik, Iceland
| | - Zinajda Alomerovic Licina
- Landspitali - The National University Hospital of Iceland, Children's Medical Center, Reykjavik, Iceland
| | - Drifa Bjork Gudmundsdottir
- Landspitali - The National University Hospital of Iceland, Children's Medical Center, Reykjavik, Iceland
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Knapp P, Martin-Kerry J, Moe-Byrne T, Sheridan R, Coleman E, Roche J, Young B, Higgins S, Preston J, Bower P, Gamble C, Stones C. The effectiveness and acceptability of multimedia information when recruiting children and young people to trials: the TRECA meta-analysis of SWATs. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-112. [PMID: 38140894 DOI: 10.3310/htpm3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Background The information provided to potential trial participants plays a crucial role in their decision-making. Printed participant information sheets for trials have received recurrent criticism as being too long and technical, unappealing and hard to navigate. An alternative is to provide information through multimedia (text, animations, video, audio, diagrams and photos). However, there is limited evidence on the effects of multimedia participant information on research recruitment rates, particularly in children and young people. Objectives The study objectives were as follows: 1. to develop template multimedia information resources through participatory design, for use when recruiting children and young people to trials 2. to evaluate the multimedia information resources in a series of Studies Within A Trial, to test their effects on recruitment and retention rates, and participant decision-making, by comparing the provision of multimedia information resources instead of printed participant information sheets, and comparing the provision of multimedia information resources in addition to printed participant information sheets. Design Two-phase study: 1. multimedia information resources development including qualitative study; user testing study; readability metrics; enhanced patient and public involvement 2. multimedia information resources' evaluation comprising Studies Within A Trial undertaken within host trials recruiting children and young people. Setting United Kingdom trials involving patients aged under 18. Participants Development phase: n = 120 (children and young people, parents, clinicians, trial personnel). Evaluation phase: n = 1906 (children and young people being asked to take part in trials). Interventions Multimedia information resources (comprising text, audio, 'talking heads' video, trial-specific and trial-generic animations). Printed participant information sheets. Main outcome measures Primary outcome: trial recruitment rate comparing multimedia information resource-only with printed participant information sheet-only provision. Secondary outcomes: trial recruitment rate comparing combined multimedia information resource and printed participant information sheet with printed participant information sheet-only provision; trial retention rate; quality of participant decision-making. Results for each trial were calculated and combined in a two-stage random-effects meta-analysis. Results Phase 1 generated two multimedia information resource templates: (1) for children aged 6-11 years; (2) for children aged 12-18 years and parents. In the Phase 2 Studies Within A Trial the multimedia information resources improved trial recruitment, when compared to printed information alone [odds ratio (OR) = 1.54; 95% confidence interval (CI) 1.05 to 2.28; p = 0.03; I2 = 0%]. When printed participant information sheet-only provision was compared to combined multimedia information resource and printed participant information sheet provision, there was no effect on trial recruitment (OR = 0.89; 95% CI 0.53 to 1.50; I2 = 0%). There were no differences between multimedia information resource and printed participant information sheet on trial retention or participant decision-making quality. In a study within a hypothetical trial setting, multimedia information resource-only provision produced higher ratings of 'information was easy to understand' (Z = 3.03; p = 0.003) and 'I had confidence in decision-making' (Z = 2.00; p = 0.044) than printed participant information sheet-only provision. Limitations It was not possible to include data from three Studies Within A Trial in the meta-analysis due to limited sample size, and questionnaire return rates were low, which reduced the strength of the findings. Conclusions Use of multimedia information increased the rate of recruitment to trials involving children and young people compared to standard patient information sheets. Future work There should be further evaluation of the effects of multimedia information on recruitment to trials involving children and young people. It would be valuable to assess any impacts of multimedia information resources on communication between trial recruiters, children and young people, and parents. Study registration This trial is registered as TRECA ISRCTN 73136092 and Northern Ireland Hub for Trials Methodology Research SWAT Repository (SWAT 97). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 14/21/21) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 24. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Peter Knapp
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Jacqueline Martin-Kerry
- Department of Health Sciences, University of York, York, UK
- School of Allied Health Professions, College of Life Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Jenny Roche
- York Trials Unit, University of York, York, UK
| | - Bridget Young
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Jennifer Preston
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Peter Bower
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Carrol Gamble
- Centre for Medical Statistics and Health Evaluation, University of Liverpool, Liverpool, UK
| | - Catherine Stones
- School of Design, Clothworkers' Central, University of Leeds, Leeds, UK
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France E, Uny I, Turley R, Thomson K, Noyes J, Jordan A, Forbat L, Caes L, Silveira Bianchim M. A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments. Cochrane Database Syst Rev 2023; 10:CD014873. [PMID: 37795766 PMCID: PMC10552070 DOI: 10.1002/14651858.cd014873.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them. OBJECTIVES 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services? SEARCH METHODS Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022. SELECTION CRITERIA To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families. DATA COLLECTION AND ANALYSIS We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain. MAIN RESULTS We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work. AUTHORS' CONCLUSIONS We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.
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Affiliation(s)
- Emma France
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Isabelle Uny
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Ruth Turley
- Development Directorate, Cochrane Central Executive, Cochrane, London, UK
| | - Katie Thomson
- Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Bath Centre for Pain Research, University of Bath, Bath, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Line Caes
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Mayara Silveira Bianchim
- NMAHP Research Unit, University of Stirling, Stirling, UK
- Centre for Population Health and Wellbeing Research, School of Medical and Health Sciences, Bangor University, Bangor, UK
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Grolier M, Arefyev A, Pereira B, Tavares Figueiredo I, Gerbaud L, Coudeyre E. Refining the design of a smartphone application for people with chronic low back pain using mixed quantitative and qualitative approaches. Disabil Rehabil Assist Technol 2023; 18:145-150. [PMID: 33151760 DOI: 10.1080/17483107.2020.1839575] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION A mobile application has the potential to involve people with chronic NSLBP in their rehabilitation. To refine the design of a smartphone application for people with chronic NSLBP using mixed quantitative and qualitative approaches. METHODS We used a user-centred design approach involving people with chronic NSLBP and healthcare professionals (HCPs). We used a three-step methodology: developing consensus on the features, content, and design of the app; developing a user interface; and usability testing of the app and assessing users' experience. Transcripts of interviews of users were analyzed by qualitative content analysis. RESULTS A total of 18 people (aged 45 [23-53] years old) with chronic NSLBP, and 7 HCPs (aged 29.5 [25-55] years old) involved in NSLBP management were interviewed. The overall experience of using the smartphone eLombactif app was initially assessed. Then, with close-ended questions we evaluated users' judgements on the content, its presentation and navigation. Finally, we asked for suggestions: "application content and functionality" and "content presentation" from participants regarding the use and development of the app analyzed by a qualitative methodology. CONCLUSIONS This study described how we refined the design of our application for people with chronic NSLBP using a qualitative and quantitative approaches. This methodology allows for deepening the knowledge of the needs and expectations of potential users by measuring their user experience.IMPLICATIONS FOR REHABILITATIONNon-specific low back pain (NSLBP) is a major global public health issue leading to considerable economic cost and is primarily responsible for pain and disability.Mobile application has the potential to involve people with chronic NSLBP in their rehabilitation.This study described how we refined the design of our application for people with chronic NSLBP using a qualitative and quantitative approaches.
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Affiliation(s)
- Maxime Grolier
- Service de Médecine Physique et de Réadaptation, C.H.U. Clermont-Ferrand, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Alexandre Arefyev
- Service de Médecine Physique et de Réadaptation, C.H.U. Clermont-Ferrand, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation à la Recherche Clinique et à l'Innovation, C.H.U. Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Laurent Gerbaud
- Service de santé publique, C.H.U. Clermont-Ferrand, équipe PEPRADE, Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, C.H.U. Clermont-Ferrand, Université Clermont-Auvergne, Clermont-Ferrand, France
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Beauvais C, Pham T, Montagu G, Gleizes S, Madrisotti F, Lafourcade A, Vidal C, Dervin G, Baudard P, Desouches S, Tubach F, Le Calvez J, de Quatrebarbes M, Lafarge D, Grange L, Alliot-Launois F, Jeantet H, Antignac M, Tropé S, Besset L, Sellam J. Development and real-life use assessment of a self-management smartphone application for patients with inflammatory arthritis. A user-centred step-by-step approach. PLoS One 2022; 17:e0272235. [PMID: 36107954 PMCID: PMC9477307 DOI: 10.1371/journal.pone.0272235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Mobile health applications (apps) are increasing in interest to enhance patient self-management. Few apps are actually used by patients and have been developed for patients with inflammatory arthritis (IA) treated with disease-modifying anti-rheumatic drugs which use entails risk of adverse effects such as infections. Objective To develop Hiboot, a self-management mobile app for patients with IA, by using a user-centred step-by-step approach and assess its real-life use. Methods The app development included first a qualitative study with semi-guided audiotaped interviews of 21 patients to identify the impact of IA on daily life and patient treatments practices and an online cross-sectional survey of 344 patients to assess their health apps use in general and potential user needs. A multidisciplinary team developed the first version of the app via five face-to-face meetings. After app launch, a second qualitative study of 21 patients and a users’ test of 13 patients and 3 rheumatologists led to the app’s current version. The number of app installations, current users and comments were collected from the Google Play store and the Apple store. Results The qualitative study revealed needs for counselling, patient–health professional partnership, and skills to cope with risk situations; 86.8% participants would be ready to use an app primarily on their rheumatologist’s recommendation. Six functionalities were implemented: a safety checklist before treatment administration, aids in daily life situations based on the French academic recommendations, treatment reminders, global well-being self-assessment, periodic counselling messages, and a diary. The Hiboot app was installed 20,500 times from September 2017 to October 2020, with 4300 regular current users. Scores were 4.4/5 stars at Android and iOS stores. Conclusion Hiboot is a free self-management app for patients with IA developed by a step-by-step process including patients and health professionals. Further evaluation of the Hiboot benefit is needed.
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Affiliation(s)
- Catherine Beauvais
- Service de Rhumatologie, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
- * E-mail:
| | - Thao Pham
- Service de Rhumatologie, Hôpital Sainte Marguerite, Aix Marseille Univ, Assistance Publique Hôpitaux de Paris (APHM), Marseille, France
| | - Guillaume Montagu
- Département de Recherche, Unknowns, Conseil en Stratégie et Innovation, Paris, France
| | - Sophie Gleizes
- Département de Recherche, Unknowns, Conseil en Stratégie et Innovation, Paris, France
- Laboratoire d’Anthropologie Sociale (LAS), Collège de France/EHESS/EPHE, Paris, France
| | - Francesco Madrisotti
- Département de Recherche, Unknowns, Conseil en Stratégie et Innovation, Paris, France
- Centre de National de la Recherche Scientifique (CNRS), Laboratoire CERMES3 (CNRS-EHESS-INSERM), Université de Paris, Paris, France
| | - Alexandre Lafourcade
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, Hôpital Pitié Salpêtrière, Sorbonne Université, APHP, Paris, France
| | | | - Guillaume Dervin
- Clinique Juge, Institut Médical Sport Santé Marseille, Marseille, France
| | - Pauline Baudard
- Service de Rhumatologie, Centre Hospitalo-Universitaire Caen, Caen, France
| | - Sandra Desouches
- Service de Rhumatologie, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Florence Tubach
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, Hôpital Pitié Salpêtrière, Sorbonne Université, APHP, Paris, France
| | | | | | | | - Laurent Grange
- AFLAR Association Française de Lutte Anti rhumatismale (AFLAR), Paris, France
| | | | - Henri Jeantet
- Unknowns, Conseil en Stratégie et Innovation, Paris, France
| | - Marie Antignac
- Service de Pharmacie, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
- Equipe d’Épidémiologie Intégrative, INSERM U 970, PARCC, Paris, France
| | - Sonia Tropé
- Association Nationale de Défense Contre l’Arthrite Rhumatoïde (ANDAR), Paris, France
| | - Ludovic Besset
- Unknowns, Conseil en Stratégie et Innovation, Paris, France
| | - Jérémie Sellam
- Service de Rhumatologie, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMRS_938, FHU PaCeMM, Paris, France
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McErlane F, Anderson C, Lawson-Tovey S, Lee B, Lee C, Lunt L, McDonagh JE, Smith AD, Smith N, Cleary G. Quality improvement in juvenile idiopathic arthritis: a mixed-methods implementation pilot of the CAPTURE-JIA dataset. Pediatr Rheumatol Online J 2022; 20:43. [PMID: 35717328 PMCID: PMC9206126 DOI: 10.1186/s12969-022-00697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A significant proportion of children and young people with juvenile idiopathic arthritis (JIA) do not achieve inactive disease during the first two years following diagnosis. Refinements to clinical care pathways have the potential to improve clinical outcomes but a lack of consistent and contemporaneous clinical data presently precludes standard setting and implementation of meaningful quality improvement programmes. This study was the first to pilot clinical data collection and analysis using the CAPTURE-JIA dataset, and to explore patient and clinician-reported feasibility and acceptability data. METHODS A multiphase mixed-methods approach enabled prospective collection of quantitative data to examine the feasibility and efficacy of dataset collection and of qualitative data informing the context and processes of implementation. An initial paper pilot informed the design of a bespoke electronic data collection system (the Agileware system), with a subsequent electronic pilot informing the final CAPTURE-JIA data collection tool. RESULTS Paper collection of patient data was feasible but time-consuming in the clinical setting. Phase 1 paper pilot data (121 patients) identified three themes: problematic data items (14/62 data items received >40% missing data), formatting of data collection forms and a clinician-highlighted need for digital data collection, informing Phase 2 electronic data collection tool development. Patients and families were universally supportive of the collection and analysis of anonymised patient data to inform clinical care. No apparent preference for paper / electronic data collection was reported by families. Phase 3 electronic pilot data (38 patients) appeared complete and the system reported to be easy to use. Analysis of the study dataset and a dummy longitudinal dataset confirmed that all eleven JIA national audit questions can be answered using the electronic system. CONCLUSIONS Multicentre CAPTURE-JIA data collection is feasible and acceptable, with a bespoke data collection system highlighted as the most satisfactory solution. The study is informing ongoing work towards a streamlined and flexible national paediatric data collection system to drive quality improvement in clinical care.
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Affiliation(s)
- Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. .,Institute of Population and Health Sciences, Medical School, Newcastle University, Newcastle upon Tyne, UK.
| | | | - Saskia Lawson-Tovey
- grid.5379.80000000121662407Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK ,grid.498924.a0000 0004 0430 9101National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Chris Lee
- Appligo Ltd, https://www.agileware.io/about
| | - Laura Lunt
- grid.498924.a0000 0004 0430 9101National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK ,grid.5379.80000000121662407Versus Arthritis Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Janet E. McDonagh
- grid.498924.a0000 0004 0430 9101National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK ,grid.5379.80000000121662407Versus Arthritis Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK ,grid.415910.80000 0001 0235 2382Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Andrew D. Smith
- grid.498924.a0000 0004 0430 9101National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK ,grid.5379.80000000121662407Versus Arthritis Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Nicola Smith
- grid.1006.70000 0001 0462 7212Musculoskeletal Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Gavin Cleary
- grid.413582.90000 0001 0503 2798Department of Rheumatology, Alder Hey Children’s Hospital, Liverpool, UK
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8
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Beukenhorst AL, Druce KL, De Cock D. Smartphones for musculoskeletal research - hype or hope? Lessons from a decennium of mHealth studies. BMC Musculoskelet Disord 2022; 23:487. [PMID: 35606783 PMCID: PMC9124742 DOI: 10.1186/s12891-022-05420-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smartphones provide opportunities for musculoskeletal research: they are integrated in participants' daily lives and can be used to collect patient-reported outcomes as well as sensor data from large groups of people. As the field of research with smartphones and smartwatches matures, it has transpired that some of the advantages of this modern technology are in fact double-edged swords. BODY: In this narrative review, we illustrate the advantages of using smartphones for data collection with 18 studies from various musculoskeletal domains. We critically appraised existing literature, debunking some myths around the advantages of smartphones: the myth that smartphone studies automatically enable high engagement, that they reach more representative samples, that they cost little, and that sensor data is objective. We provide a nuanced view of evidence in these areas and discuss strategies to increase engagement, to reach representative samples, to reduce costs and to avoid potential sources of subjectivity in analysing sensor data. CONCLUSION If smartphone studies are designed without awareness of the challenges inherent to smartphone use, they may fail or may provide biased results. Keeping participants of smartphone studies engaged longitudinally is a major challenge. Based on prior research, we provide 6 actions by researchers to increase engagement. Smartphone studies often have participants that are younger, have higher incomes and high digital literacy. We provide advice for reaching more representative participant groups, and for ensuring that study conclusions are not plagued by bias resulting from unrepresentative sampling. Costs associated with app development and testing, data storage and analysis, and tech support are substantial, even if studies use a 'bring your own device'-policy. Exchange of information on costs, collective app development and usage of open-source tools would help the musculoskeletal community reduce costs of smartphone studies. In general, transparency and wider adoption of best practices would help bringing smartphone studies to the next level. Then, the community can focus on specific challenges of smartphones in musculoskeletal contexts, such as symptom-related barriers to using smartphones for research, validating algorithms in patient populations with reduced functional ability, digitising validated questionnaires, and methods to reliably quantify pain, quality of life and fatigue.
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Affiliation(s)
- Anna L Beukenhorst
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. .,Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Katie L Druce
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Diederik De Cock
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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9
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Smits M, Kim CM, van Goor H, Ludden GDS. From Digital Health to Digital Well-being: Systematic Scoping Review. J Med Internet Res 2022; 24:e33787. [PMID: 35377328 PMCID: PMC9016508 DOI: 10.2196/33787] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/27/2022] [Accepted: 02/20/2022] [Indexed: 12/14/2022] Open
Abstract
Background Digital health refers to the proper use of technology for improving the health and well-being of people and enhancing the care of patients through the intelligent processing of clinical and genetic data. Despite increasing interest in well-being in both health care and technology, there is no clear understanding of what constitutes well-being, which leads to uncertainty in how to create well-being through digital health. In an effort to clarify this uncertainty, Brey developed a framework to define problems in technology for well-being using the following four categories: epistemological problem, scope problem, specification problem, and aggregation problem. Objective This systematic scoping review aims to gain insights into how to define and address well-being in digital health. Methods We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Papers were identified from 6 databases and included if they addressed the design or evaluation of digital health and reported the enhancement of patient well-being as their purpose. These papers were divided into design and evaluation papers. We studied how the 4 problems in technology for well-being are considered per paper. Results A total of 117 studies were eligible for analysis (n=46, 39.3% design papers and n=71, 60.7% evaluation papers). For the epistemological problem, the thematic analysis resulted in various definitions of well-being, which were grouped into the following seven values: healthy body, functional me, healthy mind, happy me, social me, self-managing me, and external conditions. Design papers mostly considered well-being as healthy body and self-managing me, whereas evaluation papers considered the values of healthy mind and happy me. Users were rarely involved in defining well-being. For the scope problem, patients with chronic care needs were commonly considered as the main users. Design papers also regularly involved other users, such as caregivers and relatives. These users were often not involved in evaluation papers. For the specification problem, most design and evaluation papers focused on the provision of care support through a digital platform. Design papers used numerous design methods, whereas evaluation papers mostly considered pre-post measurements and randomized controlled trials. For the aggregation problem, value conflicts were rarely described. Conclusions Current practice has found pragmatic ways of circumventing or dealing with the problems of digital health for well-being. Major differences exist between the design and evaluation of digital health, particularly regarding their conceptualization of well-being and the types of users studied. In addition, we found that current methodologies for designing and evaluating digital health can be improved. For optimal digital health for well-being, multidisciplinary collaborations that move beyond the common dichotomy of design and evaluation are needed.
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Affiliation(s)
- Merlijn Smits
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Chan Mi Kim
- Department of Design, Production, and Management, Faculty of Engineering Technology, University of Twente, Enschede, Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Geke D S Ludden
- Department of Design, Production, and Management, Faculty of Engineering Technology, University of Twente, Enschede, Netherlands
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10
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Keel S, Schmid A, Keller F, Schoeb V. Investigating the use of digital health tools in physiotherapy: facilitators and barriers. Physiother Theory Pract 2022:1-20. [PMID: 35293846 DOI: 10.1080/09593985.2022.2042439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Digital tools are becoming more and more common in healthcare. Their potential to improve treatment, monitoring, and coaching in physiotherapy has been recognized. Yet studies report that the adoption of digital health tools in ambulatory physiotherapy is rather low and that their potential is underexploited. OBJECTIVE This paper aims to investigate how digital health tools in general, and the mobile health tool physitrackTM (hereafter the app) more particularly, are used in outpatient physiotherapy clinics and also to identify what facilitates or hinders the app's use. METHODS The paper is part of a larger study and adopts an ethnographic approach. It is based on observational and interview data collected at two outpatient clinics. RESULTS We reveal how physiotherapists and patients use the app in physiotherapy and identify 16 interdependent factors, on the macro-, meso-, and micro-level, that either facilitate or hinder its use. CONCLUSIONS We argue that a single factor's facilitating or hindering impact cannot be grasped in isolation but needs to be investigated as one piece of a dynamic interplay. Further qualitative research is required, especially to shed more light on the app's compatibility with physiotherapy practice and use in therapist-patient interactions.
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Affiliation(s)
- Sara Keel
- School of Health Sciences, (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne Switzerland
| | - Anja Schmid
- School of Health Sciences, (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne Switzerland
| | - Fabienne Keller
- School of Health Sciences, (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne Switzerland
| | - Veronika Schoeb
- School of Health Sciences, (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne Switzerland
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11
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Zhang P, Fonnesbeck C, Schmidt DC, White J, Kleinberg S, Mulvaney SA. Using Momentary Assessment and Machine Learning to Identify Barriers to Self-management in Type 1 Diabetes: Observational Study. JMIR Mhealth Uhealth 2022; 10:e21959. [PMID: 35238791 PMCID: PMC8931646 DOI: 10.2196/21959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/16/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background For adolescents living with type 1 diabetes (T1D), completion of multiple daily self-management tasks, such as monitoring blood glucose and administering insulin, can be challenging because of psychosocial and contextual barriers. These barriers are hard to assess accurately and specifically by using traditional retrospective recall. Ecological momentary assessment (EMA) uses mobile technologies to assess the contexts, subjective experiences, and psychosocial processes that surround self-management decision-making in daily life. However, the rich data generated via EMA have not been frequently examined in T1D or integrated with machine learning analytic approaches. Objective The goal of this study is to develop a machine learning algorithm to predict the risk of missed self-management in young adults with T1D. To achieve this goal, we train and compare a number of machine learning models through a learned filtering architecture to explore the extent to which EMA data were associated with the completion of two self-management behaviors: mealtime self-monitoring of blood glucose (SMBG) and insulin administration. Methods We analyzed data from a randomized controlled pilot study using machine learning–based filtering architecture to investigate whether novel information related to contextual, psychosocial, and time-related factors (ie, time of day) relate to self-management. We combined EMA-collected contextual and insulin variables via the MyDay mobile app with Bluetooth blood glucose data to construct machine learning classifiers that predicted the 2 self-management behaviors of interest. Results With 1231 day-level SMBG frequency counts for 45 participants, demographic variables and time-related variables were able to predict whether daily SMBG was below the clinical threshold of 4 times a day. Using the 1869 data points derived from app-based EMA data of 31 participants, our learned filtering architecture method was able to infer nonadherence events with high accuracy and precision. Although the recall score is low, there is high confidence that the nonadherence events identified by the model are truly nonadherent. Conclusions Combining EMA data with machine learning methods showed promise in the relationship with risk for nonadherence. The next steps include collecting larger data sets that would more effectively power a classifier that can be deployed to infer individual behavior. Improvements in individual self-management insights, behavioral risk predictions, enhanced clinical decision-making, and just-in-time patient support in diabetes could result from this type of approach.
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Affiliation(s)
- Peng Zhang
- Department of Computer Science, School of Engineering, Vanderbilt University, Nashville, TN, United States
- Data Science Institute, Vanderbilt University, Nashville, TN, United States
| | | | - Douglas C Schmidt
- Department of Computer Science, School of Engineering, Vanderbilt University, Nashville, TN, United States
- Data Science Institute, Vanderbilt University, Nashville, TN, United States
| | - Jules White
- Department of Computer Science, School of Engineering, Vanderbilt University, Nashville, TN, United States
| | - Samantha Kleinberg
- Department of Computer Science, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Shelagh A Mulvaney
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
- School of Nursing, Vanderbilt University, Nashville, TN, United States
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12
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Butler S, Sculley D, Santos D, Fellas A, Gironès X, Singh-Grewal D, Coda A. Effectiveness of eHealth and mHealth Interventions Supporting Children and Young People Living With Juvenile Idiopathic Arthritis: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e30457. [PMID: 35107431 PMCID: PMC8851322 DOI: 10.2196/30457] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/10/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) management aims to promote remission through timely, individualized, well-coordinated interdisciplinary care using a range of pharmacological, physical, psychological, and educational interventions. However, achieving this goal is workforce-intensive. Harnessing the burgeoning eHealth and mobile health (mHealth) interventions could be a resource-efficient way of supplementing JIA management. OBJECTIVE This systematic review aims to identify the eHealth and mHealth interventions that have been proven to be effective in supporting health outcomes for children and young people (aged 1-18 years) living with JIA. METHODS We systematically searched 15 databases (2018-2021). Studies were eligible if they considered children and young people (aged 1-18 years) diagnosed with JIA, an eHealth or mHealth intervention, any comparator, and health outcomes related to the used interventions. Independently, 2 reviewers screened the studies for inclusion and appraised the study quality using the Downs and Black (modified) checklist. Study outcomes were summarized using a narrative, descriptive method and, where possible, combined for a meta-analysis using a random-effects model. RESULTS Of the 301 studies identified in the search strategy, 15 (5%) fair-to-good-quality studies met the inclusion criteria, which identified 10 interventions for JIA (age 4-18.6 years). Of these 10 interventions, 5 (50%) supported symptom monitoring by capturing real-time data using health applications, electronic diaries, or web-based portals to monitor pain or health-related quality of life (HRQoL). Within individual studies, a preference was demonstrated for real-time pain monitoring over recall pain assessments because of a peak-end effect, improved time efficiency (P=.002), and meeting children's and young people's HRQoL needs (P<.001) during pediatric rheumatology consultations. Furthermore, 20% (2/10) of interventions supported physical activity promotion using a web-based program or a wearable activity tracker. The web-based program exhibited a moderate effect, which increased endurance time, physical activity levels, and moderate to vigorous physical activity (standardized mean difference [SMD] 0.60, SD 0.02-1.18; I2=79%; P=.04). The final 30% (3/10) of interventions supported self-management development through web-based programs, or apps, facilitating a small effect, reducing pain intensity (SMD -0.14, 95% CI -0.43 to 0.15; I2=53%; P=.33), and increasing disease knowledge and self-efficacy (SMD 0.30, 95% CI 0.03-0.56; I2=74%; P=.03). These results were not statistically significant. No effect was seen regarding pain interference, HRQoL, anxiety, depression, pain coping, disease activity, functional ability, or treatment adherence. CONCLUSIONS Evidence that supports the inclusion of eHealth and mHealth interventions in JIA management is increasing. However, this evidence needs to be considered cautiously because of the small sample size, wide CIs, and moderate to high statistical heterogeneity. More rigorous research is needed on the longitudinal effects of real-time monitoring, web-based pediatric rheumatologist-children and young people interactions, the comparison among different self-management programs, and the use of wearable technologies as an objective measurement for monitoring physical activity before any recommendations that inform current practice can be given.
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Affiliation(s)
- Sonia Butler
- School of Bioscience and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, Australia
| | - Dean Sculley
- School of Bioscience and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, Australia
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Antoni Fellas
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Xavier Gironès
- University of Vic-Central University of Catalonia, Manresa, Spain
| | - Davinder Singh-Grewal
- Department of Rheumatology, Sydney Children's Hospitals Network, Randwick and Westmead, Sydney, Australia.,Department of Rheumatology, John Hunter Children's Hospital, Newcastle, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia.,Priority Research Centre Health Behaviour, Hunter Medical Research Institute, Newcastle, Australia
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13
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Arthurs N, Tully L, O’Malley G, Browne S. Usability and Engagement Testing of mHealth Apps in Paediatric Obesity: A Narrative Review of Current Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031453. [PMID: 35162470 PMCID: PMC8834793 DOI: 10.3390/ijerph19031453] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023]
Abstract
Mobile health (mHealth) platforms have become increasingly popular for delivering health interventions in recent years and particularly in light of the COVID-19 pandemic. Childhood obesity treatment is an area where mHealth interventions may be useful due to the multidisciplinary nature of interventions and the need for long-term care. Many mHealth apps targeting youth exist but the evidence base underpinning the methods for assessing technical usability, user engagement and user satisfaction of such apps with target end-users or among clinical populations is unclear, including for those aimed at paediatric overweight and obesity management. This review aims to examine the current literature and provide an overview of the scientific methods employed to test usability and engagement with mHealth apps in children and adolescents with obesity. A narrative literature review was undertaken following a systematic search. Four academic databases were searched. Inclusion criteria were studies describing the usability of mHealth interventions for childhood obesity treatment. Following the application of inclusion and exclusion criteria, fifty-nine articles were included for full-text review, and seven studies met the criteria for usability and engagement in a clinical paediatric population with obesity. Six apps were tested for usability and one for engagement in childhood obesity treatment. Sample sizes ranged from 6–1120 participants. The included studies reported several heterogenous measurement instruments, data collection approaches, and outcomes. Recommendations for future research include the standardization and validation of instruments to measure usability and engagement within mHealth studies in this population.
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Affiliation(s)
- Niamh Arthurs
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, D01 XD99 Dublin, Ireland;
- School Public Health, Physiotherapy & Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland;
- Correspondence:
| | - Louise Tully
- School of Physiotherapy, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland;
| | - Grace O’Malley
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, D01 XD99 Dublin, Ireland;
- School of Physiotherapy, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland;
| | - Sarah Browne
- School Public Health, Physiotherapy & Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland;
- School of Physiotherapy, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland;
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14
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Turnbull A, Sculley D, Santos D, Maarj M, Chapple L, Gironès X, Fellas A, Coda A. Emerging Tools to Capture Self-Reported Acute and Chronic Pain Outcome in Children and Adolescents: A Literature Review. Med Sci (Basel) 2022; 10:medsci10010006. [PMID: 35225940 PMCID: PMC8884018 DOI: 10.3390/medsci10010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022] Open
Abstract
The advancement of digital health provides strategic and cost-effective opportunities for the progression of health care in children and adolescents. It is important for clinicians to be aware of the potential of emerging pain outcome measures and employ evidence-based tools capable of reliably tracking acute and chronic pain over time. The main emerging pain outcome measures for children and adolescents were examined. Overall, seven main texts and their corresponding digital health technologies were included in this study. The main findings indicated that the use of emerging digital health is able to reduce recall bias and can improve the real time paediatric data capture of acute and chronic symptoms. This literature review highlights new developments in pain management in children and adolescents and emphasizes the need for further research to be conducted on the use of emerging technologies in pain management. This may include larger scale, multicentre studies to further assess validity and reliability of these tools across various demographics. The privacy and security of mHealth data must also be carefully evaluated when choosing health applications that can be introduced into daily clinical settings.
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Affiliation(s)
- Alexandra Turnbull
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
| | - Dean Sculley
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia;
| | - Derek Santos
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Mohammed Maarj
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
| | - Lachlan Chapple
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
| | - Xavier Gironès
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya, 08242 Manresa, Spain;
| | - Antoni Fellas
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
- Priority Research Centre Health Behaviour, Hunter Medical Research Institute, Newcastle 2305, Australia
- Correspondence:
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15
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Nimmanterdwong Z, Boonviriya S, Tangkijvanich P. Human-Centered Design of Mobile Health Apps for Older Adults: Systematic Review and Narrative Synthesis. JMIR Mhealth Uhealth 2022; 10:e29512. [PMID: 35029535 PMCID: PMC8800094 DOI: 10.2196/29512] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/24/2021] [Accepted: 11/23/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The world is aging. The number of older patients is on the rise, and along with it comes the burden of noncommunicable diseases, both clinical and economic. Attempts with mobile health (mHealth) have been made to remedy the situation with promising outcomes. Researchers have adopted human-centered design (HCD) in mHealth creation to ensure those promises become a reality. OBJECTIVE This systematic review aims to explore existing literature on relevant primary research and case studies to (1) illustrate how HCD can be used to create mHealth solutions for older adults and (2) summarize the overall process with recommendations specific to the older population. METHODS We conducted a systematic review to address the study objectives. IEEE Xplore, Medline via Ovid, PubMed, and Scopus were searched for HCD research of mHealth solutions for older adults. Two independent reviewers then included the papers if they (1) were written in English, (2) included participants equal to or older than 60 years old, (3) were primary research, and (4) reported about mHealth apps and their HCD developments from start to finish. The 2 reviewers continued to assess the included studies' qualities using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was then carried out and completed. RESULTS Eight studies passed the eligibility criteria: 5 were mixed methods studies and 3 were case studies. Some studies were about the same mHealth projects with a total of 5 mHealth apps. The included studies differed in HCD goals, target groups, and details of their HCD methodologies. The HCD process was explored through narrative synthesis in 4 steps according to the International Standardization Organization (ISO) standard 9241-210: (1) understand and specify the context of use, (2) specify the user requirements, (3) produce design solutions to meet these requirements, and (4) evaluate the designs against requirements. The overall process and recommendations unique to older adults are summarized logically with structural order and time order based on the Minto pyramid principle and ISO 9241-210. CONCLUSIONS Findings show that HCD can be used to create mHealth solutions for older adults with positive outcomes. This review has also summarized practical HCD steps and additional suggestions based on existing literature in the subfield. However, evidence-based results are still limited because most included studies lacked details about their sampling methods and did not set objective and quantifiable goals, leading to failure to draw significant conclusions. More studies of HCD application on mHealth for older adults with measurable design goals and rigorous research strategy are warranted.
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Affiliation(s)
| | - Suchaya Boonviriya
- Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pisit Tangkijvanich
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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16
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Newton AS, March S, Gehring ND, Rowe AK, Radomski AD. Establishing a Working Definition of User Experience for eHealth Interventions of Self-reported User Experience Measures With eHealth Researchers and Adolescents: Scoping Review. J Med Internet Res 2021; 23:e25012. [PMID: 34860671 PMCID: PMC8686463 DOI: 10.2196/25012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/27/2021] [Accepted: 09/23/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Across eHealth intervention studies involving children, adolescents, and their parents, researchers have measured user experience to assist with intervention development, refinement, and evaluation. To date, no widely accepted definitions or measures of user experience exist to support a standardized approach for evaluation and comparison within or across interventions. OBJECTIVE We conduct a scoping review with subsequent Delphi consultation to identify how user experience is defined and measured in eHealth research studies, characterize the measurement tools used, and establish working definitions for domains of user experience that could be used in future eHealth evaluations. METHODS We systematically searched electronic databases for published and gray literature available from January 1, 2005, to April 11, 2019. We included studies assessing an eHealth intervention that targeted any health condition and was designed for use by children, adolescents, and their parents. eHealth interventions needed to be web-, computer-, or mobile-based, mediated by the internet with some degree of interactivity. We required studies to report the measurement of user experience as first-person experiences, involving cognitive and behavioral factors reported by intervention users. We appraised the quality of user experience measures in included studies using published criteria: well-established, approaching well-established, promising, or not yet established. We conducted a descriptive analysis of how user experience was defined and measured in each study. Review findings subsequently informed the survey questions used in the Delphi consultations with eHealth researchers and adolescent users for how user experience should be defined and measured. RESULTS Of the 8634 articles screened for eligibility, 129 articles and 1 erratum were included in the review. A total of 30 eHealth researchers and 27 adolescents participated in the Delphi consultations. On the basis of the literature and consultations, we proposed working definitions for 6 main user experience domains: acceptability, satisfaction, credibility, usability, user-reported adherence, and perceived impact. Although most studies incorporated a study-specific measure, we identified 10 well-established measures to quantify 5 of the 6 domains of user experience (all except for self-reported adherence). Our adolescent and researcher participants ranked perceived impact as one of the most important domains of user experience and usability as one of the least important domains. Rankings between adolescents and researchers diverged for other domains. CONCLUSIONS Findings highlight the various ways in which user experience has been defined and measured across studies and what aspects are most valued by researchers and adolescent users. We propose incorporating the working definitions and available measures of user experience to support consistent evaluation and reporting of outcomes across studies. Future studies can refine the definitions and measurement of user experience, explore how user experience relates to other eHealth outcomes, and inform the design and use of human-centered eHealth interventions.
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Affiliation(s)
- Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sonja March
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Nicole D Gehring
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Arlen K Rowe
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Ashley D Radomski
- Knowledge Institute for Child and Youth Mental Health and Addictions, Ottawa, ON, Canada.,CHEO (Children's Hospital of Eastern Ontario) Research Institute, Ottawa, ON, Canada
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17
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Nwolise CH, Carey N, Shawe J. Preconception and Diabetes Information (PADI) App for Women with Pregestational Diabetes: a Feasibility and Acceptability Study. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 5:446-473. [PMID: 35415455 PMCID: PMC8982818 DOI: 10.1007/s41666-021-00104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 03/07/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
Diabetes mellitus increases the risk of adverse maternal and fetal outcomes. Preconception care is vital to minimise complications; however, preconception care service provision is hindered by inadequate knowledge, resources and care fragmentation. Mobile health technology, particularly smartphone apps, could improve preconception care and pregnancy outcomes for women with diabetes. The aim of this study is to co-create a preconception and diabetes information app with healthcare professionals and women with diabetes and explore the feasibility, acceptability and preliminary effects of the app. A mixed-methods study design employing questionnaires and semi-structured interviews was used to assess preliminary outcome estimates (preconception care knowledge, attitudes and behaviours), and user acceptability. Data analysis included thematic analysis, descriptive statistics and non-parametric tests. Improvements were recorded in knowledge and attitudes to preconception care and patient activation measure following the 3-month app usage. Participants found the app acceptable (satisfaction rating was 72%), useful and informative. The app's usability and usefulness facilitated usage while manual data input and competing priorities were barriers which participants felt could be overcome via personalisation, automation and use of daily reminders. This is the first study to explore the acceptability and feasibility of a preconception and diabetes information app for women with diabetes. Triangulated data suggest that the app has potential to improve preconception care knowledge, attitudes and behaviours. However, in order for women with DM to realise the full potential of the app intervention, particularly improved maternal and fetal outcomes, further development and evaluation is required.
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Affiliation(s)
- Chidiebere H Nwolise
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, L1/16 Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Nicola Carey
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Jill Shawe
- School of Nursing & Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
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18
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Taxter A, Johnson L, Tabussi D, Kimura Y, Donaldson B, Lawson E, Del Gaizo V, Vitelli D, Pinter C, Van Citters A, Nelson E, Lee T. Co-Design of an Electronic Dashboard to Support Coproduction of Care in Pediatric Rheumatic Disease: Human-Centered Design and Usability Testing (Preprint). J Particip Med 2021; 14:e34735. [PMID: 35133283 PMCID: PMC9077505 DOI: 10.2196/34735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/09/2022] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alysha Taxter
- Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Doreen Tabussi
- Hackensack University Medical Center, Hackensack, NJ, United States
| | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, NJ, United States
| | | | - Erica Lawson
- University of California San Francisco, San Francisco, CA, United States
| | - Vincent Del Gaizo
- Childhood Arthritis and Rheumatology Research Alliance (CARRA), Milwaukee, WI, United States
| | | | | | | | | | - Tzielan Lee
- Stanford Children's Health, Palo Alto, CA, United States
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19
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Murphy J, McSharry J, Hynes L, Molloy GJ. A Smartphone App to Support Adherence to Inhaled Corticosteroids in Young Adults With Asthma: Multi-Methods Feasibility Study. JMIR Form Res 2021; 5:e28784. [PMID: 34468325 PMCID: PMC8444040 DOI: 10.2196/28784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/30/2021] [Accepted: 07/05/2021] [Indexed: 01/22/2023] Open
Abstract
Background Young adults with asthma often report low adherence to inhaled corticosteroids (ICS), leading to uncontrolled symptoms and poor disease outcomes. Technology-enabled digital supports such as mobile health (mHealth) asthma smartphone apps have the potential to support adherence to ICS and asthma self-management. There is a need for feasibility studies to determine the usability, acceptability, and feasibility of these interventions. In addition, it is essential to determine the feasibility of recruiting and retaining young adults to plan future efficacy and effectiveness trials and therefore, establish evidence-based asthma apps. Objective This study aimed to determine (1) the feasibility of recruiting and retaining young adults to a trial and (2) the usability, acceptability, and feasibility of using the AsthmaMD app to support adherence to ICS in a population of young adults living with asthma. Methods A multi-methods feasibility study was conducted. Young adults aged 18-30 years with asthma and current prescription for ICS were eligible and invited to take part through a university circular email, social media, and general practice sites. Participation involved completing a baseline self-report questionnaire, downloading and using the AsthmaMD app for 2 weeks, and completing the follow-up assessment, including self-report and open-ended questions about participants’ experience of using the app. Primary outcomes included participant recruitment and retention and the usability, acceptability, and feasibility of using AsthmaMD. Quantitative self-report data were analyzed using descriptive statistics, and qualitative open-ended data were analyzed using inductive reflexive thematic analysis. Results A total of 122 young adults (females, n=101, 82.8%) with a mean age of 24.4 (SD 3.8) years were recruited and they completed baseline measures. Of the 122 young adults, 59 (48.4%) completed the study. The AsthmaMD app received a mean score of 63.1/100 (SD 20.1) on the System Usability Scale (ie, a standardized measure of usability for technology-based apps), and an overall user satisfaction score of 5.8/10 (SD 2.2). Of the 59 participants who completed the study, 49 (83%) participants used the app ≥1 day per week. Two main themes were identified in the qualitative analysis of user experiences: (1) learning how to use the app to suit the individual and (2) benefits and relevance of using the app. Conclusions The findings from this study indicate that it is feasible to recruit and retain young adults to examine efficacy and effectiveness in a future trial and that young adults living with asthma may find AsthmaMD to be usable, acceptable, and feasible to support adherence to ICS. Our findings also identified opportunities to further optimize the usability of AsthmaMD and similar apps. Based on our findings, we recommend providing more accessible information on how to use the app and replacing medical terminology with simplified language within the app to improve usability. Trial Registration ISRCTN Registry ISRCTN11295269; https://www.isrctn.com/ISRCTN11295269
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Affiliation(s)
- Jane Murphy
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Jenny McSharry
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Lisa Hynes
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
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20
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Robertson AO, Tadić V, Cortina-Borja M, Rahi J. Feasibility of using patient-reported outcome measures with visually impaired children/young people attending paediatric ophthalmology clinics. Arch Dis Child 2021; 106:687-692. [PMID: 33153986 DOI: 10.1136/archdischild-2020-318991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore feasibility of using child/young person patient-reported outcome measures (PROMs) routinely in practice, using vision-specific instruments and paediatric ophthalmology as the exemplar. METHODS Participants comprised patients aged 8-17 years, with visual impairment or low vision (visual acuity of the logarithm of the minimum angle of resolution (logMAR) worse than 0.3 in the better eye), attending the Department of Ophthalmology at Great Ormond Street Hospital, London, UK. All participants completed age-appropriate PROMs before attending their outpatient appointment. Half were randomly assigned to completion at home, with the choice of paper-and-pencil or electronic format. The other half were invited to complete PROMs during their hospital appointment, and randomly assigned to completion format. All participants completed a face-to-face survey exploring their attitudes and preferences. Analysis comprised survival analysis, and direct comparisons of proportions, with complementary qualitative data analysis. RESULTS 93 patients participated. 48 (98%) completing PROMs at home chose the paper-and-pencil format. Completion at home took longer than at hospital (median=20, vs 14 min, p<0.001). Visual acuity was associated with completion time (p=0.007) and missing data (p=0.03). Overall, 52 (60%) reported a preference for completion at home but there was no clear preference for format (37 (43%) preferred either format). CONCLUSION PROM completion at home ahead of hospital appointments may be preferable for collecting complete, high-quality datasets. Despite equipoise on preference for format, the majority of those completing at home chose the traditional paper-and-pencil format, despite impaired sight. These findings should inform implementation of child/young person PROMs into routine practice.
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Affiliation(s)
- Alexandra O Robertson
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Valerija Tadić
- School of Human Sciences, University of Greenwich, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Jugnoo Rahi
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK .,Great Ormond Street Hospital NHS Foundation Trust, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Ulverscroft Vision Research Group, London, UK
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21
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Tonga E, Williamson E, Srikesavan C, Özen T, Sarıtaş F, Lamb SE. A hand exercise mobile app for people with rheumatoid arthritis in Turkey: design, development and usability study. Rheumatol Int 2021; 41:1151-1160. [PMID: 33870452 DOI: 10.1007/s00296-021-04860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
To design and develop a smartphone application for a structured hand exercise programme for patients with rheumatoid arthritis (RA) in Turkey and to test its usability. We followed a two-stage process: (1) Design and Development and (2) Usability testing. In stage 1, we used a qualitative user-centered design approach. We conducted a focus group (8 therapists and people with RA) to discuss the content, features and design to produce a prototype of the application. In a second focus group session, the participants tested the prototype, provided feedback and further revisions were made. In stage 2, 17 participants with RA used the app for 4 to 6 weeks. The System Usability Scale and the adapted Usability, Satisfaction and Ease to Use Questionnaires were used to measure usability, ease of use. Semi-structured interviews were conducted to explore user experiences with the application with 17 participants. In stage 1, the following themes were identified from the focus groups (a) login techniques (b) self-monitoring (c) exercises, (d) exercise diary, (e) information, (f) behavioral change and encouragement (g) exercise adherence. In stage 2, 3 themes were determined from interviews: (a) learning and accuracy, (b) ease of use, (c) motivation and adherence. USE and SUS scores indicated that users reported a high level of usability, satisfaction and ease of use. A mobile app for hand exercise for people with RA was developed using a mixed-method and iterative design. Participants perceived the mobile app as easy to use with high levels of satisfaction.
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Affiliation(s)
- Eda Tonga
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Marmara University, Başıbüyük Campus, Başıbüyük St. 3484, Maltepe, Istanbul, Turkey.
| | - Esther Williamson
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Cynthia Srikesavan
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Tuğçe Özen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Marmara University, Başıbüyük Campus, Başıbüyük St. 3484, Maltepe, Istanbul, Turkey
| | - Fatih Sarıtaş
- Haydarpasa Numune Research and Education Hospital, Rheumatology Clinic, Istanbul, Turkey
| | - Sarah E Lamb
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Collage of Medicine and Health, University of Exeter, Exeter, UK
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22
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Shaw Y, Courvoisier DS, Scherer A, Ciurea A, Lehmann T, Jaeger VK, Walker UA, Finckh A. Impact of assessing patient-reported outcomes with mobile apps on patient-provider interaction. RMD Open 2021; 7:e001566. [PMID: 33811177 PMCID: PMC8023945 DOI: 10.1136/rmdopen-2021-001566] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To explore the effect of apps measuring patient-reported outcomes (PROs) on patient-provider interaction in the rheumatic diseases in an observational setting. METHODS Patients in the Swiss Clinical Quality Management in Rheumatic Diseases Registry were offered mobile apps (iDialog and COmPASS) to track disease status between rheumatology visits using validated PROs (Rheumatoid Arthritis Disease Activity Index-5 score, Bath Ankylosing Spondylitis Disease Activity Index score, Routine Assessment of Patient Index Data-3 score and Visual Analogue Scale score for pain, disease activity and skin symptoms). We assessed two aspects of patient-provider interaction: shared decision making (SDM) and physician awareness of disease fluctuations. We used logistic regressions to compare outcomes among patients who (1) used an app and discussed app data with their physician (app+discussion group), (2) used an app without discussing the data (app-only group) or (3) did not use any app (non-app users). RESULTS 2111 patients were analysed, including 1799 non-app users, 150 app-only users and 162 app+discussion users (43% male; with 902 patients with rheumatoid arthritis, 766 patients with axial spondyloarthritis and 443 patients with psoriatic arthritis). App users were younger than non-app users (mean age of 47 vs 51 years, p<0.001). Compared with non-app users, the app+discussion group rated their rheumatologist more highly in SDM (OR 1.7, 95% CI 1.1 to 2.4) and physician awareness of disease fluctuations (OR 2.0, 95% CI 1.3 to 3.1). This improvement was absent in the app-only group. CONCLUSION App users who discussed app data with their rheumatologist reported more favourably on patient-provider interactions than app users who did not and non-app users. Apps measuring PROs may contribute little to patient-provider interactions without integration of app data into care processes.
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Affiliation(s)
- Yomei Shaw
- Department of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Almut Scherer
- Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Veronika K Jaeger
- Institute of Epidemiology and Social Medicine, University of Munster, Munster, Nordrhein-Westfalen, Germany
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Axel Finckh
- Department of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
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23
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Horton DB, Salas J, Wec A, Kohlheim M, Kapadia P, Beukelman T, Boneparth A, Haverkamp K, Mannion ML, Moorthy LN, Ringold S, Rosenthal M. Making Decisions About Stopping Medicines for Well-Controlled Juvenile Idiopathic Arthritis: A Mixed-Methods Study of Patients and Caregivers. Arthritis Care Res (Hoboken) 2021; 73:374-385. [PMID: 31880862 PMCID: PMC7319899 DOI: 10.1002/acr.24129] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Improved treatments for juvenile idiopathic arthritis (JIA) have increased remission rates. We conducted this study to investigate how patients and caregivers make decisions about stopping medications when JIA is inactive. METHODS We performed a mixed-methods study of caregivers and patients affected by JIA, recruited through social media and flyers, and selected by purposive sampling. Participants discussed their experiences with JIA, medications, and decision-making through recorded telephone interviews. Of 44 interviewees, 20 were patients (50% ages <18 years), and 24 were caregivers (50% caring for children ages ≤10 years). We evaluated characteristics associated with high levels of reported concerns about JIA or medicines using Fisher's exact testing. RESULTS Decisions about stopping medicines were informed by competing risks between disease activity and treatment. Participants who expressed more concerns about JIA were more likely to report disease-related complications (P = 0.002) and more motivated to continue treatment. However, participants expressing more concern about medicines were more likely to report treatment-related complications (P = 0.04) and felt more compelled to stop treatment. Additionally, participants considered how JIA or treatments facilitated or interfered with their sense of normalcy and safety, expressed feelings of guilt and regret about previous or potential adverse events, and reflected on uncertainty and unpredictability of future harms. Decision-making was also informed by trust in rheumatologists and other information sources (e.g., family and online support groups). CONCLUSION When deciding whether to stop medicines whenever JIA is inactive, patients and caregivers weigh competing risks between disease activity and treatment. Based on our results, we suggest specific approaches for clinicians to perform shared decision-making regarding stopping medicines for JIA.
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Affiliation(s)
- Daniel B. Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Jomaira Salas
- Department of Sociology, Rutgers University, New Brunswick, NJ, USA
| | | | - Melanie Kohlheim
- Pediatric Rheumatology Care and Outcomes Improvement Network, Cincinnati, OH, USA
| | - Pooja Kapadia
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | | | | | - Ky Haverkamp
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - L. Nandini Moorthy
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Marsha Rosenthal
- Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
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24
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Blower S, Swallow V, Maturana C, Stones S, Phillips R, Dimitri P, Marshman Z, Knapp P, Dean A, Higgins S, Kellar I, Curtis P, Mills N, Martin-Kerry J. Children and young people's concerns and needs relating to their use of health technology to self-manage long-term conditions: a scoping review. Arch Dis Child 2020; 105:1093-1104. [PMID: 32444448 PMCID: PMC7588410 DOI: 10.1136/archdischild-2020-319103] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of patient-facing health technologies to manage long-term conditions is increasing; however, children and young people may have particular concerns or needs before deciding to use different health technologies. AIMS To identify children and young people's reported concerns or needs in relation to using health technologies to self-manage long-term conditions. METHODS A scoping review was conducted. We searched MEDLINE, PsycINFO and CINAHL in February 2019. Searches were limited to papers published between January 2008 and February 2019. We included any health technology used to manage long-term conditions. A thematic synthesis of the data from the included studies was undertaken. We engaged children with long-term conditions (and parents) to support review design, interpretation of findings and development of recommendations. RESULTS Thirty-eight journal articles were included, describing concerns or needs expressed by n=970 children and/or young people aged 5-18 years. Most included studies were undertaken in high-income countries with children aged 11 years and older. Studies examined concerns with mobile applications (n=14), internet (n=9), social media (n=3), interactive online treatment programmes (n=3), telehealth (n=1), devices (n=3) or a combination (n=5). Children and young people's main concerns were labelling and identity; accessibility; privacy and reliability; and trustworthiness of information. DISCUSSION This review highlights important concerns that children and young people may have before using technology to self-manage their long-term condition. In future, research should involve children and young people throughout the development of technology, from identifying their unmet needs through to design and evaluation of interventions.
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Affiliation(s)
- Sarah Blower
- Department of Health Sciences, University of York, York, UK
| | - Veronica Swallow
- College of Health, Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - Camila Maturana
- York Trials Unit, University of York, York, North Yorkshire, UK
| | - Simon Stones
- School of Healthcare, University of Leeds, Leeds, West Yorkshire, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
| | - Paul Dimitri
- NIHR Children and Young People MedTech Cooperative, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, Sheffield, UK
| | - Zoe Marshman
- School of Clinical Dentistry, The University of Sheffield, Sheffield, Sheffield, UK
| | - Peter Knapp
- Department of Health Sciences and Hull York Medical School, University of York, York, North Yorkshire, UK
| | - Alexandra Dean
- York Trials Unit, University of York, York, North Yorkshire, UK
| | | | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK
| | - Penny Curtis
- School of Nursing and Midwifery, The University of Sheffield, Sheffield, Sheffield, UK
| | - Nathaniel Mills
- NIHR Children and Young People MedTech Co-operative and NIHR Devices for Dignity MedTech Co-operative, Sheffield Children's NHS Trust, Sheffield, UK
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25
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Seppen BF, Wiegel J, L'ami MJ, Duarte Dos Santos Rico S, Catarinella FS, Turkstra F, Boers M, Bos WH. Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies. JMIR Form Res 2020; 4:e20165. [PMID: 32955447 PMCID: PMC7536594 DOI: 10.2196/20165] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/16/2023] Open
Abstract
Background Several mobile apps that monitor symptoms of rheumatoid arthritis (RA) exist, but a recent systematic review indicated that high-quality apps are lacking. When patients self-monitor their own disease with patient-reported outcomes (PROs) and self-initiate care at the right moment, it may be possible to reduce the frequency of their clinic visits, which would reduce health care burden and costs. We developed an app, that is, the MijnReuma Reade app, for this purpose and performed 2 pilot tests with weekly self-monitoring. Objective The primary objective of this study was to design, develop, and evaluate the usability, satisfaction, and usage of the MijnReuma Reade app—an app that allows patients with RA to monitor their own disease. The secondary objective was to review the patients’ perspectives on app usage and its intended purpose. Methods This app was designed in collaboration with patients with RA, rheumatologists, and information technology experts. Two 1-month pilot studies were performed, after which satisfaction (0-10 scale), usability (system usability scale, 0-100), and usage (proportion of completed questionnaires) of this app were assessed. After the second pilot study, semistructured interviews were performed to determine patients’ perspectives and the promoters and barriers of app usage. Results In the first and second pilot study, 42 and 27 patients were included, respectively. Overall, the patients were satisfied (medians, 8 and 7) and found the app usable (mean system usability scores, 76 and 71) in pilot studies 1 and 2, respectively. App usage declined over time in both the pilot studies; 61% (17/28) and 37% (10/27) of the patients who disclosed their usage statistics completed the final weekly questionnaire in pilot study 1 and pilot study 2, respectively. Approximately 81% (25/31) of the patients indicated they would like to skip hospital visits if the self-monitored disease activity is low. In the semistructured interviews, technical problems, internal resistance (respondent fatigue, the app reminded them of their disease), and a lack of symptoms were identified as barriers for usage. Patients reported that “experiencing more grip on their disease” and “improved communication with their physician” were promoters for usage. Patients reported that pain positively mediated usage, that is, more pain promoted and less pain discouraged app usage. Conclusions This study illustrates the feasibility of the MijnReuma Reade app that enables self-monitoring of the disease activity in patients with RA with the overarching aim to allocate clinical consultations according to need. Satisfaction with the app and usability of the app were found to be high; however, app usage declined over time. Patients acknowledged the potential of the app to self-monitor their own disease and would like to be able to skip clinic visits if the monitored disease activity is low. To evaluate this strategy, a randomized controlled trial is underway.
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Affiliation(s)
- Bart F Seppen
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Rheumatology, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Jimmy Wiegel
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Rheumatology, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Merel J L'ami
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | | | | | - Franktien Turkstra
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Maarten Boers
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Wouter H Bos
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
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26
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Beneitez I, Nieto R, Hernández E, Boixadós M. Adolescents’ social needs living with juvenile idiopathic arthritis and their views about digital resources. Adv Rheumatol 2020; 60:36. [DOI: 10.1186/s42358-020-00138-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Juvenile Idiopathic Arthritis (JIA) and its related symptoms (e.g. pain) have been associated with interference in the daily life of adolescents with JIA including their friendships. There is little research in that sense and in consequence, interventions designed to improve this area. The objectives of this study are 1) to gain knowledge about the needs of adolescents with JIA, particularly focused on their friendships; 2) to explore the potential of the Internet to help them, and 3) to determine what kind of online resource would be the best and what elements it should include.
Methods
To achieve the proposed objectives we designed a qualitative study including two phases: the first one exploratory (semi-structured interviews) and the following, confirmatory (online focus group).
Results
14 adolescents were interviewed and 7 participated in the focus group. They reported some social challenges related to their illness: feeling different, criticized by peers, or not believed. Additionally, they specified some of the coping strategies they used, such as disclosing to others that they have JIA, using communication skills, maintaining activities with friends, trying to minimize pain, and ignoring negative comments. Adolescents considered an online resource useful and mentioned that they would like to find general information and to have the possibility to interact with others. They considered Instagram and WhatsApp as good platforms to implement the online resource.
Conclusions
According to their perceptions, adolescents with JIA can benefit from an online resource which delivers information, strategies and facilitates interaction with others.
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Grainger R, Townsley HR, Ferguson CA, Riley FE, Langlotz T, Taylor WJ. Patient and clinician views on an app for rheumatoid arthritis disease monitoring: Function, implementation and implications. Int J Rheum Dis 2020; 23:813-827. [PMID: 32424997 DOI: 10.1111/1756-185x.13850] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022]
Abstract
AIM Best practice management for rheumatoid arthritis (RA) involves regular clinical assessment of RA disease activity. This is not achievable with current rheumatology systems of care. We aimed to use opinions from people with RA and their specialist rheumatology healthcare professionals to inform development of a mobile app for people with RA for recording their disease activity data for potential integration into clinical service, and assess usability of the app. METHOD In phase 1 we interviewed nine people with RA and seven healthcare professionals. In phase 2 we developed an app with professional software developers. In phase 3 we evaluated app usability for people with RA using the System Usability Scale (SUS). RESULTS Interview data showed four themes regarding functionality and implementation of a patient-held app in RA care: (a) variable app acceptance and readiness; (b) app use to reduce barriers; (c) pros and cons of patient-reported outcomes; and (d) allocation of clinics by need. The app developed has high usability in people with RA using the app on their own device for a month (SUS 79.5, n = 16) or using the app on a study device for 10 minutes (SUS 83, n = 100). CONCLUSION People with RA and healthcare professionals have clearly identified features, benefits and risks of an app for self-assessment of RA and incorporation into clinical care. An app developed informed by these opinions has high usability. Next steps are development and validation of a method of patient-performed joint counts, and implementation, with evaluation, in the clinical setting.
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Affiliation(s)
- Rebecca Grainger
- University of Otago Wellington, Wellington, New Zealand.,Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | | | | | | | - Tobias Langlotz
- Department of Information Science, University of Otago, Dunedin, New Zealand
| | - William John Taylor
- University of Otago Wellington, Wellington, New Zealand.,Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
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Molina-Recio G, Molina-Luque R, Jiménez-García AM, Ventura-Puertos PE, Hernández-Reyes A, Romero-Saldaña M. Proposal for the User-Centered Design Approach for Health Apps Based on Successful Experiences: Integrative Review. JMIR Mhealth Uhealth 2020; 8:e14376. [PMID: 32319965 PMCID: PMC7203616 DOI: 10.2196/14376] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 11/05/2019] [Accepted: 01/26/2020] [Indexed: 12/31/2022] Open
Abstract
Background Different strategies encompassed within mHealth have shown themselves to be effective for maintaining good health or controlling certain diseases. However, there is usually a very high rate of abandonment of health apps. Therefore, it would seem obvious that there is a need for involving the end users (whether they are health professionals, patients, or both) in the design process from the early stages in order to enable their needs and characteristics to be identified. In this sense, it is common knowledge that focusing on the user permits the consideration of valuable details aimed at making the correct adjustment between the patient, the technology, and the organization of attention. Objective The goal of the research was to propose a methodology based on the review of previous successful user experiences in setting up health apps by using qualitative techniques (focus groups and discussion groups) that includes the participation of information technology and health professionals and the patients themselves. Methods An integrative review was made of studies in which a qualitative methodology was employed mainly through focus and/or discussion groups for the design and development of health apps, consulting diverse databases (PubMed, Scopus, and Proquest) with the following search strategy: “mHealth AND apps AND focus group OR discussion group.” A total of 69 papers were included in the review. Results A proposal structured in 4 sessions of variable duration was made in which information technology and health professionals and patients take part: composing, preparing, and organizing contents (session 1); testing structure and usability (session 2); does the app fit the needs of end users? (session 3); and last testing—keep on improving (session 4). Throughout the sessions, we propose studying aspects like previous user experiences in mHealth, barriers to the adoption of mHealth, interface contents, management and browsability, usability, perceived quality, security and privacy, capacity to self-manage disease with the app, ergonomics, and glanceability, etc. Specific tools that have proved useful in previous research for measuring these aspects are presented. Conclusions These work sessions would be based on predominantly qualitative methodologies although, as they evolve, validated questionnaires permitting the assessment of the objectivity of certain technical aspects could be incorporated. With this proposal, a project centered on end users could be effected, responding to their needs. However, this requires validation that will be made via implementation in the development of health apps, with the subsequent measurement of results in terms of adherence and improvement in the clinical variables of the end users.
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Odendaal WA, Anstey Watkins J, Leon N, Goudge J, Griffiths F, Tomlinson M, Daniels K. Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 3:CD011942. [PMID: 32216074 PMCID: PMC7098082 DOI: 10.1002/14651858.cd011942.pub2] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mobile health (mHealth), refers to healthcare practices supported by mobile devices, such as mobile phones and tablets. Within primary care, health workers often use mobile devices to register clients, track their health, and make decisions about care, as well as to communicate with clients and other health workers. An understanding of how health workers relate to, and experience mHealth, can help in its implementation. OBJECTIVES To synthesise qualitative research evidence on health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services, and to develop hypotheses about why some technologies are more effective than others. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, Science Citation Index and Social Sciences Citation Index in January 2018. We searched Global Health in December 2015. We screened the reference lists of included studies and key references and searched seven sources for grey literature (16 February to 5 March 2018). We re-ran the search strategies in February 2020. We screened these records and any studies that we identified as potentially relevant are awaiting classification. SELECTION CRITERIA We included studies that used qualitative data collection and analysis methods. We included studies of mHealth programmes that were part of primary healthcare services. These services could be implemented in public or private primary healthcare facilities, community and workplace, or the homes of clients. We included all categories of health workers, as well as those persons who supported the delivery and management of the mHealth programmes. We excluded participants identified as technical staff who developed and maintained the mHealth technology, without otherwise being involved in the programme delivery. We included studies conducted in any country. DATA COLLECTION AND ANALYSIS We assessed abstracts, titles and full-text papers according to the inclusion criteria. We found 53 studies that met the inclusion criteria and sampled 43 of these for our analysis. For the 43 sampled studies, we extracted information, such as country, health worker category, and the mHealth technology. We used a thematic analysis process. We used GRADE-CERQual to assess our confidence in the findings. MAIN RESULTS Most of the 43 included sample studies were from low- or middle-income countries. In many of the studies, the mobile devices had decision support software loaded onto them, which showed the steps the health workers had to follow when they provided health care. Other uses included in-person and/or text message communication, and recording clients' health information. Almost half of the studies looked at health workers' use of mobile devices for mother, child, and newborn health. We have moderate or high confidence in the following findings. mHealth changed how health workers worked with each other: health workers appreciated being more connected to colleagues, and thought that this improved co-ordination and quality of care. However, some described problems when senior colleagues did not respond or responded in anger. Some preferred face-to-face connection with colleagues. Some believed that mHealth improved their reporting, while others compared it to "big brother watching". mHealth changed how health workers delivered care: health workers appreciated how mHealth let them take on new tasks, work flexibly, and reach clients in difficult-to-reach areas. They appreciated mHealth when it improved feedback, speed and workflow, but not when it was slow or time consuming. Some health workers found decision support software useful; others thought it threatened their clinical skills. Most health workers saw mHealth as better than paper, but some preferred paper. Some health workers saw mHealth as creating more work. mHealth led to new forms of engagement and relationships with clients and communities: health workers felt that communicating with clients by mobile phone improved care and their relationships with clients, but felt that some clients needed face-to-face contact. Health workers were aware of the importance of protecting confidential client information when using mobile devices. Some health workers did not mind being contacted by clients outside working hours, while others wanted boundaries. Health workers described how some community members trusted health workers that used mHealth while others were sceptical. Health workers pointed to problems when clients needed to own their own phones. Health workers' use and perceptions of mHealth could be influenced by factors tied to costs, the health worker, the technology, the health system and society, poor network access, and poor access to electricity: some health workers did not mind covering extra costs. Others complained that phone credit was not delivered on time. Health workers who were accustomed to using mobile phones were sometimes more positive towards mHealth. Others with less experience, were sometimes embarrassed about making mistakes in front of clients or worried about job security. Health workers wanted training, technical support, user-friendly devices, and systems that were integrated into existing electronic health systems. The main challenges health workers experienced were poor network connections, access to electricity, and the cost of recharging phones. Other problems included damaged phones. Factors outside the health system also influenced how health workers experienced mHealth, including language, gender, and poverty issues. Health workers felt that their commitment to clients helped them cope with these challenges. AUTHORS' CONCLUSIONS Our findings propose a nuanced view about mHealth programmes. The complexities of healthcare delivery and human interactions defy simplistic conclusions on how health workers will perceive and experience their use of mHealth. Perceptions reflect the interplay between the technology, contexts, and human attributes. Detailed descriptions of the programme, implementation processes and contexts, alongside effectiveness studies, will help to unravel this interplay to formulate hypotheses regarding the effectiveness of mHealth.
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Affiliation(s)
- Willem A Odendaal
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Stellenbosch UniversityDepartment of PsychiatryCape TownSouth Africa
| | | | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Brown UniversitySchool of Public HealthProvidenceRhode IslandUSA
| | - Jane Goudge
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Frances Griffiths
- University of WarwickWarwick Medical SchoolCoventryUK
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Mark Tomlinson
- Stellenbosch UniversityInstitute for Life Course Health Research, Department of Global HealthCape TownSouth Africa
- Queens UniversitySchool of Nursing and MidwiferyBelfastUK
| | - Karen Daniels
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- University of Cape TownHealth Policy and Systems Division, School of Public Health and Family MedicineCape TownWestern CapeSouth Africa7925
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Developing a smartphone application to support social connectedness and wellbeing in young people with cystic fibrosis. J Cyst Fibros 2020; 19:277-283. [DOI: 10.1016/j.jcf.2019.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/03/2019] [Accepted: 12/20/2019] [Indexed: 01/26/2023]
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Najm A, Gossec L, Weill C, Benoist D, Berenbaum F, Nikiphorou E. Mobile Health Apps for Self-Management of Rheumatic and Musculoskeletal Diseases: Systematic Literature Review. JMIR Mhealth Uhealth 2019; 7:e14730. [PMID: 31769758 PMCID: PMC6904900 DOI: 10.2196/14730] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Although the increasing availability of mobile health (mHealth) apps may enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health, there is a general lack of evidence on ways to ensure appropriate development and evaluation of apps. OBJECTIVE This study aimed to obtain an overview on existing mHealth apps for self-management in patients with RMDs, focusing on content and development methods. METHODS A search was performed up to December 2017 across 5 databases. For each publication relevant to an app for RMDs, information on the disease, purpose, content, and development strategies was extracted and qualitatively assessed. RESULTS Of 562 abstracts, 32 were included in the analysis. Of these 32 abstracts, 11 (34%) referred to an app linked to a connected device. Most of the apps targeted rheumatoid arthritis (11/32, 34%). The top three aspects addressed by the apps were pain (23/32, 71%), fatigue (15/32, 47%), and physical activity (15/32, 47%). The development process of the apps was described in 84% (27/32) of the articles and was of low to moderate quality in most of the cases. Despite most of the articles having been published within the past two years, only 5 apps were still commercially available at the time of our search. Moreover, only very few studies showed improvement of RMD outcome measures. CONCLUSIONS The development process of most apps was of low or moderate quality in many studies. Owing to the increasing RMD patients' willingness to use mHealth apps for self-management, optimal standards and quality assurance of new apps are mandatory.
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Affiliation(s)
- Aurélie Najm
- Department of Rheumatology, Nantes University Hospital, Nantes, France.,INSERM UMR 1238, Nantes University of Medicine, Nantes, France
| | - Laure Gossec
- INSERM UMR S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.,Rheumatology department, Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Catherine Weill
- Bibliothèque interuniversitaire de Santé, Paris Descartes University, Paris, France
| | - David Benoist
- Bibliothèque interuniversitaire de Santé, Paris Descartes University, Paris, France
| | - Francis Berenbaum
- Department of rheumatology, Sorbonne Université, INSERM CRSA Saint-Antoine, AP-HP, Saint Antoine Hospital, Paris, France
| | - Elena Nikiphorou
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King's College London, Paris, France
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Vera-Jiménez JC, Ferreiro-González M, Barbero GF, Álvarez JÁ, Fernández-Zacarías F, Ayuso J. OTP-PRL: an app for occupational risk prevention in policing activities. BMC Public Health 2019; 19:1549. [PMID: 31752804 PMCID: PMC6873564 DOI: 10.1186/s12889-019-7935-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/11/2019] [Indexed: 12/02/2022] Open
Abstract
Background The rapid progress in information and communication technologies has promoted the development of smartphone applications (apps) for a wide variety of purposes including workplace safety. However, no specific apps for occupational risk prevention in the police domain seemingly exist as yet. In this work, an app running under the iOS and Android operating systems was developed to help police officers become acquainted with policing-related occupational risks and to prevent their damaging consequences. Results The proposed app, which uses an iterative user-centered design to avoid occupational risks in policing activities, was assessed for performance by a group of users and experts through a System Usability Scale (SUS) questionnaire. The mean overall score for the questionnaire was 82.3. The app has backend support to facilitate continual improvement through contributions from users and administrators. A field test revealed increased awareness of policing occupational risks after using the app in many users. Conclusions A novel product that covers the needs of ORP requirements of police officers has been developed.
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Affiliation(s)
- José C Vera-Jiménez
- Cadiz Municipal Police, Police Technology Area, Public Safety School, Cadiz Council, Cadiz, Spain
| | - Marta Ferreiro-González
- Department of Analytical Chemistry, Faculty of Sciences, IVAGRO, CeiA3, University of Cadiz, P.O. Box 40, 11510, Cadiz, Puerto Real, Spain.
| | - Gerardo F Barbero
- Department of Analytical Chemistry, Faculty of Sciences, IVAGRO, CeiA3, University of Cadiz, P.O. Box 40, 11510, Cadiz, Puerto Real, Spain
| | - José Ángel Álvarez
- Department of Physical Chemistry, Faculty of Sciences, Institute of Biomolecules (INBIO), University of Cadiz, 11510, Cadiz, Puerto Real, Spain
| | | | - Jesús Ayuso
- Department of Physical Chemistry, Faculty of Sciences, Institute of Biomolecules (INBIO), University of Cadiz, 11510, Cadiz, Puerto Real, Spain
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Fernandez MP, Bron GM, Kache PA, Larson SR, Maus A, Gustafson D, Tsao JI, Bartholomay LC, Paskewitz SM, Diuk-Wasser MA. Usability and Feasibility of a Smartphone App to Assess Human Behavioral Factors Associated with Tick Exposure (The Tick App): Quantitative and Qualitative Study. JMIR Mhealth Uhealth 2019; 7:e14769. [PMID: 31651409 PMCID: PMC6913724 DOI: 10.2196/14769] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 01/29/2023] Open
Abstract
Background Mobile health (mHealth) technology takes advantage of smartphone features to turn them into research tools, with the potential to reach a larger section of the population in a cost-effective manner, compared with traditional epidemiological methods. Although mHealth apps have been widely implemented in chronic diseases and psychology, their potential use in the research of vector-borne diseases has not yet been fully exploited. Objective This study aimed to assess the usability and feasibility of The Tick App, the first tick research–focused app in the United States. Methods The Tick App was designed as a survey tool to collect data on human behaviors and movements associated with tick exposure while engaging users in tick identification and reporting. It consists of an enrollment survey to identify general risk factors, daily surveys to collect data on human activities and tick encounters (Tick Diaries), a survey to enter the details of tick encounters coupled with tick identification services provided by the research team (Report a Tick), and educational material. Using quantitative and qualitative methods, we evaluated the enrollment strategy (passive vs active), the user profile, location, longitudinal use of its features, and users’ feedback. Results Between May and September 2018, 1468 adult users enrolled in the app. The Tick App users were equally represented across genders and evenly distributed across age groups. Most users owned a pet (65.94%, 962/1459; P<.001), did frequent outdoor activities (recreational or peridomestic; 75.24%, 1094/1454; P<.001 and 64.58%, 941/1457; P<.001, respectively), and lived in the Midwest (56.55%, 824/1457) and Northeast (33.0%, 481/1457) regions in the United States, more specifically in Wisconsin, southern New York, and New Jersey. Users lived more frequently in high-incidence counties for Lyme disease (incidence rate ratio [IRR] 3.5, 95% CI 1.8-7.2; P<.001) and in counties with cases recently increasing (IRR 1.8, 95% CI 1.1-3.2; P=.03). Recurring users (49.25%, 723/1468) had a similar demographic profile to all users but participated in outdoor activities more frequently (80.5%, 575/714; P<.01). The number of Tick Diaries submitted per user (median 2, interquartile range [IQR] 1-11) was higher for older age groups (aged >55 years; IRR 3.4, 95% CI 1.5-7.6; P<.001) and lower in the Northeast (IRR[NE] 0.4, 95% CI 0.3-0.7; P<.001), whereas the number of tick reports (median 1, IQR 1-2) increased with the frequency of outdoor activities (IRR 1.5, 95% CI 1.3-1.8; P<.001). Conclusions This assessment allowed us to identify what fraction of the population used The Tick App and how it was used during a pilot phase. This information will be used to improve future iterations of The Tick App and tailor potential tick prevention interventions to the users’ characteristics.
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Affiliation(s)
- Maria P Fernandez
- Earth Institute, Columbia University, New York City, NY, United States.,Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, NY, United States
| | - Gebbiena M Bron
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, United States
| | - Pallavi A Kache
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, NY, United States
| | - Scott R Larson
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, United States
| | - Adam Maus
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - David Gustafson
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Jean I Tsao
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, United States
| | - Lyric C Bartholomay
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Susan M Paskewitz
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, United States
| | - Maria A Diuk-Wasser
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, NY, United States
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Najm A, Nikiphorou E, Kostine M, Richez C, Pauling JD, Finckh A, Ritschl V, Prior Y, Balážová P, Stones S, Szekanecz Z, Iagnocco A, Ramiro S, Sivera F, Dougados M, Carmona L, Burmester G, Wiek D, Gossec L, Berenbaum F. EULAR points to consider for the development, evaluation and implementation of mobile health applications aiding self-management in people living with rheumatic and musculoskeletal diseases. RMD Open 2019; 5:e001014. [PMID: 31565245 PMCID: PMC6744072 DOI: 10.1136/rmdopen-2019-001014] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/24/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022] Open
Abstract
Background Mobile health applications (apps) are available to enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health. However, guidance on the development and evaluation of such apps is lacking. Objectives The objective of this EULAR task force was to establish points to consider (PtC) for the development, evaluation and implementation of apps for self-management of RMDs. Methods A systematic literature review of app content and development strategies was conducted, followed by patient focus group and an online survey. Based on this information and along with task force expert opinion, PtC were formulated in a face-to-face meeting by a multidisciplinary task force panel of experts, including two patient research partners. The level of agreement among the panel in regard to each PtC was established by anonymous online voting. Results Three overarching principles and 10 PtC were formulated. Three PtC are related to patient safety, considered as a critical issue by the panel. Three are related to relevance of the content and functionalities. The requirement for transparency around app development and funding sources, along with involvement of relevant health professionals, were also raised. Ease of app access across ages and abilities was highlighted, in addition to considering the cost benefit of apps from the outset. The level of agreement was from 8.8 to 9.9 out of 10. Conclusion These EULAR PtC provide guidance on important aspects that should be considered for the development, evaluation and implementation of existing and new apps.
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Affiliation(s)
- Aurélie Najm
- Rheumatology Department, University Hospital Centre Nantes, Nantes, France
- INSERM UMR 1238, Universite de Nantes Ecole Doctorale Biologie-Sante, Nantes, France
| | - Elena Nikiphorou
- Department of Inflammation Biology, King's College London Academic, London, UK
| | - Marie Kostine
- Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - Christophe Richez
- Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Royal United Hospital Bath NHS Trust, Bath, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Wien, Austria
- Division of Occupational Therapy, University of Applied Sciences, FH Campus Wien, Wien, Austria
| | - Yeliz Prior
- Centre for Health Sciences Research, University of Salford, Salford, UK
- Mid Cheshire NHS Foundation Trust Hospitals, Crewe, UK
| | - Petra Balážová
- EULAR Young PARE, Zurich, Switzerland
- Slovak League Against Rheumatism, Piestany, Slovakia
| | - Simon Stones
- School of Healthcare, University of Leeds, Leeds, UK
| | - Zoltan Szekanecz
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Torino, Italy
| | - Sofia Ramiro
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Francisca Sivera
- Rheumatology, Hospital General Universitario de Elda, Elda, Spain
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | | | - Gerd Burmester
- Rheumatology, Charité - University Medicine Berlin, Berlin, Germany
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM UMR S1136, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Francis Berenbaum
- Rheumatology Department, AP-HP, Hopital Saint-Antoine, Paris, France
- INSERM CRSA, Sorbonne Université, Paris, France
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Vo V, Auroy L, Sarradon-Eck A. Patients' Perceptions of mHealth Apps: Meta-Ethnographic Review of Qualitative Studies. JMIR Mhealth Uhealth 2019; 7:e13817. [PMID: 31293246 PMCID: PMC6652126 DOI: 10.2196/13817] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/09/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mobile phones and tablets are being increasingly integrated into the daily lives of many people worldwide. Mobile health (mHealth) apps have promising possibilities for optimizing health systems, improving care and health, and reducing health disparities. However, health care apps often seem to be underused after being downloaded. OBJECTIVE The aim of this paper is to reach a better understanding of people's perceptions, beliefs, and experience of mHealth apps as well as to determine how highly they appreciate these tools. METHODS A systematic review was carried out on qualitative studies published in English, on patients' perception of mHealth apps between January 2013 and June 2018. Data extracted from these articles were synthesized using a meta-ethnographic approach and an interpretative method. RESULTS A total of 356 articles were selected for screening, and 43 of them met the inclusion criteria. Most of the articles included populations inhabiting developed countries and were published during the last 2 years, and most of the apps on which they focused were designed to help patients with chronic diseases. In this review, we present the strengths and weaknesses of using mHealth apps from the patients' point of view. The strengths can be categorized into two main aspects: engaging patients in their own health care and increasing patient empowerment. The weaknesses pointed out by the participants focus on four main topics: trustworthiness, appropriateness, personalization, and accessibility of these tools. CONCLUSIONS Although many of the patients included in the studies reviewed considered mHealth apps as a useful complementary tool, some major problems arise in their optimal use, including the need for more closely tailored designs, the cost of these apps, the validity of the information delivered, and security and privacy issues. Many of these issues could be resolved with more support from health providers. In addition, it would be worth developing standards to ensure that these apps provide patients accurate evidence-based information.
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Affiliation(s)
- VanAnh Vo
- Department of Epidemiology, Columbia University, New York, NY, United States
| | - Lola Auroy
- Université Grenoble Alpes, Centre National de la Recherche Scientifique, Sciences Po Grenoble, Pacte, Grenoble, France
| | - Aline Sarradon-Eck
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Développement, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,Institut Paoli-Calmettes, CanBios UMR1252, Marseille, France
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Jeminiwa RN, Hohmann NS, Fox BI. Developing a Theoretical Framework for Evaluating the Quality of mHealth Apps for Adolescent Users: A Systematic Review. J Pediatr Pharmacol Ther 2019; 24:254-269. [PMID: 31337988 DOI: 10.5863/1551-6776-24.4.254] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess adolescents' preferred mobile app features and to propose a framework for evaluating health-related mobile apps for adolescents. METHODS PubMed, CINAHL, PsycINFO, ERIC, HealthIT.gov, and ClinicalTrials.gov were systematically searched in August 2017. Studies pertaining to app development, feasibility, or usability that reported preferred app features and rating criteria on mHealth (mobile health) apps intended for adolescents were included. Quality assessment was performed using the Mixed Methods Appraisal Tool. Qualitative synthesis was performed to develop themes reflecting best practices for evaluating the quality of mHealth apps for adolescents. Using a grounded theory approach, we constructed a theoretical framework of rating criteria that can be used to inform development of an evaluation tool for mHealth apps targeted to adolescents. RESULTS Thirteen articles were included. Most commonly preferred features include ability to track test results or self-management progress, connect to social media, and gain points or prizes through app gamification. Common rating criteria include degree of app customizability, ease of use, visual appeal, and interactivity. Five emerging dimensions were used in the theoretical framework: Technical Quality; Engagement; Support System; Autonomy; and Safety, Privacy, and Trust. CONCLUSIONS We found that adolescents prefer mHealth apps that are customizable, offer peer support through social media, sustain engagement via gamification, and support the ability to visualize health trends via simplified graphs. Findings may help in the development of mHealth apps that are preferred by adolescents, as well as the development of a quality evaluation tool for mHealth apps targeted to this population.
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Elmagboul N, Coburn BW, Foster J, Mudano A, Melnick J, Bergman D, Yang S, Redden D, Chen L, Filby C, Curtis JR, Mikuls TR, Saag KG. Comparison of an interactive voice response system and smartphone application in the identification of gout flares. Arthritis Res Ther 2019; 21:160. [PMID: 31255174 PMCID: PMC6599289 DOI: 10.1186/s13075-019-1944-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/14/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To examine the feasibility, preference, and satisfaction of an interactive voice response (IVR) system versus a customized smartphone application (StudyBuddy) to capture gout flares METHODS: In this 24-week prospective, randomized, crossover, open-label pilot study, 44 gout patients were randomized to IVR vs. StudyBuddy and were crossed over to the other technology after 12 weeks. Flares were reported via weekly (and later daily) scheduled StudyBuddy or IVR queries. Feasibility was ascertained via response rate to scheduled queries. At 12 and 24 weeks, participants completed preference/satisfaction surveys. Preference and satisfaction were assessed using dichotomous or ordinal questions. Sensitivity was assessed by the frequency of flare reporting with each approach. RESULTS Thirty-eight of 44 participants completed the study. Among completers, feasibility was similar for IVR (81%) and StudyBuddy (80%). Conversely, most (74%) preferred StudyBuddy. Measures of satisfaction (ease of use, preference over in-person clinic visits, and willingness for future use) were similar between the IVR and StudyBuddy; however, more participants deemed the StudyBuddy as convenient (95% vs. 73%, P = 0.01) and less disruptive (97% vs. 82%, P = 0.03). Although the per patient number of weeks in flare was not significantly different (mean 3.4 vs. 2.6 weeks/patient, P = 0.15), the StudyBuddy captured more of the total flare weeks (35%) than IVR (27%, P = 0.02). CONCLUSION A smartphone application and IVR demonstrated similar feasibility but overall sensitivity to capture gout flares and participant preference were greater for the smartphone application. Participant preference for the smartphone application appeared to relate to perceptions of greater convenience and lower disruption. TRIAL REGISTRATION NCT, NCT02855437 . Registered 4 August 2016.
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Affiliation(s)
- Nada Elmagboul
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Brian W Coburn
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Jeffrey Foster
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Amy Mudano
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Joshua Melnick
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Debra Bergman
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Shuo Yang
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - David Redden
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Lang Chen
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Cooper Filby
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Jeffrey R Curtis
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Ted R Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Kenneth G Saag
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
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Gill R, Ogilvie G, Norman WV, Fitzsimmons B, Maher C, Renner R. Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care in British Columbia: Phase I. J Med Internet Res 2019; 21:e13387. [PMID: 31144668 PMCID: PMC6658228 DOI: 10.2196/13387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/10/2019] [Accepted: 04/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background Over 30% of women in Canada undergo an abortion. Despite the prevalence of the procedure, stigma surrounding abortion in Canada leads to barriers for women to access this service. The vast majority of care is concentrated in urban settings. There is evidence to support utilization of innovative mobile and other technology solutions to empower women to safely and effectively self-manage aspects of the abortion process. This study is part 1 of a 3-phase study that utilizes user-centered design methodology to develop a digital health solution to specifically support follow-up after an induced surgical abortion. Objective This study aimed to (1) understand how women at 3 surgical abortion clinics in an urban center of British Columbia utilize their mobile phones to access health care information and (2) understand women’s preferences of content and design of an intervention that will support follow-up care after an induced abortion, including contraceptive use. Methods The study design was based on development-evaluation-implementation process from Medical Research Council Framework for Complex Medical Interventions. This was a mixed-methods formative study. Women (aged 14-45 years) were recruited from 3 urban abortion facilities in British Columbia who underwent an induced abortion. Adaptation of validated surveys and using the technology acceptance model and theory of reasoned action, a cross-sectional survey was designed. Interview topics included demographic information; type of wireless device used; cell phone usage; acceptable information to include in a mobile intervention to support women’s abortion care; willingness to use a mobile phone to obtain reproductive health information; optimal strategies to use a mobile intervention to support women; understand preferences for health information resources; and design qualities in a mobile intervention important for ease of use, privacy, and security. Responses to questions in the survey were summarized using descriptive statistics. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the local ethics board. Results A waiting-room survey was completed by 50 participants, and semistructured interviews were completed with 8 participants. The average age of participants was 26 years. Furthermore, 94% (47/50) owned a smartphone, 85% (41/48) used their personal phones to go online, and 85% would use their cell phone to assist in clinical care. Qualitative analysis demonstrated that women prefer a comprehensive website that included secure email or text notifications to provide tools and resources for emotional well-being, contraceptive decision making, general sexual health, and postprocedure care. Conclusions A community-based mixed-methods approach allowed us to understand how women use their cell phones and what women desire in a mobile intervention to support their postabortion care. The findings from this formative phase will assist in the development and testing of a mobile intervention to support follow-up care after an induced surgical abortion.
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Affiliation(s)
- Roopan Gill
- Department of Obstetrics and Gynaecology, Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Gina Ogilvie
- Department of Obstetrics and Gynaecology, Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Wendy V Norman
- Department of Obstetrics and Gynaecology, Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Brian Fitzsimmons
- Department of Obstetrics and Gynaecology, Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Ciana Maher
- Department of Obstetrics and Gynaecology, Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Regina Renner
- Department of Obstetrics and Gynaecology, Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
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Nathan JK, Rodoni BM, Joseph JR, Smith BW, Park P. Smartphone Use and Interest in a Spine Surgery Recovery Mobile Application Among Patients in a US Academic Neurosurgery Practice. Oper Neurosurg (Hagerstown) 2019; 18:98-102. [DOI: 10.1093/ons/opz061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Mobile applications (apps) are serving an increasingly important role in healthcare for patients and providers alike. In addition to streamlining active communication of patient-reported outcomes regarding quality of life, pain, and opioid consumption, smartphones equipped with activity tracking afford the opportunity to passively and objectively measure mobility, a key metric of recovery in spine surgery. However, app development is a resource-intensive process.
OBJECTIVE
To survey adult neurosurgery patients regarding access to and interest in this platform.
METHODS
In June and July 2017, a paper-based anonymous survey was distributed to patients in the waiting room of the adult neurosurgery clinic of a large US academic medical center. Patients’ smartphone use and interest in using a mobile app following spine surgery were the primary and secondary outcomes, respectively.
RESULTS
Of 146 included responses, 102 patients (70%) regularly used a smartphone, and this number increased to 77% among patients with a history of spine surgery (n = 66, 45% of respondents). Seventy-one percent of patients with previous spine surgery expressed an interest in using a postoperative monitoring and communication app, compared to 81% of patients without prior spine operations (n = 80, 55%).
CONCLUSION
Among neurosurgery patients, there is a high level of access to and interest in smartphone apps to aid postoperative recovery. These results are useful for other neurosurgeons considering mobile app development for this purpose.
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Affiliation(s)
- Jay K Nathan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Bridger M Rodoni
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Jacob R Joseph
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Brandon W Smith
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Metcalf CS, Huntsman M, Garcia G, Kochanski AK, Chikinda M, Watanabe E, Underwood T, Vanegas F, Smith MD, White HS, Bulaj G. Music-Enhanced Analgesia and Antiseizure Activities in Animal Models of Pain and Epilepsy: Toward Preclinical Studies Supporting Development of Digital Therapeutics and Their Combinations With Pharmaceutical Drugs. Front Neurol 2019; 10:277. [PMID: 30972009 PMCID: PMC6446215 DOI: 10.3389/fneur.2019.00277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/04/2019] [Indexed: 12/29/2022] Open
Abstract
Digital therapeutics (software as a medical device) and mobile health (mHealth) technologies offer a means to deliver behavioral, psychosocial, disease self-management and music-based interventions to improve therapy outcomes for chronic diseases, including pain and epilepsy. To explore new translational opportunities in developing digital therapeutics for neurological disorders, and their integration with pharmacotherapies, we examined analgesic and antiseizure effects of specific musical compositions in mouse models of pain and epilepsy. The music playlist was created based on the modular progression of Mozart compositions for which reduction of seizures and epileptiform discharges were previously reported in people with epilepsy. Our results indicated that music-treated mice exhibited significant analgesia and reduction of paw edema in the carrageenan model of inflammatory pain. Among analgesic drugs tested (ibuprofen, cannabidiol (CBD), levetiracetam, and the galanin analog NAX 5055), music intervention significantly decreased paw withdrawal latency difference in ibuprofen-treated mice and reduced paw edema in combination with CBD or NAX 5055. To the best of our knowledge, this is the first animal study on music-enhanced antinociceptive activity of analgesic drugs. In the plantar incision model of surgical pain, music-pretreated mice had significant reduction of mechanical allodynia. In the corneal kindling model of epilepsy, the cumulative seizure burden following kindling acquisition was lower in animals exposed to music. The music-treated group also exhibited significantly improved survival, warranting further research on music interventions for preventing Sudden Unexpected Death in Epilepsy (SUDEP). We propose a working model of how musical elements such as rhythm, sequences, phrases and punctuation found in K.448 and K.545 may exert responses via parasympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Based on our findings, we discuss: (1) how enriched environment (EE) can serve as a preclinical surrogate for testing combinations of non-pharmacological modalities and drugs for the treatment of pain and other chronic diseases, and (2) a new paradigm for preclinical and clinical development of therapies leading to drug-device combination products for neurological disorders, depression and cancer. In summary, our present results encourage translational research on integrating non-pharmacological and pharmacological interventions for pain and epilepsy using digital therapeutics.
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Affiliation(s)
- Cameron S. Metcalf
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake, UT, United States
| | - Merodean Huntsman
- Department of Medicinal Chemistry, University of Utah, Salt Lake, UT, United States
| | - Gerry Garcia
- Greatful Living Productions, Salt Lake, UT, United States
| | - Adam K. Kochanski
- Department of Atmospheric Sciences, University of Utah, Salt Lake, UT, United States
| | - Michael Chikinda
- The Gifted Music School, Salt Lake, UT, United States
- The School of Music, University of Utah, Salt Lake, UT, United States
| | | | - Tristan Underwood
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake, UT, United States
| | - Fabiola Vanegas
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake, UT, United States
| | - Misty D. Smith
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake, UT, United States
- The School of Dentistry, University of Utah, Salt Lake, UT, United States
| | - H. Steve White
- School of Pharmacy, University of Washington, Seattle, WA, United States
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, University of Utah, Salt Lake, UT, United States
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Geuens J, Geurts L, Swinnen TW, Westhovens R, Vanden Abeele V. Mobile Health Features Supporting Self-Management Behavior in Patients With Chronic Arthritis: Mixed-Methods Approach on Patient Preferences. JMIR Mhealth Uhealth 2019; 7:e12535. [PMID: 30907737 PMCID: PMC6452281 DOI: 10.2196/12535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 01/10/2023] Open
Abstract
Background Patients with chronic arthritis (CA) ideally apply self-management behaviors between consultations. This enduring, tedious task of keeping track of disease-related parameters, adhering to medication schemes, and engaging in physical therapy may be supported by using a mobile health (mHealth) app. However, further research is needed to determine which self-management features are valued most by adult patients with CA patients. Objective The aim of this study was to determine the preference of features for an mHealth app to support self-management behavior in patients with CA. In addition, we aimed to explore the motives behind these ratings. Methods A mixed-methods approach was used to gather information from 31 adult patients (14 females), aged 23 to 71 years (mean 51 [SD 12.16]), with CA. Structured interviews were conducted to gather data pertaining to preferences of app features. Interviews were analyzed qualitatively, whereas ratings for each of the 28 features studied were analyzed quantitatively. Results In general, patients with CA favored the use of features pertaining to supporting active and direct disease management, (eg, medication intake and detecting and alarming of bad posture), helping them to keep a close watch on their disease status and inform their health care professional (eg, providing a means to log and report disease-related data) and receiving personalized information (eg, offering tailored information based on the patient’s health data). Patients strongly disliked features that provide a means of social interaction or provide incentivization for disease-related actions (eg, being able to compare yourself with other patients, cooperating toward a common goal, and receiving encouragement from friends and/or family). Driving these evaluations is the finding that every patient with CA hurts in his/her own way, the way the disease unfolds over time and manifests itself in the patient and social environment is different for every patient, and patients with CA are well aware of this. Conclusions We have offered an insight into how patients with CA favor mHealth features for self-management apps. The results of this research can inform the design and development of prospective self-management apps for patients with CA.
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Affiliation(s)
- Jonas Geuens
- e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Luc Geurts
- e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Thijs W Swinnen
- Division of Rheumatology, Universitaire Ziekenhuizen Gasthuisberg, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Rene Westhovens
- Division of Rheumatology, Universitaire Ziekenhuizen Gasthuisberg, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Katholieke Universiteit Leuven, Leuven, Belgium
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Grande SW, Longacre MR, Palmblad K, Montan MV, Berquist RP, Hager A, Kotzbauer G. Empowering Young People Living With Juvenile Idiopathic Arthritis to Better Communicate With Families and Care Teams: Content Analysis of Semistructured Interviews. JMIR Mhealth Uhealth 2019; 7:e10401. [PMID: 30794202 PMCID: PMC6406228 DOI: 10.2196/10401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 11/02/2018] [Accepted: 11/10/2018] [Indexed: 01/06/2023] Open
Abstract
Background Young people living with juvenile idiopathic arthritis (JIA) face a number of communication barriers for achieving optimal health as they transition from pediatric care into adult care. Despite growing interest in mobile or wireless technologies to support health (mHealth), it is uncertain how these engagement tools might support young people, their families, and care teams to optimize preference-based treatment strategies. Objective This study aims to examine how an mHealth patient support system (mPSS) might foster partnership between young people living with JIA, their families, and care teams. Methods Semistructured interviews with young people (5-15 years old), their families, and JIA care teams were conducted using researcher-developed interviews guides. Transcribed data were qualitatively analyzed using conventional content analysis. Results We conducted semistructured interviews with 15 young people, their parents, and 4 care team members. Content analysis revealed the potential of an mPSS to support productive dialogue between families and care teams. We identified four main themes: (1) young people with JIA face communication challenges, (2) normalizing illness through shared experience may improve adherence, (3) partnership opens windows into illness experiences, and (4) readiness to engage appears critical for clinic implementation. Conclusions A human-centered mPSS design that offers JIA patients the ability to track personally relevant illness concerns and needs can enhance communication, generate consensus-based treatment decisions, and improve efficiency and personalization of care. Technology that supports continuous learning and promotes better understanding of disease management may reduce practice burden while increasing patient engagement and autonomy in fostering lasting treatment decisions and ultimately supporting personalized care and improving outcomes.
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Affiliation(s)
- Stuart W Grande
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Meghan R Longacre
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Karin Palmblad
- Karolinska Institutet, Department of Women and Child Health, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Greg Kotzbauer
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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Lee J, Park S, Ju JH, Cho JH. Application of a real‐time pain monitoring system in Korean fibromyalgia patients: A pilot study. Int J Rheum Dis 2019; 22:934-939. [DOI: 10.1111/1756-185x.13472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/19/2018] [Accepted: 12/17/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Jennifer Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine The Catholic University of Korea Seoul Korea
| | - Sung‐Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine The Catholic University of Korea Seoul Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine The Catholic University of Korea Seoul Korea
| | - Jae Hyoung Cho
- Division of Endocrinology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine The Catholic University of Korea Seoul Korea
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Mendez CB, Salum NC, Junkes C, Amante LN, Mendez CML. Mobile educational follow-up application for patients with peripheral arterial disease. Rev Lat Am Enfermagem 2019; 27:e3122. [PMID: 30698220 PMCID: PMC6336362 DOI: 10.1590/1518-8345.2693-3122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/28/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE to describe the development of a prototype mobile educational application for nursing follow-up aimed at patients diagnosed with peripheral arterial disease. METHOD a prototype-based technological production study. The construction followed the contextualized instructional design model using two steps: analysis and design and development. RESULTS the pedagogical content of the application was based on a survey of needs of patients with Peripheral Arterial Disease and treatments recommended in the literature. The prototype developed contained concepts, risk factors, signs and symptoms, treatment, importance of medications and their side effects, frequent doubts, necessary health care, and follow-up of patients by monitoring the evolution of the cicatricial process of lesions and possible complications, clarification of doubts and stimulus for continuation of treatment. CONCLUSION the use of health applications is a technological tool with the potential to improve the follow-up of patients regarding the progress of the disease and self-care, monitoring of risk factors, co-participation of the patient in the treatment, family participation, as well as planning of individualized care, and cost reduction for the health system.
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Affiliation(s)
- Cristiane Baldessar Mendez
- Universidade Federal de Santa Catarina, Hospital Universitário Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil
| | - Nádia Chiodelli Salum
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Florianópolis, SC, Brazil
| | - Cintia Junkes
- Universidade Federal de Santa Catarina, Hospital Universitário Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil
| | - Lucia Nazareth Amante
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Florianópolis, SC, Brazil
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Martin-Kerry JM, Knapp P, Atkin K, Bower P, Watt I, Stones C, Higgins S, Sheridan R, Preston J, Horton Taylor D, Baines P, Young B. Supporting children and young people when making decisions about joining clinical trials: qualitative study to inform multimedia website development. BMJ Open 2019; 9:e023984. [PMID: 30782720 PMCID: PMC6340013 DOI: 10.1136/bmjopen-2018-023984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To understand stakeholders' views regarding the content and design of paediatric clinical trial multimedia websites. To describe how this knowledge informed the development of the multimedia websites. DESIGN Qualitative study comprising two rounds of interviews or focus groups, with thematic analysis of interview transcripts. PARTICIPANTS Sixty-two people (21 children and young people with long-term health conditions, 24 parents and 17 professionals). SETTING One UK children's hospital and one UK Young Persons' Advisory Group. RESULTS When asked what was important in deciding whether to join a trial, children, young people and parents prioritised information about what participation would involve, what the trial was testing, potential benefits and risks of participation and knowing they could leave the trial if they later changed their minds. Young people and parents trusted trial teams to follow regulatory and quality requirements and therefore did not think such information was a priority for the websites, although logos of trusted organisations could lend credibility. Professionals largely concurred with these views. Children and young people advised on the importance of designing the multimedia website to ensure its appearance, tone and wording suited the intended audience and on using animated characters to facilitate children's engagement. CONCLUSIONS Our study provides insights into the information that families value when deciding about healthcare trial participation. It provides guidance on the design of information resources to appeal to children and young people, while also being acceptable to parents and professionals who are often gatekeepers of children's access to information. Our findings will be of use to others developing similar multimedia websites. We report specific information needs and new visual preferences that are not usually addressed in printed trial information. Our work illustrates what qualitative research and participatory design practices can contribute to the development of information resources more generally. TRIAL REGISTRATION NUMBER ISRCTN73136092; Pre-results.
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Affiliation(s)
| | - Peter Knapp
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Peter Bower
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Ian Watt
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Catherine Stones
- School of Design, Clothworkers' Central, University of Leeds, Leeds, UK
| | | | | | - Jenny Preston
- University of Liverpool, Liverpool, UK
- Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | | | - Paul Baines
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Bridget Young
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Edwards EA, Caton H, Lumsden J, Rivas C, Steed L, Pirunsarn Y, Jumbe S, Newby C, Shenvi A, Mazumdar S, Smith JQ, Greenhill D, Griffiths CJ, Walton RT. Creating a Theoretically Grounded, Gamified Health App: Lessons From Developing the Cigbreak Smoking Cessation Mobile Phone Game. JMIR Serious Games 2018; 6:e10252. [PMID: 30497994 PMCID: PMC6293248 DOI: 10.2196/10252] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/25/2018] [Accepted: 07/28/2018] [Indexed: 12/11/2022] Open
Abstract
Background Gaming techniques are increasingly recognized as effective methods for changing behavior and increasing user engagement with mobile phone apps. The rapid uptake of mobile phone games provides an unprecedented opportunity to reach large numbers of people and to influence a wide range of health-related behaviors. However, digital interventions are still nascent in the field of health care, and optimum gamified methods of achieving health behavior change are still being investigated. There is currently a lack of worked methodologies that app developers and health care professionals can follow to facilitate theoretically informed design of gamified health apps. Objective This study aimed to present a series of steps undertaken during the development of Cigbreak, a gamified smoking cessation health app. Methods A systematic and iterative approach was adopted by (1) forming an expert multidisciplinary design team, (2) defining the problem and establishing user preferences, (3) incorporating the evidence base, (4) integrating gamification, (5) adding behavior change techniques, (6) forming a logic model, and (7) user testing. A total of 10 focus groups were conducted with 73 smokers. Results Users found the app an engaging and motivating way to gain smoking cessation advice and a helpful distraction from smoking; 84% (62/73) of smokers said they would play again and recommend it to a friend. Conclusions A dedicated gamified app to promote smoking cessation has the potential to modify smoking behavior and to deliver effective smoking cessation advice. Iterative, collaborative development using evidence-based behavior change techniques and gamification may help to make the game engaging and potentially effective. Gamified health apps developed in this way may have the potential to provide effective and low-cost health interventions in a wide range of clinical settings.
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Affiliation(s)
- Elizabeth A Edwards
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Hope Caton
- Faculty of Science, Engineering Computing, Kingston University, London, United Kingdom
| | - Jim Lumsden
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.,School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Carol Rivas
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Social Science Research Unit, University College London, London, United Kingdom
| | - Liz Steed
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yutthana Pirunsarn
- Faculty of Science, Engineering Computing, Kingston University, London, United Kingdom
| | - Sandra Jumbe
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Chris Newby
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Aditi Shenvi
- Centre for Complexity Science, University of Warwick, Coventry, United Kingdom
| | - Samaresh Mazumdar
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jim Q Smith
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Darrel Greenhill
- Faculty of Science, Engineering Computing, Kingston University, London, United Kingdom
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Robert T Walton
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Lindsay S, Kolne K, Cagliostro E. Electronic Mentoring Programs and Interventions for Children and Youth With Disabilities: Systematic Review. JMIR Pediatr Parent 2018; 1:e11679. [PMID: 31518310 PMCID: PMC6716434 DOI: 10.2196/11679] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/08/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Children and youth with disabilities experience many challenges in their development, including higher risk of poor self-esteem, fewer friendships, and social isolation. Electronic mentoring is a potentially viable approach for youth with disabilities to access social and peer support within a format that reduces physical barriers to accessing mentors. OBJECTIVE Our objective was to synthesize and review the literature on the impact of electronic mentoring for children and youth with disabilities. METHODS We conducted a systematic review, completing comprehensive searches of 7 databases from 1993 to May 2018. We selected articles for inclusion that were peer-reviewed publications, had a sample of children or youth with disabilities (≤25 years of age), and had empirical findings with at least one outcome focusing on the impact of electronic mentoring. Two reviewers independently applied the inclusion criteria, extracted the data, and rated the study quality before discussing the findings. RESULTS In the 25 studies meeting our inclusion criteria, 897 participants (aged 12-26, mean 17.4 years) were represented across 6 countries. Although the outcomes varied across the studies, of 11 studies testing significance, 9 (81%) reported a significant improvement in at least one of the following: career decision making, self-determination, self-advocacy, self-confidence, self-management, social skills, attitude toward disability, and coping with daily life. The electronic mentoring interventions varied in their delivery format and involved 1 or more of the following: interactive websites, virtual environment, email, mobile apps, Skype video calls, and phone calls. A total of 13 studies involved one-to-one mentoring, 6 had group-based mentoring, and 6 had a combination of both. CONCLUSIONS The evidence in this review suggests it is possible that electronic mentoring is effective for children and youth with disabilities. More rigorously designed studies are needed to understand the impact and effective components of electronic mentoring interventions.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Kendall Kolne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Elaine Cagliostro
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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A Granulocyte-Specific Protein S100A12 as a Potential Prognostic Factor Affecting Aggressiveness of Therapy in Patients with Juvenile Idiopathic Arthritis. J Immunol Res 2018; 2018:5349837. [PMID: 30426025 PMCID: PMC6217747 DOI: 10.1155/2018/5349837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/16/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022] Open
Abstract
Background Defining new prognostic biomarkers has become one of the most promising perspectives for the long-term care of patients with juvenile idiopathic arthritis (JIA). The new efficient indicators of disease activity and potential response to treatment are crucial in establishing new therapeutic plans in accordance with the “treat to target” strategy. One of the most studied proteins is called S100A12, which is an alarmin specific for granulocytes, considered as a marker of their activity. Materials and Methods Study involved 80 patients diagnosed with JIA. Children with systemic subtype were not included in the study. In 53 cases, blood samples were obtained in two time points. Results from the study group were compared to 29 age- and sex-matched healthy individuals. Results Serum S100A12 levels were higher in JIA than in healthy controls at the study baseline (11.67 ± 6.59 vs. 6.01 ± 2.33 ng/ml). There were no significant differences in S100A12 values between assessed subtypes of JIA. The highest concentrations were observed in patients within a disease flare. S100A12 levels were not dependent from using glucocorticosteroids. The studied protein appeared to be an efficient biomarker for JIA patients: 100% specificity as a diagnostic marker (cut-off level: 10.73 ng/ml) and 100% sensitivity as an indicator of exacerbations within a 3-month observation (cut-off level: 5.48 ng/ml). Conclusions S100A12 may become an important factor influencing decisions on aggressiveness of JIA therapy. Further elaboration on the clinical algorithm is necessary for that protein to be included in everyday practice.
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Schults J, Cooke M, Richards J, Theodoros J, Andresen E, Paterson R, Alcock M. mHealth Applications for Children and Young People With Persistent Pain: A Scoping Review. Clin Nurs Res 2018; 28:779-794. [PMID: 30126292 DOI: 10.1177/1054773818795078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Persistent pain is a global health care issue affecting more than 30% of children and young people. mHealth applications delivered using smartphones, are an innovative method to engage children in pain self-management. This article outlines the evidence concerning the development, implementation, and evaluation of mHealth apps for these children in terms of feasibility, acceptability, and impact on important pain outcomes such as quality of life and health care utilization.
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Affiliation(s)
- Jessica Schults
- 1 Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia
- 2 Menzies Health Queensland, Griffith University, Queensland, Australia
| | - Marie Cooke
- 2 Menzies Health Queensland, Griffith University, Queensland, Australia
| | - Julianne Richards
- 1 Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia
| | - Joanne Theodoros
- 1 Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia
| | - Elizabeth Andresen
- 1 Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia
| | - Rebecca Paterson
- 2 Menzies Health Queensland, Griffith University, Queensland, Australia
| | - Mark Alcock
- 1 Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia
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50
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Waite-Jones JM, Majeed-Ariss R, Smith J, Stones SR, Van Rooyen V, Swallow V. Young People's, Parents', and Professionals' Views on Required Components of Mobile Apps to Support Self-Management of Juvenile Arthritis: Qualitative Study. JMIR Mhealth Uhealth 2018; 6:e25. [PMID: 29351898 PMCID: PMC5797289 DOI: 10.2196/mhealth.9179] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 11/17/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is growing evidence that supporting self-management of Juvenile Arthritis can benefit both patients and professionals. Young people with Juvenile Arthritis and their healthy peers increasingly use mobile technologies to access information and support in day-to-day life. Therefore, a user-led, rigorously developed and evaluated mobile app could be valuable for facilitating young people's self-management of Juvenile Arthritis. OBJECTIVE The objective of this study was to seek the views of young people with Juvenile Arthritis, their parents or carers, and health care professionals (HCPs) as to what should be included in a mobile app to facilitate young people's self-management of chronic Juvenile Arthritis. METHODS A qualitative approach was adopted with a purposeful sample of 9 young people aged 10-18 years with Juvenile Arthritis, 8 parents or carers, and 8 HCPs involved in their care. Data were gathered through semi-structured focus group and individual interviews with young people and their parents or carers and HCPs. Interview discussion was facilitated through demonstration of four existing health apps to explore participants' views on strengths and limitations of these, barriers and facilitators to mobile app use, preferred designs, functionality, levels of interaction, and data sharing arrangements. Data were analyzed using the framework approach. RESULTS Analysis revealed three interlinked, overarching themes: (1) purpose, (2) components and content, and (3) social support. Despite some differences in emphasis on essential content, general agreement was found between young people with Juvenile Arthritis their parents or carers, and professionals that a mobile app to aid self-management would be useful. Underpinning the themes was a prerequisite that young people are enabled to feel a sense of ownership and control of the app, and that it be an interactive, engaging resource that offers developmentally appropriate information and reminders, as well as enabling them to monitor their symptoms and access social support. CONCLUSIONS Findings justify and pave the way for a future feasibility study into the production and preliminary testing of such an app. This would consider issues such as compatibility with existing technologies, costs, age, and cross-gender appeal as well as resource implications.
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Affiliation(s)
| | - Rabiya Majeed-Ariss
- School of Psychological Sciences, University of Manchester, Manchester, United Kingdom
| | - Joanna Smith
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Simon R Stones
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | | | - Veronica Swallow
- School of Healthcare, University of Leeds, Leeds, United Kingdom
- Faculty of Science, Charles Sturt University, Bathurst, Australia
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